Doctor shortage at Quebec City hospital means patients lose access to outpatient palliative care

An exodus of doctors at Quebec City's Hôtel-Dieu has forced the hospital to shut down its palliative care outpatient unit, leaving almost 100 people without adequate end-of-life care.

Dr. Louis Roy, a family doctor and head of palliative care at the Centre hospitalier universitaire de Québec, which includes Hôtel-Dieu, said the remaining physicians' workload grew to the point that it was no longer possible to keep the unit operational.

"The teams of physicians are tired," he said.

"We cut vacations, and all the physicians are working longer hours every week, and we just can't keep up like that."

He said the doctors are often on call around the clock.

The hospital has lost the equivalent of four full-time physicians in the past 14 months, for various reasons: one went to work in another part of the province, while another is now working full-time at Maison Michel-Sarrazin, a Quebec City hospice.

Roy said the strain of being so short-staffed forced administrators to decide between outpatient services and in-hospital needs.

The outpatient clinic allowed patients to drop by to have their pain medication or other prescriptions adjusted and have other needs met, without having to be admitted to the hospital or kept there overnight.

Almost all of the affected patients have been redirected to family physicians or specialists, and Roy said the hospital is trying to ensure they also have access to nurses or pharmacists who are up to date on their cases.

However, he said, there are still about a dozen people without adequate care.

"We tried everything we can to make sure that no patient will be alone in the wild with no resources and nobody to help them," he said.

Roy, who established the palliative care unit at Hôtel-Dieu almost 20 years ago, said the situation is "really frustrating."

"We created things that were working well and then within a little bit more than a year, so [much] changed," he said.

Roy said the problem is that doctors who specialize in palliative care are expected to also do clinical work in hospital or in private practice, in order to maintain the minimum patient load imposed on them by former Liberal health minister Gaétan Barrette.

He said end-of-life care should be their primary focus.  

MNA calls palliative care 'essential'

Véronique Hivon, the Parti Québécois MNA who co-authored the province's end-of-life legislation and the PQ critic for end-of-life care, said Health Minister Danielle McCann needs to act immediately to help remedy the situation.

"Palliative care is important. It's essential for those people," she said.  

Hivon said patients have a legal right to palliative care under Quebec's legislation, stressing that seeing a general practitioner or a nurse is not the same as seeing a palliative care specialist.

"I thought this was totally unacceptable, almost unbelievable, because it's exactly in the opposite way that we are working," she said. "This law was there to make sure that every patient whose state of health needs it can get palliative care."

"You're already in pain, and the psychological effect of being told you cannot be taken care of anymore, I cannot [imagine] the impact it can have on you," Hivon said.

Roy said that if and when it becomes possible, he will reinstate outpatient services for palliative care.

Health Minister Danielle McCann said she, too, is concerned about the loss of outpatient services.

She said she has been in touch with the regional health agency, the CIUSSS de la Capitale-Nationale, as well as the CHU du Québec, "to make sure that every patient receives the clinical care they need ... without delay."