On Jan. 26, Maclean’s is hosting “Health Care in Canada: Time to Rebuild Medicare,” a town hall discussion at the Sir James Dunn Theatre, Dalhousie University, Halifax. The event, in conjunction with the Canadian Medical Association, will be broadcast live by CPAC. The conversation on health reform continues in the coming months in the magazine and at town halls in Toronto, Edmonton, Vancouver and Ottawa.
A distraught 41-year-old man from West Kelowna, B.C., arrived at the emergency department of Kelowna General Hospital on the night of Dec. 28. “He was broken mentally,” his wife later told the local Daily Courier. “He wanted help.” By her account, he waited 90 minutes without seeing a doctor, minor by today’s emergency room standards. Kelowna RCMP put the wait at just 45 minutes. Regardless, he snapped, warning staff that he’d drive his truck into the hospital if he didn’t get treatment. When threats didn’t get results, he stormed out and returned at the wheel of his Chevy Blazer. As promised, he smashed through the ER’s double doors, narrowly missing two elderly people (one assumes they were elderly before their wait in emergency) and came to a halt in a hospital hallway.
Police arrived to find him waiting co-operatively in his truck. The bed he was assigned that night was in the RCMP detachment cell; he faces several charges including dangerous operation of a motor vehicle. While his strategy was extreme, his cry for attention resonates with many who’ve had the misfortune to trade germs and waste time in one of Canada’s overstressed emergency wards.
It’s a Canadian conceit that ours is one of the best public health care systems in the world, a defining characteristic of nationhood; something that separates us from the Americans. In a poll by Angus Reid Public Opinion in June, 69 per cent of Canadians said they’re proud of the health care system, edging out the state of Canadian democracy, multiculturalism and bilingualism.
Yet the reality, based on any number of international comparisons, shows that pride in a supposedly world-beating standard of care is often misplaced, an “illusion,” as Liberal MP and medical doctor Keith Martin puts it. The sorry state of the nation’s emergency wards is just one indicator of trouble today and trouble to come. ERs are just “the canary in the coal mine,” says Dr. John Ross, Nova Scotia’s adviser on emergency care.
Martin, a former family and emergency room doctor and an MP from Vancouver Island, has been saying as much since he entered federal politics 17 years ago as a Reform party member. He practised medicine part-time until about three years ago, experiencing the same things that first spurred him into politics: the indignity of examining patients on gurneys in hospital hallways; people enduring such agonizing waits for hip or knee replacements that they suffered heart attacks; tumours that grew to inoperable sizes as people waited months for diagnostic scans. “Those,” he says, “are the casualties of our health care system, and the casualties of the inaction of modernizing the system, that people don’t talk about.”
Emergency wards are all too often the first point of contact with the health care system, a problem exacerbated by the fact that five million Canadians don’t have a family physician, and because acute-care beds are often stuffed with elderly patients who would be better served in long-term care facilities. Often the waits are excruciating. For a man in the throes of a mental breakdown, driving to, and through, the ER of Kelowna General should have been the last, worst option. “He was at the end of his rope,” his wife said. “You can’t see a psychiatrist. It takes a while to get an appointment. That’s why people go to the hospital.”
And what they often find in maxed-out ERs is a chaotic environment and waits, of six, eight hours and more. The consequences can be deadly. In Edmonton’s Royal Alexandra Hospital this September, Shayne Hay reported to the hospital’s emergency ward, telling staff he was suicidal. He was placed in a room on an emergency stretcher and checked periodically, though repeated requests to see a counsellor went unanswered, his family says. Some 12 hours later he was found dead, hanging from a strap of his backpack. In Montreal, long waits in the ER at Maisonneuve-Rosemont hospital were blamed by families for contributing to the deaths of two people last year. Mariette Fournier, 86, spent four days on a stretcher in the hallway waiting for a bed in the geriatric department. She contracted pneumonia, developed a blood clot, and died on Feb. 23, a day after finally getting a bed. That same month, 75-year-old Mieczyslaw Figiel died beside the triage nursing station, with his daughter banging on the station’s window as he gasped for breath. The ER was at 180 per cent capacity.