The contingency plan of the Outaouais Integrated Health and Social Services Center (CISSSO) leaves no doubt about the precariousness of the situation. The “confidential” document of which The right obtained copy presents two game plans for the period from June 17 to September 8: one for the operating theaters, the other for the imaging sector. Each plan contains three steps and identifies what conditions must be met for them to be achieved.
The consequences would be dramatic in many ways. In the worst-case scenario, the Gatineau Hospital could become a center offering only limited emergency services, as well as beds for mental health and for patients waiting for long-term accommodation. The operating theaters of hospitals in Gatineau, Papineau, Pontiac and Maniwaki could close.
The unions learned of the CISSSO game plan on Thursday. The president of the Union of Healthcare Professionals of Outaouais (SPSO), Karine D’Auteuil, speaks of a “catastrophic plan” and says she had “a shock” when she saw the extent to which services could be disrupted this summer. Same reaction from the regional president of the Alliance of Professional and Technical Personnel in Health and Social Services (APTS), Guylaine Laroche. “I have never seen a contingency plan like this in my union career,” says the woman who has been involved in union activities for 17 years.
Guylaine Laroche is president of the APTS in Outaouais. (Simon Séguin-Bertrand/Archives Le Droit)
The CISSSO did not want to react on Tuesday to the content of its contingency plan. The organization instead chose to summon regional media to a press briefing scheduled for Wednesday morning with its president and CEO, Dr. Marc Bilodeau.
Step 1 in surgery
In the operating rooms, the first stage would be triggered if 90% of the staff is missing for the evening shift at the Gatineau Hospital, without the possibility of using retirees to compensate. The CISSSO would then rely on the “voluntary movement” of employees from the Papineau Hospital to Hull and Gatineau. Endoscopies would also be suspended in Papineau.
The operating theater at Hull Hospital. (Archives Le Droit)
From this stage, there would be a “delay in treatment”, even for surgical emergencies. At the Gatineau Hospital, operating room activities would be reduced by 93%. There would no longer be any elective surgeries in Papineau.
Cancer patients would not be spared. Only 60% of oncological cases could be operated on within the maximum target of 56 days.
Such a drastic reduction in surgical activities in Outaouais would expose the regional network to a “risk of resignations of anesthesiologists”, estimates the CISSSO.
At the SPSO, Karine D’Auteuil believes that the situation in which the regional network finds itself results from “government inaction”. The contingency plan “is nothing to help the critical situation in the Outaouais,” she protests. “It is the care of the population that is put at risk with such a plan.”
Step 1 in imaging
In medical imaging, the contingency plan would be put in place if there are not enough employees for shifts affecting emergencies, critical care and trauma services. The CISSSO would then try to find volunteers within its meager pool of technologists at the Hull Hospital. The organization has already been notified of the “categorical refusal” of technologists from other hospitals to travel to work shifts in Hull.
The medical imaging sector is the subject of a contingency plan at the CISSSO for the summer season. (Simon Séguin-Bertrand/Archives Le Droit)
At the APTS, Guylaine Laroche explains that by opting for voluntary travel, technologists would not have access to the financial incentives recently announced for the hospitals of Hull and Gatineau.
The CISSSO game plan also mentions the closure of certain less priority external services and the closure of one of the two computed tomography (scan) machines at Hull Hospital during the day shift – which is already sometimes the case, according to the APTS.
The situation is “serious and fraught with consequences,” says Guylaine Laroche. The CISSSO speaks, among other things, of an increase in delays for cancer diagnoses, prolonged stays in the emergency room and care units and the risk of losing other technologists.
Step 2 in surgery
If the measures of the first stage are no longer sufficient to ensure adequate coverage in the operating room of the Gatineau Hospital, it will be the Papineau Hospital that will suffer. The CISSSO would completely close the operating rooms there in order to repatriate staff to Gatineau. For certain specialties, interventions would still have to be moved to Hull, because the Gatineau operating room would no longer do non-urgent surgeries (except cesarean sections) and would be at risk of experiencing a disruption in services.
Karine D’Auteuil is president of the Union of Healthcare Professionals of Outaouais. (Simon Séguin-Bertrand/Archives Le Droit)
At this stage, the CISSSO expects a “significant impact” on human resources. There would be a “net loss” in the number of employees due to departures and sick leave, authorities fear. Mandatory overtime should be used even more. The contingency plan also mentions the possibility that the Papineau operating room will not reopen in the “medium and long term”.
