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Patients First in Emergency Care Presented By: Dr PATIENTS FIRST IN EMERGENCY CARE PRESENTED BY: DR. LISA SALAMON MD, CCFP (EM) FCFP, EMERGENCY PHYSICIAN, SCARBOROUGH HEALTH NETWORK DR. NARIMAN MALIK MD, FRCPC, ANESTHESIOLOGIST, SCARBOROUGH HEALTH NETWORK Scarborough North Most vulnerable population in CELHIN Birchmount Emergency Department Statistics 2017/2018 – Source NACRS Total ED visits: 51864 Children and infants: 8625 (17%) Age 18-64: 28745 Age > 65: 14314 P4R (wait times, LOS): 1st in CELHIN, 8th in Ontario Obstetrics and Gynaecology (OHIP Specialty '20') Hospital Visits by Scarborough Health Network Sites: FY2015/16 - FY2017/18 Hospital Visits by Scarborough Health Network Sites: % Total Hospital Visits 2017/18 FY2015/16 - FY2017/18 10,000 9,738 Scarboroug Birchmount h General, , 33% 30% Centenary 9,000 Centenary, 8,124 38% 8,000 % Total Hospital Visits 2016/17 7,050 Scarboroug Birchmount 7,000 h General, , 31% 27% 6,031 6,109 6,000 5,782 Birchmount Centenary, 42% 5,582 5,568 5,366 5,000 Scarborough General % Total Hospital Visits 2015/16 Scarboroug Birchmount h General, , 27% 4,000 26% . 2015/16 2016/17 2017/18 Centenary, 46% Source: MOH datafiles, FFS and SB claims, FY2015/16 to FY2017/18. Prepared by OMA Economics, Policy & Research, February 15, 2019. Notes: 1. A visit is defined as a physician - patient encounter per day. 2. Analysis restricted to services rendered by Obstetrics and Gynaecology specialists (OHIP Specialty "20") and does not include anaesthesia, surgical assistant or technical fee claim submissions. Recent visits to Birchmount ED requiring immediate Pediatric and Obstetrical assistance 7 week old baby stopped breathing in mom’s car – brought by EMS to Birchmount Emergency department Woman delivered baby in taxi cab outside of Emergency department 15 year old child with multiple complex medical issues having seizure for over an hour. Parents drove him from home which is nearby Teenager delivered stillbirth – heavily bleeding which required urgent surgical intervention Inpatient Pediatrics and Obstetrics and Gynecology is the Standard of Care in GTA William Osler Health System - Brampton Civic Site Very High-Volume William Osler Health System - Etobicoke General Hospital High-Volume Trillium Health Partners - Credit Valley Site Very High-Volume Trillium Health Partners - Mississauga Site Very High-Volume St. Joseph’s hosptial Very High-Volume Toronto East Health Network - Michael Garron Hospital High-Volume Humber River Hospital - Wilson Site Very High-Volume Mackenzie Health Very High-Volume Markham Stouffville Hospital - Markham Site Very High-Volume Southlake Regional Health Centre Very High-Volume Lakeridge Health - Ajax Site High-Volume Lakeridge Health - Oshawa Very High-Volume Scarborough Health Network - Birchmount High-Volume Scarborough Health Network - Centenary High-Volume Scarborough Health Network - Scar.Gen.Site High-Volume In Ontario, the Public Hospitals Act requires hospitals to maintain a reasonable standard of care in their management, staffing and provision of services It is anticipated that courts will be reluctant to permit a reduction in the standard of care when conscious decisions are made to withhold available services for reasons of cost containment alone. Decisions made by physicians to withhold potentially available services for reasons of budgetary restraint have been found to be negligent by the courts as was found in Law Estate v. Simice. In Bateman v. Doiron, the court states that the hospital must be judged according to the standards reasonable expected by the community it serves. There is a risk to both the hospital and the physicians in removing these services. In Yepremian v. Scarborough General Hospital, it was noted that “the recognition of a direct duty of hospitals to provide non-negligent medical treatment reflects the reality of the relationship between hospitals and the public in contemporary