Commentary

There are few medical emergencies as urgent as an acute obstetrical emergency. Minutes can be the difference between life and death, both for the mother and the infant.

Victoria General Hospital is a tertiary-level centre expected to provide care for the most serious obstetrical complications. Every tertiary-level obstetrical centre in Canada has a dedicated anesthesiologist available to provide anesthesia immediately for these patients.

Everywhere except British Columbia. B.C. Women's Health Centre in Vancouver is staffed with dedicated anesthesiologists, but VGH, Surrey Memorial and the Royal Columbian hospitals are also tertiarylevel centres, expected to provide the same level of care, without the same funding.

In fact, VGH is the only hospital in the province which has both obstetrical and pediatric tertiary-level designation.

I was the head of the anesthesiology department at Victoria General Hospital from 1999 to 2010 and negotiated a contract with what was then the Capital Health Region to provide for the constant on-site presence of an anesthesiologist to deal with any surgical emergencies, particularly obstetrical. This preceded what is now a province-wide system of contracts for physicians' on-call services.

The statement by Dr. Richard Crow that the Vancouver Island Health Authority "completely supports the concept of having a dedicated obstetrical anesthesiology service" is disingenuous. There have been communications with health authority administration since 2007 describing the inadequacy of the existing anesthesia coverage of the caseroom at VGH and the need for a dedicated obstetrical anesthesiologist.

In 2008, a proposal was put forward to VIHA for such a service, but it was rated such a low priority that it was not even forwarded to the Ministry of Health for consideration.

As head of the VGH anesthesia department, I wrote to Crow in December 2009 and January 2010, expressing concerns about the current situation and a proposal to further reduce the funding of VGH anesthesia on-call services.

When there was no reply, I wrote in February 2010 to VIHA CEO Howard Waldner with a copy to VIHA's board chairman, and I included details of an infant who had recently been born at VGH and suffered severe injury, partly because of a delay in emergency delivery via caesarean section.

Neither party replied to my letter.

Shortly after, Crow sent a communication to all family physicians in Victoria stating there was no cause for concern as there already was a dedicated obstetrical anesthesiologist at VGH, when that was not the case.

VIHA has finally acknowledged that a dedicated obstetrical anesthesiologist is needed at VGH, and that it does not presently exist.

I have worked at VGH for almost 24 years and cannot count the number of times I have had to deal with an obstetrical emergency while already in the middle of another surgical emergency, waiting for a colleague to arrive from home or having been that person racing from home.

All of my colleagues have had similar experiences, and I would estimate this to occur at least once a month. Crow's description of these events as rare is false.

Part of the problem is an economic reality and in this the Health Ministry and the B.C. Medical Association have failed obstetrical patients. Attempts by VGH and Surrey Memorial anesthesia departments to attract obstetrical anesthesiologists to work under the proposed remuneration have met with zero applications.

The lowest fee schedule among Canadian provinces and the high cost of housing in Victoria and Vancouver are obvious impediments. Health authorities are well aware of these issues. Mother Nature has always been very cruel when what should be a joyous occasion goes wrong.

In the past year at VGH there have been two infants who suffered serious injury at birth and one death. In all three cases, more rapid emergency delivery might have made a difference.

The obstetrical patients at VGH are cared for by caseroom and operatingroom nurses, obstetricians, pediatricians and anesthesiologists who are dedicated to providing the best care possible, but if one or more of these team members are not immediately available, the consequences should be obvious.

Dr. Tim Relf works in the department of anesthesiology at Victoria General Hospital.