Trauma doctor sets record straight Published Saturday May 23rd, 2009
A11
Dr. Andrew Trenholm Commentary
I'm not one to write a newspaper column, and I typically shy away from the media. My comfort zone is an operating room, or one-on-one with a patient. The last few months of scrutiny have been a challenge, and at times misleading. I'm writing simply to clear the air and explain my journey through trauma care in this province.
Cindy Wilson/Telegraph-Journal
Dr. Andrew Trenholm explains his journey through trauma care in New Brunswick.
I am a New Brunswicker. I was born in Edmundston and raised in Riverview. I was educated in both official languages. I spent 15 years training to become an Orthopedic Trauma Surgeon before returning to New Brunswick. Saint John was the obvious choice for my family: it brought us closer to our loved ones, and allowed me to practise medicine in a Tertiary Care Accredited Trauma Center - the Saint John Regional Hospital.
My practice in orthopedic trauma surgery would never have received any attention, but for my involvement in the care of a gravely injured patient named Donald Thomas. With his permission, I will tell some of his story.
Mr. Thomas was a 67-year-old francophone man from Tracadie involved in a serious motor vehicle collision in November 2005. He suffered for 18 hours before finally arriving at the Saint John Regional Hospital for treatment. His injuries were serious and extensive: a closed head injury, a broken neck, multiple broken ribs on both sides of his chest, a broken breast bone, a bruised heart (cardiac contusion), a collapsed lung, a liver laceration, both hips were broken, both thigh bones shattered, right knee cap broken, right ankle broken and dislocated out of joint, and lastly a broken right upper arm. His treating physician knew that his injuries could not be treated at his local hospital. Because there was no co-ordinated trauma system in place, it took many hours to get him to the right hospital.
We received Mr. Thomas in Saint John, and he spent the next 12 hours in surgery with four orthopedic surgeons, all working in concert to treat him. Two days later, he returned to the operating room to treat the remainder of his injuries. He completed his rehabilitation at the Saint John Regional Hospital and learned to walk again.
I wish I could reassure residents of New Brunswick, and in particular Northern New Brunswick, that the delay in affording treatment to Mr. Thomas was a rare and unusual case. It wasn't. We have known for some time that care for traumatic injuries would be improved with the implementation of a co-ordinated trauma system. Last year (2007-08 statistics), we treated 661 patients with severe injuries. Of the most severely injured of these, 90 per cent came from other parts of the Province. The fate of these patients impacts me, so it should surprise no one that I am passionate about improving their outcomes.
Long before the search for a Trauma Director began, I was asked to attend a meeting with our sitting Minister of Health, Michael Murphy. He was relatively new to the position, and I was admittedly passionate about the subject of trauma and the needs of this Province. Today, I offer to Minister Murphy an apology if, for whatever reason, I made a less-than-favourable impression. The feedback has been undeniably negative. In my defence, we only met the one time, and I was operating under the impression that my input was welcome. I do not fault our Minister for the deficiencies of the broader health system - he is but one person. Any "fix" will require great leadership and vision.
Last summer, the Province began to advertise for the position of Provincial Medical Director of Trauma and I was asked to submit my application. I did. It was never acknowledged - verbally or in writing. Indeed, I don't have one piece of paper to show that I ever applied. My impression, perhaps mistaken, was that I was invited to apply in order to give credibility to the search process. I applied anyway.
In the back of my mind, I always had some trepidation about my application. My concerns were not unfounded: I had been told by a highly placed bureaucrat in the health-care system that I would never get the position because I was "not French." I dismissed the statement initially, as the person speaking to me had no idea as to my French language capabilities. Many of my patients were francophone and I communicated with them in French without difficulty. I spoke French regularly with my medical colleagues throughout the Province. In addition, I had been acting as the Trauma Director on an informal basis (without pay) for the past six years, and had considerable first-hand knowledge of where the system needed to be fixed. Surely, my expertise could be brought to bear on the process in some way.
As months went on, I remained the only candidate for the job. I was not entirely surprised, given that there are only a handful of trauma specialists in the country. When I asked about the delay, I was told that the search process would be expanded to an international level if necessary to ensure there was a "selection of candidates."
The job posting for the position required that the candidate speak French at an "intermediate level." Bilingualism was obviously a necessity for the position, and I was certain I could meet this qualification. I had myself assessed and confirmed that, indeed, I could speak French at an Intermediate Plus (Level 2 ) level - a higher level than provided in the job posting. I also began working with a tutor, who expected me to reach a Level 3 (Superior) by summer.
On March 17, 2009 I completed formal language testing with the province as part of the application process, which again confirmed my capacity at an Intermediate Plus level. Shortly thereafter, it was rumoured - again through obscure back channels - that I had "flunked" my French language test. I was more than surprised by this, and contacted Dr. Dennis Furlong to address the matter. I was later told that the language criteria had been "changed" from a Level 2 to a Level 3, and that I therefore did not meet the language requirements of the job. Despite my commitment to reaching a Level 3 by summer, it was felt that I could not be accorded the position. Nevertheless, I was still invited to participate in the interview process, along with another candidate from Quebec. Mired down in this discussion, Dr. Furlong floated the idea of a co-chair scenario - one anglophone and one francophone. This proposal was more costly to the system, and would amount to duplication. I again reassured Dr. Furlong that my French language skills were equal to the task at hand.
As the proposed date for an interview approached, my candidacy was met with ever more resistance. Despite my repeated requests for privacy surrounding my application, I would wake up to Minister Murphy and Dr. Furlong discussing my application on the morning radio show. Dr. Furlong began alluding to the fact that the successful candidate would effectively have to give up his surgical practice. This was a surprising and incredible notion. If I gave up my surgical practice, there would be one trauma surgeon left in the entire province to deliver trauma care. When I asked for clarification, I learned instead that I would be paid at a rate well below other specialists in administrative positions. While no one wants to hear a physician "cry poor" over money, I can assure you that I will be paying off my medical school debt for many years to come.
Contrary to Dr. Furlong's disappointing comments on the radio, I did not withdraw my candidacy because of the restrictions it would impose on my surgical practice. In addition, the prospect of competing for the job did not scare me. I simply withdrew from a process that became mired down in politics, rumours and innuendo, that did not respect my right to privacy, and in which I had lost all confidence. I repeatedly requested a job description, but one was never provided. It came to a point that I no longer knew what job I was applying for.
While no one wants to say so publicly, this process has lost credibility at a national level. With all due respect, nothing innovative can come from a solely academic process. What looks good on paper will often not withstand the test of real life. While Dr. Furlong alludes to the well-meaning experts sitting on his trauma committees, they were not told of my withdrawal from the process during their meetings the following day. In many ways, it was as if I never applied.
I have committed to the Minister, the Department of Health, and the Saint John Regional Hospital that I will work collaboratively with the successful candidate, whomever that might be. I am also staying right here in Saint John. I am incredibly fortunate and grateful for the excellent support of my colleagues and ancillary health-care staff, and my loyalty to this province is strong. This process will not detract me from my commitment to excellence in trauma care for all the residents of New Brunswick - I simply will not be the person implementing the system.
To my patients who have also suffered through this very public process and provided their unqualified support, I wish to say thank you for the privilege of serving you.
Dr. Andrew Trenholm is Medical/Surgical Director of Trauma, Atlantic Health Sciences Centre in Saint John.
