Ontario suffering severe shortage of newborn ICU beds, doctors say

More than half the units were full and closed to new patients this week

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 came to a head this week as more than half the intensive-care units that treat Ontario’s sickest newborn babies were full and closed to new patients.

“What on earth are we going to do with three newborns that need Level 3 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.

Level 3 NICUs 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 2 NICUs that treat less severe cases.

The situation grew particularly dire earlier this week when the Level 3 NICUs at two hospitals in Toronto and one each in London and Hamilton were closed because all the beds were full. Two more hospitals in Toronto and 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 listed as open.

Windsor Regional Hospital received notification this week that its NICU should be prepared to receive premature babies from elsewhere in the province, said president and CEO David Musyj.

Windsor’s NICU is unique in that it is categorized as “modified Level 3.” A full Level 3 facility accepts babies born prematurely at 24 weeks or later, while Windsor’s can accept babies born at 26 weeks or later, said Musyj.

Currently, Windsor Regional Hospital’s NICU has 16 of 20 of its issolettes, or baby incubators, occupied, but Musyj said it can boost that capacity to handle 24 babies. So far, no babies have arrived from other hospitals, he said.

Given the current situation, however, with hospitals in London, Hamilton and Toronto closing their NICU doors to new arrivals, Musyj said it could have an impact on locally born babies requiring Level 3 attention.

Of 3,724 births in the most recent fiscal year in the most recent fiscal year, Windsor’s NICU admitted 498 babies, with 13 being transferred to London and another five to hospitals in Michigan.

“We have the release valve, which is Detroit,” Musyj said. “If a mom showed up and gave birth to a baby of less than 26 weeks, she’d likely have to be sent to Detroit.”

Ontario’s Health Ministry is working with local health integration networks (LHINs) to deal with the “unusual surge” in demand, said spokesman David Jensen.

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,” Jensen said.

But Dr. Shawn Whatley, president of the Ontario Medical Association, said the current pressures are a 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,” Whatley said. “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 3 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. “No babies are turned away.” 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 and transfer newborn twins to separate hospitals, one in Londonand 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,” MacDonald said.

“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.”

The Canadian Press

The system is chronically underfunded and is managed in such a way to guarantee these kinds of bad outcomes.