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Pontiac Hospital in month-long OBS interruption - Will the new year be “brighter”?

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Added: Wed, 12/18/2019 - 2:27pm
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Allyson Beauregard

SHAWVILLE – The Pontiac Community Hospital (PCH) experienced its tenth
service interruption this year in the obstetrics (OBS) department from December 6 to 11 due to a lack of nursing staff.
On December 12, Marie-Ève Cloutier, Director of Nursing for the Centre intégré de santé et des services sociaux de l'Outaouais (CISSSO), held a press conference in Gatineau to detail the situation at the PCH, where she announced the unit would suffer its eleventh interruption, lasting 21 days from December 13 to January 3.  
“CISSSO is determined to maintain this service, but in order to take care of personnel, we had no other choice but to take a break to allow the teams to catch their breath … it’s a difficult decision, and we’re aware of the impact it has
on expectant mothers. We’re working to stabilize the situation as quickly as possible,” said Cloutier.
The conference was held hours after a news report was released about a family who lost their baby at three days old following an emergency delivery at the PCH in September. The mother, Anik Lavigne from Mansfield, had an emergency cesarean at the PCH after days of abdominal pain and bleeding, although she was told during multiple consultations that the symptoms were normal. The family believes the baby may have survived if he was born at another hospital with specialists on site for faster care. 
The family filed a complaint with CISSSO and the Collège des médecins and
the death is currently being investigated by Ontario’s coroner because the baby
was transferred to CHEO in Ottawa, where he passed away from asphyxiation due to placenta abruption.
According to Cloutier, the tragedy didn’t occur during a service interruption and
“very competent employees” provided the care.
A brighter future?
While the hospital’s OBS unit has appeared to be on very shaky ground in recent months, according to Dr. Genevieve Smith, one of five OBS doctors, the situation “isn’t as bad as it looks” and she is optimistic about what the new year will bring.   
While the OBS unit should have twelve nurses to provide full service, there are currently only five; in total, they worked close to 600 hours of overtime in August and September. Two nurses from the Jewish General Hospital in Centre-Ouest-de-l’Ile-de-Montreal provided extra staffing in November and a team of midwives from La Maison de Naissance in Gatineau helped divert a month-long OBS interruption this fall.
Last month, an OBS nurse anonymously spoke out about the situation at the hospital, saying the persistent staff shortage is putting mothers and babies at risk and seriously affecting the mental health of what few staff remain.
In response, Québec Health Minister Danielle McCann said the safety of mothers and newborns will be reassessed at the hospital.
However, according to Smith, this testimony doesn’t describe the overall feeling at the hospital. “In general, the feeling here is positive. Everyone is definitely feeling the strain [of the short staffing], but everyone is jumping in and pulling together where they can to make it work,” she said.
During service interruptions, women in labour are evaluated at the PCH before they are transferred to the Gatineau hospital. For imminent births, the baby is
delivered on site, but both the mother and baby are later transferred to Gatineau
for post-partum care.
Help is on the way
McCann announced two OBS nurses will begin working at the PCH after the holidays, and in addition, Smith said a third nurse will join the team early in the new year, bringing the department’s total to 8 nurses.
Word that two of the five doctors forming the PCH’s birthing team will be leaving at the end of the year caused further stress and left the CISSSO scrambling to find replacements because initially, their schedule was only covered until the end of January. However, Smith said a local doctor will return to the OBS unit until replacements are hired, and schedules are covered until the summer.
“We’re not feeling so rocky anymore and we’re continuing to actively recruit,” she told the Journal.
A potential new partnership
 Following the month-long partnership with the Maison de Naissance this fall, the
presence of midwives in Shawville could become permanent. 
“The midwives are interested in making Shawville a site of practice and there will be a meeting early next year to discuss the possibility. The month they were here was definitely a positive experience, but there are things to iron out,” said Smith.
Currently, the midwives either deliver babies at the birthing center in Gatineau or the nearby Gatineau hospital.
‘SWAT’ team mobilized
The PCH also experienced three general surgery service failures this year, which consequently impacted OBS and led to the same transfer arrangements for expectant mothers in case a cesarean was needed.
On November 28, McCann announced the government signed an agreement with the Québec Federation of Specialist Doctors to help ensure the continuity of OBS and surgical services in rural areas by creating a “SWAT team” of physicians who will travel to different regions to cover shifts, effective December 1. However, the agreement will not improve the nursing staff shortage.
Pontiac MNA André Fortin is disappointed with the delay in signing the agreement.
“Over the past year, I personally asked 21 questions in the Assembly encouraging the Minister to sign this agreement. In March, she said it would be signed in the
coming days. Finally, 250 days later, it is. It’s unfortunate it took this long, as patients were put at risk. In Charlevoix, a woman gave birth in her car because she had to drive to an urban hospital hours away,” he added.
In the Pontiac, a baby was delivered in an ambulance en route to the hospital amid
confusion about whether the PCH’s OBS unit was open or not.
Communication needed
According to an anonymous doctor at the PCH, the current situation calls
for increased communication between the various departments as well as from
CISSSO, which isn’t happening sufficiently.  
“Nobody has sat down with the whole team and brainstormed what we can do to [improve the situation]. I think that’s a failure. CISSSO passes the image that everything’s under control, but that’s far from true,” they said.
“In this situation, you have to ask how [unexpected
deliveries will be handled] and what to do if someone comes to the ER when the OBS unit is closed. CISSSO says the ER doctors are qualified to deliver babies, but many haven’t done any obstetrics recently and there’s no form of program to [teach] them to deal with that if it happened … there’s basically been no communication from CISSSO on the medical side about how to handle all this or how they can support us,” they explained.
The doctor emphasized that in rural hospitals, a team approach involving doctors, nurses, surgeons, anesthesiology, emergency rooms, etc.
is required, especially in obstetrics, because each department is interdependent.
Before the creation of CISSSO, all of the PCH’s departments were integrated under one chief department, which facilitated communication. Now, each are separate entities that relay to Gatineau. 
“There’s no horizontal communication, just silos of responsibility. That doesn’t make for functionality with a team approach. Bureaucracy has impeded cooperation rather than facilitated it,” they concluded. 
Solutions available
According to Fortin, solutions are on the table to address the nursing staff
shortage and the government (CAQ) just needs to act on them: implementing improved patient care ratios for nurses and ward aids, the end of forced overtime (which the CAQ said they would do within a year of the election), and better salaries for nurses in the Outaouais specifically.
“These measures would contribute to making the profession more interesting and attractive. To address difficulties in staff retention, there has to be a comparable salary for Ontario and Québec nurses,” concluded Fortin.