Rob Breakenridge: Alberta's ER crisis is just the latest proof that Canadian health care is broken

Danielle Smith's reforms might not be a panacea, but anything is better than the status quo

Photo by Jake Espedido on Unsplash

By: Rob Breakenridge

Here’s what we know at this point: just before noon on Dec. 22, 44-year-old Prashant Sreekumar arrived at the emergency room at Edmonton’s Grey Nuns Hospital. He did not come out alive.

The Alberta government has ordered a fatality inquiry into this case, which has shone a spotlight on the overcrowding and delays plaguing the province’s emergency rooms. The possible implication, then, is a rather troubling one: to what extent is all of that chaos contributing to otherwise preventable deaths?

It’s not a question that’s specific to Alberta’s health-care system, nor is this a uniquely Alberta problem. The prevalence of the problem, though, almost becomes its own excuse for government inaction. When it’s an issue everywhere, provincial governments tend to just throw up their hands, as if this is all somehow outside of their control.

It has echoes of Calgary’s water system disaster, where dithering, inaction, and false hope resulted in a crumbling and vulnerable system. This is far more serious, however. Acute care in Alberta appears to be at the breaking point and it’s surely not the exception in Canada. When major hospitals are operating at over 100 per cent capacity, it’s just not sustainable.

According to Mr. Sreekumar’s family, the father of three sought emergency care after experiencing chest pains. Somehow, though, he was neglected for more than eight hours. When he was finally admitted, he collapsed into the arms of the family members who were there to support him.

It would be one thing if that sort of tragic outcome was a rare or isolated incident, but let’s not kid ourselves here. If anything, this case may just be the tip of the iceberg.

We learned last week of a letter sent to the Alberta government, which included other recent examples compiled by ER doctors of preventable deaths and near misses in the acute care system. It’s horrifying stuff.

There was, for example, the case of another eight-hour ER wait, this time involving a female patient who was suffering from bowel obstruction and perforation. By the time doctors got to her, she was septic and quite ill. Emergency surgery was performed, but it wasn’t enough to save the woman’s life.

Another disturbing example in the letter highlights one of the other risks of overburdened emergency rooms: patients who give up in frustration and leave without being seen. This case involved a man in his 50s who initially showed up at an ER with a fever, sore throat, and weakness which had led to falls and intermittent confusion. After waiting nearly eight hours, the man went home only to then have paramedics called to his home the next day. The man was admitted to intensive care with strep bacteremia, but died of multi-organ failure.

These are just two of the examples cited in the letter, and what’s in the letter is hardly an exhaustive list, either. There are obviously privacy issues when dealing with cases such as this, and perhaps even additional nuance or context that needs to be considered, but the public has a right to know. The lack of transparency and accountability is a barrier to progress.

But again, to emphasize, Alberta is not the only province facing this crisis.

In Saskatchewan, the opposition NDP released a leaked memo last month showing that wait times at a number of hospitals are at levels high enough to constitute a “very high safety risk.” The longest patient wait-time recorded was a shocking 41 hours at a hospital that was running at 117 per cent capacity.

It’s a similar story in right now in B.C., where the majority of hospitals “are consistently operating over 100 per cent capacity,” which is affecting how well doctors can care for their patients in emergency departments. At the hardest-hit hospitals, “at least one in six patients is being cared for in unfunded ‘surge beds,’ often in hallways and other inappropriate spaces.”

A recent CBC investigation found similar problems across the country, with the highest recorded median wait time in Ontario at over eight hours, while the highest number in Quebec was over 13 hours.

The common thread in all of these situations seems to be a lack of foresight. We didn’t prepare for the impact of a growing and aging population. We also failed, it seems, to learn the lesson of the recent pandemic and the strain that a crisis can put on a system already pushed to the brink.

It’s also a symptom of problems elsewhere in the health-care system. Those without a family doctor or access to primary care often turn to ERs, or simply end up needing emergency care because their illness or ailment has worsened.

There’s also the fact that many elderly patients remain stuck in ER beds because there’s nowhere for them to go once they’ve been treated. As Alberta Medical Association past-president Dr. Paul Parks recently explained, the cost of keeping these patients in acute care is approximately ten times what it would be when compared with assisted living or continuing care.

These are costly, difficult fixes, especially after years of kicking the can down the road. It would be fair, though, to fault leaders who have sold the notion that this can be easily or quickly solved.

Alberta’s premier has learned the hard way that there are no shortcuts or magic wands to wave. But before becoming premier, Danielle Smith frequently criticized Alberta Health Services (an agency she has now more or less eliminated) during the pandemic for not conjuring up 1,000 extra ICU beds. She also suggested moving patients to hotel rooms to free up hospital capacity.

While the situation has arguably worsened since she became premier, Smith is implementing a radical (by Canadian standards) set of health-care reforms, seeking to increase the amount of for-profit health-care delivery operating in the public system. The impact of those reforms will be interesting to behold.

As many observers have noted, the idea of competition or market forces doesn’t really apply at the level of acute care or emergency rooms. But it’s possible that health-care reform can reduce backlogs elsewhere in the system — and, in turn, help ease pressure on ERs.

Time will tell, of course, but clearly Canadians have been failed by our status quo. And unless something changes, things will only get worse. We deserve — and should demand — better.

Rob Breakenridge is a Calgary-based podcaster and writer and host of The Line: Alberta Podcast. He can be found at robbreakenridge.ca and and reached at rob.breakenridge@gmail.com

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