Orthopedist: Surgical Waiting Lists for Children “Unacceptable”

Press photo of the year 2020

An orthopedist at Landspítalinn hospital has told the Minister of Health that surgical waiting lists for children are unacceptable. “I can’t get them into surgery within an acceptable time frame,” Sigurveig Pétursdóttir told Willum Þór Þórsson during an annual meeting of the Icelandic Medical Association in October.

“I’m on my knees”

Sigurveig Pétursdóttir, 64, has been employed as a doctor for 38 years. She’s spent 30 years working with disabled children as a paediatric orthopedist. At an annual meeting of the Icelandic Medical Association, held on October 14, Sigurveig told Minister of Health Willum Þór Þórsson that the state of the hospital “has never been worse.”

Read More: Mass Resignations at the University Hospital

“I’ve got children who’ve waited a year,” she called out from the assembly hall, according to a transcript of the meeting published by the Icelandic Medical Journal: “A disabled child who walks with one leg crooked for an entire year because there’s no space in the operating room. And why is there no space? Well, because the staff has quit. It’s not a matter of not having the staff. They quit. The hospital’s a mess. It’s a mess right now. It’s not going to become a mess tomorrow. It didn’t happen yesterday.”

Sigurveig preempted familiar bureaucratic talking points with the statement that all talk of analysis and assessment was unacceptable: “I’ve heard it a hundred times, but the situation has never been worse than now,” she stated. “It means nothing to me, being told that I did so well during the pandemic, not having missed a day of work.”

“I’m on my knees,” she continued. “I’m giving up, and I’m not the kind of person who gives up when things get rough. But no one will be able to walk in my shoes. No one!”

Increased funding required

Those present at the annual meeting urged the government to heed the will of the public and to increase healthcare funding. They also announced their disappointment in next year’s budget bill, urged healthcare institutions to ensure the safety of their staff, and called for actions to be taken to deal with the failing health of doctors and the growing number of healthcare professionals who are resigning from their jobs.

In late October, sixteen middle managers employed at the National University Hospital of Iceland received letters of termination. The terminations stemmed from the adoption of a new organisational chart intended to improve the hospital’s operations.

“The main purpose is to get a handle on the hospital’s management and operations, to strengthen our clinical services, and to harmonise other key services,” Runólfur remarked in an interview with RÚV.

Sixteen Middle Managers at Landspítali Hospital Dismissed

Landspítali

Sixteen middle managers employed at the National University Hospital of Iceland received letters of termination yesterday, RÚV reports. The terminations stem from the adoption of a new organisational chart intended to improve the hospital’s operations.

Improved service, efficiency

A new organisational chart will come into effect at the National University Hospital on January 1. According to director Runólfur Pálsson, the organisational chart is intended to simplify the hospital’s operations and make them more efficient.

“The main purpose is to get a handle on the hospital’s management and operations, to strengthen our clinical services, and to harmonise other key services,” Runólfur remarked in an interview with RÚV. Over the past months, questions concerning the sustainability of the hospital’s operations have come to the fore.

When asked if these changes would be felt by the public, Runólfur replied: “I hope it’ll translate into a stronger hospital, that we’ll be able to improve our service: improve our emergency services, the flow of patients while also strengthening our surgical department. If we’re successful in this regard, then the public will certainly feel it.”

The hospital’s organisational chart was introduced to the Minister of Health today. The changes imply a decrease in the number of middle managers and increased responsibility among front-line managers. “Six directorial positions will be cut, but there are two positions that are bound by law, namely the directorship of nurses and medicine – but the other six will be cut alongside all of the ten managerial positions,” Runólfur remarked.

As reported by RÚV, the sixteen individuals holding the aforementioned positions received a letter of notice yesterday. Runólfur added that because the organisational chart had yet to be implemented, it remained to be seen whether it would result in increased efficiency.

