The Government of Alberta has ordered a fatality inquiry into the death of Prashanth Sreekumar who died waiting for treatment in an Edmonton emergency room last month.
Sreekumar waited at the Grey Nuns Community Hospital in Mill Woods on Dec. 22 with chest pains for nearly eight hours. He died from apparent cardiac arrest.
Clinical and quality assurance reviews were underway a week later in tandem with an independent investigation by the Office of the Chief Medical Officer.
A judicial inquiry differs from the aforementioned reviews in that it is conducted by a judge. Once completed, the report is made public, whereas clinical and quality assurance reports are kept confidential.
Aaron Low, Acute Care Alberta’s (ACA) Chief Medical Officer, wasn’t able to speak specifically to the recommendations made in the quality assurance review, but said broadly the recommendations speak to addressing pressures in emergency rooms with transfers and admissions.
Covenant Health has completed an internal review into the death of Sreekumar.
Holding back tears at a press conference Thursday, Covenant Health CEO Patrick Dumelie said the death of Sreekumar, as well as two other individuals who died while receiving emergency care on the same day, is “deeply affecting” care teams, leadership, and the organization.
“Your loved ones were not just patients to us,” said Dumelie. “The reality is that Alberta’s emergency department and acute care hospitals are under extraordinary pressure. These pressures are not isolated to one organization or one site. These pressures reflect system-wide demand.”
Varinder Bhullar, a family friend and spokesperson for the Sreekumar family, said they have yet to receive any communication from the premier’s or health minister’s offices.
“It’s frustrating, annoying, bothering,” said Bhullar. “It’s not satisfying at all when the minister is not even acknowledging what health-care professionals are saying.”
The family invited Premier Danielle Smith and Jones to Sreekumar’s funeral on Dec. 31. Neither of them showed.
“If they had a little bit of a sense of compassion, I would have seen them show up at the funeral and give the wife a hug and say ‘we’re sorry we couldn’t live up to the standard,’” said Bhullar.
Hospital and Surgical Health Services Minister Matt Jones announced a request that Alberta’s minister of justice order a fatality inquiry into the death of Sreekumar. The inquiry would examine the full circumstances of the death and issue public findings and recommendations to help prevent tragic events in the future.
“While system level improvements are underway, a detailed, independent and public review of how the specific case was managed also needs to be undertaken,” said Jones. “We owe that to his family and all Albertans.”
Jones said Justice Minister Mickey Amery has approved the order and is looking at next steps into the inquiry.
He added that an inquiry would address “unanswered questions” but did not go into specifics as to what eluded the other reviews, and said the report may contain recommendations in preventing similar deaths.
Fatality inquiries were not ordered for the two other patients who died in the same hospital on the same day, but Dumelie said both are being followed up on.
Hospitals still under pressure
After weeks of doctors and nurses calling on the Alberta government to declare a state of crisis in emergency rooms and hospitals, provincial officials gave an update on the situation.
“I will fully acknowledge that we should have more acute care capacity in the Edmonton area than we do today,” Jones told media. “But we have a plan in place to build the appropriate acute care capacity wherever it’s going to be needed as our population grows and shifts and ages.”
But a state of emergency will not be called.
“I don’t need to seize anyone’s land, go on it without warrant or stand on the street distributing medical supplies,” said Jones. “We do have the tools to appropriately respond to respiratory virus and hospital pressures.”
Raj Sherman, an emergency physician and former MLA for Edmonton-Meadowlark, said the minister is in denial.
“When an ER doctor has to walk the waiting rooms to find out who’s about to die or not, that is a disaster protocol. That means we are beyond crisis,” Sherman told CTV News Edmonton. “The elected officials of our province need to have an emergency meeting of the Legislative Assembly … they need to engage front line experts and senior medical managers.”
Sarah Hoffman, the Alberta NDP’s shadow minister of hospital and surgical health, said she would have called a state of emergency “long ago.”
“It was a year-and-a-half ago that the then-chief medical officer of health first flagged that and said this could become a crisis,” she said at a virtual press conference Thursday. “It is a crisis. We know there are people dying in emergency departments, people waiting days to get admitted, that our emergency beds are full … we deserve so much better.”
While she disagrees with the province’s approach, Hoffman supports the order for a fatality inquiry, although she said it was “better late than never.”
“It’s been three weeks. We all need answers to what happened because we want to make sure that it never happens again.”
Alberta Union of Public Employees president Sandra Azocar said the province’s dismantling of Alberta Health Services (AHS) has put a strain on the system.
“Dismantling AHS created a situation where we have too many cooks in the kitchen at a time when we need solid decision-making,” said Azocar in a statement. “That is exactly why the Alberta Medical Association (AMA) has called on the government to declare a state of emergency.”
Jones said the province is now seeing signs that the situation in hospitals is easing, with flu and respiratory viruses trending downward.
“These early signs are encouraging. We’re down to 675 respiratory virus patients from the late December peak of about 1,000,” said Jones.
He added that the Alberta government and health agencies have been coordinating a province-wide response to address capacity by accelerating discharges and transfers where appropriate, diverting recovery and social supports, limiting non-essential inbound transfers, transitioning alternate level care patients to more appropriate care settings, and opening designated surge bases.
Paul Parks, AMA president-elect of emergency medicine, said that hospital wards in Edmonton have been hovering around 110- to 120-per-cent capacity, with internal wards seeing even more.
ACA CEO David Diamond said 16 of Alberta’s largest hospitals are currently at 102-per-cent capacity as of Thursday afternoon.
“Despite the improvements we’ve talked about, the minister talked about in terms of flu trending in hospitalization … that’s all really in a good direction,” said Diamond. “But for the next short period of time, we still have pressure, and we really appreciate the staff and what people are doing.”
Jones said the province is working to develop publicly available data dashboards, starting with surgical wait times, and then on EMS and primary care data.
“The goal is to have standardized metrics that we’re all held accountable to, that Albertans can understand and follow, and then to publicly share those,” he said, adding that dashboards will be released in the coming weeks and months.
When asked if he would be comfortable going to the ER, Jones said: “Yes, I would.”
With files from CTV News Edmonton’s Dave Mitchell
