Saskatoon psychiatrist says refusing patient referrals with no reason is '100% inappropriate'

Doctors upset over rejected referrals Watch: Dr. Marlys Misfeldt says she felt 'absolute fury' when she saw that her psychiatric referral had been deemed unnecessary.

SASKATOON — A Saskatoon psychiatrist says it’s unusual, inappropriate and unethical for a patient referral to be denied without an explanation.

Earlier this week, family physician Dr. Marlys Misfeldt, shared her fury over rejection letters from the psychiatry department.

One letter, shared with CTV News, followed Misfeldt’s request to get her patient, battling anxiety and depression, psychiatric help. The letter did not provide a reason for the refusal.

“What Dr. Misfeldt says happened is 100 per cent inappropriate. That should never have happened. No family physician should have their consult turned down without an explanation as to why,” psychiatrist Dr. Sara Dungavell told CTV News.

Dungavell said she has denied a patient referral in cases where the patient doesn’t fit her specialty of care - but a reason is always provided.

“Someone who's drowning you don't tell them, ‘Oh no, sorry I you know I can't help,’ and then just wander away. That’s unethical,” Dungavell said.

Misfeldt said she wants answers why her requests are being rejected.

“This is not something that can be postponed. People die. I’ve had patients commit suicide. It’s devastating,” the family doctor said.

The Saskatchewan Health Authority (SHA), Saskatoon Psychiatry Pool Referral and the Saskatchewan Ministry of Health issued a joint response to CTV News Thursday morning.

“There are a number of reasons for cancellations, but cancellation by psychiatrists is uncommon and we continue to look into the individual reasons they may occur in certain instances. Other more common reasons for cancellations include inability to contact patient, cancellations by the patient, including no-shows to appointments, and cancellations by referring provider,” the statement said.

Dungavell said Misfeldt’s rejection letter reflects a bigger problem in the province: there aren’t enough psychiatrists.

“Even when patients are accepted, the wait lists can be too long to be helpful,” Dungavell explained.

She said the province needs to hire more psychiatrists and supports, such as social workers, to make the work more efficient.

“The people of Saskatchewan need to know that this is happening. They need to know that if their spouse, partner, or child commits suicide while they’re waiting — we have a big problem in this province,” Misfeldt said.

According to the statement, the Saskatoon area pooled referral program began in June of 2019 to help streamline the referral process for family physicians. The program was developed after a few years of trying to “better understand“ wait times.

The pool is a collaborative effort amongst a group of outpatient psychiatrists in the Saskatoon area that collectively entered into an understanding to try and streamline referrals. It is partnered with referral management services at Ministry of Health, the statement said.

“The program is operated and directed by the psychiatrists themselves. It is voluntary and includes 22 psychiatrists. Eight other psychiatrists continue to see patients referred directly to them from family physicians and other physicians. SHA provides support to the pooled referral program through one staff member (triage nurse).”

There are between 125 – 305 referrals monthly and the average wait time is about 12 weeks, the statement said.

However, the capacity of pooled referral psychiatrists is significantly below the rate of incoming referrals, the statement said.

“As a result, a measurable portion of referrals yet remain to be assigned and accepted to be seen.”

According to the joint statement, in all situations where a patient has been triaged and recommended for treatment other than psychiatry, a letter always accompanies the return with information about the review and includes clear guidance on mental health access points as well as the phone number for the intake triage.