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Are Canadians ‘losing their faith’ in the ER? Deaths, waiting times prompt questions


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Are Canadians ‘losing their faith’ in the ER? Deaths, waiting times prompt questions

HALIFAX—In a small Cape Breton town of just over 500, more than 350 people showed up in the community room of the local hockey rink to mourn the passing of 67-year-old Charlene Snow.

There were family members there, and friends. Snow, with two sons, four grandchildren and a great-grandchild, was the glue that held an extended family together, said her daughter-in-law, Katherine Snow.

But also, oddly, one side of the room was filled with teenage hockey players, all wearing their jerseys.

They were teammates and opponents of Charlene’s grandson, Blake, there to pay tribute to a woman who had been a fixture on many a cold, winter hockey rink morning, who had, over the years, become much more to them than just a hockey (grand)mom.

It was a remarkable sight, said Katherine, who had seen Charlene spend countless hours at the rink, watching Blake as he made his way on- and off-ice through high school to this, his graduating year.

“I’ve never seen such a response from teenagers before,” Katherine says. “These kids, they knew her and loved her.”

Charlene Snow, a woman whose life entwined vast swaths of her community, died at home Dec. 30 after waiting to be seen, unsuccessfully, for seven hours at a hospital emergency room.

She had gone to the hospital around noon that day, with flu-like symptoms and a sore jaw and, after those seven painful hours — with the prospect that it might be several hours still before she could be seen — decided to try her luck at an Urgent Care centre in North Sydney the following morning.

“She had been sitting close to a set of really sick baby twins and she thought, ‘It’s too hard for me to stay here anyway. And if I leave, maybe they’ll be one person closer to getting attention,’ ” recounts Katherine.

She didn’t make it to North Sydney — she died on the couch less than an hour after making it home that night.

Hers was one of the recent deaths of someone who had gone to an ER for help. Such high-profile tragedies have focused attention on a situation that has been witnessed across the country — crowded ERs pushed to the brink by overworked doctors and nurses, pressures compounded by an aging population that is finding itself woefully short of primary care providers.

It’s a situation that has played out in unprecedented wait times, a shortage of nurses and not enough beds.

And the people who work in emergency departments — once the “health safety nets of society” — are calling out for help.

“Right now, we need focused investment to help prop up staffing in the emergency departments and critical care areas,” says Dr. Michael Howlett, president of the Canadian Association of Emergency Physicians.

“And then we need emergency movement of people out of hospital to other places.”

A letter this month from the emergency physicians association to provincial health ministers, premiers and the federal government cited a lack of government investment in primary care, which results in patients turning to emergency departments.

Combine that with an aging population — stuck in acute-care hospital beds because there aren’t enough community supports to release them — and a reduction in hospital nursing staff, caused by pandemic burnout, and, in Ontario, the wage cap legislated by Bill 124, and it’s the “perfect storm,” Howlett says.

When hospital beds are full, hospitals stop admitting patients from emergency departments, a which jams up ambulances waiting to drop off patients, creating a holding pattern the association says is called “boarding.”

“Boarding is the evidence of a broken system in decline,” wrote the association in its open letter, a problem with “lethal consequences.”

Most Canadian cities have more than 100 boarded patients in their emergency departments every day, the association says.

Recent research from England suggests that such waits have dire effects — an additional death for every 82 patients who spend more than six to eight hours in the emergency department waiting for a hospital bed.

“This is something we’ve known for years,” says Howlett. Other literature has shown that “risks go up when you start to keep people on stretchers in the emergency department in crowded conditions where staff have difficulty keeping up with all their nursing and physician functions in the face of crowds.”

In 2021, Canadians spent more time waiting in emergency departments than any other year, according to the Canadian Institute for Health Information — 40.7 hours to get a bed compared to 33.5 hours in 2020.

And for paramedics trying to deliver patients to a hospital, the backlog moves downstream, resulting in slower 911 responses.

Just this week, ER nurse Helen Winter says she arrived at the Toronto hospital where she works to find seven ambulances waiting to offload patients.

After struggling through the pandemic, the current situation is “devastating,” she says.

“We see people constantly unable to access the medical care that they need,” says Winter. “Sick, sick, sick children coming in and unable to be admitted so parents are having to take care of them at home. And they come in repeatedly.

“Elderly people sent home, discharged far sooner than it’s safer for them to go home. And they end up either coming back or we never see them again,” says Winter. “And I just I don’t understand why Ontario isn’t angry. I’m watching the (Toronto) city budget. I’m watching an increase to police services,” she says. “They have no shortage.”

The strains to the system have been showing up, in different ways, across the country.


In the village of Ashcroft, B.C., closures and wait times have been blamed for an elderly woman’s death last summer from a heart attack despite living next door to a hospital.

The small hospital’s ER was closed and there was a half-hour wait for an ambulance from the closest city, Kamloops.

Ashcroft Mayor Barbara Roden said she knew the woman, who lived in a retirement home and was a familiar face to many in the village.

“She used to go to the bakery every day and sit and have coffee, that was her happy place,” Roden said. “It was her way of socializing and getting out and about.”

The woman, whose name has not been released, was found unresponsive in her room in July 2022 by a friend visiting on a Sunday.

At the time there were staffing problems for B.C. ambulance, Roden said, made worse by stress-related departures or recruitment lags due to the pandemic. Since then, more full-time positions have been added to the ambulance station in Ashcroft. There is now an urgent primary care centre open 12 hours a day, seven days a week.

During the same month, media in B.C. reported another elderly woman died while waiting two days on a stretcher for medical attention in an emergency waiting room at Lions Gate Hospital in North Vancouver.

