Physicians seek public support for surgery program

By Diane Spoor
Staff Reporter

On Sept. 24, the Physicians Group of Rocky Mountain House released a letter to the community asking for support for the surgical program at the Rocky Mountain House Health Centre.

In the letter, the physicians said, “Over the past 10 years, we have had multiple surgeons who have wanted to serve our community with their skills, but who have faced roadblocks preventing them from working to their full capacity. AHS Central Zone Medical Affairs has consistently created obstacles. Without fail, our previous surgeons have all moved on to other areas in Alberta or other provinces, where they have been allowed to work instead of being hindered at every step.”

In an interview with The Mountaineer, Rocky doctor Jo Mundell expanded on this statement.

“Doctors have to have their surgical privileges approved by AHS Central Zone to work here with us, regardless of where they trained. Many of the surgeons who have come to Rocky have been granted a wide array of privileges in other zones, so it is not that they are not trained. And often they have been allowed to perform a long list of procedures in hospitals in other zones where the hospital is the same size and has the same abilities as ours,” Mundell said.

In a statement posted on the AHS website on Sept. 26, AHS president and CEO Athana Mentzelopoulos said, “We know that there has been some frustration in the past when a surgeon has wanted to do certain procedures that they do not have privileges for. It is important that processes are followed when a surgeon wants to add a service. Decisions to expand services must take into account patient safety, volumes, and the ability to practice and maintain surgical skillsets (sic). These processes are in place to protect patients, while balancing the skills of our surgeons and the needs of the community.”

Mundell explained, “The medical staff have been fighting this exact battle for many years. We’ve been going through the official channels. We’ve been going by due process and doing everything we can to fight for our surgical program but that hasn’t gotten results.”

Mundell said it is because these official channels have not resulted in changes that the physicians have gone to the public.

“The public deserves to know,” she said.

Most recently, general surgeon Dr. Dawnelle Topstad has indicated she is resigning. Topstad has been working in Rocky in a locum position for many years. Mundell said after the last full-time surgeon left the community, Topstad “generously stepped up to help with our surgical program to make sure there was minimal interruption in care for our communities.”

“Many of our residents may have met her, whether it was for a colonoscopy, hernia repair or perhaps a gallbladder removal,” said Mundell. She added, “It has been wonderful to be able to continue offering these services close to home so that people are not travelling long distances away from their families and responsibilities.”

Mundell also explained that Topstad took personal time to work with an obstetrician in Red Deer to get privileges to do caesarean sections at the Rocky hospital. Mundell added, to her knowledge, Topstad and two other surgeons applied for the surgeon job posting on the AHS website.

Mundell said her understanding is that the surgeons applied for a full-time position and were told after the fact the position is 0.5. On the AHS website it states, “Alberta Health Services, Central Zone, and the Department of General Surgery at the Rocky Mountain House Health Centre, invites applications for a General Surgeon to establish a full-time practice in the community of Rocky Mountain House Health Centre.” Further in the job posting it states, “position classification: part-time, FTE: 0.5.”

Mundell explained a half-time surgeon position “would involve a reduction in OR days to a point where it would not equate to a sustainable practice for a general surgeon.”

In the Sept. 26 AHS statement, Mentzelopoulos said, “We are aware of one surgeon who has opted to no longer work at the site, and that is their decision. This physician was a locum and did not have a fulltime (sic), permanent position in Rocky Mountain House. It is not accurate to suggest their operating hours were decreased.”

Health Professions Engagement team chair Lori Pratt said, “I would say there is some confusion. It feels like there is a disconnect that needs to be cleared up immediately.”

Mundell said Topstad’s dedication to earning her c-section privileges has been very beneficial to the community. There are two other physicians with the ability to perform caesarean sections “and being on call half the time is unrealistic. So it was wonderful for her to be able to help us to avoid gaps in coverage.”

Mundell explained the importance of having multiple physicians able to perform c-sections, located in our community.

“It means that people can labour and deliver in their own community.” There are several circumstances where “we are not allowed to keep somebody here for labour without having OR backup. For example, if someone is having their first baby and needs to be induced as we don’t know how their body will cope with birth. Or if someone had a previous c-section. We have to make sure we have every eventuality covered for the health and safety of the baby and the parent.” And Mundell added “even pregnancies that are classified as low risk, there is always the possibility that things can change and access to emergency c-sections is vital to the health and safety of baby and parent.” She added, “This affects the midwives as well, as to do a home birth it is really important for there to be c-section back up at the hospital.”

