Horizon Health exec denies thoracic surgery 'crisis' in Saint John

Thoracic surgery services won't leave Saint John, medical staff leader insists

A Horizon Health Network official denies there is a "crisis" in thoracic surgery coverage in the Saint John region, even though the only thoracic surgeon is on indefinite medical leave.

Dr. Edouard Hendriks, vice-president of medical, academic and research affairs, says all patients in the region who need thoracic surgery have been successfully referred to other surgeons and none have faced "undue delays."

They may, however, have to travel farther for treatment, he said.

"I'm calling this a difficult situation, a situation that needs to be managed, a situation that needs to be monitored on a daily basis, and this is what we are doing," Hendriks told reporters during a news conference in Fredericton on Friday morning.

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 cancer to gastroesophageal reflux, remove benign tumours, perform chest reconstruction after major traumas and handle lung transplants.

'Adequate number' in N.B.

"At this point in time … in New Brunswick we have, I would call it, an adequate number of surgeons providing this service to the province," said Hendriks.

"Now the question that we had for the past few months is how can we better consolidate the service.

Horizon is reviewing patient volumes and meeting with the New Brunswick Medical Society and medicare to discuss whether more thoracic surgeons are needed, given the aging population and high cancer rates, where they should be located, and what the best remuneration model would be.

"The discussion has been going very positively in the past few months so we are expecting potentially good news in the very near future," Hendriks said without elaborating.

Internal Horizon memos obtained by CBC News over the past couple of weeks have referred to the thoracic staffing shortage as a "crisis."

Dr. David Tees, chief of surgery for the Saint John area, sent an "urgent" memo to all members of the department of family medicine on Feb. 28.

"We are working on finding a solution to this crisis," he wrote.

On March 14, in a memo marked, "CONFIDENTIAL," Tees told doctors the "situation is likely to continue for at least another four weeks."​

Nova Scotia, Quebec surgeons may assist

​Hendriks told reporters the thoracic surgeon's leave "came quite unexpectedly" and he is off for "an undefined period of time."

But alternative arrangements have been made with other surgeons in New Brunswick, as well as Nova Scotia and Quebec "if need be" to "ensure, of course, proper access to care."

"So far, all the patients that needed in the past couple of weeks to have their surgeries done, have been successfully referred to [other] surgeons, so there has been no undue delay or problems," he said.

"So at this point in time, I'm not saying it's all easy for everyone, but we've been able — with the co-operation of everyone — to meet all of the demands."

'Really scary'

Earlier this week, a 65-year-old Saint John woman with esophageal cancer told CBC News her gastroenterologist referred her to four different surgeons in New Brunswick and Nova Scotia and she was turned away by all of them.

"It's really scary," said Eileen Shaw, who is having difficulty getting food past the growing tumour in her throat.

"I'm thinking, 'Oh my goodness, where am I going to go? Am I going to die?'"

Hendriks said ​a group of clinicians has been established to review cases and wait lists "at least twice a month."

"In between of course there is a daily review of the situation so if someone is in need of a more urgent surgery, we have processes in place to ensure a patient will be actively and positively referred to a surgeon," he said.

"I'm aware of one case that needed [a] more urgent referral."

Dr. Patti Forgeron, ​the president of the medical staff organization for the Saint John region, says Horizon and the Department of Health have been warned repeatedly for the past four years about the current "crisis."

She says having one thoracic surgeon covering from Sussex to St. Stephen by himself for years was simply "not sustainable" and now he's on medical leave.

Forgeron contends the region needs a second thoracic surgeon and the current fee-for-service remuneration needs to be changed to some form of salary model.