Manitoba

Winnipeg patient 'furious' after waiting months for heart procedure

A Winnipeg woman feels failed by Manitoba's healthcare system after spending months waiting for a life-altering heart procedure only to have a stroke following an 11-hour wait in an emergency room.

Cheryl Gilarski is out of options in Winnipeg after suffering a stroke while waiting for a heart procedure

Cheryl Gilarski, 60, says she suffered a stroke after waiting 11 hours in an emergency room and months for a heart procedure. She holds a stack of medical documents she has collected over the past year navigating the system. (Trevor Brine / CBC)

A Winnipeg woman feels failed by Manitoba's healthcare system after spending months waiting for a life-altering heart procedure only to have a stroke following an 11-hour wait in an emergency room.

Cheryl Gilarski, 60, was waiting for a procedure called a cardiac ablation — an in-hospital procedure that scars or destroys tissues in the heart to bring it back to a normal rhythm.

Before she could make it to the top of the list, she had a stroke which she says meant she couldn't have the procedure.

"I was furious. I was mad. I was fed up and I was tired," she said.

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Gilarski was diagnosed with an atrial flutter two decades ago — an abnormal heartbeat that can periodically speed up to dangerous rates. A previous ablation alleviated the symptoms and for more than a decade she was able to lead a normal life.

The flutter came back last year, making her life consistently uncomfortable. She can't work everyday and any strenuous physical activity beyond walking is out of the question. 

Another ablation procedure was pitched to her as the best course of action — giving her a normal heartbeat and a return to a normal way of life. 

16-month wait

"And I said 'Great. Let's do it. I'm all for it,'" she said.

But it came with a catch. 

She was told the wait for the procedure would be 16 months. This was after waiting months to see a cardiac specialist, she said. 

"Finally I see this person. Well now it's months again, many months and then it's years (for the procedure)," she said.

"To this woman I'd say we regret the long time that she had to wait in the emergency room- Health Minister Cameron Friesen

As she waited, she had to undergo monthly trips to the emergency room to have her heart shocked back into rhythm when her heart rate became too high.

During a trip to St. Boniface Hospital's ER on May 12, she said she waited 11 hours for treatment because there were no cardiac beds available.

"I felt horrible. My heart was racing. I was exhausted. I couldn't eat anything. I could not drink anything," she said. 

After waiting 11 hours she was brought into the room and given the 10-minute procedure, known as a cardioversion. 

The next day she suffered a cardioembolic stroke, which she said neurologists told her was caused by the sustained arrhythmia and because she wasn't taking blood thinners.  She was fortunate that it was caught in time and doctors were able to give her an oral medication which stopped the stroke from causing any permanent damage.

"I could not have asked for a better team," she said.

'Be very mindful'

Because of the stroke, she said her cardiologist told her she was no longer eligible for an ablation. 

"He says, 'you're off the list,'" she said. "It was just one thing after another."

She has now waited over a month for a referral to a hospital in London, Ontario to see if a doctor there can perform the procedure.

Dr. Ross Feldman, the medical director of the Cardiac Sciences Program, said a cardiac ablation would not have likely prevented Gilarski's stroke, but being on blood thinners could have. (Kristin Annable / CBC)

Officials at St. Boniface's Cardiac Sciences Program, without knowing Gilarski's patient history, say there must have been a communication error as a stroke would not preclude her from the wait list.

Dr. Ross Feldman, the medical director of the Cardiac Sciences Program, said the ablation would not have likely prevented the stroke, but being on blood thinners could have. He was not in a position to comment on any medical decisions made in the Gilarski case.

"The wait times and gaps in the management of patients with heart irregularities has been a focus (of the program)," he said. 

"I think that we need to be very mindful of patients who fall between the cracks and especially have bad results."

He says not all of her information "fits together" and recommended Gilarski speak further to her doctor to see what other options are available.

Demand increased 60%

Feldman noted the demand for cardiac ablation procedures has increased by 60 per cent over the past three years, putting a strain on the limited available program resources for the procedure. 

The system only allows for three or four procedures a day and the lab is only open three times a week.

The result is a wait list of more than 180 patients and median wait times sitting almost steadily above 6 months in non-urgent cases for the past three years.

Officials with the program admit they don't know how long patients are waiting as the system only tracks the median. They don't know how long the top 50 per cent of patients are waiting.

Manitoba Health Minister Cameron Friesen says two new doctors are being brought on to alleviate the wait times for cardiac ablation procedures. (David Lipnowski)
In Nova Scotia for example, the median wait time for the procedure is 62 days, while the 90th percentile (meaning the time within 90 per cent of patients had their procedure) is 272 days.

The current median wait time is between 27 and 37 weeks for non-urgent cases, 24 weeks for semi-urgent cases and 13 weeks in urgent cases.

National benchmarks say the procedure should be done within 14 days in urgent cases or 12 weeks in non-urgent.

2 new doctors

Manitoba Health Minister Cameron Friesen admits the wait times "are too high." He says because it is a procedure the province only started doing around 2015, there have been some learning curves.

He says it is too early to comment on the Gilarski's situation. 

Dr. Chris Simpson, an Ontario cardiologist and vice-dean of the Queen's University School of Medicine, says the wait times for these procedures are long across the country. (Canadian Medical Association)

"Obviously we feel for this woman," Friesen said. 

"To this woman I'd say we regret the long time that she had to wait in the emergency room. But we are encouraged to see more of these cardiac ablation procedures coming online."

Two cardiac doctors have been hired, one starting in September and the other in September 2020. They will specifically concentrate on heart rhythm treatments. Friesen said the aim is to have the lab running five times a week.

Manitoba isn't an outlier when it comes to long wait lists for this procedure. Dr. Chris Simpson, an Ontario cardiologist and vice-dean of the Queen's University School of Medicine, says Ontario has struggled with similar wait times.

Nationwide struggle

With more doctors becoming aware of the procedure, more are sending referrals, he said. The procedures also aren't simple and can sometimes last eight hours. And Ontario has also seen a large increase in patients eligible for the procedure.

I think that we need to be very mindful of patients who fall between the cracks and especially have bad results- Dr. Ross Feldman, medical director of the Cardiac Sciences Program

"It is just not possible to even have the number of doctors trained to do this instantly let alone the you know the specialized labs that it takes to do this," he said.

"It takes a tremendous amount of capacity building and investment. 

"It's highly cost-effective because you do one procedure and then basically they never have the problem again," he said.

A Winnipeg woman feels failed by Manitoba's healthcare system after spending months waiting for a life-altering heart procedure only to have a stroke following an 11-hour wait in an emergency room. 2:45

About the Author

Kristin Annable is a member of CBC's investigative unit based in Winnipeg. She can be reached at kristin.annable@cbc.ca

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