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CBC
a day ago
- Health
- CBC
Emergency departments in N.S. still struggling with closures
On a recent July day at the Digby General Hospital's emergency department, visitors would have been greeted by a sign no one wants to encounter as they reach the front door: the site was closed. It's a sign that's been getting a lot of use lately. Digby, like many rural health-care facilities around Nova Scotia and across Canada, has staffing problems and those problems cause closures. Right now, the site has just one full-time emergency medicine doctor, with the remaining shifts covered by locums — doctors who travel to the community to fill in. According to publicly-available information, the emergency department in Digby was closed for 518 hours in June, 514 hours in May and 383 hours in April. For years, closures have been stubbornly difficult to solve at certain sites, but Nancy Whalley is hoping there could be light at the end of the tunnel for Digby. Whalley, the area's community navigator, said Digby General will welcome two nurse practitioners in the fall who are relocating from the United States and another doctor could be in place by the end of the year, all to bolster the ranks of the emergency department. "It'll be huge," Whalley said during a recent interview. It's the kind of payoff health-care professional recruiters and community navigators around the province hope to achieve as they pursue doctors, nurses and other health-care professionals. Digby is not the only site in Nova Scotia with an emergency department plagued by closures. Roseway Hospital in Shelburne, which has relied entirely on locums for at least the last five years, is consistently one of the emergency departments in the province that struggles the most to remain open each year. The site was closed for 498 hours in June, 631 hours in May and 489 hours in April. The emergency departments at Eastern Memorial Hospital in Canso and Strait Richmond Hospital near Port Hawkesbury also see persistently high closure hours. For years, the provincial government was required by legislation to produce an annual report on emergency department closures, outlining where and when they happened, along with details about community meetings to discuss problem areas. A change in reporting Health Minister Michelle Thompson said earlier this year that the report is no longer useful because of the gap between when it's published and the time it covers, and other information the government and health authority make publicly available. The annual accountability report covered a fiscal year, but was not released until the following December. Thompson's government passed legislation during the winter session at Province House to do away with the requirement to produce and publish the report. Despite that decision, CBC News has been tracking emergency department closures across the province using public notices released each week by Nova Scotia Health. Dr. Rod Wilson, the NDP health critic, said that regardless of whether the government is producing an annual report, people in rural communities know when their emergency department is closed and he's worried closures might be viewed as standard practice by people in some areas. "We shouldn't accept that," he said in an interview. A physician by training who still does some part-time coverage at emergency departments, Wilson said that what communities need to see is a plan from the government outlining how many hours people should expect sites to be open and how much staff is required to meet those expectations. The government should also report on how it does meeting such benchmarks, he said. "If there's a plan, we're not aware of it," said Wilson. Despite the ongoing struggles to keep some sites open, a senior official with Nova Scotia Health said there are no considerations to downgrade any of the sites to a different service model. Tanya Penney said there are geographic considerations for rural emergency departments because of the distance from them to the nearest regional hospital. "Rural emergency departments are absolutely vital and staffing shortages sometimes, unfortunately, make it difficult to keep them open," she said in a recent interview. "But we're super focused on recruiting and retaining and supporting health-care workers needed to provide care in those areas." As recruitment efforts continue, Penney pointed to other initiatives that have been rolled out to help get people access to care closer to home even when an emergency department is closed. That includes primary care clinics at pharmacies, mobile care clinics and virtual urgent care. Easing doctors' workloads The latter, now available at more than 20 sites around the province, operates even when an emergency department is closed. Qualifying patients see a nurse in person and have access to a doctor virtually. Blood work and X-rays can be ordered, prescriptions written and follow-up care is provided. The sites normally operate seven days a week, 12 hours a day. Whalley said having services like that in place can be helpful for people considering working in Digby because it shows them that the responsibility to provide care for the community won't rest entirely on their shoulders. "I think that's huge and I think that that is the way it's going now everywhere," she said. "[Doctors are] getting used to having those other accesses to care so that it's not falling all on them."
