Global Courant 2023-05-16 14:00:00
Hospital closures on PEI have increased since the start of the pandemic, according to data collected by CBC News.
That’s as Health PEI says it has completed an assessment that will determine what service delivery in rural areas could look like for years to come.
CBC News combed through all of the hospital service closure notices the county had issued over the past three years.
It found that rural hospitals are most affected by said closures, and that they are mainly concentrated in two hospitals: Kings County Memorial Hospital (KCMH) in Montague and Alberton’s Western Hospital.
“It’s not a budget issue. It’s not a matter of whether we want to provide service in any area,” said Dr. Michael Gardam, CEO of Health PEI.
“If we don’t have enough people, we just can’t run the service.”
About 83 percent of closures since 2020 have been attributed to staffing issues. About 76 percent of that overlaps with weekends and holidays.
“It just confirms that we don’t have the resources right now to provide the services we’re being asked to provide,” said Barbara Brookins, president of the PEI Nurses’ Union.
“We don’t have enough nurses and more and more are being asked of us, but we can’t keep the services running as they are now.”
Closures skyrocketed in 2022
In 2020, closures took place 31 days a year, either in cooperating emergency centers or in control rooms. That equates to approximately 133 hours of closed shifts.
In 2021, the number of affected days dropped to 26 days. But the hours when services were not offered increased by nearly 50 percent to 195 hours, as they either closed earlier or did not open at all.
In 2022, the figures were 14 times higher than the year before: 2,727 hours over 293 days.
Barbara Brookins is the president of the PEI Nurses Union. She says her members are frustrated and some are choosing to move within the system to find more stability. (Laura Meader/CBC)
Many of those closures are related to the availability of doctors and nurses to work.
“We lost big numbers during the pandemic, and last year we had 33 retirees and that (didn’t) recognize those who left at the end of the year,” Brookins said.
“This year I mean we have almost 200 who are eligible to retire. So the positions are empty. We have over 300 positions, which is currently missing 23 percent of our members.”
PEI is already on track to surpass last year’s numbers in 2023. From January 1 to April 30, the islanders had approximately 1,635 hours of closures.
So has the long-term closure of the Western Hospital Collaborative Emergency Center (CEC), which was staffed by a nurse and a paramedic for 12 hours each evening but has not opened its doors since July last year.
That means service closures have affected every day of the year so far.
Souris Hospital permanently closed its emergency room in 2006 due to a shortage of doctors.
Every day is a struggle, says the CEO of Health PEI
Alberton residents have expressed deep concern for the future of Western Hospital. It became an election issue this spring, with all four parties committing to keep rural hospitals open.
PEI CEO Michael Gardam says the county’s health care system needs to move beyond models where it relies on one or two staff members to run a service. (Nicola MacLeod/CBC)
But manning them is the more difficult task.
“We’re really struggling to just keep the services running every day and it’s all about staffing,” says Gardam.
Although the overnight CEC at Western Hospital has been closed for nearly 10 months and there is no indication when it will reopen, the ER is open regularly during the day from 8 a.m. to 8 p.m.
But the ER also closed more than 24 times last year – and already 11 times in the first four months of 2023. All closures were attributed to staff shortages or overcapacity.
Brookins said resources are scarce within facilities nationwide like Western Hospital, and nurses are often pulled from the emergency room to staff other areas of the hospital, such as the inpatient departments.
“In many of our job locations, we only have one registered nurse or two registered nurses,” she said.
“So if one is missing, that’s 50 percent of your staff. And if there’s only one and that person is missing, you’re missing all of your staff.”
Protection of the QEH and PCH
More islanders are also entering the emergency room because they do not have access to a primary care provider.
Madelyn Medilo lives in the Montague area and is on the patient registry waiting for a doctor. She had to go to the emergency room at KCMH three times to get the care she needed.
“It’s really hard because we have to wait. We are sick and we need an immediate response from them,” Medilo said.
“I just hope there are changes because health is so important.”
CBC found that the KCMH has never fully closed since 2020, but the emergency room has closed early due to staff shortages or COVID-19 outbreaks. Gardam says it is a busy ER and the closures will affect traffic at the Queen Elizabeth Hospital ER. (Shane Hennessey/CBC)
Health PEI agrees. Gardam said access to primary care is the biggest problem in the entire system.
Health PEI has completed the service review it announced when Western Hospital CEC closed.
Gardam said the data showed that many who used Montague’s emergency room did not have a primary care physician, but those at Western Hospital did.
“Western is very small with lower sharpness compared to KCMH…KCMH is the one I’m most concerned about.”
Unlike Western Hospital, Kings County Memorial Hospital is never closed all day due to staffing. However, it limited being ER regularly to reduced hours.
Health PEI has said it may be forced to close ER on weekends this summer due to a shortage of doctors.
When asked how close the hospitals in Charlottetown and Summerside were to seeing this kind of service interruption, Gardam said it would never be an option.
“That would be deadly…we need to protect those two emergency departments as much as possible. So we will make changes elsewhere to protect those.”
But Gardam said that doesn’t mean the ripples caused by nationwide hospital closures aren’t being felt elsewhere.
He said Montague Hospital is “very, very busy” during surgery, and closures at the KCMH often mean increased traffic in Charlottetown’s emergency room.
We are really struggling to just keep the services running every day— dr. Michael Gardam, CEO of PEI Health
The KCMH closed 64 days early in 2022, including during three separate COVID-19 outbreaks.
It has closed 22 days early so far this year, half of them during an outbreak.
Because some ERs and CECs function more like primary care units than true “emergency rooms,” Gardam said closing them doesn’t necessarily mean lives are at stake.
“I’ll give you a hypothetical example: Someone is involved in a major car accident right before the CEC. Whether the CEC is open or not doesn’t matter,” he said in an interview last September.
“The CEC is essentially a walk-in clinic at most. What they could do is provide first aid, but if we had a well-funded, well-positioned ambulance service, they would do the exact same thing while moving to a larger center.”
Gardam said Western Hospital is not seeing the same patient traffic as Montague’s emergency room, and the closures are not being felt at Prince County Hospital in Summerside.
The results of the review could be available this summer
Health PEI’s CEO said he has seen an initial draft of the assessment that will set the direction for the service in the years to come.
Gardam says PEI data from Health shows the Western Hospital doesn’t see much traffic and many of the patients have a GP. (Shane Hennessey/CBC)
“It is certainly our intention to provide emergency services to all islanders … within a reasonable distance of where they live. In terms of that, we would keep exactly the same model that we have now, which is what the data will show us,” Gardam said .
“If we’re going to have a service, we need to have enough resilience from that service (so that) it’s not going to close because someone went on vacation.”
Gardam said he doesn’t have an exact timeline, but the results of the assessment could be “done and known” this summer.
