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Canada: Why ERs are struggling to stay open nationwide – BBC

Published

2 years ago

September 2, 2022

A nurse holding a sign that says colleagues are short-staffed and burnt out at 2021 rally in Toronto, Canada.

On a Thursday in mid-August, the doors of a hospital’s emergency department two hours west of Toronto were shut.

A note posted on the front said the ER was closed for the day. It would reopen the following morning at 08:00, but close again for the evening. Patients who needed urgent care were asked to go to nearby hospitals – a 15- to 35-minute drive away.

It was the ninth time since April that the Huron Public Healthcare Alliance – a network of four hospitals serving around 150,000 people in western Ontario – had to temporarily close or cut back hours at one of its emergency departments.

And it won’t be the last, said the organisation’s CEO Andrew Williams.

The reason? There aren’t enough nurses to staff the ER.

“You are seeing – almost weekly – hospitals having to reduce their services,” Mr Williams told the BBC.

It’s a dilemma playing out at emergency departments across Canada, particularly at smaller hospitals where reduced services have become commonplace.

In the maritime province of Nova Scotia, one hospital’s ER has been closed since June 2021 due to staffing shortages.

Canada is one of the richest countries in the world. Its universal publicly funded healthcare system has been touted by progressive politicians in the US, the country’s southern neighbour, who see it as a needed alternative to an American system where millions remain uninsured.

But in recent months, Canada’s system has been described by workers and hospital executives as being in a state of “crisis”.

That includes struggling emergency rooms.

Toronto ER physician Dr Raghu Venugopal said he has seen stretchers lining the hallways, occupied by patients suffering from ailments like a broken hip or abdominal pains.

On some days, those patients may wait anywhere from two to four days to be admitted to hospital, all while a team of two nurses tends to a total of 50 to 60 patients on the unit.

Other patients are being examined in the waiting room because the lack of staff has forced parts of the ER to close, meaning there is limited space for doctors to see them privately.

“We are in a standard-less void where anything goes, and it is shocking,” Dr Venugopal said.

In the prairie province of Saskatchewan, one nurse said some paramedics have spent the entirety of their 12-hour shift waiting with a patient on a stretcher as no one was around to admit them for treatment, leaving the paramedic unavailable to respond to other calls.

Patient stories have also emerged across the country.

In Ontario, a woman told the CBC she spent a total of 19 hours in ER with severe backpain before she was admitted. She was later diagnosed with cancer. In New Brunswick in July, a man died while waiting for care, and the hospital has launched a review.

The challenges brought on by Covid-19 bear part of the blame.

Many nurses in Canada – fatigued from the pandemic -have said they plan to leave the profession due to burnout and limited support. Similar sentiments have been expressed by nurses in the US and in the UK, where a strike vote over wages is looming.

But experts say decades of bad policy, including the closure of hospitals and past austerity budgets, coupled with Canada’s vast and complex geography, have exacerbated the pandemic pressure.

This has ignited a national debate on how to retain staff – primarily nurses – and how to save a cherished public health system that is facing mounting pressure as it tries to care for an ageing population.

Many are asking “what kind of system do we want”, said Jennifer Jackson, an assistant professor at the University of Calgary’s faculty of nursing, “And if we want that system, what is required of us as a society to get there?”

Chart showing number of hospital beds per 1,000 people from 11 richest countries in the world.

The modern version of Canada’s universal healthcare system – under the Canada Health Act – has existed since 1984, though its roots were laid decades earlier in the province of Saskatchewan. Britain’s National Health Service, established in 1948, served as inspiration.

Canada’s system, however, ranks lower overall than the UK and others in international comparisons.

A 2021 report by the Commonwealth Fund listed it as second-last overall among a list of 11 rich countries – above only the US. There are 2.5 hospital beds in Canada per 1,000 people, placing it near the bottom of OECD countries.

Canada specifically lags when it comes to equitable access and care outcomes.

Data over the last five years shows people are waiting longer in the ER before they are either seen by a doctor or admitted to hospital. Nearly five million Canadians don’t have a family doctor, often making an emergency room their primary place to get help if they need it.

Over the years, as Canada’s population grew in size and age, its healthcare capacity struggled to keep up. Rural hospitals – where it can be a challenge to recruit staff – have been most affected.

This is made worse by a vacuum of nursing talent that existed before the pandemic. There were 34,315 vacant nursing jobs in Canada at the end of 2021 – a 133% increase from 2019.

It is estimated that Canada will be short 117,600 nurses by 2030. A third of the current workforce is close to retirement, and in a 2021 national survey, nearly 60% of early-career nurses say they are considering leaving their current job.

