Fredericton doctors say delayed cancer treatment among 'costs of inaction' on new OR

Senior Fredericton physicians are calling on the provincial government to immediately commit to proceeding with the opening of a specialized surgical suite at the Dr. Everett Chalmers Regional Hospital.

The Greater Fredericton Area Physician Staff Organization has issued a rare public statement, warning that "the costs of inaction are rapidly accumulating."

These costs include a six-week wait for biopsies to diagnose cancer, which delays the start of treatment "beyond acceptable time frames," according to the statement, signed Monday night by the president and past president of the organization, as well as 10 department heads.

It comes following a debate in the legislature last week, when David Coon, the Green Party leader and Fredericton South MLA, accused Premier Blaine Higgs of "standing in the way" of the Chalmers Foundation raising money to purchase equipment for the hybrid operating suite, built as part of a new surgical wing.

Health Minister Bruce Fitch said at the time, "The answer is not, 'No,' it's just, 'Not now.'"

On Tuesday, Coon described the doctors' statement as "very worrisome."

Fitch reiterated that government is "just at this point in time saying, 'Look, it's not now.'"

Other impacts

The doctors contend the "time is now" for opening the state-of-the-art suite that would enable surgeons to do imaging, biopsy, diagnosis, and surgery all in the same room, without having to move the patient between an imaging suite and an OR.

Dr. Liam Hickey, head of urology, said the doctors have been seeking an explanation for why the project remains 'in limbo,' when equipment needs to be ordered and installed and resources and recruitment planned. (Submitted by Dr. Liam Hickey)

"Patients are already experiencing delays of treatment, prolonged hospital stays, increasing number of expensive after-hours procedures, and transfers to other New Brunswick hospitals," they say.

"Physicians are simply asking for the tools to do their job caring for patients. Working in poorly resourced environments is known to be a major contributor to health care provider burnout and impacts recruitment and retention of the workforce."

Fitch said he and Horizon interim president and CEO Margaret Melanson already met with most, if not all of the 12 doctors who signed the document. He and Higgs will meet with them again in the coming days, he said.

The Chalmers Foundation has already committed to raise the necessary funds, according to Dr. Liam Hickey, the head of urology and one of the signatories. And the Horizon Health Network supports the project, he said.

"The government [is] saying, 'Not now,' and you know, our response is, 'When?' Because if not now, when everything's ready to go, and the space is available and the demand is certainly there, I'm not sure what circumstance the government is looking for that would make it a better time," said Hickey, who has worked at the hospital for 18 years.

Coon agreed. The foundation is "chomping at the bit to raise this money, and they need the go-ahead to do so. So what is the holdup?"

It's "fairly standard" for foundations to raise money for equipment and for it to become part of the operating cost of the hospital, which is budgeted for, he told reporters outside the legislature Tuesday.

Saint John should be first, minister says

Asked about the delay, Fitch said the government is trying to ensure access to surgery, which is one of its platforms, is "addressed in a reasonable way."

"There's some science behind where the most procedures are done within the province. And if [there's] a hybrid OR, the first location would have been Saint John because of the number of surgeries done in Saint John versus the number done in Fredericton," he told reporters.

"So the Level 1 trauma centre would be the first logical place to put it."

In the meantime, the government has told the Chalmers Foundation to put any surgical suite funding aside and work on other projects, Fitch said.

Health Minister Bruce Fitch said he recently met with most, if not all 12 of the doctors who signed the letter to explain 'the last chapter isn't written.' Hickey said he is unaware of any such meeting. (Pierre Fournier/CBC)

"I can appreciate the urgency, what they are feeling, but I think there has to be some respect in what we're trying to do to have a provincial health plan that we're moving forward with," he said, noting the government is only in year two of a five-year plan. "Sometimes the timing just doesn't mesh."

Fitch could not immediately say how much money the government has committed to purchase equipment for a yet-to-be-built new surgical suite at the Saint John Regional Hospital. But he did say there are no plans to move any existing surgical abilities out of Fredericton.

'Doesn't make any sense'

Hickey argues the minister's answer "doesn't make any sense."

"We have the space, we have the equipment, we have the funding, it just requires authorization by government for it to be approved," he said, noting the new surgical wing is scheduled to open in July.

"Whereas Saint John wouldn't have it for several years. So in a way, it's depriving a resource from the people of New Brunswick for some hypothetical timeframe down the road."

The 12 physicians who issued a public statement about the hybrid operating room at the Dr. Everett Chalmers Hospital in Fredericton include the heads of vascular surgery, interventional radiology, anesthesia, oncology, surgery, obstetrics and gynecology, family medicine, the hospitalist program and orthopedics. (Pat Richard/CBC)

Fitch said access to surgery isn't just about the space. One of the biggest constraints is human resources, he said, citing anesthesiologists and registered nurses as examples. Sometimes it's bed shortages, he said.

"So there's a lot going on, and part of our whole new governance system is, again, to make decisions that are based on a provincialwide basis and not just a one-off in a particular facility."

Concerns services will be lost

Last week, Coon warned that without the premier's "go-ahead" to outfit the hybrid surgical suite with the relevant equipment it will be impossible to recruit a new vascular surgeon to Fredericton to replace the one who plans to retire.

Vascular surgical services will be lost not just for Fredericton but for western and central New Brunswick as well, he said, calling it a "dire situation."

"What would have been a one-hour or two-hour emergency ambulance trip from the communities in the upper St. John River Valley to Fredericton for life-saving vascular surgery will be too long to save some people's lives," said Coon, citing aneurysms as an example.

"What would be a one hour and 45 minute drive from Perth Andover to life-saving surgery will turn into a trip of close to three hours to get to Saint John."

Green Party Leader David Coon said the hybrid surgical suite is already built and awaiting equipment. 'We don't want it turned into a storage room.' (Jacques Poitras/CBC)

Ftich accused Coon of sensationalism.

"In the conversation that we had with the folks from the DECH, we didn't say, 'No,' we said, 'Not now,'" he said, adding that the equipment is "very specialized" and can "take years" to purchase, build and put in place.

Coon replied that medical staff across all departments are "deeply concerned" vascular services could disappear from the region without the equipment and that it could have "cascading effects," including the loss of up to two anesthesiologists and other medical staff, "ultimately, perhaps, leading to the downgrading of the Chambers Hospital as a tertiary care hospital.

"That's coming from those medical professionals … not from me," he stressed.

On Tuesday, Fitch said "the last chapter isn't written." There are "a number of options" available, he said, and strategic talks continue.

The capital budget is expected next month.

The $250-million expansion and upgrade of the Chalmers was announced in 2017 under former premier Brian Gallant.