Doctors say immediate action needed as patient collapses in closed Vancouver Island ER

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An incident in which a patient complaining of chest pain collapsed at the ­registration desk at Port Hardy Hospital while the emergency department was closed last week raised jurisdictional questions and bolstered calls to consolidate Port McNeill and Port Hardy emergency ­staffing.

“We need to significantly pivot our operations immediately, in order to provide safe predictable care for our patients and a reliable place for our health-care providers to practice,” wrote Dr. Nicole Bennett-Boutilier, medical director for Mt. Waddington-Strathcona, in a Nov. 27 email to Island Health president Kathy MacNeil.

In the email, obtained by the Times Colonist, Bennett-Boutilier notes the Nov. 25 case of a patient collapsing outside the closed ER follows two previous cases where there was confusion about what to do during such a closure prior to an ambulance showing up.

In one case, health-care providers at Cormorant Island Hospital in Alert Bay rushed to help and in another case in Port Hardy, they did not. In an email sent Nov. 26 about the latest incident, physician lead Dr. Jessica Macleod said staff called 911 but the B.C. Ambulance Service said a crew from Port McNeill, 43 kilometres away, would need to pick up the patient.

Meanwhile, a nurse helped the patient onto a stretcher and obtained his vital signs. When no ambulance arrived “after some delay,” Macleod said in the email, she called B.C. Ambulance Service again.

“It was reported to me by BCAS that as soon as health-care staff intervened, the hospital was considered to have ‘taken control of the patient,’ ” she said. Extra steps would now need to be taken to make a hospital-to-hospital ambulance transfer, she was told. “This obviously raises the question of what to do with a patient in medical distress who presents during a hard closure,” said Macleod. “In my opinion, the safer and more logical solution is for BCAS to simply take the patient to the nearest open ER, regardless of initial assistance provided on scene.”

Macleod said she was told by a representative of B.C. Emergency Health Services that it would typically treat such a call for service like any other call. He committed to get answers “to ensure it does not happen again.”

In her message to Island Health, ­Bennett-Boutilier said the “stickhandling” of maintaining operations during ongoing closures and skeletal staffing has become too much. “These efforts are coming at a great cost to an already grossly extended health-care team,” wrote Bennett-Boutilier.

Port McNeill and Port Hardy hospitals have been crippled by doctor and nurse shortages, often closing their ER departments on alternating weekends since the spring. The hiring of two new physicians in Port McNeill eased shortages there, but Port Hardy’s ER has lost physicians, resulting in increasing closures, most recently on Wednesday.

Emergency Health Services crews are doing back-to-back transfers, lab technicians “are being pulled in multiple directions,” nurses are calling in sick frequently and not wanting to pick up extra shifts, and physicians are suffering from mental and physical fatigue, wrote Bennett-Boutilier in her email, which was copied to Doctors of B.C., B.C. Emergency Health Services and North Island physicians. Bennett-Boutilier said consolidation of emergency services remains key. “Until we do so we continue to place our patients and ourselves at risk.”

If Port Hardy and Port McNeill teams are consolidated, local leadership can “adapt our operations into a much safer, predictable and sustainable way,” she said, asking for immediate action. “There are simply not enough of us, to do what is being asked.”

In response to a request for comment on the Nov. 25 incident, Island Health said it will review the incident “to fully understand what happened and to inform future process improvements.” It said the health authority and B.C. Emergency Health Services have clarified processes to ensure a similar situation does not happen again. “BCEHS has confirmed that any calls for service that originate from area hospitals that are closed at that time will be treated as a pre-hospital call, ensuring an urgent response by an ambulance to transport the patient to the nearest open emergency department.”

The health authority acknowledged that recent closures have “created confusion” for people living in the region, and for health-care workers. It said it’s working on strategies to create short-term stability and predictability to service delivery in the region, noting it recently took part in a health summit “to learn more about the needs of all involved.”