Senior’s lengthy wait for surgery as Covid worsens ‘longstanding bed crisis’
An 87-year-old man suffering from agonising knee pain has been told he will have to wait more than a year to get replacement surgery on the island.
Allan DeSilva said he was shocked to be given an appointment in July 2023 for the operation at the King Edward VII Memorial Hospital — and questioned how many others were facing similar delays.
“People are suffering because of a backlog,” he claimed. “All we need to know is why it is taking so long. It just doesn’t seem right.”
The Bermuda Hospitals Board, which runs the hospital, told The Royal Gazette there was a surgery backlog caused by the pandemic but could not give the number of patients on the wait-list or average wait times.
Orthopaedic surgeon William Peckett said there was a “significant backlog” and that he was willing to carry out as many surgeries as possible if the hospital allocated the beds.
Mr DeSilva, who is on the Government’s FutureCare health insurance plan, has had severe knee pain for at least a year owing to general wear and tear and a build-up of calcium in the joint.
Doctors agree he needs a replacement knee but he was told Dr Peckett could not slot him in for surgery until July 7 next year.
“It’s taking too long,” said Mr DeSilva, who is very active and plays golf weekly.
“If it wasn’t for cortisone shots, I wouldn’t be able to move. That’s the only reason I’m mobile.”
It is understood surgery slots often become available sooner than allocated because of cancellations, but Mr DeSilva said he had received no such assurances.
The widower and father of one, from Paget, said he would prefer to have the operation in Bermuda than overseas.
He added that he had spoken to other seniors also upset because of long waits for surgery on island.
Mr DeSilva stressed that he was not criticising surgeons but felt BHB should be upfront about the scale and cause of the problem.
“It impacts the quality of my life,” he said. “The suffering and pain to even get in the car is terrible — and that’s been going on for a year. Now I have to wait another year?”
A board spokeswoman said the backlog of patients needing surgery was “due to the pandemic”.
Elective surgeries were suspended twice during the past two years because of Covid-19 — between March 16 and June 8, 2020, and between September 6 and November 1, 2021.
But it is understood that the pandemic merely added to an existing problem caused by seniors with long-term care needs occupying beds at KEMH because of a lack of alternatives — a situation known as “bed blocking”.
Last month, a board spokeswoman, commenting on the likely impact if the island’s largest care home closed, said: “A lack of available beds in the community for people ready for discharge leads to fewer available beds in the hospital, causing delays in emergency and impacting available beds for surgeries.”
The King Edward VII Memorial Hospital is at full capacity for long-term care.
A Bermuda Hospitals Board spokeswoman said there were no available beds on the three long-term care wards: Perry, Cooper and Gordon.
She said: “BHB’s long-term care service has been under increasing pressure, as we need more community long-term care beds.
“As can be seen from the data, occupancy has risen over the last few years, even prior to the pandemic. This is because the number of discharges has dropped, leading to an increasing length of stay …
“This drop in discharges has predominantly been due to the lack of available nursing home placements in the community, which causes sometimes lengthy delays in discharging for people who are medically fit to leave BHB.”
KEMH has 105 long-term care beds. Between April 1, 2021 and March 31, 2022, the average occupancy rate was 94 per cent and the average stay was 322.2 days.
Hospital chiefs have the difficult job of balancing the need to have beds available for those being admitted to a ward from the emergency department with the need for beds for patients having elective surgeries.
The hospitals board has received a capped annual grant from the Government since 2019, rather than getting paid on a fee-for-service basis — and some have suggested that that means it has no financial incentive to allocate beds for elective surgeries.
Shadow health minister Michael Dunkley has said the grant system needs to be looked at in light of the “precarious” financial position of KEMH.
There were 15 total joint replacements carried out at KEMH in May and 21 in April, among 729 and 770 total surgeries, respectively.
The figures suggest the number of surgeries conducted monthly is back to pre-pandemic levels: in the financial year 2018-19, there were 164 total joint replacements, out of 8,779 total surgeries.
But the hospitals board could not tell the Gazette the number of people awaiting surgery at KEMH at present or the average wait time now compared with pre-pandemic.
The board spokeswoman said: “Bermuda Hospitals Board does not manage wait times for individual surgeons.
“Surgeons are private practitioners, with the exception of the BHB urologist.
“They schedule their patients themselves and pass that information to the BHB.
“We are aware that due to the pandemic there is a backlog of patients needing surgery, but it is the surgeons themselves that have the detail on how many and how long people have been waiting.”
Total surgeries: 729
Outpatient pilot programme for knee and hip surgeries: 4 hip replacements, 5 knee replacements
Same day admissions: 6 (4 hip replacements, 2 knee replacements)
4 days of orthopaedic time used by the visiting spinal surgeon carrying out 14 surgeries
Total orthopaedic surgeries: 109
Total surgeries: 770
Outpatient pilot for knee and hip surgeries: 2 hip replacements, 3 knee replacements
Same day admissions: 16 (6 hip replacements, 10 knee replacements)
Total orthopaedic surgeries: 110
Pre pandemic 2018-19 financial year
Total surgeries: 8,779
Total orthopaedic surgeries: 1,435 (164 joint replacements – 99 knee and 65 hip)
Dr Peckett, of Orthopaedic and Physiotherapy Associates, said there had been a “longstanding bed crisis at KEMH”.
The surgeon said: “One factor which has exacerbated it is the Covid pandemic.
“As the pandemic seemingly recedes, I am ready, willing and able to provide what I believe is a world-class joint replacement service.”
He added: “Bermuda, as with most other jurisdictions in the world, undoubtedly has limited resources.
“I would welcome an increase in resource allocation to the many needy Bermuda patients who require inpatient surgery, so that we may address the significant backlog.
“I am happy to operate any day of the week, on as many patients as we can safely accommodate, whenever those resources can be applied. It is up to hospital management to facilitate that process.”
Ricky Brathwaite, CEO of the Bermuda Health Council, said the regulator was “not aware of any abnormal current backlogs” but knew that Covid led to “reallocation of hospital resources”.
He said the council had received “minimal queries” about surgical delays over the past two years.
Dr Brathwaite said there should be no connection between the type of someone's insurance and concerns about delays.
But he said the 2023 surgery date given to Mr DeSilva implied there was no opportunity to have the operation here for at least six months, "which to me would seem odd considering the volume of people living in Bermuda and generally high access to healthcare providers“.
He added that the council did not have enough information to say why Mr DeSilva’s appointment was more than a year away but would try to find out more.
A pilot project between the BHB and local orthopaedists, which sees some knee and hip surgeries performed on an outpatient basis, began in April.
The board spokeswoman said: “The standard of care in most jurisdictions, including the US, is that these surgeries are performed as an outpatient service.
“BHB strives to meet and aid the surgeon to meet that standard.
“Providing these surgeries as an outpatient service will help ease the backlog. It is the surgeons who decide if their patient requires same day or outpatient surgery.”