Dr. Sanjiv Gandhi was more frustrated than usual. The pediatric cardiothoracic surgeon and former chief of cardiac surgery at BC Children’s Hospital had just spent a shift in the midst of an unrelenting respiratory illness season. In between caring for his most urgent patients, he’d had to inform some parents their children’s non-emergency surgeries were being postponed yet again.
Before driving home that night of Nov. 14, Gandhi fired off a tweet to his few dozen followers at the time, calling for mask-wearing as a “mandatory inconvenience” during such a crisis.
The tweet blew up, gathering more than 11,500 likes to date. It also added to the ire from Gandhi’s employer, the Provincial Health Services Authority, for his comments to media outside the official channels.
Gandhi had already begun sounding his alarms about British Columbia’s handling of the COVID-19 pandemic. More than once in the previous six months he spoke at BC Green press conferences to urge more masking and cleaner air in schools.
When the BC Greens announced Gandhi would join their party as a deputy leader late last month, it was easy to draw a line backwards to Gandhi’s many critical comments that resulted in at least two emails of reprimand he shared on Twitter on Jan. 19.
But the 54-year-old’s decision to leave his post as one of just two surgeons able to repair or replace a child’s heart in B.C. had been a long time coming, prompted by what he called a toxic work environment at the hospital he alleges compromised patient care.
Back in November 2021 he wrote a signed and undated resignation letter and placed it in his office drawer. That Christmas he shared his thoughts with his three adult children as they made the winding drive across Vancouver Island to Tofino.
“It didn’t feel right, morally and ethically. I didn’t in good conscience think we were providing the best possible care to our patients anymore,” Gandhi told The Tyee last week. “And when I told my children on that drive that I was thinking of not being a surgeon anymore, their relief made my decision for me.”
Gandhi’s last day of employment with BC Children’s was Dec. 31, 2022. The son of two small-town family doctors in Nova Scotia remains a clinical professor at the University of British Columbia.
In a wide-ranging interview at his West Vancouver home, Gandhi alleged the respiratory illness surge was not the only reason for many pediatric heart surgery cancellations. He blamed administrative meddling and mismanagement at PHSA and BC Children’s.
The Tyee shared his allegations with PHSA, whose vice-president of medical and academic affairs declined to go into any detail about Gandhi’s employment at the hospital, including his disagreements with administration.
“We thank Dr. Gandhi for his more than 12 years of service and wish him well in his future political endeavours,” wrote Dr. Sean Virani in a statement to The Tyee.
Since being recruited to BC Children’s in 2010, Gandhi says the health authority instructed him multiple times not to speak publicly when media requested his insight on virtually any health-care issue.
It was only after he tendered his December 2021 resignation he felt emboldened to speak out about the toll of the pandemic on BC Children’s. “The worst they could do was fire me early,” said Gandhi.
Other health-care workers have anonymously told media they’ve been muzzled by health authorities and government to squelch criticism of B.C.’s health-care policies. Information leaked by a health-care worker is how the public learned last fall’s respiratory surge had killed six children treated at BC Children’s.
When asked whether it was policy to prevent employees from speaking to media or commenting on health policy online at all, Virani did not directly respond.
BCCH does make experts it employs available to media, Virani wrote, through a “robust communications process” to determine who has the best expertise to speak.
But Gandhi warned that behind controlled messaging, administrators are funnelling resources away from patient care, fuelling B.C.'s cascading acute and primary care crises.
“You show up to work to give the best care you can, and there are so many impediments you can’t control and the public can’t see,” Gandhi said. “You feel handcuffed on a daily basis and it’s driven so many people out.”
He came to a harsh conclusion. “The health authority’s positive narrative was the only thing that mattered to them, and my focus was always on my patients.”
Now he turns to politics to tackle what ails B.C.’s health system. “Two years ago, I never would have thought I wouldn’t be a heart surgeon,” said Gandhi.
Gandhi leaves behind, as well, a fractious relationship with a fellow cardiothoracic surgeon that resulted, in the summer of 2021, in a temporary suspension of the heart transplant program, affecting as many as 13 children and families.
“We remain committed to providing children and their families with the highest quality patient care, but we acknowledge that in recent weeks we have been faced with challenges in delivering on this,” a spokesperson for PHSA wrote to Postmedia at the time. “We apologize for the stress this may have caused the patients and families who need us most.”
The episode made Gandhi “uncomfortable” with the work environment and quality of care, and it affected his mental health so deeply his children said they feared something bad would happen to him, Gandhi recalled. “We want our dad back,’” he remembers them saying.