“These are big changes, and we must be aware that changes to the organisational chart, in themselves, are not enough to improve our output – there are other things that must work out as well,” Runólfur stated. “But the purpose of these changes is to get a better handle on and harmonise our clinical services. In the near future, we will aim to overhaul all of the clinical organisational units in the front line and strengthen its management affording them greater responsibility.”

Mass Resignations at the University Hospital

landspítali hospital

Fourteen emergency-room nurses completed their final shift at the National University Hospital of Iceland (Landspítali) yesterday, RÚV reports. The departures are “a cause for worry,” Director Runólfur Pálsson stated, although he remains confident that brighter days lie ahead.

“A long time coming”

Speaking to RÚV yesterday, Soffía Steingrímsdóttir, who’s been employed as an emergency room nurse at the National University Hospital (Landspítali) for almost eight years, explained why she and 14 of her colleagues had decided to quit their jobs:

“It’s been a long time coming. We’ve been trying to call attention to stressful work conditions and the threat to the safety of our patients for years now. Over these past two years, especially – where conditions have been unacceptable.”

According to Soffía, the 14 nurses who completed their final shifts yesterday will not be easily replaced; experience and competence only come with time. A similar number of resignations are expected to be tendered next month.

Trying to break the vicious cycle

Speaking to RÚV, Runólfur Pálsson, Director of the National University Hospital, stated that hospital administrators would do everything in their power to reverse this trend. “The work conditions are extremely difficult. There’s a lot of stress, which means that people resign, which leads to staff shortages, which makes things even more difficult. It’s a vicious cycle that we’ve been trying to break.”

Runólfur stated that he was hopeful that resources designed for patients who have completed treatment at the hospital but cannot leave on account of disabilities would help lighten the load: “And we’ve been waiting for hospital and rehabilitation rooms, which we hope will be available in September. We have high expectations for these new facilities. They will help lighten the emergency room’s load.”

Soffía stated that the nurses were sad and disappointed that no measures were taken in response to their resignations: “I certainly hope that I haven’t completed my last shift at the emergency room, that I’ll return when an acceptable work environment has been created.”

New Hospital Won’t Meet Bed-Demand, Report Finds

landspítali hospital

A new government report finds that the healthcare system will be significantly short of hospital beds by 2040, even with the new hospital opening on Hringbraut in Reykjavík. The Director of the new hospital hopes that the war in Ukraine won’t delay construction.

Demographic changes driving demand

On March 18, the Ministry of Health released a report on the future development of the National University Hospital of Iceland (Landspítali). The report, which was based on data from 2019, was predicated on analytical work done by the management consulting company McKinsey & Company.

Among the report’s main findings was that the need for hospital beds in Iceland is expected to rise by 80% by 2040. This need is driven mainly by demographic changes, with the average age in the country expected to increase by 9% and the total population expected to increase by 18% over the next 18 years.

Given these changes, the healthcare system would have only half of the needed hospital beds by 2040 if no significant actions were taken – even with the opening of the new hospital on Hringbraut (expected to open in 2026).

According to the report, the healthcare system can tackle the shortage by shifting long-term and primary care from Landspítali to “a more (sic) adequate healthcare setting.” The health authorities would need to create the equivalent of ca. 240 bed capacity in home-based, elderly, and rehabilitation-care facilities.

“We can’t lose any time”

In an interview with RÚV yesterday, Runólfur Pálsson, Director of the National University Hospital of Iceland, responded to the report by saying that “time was of the essence.”

“Everybody is familiar with the current facilities as far as hospital beds are concerned,” Páll observed. “Personnel shortage is also a growing concern. We should have acted sooner; the preparation time required for the construction of the new hospital was way too long.”

As noted on RÚV yesterday, the current conditions at Landspítali er still difficult, even with a decline in COVID-19 cases. There is a significant shortage of hospital beds. Every day, almost 30 people must wait in the emergency ward to be admitted into the hospital.

Furthermore, illnesses among staff, whether resulting from COVID-19 or influenza, have also made operations difficult. Many employees of the hospital have also gone on sick leave owing to work-related stress.