The Rocky Health Centre serves a large area, including three First Nations.

“For people living on the neighbouring three First Nations, it is already a long way to come to Rocky when they are in labour or for other medical concerns. The outcomes for these labours could look very different if they had to travel to Red Deer instead of Rocky,” said Mundell.

Mundell said some of the Rocky physicians shared with representatives from the First Nations that “we may see a decrease in access to c-sections because of the loss of our surgeon and they expressed distress.”

Mundell stressed, “As a physician group, we serve Rocky, Clearwater County and the three First Nations and we feel as though this decision from Central Zone is really affecting our ability to provide the health care to the First Nation communities that their treaty rights guarantee.”

Mundell further said, “Timely access to obstetric care can literally be the difference between a good and a devastating outcome."

"Their access to healthcare is being undermined by decisions that Central Zone is making unilaterally and without heed to local needs,” said Mundell. 

Mundell said the loss of one service, such as the general surgery program, can have a domino effect.

“For general physicians their patients don’t have access to the scopes, to the surgical procedures they need in a timely fashion in their own community. General physicians feel like they are not providing the best care to their patients and they are going to look elsewhere, where they can fulfill their professional obligations to their professional standards.”

The letter from the Physicians Group expands on that saying, “Wait times for gastroscopies and colonoscopies are very long elsewhere in the province These procedures are extremely important in detecting or ruling out cancers and other conditions.”

Mundell said having Topstad practice in our community has been fantastic. “Local doctors are able to contact a surgeon easily and she has been willing to help us out and get people into the OR in a timely manner when we have increased concern. And for our non-urgent cases she has been really excellent for the community because the wait times to, first, see a surgeon and then get the surgery done, she has been very efficient with that. The people of this area have been able to see a surgeon and get the procedure done in a much more timely manner than if they were on a waiting list for a bigger centre.”

In addition to the timeliness of getting patients in for surgery, Topstad has caught one per cent of the province’s colorectal cancers so far this year.

Lori Pratt, Health Professional Engagement team chair, said this whole situation “is really disheartening. Especially when you hear the stats of how many people have gone through Rocky and had early cancer diagnosis and getting the care they need in their home community. It is mind-boggling to all of us that this is the situation that we are in.”

“Our biggest concern is that going forward it feels like we are getting less and less support in a very busy area. And we have a community that we need these services in and it feels like more and more services are getting centralized. And we are a remote area that needs these services. We service a large area, especially when people are in the backcountry. We can’t lose more health professionals.” Pratt went on to say, “Having something like this happen is detrimental in our recruitment efforts. The positions become much more difficult to fill. It makes doctors not give our community a second look because they are concerned about what might happen.”
Mundell also addressed the community’s concerns about how the reduction in the surgeon position may affect the new OR.

“Our local health care foundation has been working hard for years now to raise money for our new OR. And our community has been very generous in their outpouring of financial support of this. We now have this beautiful operating room which we had hoped would result in improved care for our area.” The letter from the Rocky physicians said “any rural general surgeon who considers applying for the position in Rocky is going to have substantially less than usual access to the operating room, making this an unappealing job prospect.”

Part of the access change to the OR has been the addition of orthopedic surgeries. Knee replacements are now done in Rocky once a week, supported by orthopedic surgeons travelling to Rocky.

“This is an exciting addition to our surgical program,” Mundell said, but she added, “It is vital for our community that our existing surgical programs remain as robust as they were and that the ortho program is in addition to the general surgery program.”

Mundell said Rocky “underwent an Impact Assessment which determined that our community needs a full-time general surgeon. So, it is not as if we are asking for something we do not need. When we heard that Central Zone had changed the position to half-time we were perturbed as we were not sure what the process is that needs to be followed to amend an Impact Assessment.”

Mundell summed up what the physicians are asking the province for.

“We want the full time position back. We want to be consulted and we want autonomy over our own surgical program and we want to be able to be a voice for the people we serve. People who aren’t in Rocky don’t understand local needs. When people who are not deeply familiar with local needs are the ones making decisions, then those decisions are often not what is best for the community.” 

Both Pratt and Mundell encouraged the community can take action by contacting MLA Jason Nixon, Health Minister Adriana LaGrange and Premier Danielle Smith.