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Health, Politics

Why a Top BC Heart Surgeon Quit for Politics

By Moira Wyton, The Tyee, Local Journalism Initiative Reporter

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.”

Top image credit: Photo of Dr. Sanjiv Gandhi taken from Green party news release of Jan 23, 2023, adapted to fit the page

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