A sign points the way to the emergency room at the hospital in Kitimat, B.C. The hospital’s ER crisis peaked in January, 2024, when it was shuttered for almost 250 hours.Robin Rowland/The Globe and Mail
Don Glasgow is lucky he had a heart attack on April 24.
Had his organ faltered after 7 p.m. a day earlier or a day later, he would have found the doors locked at his nearest emergency department in Lillooet, a mountain town about two hours from Kamloops.
The Lillooet ER has been shuttered for 1,384 hours over the past year, including overnight on April 23 and April 25. The chronic, unplanned closings are salt in the wounds of people like Mr. Glasgow, 71, and his wife, Tricia Thorpe, 64, who lost their hobby farm and home in a wildfire that decimated the village of Lytton in 2021.
That blaze also destroyed a cherished 24/7 health centre in Lytton, forcing residents who need time-sensitive care to drive an hour to Lillooet, where emergency services have become unreliable because there aren’t enough physicians to cover the ER.
“It’s hard to believe,” Mr. Glasgow said. “We’re supposed to be an advanced industrial country, a rich country, and we can’t afford emergency openings? It just doesn’t make sense.”
Tricia Thorpe, left, and Don Glasgow lost their home in the 2021 Lytton wildfire, which destroyed the local 24/7 health centre. Now the closest emergency services are an hour away in Lillooet – but that emergency department has been shuttered for 1,384 hours over the past year.Melissa Tait/The Globe and Mail
The unplanned emergency closings are less a question of what British Columbia and the rest of rural Canada can afford, and more a question of where and how a new generation of doctors and nurses are willing to work.
Staff shortages, especially in the years since COVID-19 peaked, have forced 35 per cent of Canadian emergency departments to close temporarily at least once since 2019, according to figures The Globe and Mail compiled for its Secret Canada: Your Health project, which reveals important health care information that isn’t systematically tracked or made public.
New data about the state of emergency departments in B.C., which The Globe obtained through a Freedom of Information Act request, show that 29 of the province’s 77 ERs have had at least one unplanned closing since the start of 2023.
Two of those emergency departments, in Port Hardy and Saanichton on Vancouver Island, are also enduring long-term, planned reductions in overnight hours because of staff shortages.
Collectively, B.C. ERs were shuttered temporarily for just more than 16,453 hours – the equivalent of nearly 686 days – from the beginning of 2023 to mid-April of this year, the period for which the B.C. Ministry of Health released figures to The Globe. (The Globe did not include B.C. in its original national tally because the data were released two days before publication, too late to be analyzed.)
The closings demonstrate “just how fragile” the medical system has become in the hinterlands, according to Paul Adams, executive director of the BC Rural Health Network, an umbrella group for non-profits, local governments and individuals trying to improve health access outside cities.
“It takes just one nurse or one physician to be unavailable for the department to close,” he said, “and the impact to the residents is immense.”
Health leaders in B.C. are well aware of the scale of the crisis. They’ve been working to shore up rural emergency care. They’ve expanded a publicly funded and operated travel nursing program called GoHealthBC and signed up more locum doctors, physicians who work ER shifts on a short-term basis.
They’ve also turned to virtual ERs to prevent overnight closings at some small hospitals.
Those efforts are paying off: The number of temporary ER closings in B.C. dropped 26 per cent in the first quarter of this year compared with the same time last year.
The scale and duration of the closings in northern B.C., for example, are decreasing, “which is good,” said Ciro Panessa, the Northern Health authority’s chief executive officer, “but nevertheless, it’s still a top issue for us.”
In B.C., the hardest-hit ERs are in small communities that are sometimes hours away by ferry or mountain road from the next hospital. Emergency rooms at Chetwynd General Hospital and Mackenzie and District Hospital, both in the Northern Health region, were closed for 2,430 and 2,050 hours, respectively, between January, 2023, and mid-April.
That is the equivalent of 101 days in Chetwynd and 85 in Mackenzie, making their ERs the most frequently closed in the province.
Next is Kitimat, an industrial community of about 9,000 people 650 kilometres northwest of Vancouver. Best known for its liquefied natural gas terminal and aluminum smelter, Kitimat is the largest place by population to appear near the top of the list for unplanned ER closings.
The ER at Kitimat General Hospital, which also serves the nearby Haisla First Nation, closed for 1,690 hours since January, 2023 – just more than 70 days. When the doors were locked, Kitimat residents were forced to drive 60 kilometres to Terrace.
“We’re in northern B.C., so in the winter, that can be terrible. There’s times when the highway has been closed,” Kitimat Mayor Phil Germuth said. “We were very lucky that no tragedies happened, but the potential was clearly there.”
Kitimat’s ER crisis peaked in January, 2024, when the hospital was shuttered for 247.5 hours. Temporary closings have abated since, a positive development the mayor attributes to Northern Health creating an ER stabilization task force, and to local family doctors going “above and beyond” to pull long hours in the ER.
The downside is that those family doctors are less available to provide primary care in the community, Mr. Germuth added. He recently tried to book a prescription renewal with his doctor and couldn’t get a phone appointment until mid-August.
While ER staffing has stabilized in Kitimat, it has deteriorated in other B.C. towns, including Oliver and Lillooet, where Mr. Glasgow was initially treated for his heart attack in April. It was his second heart attack in three years.
He and his wife, Ms. Thorpe, an elected representative for a rural area near Lytton, have watched with trepidation as ER closure notices have piled up for the Lillooet Hospital, which serves a local population of about 4,000. The next closest hospital is in Kamloops, a two-hour drive away.
“It’s scary,” Ms. Thorpe said. “We’ve got people that are reluctant to get care because they don’t know if the ER is going to be open.”
Mark Masterson, the vice-president of medicine for the Interior Health authority, said the situation in Lillooet should improve significantly in September, when three international doctors licensed through a practice-ready assessment program are expected to start.
Another foreign-trained doctor brought to Lillooet through the program began practising in April, Dr. Masterson said.
Lillooet is no different from many small, isolated Canadian towns struggling to recruit medical personnel in the wake of the pandemic.
Many health professionals retired, cut back their hours or moved away from rural areas as COVID-19 subsided.
Their younger replacements crave more work-life balance and may not be keen on settling in one community forever, said Jude Kornelsen, co-director of the Centre for Rural Health Research in the Department of Family Medicine at the University of British Columbia.
She praised the recruitment philosophy of colleagues in rural Australia who target physicians at the beginning and end of their careers. In the years between, those doctors may prefer to raise families in cities with better amenities and more health professionals to share the workload.
“Let’s not have the expectation that they’re going to stay for life,” Dr. Kornelsen said. “But if we got a good five, six years out of them, that would be phenomenal.”