Old idea to quell ER closures in 2 neighbouring B.C. communities resurfaces: shut one down

As work continues to try to solve nurse and doctor shortages in the neighbouring Vancouver Island communities of Port Hardy and Port McNeill, an old idea has resurfaced: shut down one ER in the short-term and pool resources to keep the other one open.

Versions of the idea have been around since at least 2011, following a meeting to address the communities' overstretched emergency rooms at that time.

A draft list of recommendations written following the report, which was recently leaked to the CBC, started with a call to immediately close one of the ERs overnight and on weekends while staff recovered from burnout and a more sustainable plan was developed. 

Neither Island Health nor the agency which wrote the report would say what action was taken in 2011, but stakeholders, like Port Hardy Mayor Pat Corbett-Labatt, say even a total closure of one of the ERs could be a short-term solution to today's challenges.  

The hospitals in both communities, which are a 30- to 45-minute drive apart on the north Island, have faced closures of their ERs this year — usually overnight or for weekends.

For both hospitals, it's the community's family doctors who staff the emergency room. Those who choose to, sign up to be part of a rotation to cover the ER. 

When there isn't a doctor, or there aren't enough nurses to fill shifts, Island Health issues a notice that the emergency room will be closed for a stated period of time. People are asked to go to the other hospital's emergency room instead.

It's happened nearly 30 times in Port Hardy and 10 times in Port McNeill this year. 

Port Hardy Mayor Pat Corbett-Labatt says the short notice and the inconsistency are tough on residents. 

"[To] find out three hours ahead that it's closing for the weekend, or that it's closing overnight, it's just not enough time."

She says Island Health is working to recruit more staff, and there was recently a summit looking at solutions to the crisis, but in the short term, they need consistency. And that could come from shutting down one of the two ERs and pooling resources to staff the other. 

The challenge? How to decide which ER to close 

Corbett-Labatt acknowledges it would be politically tricky to decide which ER would get to stay open. 

She says the decision would need to be based on data about how each emergency room is used. 

Dr. Prean Armogam has worked in Port McNeill and surrounding communities for nearly 17 years — and has long called for an amalgamation of acute care services on the north island. He says, at the very least, closing one ER until more doctors and nurses are recruited would help prevent burnout. 

"The immediate answer, as a pressure release valve, needs to be one single acute care site."

While Port Hardy is bigger (a population of 3,393 to Port McNeill's 2,234), serves several First Nations communities and tends to have a busier hospital, it's also the one that has struggled the most to keep the ER open. 

Given that, Dr. Armogam says Port McNeill would be the ideal site for a short-term amalgamated emergency room. 

Impact beyond the 2 communities 

A shutdown of either ER would affect places beyond Port Hardy and Port McNeill. Smaller communities on inland Vancouver Island and populations on nearby islands feed into their hospitals. 

Alert Bay, a village which is a 40-minute ferry ride from Port McNeill, is facing its own acute care crisis. 

Its health centre, which normally has a 24-hour emergency room, has been closed overnight for four months straight because it doesn't have enough nurses. 

Don Svanvik, chief councillor of the 'Namgis First Nation, says people in the community are now at least an hour away from emergency care. 

"The impact is scary. People are nervous, We all have old people in our families, people that are not well."

He says if the Port McNeill emergency room were to close, that hour would become nearly two.  

But he wants staffing solutions in Alert Bay so they don't have to worry about getting to another hospital. 

Island Health 'recognizes the need for predictability and stability'

Island Health would not specifically say whether it is considering closing one ER as a short-term solution. 

In a statement to CBC News, it said: "Several options to address service sustainability are being considered, and we are acting as quickly as possible to ensure the continued provision of safe care for our patients and staff."

It pointed out that two new doctors recently started working in Port McNeill, and one has started in Port Hardy. 

Island Health was one of the participants in the early November summit looking at the health-care situation in the region and says it looks forward to learning from the final report. 

The report is expected to be released early next year.