Doctor warns of ‘huge’ problem in neonatal ICUs

Dr. Rick MacDonald has a patient expecting premature triplets any day now, and he’s worried they may have nowhere to go.

What he calls a “huge” and festering health-care shortage problem came to a head this week as more than half the intensive-care units that treat Ontario’s sickest newborn babies were full up and closed to new patients.

“What on earth are we going to do with three newborns that need level-three nurseries?” asked MacDonald, a pediatrician who serves a trio of hospitals in the fast-growing Halton region west of Toronto. “We don’t have the beds.”

The shortage of space in neonatal intensive-care units (NICUs) already means that tiny infants sometimes have to be shipped across the province or even to the U.S. to find an open bed, he said.

Provincial and local health officials say no baby will go without the intensive care he or she needs — and none has recently been sent outside the province — but acknowledged there has been an “unprecedented” spike in demand for the specialized service.

The level-three NICUs in question treat babies who are born with serious abnormalities — and often extremely premature — and need to be on ventilation and monitored by a neonatology specialist. The province also has another 40 or so level-two NICUs that treat less severe cases.

The situation grew particularly dire earlier this week. As of Tuesday night, the level-three NICUs at two hospitals in Toronto and one each in London and Hamilton were closed because all the beds were full. Another Toronto facility and a hospital in Kingston were “restricted” as they had only one bed each available in their units, according to a provincial memo.

Only the Children’s Hospital of Eastern Ontario’s department in Ottawa was rated as open.

“The NICU surge situation continues to be a great challenge and at this point a high risk for the system,” said the message. “Acuity levels remain high, equipment is low and staffing is a great challenge with the number and acuity of patients at the sites.”

Ontario’s health ministry is aware that some of those units are facing an “unusual surge” in demand and is working with local health integration networks (LHINs) to rectify the situation, said David Jensen, a spokesman for the department.

A number of factors have come together to create the challenge, including a “unique” jump in the number of acutely ill newborns reported by hospitals, he said.

“This is an unusual situation that has not been previously encountered,” said Jensen.

He said the government will continue to ensure such infants get the care they need. In Toronto, for instance, additional staff will be brought in and resources otherwise “prioritized” to help the situation.

The number of neonatal cases needing high-level care “has reached unprecedented volumes” in recent weeks, said Megan Primeau, a spokeswoman for the Toronto Central LHIN. But she stressed that all such babies are getting the help they need within Ontario and none are at risk.

And a plan to take effect in September will provide the three Toronto hospitals operating level-three NICUs with more bassinets, said Primeau.

But Dr. Shawn Whatley, president of the Ontario Medical Association, said the current pressures are a classic result of running hospitals at such high occupancy rates that unscheduled surges in demand will inevitably create serious problems.

Canada’s 2.7 beds per 1,000 people is 33rd lowest among Organization for Economic Co-operation and Development countries, he said.

“We have to stop blaming this on one-off events,” said Whatley. “The system is chronically underfunded and is managed in such a way to guarantee these kinds of bad outcomes.”

Jensen noted that Ontario hospitals received a 3.1 per cent funding increase in the most recent provincial budget.

At Toronto’s Mount Sinai Hospital, which runs one of the level-three NICUs, there has been an unusually steep rise in number and severity of such newborns since June, said spokeswoman Sally Szuster.

The hospital installed temporary bassinets, but has recently received provincial funding that will let it add four beds permanently, she said.

MacDonald, based in Oakville, said he is skeptical about whether demand for such services has markedly increased lately, saying there has been a long-running shortage of resources for babies needing extreme care.

“It’s like a festering sore. It’s been there, it’s been hidden, it’s been covered because it’s like the Stockholm syndrome: we’re used to dealing with it,” he said. “Everything has been so pared down. It’s skeletal.”

The pediatrician said he’s had to send an infant to Buffalo, N.Y., and transfer newborn twins to separate hospitals, one in London, Ont. and one in Toronto, just to find them beds.

“You already have terrified parents, because this is not the delivery that they expected, the complications that they even dreamed about,” said MacDonald. “And then you have to tell them that their kid is being transferred, not just from your hospital but to two different hospitals and an area they don’t even live in. I don’t know how they even deal with that.”