Almost two years into a “temporary” overnight shutdown of Port Hardy and Cormorant Island Health Centre emergency departments, there is no immediate plan to reopen and what doctors have called a crisis in rural emergency care has only grown.
Newly minted Health Minister Josie Osborne acknowledges ER closures in rural communities cause anxiety and stress, and said while progress has been made in recruitment of health-care workers across Vancouver Island, there’s no plan yet to permanently reopen Port Hardy’s ER overnight.
“We want to make sure when we bring back 24/7 coverage to emergency departments like Port Hardy that it’s sustainable,” said Osborne. “So that means that we still have more work to do.”
In January 2023, then health minister Adrian Dix and Island Health president and CEO Kathy MacNeil introduced $30 million in capital and operating funding for the Mount Waddington region — which includes Port McNeill, Port Hardy, Port Alice and Alert Bay — that was supposed to provide stability after months of revolving overnight closures.
Under the plan implemented at that point, Port McNeill Hospital, about 40 kilometres from Port Hardy, would be the only acute-care hospital ER in the region open 24 hours a day. ER services would be available from 7 a.m. to 5 p.m. at Port Hardy’s hospital and from 8 a.m. to 7 p.m. on Cormorant Island
The plan included a daily shuttle between hospitals, a mobile CT service, hiring of new physicians and nurses, construction of staff housing and upgrading of facilities, with regular 24-hour ER availability to be restored “as soon as possible.”
A year later, five North Island doctors said in a letter to the sa国际传媒 Medical Association (Doctors of BC) and Health Ministry that they had fewer physicians “and there has actually been very little stabilization taking place.”
This month, however, Port Hardy Mayor Pat Corbett-Labatt said there are signs of progress: Some of the new staff housing is soon to open, the CT diagnostic service is working well and “people are being hired.”
Corbett-Labatt believes Osborne will deliver. “We’re getting more doctors, and it looks like more doctors are going to be coming in the spring,” she said. “And the doctors in Port McNeill have been absolutely amazing.”
While it still sometimes takes the absence of just one nurse to force an emergency-department closure, Corbett-Labatt said there are many reasons to be optimistic.
She pointed to an Island Health program that provides paid upgrading training in emergency care for nurses in return for 18 months’ service in a hospital ER.
Port McNeill Mayor James Furney said the town now has more physicians, but its doctors, nurses and other health-care staff are burning out delivering overnight ER coverage for the whole region.
“I think there’s a little light at the end of the tunnel in that there’s a few more doctors that have been attracted to the area,” said Furney, “but we are struggling again on the retention of nurses and we’ve got a high turnover of travel nurses.”
Travel nurses are nurses who work for private companies — often making more money than nurses who work for the public system — and are contracted by health authorities on an as-needed basis.
While headlines often focus on the doctor shortages, finding nurses is just as difficult, said Furney. “I like to joke that if we just stopped the entire travel nurse program and everybody went home, we’d be fine.”
Furney said he has “great faith” in Osborne’s rural experience and her “hands-on” approach. Osborne served as mayor of Tofino from 2013 to 2020 before winning a seat as MLA for Mid Island-Pacific Rim.
“I’m very confident that the small-town lens that has been missing is going to be firmly in place with Josie’s appointment there,” said Furney. “So I think there’s great excitement for her appointment.”
Dr. Carrie Marshall, who operates a family practice in Ucluelet and serves as chief of staff at Tofino General Hospital along with working at Port Alberni Hospital, said the region’s hospitals are all comparatively well staffed, though attaching patients to family doctors is always a challenge.
Marshall said those in rural health are excited about Osborne as minister. “[Personally] I think it’s good for the province,” she said. “It’s one thing to have a briefing note about rural health but it’s another thing to live it.”
Farther south at Saanich Peninsula Hospital, which also saw its emergency department “temporarily” close overnight in July 2023, Dr. Aimee Kernick, who works in the ER, said it’s unlikely the department will reopen overnight “in the near future.”
The situation is complex and regularly evaluated, but health-care-worker-to-patient ratios remain a concern, said Kernick, who is president of the Canadian Association of Emergency Physicians.
Kernick said the emergency department is seeing the same or more patients than it did before the overnight closure, “so we’re seeing more patients in fewer hours.”
Kernick is hopeful about what Osborne might achieve, given that she has said rural health is a priority. But the solutions so far for increased staffing and retention are not “drastic enough,” she said.
Root causes of the crisis in emergency care need to be addressed, such as overcrowded ERs that are unable to admit patients to hospital because beds are occupied by people awaiting long-term care, she said.
ER physician shortages and burnout are also issues, as are Urgent and Primary Care Centres, said Kernick.
While UPCCs were intended to provide episodic care to reduce emergency-department volumes, instead, they’ve pulled family doctors from primary care, “which is about health-care prevention, which is what leads to reduced need for emergency departments.”
“So overall, it doesn’t seem like the UPCCs have benefited the emergency-department crisis,” she said.
A study released this past week says one in seven visits to an emergency department could potentially be managed in primary care and half of those could potentially be managed virtually.
The Canadian Institute for Health Information found those most likely to use the emergency department for primary care include young children, people who live in rural or remote areas, and people who reported not having access to primary care.
The first UPCC to open in sa国际传媒 was in Langford in 2018. The centres have since mushroomed across the province.
Osborne said there are no plans to reconfigure UPCCs that are currently open or halt those that have been announced or are being built. A second Urgent and Primary Care Centre is set to open in Nanaimo in 2025 at 3260 Norwell Drive.
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