A Quebec ombudsman report into the situation at Anna-Laberge hospital on Montreal's South Shore reveals that patient care has suffered significantly due a critical lack of staff, poor organization and outdated information technology tools.
The report, completed by Quebec ombudsperson Marie Rinfret and released June 30, details how patients are effectively receiving acute care in the emergency room of the hospital in Châteauguay, Que.
"Due to the length of stay which frequently extends beyond 24 and even 48 hours, the emergency becomes an inpatient unit, without being designed for this function," reads the report.
Rinfret notes that as a result of the lack of staff and available beds, people are being treated in inappropriate places such as hallways and waiting rooms.
"We saw cases where people were essentially hospitalized at the emergency room, and they would return home after 48 hours, up to six days, being on a stretcher in the ER," said Rinfret in an interview with Radio-Canada.
The report states that on top of a lack of staffing and beds, "organizational tensions, difficulties in mobilizing around actions or promising projects, as well as issues concerning internal communications, hinder improvement efforts."
Rinfret's investigation found that people are not receiving the care they need and a confluence of problems has led to patients being given the wrong medication or COVID-19-negative patients being exposed to outbreak zones.
She writes that information about how long patients have been waiting is not tracked, and mistakes can happen because some information about their files is entered electronically and some is handwritten.
The investigation was launched after recommendations made to the hospital in 2018 failed to be implemented to the satisfaction of the ombudsman.
Many of the problems plaguing the hospital predate the pandemic, Rinfret says, with the filling up of beds by COVID-19 patients only exacerbating the situation.
The report states that "the COVID-19 pandemic has aggravated a situation that was already critical with regard to security and quality of care."
Rinfret noted that issues at the leadership level have resulted in solutions not being put in place, citing multiple projects where the government authorized improvements only to have no one put in charge of implementing them at the hospital.
'The level of patient care is deplorable'
An employee of the hospital, who spoke to CBC News under the condition of anonymity, said that they have seen firsthand the way that patient care has been impacted by the issues outlined in the report.
"The level of patient care is deplorable," they said "It's not the time to get sick in Quebec."
The employee went on to describe how staffing shortages were made worse by mandatory overtime, which led many experienced nurses to quit or retire.
"The public system is on life support," they said.
Mélanie Gignac, president of the union representing nurses and respiratory therapists in the region, said that in the middle of the pandemic, 500 people left their jobs.
She said there are currently 1,000 posts that need to be filled within the Centre intégré de santé et de services (CISSS) Montérégie-Ouest, which oversees Anna-Laberge hospital.
"Right now, we have less than 50 per cent of personnel present to cover all the beds in the hospital," said Gignac.
She said she's seen cases where a nurse will work a 20-hour shift because there is no one to replace them.
"We are living a catastrophe," she said.
Gignac said sometimes when mistakes are made, such as patients falling or people getting the wrong dose of medication, the incidents don't get recorded.
"The staff are under a lot of pressure and fatigue," she said. "After you've done 16, 17, 18 hours of work, they don't want to write up an incident report."
Gignac said nurses are doing their best with a difficult situation and advised people to avoid the emergency room at Anna-Laberge when possible.
In an interview, Rinfret said she doesn't want the public to believe the problems at the hospital can't be solved.
"There are solutions that can be put in place short term," she said.
The report makes numerous recommendations for how the CISSS Montérégie-Ouest can rapidly improve services.
First and foremost, there needs to be enough staff to care for the patients. But beyond that, Rinfret says that the IT infrastructure needs to be updated, the emergency room needs to be physically reorganized and an emergency action-support team needs to be created.
The CISSS also needs to develop "a mechanism for monitoring emergency consultation times, in order to to know the average time between the consultation request and the doctor's response" and to implement and disseminate existing policies on how emergency rooms should be run.
The report also includes recommendations for the Health Ministry, saying it needs to prioritize recruitment of registered nurses outside Quebec and that it should divert resources from elsewhere to the CISSS Montérégie-Ouest.
The report mandates the CISSS to "demonstrate to the Quebec ombudsman, by Oct. 29, 2021, that the recommendation has been carried out, indicating the measures taken to achieve this objective."
Gignac, with the nurses' union, says that's not going to happen.
"They won't be able to meet any of the requirements by Oct. 29, it is impossible. It is impossible because everything is linked to the lack of personnel."
The CISSS Montérégie-Ouest declined to comment on the report.