A coroner's jury in Ontario says all hospitals should consider developing formal conflict-management policies for their emergency departments, but the organization representing the country's emergency doctors say this recommendation is probably unworkable.
The inquest examined the circumstances surrounding the death of Angelina Peluso from complications of gastrointestinal hemorrhage. Peluso, who was 68, had a history of hepatitis C infection, diabetes and hypertension. In November 1998 she was taken to the emergency ward at York Central Hospital in Richmond Hill, Ont., because of back discomfort. She was subsequently diagnosed with gastrointestinal bleeding, thought secondary to ASA ingestion, and a gastroscopy was scheduled for the next morning. Her family twice asked the internist to arrange for the test that evening, but he refused. Peluso died during the night.
At the core of the inquest was the dispute between the family and internist on call. Although the hospital had a conflict-management policy, the family was not made aware of its existence. As a result, the coroner's jury recommended that all hospitals consider instituting a formal conflict-management policy for emergency wards and post notices that the service is available.
Dr. Doug Sinclair, chief of emergency medicine at Halifax's Queen Elizabeth II Health Sciences Centre, says most hospitals already have these policies in place, but the process usually takes a few days and the necessary personnel usually aren't available after hours, when many of these disputes occur. “There is a real issue around this, especially after hours,” says Sinclair, who heads the Canadian Association of Emergency Physicians. He also said that conflict management is being made more difficult because many of the managers needed to resolve such disputes have been laid off.
A medical expert on dispute resolution says a number of emergency staff ought to be trained so that someone is always available. Stanford University Medical Centre is setting up such a system. “There's fairly good evidence that [conflict resolution] works,” said Dr. Rob Robson, director of Mediate.com. Staff are pressed for time, he agrees, but it take even “more time to deal with significantly unhappy, dissatisfied patients.”
Some Toronto hospitals recently announced that they will hire extra guards for their emergency departments. “It's the wrong approach,” says Robson.
Coroner Karen Smith said the Richmond Hill case pointed to the need for improved communication. “The family did not know that they could make a complaint and get help. The jury felt that if some information had been posted the conflict may have been resolved and this lady might have been saved.”