Doctors worried about loss of ICU specialist

Deana Stokes Sullivan
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ER physician says Janeway will be ‘crippled’ without pediatric intensive care unit

Janeway emergency room doctors Robert Porter (left) and Ian Marshall speak at a news conference Monday on the impact the resignation of a pediatric intensive care physician will have on emergency medical services for children.

Two emergency room physicians at the Janeway Children’s Hospital in St. John’s are worried about how the hospital will function if it loses one of its two pediatric intensive care specialists.

Dr. Robert Porter, who has worked at the Janeway for about nine years, and Dr. Ian Marshall, who has been employed there about 20 years, spoke to reporters Monday about Dr. Debbie Reid’s resignation.

Reid is one of 14 medical specialists who plan to resign Feb. 4, 2011 because of a labour dispute with the provincial government over a two-tiered pay scale that gives pathologists and oncologists substantially higher salaries.

The two doctors are concerned that the hospital’s pediatric intensive care unit won’t be able to function without at least two intensive care specialists.

And, Porter says, the loss of the unit would cripple the Janeway.

Porter said the Janeway emergency department is unique in that it sees children exclusively and because of that, the public and other physicians expect a high level of care.

“And rightly so,” Porter added.

While the Janeway sees a lot of children with fairly minor and non-life-threatening ailments, he said it also cares for patients with critical illnesses and injuries.

As examples, Porter said, a child might show up at emergency with meningitis or in shock, or it could be a shaken baby.

In order for these patients to receive the best care, he said, there first has to be excellent pre-hospital care. Emergency room physicians provide the next level of care, he said, which might include aggressive use of intravenous fluids or putting the child to sleep and inserting a breathing tube.

“After we’ve done our piece, there’s another level of care that’s necessary and, in a hospital like ours,” Porter said, “which is a tertiary care children’s hospital, that level of care needs to be pediatric intensive care, provided in a pediatric intensive care unit, and we need to have pediatric intensive care specialists to staff that unit.”

There are only two pediatric intensive care specialists at the Janeway, Reid and Dr. Jill Barter.

Porter said the hospital needs two more, but recruitment efforts in the past couple of years have been unsuccessful.

With Reid’s resignation, Porter said, “it leaves us contemplating the possibility that, at some point in the future, we may not have a pediatric intensive care unit, even on a temporary basis.”

Major surgeries won’t be able to go ahead, he said.

As for children with serious injury or illness, Porter said, “Without the services of a fully staffed pediatric intensive care unit, I personally am at a loss as to what we will do with some of those patients after we provide their emergency care.”

Marshall began working with Reid at the Janeway when he was a medical student, clinical clerk and intern resident.

“She’s done many, many years of valuable service to the Janeway,” he said.

“It’s very important that the government and NLMA need to focus on lifestyles of the physicians that are suffering and are not happy with the ongoing process.”

Physicians like Reid and Barter also know a lot of the patients who show up at Emergency, Marshall said, because many of these children have chronic illnesses and have been going to the Janeway for treatment for quite some time. “With one phone call,” he said, “we can phone Dr. Reid and she knows the complete history.”

Marshall said the hospital needs a full complement of four intensive care physicians to keep it running efficiently.

Porter said the government needs to recognize that the unfair payment system for specialists is part of the reason why the hospital can’t recruit specialists.

“Government needs to realize one of the things that has to happen is that the payment to those people has to be competitive with other places. We need to be able to recruit people to fill our pediatric intensive care unit. I think it’s very important that things not get worse over time,” Porter added.

Marshall said he can’t see how critically ill children can be flown outside the province to another hospital if the Janeway loses its pediatric intensive care unit.

Some children have severe traumas, he said, some come in with diabetic ketoacidosis, a life-threatening condition among children with diabetes, while others have severe sepsis or infections, and a good percentage of these children have to be on life support, temporarily.

“If I was critically ill I wouldn’t want to be getting on a plane and flying to Halifax,” Marshall said.

Porter said some children are too unstable to move them immediately from Emergency to the intensive care unit or even to a computed tomography (CT) scanner, so contemplating an air ambulance trip wouldn’t be wise.

Doctors around the province are voting on the government’s latest offer, with ballots due back to the NLMA by Dec. 13.

Geographic location: Janeway Children, Halifax

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Recent comments

  • Steve
    December 01, 2010 - 05:49

    Everywhere else in the world this is called blackmail. The hell with the greedy b@$t@rd$, if you don't like it here then move. It's not more doctors but people living healthier that we need. Everybody dies eventually. If you want to live more comfortably, Just put 'ologist' behind your job title and demand a king's ransom.

  • Tina
    November 30, 2010 - 20:43

    The Health Care issues existed LONG before Danny Williams and will continue into the future.

