Peel Region’s Sikh community played a key role in establishing Brampton’s gleaming new hospital. It has played an equally major role in the troubled institution’s first major crisis.

BRAMPTON: The opening of Brampton Civic Hospital was supposed to be an occasion for celebration, especially among the city’s burgeoning Sikh community.

They had been actively courted by the hospital foundation, and responded with tremendous enthusiasm, raising $2.8-million with a Punjabi radiothon and an incredible $200,000 during a 48-hour Sikh prayer ceremony in July.

The new $790-million facility, built in a field in northeast Brampton, was meant to take pressure off the aging Peel Memorial Hospital downtown, with its water leaks and occasional blackouts, and offer the community an improved level of health care.

Instead, the new hospital, which opened two months ago, has become a public relations nightmare for staff and administrators, with unproven allegations of mismanagement and substandard health care sparking street protests among the very community that worked to help raise funds for the project.

The deaths of two hospital patients, both Sikhs – one of them a man whose family donated $25,000 to the foundation – have been held up as examples of how the hospital is failing the community. Hamstrung by privacy legislation that prevents them from talking about individual cases, hospital administrators have been forced to limit their response to press releases outlining hospital procedures.

Responding to community pressure, the province appointed a supervisor to oversee the hospital in a bid to restore public confidence in the new facility. How it went wrong is a puzzle. In five pieces.

Sikhs in Brampton

According to 2001 Statistics Canada information, the Sikh religion is the third largest in Brampton behind Catholic and Protestant. Under the public private partnership (P3) funding formula being used to build the new hospital, the community had to raise 30 per cent of the building’s total cost of $536 million.

William Osler Health Centre (WOHC) paid a tribute to the Canadian Sikh community by naming the new hospital’s emergency department as Guru Nanak Emergency Services Department.

The press

Rajinder Saini was listening to a local Punjabi radio program about Brampton Civic Hospital when local MPP Vic Dhillon called into the show to say one of his close family friends had recently died there.

As the publisher of the Parvasi Weekly newspaper, Saini had been receiving complaints for years from readers about the quality of health care in Brampton. Things were supposed to be different at the new Brampton Civic Hospital, a state-of-the-art facility that had opened on Oct. 28.

Dhillon, Saini remembers, described how his friend had waited eight or 10 hours in the emergency room at the new hospital, and that during the man’s subsequent 10-day stay at the hospital for pancreatitis, his family complained that he was not properly cared for.

Saini called Dhillon, who put him in touch with the family. The next day, Nov. 20, the family’s story was front-page news in Parvasi Weekly, which has a circulation of 20,000 in the GTA, Vancouver and India.

Local Punjabi radio shows picked it up, and Saini talked about it on his own radio show, which runs on CJMR 1320 AM. The Times of India picked up the story, says Saini. He was invited to talk about it on television.

“It was big news,” says Saini. “Everybody talked about this story. There was big outrage in our community.”

“It’s a very small kind of community newspaper, but still I am trying to run it very professionally,” says Saini, who operates out of a small office opposite a strip mall in Mississauga.

“We have nothing against the hospital staff or management. We are trying to raise the voice. The voice of the people.”

The doctor

By the time stories of what was happening in the emergency department of Brampton Civic Hospital reached the ears of the man who runs the place, the facts had been distorted beyond recognition.

“`I know somebody delivered a baby on the sidewalk outside the emergency department…while this man was dying on the floor of your waiting room,'” Dr. Naveed Mohammad was told at a dinner party.

“There was a lot of misinformation out there,” says Mohammad. “That was one of the most painful parts for me. It really painted our hospital and the emergency department in a negative manner and that wasn’t the truth.”

Neither of the two cases that became lightning rods for controversy involved medical error in the emergency room, says Mohammad.

“Nobody waits 10 hours in emergency to see a doctor. Everyone is assessed in a timely fashion”

The problem was one of expectations, says Mohammad. The community was expecting that the hospital would open at full capacity, with 608 beds. It has 479. The remainder will open over the next four years. Physicians, nurses and staff didn’t anticipate the challenges that would come with moving to a spanking new hospital, from mastering the computer system to finding the stairs.

They didn’t anticipate that demand would soar as it did – the new facility drew 20 per cent more emergency-room traffic than predicted, and the number of very sick patients to emergency doubled. Mohammad is Punjabi. He says he understands the culture. He understands why members of the community are upset. He even understands why the same people who told him they understand his position took to the streets in protest.

“A lot of community leaders had to decide whether to support the hospital or the community,” says Mohammad. “The community is large, it’s what’s around you all the time. If you’re someone who has to depend on the community for business…it’s difficult.”

