'Hanging by a thread': Montreal's pediatric hospital crisis worsens, teens sent to adult ICUs, surgeries postponed

The crisis at Montreal's pediatric institutions has become so dire that hospitals and the Quebec government are grabbing hold of any idea that may help prevent the system from breaking down since circumstances are only expected to get worse.

That includes a directive the government issued on Monday instructing that 16 and 17-year-olds be admitted to adult ICUs to free up pediatric beds.

"Young people aged 16 to 18 who need to be admitted to intensive care must be admitted to adult sectors if they cannot be transferred to intensive care in pediatric centres," health ministry spokesperson Noemie Vanheuverzwijn told CTV News.

Hospitals are also doubling up patients in ICU rooms and are appealing to community pediatricians to take a shift in an ER to handle less urgent cases. Surgeries are being delayed.

According to Dr. Beth Foster, chief of pediatrics at the Montreal Children's Hospital (MCH), a child's kidney transplant surgery had to be postponed as a result of the surge in patients admitted with a cocktail of viral infections. The transplant went ahead a couple of weeks later when a new organ donor was found.

"It's hanging by a thread, yes. We're very stressed because we don't want something to go wrong," said Dr. Anne Monique Nuyt, chief of pediatrics at Ste-Justine Hospital.

More than 300 patients a day flood Sainte-Justine Hospital's emergency room, double its capacity. Its ICUs and other care units are full.

"It's not something we've seen in 20 years. In that way, it's historic, unprecedented," she said, both in terms of the number of sick children, the severity of cases and the fragility of the health care system.

The overall situation at the Montreal Children's Hospital (MCH) is no better.

"We're struggling to cope with the number of acutely ill children who we absolutely must save today," said Dr. Robert Barnes, the associate director of professional services at the MCH.

 "We must be able to save the next child…the quantity of children is overwhelming."

Barnes said it's "extremely frustrating" not to be able to provide care quickly to every child in the waiting room, but serious "viruses are ravaging our youngest children right now."

Most of them are under the age of two, and many are suffering from complications of RSV and influenza. Barnes described it as the worst winter virus season they've ever had, and the season hasn't even started yet.

He is urging everyone to go and get a flu shot even if they're not eligible for a free dose under the government plan, saying that would be "a big contribution."

Both Nuyt and Barnes emphasize, however, that parents should not be afraid to bring their very sick child to an emergency room.

"The children who arrive in the emergency room who require immediate care are being taken care of immediately," Nuyt said.

Ste-Justine has issued a plea to fellow doctors to lend a hand because there isn't enough staff to meet the extra demands.

"We've asked the pediatricians of the University of Montreal network if they want to come and do extra hours in the…less urgent side of the emergency room," Nuyt said.

DELAYED SURGERIES CREATE A BACKLOG

Both of Montreal's pediatric centres continue to put off some surgeries. The delays began at the MCH in mid-October. According to the MCH, in the last four weeks:

• 8 surgeries were postponed due to a lack of free beds on the wards, the Pediatric Intensive Care Unit or the Pediatric Acute Care Unit
• 6 surgeries were postponed due to COVID-19
• 17 surgeries were postponed due to other illnesses

Some surgeries can be considered "cancelled," Barnes explained, because they were hopeful the operations could take place up to the last minute, but then were required to cancel them due to one of the reasons listed above.

Also, "there's a whole series of children who don't even count in numbers because we have not even attempted to schedule them," he said. They know they likely won't have beds available when the scheduled time comes because the hospital is so overwhelmed.

Emergency surgeries, however, don't wait.

"We are finding a way to cope," said Barnes. "For those children needing emergency surgeries or if God forbid a tumour or cancer is discovered, we are proceeding… (or) if a child has been suffering with a particular condition for weeks to months for which a surgery would be helpful."

Children with complex cases and underlying conditions may be among the surgical cases who are suffering the most.

"When we are so full with viral bronchitis and asthma and pneumonia in very young children, it would be unsafe for that particular child in the post-op mode to be in our hospital," Barnes said.

Each postponement pains them because it pains the young patient and the family.

"We don't engage in frivolous luxuries. When we put a child on a list for surgery, that child needs the surgery," he said, adding that the delays create a domino effect and make the waiting lists much longer. "We're building a greater problem for later."

The hospital has been able to use cancelled operating time originally allotted to more complex cases requiring hospitalizations, to perform day surgeries, helping to reduce that waiting list instead.

ICU ROOMMATES

Another "exceptional" mitigation measure put in place has the MCH rearranging half of its usually individual ICU rooms to accommodate two patients.

Five of the 12 intensive care unit (ICU) rooms are prepped to double up, spokesperson Christine Bouthillier confirmed Friday.

She noted that so far, only one room is occupied by two children, but the rest are standing by if the need arises, a purpose for which they were designed.

The same concept is at play with the new arrangement to send 16 and 17-year-old ICU candidates to the adult sector, an idea set up by the MUHC weeks ago that the government adopted as a directive on Monday.

Only a small number of older teens have been admitted to its attached adult site, the Royal Victoria, but it made a big difference.

"We're in a situation where every little bit helps," said Barnes, recalling how during the height of the pandemic, the MCH took adult patients into its pediatric ICU.

"Our friends are returning the favour…now the pendulum has swung back the other way," said Barnes.

"Our people are tired and they're still working extremely hard…we have a really special spot in our heart for sick children, and we want them to get better."