Agreement for Dedicated Obstetric Anaesthesiology at Victoria General Hospital is Reached

I am very pleased to find the following most welcomed news this morning:

Agreement Reached for Dedicated Obstetrical Anesthesiology Service at VGH

January 9, 2012
JOINT STATEMENT BY THE VANCOUVER ISLAND HEALTH AUTHORITY AND DEPARTMENT OF ANESTHESIOLOGY:

Agreement Reached for Dedicated Obstetrical Anesthesiology Service at VGH

VICTORIA – Mothers giving birth at Victoria General Hospital (VGH) will benefit from enhanced anesthesiology and pain services.

The Vancouver Island Health Authority (VIHA) and Department of Anesthesiology are pleased positive discussions have resulted in an agreement for a program that will deliver dedicated anesthesiology services to obstetrical patients and provide a dedicated pain service for inpatients with a focus on epidural anesthesiology for mothers in labour.

“VIHA is delighted an agreement has been reached,” said Howard Waldner, VIHA President and CEO. “The improved service will provide an increased number of dedicated hours of service for the 3,000 mothers who deliver their babies each year at VGH, and will pave the way for an exceptional program for women and their families.”

Speaking on behalf of the Department of Anesthesiology, Dr. Craig Bosenberg, Medical Director, Anesthesiology and regional head of the department for VIHA stated: “We are extremely pleased to have reached an agreement on this very important service for mothers and their babies. We look forward to partnering with the dedicated professionals who provide obstetrical services at VGH to establish this new service as quickly as possible.”

Improvements will result in 24/7 Dedicated Obstetrical Anesthesiology (DOBA) and pain service at VGH, incorporating an on on-site anesthesiologist dedicated to obstetrical care. VGH is the location for tertiary obstetrical services on Vancouver Island, providing care for high risk mothers and babies, as well as being the site for regular obstetrical services for South Island residents.

Dr. Gavin Sapsford, President of the Association of Victoria Anesthesiologists (AVA) stated: "The AVA welcomes the agreement which will benefit all women admitted to the obstetric unit as well as their families and new babies from both Vancouver Island and the rest of BC.”

The new service will be phased with full implementation in summer 2012, following recruitment of additional anesthesiologists. VIHA and the Department of Anesthesiology have a number of qualified potential applicants for these positions.

The agreement will see additional funding of approximately $1 million to support the development of this important service. The agreement will also allow all parties to make progress on the implementation of the recommendations from the September 2011 independent review commissioned by VIHA into tertiary obstetrical services at VGH.

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Media Contact:
Shannon Marshall
VIHA Communications
250.370.8270

I only hope that this is not yet another false start, as it is my understanding that VIHA and Victoria General Hospital tried to implement Dedicated Obstetric Anaesthesiology in 2009, but failed to do so as no anaesthesiologists applied for the position.

Further, my heart goes out to those women who were unable to access timely access to pain relief and medical care during their labours, and those who may be unable to do so until this service is fully implemented in the summer of 2012.

The BC Maternity Care Rant

I'm a bit livid right now. I'm livid with the anesthesiologists. I'm livid with the BC Medical Association. I'm livid with the BC Ministry of Health. The situation right now is an all out cluster f**k - the game playing has reached an obscene level, and in the middle of it are the patients. The mothers and the babies.

Yesterday the BC Government, announced funding for dedicated obstetric anesthesiology at Surrey Memorial, Royal Columbian and Victoria General Hospital. But don't break out the cigars just yet...this is not the birth of DOBA, at least not yet - I'm not sure if this will be yet another miscarriage or actually result in DOBA being a resource for pregnant mothers to rely on that will actually result in women having access to timely care (epidurals and c-sections) during labour and delivery.

So what is the cause of my cynicism? DOBA in BC has a long history - a history of being 'supported', but not actually realized. There has been a series of miscarriages. You see, the announcement yesterday is about 3 years too late. Why? Because, the government actually did try to get DOBA at these hospitals in 2009. What happend? Well not a single anesthesiologist applied to the positions. So as much as DOBA was then recognized to be a good thing that should be at all level 3 hospitals in BC, it did not come to be.

As a result - when I had my baby in July 2010, DOBA was not there. When Mrs. Frith had her baby in December 2010, DOBA was not there. When the baby in August was stillborn and sparked an external review, DOBA was not there.

So now, given the outright hostility between the BCMA, the Ministry of Health and the Anesthesiologists - I am in no way certain that DOBA will be in place anytime soon. I'll believe it when I see it, and in the interim - what about all the women who have been harmed between the time the government first realized that DOBA should be in all tertiary hospitals in BC and the time it actually becomes a reality?

