Chronics put hospital in critical condition

In the past two months, Dr. Rao Tadepalli has seen five regulars die. The regulars are Whitehorse's down-and-out - chronic alcoholics who usually have no place to call home. Visits to Whitehorse General Hospital's emergency department are one of the few constants in their lives. Sometimes they fake seizures to get there, said Tadepalli.

In the past two months, Dr. Rao Tadepalli has seen five regulars die.

The regulars are Whitehorse’s down-and-out – chronic alcoholics who usually have no place to call home.

Visits to Whitehorse General Hospital’s emergency department are one of the few constants in their lives.

Sometimes they fake seizures to get there, said Tadepalli.

And sometimes they force themselves to wretch until they throw up blood, ensuring a trip from the RCMP drunk tank to the ER.

But when they come through those sliding glass doors – even if they were just there the night before with the same problem – the regulars are taken seriously.

“Because you never know when someone is genuinely sick, or if they’re faking it,” said Tadepalli.

Since Raymond Silverfox’s death in RCMP custody in 2008, and Robert Stone’s death at the local detox facilities in 2010, the hospital has seen a huge jump in ER visits.

“Now, nobody wants to take responsibility for these people, so they bring them all to the ER,” said Tadepalli.

But the hospital emergency room is not the best place for the severely intoxicated.

The hospital doesn’t have “the staff, security or space” to deal with them, he said.

Dr. Bruce Beaton worked in the Whitehorse ER for 30 years.

And it’s not a place to hold the acutely intoxicated, he said.

“There is not enough staff to constantly monitor them.

“So they can fall off the gurney, impale themselves on stuff sticking out of the wall, twist handles and release oxygen into the room, or get into drawers in the bedside table where there are surgical tools.

“It’s a dangerous environment.”

Beaton, along with Champagne/Ashihik Chief James Allen, recently wrote a report titled Task Force on Acutely Intoxicated Persons at Risk.

It was given to Health and Social Services on December 31.

The 32-page document came up with 12 recommendations that included building a new sobering centre and medical detox in the downtown core, rewriting the Yukon Liquor Act, creating a street outreach team and building a shelter that accepts intoxicated clients.

But its No. 1 recommendation – which it stressed should take precedence over all others – was to “alleviate rapidly the staffing and physical resource crisis” caused by “acutely intoxicated persons at risk in the emergency department.”

On Tuesday, crediting recommendations from the report, the government announced plans to build a secure assessment centre at the new jail by the spring of 2012.

But the secure assessment centre was already in the works long before the report came out two weeks ago, said Beaton.

In fact, Beaton mentioned the government’s plans to build the centre in his report.

And he advised against it.

It’s not downtown, as the report recommended.

It is not a medical detox, also recommended.

It will not be attached to a detox, which was recommended.

And it will only accept people who’ve been picked up by the RCMP.

“But it is a great first step,” said Beaton.

The only trouble is, “the Whitehorse General Hospital’s ER department can’t wait until April 2012,” he said.

The new centre will have registered nurses monitoring the acutely intoxicated around the clock, which should cut down on hospital visits, said Tadepalli.

But in the interim, things have to change, he said.

On Wednesday, Tadepalli met with the ER doctors to discuss Beaton and Allen’s report.

“And we are all in unanimous support of it,” he said.

Right now, when chronic alcoholics are dropped off at the ER, they are “stacked in a corner room,” said Tadepalli.

There’s not enough staff to monitor them, and the bathroom is way down the hall.

“So they can easily fall and bump their heads,” he said.

“This is not the way to do it.”

In the fall, Canadian Medical Association president Jeff Turnbull came to Whitehorse to meet with Tadepalli and the Yukon Medical Association.

At the time, Tadepalli asked Turnbull to set aside his scheduled speech on health-care transformation and instead talk about his work with Ottawa’s hardcore alcoholics.

In the capital, Turnbull has set up homeless shelters that run as clinics, with nurses, doctors, a medical detox and even vets to care for down-and-out clients and their pets.

There are also street nurses who track down patients in alleys and under bridges to make sure they’re taking their meds.

Turnbull’s shelters save Ottawa’s health-care system more than $3.5 million a year.

Winnipeg has a similar shelter system with a medical detox, a sobering centre and a shelter all co-located in the downtown core.

Beaton, Allen and Tadepalli would like to see something similar in Whitehorse.

It’s what the report recommends.

Building a secure assessment centre at the jail is an interim measure, said Allen.

“It’s a solution that is a little better than what we have,” he said.

What we have in place now, hasn’t changed since the gold rush, added Beaton.

“The only management of the acutely intoxicated in the Yukon has involved law enforcement,” he said.

“Now the pendulum is finally beginning to swing the other way.”

The proposed assessment centre at the jail will replace the RCMP’s drunk tank downtown.

But it still revolves around law enforcement.

“We need a sobering centre downtown,” said Allen.

Health Minister Glenn Hart is onboard, said deputy minister Stuart Whitley during a technical briefing on Wednesday.

Hart flew to Ottawa to tour Turnbull’s shelters.

And there’s a plan in the works that will be announced in the next couple of months, said Whitley.

In the meantime, the hospital’s understaffed, ill-equipped ER will continue to struggle to help Whitehorse’s down and out, said Beaton.

Contact Genesee Keevil at

gkeevil@yukon-news.com

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