Timing was every part for Bruce Pieroway when he suffered a coronary heart assault in late October within the rural farming group of Chesley, Ont., about two hours north of Kitchener.
It occurred early on a Monday afternoon when the city’s solely emergency room was nonetheless open.
“The worst factor concerning the hospital right here is you do not know whether or not it is open or closed,” stated Pieroway, referring to Chesley’s ER, which has confronted power closures since 2022 and now solely operates between 7 a.m. and 5 p.m., Monday to Friday.
For Pieroway, who’s 70, the following closest emergency division is a 25-minute drive away.
However happily, at 2 p.m. that October day, the Chesley ER was open and hospital workers had been capable of get him stabilized.
Over the previous three years, at the very least 38 Ontario hospitals with emergency rooms or pressing care centres (UCCs) have skilled closures — about one in 5 of 176 publicly funded services.
Most are in rural areas. And Chesley’s ER tops the record with the very best variety of hours closed.
That is in keeping with CBC’s new compilation of all non permanent closures and repair interruptions introduced by ER and UCC departments between Jan. 1, 2022, and Nov. 30, 2024.
CBC’s evaluation tracked the hours they had been closed and the variety of days with a partial closure.
Though 2024 is not over, the information exhibits this would be the province’s worst yr for ER closures, a phenomenon that was “very uncommon” earlier than 2019-20, in keeping with a report by the Workplace of the Auditor Basic of Ontario.
“What it is meant right here is numerous anxiousness from individuals in the neighborhood [and] frustration generally boiling over into anger,” stated Brenda Scott, co-chair of the Save the Chesley Hospital Committee.
“I’ve all the time stated, you like to be primary, however not on this contest,” she stated. “You may really feel that stress in the neighborhood.”
Since hospital emergency departments are thought of 24-hour operations, any disruptions or adjustments to these hours, both non permanent or everlasting, had been counted as closures in CBC’s evaluation.
“What an emergency division is, it is an entry level for twenty-four/7 take care of sufferers of any acuity,” stated Dr. David Savage, an ER doctor in Thunder Bay. “I feel it is difficult to name a centre an ER if it is closing throughout sure components of the day.”
If a affected person exhibits as much as an ER and so they’re nonetheless ready at closing time, medical workers inform CBC that they may attend to their care even after locking the doorways for the night time.
In response to CBC’s evaluation, unscheduled ER closures have considerably decreased over the previous few years — from amounting to just about 4,200 hours in 2022 to about 939 hours this yr.
However some emergency departments, together with Chesley’s, have shifted to daytime, office-like hours.
These so-called “scheduled closures” symbolize greater than 93 p.c of all service interruptions for ERs within the province thus far this yr, greater than offsetting any enhancements in “unscheduled closures.”
“A closure is a closure, whether or not it is scheduled or not”, stated Savage. “That does restrict individuals’s entry to care.”
Savage is considered one of two emergency medical doctors, together with a health-care advocate and a nurse affiliation government, to have gone over CBC’s methodology and findings.
“This actually is the worst that it is ever been. This isn’t regular, and it ought to by no means develop into a brand new regular,” stated Natalie Mehra, government director of the Ontario Well being Coalition.
That group has stored its personal tally of closures, whereas a grassroots group referred to as Ghost Gurney maintains a map detailing closures.
For Mehra, formally lowering hours of ER service cannot be the reply.
“That’s fully unacceptable and it has to cease. That takes management. Actually the minister of well being might do this,” Mehra stated.
Natalie Mehra, government director of the Ontario Well being Coalition, says scheduled ER closures are unacceptable and need to cease. (Susan Goodspeed/CBC)
Decreased hours at 6 pressing care centres
2024 additionally seems to be a file yr for closures at UCCs, medical clinics that present same-day pressing therapy for accidents equivalent to sprains and damaged bones and diseases like fevers.
A number of ER physicians inform CBC that whereas UCCs do not serve the identical features as ERs, these departments have develop into a essential entry level for a lot of sufferers in a province the place 2.5 million persons are with no household physician.
“I see my colleagues in pressing care doing very emergency medicine-style work,” stated Dr. Andrew Park, former president of the Ontario Medical Affiliation and ER doctor in St. Thomas, Ont.
“Whether or not they are going to emergency departments or pressing care … they’re looking for entry to care that they only merely haven’t got.”
