ER not best place to treat miscarriages: letter to patient

Barb Sweet bsweet@thetelegram.com
Published on November 19, 2013

A decade ago, hospital officials in St. John’s acknowledged the drawbacks of the emergency room as a place to treat patients suffering miscarriages.

“We know the emergency de­part­ment is not the ideal place to treat these people and we have now established an early pregnancy unit,” a patient relations officer for the then St. John’s Health Care Corp. wrote to a woman who had complained about the way her miscarriage was handled in 2003.

The official referenced the unit as being among initiatives to improve supports for patients and families undergoing miscarriage and other pregnancy problems.

The letter from the corporation — which was amalgamated into Eastern Health in 2005 — acknowledged the “psychological impact of a pregnancy loss” and promised efforts would be made to ensure “the most suitable location possible.”

Eastern Health does operate an early pregnancy assessment clinic for women fewer than 20 weeks pregnant. Patients suffering some abnormal symptoms can be referr­ed by a family doctor or obstetrician, or even the ER, but the clinic — part of the women’s health clinic — isn’t intended to treat miscarriag­es, according to a spokeswoman.

The patient who received the 2003 letter told her story to The Telegram last week in outrage after reading about recent patients who are concerned about miscarriages being treated in emergency, particularly at the Health Sciences Centre.

In the last few weeks, more than a dozen people — women who suffered miscarriages and some spouses of patients who had gone through the ordeal — contacted The Telegram after a story appeared about an expectant mother who in August, at nine weeks pregnant, waited in the ER, told a nurse her bleeding and pain were getting worse and finally miscarried in a toilet in the ER area.

Days later, she found out a nurse on duty, backed by the opinion of a colleague, made the decision to flush the remains, she said. Meanwhile, she waited in a room for hours.

Overwhelmingly, those who have contacted The Telegram about their personal experiences have express­ed dismay at being treated in the ER, where they say the emotional trauma of their pregnancy ending falls by the wayside.

According to current Eastern Health policy, women who are less than 20 weeks pregnant are first assessed in the ER; women who are 20 weeks or more along in their pregnancy are sent to the labour and delivery unit for assessment. So are women who don’t know how far along they are.

All patients in the emergency room — where cases run the gamut of injuries, viruses, illnesses and trauma — are triaged to ensure the most urgent are seen first.

Eastern Health said a pregnant woman who presents with bleeding needs an ER assessment to see if it’s related to the pregnancy or not.

When the Mount Pearl woman, upset about her emergency room ordeal in 2003, contacted the then St. John’s Health Care Corp. about her concerns, administrators set up a meeting with her.

And in April that year, the woman received a followup letter in which the city-based health authority said, “As was discussed during our meeting, we intend to implement certain changes in our practices as a result of your feedback.”

The woman said after she first spoke to The Telegram, she went looking on the weekend for the correspondence, long ago packed away in boxes. The documents included a letter advising her a meeting would take place as well as the followup letter.

“I sat down in my basement, sat back and I read them,” the woman said Monday.

“This letter I had gotten 10 years ago had brought me peace that I had made a difference at that particular time. … (Now) I feel like I have been told what I wanted to hear to shut me up and move on.”

Among those changes supposed to take place in 2003 were:

• Providing support for women who have just been informed that their pregnancy will end. Through this measure, a staff member was to accompany and support the patient and there was to be a place where patients could go for privacy while dealing with their loss.

• An information sheet was to be passed to women who suffered miscarriages about what is normal or abnormal.

“We understand this is a stressful time and much of the verbal information given by the doctor may not be remembered,” the letter said.

Patients were also supposed to be given a phone number for a nurse in the women’s health clinic they could speak to for advice if they had concerns.

• Patients were also to be offered bereavement supports and the support of a psychologist for counselling.

According to Eastern Health’s current policy, when a miscarriage occurs, emergency department staff can consult the psychiatric nurse on duty to support a patient who is in crisis, and there are full-time social work staff in the city’s hospitals.

Patients are also supposed to be offered the number for its mental-health crisis line, where support can be provided and a referral made for counselling.

However, most of the patients who contacted The Telegram said they were not offered any of those services, not even the mental-health crisis line phone number.

An Eastern Health spokeswoman said Monday informational material — including brochures, fact sheets and contact information — are handed out at the early pregancy clinic.

But the authority encourages women who experience heavy bleeding to go to emergency.

bsweet@thetelegram.com

Read the full letter here.