The Northern Health Region (NHR) released more information behind the suspension of obstetric services last week.
In her first comments at an open public meeting since the obstetrics closure first went into effect on Nov. 18, Northern Health Region (NHR) CEO Helga Bryant gave reasons for the suspension during a Flin Flon and District Chamber of Commerce meeting. She cited a lack of availability of qualified obstetricians, gaps in care in Flin Flon, potential safety risks for expectant mothers and staff and the results of an external review last year as the central causes behind the suspension.
Flin Flon General Hospital last had a qualified, full-time obstetrician in 2017. When that doctor moved away from town that fall, obstetric care in the community relied almost exclusively on locums, who were only available for a small percentage of total time.
Scott Hamel, the executive director of health administration and regional administrative officer for the NHR, said care from a qualified obstetric professional was not available in Flin Flon for weeks at some points.
“Over the year when [the previous obstetrician left] to when we ceased the service, for the last six months, the vacancy was 50 to 75 per cent. We could not find locums or itinerants 50 to 75 per cent of the time. There might be one week a month where there’s an obstetrician, then three weeks with no coverage.”
“We found ourselves in this situation where we were really not able to recruit and heading toward only being able to provide service one week out of four. It’s really not an acceptable way of providing services, at all,” said Bryant.
The NHR has had difficulty finding either obstetricians and obstetrical locums to work in Flin Flon. Hamel said multiple avenues turned up little success.
“We looked for locums. They live somewhere else and they provide a short-term coverage. We looked for those out of the Women’s Health Care program in Winnipeg and were not successful. We looked to the northern and remote stream [from the University of Manitoba school of medicine] and we looked to provide an additional year of training for them, the GP/obstetrics and to support that and all their practice desires in order to provide that service here. That was not successful.”
“We worked with Manitoba Health, the providers and the physician’s union, Doctors Manitoba, to make that happen, but at the end of the day, they didn’t want to sign contracts. We looked across Canada for a GP/obstetrician to move here. Didn’t happen. We looked for locum itinerants, on a revolving schedule, coming in for a week or two weeks at a time. There’s a national shortage. That didn’t happen.”
Flin Flon General Hospital was rated as a Level 1 centre for obstetrics, meaning only low risk pregnancies could be dealt with at the hospital. According to provincial guidelines, low risk deliveries cannot be done by a general practitioner unless they have had an additional year of obstetric training. Bryant said high risk cases were transferred away from Flin Flon to other sites able to handle the delivery.
With recruitment not working and major gaps in staffing, Bryant said the NHR ordered an external review of obstetric services at the NHR’s three main facilities. Dr. Carol Schneider, a Winnipeg-based gynecologist and an associate professor at the University of Manitoba and Christine Finnbogason, a clinical nurse specialist with the Winnipeg Regional Health Authority, conducted the external review. The review found concerns with obstetric care in Flin Flon.
“There was very clear, expert medical advice that, due to the gaps in service and the low births and only low risk births, that obstetrics in Flin Flon should be suspended until there is a provincial plan,” she said.
“Specific to Flin Flon, that was the advice that was given.”
Bryant also said ER staff and physicians were raising concerns, saying they felt “unsafe and unsupported” during gap times in obstetrics.
“It was not clear to them if we were delivering, if we were not delivering, would the contingency plan work, would it not work. There was great uncertainty and a high level of worry for patient safety and worry for their practices.”
With the results of the review, difficulties in recruitment and availability and concerns from in-house professionals, Bryant said the choice was clear.
“It’s one of the most difficult decisions I’ve ever had to make,” she said.
“We wanted to ensure that we had safe situations for moms and babies who were seeking care in Flin Flon and how we could best do it. We weren’t doing it very well with those gaps in service.”
The decision of whether or not to restore obstetric care in Flin Flon will be made following the results of a provincial clinical plan, slated to be released later this year.
Since the suspension, a pre-natal clinic was started at the Flin Flon clinic. Pregnant women can access help and make birth plans with a pre-natal nurse and a primary care provider at the clinic.
Bryant said that since the suspension, one woman had presented to Flin Flon General Hospital in labour and two pregnant women were transferred out via ambulance. Four children with parents from Flin Flon have been born in The Pas since the suspension went into effect, according to Bryant. Statistics regarding how many Flin Flon mothers had given birth in non-NHR facilities or how many mothers from Saskatchewan communities that previously relied on the Flin Flon obstetric unit were not given, although Bryant said the NHR has provided pre-natal care and was tracking some expectant mothers from Saskatchewan.
“We don’t know about births elsewhere. Unless a woman shares that information with us, we really don’t know that piece of information.”
Only a small number of questions from the public were asked during the meeting. One questioner, business owner Telis Keramydas, shared his own family’s experience with birth care in Flin Flon and the general feeling around the community following the suspension.
“I have two young kids who were delivered here in Flin Flon. Both times, we had very good service when they were delivered. When the announcement came up that the service is going to be interrupted in Flin Flon, it was chaos. Add that to the news of [Hudbay] closing down, then the city was starting to panic and people were scared about what was going to happen. What you said today was good news,” he said.
“Are we going to get the service back? Is the government going to say, ‘hey, it’s working without it, so you guys don’t need it.’ These are questions that people are afraid of thinking about. Like every other business owner, we want to see this place thriving. This is our community. How are you going to communicate this to Flin Flon?”
Bryant replied by saying the NHR has a frequently asked questions page on their website and restated the reason for the suspension.
“The reason for this was around clinical care. There is a contingency plan and we are awaiting the provincial plan. Those are the three main points.”