Chain reaction: How 2 vacant doctor jobs closed Whitbourne's ER and put pressure on paramedics
Red alerts, unpredictability and long transport times plague paramedics
You won't find many ambulances parked outside the Dr. William H. Newhook Health Centre in Whitbourne these days.
Two vacant physician positions at the facility have caused a chain reaction in the health-care system that has forced the emergency room to remain closed for almost five months and making a tough job even harder for paramedics with the nearby Smith's Ambulance Service.
The first temporary closure of the ER, for a week, was June 27. But week after week, Eastern Health has issued press releases extending the temporary closure, which remains in effect until at least 8 a.m. on Monday.
Wade Smith, who owns the private ambulance service, said the closure has had a big impact on the region.
"Red alerts and no coverage for four to six hours, nearest ambulances is probably 35 to 40 minutes away," Smith said.
He said patients have to wait longer for care because the closure forces ambulances to take people to hospitals farther away, in Placentia (50 kilometres away), Carbonear (60 kilometres) or St. John's (90 kilometres).
According to Eastern Health, Smith's — which covers 14 communities from Roche's Line to Chance Cove — has answered more than 300 calls since Whitbourne's ER closed in June.
"It's a never-ending battle with long transport times, fatigued crew, patients just complaining that it's taking forever to get an ambulance and taking forever to get to a hospital," said Rudy Mercer, Smith's lead hand and paramedic of 20 years.
And when patients get to the hospital, there's often more waiting with delays getting patients inside for treatment, says Smith.
"That's probably the biggest impact that we're seeing on staff," he said.
"We're standing in hallways, no place to sit down, tending to patients for anywhere from two to four to six hours, sitting in the back of an ambulance with a COVID-positive patient or possible COVID-positive patient for hours on end," Smith said.
Smith says he's even had to respond to the Whitbourne Health Centre to pick up someone experiencing chest pain who was already there for an appointment but couldn't be triaged or treated by nurses.
Unpredictability of paramedicine
Smith, who has been operating a private ambulance service since 1996, says current conditions are the worst he's experienced.
He has four ambulances at his base near Whitbourne but says there's only enough funding from the provincial government to run three of them full time. Two operate 24/7 and the third is staffed during the day Monday through Friday.
WATCH | Paramedics describe the impact of the Whitbourne ER closure:
On a recent day at the base, an ambulance leaves for Dildo, 25 kilometres away, to pick up a patient and bring them to St. John's for a doctor's appointment — a trip that will tie up the ambulance for three hours, possibly more.
But upon arrival, the crew is notified the transport was cancelled the previous day but dispatch didn't tell them.
"It's been a day already," says emergency medical responder Dan Strickland, returning from that call.
It was supposed to be emergency medical responder Erica Clarke's first call without a supervising trainer.
"We were going to be gone all day. So now we are just sitting back and waiting for another call to come in," says Clarke.
Not long after, a different ambulance is summoned to St. John's because the metro area is in "red alert," which means there are no ambulances free to respond to emergencies.
"When the Health Sciences gets short on resources, they call on private operators to come in and help fill the gaps for them … so they take ambulances out of other areas that may have a spare one. In this particular case, they took one of ours," says Mercer.
That leaves just one Smith's ambulance in the Whitbourne region to respond to an emergency and it means Mercer needs to leave his post in the office, filing paperwork, to fill in on an ambulance if another call comes in.
"A week and a half ago we had four ambulances gone, two gone on routines, two doing back-to-back emergencies, and we were six to seven hours with not one ambulance in our particular area," he says.
"But that's just the irregularity of the calls, the unpredictability," says Mercer.
Back inside the staff quarters, some are resting in bedrooms while others make lunch.
"We work 24-hour shifts. So really when you get a chance and you're feeling a little bit hungry, that's the time to eat because you don't know when that phone's gonna ring," says primary-care paramedic Lindsay Clarke, who has worked with Smith's for two years.
Trauma and its toll
With a busy section of the Trans-Canada Highway nearby, first responders in the Whitbourne area say they see a lot of traumatic calls.
And it can take a toll.
In a rural area where everyone knows everyone, Mercer said, it can make responding to serious calls hit too close to home.
"There's very few patients that I've ever picked up that I didn't have some sort of connection with." he said.
"I've picked up my family members. My father passed away. I was on call. I had to respond."
Mercer said that call still weighs on his mind 16 years later.
"It's hard, but you always put the patient first," he said, welling up.
Every paramedic has their breaking point, says Mercer. He isn't there yet. But it's clear he's close.
"After 30 years of doing this job, I actually said to my wife there for the first time in my life within the last two months, 'I'm ready to go. I'm like, 'Can you get me a job somewhere else? Is there somewhere else I can go?'" he said.
He's getting frustrated, he says.
It is actually very hard," he said, getting visibly more upset, "not knowing if in a month's time, six months' time, you're going to have a job because you can't handle it no more."
Recruitment 'nearly impossible'
Veteran paramedics like Mercer, with more than 20 years of experience, are hard to replace, says Smith.
These days, Smith said, it takes at least six months to hire someone new.
"For us to recruit staff is almost nearly impossible. We've had people leaving the industry because of the pandemic and because of the way the system is being operated by government," Smith said.
And when staff do leave, he said, it puts more pressure on everyone left behind.
In October, the provincial government announced $50,000 recruitment bonuses for primary-care paramedics who agree to return to the province to work for three years, but those already working in the system say there was no incentive to retain them.
"It was an insult to every paramedic who works on the island. I don't care if you're hospital-based or private, that was a kick. It hurt," said Mercer.
Inflation impacts
Out on the road, everything in an ambulance is getting more expensive.
Smith estimates the cost of supplies is up about $6,000 a year and vehicle maintenance costs are nearly $30,000 more. Oxygen deliveries and insurance costs are up, too.
So is gasoline, but Smith says his contract has a clause that covers the increases and the provincial government is also helping with personal protective equipment during the pandemic.
But the other increases eat into his budget, which the government hasn't increased since 2014 — another pressure point for Smith.
In the long term, the provincial Health Accord — a government blueprint for revising health-care delivery — envisions integrating N.L.'s road and air ambulance system, with a provincewide central dispatch, but any change could be years away.
No permanent plans to close: Eastern Health
As winter approaches, Smith's anxiety is growing.
Bad accidents can happen on the highway and snow, ice and slush on the roads can further slow patient transport times to hospital.
"We're going to really see the need for that health centre," he said, calling the Whitbourne ER a vital link in the health-care system that is sometimes used to stabilize patients en route to St. John's.
And as the ER closure drags on, Smith wonders if it will ever operate on a 24/7 basis again.
In a statement, Eastern Health says "there is no plan" to close the facility's emergency services permanently, but Smith doesn't buy it. He blames Eastern Health for creating the conditions that caused the ER closure while trying to fix the doctor shortage in another area of the health-care system.
"The [doctors] that are no longer there went to collaborative clinics. They were offered positions in collaborative clinics by Eastern Health. So technically, Eastern Health was the one who caused the staffing problems there in the first place," he said.
Eastern Health says it is trying to recruit doctors, has interviewed some and extended offers.
"Eastern Health has not yet been able to fill the positions. In order to return to a 24-hour emergency service, the site requires the recruitment of two physicians in addition to the two currently on site," reads a statement.
Come Christmas, the Whitbourne ER will have been closed for six months. For now, it seems there won't be relief for the paramedics any time soon.
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