Anesthesiologists under fire as some women left in pain

• A B.C. hospital is threatening to fire all 28 of its anesthesiologists if they don’t agree to provide around- the- clock service within a year because some women are being forced to give birth without an epidural.

Dr. Roy Morton, vicepresident of medicine at Fraser Health, said patient safety and concersns over quality of care spurred the warning letters sent out recently, advising anesthesiologists that their privileges to practise at Surrey Memorial Hospital would be revoked if an agreement is not reached by March 1, 2017.

Morton said there are times when women in labour have to endure far too much pain because they either don’t get an epidural or wait too long for one. He said caesareans, which also require an anesthesiologist, may also be delayed.

“We’ve been tr ying to reach an agreement with this group for five years. At some point you just have to call it a day.”

“We need a dedicated service and no one has stepped up to the plate to say ‘ yes, I will sign on,’” said Morton, a retired anesthesiologist.

Only a third of women in labour at Surrey Memorial get an epidural for vaginal deliveries, compared with 50 per cent of women delivering babies in Vancouver. The national average is 59.4 per cent, according to the most recent (2014-15) report from the Canadian Institutes of Health Information.

Morton said there have been occasions when there is only one anesthesiologist in the hospital late at night. If that doctor is in surgery and gets called to administer an epidural or anesthetic for a caesarean section, there is a good chance the expectant mother will have to wait. He said there have been no life-and-death crises that he knows of, but it is a far from ideal situation.

Last year, Surrey Memorial doctors delivered 4,300 babies.

Dr. Roland Orfaly, chief executive officer of the B.C. Anesthesiologists Society, said the letter sent to doctors clearly states the threat was not about “disciplinary procedure, patient safety issues or quality of medical care” so no one should suggest those issues are at stake.

He said the society has been working with the government on an anesthesiology human resource plan “and it is at that table that solutions for better maternity patient care are being considered for Surrey ...”

The health authority has earmarked $ 1.2 million per year for five anesthesiologists to be available on a rotating basis for the obstetrics service. Since each one would still be able to work in other operating rooms when they aren’t in delivery suites, they would still be able to earn additional payments through fee-for-service arrangements.

Morton said he expects that between the obstetrics contracts and the fee for service for other work, anesthesiologists would earn gross compensation of about $500,000. The average for B.C. anesthesiologists is $360,000 a year, he said.

Health Minister Terry Lake said he supports the idea of having dedicated obstetric anesthesia services at highvolume maternity sites such as Surrey Memorial Hospital. It has been identified in two reports as a pressing need. Surrey Memorial has one full-time anesthesiologist on site 24/ 7 and access to oncall anaesthesiology when required. But it is expectant mothers who have to wait when there are conflicting demands.

Lake said he’s disappointed with the stalemate but hopes the sides can reach an agreement before the deadline.

“Frankly, t he doctors are asking for far too much money,” he said, without disclosing the amount.

Laura Heinze, spokeswoman for the minister added: “Fraser Health has told the anesthesiology group it will be looking for another group to take on the service, and has given the current group a full year’s notice as required.

“We are confident Fraser Health can have a dedicated obstetric anesthesia service in place, with a new group of doctors, within the year.”