Health

Pressure Point

They are the canaries in the mine shaft of the health system. When facilities are strained to breaking, the pros in emergency pay the price.

Brian Bergman February 7 2000
Health

Pressure Point

They are the canaries in the mine shaft of the health system. When facilities are strained to breaking, the pros in emergency pay the price.

Brian Bergman February 7 2000

Pressure Point

Health

Special Report

They are the canaries in the mine shaft of the health system. When facilities are strained to breaking, the pros in emergency pay the price.

With the winter come the crises. They started early this year, with hospitals across Canada reporting massive overcrowding in their emergency departments in mid-November, several weeks before the annual flu onslaught ratcheted the problem up a few notches. At their worst, the continuing strains cause big-city hospitals to shut their emergency departments to new arrivals and divert ambulances elsewhere. Doctors in smaller communities seeking to have patients transferred to larger centres for treatments of complex conditions are told there are no beds available.

Usually, the delays have relatively minor effects— uncomfortable waits for care or slightly longer trips by ambulance. Occasionally, however, the consequences are dire. A 69-year-old man died in hospital in Weyburn, Sask., on Dec. 3, a day after suffering a heart attack. His doctors say they were told repeatedly there was no bed available for him for specialist care in Regina; authorities in the capital say the urgency of the situation was not made clear. And in Ontario, inquests have been ordered into the deaths of two men—an 18-year-old asthma sufferer in Toronto on Jan. 15 and a 51-year-old work-

man who fell six storeys from scaffolding in neighbouring Mississauga on Dec. 13. In both cases, their ambulances were turned away from the closest hospital.

The problem has several causes: too many beds taken out of the hospital system during years of downsizing; inadequate provisions to care for recovering patients outside the hospital; emergency departments treating nonemergencies; the periodic stresses from flu outbreaks and other high-demand periods. But the results are the same in city after city: doctors, nurses and paramedics scrambling to cope. On the political level, Health Minister Allan Rock invited his provincial counterparts last week to meet with him in May to discuss fundamental changes to the health-care system. Alberta Premier Ralph Klein, meanwhile, said he would use this week’s First Ministers’ conference to demand that Ottawa reimburse the provinces for the billions it cut from its social-services transfer payments in the past decade.

For this Special Report, Macleans writers joined the workers on the front lines of emergency care in three cities. Their accounts:

CASE 1 Paramedics: pride and frustration

Brian Bergman

IN CALGARY

Pat Hall definitely has the human touch. During a 10-hour day shift, the 42-year-old Calgary paramedic repeatedly shows an interest in his patients that goes beyond their immediate health needs. “So what’s your five-year plan?” he asks a 23-year-old homeless man complaining of severe neck pain. As it turns out, the patient, a softspoken status Indian from northern Saskatchewan, has ambitious goals: he wants to go to university, study science and help find a cure for cancer, a disease

that killed his mother. Hall also deals with a 32-year-old systems analyst who collapsed on a downtown sidewalk due to blood-flow problems to his heart. Despite being strapped to an ambulance gurney and hooked up to a heart monitor, the man wants to make a business call on his cell phone. Hall gently rejects the request. “We need to get you to slow down,” he says, “and take a time-out to get healthy.”

A 21 -year veteran of Calgary’s Emergency Medical Services, Hall likes to think his job makes a difference. He speaks with quiet pride of how he is constantly “walking into somebody

else’s world and taking care of their emergency.” It’s a sentiment echoed by his colleague, Trevor Johns, 29, an emergency medical technician. “You don’t get a lot of glory,” he notes, “but it’s nice to know you are helping people when they need it most.” All the same, both men speak of their growing frustration—and impatience—with a health-care system they feel is battered and on life support.

They talk of consistently longer waiting periods—sometimes up to an hour—at hospital emergency departments before they can transfer their patient from an ambulance stretcher to

a hospital gurney. Or of having to continue treating a patient in a crowded emergency corridor because there is no one available to take over. Or of medical staff who, by the end of their shifts, are understandably frayed by the demands put upon them. “At some point, the family of patients have to vent and it’s usually the nurses who get it,” observes Hall. “For the most part, the nurses do a remarkable job of keeping it together. But sometimes, it’s just too much.”