While there are no official numbers on how many nurses left the profession during the pandemic, sources the BBC interviewed for this story spoke of nurses that have cut back on their hours or taken early retirements.

Those that remain say they feel the pressure. Saskatchewan ER nurse Jacelyn Wingerter, 22, began working just eight months ago but already feels burnt out.

The waiting room of the ER she works in can only hold 20 patients, but has seen up to 50 in recent months amid a chronic shortage of nurses.

“Our baseline is supposed to be 19 [nurses], but that never happens”, she said. “We are always short.”

In May, she worked a total of 290 hours to fill the gap, about 70 hours a week.

The shortcomings of the system are most visible in the ER because it’s often the catch-all for all health emergencies, said Ms Jackson.

Closing the ER is never an easy decision, said Huron Public Healthcare Alliance’s Mr Williams, but one his hospitals have had to make as a poorly-staffed ER can be dangerous.

“Our obligation all the time is to provide the safest care that we can,” he said.

Still, there are consequences. Brenda Gascho, a nurse at one of the hospitals Mr Williams oversees, said a closure at one ER means a bigger backlog at another one nearby.

Some patients end up leaving without being seen by a doctor or a nurse, aggravated by lengthier-than-usual wait times, she said.

People foregoing care because of the system’s shortcomings is something Ms Jackson worries about. Nurses and doctors in Canada are still some of the most highly trained in the world and are determined to do their best whatever the resources, she said.

Some solutions to the crisis proposed by those in the sector include increasing wages for existing nurses, allowing internationally-educated nurses to practice in Canada, and increasing the capacity of nursing schools across the country, especially in rural areas.

Others have called for funding to be increased for care based in the community, so that people can access help before they end up in the ER.

Provinces are responsible for the healthcare system in their respective jurisdictions, though they rely on funding from the federal government.

Prime Minister Justin Trudeau has said that Canada’s public health care system “is one of the greatest things” about the country, and that his government is committed to working with provinces to “ensure Canadians get good, quality” care.

Ms Jackson said the challenge of healthcare policy is that decision makers tend to focus on short-term solutions, but healthcare in Canada could also benefit from larger overhauls that can increase access to everyone in the long term.

The big decisions made today, she said, will have a profound impact on future generations.

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Whitehead becomes 1st CHL player to verbally commit to playing NCAA hockey

Published

3 hours ago

September 13, 2024

Anne Joseph

Braxton Whitehead said Friday he has verbally committed to Arizona State, making him the first member of a Canadian Hockey League team to attempt to play the sport at the Division I U.S. college level since a lawsuit was filed challenging the NCAA’s longstanding ban on players it deems to be professionals.

Whitehead posted on social media he plans to play for the Sun Devils beginning in the 2025-26 season.

An Arizona State spokesperson said the school could not comment on verbal commitments, citing NCAA rules. A message left with the CHL was not immediately returned.

A class-action lawsuit filed Aug. 13 in U.S. District Court in Buffalo, New York, could change the landscape for players from the CHL’s Western Hockey League, Ontario Hockey League and Quebec Maritimes Junior Hockey League. NCAA bylaws consider them professional leagues and bar players from there from the college ranks.

Online court records show the NCAA has not made any response to the lawsuit since it was filed.

“We’re pleased that Arizona State has made this decision, and we’re hopeful that our case will result in many other Division I programs following suit and the NCAA eliminating its ban on CHL players,” Stephen Lagos, one of the lawyers who launched the lawsuit, told The Associated Press in an email.

The lawsuit was filed on behalf of Riley Masterson, of Fort Erie, Ontario, who lost his college eligibility two years ago when, at 16, he appeared in two exhibition games for the OHL’s Windsor Spitfires. And it lists 10 Division 1 hockey programs, which were selected to show they follow the NCAA’s bylaws in barring current or former CHL players.

CHL players receive a stipend of no more than $600 per month for living expenses, which is not considered as income for tax purposes. College players receive scholarships and now can earn money through endorsements and other use of their name, image and likeness (NIL).

The implications of the lawsuit could be far-reaching. If successful, the case could increase competition for college-age talent between North America’s two top producers of NHL draft-eligible players.

“I think that everyone involved in our coaches association is aware of some of the transformational changes that are occurring in collegiate athletics,” Forrest Karr, executive director of American Hockey Coaches Association and Minnesota-Duluth athletic director said last month. “And we are trying to be proactive and trying to learn what we can about those changes.

Karr was not immediately available for comment on Friday.

Earlier this year, Karr established two committees — one each overseeing men’s and women’s hockey — to respond to various questions on eligibility submitted to the group by the NCAA. The men’s committee was scheduled to go over its responses two weeks ago.

