A former Chief of Emergency Services has called for a commission of inquiry to review access to emergency care in the face of “critical overcrowding” at King Edward VII Memorial Hospital.

Edward Schultz said he fears that everyone on the island is at risk in the event that they need urgent treatment for serious injury or illness as patients continue to languish in emergency department hallways — known as boarding — instead of being transferred to acute care wards.

He told The Royal Gazette today: “You see it as a convenience problem, I see it as a life or death issue that people are going to have adverse outcomes or actually die because of boarding.”

Dr Schultz said: “I wouldn’t go to the emergency department unless I was dying and all my friends feel exactly the same way, so it’s not just you’re doing a disservice to patients who have to go there for care, you’re discouraging patients who should go there for care.”

In a 4,000-word document submitted to the Bermuda Hospitals Board and the Ministry of Health in January, the physician and former BHB member highlighted his grave concerns and laid bare the reasons he believes chronic bed shortages at KEMH have become so perilous.

“Bermuda is facing a healthcare crisis that is worsening by the day,” Dr Schultz wrote in his summary.

“It is primarily an ‘access-to-care’ issue which potentially impacts the health concerns of every Bermudian, guest worker and visitor to these islands.

“Poor structural design of the island’s only acute care hospital and a decades-long failure to adequately plan and properly invest in how to deal with the country’s rapidly ageing population has created a situation at the hospital where there is now overcrowding of inpatient beds on a nearly daily basis.

“As a consequence, many patients in the emergency department at KEMH are ‘boarded’ for days before they are transferred to a hospital ward.

“This is dangerous as it places these patients at increased risk for serious delays in their care, an increased incidence of medical errors, adverse outcomes and even death.

“Furthermore, significant delays in the initial assessment and care of critically ill patients presenting to the emergency department may occur — simply because ‘there is no place to put them’.

“Sadly, the Bermuda Hospitals Board and the Government of Bermuda have failed to effectively partner to resolve this untenable situation, which, as previously stated, impacts everyone living on these islands and could even threaten our country’s economic livelihood.

“This is unfortunate as there are proven solutions that could have already been adopted to resolve the matter.

“These solutions, however, will require a deep social commitment as well as a significant financial investment from both of the major parties involved.”

He wrote: “I am therefore requesting that an independent, non-partisan commission of inquiry be appointed to objectively review public access to emergency care in Bermuda as well as hospitalisation at KEMH and make recommendations as to how to remedy the present situation predicated on evidence-based solutions that have been found to be effective in many other communities throughout the ‘developed world’.

“It is my firm belief that Bermuda clearly has the ability to fix this, if we simply unite in common cause for the good of all.”

Dr Schultz, who served as director then Chief of Emergency Services at KEMH for 30 years until July 2018, told hospital bosses and the ministry in January that he felt unable to keep silent after accompanying elderly friends who needed emergency care and admission to the hospital.

He claimed in his submission that for many years he has seen a lack of co-operation between the Government and the hospital, regardless of which party was in power.

Dr Schultz also noted a “very real risk” for the island’s economic health, adding that it was important to consider “what will happen if our overseas business community concludes that our healthcare delivery system is inadequate or unsafe”.

BHB figures showed that on a single day in February this year, the median time between an inpatient bed request from the emergency department and admission to a ward was 8,133 minutes — more than 5½ days.

At least twice last year the board announced major surge issues when people waited for hospital beds while medically fit patients remained in wards.

Dr Schultz wrote in his submission: “The current bed situation at KEMH was all quite preventable.”

He said that when plans for a new acute care wing began in 2010, clear guidance from multiple international healthcare agencies advised developed nations to expand the volume of emergency department beds by 10 to 20 per cent, and to increase inpatient beds by at least 10 per cent “just to deal with their ageing populations”.

He added: “For Bermuda, where we now have one of the world’s oldest populations, with a huge burden of chronic diseases often managed sub-optimally and an increasing number of residents being either uninsured or underinsured, this guidance couldn’t be more applicable.”

Dr Schultz said that the guidelines as well as recommendations from frontline KEMH clinical leaders were “essentially completely disregarded”.

He wrote: “When I first viewed the construction plan options for the new emergency department I was appalled.

