At least two patients were exposed to potential harm during a hospital IT outage in Ottawa last year, prompting doctors to speak out against keeping the emergency department open in subsequent "planned downtimes," according to internal emails obtained by CBC News.
"I think it is a recipe for disaster," an emergency department doctor urged in a message to managers at Queensway Carleton Hospital (QCH) in late September.
The hospital had already experienced at least three prior outages that month, including a major code grey (short for critical infrastructure failure) on Sept. 9 that knocked out computers, phones and medical devices for nearly 20 hours.
To address ongoing concerns, QCH told staff it needed to trigger more downtimes to update and fix the system, including one on Sept. 28 during the overnight shift.
"The purpose of this downtime is to bring our second server back online after the code grey. Right now we are running off one server, if it goes down we will have no back-up and really bad things will happen," the leadership team wrote.
The planned downtime would knock out at least nine services, including phones, Wi-Fi, the panic alarm systems and electronic patient records.
But closing the emergency department that day was "not an option", according to internal memos, because QCH's partners in the region — both the Montfort and Arnprior hospitals — would also be in downtime and have limited capacity.
In response, a doctor at QCH listed two examples of "actual patient harm that happened" during an outage shift when medical machines stopped working.
The doctor did not specify when these incidents occurred, but used the anecdotes as a cautionary tale for why the hospital should reconsider its policy.
2 near misdiagnoses
In the first instance, the doctor said a girl came in for a reassessment of her pneumothorax, or collapsed lung. But because the main diagnostic tool was out of commission, the physician said he was unable to compare her scans side by side.
"The pneumothorax had actually gotten worse," the doctor wrote.
"Fortunately, she was seen by thoracic surgery shortly after and was appropriately dealt with, but certainly this is a case where potentially the patient could have been falsely reassured and gone on to significant harm."
The second example involved a man who injured his hand and shoulder during a fall.
"While I identified and treated the shoulder fracture … I wasn't able to identify what was later identified as a thumb fracture by radiology, requiring the patient to have another visit to the ER for casting and treatment," the doctor wrote.
"These are just two minor examples, but I think a canary in the coal mine of what might happen trying to practice in this environment," he said.
The doctor wrote, "neither of these issues are mitigated by strategies put in place by our hospital."
He also urged hospital leadership to "give serious consideration to closing the ER during the downtime," adding it had been one of the most stressful experiences of his career in medicine.
Other doctors echoed the call to shut down the emergency department.
"It seems that EDs around us have closed for less," one doctor argued in another email exchange.
That doctor also described "absolute bedlam that presented a real danger to our patients" during the outage and "doctors and nurses faced increased medicolegal liability as a result."
"I would like to know why we and our patients should accept the risk," the doctor wrote.
CBC is not identifying the doctors in the email chain as their comments were internal. They've also declined an interview.
'Much like working in a rural setting'
In the heated email exchange, a member of the hospital's leadership team said he could not comment on how QCH would respond to a lawsuit should medical liability become an issue during a downtime.
"My personal feeling is that the standard of care changes with our limited access. Much like working in a rural setting," wrote the leader, who's also a doctor.
The leader acknowledged it was a "terrible situation," but said he would touch base with staff at The Ottawa Hospital's Civic campus to ask for support.
In a statement emailed to CBC News, QCH said it does not comment on "hypothetical legal situations," but thanked its frontline workers for their hard work.
QCH would go on to experience seven more outages of varying severity in the months following the internal email chain. In total, the hospital has experienced at least nine outages since September, each lasting anywhere from a few minutes to 11 hours.
According to a QCH spokesperson, five of the incidents were triggered intentionally as a means to maintain the hospital's electronic health record system called Meditech.
"Regular planned downtimes for maintenance and upgrades are necessary for any organization with an IT network, including hospitals," a statement from QCH read.
The hospital maintains no patients were harmed or had their privacy violated.
Aging equipment likely to blame
To date, QCH has not identified the exact cause of the original code grey incident — deemed internally as a "worst-case scenario" in early September.
QCH has since clarified the age of equipment as the most likely culprit.
Internal documents obtained through a Freedom of Information request suggest a key piece of hardware from the technology company Cisco was overdue for replacement.
In its latest email statement to CBC, a hospital spokesperson said QCH received the parts from Cisco earlier this month.