Construction, for the most part, “on schedule”

In an interview on Friday, Gunnar Svavarsson, Director of the New University Hospital on Hringbraut, stated that the construction of the new hospital was, for the most part, on schedule. The Russian invasion of Ukraine may cause a delay, however, as the contractors can no longer import steel from Russia.

“We hope there won’t be any delays,” Gunnar said. “As it stands, it’s looking pretty good. Some areas are behind schedule and others that are ahead of schedule.”

New Regulations May Bar Non-Infectious Residents from Boarding Commercial Flights

Keflavík Airport

Icelanders, or those who have connections to Iceland, who are fully vaccinated could find it difficult to return to the country if they become infected with COVID-19 while travelling abroad. PCR tests may detect genetic material from the virus long after individuals have recovered, which may preclude them from boarding commercial flights to Iceland. “The authorities in Denmark were speechless over the Icelandic regulations,” an Icelandic woman, who was stranded in Denmark for over a week, stated.

Could be made to wait up to two months

New regulations passed by the Minister of Health provides that passengers must submit a negative PCR test before boarding a flight to Iceland. As reported by Fréttablaðið, the regulations do not, however, include a clause concerning individuals who have recovered from COVID-19 but who nonetheless test positive on PCR tests.

As noted by a recent paper on the phenomenon, “genetic sequences from the RNA virus SARS-CoV-2 can integrate into the genome of the host cell through a process called reverse transcription. These sections of the genome can then be ‘read’ into RNAs, which could potentially be picked up by a PCR test.” Thus, Icelanders, or those with connections to Iceland, who become infected abroad could be made to wait for up to six months before they are allowed back onto commercial flights for Iceland – even if they’ve completed mandatory quarantine and are no longer infectious.

Speaking to Fréttablaðið this morning, Runólfur Pálsson, head of the COVID outpatient centre at the National University Hospital in Iceland, recalled that this was “a big issue” during the summer of 2020 when the borders were reopened before vaccinations began. “Individuals who had previously been infected were testing positive upon arrival. We had to assess whether this was an active infection or an older one, and we did this by testing for antibodies.”

“If this is done by measuring the amount of virus, it becomes quite complicated.” According to Runólfur, such an approach leaves testers in a “hopeless situation,” for it is difficult to assess whether the person is contagious or whether they are still carrying a trace of the virus’ DNA in their respiratory tract from a previous infection but are no longer contagious. Runólfur pointed out that such individuals are allowed re-entry into society after quarantining, even though there is the possibility that they won’t be allowed onto commercial flights headed to Iceland. The Icelandic Constitution declares that “an Icelandic citizen cannot be barred from entering Iceland nor expelled there from.”

Given a COVID health pass in Denmark but not allowed to return

Nanna Þórdís Árnadóttir, a kindergarten teacher from Reykjavík, flew to Denmark with her husband and two children on July 17. Two days after arriving, Nanna tested positive for COVID-19. Having quarantined for over two weeks (Nanna’s two daughters later tested positive), the family extended their stay but planned on returning last week. However, a positive PCR test precluded them from boarding a commercial flight to Iceland:

“The COVID staff in Denmark were speechless over the Icelandic regulations. I’d been issued a COVID health pass from the Danish authorities because I was no longer infectious, but I was not allowed to board a commercial flight to Iceland.”

Nanna reached out to Iceland’s Ministry of Health, which pointed her in the direction of the Ministry of Foreign Affairs. “They said that there was nothing they could do. Everyone was real friendly but they had no advice at all. And so I spoke to the COVID staff in Iceland who said that I would need to fly home in an air ambulance.”

Fortunately, Nanna took another PCR test yesterday and received a negative result this morning. “You can imagine how little I slept while waiting for the results last night … although we love staying here, the feeling of visiting Denmark when one is stuck and can’t return home is quite different. What happens if we need to extend our stay by a week? A month? We’ve needed to look for a place to stay, to consider work, finances; it’s proven quite costly for us.”

The family will be returning to Iceland tomorrow.