  • A Parent who witnessed these Doctors in action
    November 30, 2010 - 17:16

    Unfortunately many years ago my child was involved in a serious car accident. Without Dr. Debbie, & Dr. Jill (whom many of the patients referred to them as), I really don’t know where we would have been. Dr. Jill was just new to the scene at the time, and she was prepared to give everything she had to offer, and Dr. Debbie was a rock. She would sleep at the hospital, even on the nights she was supposed to be off. She would walk into intensive care and you knew by looking at her that she had been there all night watching my child and many others that were just as critical. But in some way she made you feel confident that if there was ever a possibility of your child becoming well, that she was the person that was going to make it happen. She would give you a sense of understanding of how serious the issues were, but she would also supply you with the knowledge of understanding the possible outcomes or resolves. It’s only a matter of time before Dr. David Price is on the list as well (Another outstanding Doctor). Unfortunately my son lost his fight after about 3 ½ years, but it was only for the grace of these fine people that we were fortunate enough to have our son after his accident. I feel the association I had to have with these Doctors have left me a richer person, and as we speak of Newfoundland being a have Province (Money is not everything), if we lose these amazing Doctors, it will be a very sad day in the province of Newfoundland, and I think we then should refer us back to being a have not province. My family were so important during this difficult time, that I can't imagine how it would have been if I had to leave the province for care, and at that time if we didn't have the services instantly available that he received. We would not of been so fortunate to have our son with us for the additional 3 1/2 years. He would not of been stable enough to travel for treament. When my son first went in hospital it was when the Nurses were on strike around March 1999, those Doctors every step of the way completed whatever had to be done. Then we were blessed to have a couple of Nurses that were prepared to come off Confederation Hill to continue the care required. Many talk negative about our Doctors and our Nurses. We need to step back and think what they give to us as individulas. Sure they make a great salary, but they went to school, and continued the option to further educate themselves in order to receive that salary. you too have the same option.

  • Maggie
    November 30, 2010 - 14:38

    Have these resigning doctors and their association given any thought to their own part in the inability to recruit badly needed doctors? Resigning while holding government above a barrel and bailing out on these critically ill children and leaving their own counterparts to a bigger workload and far more stress? Both sides need to get their sh!t together and stop bargaining in the media. They say they have the people of NL at heart...I say bull-oney!

  • mom
    November 30, 2010 - 14:37

    With only 2 pediatric intensive care doctors now, doesn't that mean if one of them is sick or on holiday the other has to work, or be available if needed 24/7? This is already a problem. It is a wonder that one or the other had not left already.

  • jay
    November 30, 2010 - 13:37

    Good job Danny, about time somebody stood up to these doctors and nurses. Our province is continually held hostage by these groups with scare tactics about how our people will suffer if they don't get more money. These are the same people who swear they are the backbone of healthcare and that they have the patients well being as their number one priority, then they swiftly withdraw services if the price isn't right, make up your mind, compassion or dollars!!!

  • MSmith
    November 30, 2010 - 13:30

    This article again highlights the downward spiral that our health care seems to be facing. I heard yesterday (not confirmed) that IF these 14 specialists leave, the Health Sciences-MUN Medical School will lose Accreditation. This will mean losing more doctors - medical students will have to go outside of the province for their residency and to get their accreditation. A huge budget surplus has just been announced, it's time to drop the rhetoric and get down to discussions on how to salvage our healthcare system!

  • jay
    November 30, 2010 - 13:29

    Good job Danny, about time somebody stood up to these doctors and nurses. Our province is continually held hostage by these groups with scare tactics about how our people will suffer if they don't get more money. These are the same people who swear they are the backbone of healthcare and that they have the patients well being as their number one priority, then they swiftly withdraw services if the price isn't right, make up your mind, compassion or dollars!!!

  • snhll6004
    November 30, 2010 - 13:15

    Sherry, it's been 8 years of neglect. Mr. Williams is not interested in anything that doesn't have the word "profit" attached to it. Unfortunately, running a government is nothing like running a business, regardless of what many imbeciles post on these forums. He not only neglected health care - out of ignorance and malfeasance - but he systematically dismantled the human resources component of our health care system. We have many shiny new machines and nobody to run them. It's that simple. He has blood on his hands, and he knows it. That's why he chose to run. He always seems to take the path of least resistance, whether it's through yelling and stamping his feet, or ignoring the problem. He is not the great leader you think. He failed on many fronts. He was a one-dimensional premier. Fact. Health has become a shell of what it was since this man took charge. This will be his legacy. Shame on you Danny Williams.

  • Sherry
    November 30, 2010 - 12:02

    Shame on you for not listing your name. You are a coward, what are you doing to change things, just a finger pointer with nothing constructive to say. The Healthcare issues existed long before Danny Williams and will continue into the future.

  • SOX
    November 30, 2010 - 09:58

    Are you for real? Good ol' Danny caused all of the problems with health care? I'm not so sure of that... Did you ever think that the health care system itself is partially to blame? Health care in this province will always be an issue due to it's large landmass with a limited number of taxpayers. Healthcare in the rest of Canada is just as bad, however they have more money to pay doctors with if they want do to their population and business taxes. Where do you propose the government stop spending inorder to give these doctors that already make $250,000 + a pay raise?

  • Bill
    November 30, 2010 - 09:55

    Let's get back to the issue. This province should be paying its physicians a salary that is the highest in Atlantic Canada. This would alleviate some of the recruiting difficulties being experienced by the Health Boards, and let the Janeway operate properly at a tertiary care facility for our children. So bring on the arbitration and get this settled, and forget about the danny legacy; it will eventually be written by the historians.

  • teamplayer
    November 30, 2010 - 09:32

    @ SNHLL6004, I would rather applaud Danny's actions than criticize them. It's about time someone stood up to the doctors and nurses who continually hold this province hostage with threats of withdrawal of services and then blame the province and act like they have the people's well being as their primary concern. We are only a bargaining chip to them, not sure about the nurses but pretty sure the doctors took some type of oath that didn't include stipulations about pay, hypocratic oath I believe, or perhaps hypocritic!!

  • james
    November 30, 2010 - 08:33

    williams knew if he took on the doctors he would lose

  • snhll6004
    November 30, 2010 - 07:12

    There's Danny's legacy all right. He is a coward who ran when the going got tough. Everyone expected he could sign business deals in his sleep, but it's the measure of the man in how he deals with the difficult decisions. He has chosen to run away and hide. Which is interesting considering he already had his head buried in the sand of healthcare. He created this problem and people in this province are suffering and dying because of his neglect, incompetence and arrogance. Shame on you Danny Williams. Shame.