Fracture patients are waiting too long for emergency surgery and suffering because of it

To say this has been a bad two weeks for James Emes would be an understatement.

The 78-year-old Dorset resident fell and broke his hip early last Monday morning. After being transported to Huntsville District Memorial Hospital, Emes was told by staff he would be going to Royal Victoria Hospital (RVH) in Barrie for the emergency surgery needed to repair his hip, his son Gene told this newspaper.

But the beds at RVH were full, and so Emes was kept in traction in Huntsville. In the evening he would be given dinner – his last meal until the surgery, in preparation for the anesthesia – and told the next morning he would likely be going to have his hip repaired.

The next day, the same story from Barrie: the beds were full.

“Since Monday morning every morning they tell him he’s going to go to Barrie for surgery, but Barrie doesn’t have a bed for him after the surgery,” Gene said Thursday.

Emes contacted this newspaper out of frustration that his father lay in traction in Huntsville until Thursday night, when staff were able to secure him an operation and recovery time in Newmarket.

He said his dad’s spirits were good until about the fourth day of waiting.

“He doesn’t eat from dinner the night before until midday (when they know the surgery’s not happening). . . . Considering the fact he’s a diabetic it doesn’t make life easy for him or the hospital staff.”

In addition to trying to keep his diabetes under control, Emes said his father was in a considerable amount of pain as he lay in traction, despite being medicated.

After being transported to Newmarket Thursday night, James Emes underwent the surgery on Friday and is now recovering, although Gene says his dad is experiencing complications that his doctors believe are related to the amount of time he had to wait.

Situations like the one the Emes family finds themselves in are all too common, says Muskoka Algonquin Healthcare (MAHC) chief of staff Dr. David Mathies.

“It’s in a crisis,” he told this newspaper Friday. “A few weeks ago we called over 30 hospitals looking for a bed (in a similar case). . . and we couldn’t find anyone . . . . We ended up sending that patient to Buffalo, so we are having to go out of the country just to fix an old person’s broken hip and that wasn’t the first time.”

Mathies said that both a lack of skilled surgeons with the time to perform the procedure and a lack of beds for the patient to recover in are contributing to the problem province-wide.

Although there used to be an orthopedic surgeon in Muskoka, that service was lost when that doctor passed away, said Mathies. Now patients are sent out of Muskoka for orthopedic procedures, typically to Barrie, but often elsewhere in the province when RVH can’t take the patient.

Although orthopedic surgery can be done at Orillia Soldiers Memorial Hospital (OSMH), there is only one surgeon who is not always on-call, so while patients can get referred there, they often don’t, said OSMH community relations director Terry Dyni.

In recent months MAHC has been in discussions with an orthopedic surgeon from Barrie about coming to Muskoka one day a week to perform outpatient services that would ease the workload at RVH and help service local patients.

Despite having the staff and the time to accommodate that program, Mathies said it has been shelved indefinitely because there is no room in the operating budget for the “consumables” that are required for surgical procedures.

From a financial perspective, keeping patients in traction in Huntsville or Bracebridge is bad. It adds to the organization’s ongoing problem of housing too many alternate level of care patients who are without somewhere else to go.

Mathies said in the last calendar year, over half of the emergency fracture patients have had to wait three days or more to get the surgery they need.

It costs the organization $758 per day to house those patients, said MAHC CEO Barry Lockhart, adding that last year 50 inpatients were transferred out of MAHC for orthopedic procedures.

If each of those patients spent three nights in local hospitals, the cost would have been $113,700.

From a medical perspective, keeping patients in traction is awful.

“The thing is, mortality rates rise after two days,” said Mathies.

Emes, who lives in Uxbridge and whose siblings live in and around the GTA, says he is now trying to secure a bed for his father in the city for his entire recovery, rather than being transported back to Huntsville.

“I’m angry at the system and I think it’s done my father wrong,” he said. “I’m also upset at the political, medical side of things for not being able to react to this problem (sooner) because it’s commonplace and it’s been happening for a long time.”

The North Simcoe Muskoka Local Health Integration Network (LHIN) is also aware of the problem, said Jill Tettman, senior director of planning, integration and community engagement, who was also acting chief executive officer last week.

“It’s certainly something we are aware of,” she said.

To that end, the LHIN has created a fracture working group that will meet for the first time this week to look at how emergency fractures are dealt with in our area and try and establish some short-term solutions within existing resources, said Tettman.

“They will be looking at process improvement and flow of potential and are there opportunities through better collaboration and co-ordination?” she said, adding they will “look at what can be done sort of within the short term, understanding there’s a longer term approach that needs to be looked at.”