“Instead of expanding the total number of emergency department beds by 10 to 20 per cent, the total number was reduced by 27 per cent.”

He added that concerns raised by the emergency department planning team were met with assurances that there would be no problem because a ward of the acute care wing would be reserved for unplanned admissions and that emergency patients would be transferred there immediately once a decision to admit was made.

“During the final planning phase for construction of the new ACW, the ‘unplanned admission unit’ concept was abandoned but the allocation of bed space for the ED was never modified accordingly,” Dr Schultz wrote.

He said patients found themselves placed in hallways from the outset, with no design for surge capacity and the elimination of a fast-track area for people with minor complaints.

“This was compounded by the fact that the new build actually reduced the total number of inpatient beds instead of expanding them by 10 to 20 per cent,” the submission added.

Dr Schultz said that when he complained the design would result in “absolute disaster”, he was threatened on numerous occasions with dismissal.

The BHB told the Gazette on March 31 that over the prior three months, about 40 per cent of the 90 beds in KEMH’s acute care wing were occupied by people who were medically fit for discharge, resulting in beds not being available for patients admitted through the emergency department.

Dr Schultz said that risks associated with emergency department boarding include prolonged hospital stays, delays in assessment and care as well as burnout and resignations among staff.

Most importantly, he added, it increases mortality and morbidity rates for patients.

And he warned that the hospital would be unable to cope if there was an incident which caused a large number of casualties.

“Heaven forbid if there was a natural disaster or a bus went off a cliff or we had a fire and we had to take 60 people. There would be no place to take them except in the parking lot.”

Dr Schultz, who was on the hospitals board for six years, told the Gazette: “People are suffering and dying unnecessarily because of the inactions that have occurred at the hospital.”

He added: “While I was chief for two years in the new [emergency department], I documented between six and seven deaths that I felt were entirely related to boarding and overcrowding.”

Dr Schultz highlighted the “stellar” work being performed by emergency department doctors, nurses, EMTs and service chief Chikezie Okereke.

“What I don’t have a tolerance for is administrators that get paid high salaries to make hard decisions and then don’t do what they need to do to take care of vulnerable people,” he said.

“The Ministry of Health and the Bermuda Hospitals Board has responsibility for preserving the health and wellness of the people of this country.

“If they don’t do that, that is wrong.”

Dr Schultz, who said he held talks with senior KEMH administrators and the health ministry after his missive was submitted, added: “Since I began these meetings and shared my letter of concern, the Government has stepped up to the plate, they have pledged the money that the hospital needs to make adjustments, to enact some of the actions that I recommended.”

The 2026-27 Budget included allocations to meet growing long-term care needs, with a pledge from the health ministry to advance the rebuilding of Lefroy House with increased bed capacity, progress an expansion of the Sylvia Richardson Care Facility and establish a 30-bed unit to improve patient flow and ease pressure on the emergency department.

Dr Schultz described Kim Wilson, the Minister of Health, as “fully supportive” and gave her kudos alongside Scott Pearman, the BHB chief executive, whom the doctor said was “very receptive”.

He believes that the CEO had “tried his best to fix things” but was challenged against elements of nursing staff and the hospital administration to make changes needed to alleviate the problem.

One of the quickest ways to free up space in acute care units — and in turn relieve pressure on the emergency department — would be to situate medically-fit-for-discharge people in KEMH’s unused atrium spaces or discharge lounges furnished with partitions, Dr Schultz said.

The health ministry and BHB issued a joint statement earlier today, insisting that “decisive, system-wide action” was being taken to fix emergency department waiting times and cancelled surgeries.

Both were invited to comment further in response to matters raised in this article and a Government spokeswoman responded: “We refer you to the joint release issued this morning which represents the official, coordinated response from the Ministry of Health (MOH) and BHB on this matter.”

Dr Schultz said: “I think Bermuda is the greatest place in the world, I think we have the greatest people in the world and we can fix this.

“The fact that a small number of people in high places who are paid a lot of money to make hard decisions have not addressed this is just unconscionable because everyone in this country has to use that emergency department.”

He added: “Somebody has to do the right thing.

“If it takes a commission of inquiry for people in this country do the right thing, then so be it.”

• To see Dr Schultz’s letter in full, see Related Media

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ED Boarding Letter of Concern