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andré picard

End the disgraceful wait times in the emergency room or be fired. That's the latest threat from Gaétan Barrette, Quebec's tough-talking Health and Social Services Minister.

Under proposed legislation, if patients are kept on stretchers in the emergency department for more than 24 hours, managers and physicians of those hospitals would face sanctions, up to and including losing their jobs. Of course, administrators and physicians alike are outraged.

In our expensive and underperforming health system, everything is the fault of "the system" – no individual is ever responsible for anything. There is virtually no accountability so, unsurprisingly, problems are never resolved. ER wait times are a striking example.

A report published last year by Quebec's health and welfare commissioner found that the province has had unacceptable ER wait times for at least 20 years, achieving the dubious honour of having the longest average waits in the Western world – with 35 per cent of patients waiting five or more hours for care. (In Ontario, by comparison, the figure is 15 per cent and in Germany, it's 5 per cent.)

More concerning than the average overall wait is the time patients requiring hospital admission wait on stretchers. Quebec has made some modest progress in that area, dropping from 17 hours in 2015 to 15.6 hours in 2016 to 13.6 hours in 2017.

That's nothing to crow about, but it is the lowest figure in more than a decade. Remember though, those are median waits. Progress notwithstanding, half of patients are still waiting more than 13.6 hours for a bed. It is not unusual for waits to stretch 24, 48 or even 72 hours.

Remember, too, that behind these dull statistics are real people. Those waiting on gurneys in hospital emergency-department hallways are almost all frail, frightened, elderly people, every one of them sick enough to require hospitalization. They are our parents and grandparents, and the way we treat them is disgraceful and inhumane.

Heads should roll. Finally, someone in a position of leadership is saying so, or at least half saying so. Dr. Barrette insists the legislative changes are not designed to be punitive but rather to provide "leverage" to administrators.

The minister, a physician himself, recognizes the ER wait-time problem won't be solved in the ER alone. It is a system problem. Patients fester in hallways because there are no beds available.

There are a few reasons for that blockage. Some beds are reserved for elective-surgery patients, and surgeons don't want to lose their operating-room time – even if it means inconveniencing others.

To be fair, it needs to be noted that many of those elective-surgery patients have waited months, and sometimes years, for their procedures. The solution to patients on stretchers in hallways is not lengthening already-long surgical wait times.

One of the central reasons hospitals are unable to admit new patients is that many patients who have been discharged don't leave. They continue to live in hospitals because there is a lack of long-term care beds and home-care services available to them; but these "alternate level of care" (ALC) patients actually suit administrators because they require fewer resources, and bring in income (they must pay because their care is not "medically necessary").

The ALC problem has also gone unresolved for more than decade, to the point where, today, Canada-wide, there are about 35 hospitals worth of ALC patients. Again, the people in those beds are our elders, almost all frail patients (many with dementia) who are wasting away, without adequate care.

Shouldn't heads roll for that, too? When we have a problem in Canadian health care, the solution is invariably to throw more bodies and more money at the problem.

The constant whinging about inadequate funding rings hollow: Virtually every country in the Western world delivers care more thoroughly, effectively and cost-efficiently than Canada, and they don't have our contemptible hallway medicine. It's not money we're lacking, but organization and accountability.

Last year, Dr. Barrette resorted to the tried-and-true method, pumping $100-million into Quebec's emergency departments. Nothing really changed. So now, he's telling those responsible that their jobs are on the line.

Good on him. The performance of our health system is middling at best. After decades of ladling out carrots, it's about time someone wielded a stick.

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