St. Anthony patients kept on stretchers while beds remained in storage
8 acute care beds cut at Charles S. Curtis Memorial Hospital in February
Weeks after cutting eight acute care beds at the hospital in St. Anthony, health officials were discussing how to handle an overflow of patients there — a situation that saw people kept on stretchers instead of beds being taken out of storage.
That's according to internal Labrador-Grenfell Health documents obtained by CBC News through access to information.
Charles S. Curtis Memorial Hospital in St. Anthony closed eight beds in mid-February, those documents show. There are now 42 acute care beds there.
Emails among top brass and managerial staff show the hospital was operating with too few beds soon after, by March 16.
The four-bed emergency department was full of admitted patients and there was someone on a stretcher in the corridor, waiting to get in.
The patients should have been able to move to beds in their respective units, freeing up space in emergency, but there were no available acute care beds.
In an email, the hospital's site manager suggested re-opening some of the closed beds and the idea was green lit by then interim CEO Barbara Molgaard Blake, before the acting regional director of acute and long-term care, Wanda Slade, weighed in.
It is not good, perception wise, to put beds back that were just removed.- Wanda Slade
"Just thinking it is not good, perception wise, to put beds back that were just removed," Slade said.
Blake then reversed her decision.
"I'm all for whatever message is deemed the best!" the interim CEO wrote back, adding in parentheses — "which I agree is not taking out beds unless we have to."
Problems with ER overflow
The first move was to look for patients to discharge. Staff went from floor to floor, but couldn't find any. They reached a solution an hour and a half after the initial email was sent out.
"Done with no beds coming out of storage … using a stretchers [sic] for less than 24hrs on [medicine/surgery] (should have discharge tomorrow) and keeping 2 clients in ER overnight," Blake wrote.
Two days after that, on March 18, a site supervisor sent another email explaining the overcrowding issues had continued over the weekend.
She had opened a space that "technically [she] wasn't supposed to use," because there was already an admitted patient in the emergency room and she felt it "wasn't an appropriate place to keep [the new patient]."
She also noted that the Meditech system — software for patient records — wasn't yet set up in the emergency department.
Labrador-Grenfell Health responds
Labrador-Grenfell Health said the reduction of eight beds came as a result of "right-sizing."
In a statement, the health authority said, "neither the level of care nor how care is provided has been affected by these changes."
It explained that the reduction of beds meant some four-bed wards had turned into two-bed, or semi-private, rooms, saying the reduction has "facilitated a number of benefits to service including enhancements in privacy, confidentiality and patient access to care as well as improvements to workspace areas."
Letter sent about cost-cutting
The bed reductions came six months after the deputy health minister sent a letter to the board chair of Labrador-Grenfell Health about cost-cutting measures.
"The department is working on implementation plans for expenditure reduction initiatives that are 'provincial in scope,'" the letter said, and outlines various cost-saving areas, including bed reductions.
It includes a table outlining expected savings for Labrador-Grenfell Health at $1,994,200 for 2017-2018. The biggest chunk of that savings — $1,487,400 — is expected to come from a "reduction in travel, overtime, relief and operating costs."
In an internal email, Labrador-Grenfell Health CEO Barbara Molgaard Blake referenced that letter in a discussion about "additional efficiency expectations."
The Department of Health initially declined CBC's request for an interview, instead supplying a statement.
"Over the last three years, the budget has remained steady at approximately $3 billion," the statement said, referring to the overall amount spent on health care by the province.
"There is no direction from the department to reduce the number of beds in the health-care system."
The department said it's focusing its cost-saving initiatives on other areas, instead of frontline services.
Minister answers questions at legislature
Health Minister John Haggie did address the issue at the House of Assembly Thursday afternoon, after the Opposition Tories cited CBC stories about hospital overcrowding during question period.
Haggie told reporters there have been no other acute-care bed closures in the health-care system, and none are planned.
He said the challenge is addressing the needs of patients waiting for care that is better provided in other facilities, instead of through acute care.
Haggie indicated that the solution lies in community changes — everything from commitments to build more long-term care beds — to something as simple as putting a rail in a bathroom at home.
"What's happened in St. Anthony is they had two challenges," Haggie told reporters.
"One was their average bed utilization runs around 54 to 75 per cent. So those beds are never staffed, because there's no demand for them. What then happened was there was a quality issue, the patients were complaining about privacy."
He said the four-bed rooms there are not built to modern code, and date back to the 1960s.
Labrador-Grenfell Health suggested converting them into two-bed rooms, to deal with privacy issues and help nurses provide better care.
Haggie said that doesn't interfere with patient care, because they are not staffed anyway.
As for the overflow issues affecting the emergency room in St. Anthony, Haggie called it "another unfortunate coincidence."
He said there were nine patients over that period who were placed in isolation under instructions from the medical officer of health. They couldn't share rooms, because of infection control procedures in place.
"That then cut down access to space, and to beds," Haggie noted.
The minister said that only happened once, and ended up affecting two patients.
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