The North Shore News reported in July the woman was admitted to emergency on July 9 or 10 but, because no beds were available, was kept on the stretcher for two days.

The nurses union told the paper its members were “devastated” and “traumatized” by what had happened. The union blamed chronic understaffing.


Gunter Holthoff’s 37-year-old wife, Allison, died while waiting for treatment after experiencing an upset stomach New Year’s Eve in Tidnish, N.S.

Holthoff opted to carry her on his back to their car because he says the last time they called 911, it took three hours for help to arrive.

Holthoff says when they arrived at the hospital, they were quickly assessed, but then waited more than six hours before Allison received treatment. She ultimately died in hospital.

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In an interview with CBC on Friday morning, Holthoff was asked why it was so important for him to speak about what happened.

“Because I need a functioning health-care system,” Holthoff said. “I got three kids at home now … if something like that happens to me, what is going to happen?”

He said since he started speaking out, he’s heard and read of dozens of similar stories nationwide.

“Reading those stories, all I can say is the system already failed a long time ago,” Holthoff said. “It’s just nobody realized.”


Alida Clément’s death last March hangs heavy on her grandson. At times struggling to stay composed speaking to the Star, Yves Clément tells the story of how his grandmother was rushed to the hospital in Moncton, N.B., from a nursing home with a kidney infection.

But rather than being admitted straight away, the 89-year-old former nurse had to wait in an ambulance outside for six hours. By the time she got inside she had tested positive for COVID and was developing pneumonia, Clément said.

Seventy-two hours later, his grandmother had died.

“She wasn’t in great health, but it definitely would have made a difference if our health-care system was in even a slightly better spot,” Clément said.

He said, while he’s not a medical professional, from what he has been told his grandmother could have had a better chance had she been admitted earlier.

Clément stressed he knows those in the hospital were working hard to help her and considers them heroes, saying health workers are making the best of a bad situation

As a nurse, Alida served the province and was awarded the Order of New Brunswick, he said, but it was the province that ultimately “failed her” when she needed it.

Clément called for those in the halls of power to stop squabbling and work together to solve the issues.

“Get past your differences,” he said. “It’s bigger than all of that.”


Staffing hospitals and primary care centres is an ongoing problem.

Kingston Health Sciences Centre has 200 nursing vacancies in its critical care units as well as emergency and is offering $10,000 to nurses and lab technologist who will sign a contract to work at the hospital for at least two years.

“Health human resources — we’re challenged like all other organizations across the province and across the country, globally for sure,” says Jason Hann, executive vice-president patient care and chief nurse executive of KHSC.

The hospital is also experiencing higher emergency department volumes, and more patients are being admitted. Wait times in emergency for non-acute care needs are about 6.5 hours.

“Patients are waiting, which would certainly seem like a very long time when you’re in a waiting room.”

Howlett, of the emergency physicians association, says the root of the problem is decades of government cuts to physician and nursing resources, so-called “streamlining care to make it more efficient,” he says, or closing hospitals.

“Before we used to have people for replacement work,” says Howlett. “We had sufficient new graduates, etc., and sufficient positions to keep redundancy in the system and to have people moving up as others retired.

“Well, nowadays we don’t have that anymore,” he says. “So if the nurses find their working environment untenable in one area and they go to another area, there is no one to bring in to replace them.”

The problem is so pervasive, he says it can’t possibly be random, or the result of individual hospitals not doing well.

“This is a global and systematic problem in health care. And the systematic problem is the way that efficiencies were attempted. And it’s been done on the backs of people who work in the system.

“All I’m asking for is for people in charge of funding and administering the system to see these things as a priority or at the very least, be transparent with the public and ask them if they think it’s a priority,” says Howlett.

“Because right now, it’s quite opaque. Most people don’t know what’s going on, but people are gradually losing their faith in the system one patient at a time.”


In the wake of her mother-in-law’s death, Katherine Snow reached out to the family of Allison Holthoff to offer her condolences.

It was during their conversation, Snow said, that the light bulb went off; she wondered how many others had had the same kind of experience.

At 2:30 p.m. Wednesday she put a post up on social media asking people to share their ER stories. She thought she’d collect them so people would know they weren’t alone, she said. By 6 p.m., she says, there were hundreds of stories and thousands of shares.

She called a friend in Halifax for help. He drove up to Cape Breton, and between midnight and 4 a.m., they cranked out a website to collect and share all those stories.

“I’m channelling my grief into trying to do something good,” said Snow. “I want for something good to come out of all this.

As of now, the site chronicles 559 ER deaths.

The Snow family is adamant that they don’t blame health-care workers Charlene’s death. But, said Katherine, clearly some decisions have to be made at executive levels.

“I’m not a health-care administrator and I’m not a health-care professional, so I don’t have the answer. I really don’t know what can be done,” she said.

“I think that that responsibility lays within the top bureaucracy of the Nova Scotia Health Authority. I’m just a stay-at-home mom that made a website to house stories.

“But I’m trying to provide some insight and something for those who make the decisions to reflect on when they’re making policy.”

She said the site invites health-care workers to share their own ER stories as well.

“I feel like there is probably a big disconnect between the people on the front lines delivering health care and the people at the top that are making decisions.”

With files from Omar Mosleh

Steve McKinley is a Halifax-based reporter for the Star. Follow him on Twitter: @smckinley1

Patty Winsa is a Toronto-based data reporter for the Star. Reach her via email: pwinsa@thestar.ca

Jeremy Nuttall is a Vancouver-based investigative reporter for the Star. Follow him on Twitter: @Nuttallreports

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