Former Minnesota coach and Central Collegiate Hockey Association commissioner Don Lucia said at the time that the lawsuit provides the opportunity for stakeholders to look at the situation.

“I don’t know if it would be necessarily settled through the courts or changes at the NCAA level, but I think the time is certainly fast approaching where some decisions will be made in the near future of what the eligibility will look like for a player that plays in the CHL and NCAA,” Lucia said.

Whitehead, a 20-year-old forward from Alaska who has developed into a point-a-game player, said he plans to play again this season with the Regina Pats of the Western Hockey League.

“The WHL has given me an incredible opportunity to develop as a player, and I couldn’t be more excited,” Whitehead posted on Instagram.

His addition is the latest boon for Arizona State hockey, a program that has blossomed in the desert far from traditional places like Massachusetts, Minnesota and Michigan since entering Division I in 2015. It has already produced NHL talent, including Seattle goaltender Joey Daccord and Josh Doan, the son of longtime Coyotes captain Shane Doan, who now plays for Utah after that team moved from the Phoenix area to Salt Lake City.

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Calgary Flames sign forward Jakob Pelletier to one-year contract

Published

3 hours ago

September 13, 2024

Anne Joseph

CALGARY – The Calgary Flames signed winger Jakob Pelletier to a one-year, two-way contract on Friday.

The contract has an average annual value of US$800,000.

Pelletier, a 23-year-old from Quebec City, split last season with the Flames and American Hockey League’s Calgary Wranglers.

He produced one goal and two assists in 13 games with the Flames.

Calgary drafted the five-foot-nine, 170-pound forward in the first round, 26th overall, of the 2019 NHL draft.

Pelletier has four goals and six assists in 37 career NHL games.

This report by The Canadian Press was first published Sept. 13, 2024.

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Kingston mayor’s call to close care hub after fatal assault ‘misguided’: legal clinic

Published

3 hours ago

September 13, 2024

Anne Joseph

A community legal clinic in Kingston, Ont., is denouncing the mayor’s calls to clear an encampment and close a supervised consumption site in the city following a series of alleged assaults that left two people dead and one seriously injured.

Kingston police said they were called to an encampment near a safe injection site on Thursday morning, where they allege a 47-year-old male suspect wielded an edged or blunt weapon and attacked three people. Police said he was arrested after officers negotiated with him for several hours.

The suspect is now facing two counts of second-degree murder and one count of attempted murder.

In a social media post, Kingston Mayor Bryan Paterson said he was “absolutely horrified” by the situation.

“We need to clear the encampment, close this safe injection site and the (Integrated Care Hub) until we can find a better way to support our most vulnerable residents,” he wrote.

The Kingston Community Legal Clinic called Paterson’s comments “premature and misguided” on Friday, arguing that such moves could lead to a rise in overdoses, fewer shelter beds and more homelessness.

In a phone interview, Paterson said the encampment was built around the Integrated Care Hub and safe injection site about three years ago. He said the encampment has created a “dangerous situation” in the area and has frequently been the site of fires, assaults and other public safety concerns.

“We have to find a way to be able to provide the services that people need, being empathetic and compassionate to those struggling with homelessness and mental health and addictions issues,” said Paterson, noting that the safe injection site and Integrated Care Hub are not operated by the city.

“But we cannot turn a blind eye to the very real public safety issues.”

When asked how encampment residents and people who use the services would be supported if the sites were closed, Paterson said the city would work with community partners to “find the best way forward” and introduce short-term and long-term changes.

Keeping the status quo “would be a terrible failure,” he argued.

John Done, executive director of the Kingston Community Legal Clinic, criticized the mayor’s comments and said many of the people residing in the encampment may be particularly vulnerable to overdoses and death. The safe injection site and Integrated Care Hub saves lives, he said.

Taking away those services, he said, would be “irresponsible.”

Done said the legal clinic represented several residents of the encampment when the City of Kingston made a court application last summer to clear the encampment. The court found such an injunction would be unconstitutional, he said.

Done added there’s “no reason” to attach blame while the investigation into Thursday’s attacks is ongoing. The two people who died have been identified as 38-year-old Taylor Wilkinson and 41-year-old John Hood.

“There isn’t going to be a quick, easy solution for the fact of homelessness, drug addictions in Kingston,” Done said. “So I would ask the mayor to do what he’s trained to do, which is to simply pause until we have more information.”

The concern surrounding the safe injection site in Kingston follows a recent shift in Ontario’s approach to the overdose crisis.

Last month, the province announced that it would close 10 supervised consumption sites because they’re too close to schools and daycares, and prohibit any new ones from opening as it moves to an abstinence-based treatment model.

This report by The Canadian Press was first published Sept. 13, 2024.

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