There needs to be some accountability for the harm that has been caused - and right now there isn't...there needs to be some recognition of the pain and suffering that didn't need to happen, shouldn't have happend. If you've been harmed by the lack of DOBA in level 3 hospitals in BC, speak up - your voice deserves to be heard above the petty bickering!

The 2011/12 Labour Games in BC - Featuring Anesthesiologists

This issue seems to be moving so fast today as to make my head spin. I came across the following headline this afternoon:

B.C. Government's $2.5-million Surprise Announcement Called Game-Playing

The government apparently has tried to end the bitter dispute with anesthesiologists by offering $2.5 million for dedicated obstetric services at Victoria General Hospital, Royal Columbian Hospital and Surrey Memorial Hospital.

Unfortunately, it appears that the government decided that the deal hashed out with the BCMA did not need the involvement of the anesthesiologists. As a result, the anesthesiologists were not even aware of the pending announcement.

Consequently the move is seen as game-playing by the anesthesiologists.

I think there's merit to the game-playing accusation. The issue has been ongoing for years (since 2009/10 at least) and it does appear that this latest pronouncement is in response to pending job action. I also think the anesthesiologists have a right to be unhappy with the negotiating environment. The fact that what is ostensibly a union could negotiate the terms and conditions of employment without input from the individuals it claims to represent - is a bit disturbing. It is more disturbing when that same group has been begging for its own voice for years.

Unfortunately, I think this means that I'll have to hold off on the celebratory champagne - as I've got a gut feeling that as a result of the game playing by the BCMA and the government that it might be a while before DOBA becomes a reality. I feel the announcement, particularly the timing of it and the way the deal was reached, might well inflame the situation further. This is no olive branch.

The real losers of all this game playing of course, are the women, particularly those who want and need medical services (c-sections and epidurals) during labour and delivery and have those services delayed or denied as a result.

I hope I'm wrong, the women and patients of BC deserve better - they should not have to pay the very painful price in this dispute.

Is DOBA in BC around the corner?

Last week, the anesthesiologists were given a 'final offer' in a pay dispute that has been ongoing for years. The dispute has impacted on the quality of care that mothers at Victoria General Hospital have been able to access during labour and delivery.

This week the anesthesiologists have offered $3 million of their own funding to help recruit staff to help high-risk pregnant mothers and their babies.

Unfortunately, unless offers become deals, the situation at Victoria General Hospital (and other level 3 hospitals in BC that do not have DOBA) is unlikely to change. So far the track record for resolving the problem is less than inspiring. Unless the offer made on December 1 is competitive with what is available in other provinces, I don't think its very likely that the anesthesiologists will accept it. Further, unless the BCMA and the Ministry of Health are willing to work with the anesthesiologists on their offer of $3 million to recruit maternity staff - it is unlikely to have any impact in practice.

I am watching this situation unfold, and am truly hoping for the best as patient care needs to be the priority in this province - too many moms and babies have already paid a rather dear price while the BCMA, BCAS, and Ministry of Health have squabbled.

Three Months...

Three months have passed since baby Ava was born still at Victoria General Hospital. Still there is no dedicated obstetric anaesthesiology at Victoria General Hospital, Royal Columbian Hospital or Surrey Memorial Hospital.

How many more months before women in BC giving birth in level 3 hospitals get access to appropriate resources during labour and delivery?

Why care about Dedicated Obstetric Anesthesiology in level 3 hospitals in BC?

I'm not an an anesthesiologist. I'm not a hospital administrator. I'm a mom, and by the time the situation changes in Victoria, I'll likely be done having my babies. I guess that also makes me a pessimist because baby number 2 isn't even conceived as of yet - so it reveals how confident I am that the situation will change anytime soon.

I will also say, that my biggest problem with a lack of dedicated obstetric anesthesiology at VGH, Royal Columbian and Surrey Memorial isn't even that it removes the ability of women to reasonably decide whether or not they'd like a surgical birth, or have access to epidural pain relief (although I do believe this is a big issue - that is wrong and should be addressed). These are major hospitals that handle a high volume of births every year and serve high risk mothers. And there is the true rub.

There's a false perception of safety at these hospitals. Women believe that when the cards are down, they'll be able to get the care they need when they need it. If I were a mom who had decided that I wanted to attempt a vaginal birth after c-section - could I be confident that if my uterus ruptured, I'd get access to an OR within the critical timeframe and be saved from the agony of having to bury or care for a severely disabled child who was much wanted? Is it reasonable to think that the anaesthesiologist who is handling other acute cases will be able to drop everything and tend to my needs? Will the back-up anesthesiologists actually be called, will he/she answer the call and provide the service?

It's sad and frustrating. The province claims to be bending over backwards on this and saying the anesthesiologists won't budge. The anesthesiologists claim that its the BCMA and the province who are at fault and not budging to bring their pay up to what colleagues in other provinces receive. The patients are in the middle paying the real price.