Doctors worried about loss of ICU specialist

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

Deana Stokes Sullivan dss@thetelegram.com
Published on November 30, 2010
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.
Gary Hebbard/The Telegram

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.

dss@thetelegram.com