CBC knowledge exhibits that six pressing care departments have decreased common hours and have been closed for greater than 10,000 hours thus far this yr. Scheduled night-time closures at a handful of centres make up the overwhelming majority, the identical development discovered with emergency rooms.
The Fort Erie and Port Colborne Pressing Care Centres close to Hamilton account for a good portion of those hours.
CBC additionally shared its key findings with the Ontario Hospital Affiliation (OHA), together with a listing of the ten ERs and UCCs that had essentially the most days with a closure since 2022.
The OHA, which calls itself the voice of Ontario’s public hospitals, said that CBC had “erroneously included pressing care centres in its evaluation of emergency departments”.
“Pressing care centres present companies for these with sudden however non-life-threatening well being issues that require same-day therapy,” a spokesperson wrote in an e-mail. “In 2023/24 there have been greater than 350,000 visits to pressing care centres within the province of Ontario.”
Dr. Andrew Park, ER phyician and former president of the Ontario Medical Affiliation, says closures of rural emergency departments put already marginalized individuals in danger. (Park (Submitted))
‘Nice progress’: OHA
OHA president Anthony Dale initially agreed to an interview to debate the findings however then cancelled, citing “severe issues” over a few of CBC’s methodology, together with utilizing the “variety of days with a closure” as a unit of measurement.
The OHA stated hospitals throughout the province have made “nice progress” on the subject of addressing staffing challenges.
Lately, the Ontario authorities has “applied a variety of applications designed to recruit and retain well being care staff to encourage follow in rural and distant communities,” reads the OHA assertion.
In September, Ontario Chronicle requested Ontario’s Ministry of Well being for ER closure knowledge, however was directed to file a freedom of knowledge request.
Final week, the ministry stated in an e-mail that over the past yr it had seen “the variety of emergency division decreased hours” drop by 84 per cent. In addition they stated there have been “a complete of 90 decreased hours throughout the province” from June to August 2023, dropping to “a complete of 13” throughout the identical months in 2024.
In an try to take care of closures, the province launched a non permanent locum program, primarily offering fill-in medical doctors from different areas, to workers emergency rooms in rural and northern hospitals.
In July 2023, the Ford authorities pledged $44 million – along with the $90 million invested yearly – particularly to cut back ER wait instances, tackle staffing challenges, and stop closures.
Nancy Shaw, CEO of the South Bruce Gray Well being Centre, says residents inform her they need their native ERs to function 24/7. However she says that is not doable as a result of ongoing scarcity of nurses. (Yanjun Li/CBC)
Nurse scarcity prime purpose for closures
CBC’s knowledge additionally exhibits the first explanation for ER closures has been a scarcity of nurses, accounting for greater than 85 per cent of all closure hours.
“Nurses are leaving the career. Nurses aren’t coming into the career. They don’t seem to be staying within the career, and I do not assume anybody can blame them when there’s not a lot to maintain us right here,” stated Erin Arris, an ER nurse and the president of the Ontario Nurses’ Affiliation.
In response to Arris, rural hospitals have been chronically understaffed for years. As ER wait instances develop, workers are too typically subjected to violent behaviour, Arris stated, and the ensuing stress has led to widespread burnout.
Whereas some hospital CEOs report enhancements in nursing recruitment, the reliance on company nurses — non permanent workers contracted by way of non-public businesses — helps maintain ERs open at a excessive price.
For instance, one northeastern Ontario hospital has spent almost 1,000,000 {dollars} on company nurses this yr to keep up emergency companies.
“They cost hospitals three or 4 instances the sum of money that it might price to offer the identical unionized nurse,” stated Arris. “You may’t blame the nurse. It is a programs concern.”
On Nov. 20, the province pledged greater than $500 million to coach new nurses and supply specialised coaching to present ones.
In the meantime, a scarcity of physicians was the commonest issue for service interruptions in UCCs, representing over 69 per cent of all centre closure hours, CBC’s knowledge exhibits.
Most closures in rural hospitals
The ten ERs closed for essentially the most hours since 2022 are all in rural communities with populations below 8,000, and every facility has fewer than 50 beds.
“You are impacting individuals which might be already marginalized … making their entry to well being care tougher,” stated Park.
