St. Mary's doctors in a fight against change, health agency head says

The head of the Montreal-West Island health agency now in charge of St. Mary's Hospital says a vascular surgeon who learned last summer he'd no longer be performing a potentially lifesaving surgery would have been within his rightto proceed with an emergency operation.

• St. Mary's Hospital administration defends decision to revoke surgeon's privileges

• St. Mary's ER doctor disputes CIUSSS reasons for dying patient's transfer

However, Benoit Morin said, the Montreal West Island Integrated University Health and Social Services Centre (known by its French acronym CIUSSSde l'Ouest-de-l'le-de-Montral) is sticking to its decision to discontinue aortic surgery at St. Mary's,"based solely on the need to maintain high standards of quality."

In a lengthy interview with CBC News, Morin gave the CIUSSS's version of events in the wake of a patient's death last November.

Many medical staff at St. Mary's Hospital believe that death might have been prevented, had the hospital's only vascular surgeon not been told that any patient presenting with a ruptured abdominal aortic aneurysm would henceforth betransferred to a tertiary-care hospital.

Patient died before he could undergo surgery

The patient, a man in his 70s, walked in to the hospital's emergency room last Nov. 2, complaining of abdominal pain, Morin explained.

He lost consciousness in the waiting room, and an ultrasound revealed hiscriticalcondition known in medical jargon as a "triple-A rupture."

ER staff called on the hospital's only vascular surgeon, Dr. Bernard Emond a "stellar surgeon," Morin acknowledged, with 30 years' experience at St. Mary's.

Emond,however,declined to do the operation, and the patient was transferred to the MUHC. He died before he could undergo surgery there.

Surgeon had 'full privileges,' Morin says

Morin insists the decision not to perform the operation on the spot at St. Mary's was Emond's to make.

"He had his full privileges at St. Mary's," Morin told CBC News.

"His medical privileges were not changed in any shape or form by the decision of the hospital to transfer that procedure" (to a tertiary-care institution.)

Emond has not come forward to explain his version of events.

However, another doctor has told CBC that Emond told ER staff he was no longer permitted to perform surgery to repair a triple-A rupture because the hospital's mission had changed.

Flurry of letters

The circumstances around the patient's deathleft medical staff at St. Mary's Hospital reeling. Ten days later, a letter signed by close to 130 staff members was sent to Dr. Louise Ayotte, the director of professional services at the CIUSSS.

People who have been working in a certain wayfor a long time may feel a bit at odds with the change that needs to happen.- Benoit Morin,CEOof Montreal-West IslandCIUSSS

The case "strikingly highlights why we have an absolute need to reinstate and maintain our vascular surgery team," they said in that letter, obtained by CBC.

The staff told Ayotte they "were not consulted about your plans to withdraw vascular surgery" and "not advisedthat abdominal aortic aneurysm surgery is no longer offered at our institution." They called for a meeting within the week.

Ayotte responded in a letter of her own on Nov. 23.

In that letter alsoobtained by CBC, Ayotte defends the decision to end triple-A rupture surgery at St. Mary's as a patient-safety issue, however, she acknowledges that the consultation process with staff was "flawed" and "far from optimal" and offers an apology.

Ayotte also suggests that the Couillard government's reorganization of the health care system (Bill 10, passed last April) and budget cuts contributed to the decision to cut some vascular surgery services.

"The reform that started on April 1 is the most significant one since the inception of the health care system and it came as an additional challenge for St. Mary's Hospital given the budgetary issues it faced before as a stand-alone entity. These two processes come together to create a challenging context for all," Ayotte statedin the letter.

Health reform 'the context to review services'

"That letter explains the context and tries to reach out to the community from a humane standpoint," Morin explainedTuesday.

He said while health reform did not directly lead to the vascular surgery decision, the reform"creates a context in which we review all services."

"Change is part of it," he said. "Change for the better."

However, Morin said it's clear that many medical staff at St. Mary's are resistant to the reorganization of health care services and used the November incident "to make their point that they do not wish for change to happen."

"We are aiming and working very hard to improve the standards of care, not diminish it...But in the process, people who have been working in a certain way for a long time may feel a bit at odds with the change that needs to happen."

Incident under review

Morin said the events surrounding the patient's death last Nov. 2are being reviewed by the medical act evaluation committee of Quebec'sCollege of Physicians.

In the meantime, he met St. Mary's Hospital staff, including Dr.Emond, to discuss their concerns in December.

He said the CIUSSSremains convinced that with only one vascular surgeon at St. Mary's Hospital, the "best practice" remains transferring a patient in urgent need of triple-A rupture surgery to a tertiary-care hospital the MUHC or the Jewish General.

Deaths will occur, he acknowledged, because even with an excellent vascular surgeon on hand, the condition is almost always fatal.

"It did happen in2013 and 2014, while Dr. Emond was on watch seven times. Seven people died."

If someone else walks into St. Mary's with that condition, "that person will be quickly sent to the tertiary-care environment and receive appropriate care," Morin said.