Good afternoon. Thank you, Mr. Chair and members of the committee.
I am Dr. David Neilipovitz. I am an intensive care unit physician who has cared for COVID-19 patients in our intensive care unit during this pandemic. I have seen patients make miraculous recoveries from this virus. I have also cared for patients who died from this disease, including a tragic story of a husband and wife who had been married for over 50 years who both succumbed to this virus.
I'm also the lead for critical care for Ontario east. As well, I've been the head of critical care for The Ottawa Hospital for almost 10 years. As such, I was part of the groups responsible for organizing how intensive care units prepared for caring for patients during this pandemic. As such, I hope to bring the perspective of both ICU health care professionals and critical care administrators who have been challenged by this pandemic.
The COVID-19 pandemic certainly brought out the best in many health care professionals. It also brought to light some weaknesses and failings of our Canadian health care system. An obvious failing was how our long-term care facilities operate, which I suspect will be a major focus of this committee.
However, I would like to highlight another weakness, which is that of the capacity of intensive care units, particularly in how they operate and how patients enter them. Had Canada experienced a response to COVID-19 in a manner similar to New York City or Italy, the focus, I believe, of the reviews would likely have been on intensive care units and their shortcomings.
An early concern with COVID-19, as many will recall, was whether we would have enough mechanical ventilators for critical care patients. That, however, is only one important aspect of ICU care. If I don't have the space, monitors or, most importantly, the staff to care for patients, more ventilators are essentially useless.
My team at our hospital was able to increase our level 3 ICU capacity—level 3 being the highest possible level of critical care—from our existing 57 beds to over 200 beds, an increase of well over 300%. We were not alone, as many sites across Canada were able to increase their capacity by more than doubling their existing level 3 ICUs. This, however, would not have been enough if we were New York City or Italy, so how could we improve the situation and do better?
There are three strategies that I'd like this committee to consider.
First and foremost, there are no national standards or expectations for intensive care units in Canada. How ICUs are structured, how they operate, how they are staffed and even how they are equipped have no national standards or real expectations. Some ICUs that claim to be a level 3 ICU only had enough ventilators for 20% of their beds, for example. That, quite frankly, is unacceptable. Many sites lacked formally trained ICU doctors and critical care nurses, in spite of funding being available to train nurses, and more importantly, there are trained doctors who are out of work. This cannot continue. I would hope that our federal government will address this forthwith.
Second, if we had telemedicine capacity for critical care, we could certainly improve the ability of all hospitals to provide a higher level of care to all patients in Canada. I think we all know that Canada is a vast country, so the ability to provide care in all locations is challenging at best. If, however, we had a real telemedicine capacity, larger facilities like my own could help more remote locations, be they in the north or in other various isolated areas, provide better care to their ICU patients and their citizens, our Canadians, who most certainly deserve such a high level of care.
A high level of care could have been provided in these communities, and transfers of their sick patients improved or even avoided. As I'm sure you'll appreciate, sometimes, unfortunately, there's nothing that we can do for certain patients. Avoiding a transfer, however, would allow these patients to be able to pass away in their own communities, surrounded by their families and their loved ones, which is something greatly preferable to passing away alone in a facility that is remote from their home. A comprehensive solution from our federal government to improve telemedicine capacity in Canada would be crucial to improving this situation.
I have a third and final issue that would assist the capacity of intensive care units in Canada as well as improve the care provided in intensive care units.
All Canadians have a right to health care. For this there is no dispute, in my mind. The difficult and contentious issue, however, is what care do they have a right to insist upon? ICUs in New York City and Italy had to ration critical care. That is horrible and not right. However, some families insisting that their ICUs revive their loved ones and subject them to therapies, including machines and medications, when there's no reasonable chance of recovery, is equally not correct. It is not appropriate. It also greatly limits the ability of health professionals to care for other patients and puts an undue strain on our critical care resources.
Only a change initiated by our federal government can address this issue. I would respectfully ask our government and this committee to please address this issue; even though it is unsavoury, it is sorely needed.
Thank you again for giving me this opportunity to express the three ways in which the federal government could improve and increase critical care capacity in Canada: improving ICU care by creating national standards, improving telemedicine capacity for critical care, and addressing the difficult issue of what care is or is not appropriate.
I would be happy to answer or address any of these questions or other concerns. I can also be reached directly.
Thank you.