SUNDRE — Three local physicians don’t expect obstetrical services to return to the Sundre hospital any time soon despite Alberta Health Services' (AHS) initial intention to restore the service this month following a two-year pandemic-induced break.
In fact two of the three, Drs. Rob and Michelle Warren, who own and operate the Moose & Squirrel Medical Clinic, were caught totally unaware when asked about information circulated in an NDP press release issued earlier this month.
The Friday, May 6 press statement claimed—citing information from Alberta Health Services—that the originally planned re-opening of obstetrical care at the Myron Thompson Health Centre that same day had been delayed until Friday, May 20 at the earliest.
“Nobody’s told the doctors that,” Rob told the Albertan on Monday, May 9 during a phone interview accompanied by Michelle, who is also currently serving a term as the 2021-22 president of the Alberta Medical Association.
“That comes as a complete surprise to me,” he added.
Neither of the physicians had heard about the delayed May 20 re-opening either.
“We’re not aware of any plans, let me put it that way,” said Rob. “Obviously, you have to schedule a doctor in to be available to deliver babies on our calendar. And we don’t have the calendar for doctors being scheduled in.”
Responding by email on Friday, May 13 to questions submitted by the Albertan, an AHS Central Zone spokesperson said the dates are posted on the AHS website and added the issue dates back even prior to the outbreak of COVID-19.
“The shortage of required obstetrical expertise is a long-standing issue in Sundre,” said Melissa Ballantyne.
“Given the declining number of births at the site, we have heard concerns from staff and physicians alike regarding challenges they face in maintaining the specialized skills required to deliver babies,” Ballantyne said.
According to information available on the AHS website, the Sundre hospital in 2017-18 delivered 22 babies, with a substantial decline down to 13 deliveries in 2018-19. There have since 2020 been five deliveries.
When the COVID-19 pandemic was officially declared in March 2020, AHS decided to pause obstetrical services at the hospital for the duration of the health crisis “in order to ensure expectant mothers and their babies receive the best care possible,” she said.
“The decision to do so is based on a number of factors, including challenges with obstetrical providers at this time and ensuring we do all we can to help prevent the spread of COVID-19 infection.”
Historically, the majority of Sundre patients have opted to seek obstetrical care at the hospital in Olds, which boasts a full-fledged program capable of providing services such as caesarian sections, an option many patients want access to, she said, adding that procedure is not available in Sundre as a result of an absence of an anesthesiologist and surgical expertise at the site.
The anticipated end date of the temporary suspension of obstetrics at the Sundre hospital is regularly reassessed, she said.
“We currently do not have an adequate number of physicians with the necessary insurance to provide obstetrical services,” she said. “We understand the decisions of our physicians who wish to stop providing obstetrical services in Sundre and support them in doing so.”
Early on in the pandemic during the summer of 2020, residents were assured the Sundre hospital’s emergency department would remain available 24-7, but that obstetrical care would no longer be available on a temporary basis as a result of COVID-19 restrictions.
But the situation was exacerbated by events that began to unfold the year prior after the UCP formed in 2019 a majority government that wasted little time tearing up a contract with physicians in Alberta, prompting many doctors to pull up stakes and look elsewhere for greener pastures.
When the UCP came to power, the Moose & Squirrel Medical Clinic had 13 physicians, of whom 10 practised obstetrics, Michelle said.
“Five of them are now out-of-province,” she said, adding some went out east while others either found work in B.C. or as a locum who no longer has a patient panel.
“We lost over 50 per cent of the delivery positions at that point in time in one fell swoop. That was as of last year,” she said.
And of those who remain, she said the only other member of Moose & Squirrel’s team that has obstetrical privileges will be leaving at the end of May.
“That just really leaves one physician at the Greenwood (Family Physicians) clinic, and none of our physicians have been doing obstetrics,” she said, adding her proverbial plate is too full to take on the additional workload.
“I can’t, because I’m here maybe one day a week, and then sometimes not at all,” she said, adding the provision of obstetrical care is a serious commitment.
“A pregnant woman can have a baby at any point in the last five weeks of her pregnancy, and you cannot have a thriving obstetrical program with one provider,” she said.
