P.E.I. rural hospitals bearing brunt of pandemic staffing crunch

Hospital closures have been increasing on P.E.I. since the pandemic onset, data gathered by CBC News shows.

That's as Health P.E.I. says it's completed a review that will determine what service in rural areas could look like in the years to come.

CBC News combed through all hospital service closures notices issued by the province over the last three years.

It found rural hospitals are the ones most impacted by said closures, and that they're mostly concentrated in two hospitals: Kings County Memorial Hospital (KCMH) in Montague, and Alberton's Western Hospital.

"It isn't a budget issue. It isn't an issue related to whether we want to provide service in one area or another," Health P.E.I. CEO Dr. Michael Gardam said.

"It's simply if we don't have enough people, we can't run the service."

About 83 per cent of the closures that have happened since 2020 were attributed to staffing issues. Around 76 per cent of those overlap with weekends and holidays. 

"It just validates that we don't have the resources right now to provide the services that we're being asked to provide," said Barbara Brookins, president of the P.E.I. Nurses' Union.

"We don't have enough nurses and we're being asked to do more and more all the time, but we can't continue to keep the services going the way they are right now."

Closures sky-rocketed in 2022

Closures occurred 31 days of the year in 2020, either in collaborative emergency centres or emergency rooms. That amounts to about 133 hours of closed services.

In 2021, the number of days affected fell to 26 days. But the hours services weren't on offer actually jumped by nearly 50 per cent to 195 hours, as they either shut down earlier or didn't open at all.

Then in 2022, the figures were 14 times higher than the previous year: 2,727 hours over 293 days.

Many of those closures are related to physicians' and nurses' availability to work.

"We lost large numbers during the pandemic, and last year we had 33 retirees and that [didn't] recognize the ones that left right at year end," Brookins said.

"This year, I mean we have almost 200 that are eligible to retire. So the positions are empty. We have over 300 positions, which is 23 per cent of our members missing right now."

P.E.I. is already on track to surpass last year's figures in 2023. From Jan. 1 to April 30, Islanders experienced about 1,635 hours of closures.

That includes the prolonged closure at the Western Hospital Collaborative Emergency Centre (CEC), which was staffed by a nurse and a paramedic for 12 hours each evening, but hasn't opened its doors since last July. 

That means service closures have impacted every day of the year so far.

The Souris Hospital permanently closed its ER in 2006 due to physician shortages. 

Every day a struggle, Health P.E.I. CEO says

Alberton residents have expressed great concern over the future of the Western Hospital. It became an election issue this spring, with all four parties committing to keeping rural hospitals open.

But staffing them is the more difficult task.

"We're really struggling to just keep the services going every single day and it all relates to staffing," said Gardam.

While the overnight CEC at the Western Hospital has been closed for nearly 10 months with no indication as to when it will re-open, the daytime emergency room regularly runs 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 staffing shortages or overcapacity.

Brookins said resources are stretched thin within rural facilities like Western Hospital, and nurses are often taken off the emergency room to staff other parts of the hospital, like the inpatient units. 

"In a lot of our work sites, we only have one registered nurse or two registered nurses," she said.

"So if one is missing, it's 50 per cent of your staff. And if there is only one and that person's missing, you're missing all of your staff."

Protecting the QEH and PCH

More Islanders are also ending up in emergency rooms because they don't 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's had to visit the KCMH emergency room three times to get the care she needed.

"It's difficult, really, because we need to wait. We're sick and we need immediate response from them," Medilo said.

"I just hope there will be changes because health is so important."

Health P.E.I. agrees. Gardam said access to primary care is the biggest issue across the system.

Health P.E.I. has finished the service review it announced when the Western Hospital CEC was closed. 

Gardam said the data showed that many using the Montague emergency room did not have a family doctor, but those at Western Hospital did.

"Western is very small with a lower acuity compared compared to KCMH … KCMH is the one that I worry the most about."

Unlike Western Hospital, the Kings County Memorial Hospital never closed for the entire day due to staffing. It did, however, regularly limit its ER to shortened hours. 

Health P.E.I. has said it may be forced to close the ER on weekends this summer due to physician shortages. 

When asked how close the Charlottetown and Summerside hospitals were to seeing those kinds of service disruptions, Gardam said that would never be an option.

"That would be deadly … we have to protect those two emergency departments as much as we possibly can. So we will make changes elsewhere in order to protect those."

But Gardam said that doesn't mean the ripples caused by rural hospital closures aren't being felt elsewhere. 

He said the Montague hospital is "very, very busy" when operating, and closures at the KCMH often mean increased traffic in the Charlottetown emergency room.

We're really struggling to just keep the services going every single day— Dr. Michael Gardam, Health P.E.I. CEO

The KCMH closed early 64 days in 2022, including during three separate COVID-19 outbreaks. 

It's already closed early 22 days so far this year, half of which were during an outbreak.

Because some ERs and CECs function more as primary care units than true "emergency" rooms, Gardam said closing them does not necessarily mean lives are at stake.

"I'll give you a hypothetical example: Somebody is in a large car accident right out in front of the CEC. Whether the CEC is open or not is irrelevant," he said in an interview last September.

"The CEC is essentially a walk-in clinic at most. What they could do is provide emergency first aid, but if we had a well-funded, well-positioned ambulance service, they would do exactly the same thing while they are driving to a larger centre."

Gardam said the Western Hospital is not seeing the same patient traffic as Montague's emergency room, and its closures aren't felt in Summerside's Prince County Hospital.

Review results could be out this summer

The Health P.E.I. CEO said he's seen an early draft of the review that will provide the direction for its service delivery in the coming years.

"It's certainly our intention to provide emergency department services to all Islanders ... within a reasonable distance of where they live. In terms of would we keep exactly the same model we have right now, that's what the data is going to show us," Gardam said.

"If we're going to have a service, we need to have enough resiliency of that service [so] that it's not going to close because somebody went on holidays."

Gardam said he doesn't have an exact timeline, but the results of the review could be "finished and out" this summer.