Toronto's Hospital for Sick Children is preparing to launch the biggest fundraising campaign in the history of Canadian health care as it lays the groundwork for building a new clinical hospital of the future.
The project, which the Toronto institution's president and chief executive officer, Dr. Michael Apkon, estimates will cost up to $1.6-billion, will turn to the public for the bulk of the $600-million Sick Kids will likely be expected to fund.
It's a massive undertaking, one fraught with challenges not foreseen when its existing buildings were constructed in 1949 and 1993.
A year ago, Sick Kids submitted preliminary plans to Ontario's Ministry of Health for two new buildings on its site, including a new high-acuity care hospital for its three most sensitive units. Two of its existing buildings would be torn down. But even if Sick Kids gets the approvals and funding it needs, the project is 10 years away from opening. That means 10 years of growth the current campus must manage.
That campus is already run thin.
Inside the walls of its critical cardiac care unit, a mother tiptoes over the orange tape that holds her baby's equipment to the floor. She is two hours from home in the only hospital in the country capable of caring for her child, with no end in sight and little space to access her child.
Around her, clusters of machines support other children, their families seated in the middle of a cramped communal room, out of sight of their own kids in the only chairs in the unit. Red tape defines each patient's space. When a nurse or a parent enters or exits the space, they must clean their hands, but equipment overflows, blurring lines and pushing families into one collective world.
It isn't uncommon for surgeries to happen at the bedside in critical wards at any children's hospital. But at Sick Kids, doctors can't afford to move children to operating rooms because hallways lack proper air control, risking contamination. When the room's door opens, children and their families worry if doctors are rushing for them. Sometimes resuscitation is necessary. Sometimes, mothers grieve with mothers.
These children and their families have no privacy.
Half will suffer from post-traumatic stress disorder from the things they've seen and heard inside, says Karen Kinnear, the hospital's clinical vice-president.
"You're supposed to be watching Barney, not the kid across from you," says Dr. Steven Schwartz, the hospital's head of cardiac critical care. "We can't protect them from what happens around them. They're seeing traumatic things that you're not supposed to be watching."
In the bone-marrow ward, Seri Stenning stands over her three-year-old daughter, Stella, as she rests inside a room filled wall to wall with a bed, recliner and often IV pumps and cardiac monitors. There is no room to entertain a child for as many as 60 days. Here, families aren't allowed to visit. Stella and her mother live in isolation, unable to leave and unable to get out of the bed to exercise in their small space.
Stella has acute myeloid leukemia and has just been through an extreme dose of chemotherapy. She's no longer capable of fighting disease. There is no washroom. Nurses transport bedside commodes or pans for Stella. Every time she goes to the bathroom, she risks infection from the commode, says Jennifer LaRosa, the marrow transplant program's clinical manager.
Here, Sick Kids often does more than 100 bone-marrow transplants a year.
"This is the cell that you're in," Dr. Apkon says. "It's not what the children of Ontario deserve."
Ms. Stenning's husband stays a few blocks away at Ronald McDonald House. She couldn't; she wouldn't sleep. "This is the luxury that I get to sleep in," Ms. Stenning says, laughing and pointing to the recliner.
"If you're not getting a good night's sleep, you're going to get sick and, if you get sick in our ICUs, we're going to send you home and then you're not there at your child's bedside, and we know a child gets better when their parents are near," Ms. Kinnear says.
"Separation from the parents, when you're two or three, whether you're critically ill or not, is traumatic, let alone with needles and drugs that make you feel bad," says Judy Van Clieaf, the hospital's chief of nursing.
Down a different set of hallways, in Sick Kids's neonatal intensive-care unit, as many as six bassinets in every room house the country's most premature and critically ill newborns.
It's loud. Overhanging ear monitors alert nurses and physicians when the noise level gets too high, but there's a constant hum due to the unavoidable proximity of the families. In winter, the beds nearest to the window grow cold. In summer, natural light is eliminated by blinds to avoid overheating – temperature is critical to these children, but the building's circulation is failing. There is no room for bedside breast-milk storage freezers or warming devices. Supplies are kept on lines of trolleys in the hallways, forcing nurses away from the bedside and towards potential contamination.
In a 44-bed unit, there are two isolation rooms. If a baby contracts an infection brought from the outside, the ward's ability to admit patients must be shut down and all equipment and supplies disposed of to avoid contamination. Some families spend up to a year here, sleeping in tiny reclining chairs. There is no welcoming area. A distant waiting area overflows. There are cooling units at the end of one space, gas cylinders at another and pumps at each. Work stations for medical records and drug administration further crowd it.
The entire hospital is over capacity. Last year, Sick Kids admitted 16,224 patients and conducted 12,535 surgeries, with growth for the fourth consecutive year in both areas. Nearly 7,000 of those patients spent at least one night, a 10-year high. Direct admittance and transfers into each of its three most critical wards also rose from 2015 to 2016.
Sick Kids is ill-equipped for modern technology and a rapidly growing population. None of these problems were envisioned when the 1993-built atrium was constructed, let alone the 1949-built campus on University Avenue.
To make it happen, Sick Kids would demolish the out-of-use McMaster research building between its Peter Gilgan Centre and its atrium. There, it would erect a building designed for patient support and office space. That would enable Sick Kids to move its office operations out of its nearly 75-year-old building on the west side of the campus, demolish it in a second phase and build a new critical-care hospital for its cardiac, bone-marrow and neonatal units, opening space up in the atrium for less at-risk patient care.
By doing it in two stages, the most at-risk patients wouldn't have to be displaced. Only a small amount of ambulatory care would be impacted for a short period of time, Dr. Apkon says.
"The single thing that keeps me up at night the most is thinking about how to contemplate continuing to provide cutting-edge, advanced, safe patient care in this facility for the next decade, which is the minimum that we have to address even if we were to receive full government approval for this," he says.
The hospital is growing by 2 per cent a year, forcing it to, on rare occasions, turn families away to other hospitals, Ms. Kinnear says.
"At the physician and nurses level, we believe as deeply as we can to take care of anyone that needs our care and a lot of these cases when we get a call, time matters," Dr. Schwartz says. "We will bend over backwards, but it's becoming a more complicated jigsaw puzzle to manage."
But the cost of demolishing two buildings and replacing them is not cheap.
The $600-million that Sick Kids will turn to philanthropy for will be on top of ongoing donations it already relies on to operate the hospital and its research on an annual basis. It will finance some of that funding with a bond offering, but will need charitable donations from Canadians for the bulk.
The need is urgent, says hospital staff.
"These aren't nice-to-haves, they're need-to-haves," Dr. Apkon says. "The 10-year runway to create the capacity that we need self-creates a matter of urgency for the province in ensuring that there's sufficient beds."
Ten years from now, by the time a new facility is built (if all goes according to plan), the hospital could be in crisis.
"Unless you've been in the environment, witnessed it firsthand, it's really hard to appreciate how much of a difference what we're trying to do will make in the lives of children and their families," Dr. Apkon says. "The people who have been through here and have spent a very troubling night at a loved one's bedside understand it immediately."