“So, unless they are successful in recruiting a physician with obstetrical skills who’s able to champion it or bring forward midwives to bring the service back to the community, I don’t see it returning to Sundre any time soon,” she said. “We need more people who are capable and wanting to do deliveries in Sundre.”
Even then, further complicating the situation is an absence of reliable patient transportation in the event of an unforeseen emergency such as a sudden and unplanned C-section.
“We need transportation that is guaranteed to be here if we get into trouble so we can send somebody out,” she said.
“It would be downright dangerous to have patients labour in Sundre with our EMS being as stretched as the are,” he said, adding much more needs to be done to successfully provide obstetrical care in Sundre.
“We don’t have the ability to do C-sections in Sundre,” he said. “And if somebody needs a C-section, they need it now. They can’t be at the end stages of labour waiting an hour or two for an ambulance to take them to Olds.”
While Michelle said she believes women should have a viable option to deliver as close to home as possible, she added, “it needs to be safe.”
The NDP’s press release also claimed that expecting Sundre parents are forced to travel “hundreds of kilometres” away to deliver their newborn, along the way incurring a substantial additional cost burden.
However, the Warrens said expecting mothers are able to deliver at the Olds Hospital and Care Centre—give or take 40 kilometres away. But they added that higher risk pregnancies such as patients expecting twins or who might have a medical history of past C-sections, require more specialized care at a centre in either Calgary or Red Deer.
Sundre hospital can accommodate unintended deliveries
That all being said, the Sundre hospital could in the event of an emergency accommodate a patient going into labour without enough time to transport them somewhere else as close as Olds.
“Better to be in the Sundre hospital than on the side of the road or the back seat of car,” said Rob.
“We are completely capable of delivering a baby here if we have to,” said Michelle, referring specifically to emergency situations in which time is of the essence.
“We do unintended deliveries in the hospital. But it’s not a planned thing.”
The Sundre hospital is even able to provide pregnancy assessments in the emergency room and advise patients whether they’re going into labour and must go to Olds, or if it’s a false alarm and they can return home to rest a little while longer.
“But beyond that,” she added, “we’re not doing any planned deliveries here. And I think that’s the key word, is planned.”
Janis Irwin, NDP critic for Status of Women, was quoted in the press release as saying, “Not being able to give birth close to home adds uncertainty and costs to families. To make matters worse, the UCP are unable to honestly tell people in Sundre and across Alberta when obstetric services will resume.”
Greenwood clinic's lead physician agrees with Warrens
Dr. Bill Ward, lead physician at the Greenwood Family Physicians clinic, agreed with the Warrens’ assessment.
“At the moment, nobody really wants to start doing obstetrics again in Sundre for the simple reason that we are so busy doing everything else trying to keep the hospital running,” Ward said on Tuesday, May 10. “Our workload is heavy enough as it is—as are the workloads for everybody else in every other hospital.”
Early during the pandemic’s onset, the timeline to reopen obstetrical care at the Sundre hospital was largely arbitrarily selected, he said.
“I have to say that I think what’s happened here, is that when they actually stopped obstetric services in Sundre because of the COVID outbreak, it was actually closed for a two-year period, and that time has actually elapsed,” he said, adding the planned reopening date was never actually really considered.
And just because restrictions have largely been lifted, does not mean COVID-19 is no longer causing strain on the health-care system that’s already stretched thin.
“As the COVID crisis continues, there has been no further discussion and therefore there is no plan to actually open up the obstetric services within Sundre,” said Ward.
“I think this is just one of those situations where a time limit was put on a service closure two years ago, and as this staffing situation—and really the manning crisis for the whole of the health service—continues, nobody’s actually had time or inclination to reconsider these things because of the difficulty in actually doing that.”
For as long as COVID continues to evolve and present further problems including staffing issues, Ward said he does not anticipate that obstetrical care will return to the Sundre hospital.
Additionally, all hospitals with a single-entry design—like the facility in Sundre—have throughout the pandemic been barred from doing deliveries, he said.
“Because of the constraints of the design of the hospital, we cannot guarantee that you’re not going to come into contact with COVID as you come in through emergency,” he said.
But even though expecting parents can anticipate making their delivery arrangements in Olds for the foreseeable future, Ward said that compared with many other communities across the province, “30-odd kilometres to go to Olds would actually seem to be a very short trip for obstetric care.”