In long-running New Brunswick trauma system spat, Saint John bests Moncton

The New Brunswick government has finally ended nearly two years of speculation and suspicion by awarding the top trauma care designation in the province to the Saint John Regional Hospital rather than a hospital in Moncton.

Health Minister Michael Murphy today announced the trauma level ratings for 18 hospitals across the province. The Saint John Regional Hospital (pictured above) earned the province's only Level 1 designation, while the Moncton Hospital was deemed the only Level 2 facility.

The argument between the two cities began after an 18-hour delay caused by confusion over the correct course of action nearly killed 67-year-old Tracadie man Donald Thomas, as NRM reported last year. In a bitterly ironic twist, Mr Thomas had been driving to the hospital to visit his wife when he was severely injured in a head-on collision.

Tracadie's small community hospital didn't have the facilities to deal with such a case; doctors in larger Moncton, 200km away, refused to take him, advising he be sent to Bathurst instead. Mr Thomas languished there for 12 hours with very severe injuries. He was nearly sent to Halifax (460km away) because his doctor, a Quebecer who was new to NB, wasn't aware that Saint John even existed (the city is often confused with St John's, Newfoundland) let alone had an accredited trauma centre. Luckily for Mr Thomas, when they called Halifax to arrange transfer an incredulous hospital staffer there said "Take him to Saint John!" (370km away). He was eventually transferred there and operated on.

Mr Thomas went public with his harrowing ordeal and then-health minister Elvy Robichaid commissioned a report into what went wrong. The report — details of which were released in April 2006 — by Dr Isser Dubinsky, a veteran Toronto-based healthcare consultant, contained a whole lot of criticism about the way trauma care was being handled in the province — and some 29 recommendations. Among them, Dr Dubinsky recommended a dedicated trauma centre (the cause of the current debate), more personnel devoted solely to trauma and better air ambulance service.

There were suspicions that Mr Murphy would award the top designation to a Moncton hospital; that's his riding. Some experts proposed that the job of coordinating trauma care be split between Saint John and Moncton, but another report from 2007 dismissed that idea.

The debate touched on the always-touchy language question. Moncton, a thoroughly bilingual city, was said to be a better option (its more central location was cited, as well).

As Canada's only officially bilingual province, nearly all political debates in New Brunswick touch upon the language issue. Some have argued that Saint John, a primarily English-speaking city, is a less appropriate site for a province-wide trauma centre than bilingual Moncton. [Dr Andrew Trenholm, surgical director of the Saint John Regional Hospital] dismisses this out of hand. "It's a non-issue," he says. "The Medical Services Act of New Brunswick states that you have to be able to offer treatment in both official languages in any hospital and I would say we do an extremely good job at this here in Saint John." He says his former patient Mr Thomas, a francophone, would attest to that. In fact, Mr Thomas, who lives considerably closer to Moncton, is so passionately advocating that the SJRH be named the provincial trauma centre that he's threatened to sue the province if they decide otherwise. "I think it should be Saint John because of the spirit in which the Saint John Regional Hospital was instituted," he told the Telegraph-Journal.

It remains to be seen whether the government, or Mr Murphy himself, will feel any blowback from what may be perceived as a snub of Moncton.

According to today's announcement, the Saint John Regional Hospital will also serve as "the co-ordinating centre for planning purposes for the provincial trauma system." The announcement also establishes an on-call list to keep track of trauma specialists, a registry of cases and a trauma hotline, reports the CBC.

For an explanation of what the different ratings -- Level 1 through Level 5 -- mean, see Section III of the Trauma Association of Canada accreditation guidelines (PDF).


Photo: New Brunswick Museum

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