society. Board resolutions from the Central East LHIN Board of Directors – March 27, 2013 Be it resolved that the Central East LHIN Board of Directors does not approve any service changes proposed by The Scarborough Hospital in its Strategic Plan related to the consolidation of maternal newborn changes or changes in surgical services Be it resolved that the Central East LHIN Board of Directors requires that The Scarborough Hospital must submit to the Central East LHIN, any planned divestment or transfer of services to another health service provider as an integration, as defined by the Local Health Services Integration Act, 2006. Any integration must be submitted for the Central East LHIN’s consideration before implementation and must demonstrate engagement with affected stakeholdersc Safety concerns: Implementation already began with goal to close Pediatrics/ Obstetrics unit within next 4 to 6 months Front-line physicians and nurses concerned about patient safety and quality of care Closing PEDS/OBS at Birchmount Unplugs Lifeline for 200,000 Residents Medical staff petition against the proposal to close Pediatrics and Obstetrics–Jan 2019 We, the undersigned members of the Medical Staff of The Scarborough Health Network and the Scarborough Medical Community, are writing to express our opposition to any plan for closing Obstetrics and Inpatient Pediatrics at the Birchmount site. We firmly believe that it is against the best interest of our Hospital to abandon the Maternal and Child Program in North Scarborough; an area including many highly vulnerable and lower socioeconomic families. We believe that a community hospital the size and location of the Birchmount site, which has almost 52000 Emergency department visits per year including almost 9000 pediatric visits per year, requires 24/7 on-site Pediatric & Obstetrics/Gynecology coverage as a standard of care. Anything less than that is felt by us to be substandard and a betrayal of trust for the North Scarborough Community. Signed by 161 physicians and midwives: 52 ER physicians, 12 Obstetricians and pediatricians, 11 midwives and 86 physicians from other specialties Birchmount Hospital in the Media As of Feb 26 2019 https://www.toronto.com/opinion-story/9177604-birchmount-hospital-closures-an-attack-on-north-scarborough-community https://www.toronto.com/news-story/9167170--save-the-grace-meeting-called-to-oppose-scarborough-hospital-cuts/ https://www.toronto.com/opinion-story/9151007-scarborough-hospital-s-latest-birchmount-gambit-a-cruel-manoeuvre-/ https://www.toronto.com/news-story/9149809-scarborough-health-care-divide-deepens-after-birchmount-cuts-approved/ https://www.cbc.ca/news/canada/toronto/keep-your-hands-off-doctors-caution-against-moving-wards-from-scarborough-hospital-1.4984851 https://www.toronto.com/news-story/9132543-scarborough-health-network-proposes-service-cuts-at-birchmount-campus/ https://www.toronto.com/news-story/9140794-scarborough-health-network-board-to-hear-plan-for-cuts-at-birchmount/ https://toronto.ctvnews.ca/video?clipId=1590258 https://www.thediscourse.ca/scarborough/grace-scarborough-birchmount-hospital-consolidation https://toronto.citynews.ca/video/2019/02/25/concerns-raised-over-cuts-at-scarborough-grace-hospital/ https://www.huffingtonpost.ca/michelle-cohen/ontario-hospital-mergers_a_23654121/ http://www.epochtimes.com/gb/19/1/30/n11013649.htm http://www.singtao.ca/toronto/3975660/2019-02-11/post- %E6%85%88%E6%81%A9%E9%86%AB%E9%99%A2%E9%97%9C%E7%94%A2%E7%A7%91%E5%8F%8A%E5%85%92%E7%A7%91- %E5%A3%AB%E5%98%89%E5%A0%A1%E7%A4%BE%E5%8D%80%E6%8E%A1%E8%A1%8C%E5%8B%95%E6%8A%97%E7%88%AD/?variant=zh-hk CONCLUSION Urgent need to ensure safe, equitable and timely access to high quality emergency services for growing population in CELHIN Scarborough North Subregion CELHIN to halt implementation of plan to close Paediatrics/ Obstectrics at Birchmount site of Scarborough Health Network.
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