‘I felt powerless’
Gandhi is calm and measured as he details his difficulties at BC Children’s, emotion catching in his voice only when he discusses his children.
As last fall’s respiratory virus surge hammered children’s hospitals across Canada, Gandhi was operating as much as he could while planning to curtail his practice after giving one year’s notice in January 2022, per his contract. Another cardiothoracic surgeon was hired in July 2022 to replace Gandhi, and BCCH is in the process of hiring another full-service surgeon who can perform heart transplants, Virani said.
“Ensuring we have a full-scope program remains a top priority and we are committed to providing patients and families with the timely care and support they deserve,” he wrote.
The Tyee previously reported that BC Children’s temporarily cut one of its four weekly cardiac surgical days in late November to free up space for urgent patients in the pediatric intensive care unit where surgical patients recover. Gandhi says that of the 28 physical beds in that unit, ten have never been staffed or operational since it opened in 2017, Saran wrap still sealing some brand new equipment.
Assessing capacity to operate and support the aftercare of patients needing care happens daily, Virani said.
“We do not postpone surgeries that are determined to be medically urgent or emergent,” he wrote. “Decisions on surgical postponement are not taken lightly and are absolutely done in full consultation with the most responsible surgeon based upon patient urgency and complexity.”
Gandhi said hospital and PHSA administrators told him and others not to tell parents the full reasons their children’s surgeries were being cancelled.
Those causes included an influx of respiratory patients and, according to Gandhi, a reduction in operating room time disproportionate to the staffing crunch from doctors and nurses out sick themselves.
“It was devastating for families and important for them to know what was happening,” said Gandhi. Not being able to tell them the truth “was just awful.”
At one point, he says he suggested the family of a child whose essential surgery had been pushed for months connect with an acquaintance who could put them in touch with the media. Gandhi felt it was the last avenue to get the boy’s surgery scheduled soon. “I felt powerless,” he said.
The Tyee later reported the story alongside other media outlets.
“We know that any delay in surgical care is difficult and can cause worry for patients and their families,” wrote Virani. “We continue to follow up with families directly impacted on their rescheduled dates and to offer any interim supports as a result of the impacts of any postponement.”
‘We need thoughtful creativity’
A lack of transparency from elected officials and health-care administrators predates the pandemic’s unique strains on staff and resources, Gandhi says. Ticking off mounting problems facing those who run the system, Gandhi notes that more than a million British Columbians are without family doctors, patients endure long wait times to see specialists and administrative costs are the highest per capita of any jurisdiction in Canada.
As premiers head to Ottawa to negotiate more money for health care next week, Gandhi wants to see any money offered tied to clear, patient-focused goals and metrics.
“We don’t need more money necessarily, we need thoughtful creativity,” he said, pointing to an initiative he helped lead to support children with congenital heart disease at home that, conservatively, saved the province $4.8 million over two and a half years.
“If it’s about dollars and cents, the cheapest health care is keeping people healthy in the first place,” he said.
A recently announced increased payment model to retain and support primary care physicians in B.C., Gandhi said, is a good start on primary, community-based medicine. But he is concerned it does not include metrics to measure its success at attaching patients to doctors and attracting more to B.C.
The province needs to fill the gap with physician assistants and internationally trained doctors, he added.
The Greens would drop barriers to those added reinforcements, he said, and would work to ensure cleaner air in schools to prevent viral transmission, address the toxic drug crisis with safe supply and expand MSP to cover mental health care.
“Improving people’s lives takes courage more than time, because reinvention is scary,” said Gandhi. “Band-Aids on bullet wounds, like we’re seeing now, is not the answer. We need major surgery.”
The cutting starts with trimming bureaucracy, he said. “The people running the show don’t know the show they’re running,” said Gandhi. “They’re trying to solve it miles away from where the solutions really are.”
Leaving medicine for politics may seem incongruent with this belief, Gandhi admitted. He has not yet decided whether he will be more of an in-house health policy expert for the Greens or run for office in the next election, as the other deputy leader Dr. Lisa Gunderson has said she will.
In the meantime, Gandhi is taking a six-month French cooking intensive course. He spends weekday mornings striving to make the perfect scrambled eggs, goat cheese salads and pork tenderloin. “Knife skills are about all I got,” he said with a laugh.
In the afternoons, he returns home to put in some work for the Greens. He is starting to settle into the new life he prescribed himself after a reckoning he believes burdens other frontline health providers.
“People signed up for the pressure of saving lives or holding a child’s heart in your hand,” said Gandhi. “But the political and the administrative pressure is something no one signed up for, no one is prepared for, and is only getting worse.”
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