The patients

The first patient death to draw media attention was Harnek Sidhu, 52. His family told Parvasi Weekly that he was not properly attended to in the emergency department at Brampton Civic Hospital, despite the fact that Sidhu was vomiting and in acute pain.

His son Sandeep later told the Star that it took 12 hours for his father to be assigned a bed. His father died 10 days later of pancreatitis.

Sandeep blamed it on the fact that the hospital was built and is operated as a public-private partnership, with the private sector operating non-clinical services, such as housekeeping.

He said the hospital is understaffed and the focus is not health care, but on moving patients through the system as quickly as possible.

The family had donated $25,000 to the hospital.

Amarjit Narwal was home when he suffered a stroke that paralyzed his right arm and leg. He was treated at Trillium Health Centre in Mississauga, the regional centre for acute stroke care.

Early Saturday morning, Narwal was transferred to Brampton Civic Hospital. Friends and family visited with him all day and were reassured by the fact that he was talking and asking for juice. Sunday morning, his cousin, Inderjit Nijjar, returned to find him in a coma.

“I started acting up. I started calling the nurse, asking her to call the doctor and look at him,” says Nijjar.

The nurse paged a doctor at home. The doctor called back, but did not come to the hospital, not even after Narwal began having seizures, according to Nijjar. Finally the nurses brought a doctor down from the intensive care unit. He read the file and told the family that nothing could be done.

Narwal, 42, with a 2-year-old son in India, died that night.

Nijjar said he tried to get help for his cousin – he called someone he knew on the hospital board, he called someone he knew involved in fundraising for the hospital committee.

“`Do me a favour, there’s no point in screaming. Write up a written complaint, give it to me Monday. I will follow up,'” Nijjar was told.

The opposition

Some of the groundwork for community discontent was laid down by the Ontario Health Coalition, which began calling members of the Punjabi press in September to organize a series of town hall meetings on the topic of health care in Brampton.

The Ontario Health Coalition is opposed to hospitals built on the Brampton Civic Hospital model – so-called P3s – which involve partnerships between the private and public sectors.

The coalition represents, among other community groups, the Council of Canadians and several powerful unions, including health-care unions. Executive director Natalie Mehra says that under P3 models, hospital profits are siphoned off to the private sector, at the expense of health care.

The town-hall meetings, which took place a month before the hospital opened, were designed to bring attention to the issue in time for the provincial election in October, Mehra said.

“We wanted to push the province to make some promises leading into the election and coming out of the election,” she said.

It was through the Ontario Health Coalition that journalists like Parvasi Weekly publisher Rajinder Saini learned that the newly opened hospital would have fewer beds than originally thought and that the old Peel Memorial Hospital would be closed once the new hospital opened.

“Until then, I don’t believe that anybody in the community knew that if we are getting this new hospital, they are snatching away Peel Memorial hospital, too,” says Saini. “That’s how it started simmering around, you know. People started complaining that, `Why are they closing down Peel Memorial?'”

The community

Brampton is home to a large and politically important South Asian population.

South Asians make up 83,245 of the 206,185 immigrants in the city, which now has a total population of 400,000.

The overall population of the suburb northwest of Toronto has grown by 60 per cent in 10 years, to 400,000, resulting in gridlock, crowded schools and, critics say, social and community services that have failed to keep up. The accusation that there aren’t enough services, including libraries and community centres, to serve the growing population is a frequent topic of heated debate on local Punjabi radio.

Health care has long been an issue in the city – until the new hospital was built, one-third of patients seeking emergency care travelled outside of Brampton to get it – to hospitals in Etobicoke and Mississauga.

The hospital foundation has actively sought the support of the Sikh community, says Anne Randell, president and CEO of the William Osler Health Centre Foundation, which includes Brampton Civic Hospital, Etobicoke General Hospital and Peel Memorial Hospital. A radiothon in the community two years ago raised $2.8-million.

This summer, 15,000 people attended a weekend Akhand Paath ceremony at the hospital – a continuous reading of the Sikh scripture from beginning to end. In all, $200,000 was raised.

The new emergency department was named for Guru Nanak, founder of Sikhism. Two Sikhs sit on the foundation board and three on the hospital board.

“This was a collective effort by a portion of our community to do a lot for the hospital, so it’s not that person who donated $10-million that expects you do to something for them, it’s the whole community,” says Dr. Naveed Mohammad, corporate chief of emergency services. (Courtesy thestar.com)

26 December 2007
Sikh Forum on 9/27/2008