The president of the SPSO considers that “the employer is waiting to have its nose to the wall to react”. By forcing the movement of staff, believes Ms. D’Auteuil, the consequences would be dramatic for recruitment and retention efforts. “The government will have to realize that salaries must be competitive,” she insists. […] We need to put money on the table and improve working conditions.”
The one who represents the nurses, practical nurses and respiratory therapists of the CISSSO says she has “a great fear” that services will not be able to be restarted if they are interrupted as part of the contingency plan.
Step 2 in imaging
In medical imaging, the second stage provides for the “complete closure of the Gatineau radiology department”, in the evening and at night, in order to force the movement of technologists to the Hull Hospital.
The CISSSO should then proceed with a partial closure of the Gatineau emergency, similar to that experienced between June 2021 and January 2022. The emergency room would then be reserved for mental health, obstetrics and pediatric cases during shifts. evening and night, from 4 p.m. to 8 a.m.
In such a scenario, Hull’s emergency would be even more congested. Ambulances should be added to the road. There would be delays for both diagnoses and treatments, “particularly for oncological conditions”.
In terms of human resources, the CISSSO estimates that the triggering of this second stage in medical imaging would lead to possible resignations of technologists in Gatineau and an overload of work for those in Hull. All this in a context where technologists “are at the end of their rope, tired and exhausted” because they put in 12-hour shifts, notes Ms. Laroche at the APTS.
At the same time, the Ontario network would be in greater demand by residents on the Quebec side. The CISSSO sees a “risk of escalation of irritants concerning the volume of consultations of Quebec patients in Ottawa emergency rooms”.
Step 3 in surgery
From the moment the CISSSO will no longer be able to provide coverage allowing a minimum of surgical interventions to be carried out at the Gatineau Hospital, the operating room will be completely closed. The operating room at Papineau Hospital would have already been closed at the previous stage. Those of Maniwaki and Pontiac would experience the same fate.
In this third and final stage of the surgical contingency plan, only the operating theater at Hull Hospital would remain to serve a population of some 400,000 inhabitants.
There is a glaring lack of staff in the operating theaters of Outaouais. (Archives Le Droit)
The concentration of care in Hull would be intensified in other spheres of activity. The CISSSO would repatriate several services offered in the hospitals of Gatineau, Maniwaki and Pontiac. The care units, neonatology, obstetrics and intensive care (both for adults and children) would be brought together within the old hospital center in the Hull sector. The Gatineau Hospital could be forced to offer only outpatient services.
The CISSSO expects that there will be more seriously ill people and even a “risk of avoidable deaths” due to delays in diagnoses and treatments, if this final stage of the contingency plan were to be reached.
Beds are becoming increasingly scarce in Hull, both for short-term stays and for critical care. There would also be a “decrease in access to obstetric care” in the region, where many pregnant women already opt to give birth on Ontario soil.
Step 3 in imaging
The last stage of the CISSSO contingency plan for medical imaging provides for a “complete closure” at the Gatineau Hospital in order to send employees to Hull.
While hospital activities in Gatineau would be transferred to Hull, patients bedridden in Hull awaiting long-term accommodation would be directed to Gatineau.
At this stage, Hull Hospital would therefore take care of acute care units, maternity, neonatology, obstetrics, intensive care, pediatrics and maternity. The Gatineau Hospital would focus on a minimum of emergency services and mental health hospitalizations, while welcoming people waiting for a resource more suited to their needs.
Again, such a scenario would not be without consequences on the morale of the troops. The CISSSO believes that there would undoubtedly be a “disengagement” and possible departures of employees and doctors.
Public denunciations
This contingency plan was established in a context where voices are being raised everywhere to denounce the state of the health network in Outaouais. Unions, doctors and politicians have notably made public outings in recent weeks to demand rapid intervention from the government to alleviate the crisis.
At the SPSO, Karine D’Auteuil also wonders about the expenses that will have to be made to move so many services from one hospital to another. “Why don’t we take this money to give incentives [aux employés]?,” she asks herself.
At the APTS, Guylaine Laroche also pleads for the benefits granted to certain workers to be offered throughout the region, to avoid “only moving the problem.” While recognizing that the CISSSO is making demands on Quebec to try to improve the fate of the region, the regional president of the APTS judges that “the Treasury Board and the ministry [de la Santé] only manage in cases of extreme emergency” instead of presenting global solutions.
