Horizon and Health Department were warned about thoracic surgery 'crisis' 4 years ago

The Horizon Health Network and the Department of Health have been warned repeatedly for the past four years about the Saint John region's current thoracic surgery coverage "crisis," says the president of the medical staff organization.

"We have been trying to negotiate and put a plan in place" to have a second thoracic surgeon for the region and to change the remuneration model, said Dr. Patti Forgeron.

But the plan has been "stonewalled at a number of different stages for different reasons and now we have a crisis," she said.

"I don't want a blame game, I just want it to get fixed."

Thoracic surgeons are specialists who deal with structures of the chest, such as the esophagus, lungs, and diaphragm muscle, but not the heart.

They treat diseases ranging from gastroesophageal reflux to lung and esophageal cancers, remove benign tumours, perform chest reconstruction after major traumas and handle lung transplants.

Horizon Health has been discussing the lack of thoracic surgery coverage in internal memos marked "confidential" since at least Feb. 28, but has remained tight-lipped publicly.

A spokesperson is expected to provide an update to the media at 11 a.m. in Fredericton.

Forgeron says the problem is that one thoracic surgeon has been covering the entire Saint John region by himself for years. Now, he's on medical leave.

"If you have one surgeon doing all of the cases all of the time, that individual gets absolutely no break, he doesn't get any time off," she said.

"You need a second [surgeon] … so people don't get burnt out or suffer from depression or anxiety or other health-related issues."

'Not sustainable'

The lone surgeon, based at the Saint John Regional Hospital, has been responsible for all thoracic patients from Sussex to St. Stephen, including the Fundy Isles of Grand Manan, Campobello and Deer Island, as well as complicated tertiary referrals from other parts of the province.

He's on-call for thoracic surgery 24/7 and is also part of the general surgery call rotation.

Saint John used to have a second thoracic surgeon, but he retired several years ago and was never replaced, said Forgeron.

"It's not sustainable to run a tertiary level type service with one surgeon because if anything happens to that one surgeon, you don't have any coverage and you have a crisis," she said.

Many of the thoracic patients have cancer, she stressed. "These are life-threatening things. These are not, you know, 'You can wait 14 months for your hip surgery.'"

Alternate funding model required to recruit

Forgeron says she flagged it as a problem to the former Progressive Conservative Health minister and has been pushing ever since for a second thoracic surgeon, as well as a new funding model.

The current thoracic surgeon is paid on a fee-for-service basis and can "make a good living," she said. But there wouldn't be enough patient volume with two surgeons working under fee-for-service, she said.

That's why she contends an alternate funding program (AFP) involving a salary component is required. Otherwise, she said, the region won't be able to attract and recruit a second surgeon to help ease the workload and ensure constant coverage.

'Should not have come to this'

New Brunswick Medical Society representatives met with Horizon officials in January 2016 to discuss staffing issues and the AFP request, said Forgeron.

The medical society was set to begin negotiations with medicare a couple of months later, but talks stalled with no word, she said.

In July, there was another meeting and an agreement in principle to more forward with negotiations, she said, but again, there was no word.

She says she corresponded with Health Minister Victor Boudreau to no avail and "now, the crisis."

"It certainly should not have come to this," said Forgeron, but "it often does take a crisis to move things forward in our delivery of health care in this province."

She believes Horizon is now doing its best to make alternative arrangements for thoracic patients and says she's optimistic a long-term solution can be reached.

Correction : An earlier version of this story indicated the Saint John region's thoracic surgeon has been working alone for 16 years. In fact, there was a second surgeon for part of that period, but he retired several years ago.(Mar 17, 2017 8:00 AM)