Palliative care physicians say Ontario’s ongoing shortage of medical supplies for home care is leading to unnecessary suffering in the last days of patients’ lives.
Doctors are reporting that they are having trouble accessing specialized equipment and medications, such as pain pumps, drainage bags, syringes, pain-relief drugs and even complete medical-assistance-in-dying (MAID) kits — supplies that are crucial for ensuring patients who want to die at home can do so in comfort and with dignity.
“In many cases, the availability of these supplies is the only thing that allows patients to spend their final days, weeks or months in their home, and it’s the only thing that helps them do so in a comfortable way,” says Dr. Hal Berman, a home palliative care physician in Toronto. “It’s unacceptable that the only reason that people can’t stay in their homes is because we can’t get this essential thing right.”
Home-care patients and their caregivers began to notice last month that shipments of medical supplies were delayed, arriving incomplete or not showing up at all. The problems coincided with changes to provincial contracts with companies that procure supplies and fulfil deliveries in late September.
Under the old system, local suppliers such as pharmacies, were responsible for procuring and delivering medical supplies in zones that roughly coincided with the geographic areas covered by the province’s 14 former Local Health Integration Networks (LHINs), according to sources with knowledge of the new arrangement but who are not authorized to speak publicly.
After September 24, the province switched to a system in which two companies, Cardinal Health and Ontario Medical Supply (OMS), became the master service providers responsible for procurement, sources say, and four companies, including OMS, Bayshore Specialty Rx, Shoppers Drug Mart and Robinsons, becoming responsible for distribution of supplies to patients.
A company called Calea, which used to have a contract that included both medical supplies and intravenous (IV) medications under the previous system, now fulfils some IV orders.
“The whole idea was to use economies of scale, moving from having lots of smaller companies managing procurement for the 14 different LHIN areas to having two companies responsible for procurement and five for fulfilment,” said one source, noting they believe the change was simply an exercise in “cost savings.”
Responsibility for managing this new system fell to Ontario Health atHome, the provincial agency that delivers in-home and community-based care and services. Ontario Health atHome would not confirm the names of the companies but said in an email to the Star said that “this is not a supply issue.”
“This is a delivery issue. Right now, our priority is getting patients, caregivers and providers the supplies they needy,” the agency said.
Regardless of who is responsible for the logistical problems, Berman says there needs to be a transparent assessment of how this happened so that patients don’t suffer in the event of another contract change.
He recalls a situation a couple of weekends ago where a patient needed injectable pain medication from a symptom management kit. Orders are supposed to be delivered within four to six hours, Berman said, but by the next morning, the kit still hadn’t arrived.
By the time the kit finally arrived with the medication “the patient was actually suffering,” he said.
Another of Berman’s patients was recently discharged from hospital and needed a pain pump at home, only to find that the ordered pump never arrived. The patient, who was having a “pain crisis,” had to go back to the hospital and spend a night in the emergency department.
Dr. Joyce Cheung, a palliative care physician and chair of the Ontario Medical Association’s palliative medicine section, says she has heard from doctors in “every single region” of the province who are experiencing supply issues.
Cheung recalls that she recently ordered a pain pump for a patient living with metastatic cancer because the patient would soon be unable to swallow pain pills. Normally, when she would order such a pump, she says, it would take a few hours to arrive. This time it took more than 30 hours.
One of her members reported receiving MAID kits that were incomplete, causing caregivers to scramble to ensure they could still proceed on the patient’s decided date. Others reported that they had no access to medical drainage bags needed to collect fluid that builds up around the lungs of some cancer patients.
“We are on call 24/7 and we have to respond to these things because people are in pain crises and if they don’t get the pain medications at home, they’re going to the ER against their will when they’re already frail, they’re immunocompromised, they don’t want to be in a crowded ER hallway,” Cheung says. “That’s the whole point of bringing them here in the home. It’s so that they can be comfortable and dignified in the privacy and comfort of their own homes.”