Actually, the majority of the ER closures tracked in 2024 are related to rural hospitals in Chesley, Clinton and Durham, all in southwestern Ontario and all at the moment closed at night time.
At latest public conferences, residents in that area made it clear to Nancy Shaw, CEO of the South Bruce Gray Well being Centre, that they need 24/7 emergency companies.
Shaw stated the dearth of nurses prevents the hospital authority from working all its ERs full-time.
“We all know we will not present that proper now,” stated Shaw. “We’ve got to make use of company workers or company nurses to fill these gaps in our nursing necessities.”
‘Worsening throughout the nation’
This development of frequent ER closures just isn’t restricted to Ontario, with rural hospitals from Nova Scotia to Quebec to British Columbia grappling with the problem.
“The state of affairs is worsening throughout the nation. We’re seeing extra closures yr by yr,” stated Dr. Aimee Kernick, president of the Canadian Affiliation of Emergency Physicians.
Kernick practices on the Saanich Peninsula Hospital on Vancouver Island. It has been closed in a single day for a yr.
Sufferers have informed her they’ve endured chest ache at dwelling as a result of the ER was closed, Kernick stated, selecting to attend till it reopened within the morning relatively than touring additional to a different hospital.
“Indubitably there can be poor affected person outcomes throughout the nation with closures and inaccessibility to care,” stated Kernick.
People who find themselves a part of the Save Our Hospital marketing campaign gathered exterior the hospital in Durham, Ont., in Might. The identical day, the Municipality of West Gray declared a state of emergency as a result of in-patient beds had been being moved out of the hospital. (Kate Bueckert/CBC)
Again in Chesley, Bruce Pieroway had coronary heart surgical procedure in late October and is now recovering effectively. He hopes he will not want to go to his native ER once more, but when he does, it may well nonetheless solely be throughout daytime hours.
Mehra, with the Ontario Well being Coalition, has travelled the province, speaking to residents. She’s additionally involved concerning the potential penalties of closed emergency departments.
“Once you’re having a coronary heart assault, are you alleged to be trying up on the web or phoning round to determine what emergency division is open? That is ridiculous,” stated Mehra.
In the meantime, ER physicians like Park surprise what occurs to those that do not search emergency assist due to lengthy waits or closures.
“Numerous instances we do not even hear concerning the ones that could not get care, as a result of they die at dwelling or they’ve actually dangerous outcomes,” stated Park.
“My hope is that we’re not ready until individuals die, until we make these actually structural and foundational adjustments.”
METHODOLOGY: How did CBC monitor ER and UCC closures?
This dataset paperwork each closure of an emergency room and pressing care centre (UCC) reported by considered one of 176 publicly funded hospital services with an ER or a UCC division in Ontario between Jan. 1, 2022 and Nov. 30, 2024. It was compiled and verified by CBC utilizing hospital information releases and documented media reviews.
CBC outlined a closure as any interruption to an ER’s 24-hour service or a UCC’s beforehand posted hours at any time for any period of time on a given date. If a facility was closed for a number of hours twice in a day – for instance, within the morning and later at night time – the hours had been summed up, but it surely was counted as sooner or later with a partial closure.
CBC categorized all closures as scheduled or unscheduled. Scheduled closures are cases the place a hospital or well being authority has modified its coverage to completely or semi-permanently cut back the hours of an ER or UCC. Unscheduled closures are unplanned, sporadic and happen exterior common or decreased hours.
Every entry consists of the hospital title and geographical location, the kind of closure (scheduled/unscheduled), the beginning/finish date, time, size (in hours) of every closure, and the rationale given (when specified). Entries additionally embrace the inhabitants within the area the hospital serves and the variety of inpatient beds.
To bolster accuracy, CBC in contrast its dataset in opposition to comparable closure knowledge compiled by Dr. David Savage, professor on the Northern Ontario College of Drugs, and grassroots organizations Ghost Gurney and the Ontario Hospital Coalition. Any discrepancy or new info collected by way of these sources was independently verified by CBC.
Observe {that a} multi-day closure of 137 hours at The Ottawa Hospital Basic Campus because of a hearth in November 2023 can be included within the dataset.
Information compiled and fact-checked by Kimberly Ivany and Julie Ireton (Sept.-Oct. 2024)
Information verification accomplished by senior knowledge journalist Valerie Ouellet (Nov. 2024)