RNZ News
24-06-2025
- Health
- RNZ News
Patients increasingly diagnosed with bowel cancer in ED, Northland doctor says
Demand for colonoscopies exceeded capacity in Northland earlier this year. (File photo) Photo: 123RF Doctors in Northland are blaming a massive increase in wait times for colonoscopies over the last six months on Health NZ's decision to cut rates for locums. Health NZ data has shown the number of patients waiting longer than recommended for non-urgent colonoscopies went from fewer than 20 a month at the start of last year to 553 in April this year. Whangārei Hospital emergency department consultant Dr Eugene Fayerberg was not a cancer specialist - but said he and his colleagues were increasingly the ones to find cancer in patients coming into the emergency department (ED). "[We are] diagnosing rectal metastatic cancer all the time on CT scans that are just completely incidental, because these people have had belly pain for months waiting to get a scope. "They finally come in because they've got blood coming out of their bottom, and do a CT scan and they've got a cancer, that should have been scoped months and months ago." Dr Fayerberg, the Northland branch president for the Association of Salaried Medical Specialists, was among 240 doctors who went on strike for 24-hours last week over what they say is a crisis in healthcare, with one in five specialist positions vacant. One gastroenterologist, whom RNZ agreed not to name, said Northland was previously paying locums - and staff doing extra lists - per procedure, the same rate as Auckland, Counties Manukau and Waitematā. "The rate hadn't changed in five years, which was fine. Then Northland changed to a daily rate in November, which meant a third less pay, and locums just weren't prepared to come for that money. "We were doing 80 percent of semi-urgent scopes within six weeks, but now it's less than 20 percent." Some patients, who finally had colonoscopies after months of delays, had been found to have cancer - and for a few, it was no longer curable, the specialist said. "You have to wonder if there would have been a different outcome if they could have been scoped sooner. "We rely on locums and doing extra lists to service the population up there - it's high need, high Māori population, higher rates of bowel cancer at younger ages, higher numbers of stomach cancer. So we need to keep on top of the scoping list to diagnose early." Gastroenterologist Dr Richard Stein, 72, who held a locum clinic in Kaitaia for almost a decade until it was abruptly cancelled last year , said if Health NZ was serious about fixing regional inequities, it must recognise the cost to staff. Gastroenterologist Dr Richard Stein used to run a locum clinic in the Far North. Photo: Supplied "I'm still working, just in the public system because things are just so bad. I'm working in Invercargill, Rotorua and Hawke's Bay. They're all short-staffed." When RNZ contacted Dr Stein last week, he was reviewing patient notes and test results while recovering from back surgery. "I cover my patients 24/7." Health NZ's locum rate to do colonoscopies - about $2000 a day - looked like a lot of money, he said. "They pay transport, accommodation, maybe a rental car if you push hard. But for some remote areas, it's a day of travel each side, plus you've got all your other costs. "And if you do colonoscopies in a private clinic, you get $800 in hand and the clinic gets about as much." One of Dr Stein's former patients, Mindy, who has the inflammatory bowel condition Crohn's Disease, said even getting a form for a blood test was difficult now. "I did actually have to ring him [Dr Stein] last year because I couldn't get hold of anybody to help me with something, and he some how did manage to use his magic and make it happen for me. But I shouldn't have to do that." Mindy said her condition was currently stable, but she worried for other people who were struggling to get care, or did not have the ability to advocate for themselves. "It's unfortunate that's the way it's got to be, but you have to push and make things happen, because no-one else is going to do it for you." In a written response to RNZ, Group Director of Operations for Health NZ Northland, Alex Pimm, acknowledged demand for gastroscopies and colonoscopies exceeded capacity earlier in the year. "This was due to some workforce challenges (vacancies and difficulty securing locums to cover) and increased referral to the service. "This is now mostly resolved and we're pleased to see our waiting times reduce in recent weeks." The median wait time for non-urgent colonoscopies was now 91 days, down from 130 days in January and Health NZ was recruiting for specialists and nurse endoscopists, and doing extra lists outside when staff were available. Health NZ's target was for non-urgent colonoscopies to be done within six weeks. "We are committed to further reducing wait times for these procedures in Te Tai Tokerau." Health NZ was recruiting for gastroenterologists or nurse endoscopists, utilising extra capacity and additional sessions as kaimahi were available outside of normal working hours, and constantly reviewing waiting lists to book the most urgent patients first. Since January, it had run nine twilight and three Saturday lists, with two more planned shortly. Te Tai Tokerau was confident its reviewed locum rates - which were above the collective agreement - were "not out of step" with other districts, Pimm said. Patients in Kaitaia (who were previously under Dr Stein) were now covered by locum gastroenterologists along with permanent staff, "providing a level of resourcing that exceeds previous capacity". 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