Bed crisis at PMH

 

To tackle what is being described as a crisis of bed shortages at Princess Margaret Hospital (PMH), Minister of Health Dr. Duane Sands said yesterday that elective surgery will be discontinued indefinitely as of today until the shortage eases.

Seventeen patients were admitted to hospital on Wednesday, but there were no beds “anywhere in the hospital” to accommodate them, a consequence of an increased number of boarders taking up beds and the 67 beds that remain out of commission, Sands said.

Ambulances were also lined up outside and could not offload patients because, in addition to the shortage of beds, there were no trolleys to transfer patients to and from the operating rooms.

“There is no simple fix to this,” said Sands, when contacted for comment.

“We’ve incorporated space that had been decommissioned.

“We have people in the old operating theater.

“We have people in the old intensive care unit.

“We have people in the old recovery room.

“We’ve created multiple virtual wards in the hospital.”

He added, “God forbid we have a mass casualty event.”

Sands said renovations on the out-of-commission wards began more than a year ago, but construction came to a halt due to a lack of funding.

“We have been challenged to identify the funding because, again, all of this funding shortfall would have been accumulative,” the minister said.

“In my budget presentation I would have spoken about budgetary charges from the last fiscal year of roughly $20 million, plus commitments for this year of almost $80 million.

“And identifying all of those funds, relevant to the total indebtedness of the government has been challenging, so as we were able to deal with certain items outstanding in terms of payables, we would have dealt with it.”

The hospital has discharged more than 30 of its boarders, but their families have either refused to collect them or claimed they simply cannot care for them, according to the minister.

To resolve the long-standing problem, renovations are underway on one of the wards, which is expected to bring 24 beds back in service by April.

“I would have toured that ward today and they are putting in flooring.

“It is virtually completed, once the flooring is completed.

“The light fixtures are in.

“There is some wood work to be done, and then beds, and so on and so forth.”

Sands said the boarders need to be moved out of the hospital, as they pose a “serious challenge” to new patients, but this is also not an easy fix.

Some of them can be moved to specialized nursing homes if there were subsidies, he said.

But Sands said again, the problem is finding funds that have not been budgeted.

Asked whether PMH may have to consider putting those who have been discharged out of the hospital, the minister said, “Notwithstanding the horrendous implications for healthcare that the hospital and the people of The Bahamas are being held hostage by some social realities, usually during the holiday season this type of thing spikes.

“Some people find it convenient to leave their elderly or infirmed loved ones in hospital.

“We might not want to accept that is life in The Bahamas, but it is.”

Sands said, as minister, he is committed to resolving the problem, but it will require some unpopular decisions and outcomes.

“Notwithstanding the fact that there will be cries [of] ‘You’re the minister, fix it’, some of the fixes require some unpopular medium and long-term decision making.

“One of the most important things is we need to have additional revenue in order to do what needs to be done, and that revenue ultimately has to come from the public.”

He added, “Yes, we have a plan. Yes, we are implementing the plan.

“But it is not going to be a comfortable ride because, having made the decision to cancel elective surgery, there are some people who have been waiting months for that surgery.”

Four of the 20 ICU beds have also been shut down because there are only enough nurses to care for 16 patients, according to Sands, who said he planned to meet with the entire body of the nurses union yesterday evening to see how best to address these long-standing challenges.

“As we utilize nursing staff for more and more overtime and as you lose more and more nurses, the problem becomes self-perpetuating,” he said.

According to Sands, inadequate revenue performance has also compounded the problem.

He said on average the Public Hospitals Authority (PHA) collects less than $5 per patient per annum.

The vast majority of the 60,000 patients who receive emergency care per year do not pay.

In the meantime, patients who visit the hospital with non-life threatening matters will be deferred until the bed shortage improves.

Sands said this is the reason the PHA has advised the public to use the outlying clinics preferentially, as the wait times at PMH are up to 12 hours.

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