As Macleans accompanies Hall and Johns on a shift, some of those strains are apparent. When they deliver their first patient—the stressed-out systems analyst—to Foothills hospital at 9 a.m., theirs is the only ambulance in the bay. Inside the emergency department, however, there are already three patients on overflow stretchers in the front corridor and the daily wall chart indicates 14 patients who came in overnight and need to be admitted are still waiting for beds. A separate sheet shows that of the roughly 1,800 acute-care beds across Calgary, only 38 are available. “Not bad,” jokes Johns. “We’re at 98-per-cent capacity. If we were dealing in commodities, rather than people, it would be a banner day.”

When Hall and Johns return to Foothills with another patient at 5 p.m., near the end of their shift, the backlog has not disappeared. Patients fill every spot in emerg—including the systems

analyst still waiting for a bed in intensive care—and four more lie on overflow stretchers. The staff looks harried as four more ambulances arrive in quick succession. “This is pretty normal,” says Hall. “It can get much worse.”

It wasn’t always like this. Hall recalls “the good old days,” all of five years ago, before the worst of the health-care cuts took effect in Alberta. When he arrived at a hospital, a bed would be available and staff had time to deal properly with his patient. Now, patient care is suffering—and Hall fears that someone will have to die needlessly before matters improve. “That’s going to happen,” he says. “I have no doubt about it.”

As in the rest of the country, hospital beds are at a premium in Calgary. In 1995, under orders from the province, the city’s hospitals were consolidated, along with a host of other health facilities and services, into the Calgary Regional Health Authority.

Faced with reduced provincial funding and escalating operating costs, the authority closed the city’s two downtown hospitals, leaving only three acute-care facilities, in the city’s northwest, northeast

and southwest. The closures left Calgary as the only major Canadian city without a downtown emergency department. For ambulance crews, that often means longer drives through ever-denser traffic—especially since the largest percentage of their calls come from the city core.

During last winters flu season, Calgary newspapers were filled with reports

NO VACANCY

Across the country, health authorities have shut down hospital beds before establishing a system to take care of enough discharged patients in the community. With many of the remaining hospital beds still occupied by patients who could be treated at home or in long-term-care facilities, emergency departments overflow with new cases.

Change in the number of hospital beds available over the past decade

1989 1999 change Canada 175,824 Yukon 154 N.W.T. 485 B.C. 21,842 Alta. 18,657 Sask. 7,865 Man. 6,486 Ont. 51,683 Que. 53,220 N.B. 5,066 P.E.I. 771 NS. 5,928 Nfld. 3,667

of overflowing emergency rooms and ambulances being diverted to more distant hospitals. According to both health authority and ambulance service officials, diversions are happening again this year, but not as frequently. “Anyone in life-threatening situations,” stresses Robert Abernethy, clinical head of emergency services for the regional authority, “will be taken to the nearest hospital and dealt with there, no matter how busy it is.”

Since 1995, the number of staffed acute-care beds in the city has inched up to 1,816 from 1,748— while the city’s population ballooned by 103,000. But Abernethy cautions against seeing additional acute-care beds as a panacea. It’s more important, he says, to take the pressure off existing beds by improving other aspects of health-care delivery. The regional authority, in fact, is moving on several fronts. Over the past three years, the number of spaces for home care, community care or day support has climbed to 12,500 from 9,500. The authority is also looking at opening several community-based urgentcare clinics to treat people who might otherwise head to the nearest emergency ward. And an aggressive vaccination campaign among Calgary seniors has dramatically reduced flu outbreaks—helping to bring down the overall number of visits to emergency.

As welcome as those developments are, to many frontline workers progress often seems painfully slow. And sometimes, the indignities hit very close to home. Hall’s 92-year-old father suffers from advanced Parkinson’s disease; his mother, in her 80s, is also in failing health. They are in and out of hospitals, and have each spent up to a full day in emergency waiting for a bed. “My parents talk about a health system that was built up by today’s seniors when they were young, and how it has collapsed,” says Hall quietly. “It’s not a pretty picture.”