The death of a young mother in an Amherst, N.S. hospital, is renewing scrutiny of the province’s health-care system, and how emergency departments are functioning under the strain of staffing shortages and overcrowded waiting rooms.
On Dec. 31, 37-year-old Allison Holthoff waited more than six hours to see a doctor at the Cumberland Regional Health Care Centre while she experienced excruciating pain in her abdomen.
Her husband drove her to the emergency department at 11 a.m. AT and she spent her time between a wheelchair and lying on the floor in the waiting room before she was brought to an exam room.
“At one point I even did go out and told them, ‘She’s not doing good, she says she’s feeling like she’s dying,’ and nobody said or did anything,” said her husband Gunter Holthoff.
After more time passed, the nurses prepared Allison for an X-ray, but her husband said she went into cardiac arrest before the test could be performed. She was resuscitated three times and later died in the intensive care unit.
Emergency room deaths are at a six-year high, according to figures shared with CBC News by the Nova Scotia NDP Caucus following a freedom of information request.
In 2022, 558 people in Nova Scotia died in emergency departments, up from 505 in 2021 and 393 in 2020.
“Any time we have numbers that are going up … it’s deeply concerning,” said Susan Leblanc, MLA for Dartmouth North and NDP health spokesperson.
“We know that people are waiting for long, long waits in the emergency departments … so when the waits end in a death, it’s obviously the worst case scenario.”
The number of deaths compared to patients is still extremely low, at 0.12 per cent. But the percentage was at its highest in 2022 compared to the previous five years.
Late last week, CBC News asked Nova Scotia Health for the number of deaths that have occurred in emergency departments in the province. The department declined, citing privacy rules.
The president-elect of Doctors Nova Scotia said deaths in emergency rooms do not necessarily mean a person didn’t receive adequate care.
“Often people are going to emergency departments because they’ve got life-threatening things going on, like heart attacks, or seriously injured in an accident,” said Dr. Colin Audain, anesthesia site chief for the Victoria General Hospital in Halifax. “I think it’s fair to say that health care in general is in a bit of a crisis and that the emergency department is sort of the ground zero.”
Almost 130,000 Nova Scotians don’t have a family doctor. Audain said this means more people go to the emergency department and cause backlogs.
He said staff are run off their feet.
“Most health care workers these days are under a tremendous amount of stress. They’re constantly inundated with patients that they don’t have the resources to deal with.”
In 2022, there were 536,666 total visits to emergency departments across the province. Around eight percent, or 43,142 patients, left without being seen.
Issue across the country
Dr. Robert Robson, a longtime physician and patient safety consultant in Dundas, Ont., said he was saddened by the news of Allison’s death, but he was not surprised.
In the last year, several people have died after waiting for care in emergency rooms in New Brunswick and Quebec.
“It’s reflective of a bigger problem which affects hospitals all across the country and that’s the important issue, I think,” he said.
“This is not just a Maritime issue, I’m not trying to minimize what happened in Amherst, and this is not just a small- or medium-sized emergency department hospital issue — this kind of breakdown in the way care is provided occurs in all types of hospitals.”
He said there has been a “deterioration” in health care, as medical professionals are exhausted after two years of the COVID-19 pandemic, and as hospitals lose funding.
“None of the people working at [the Amherst] hospital — I am absolutely certain — would go to work with the intention of harming or the intention of not providing care, but the fact is that the circumstances in which they’re working are such that it becomes very challenging,” he said.
“I’m not saying this to let anybody off the hook, but we need to understand all of those factors, and if we don’t seriously look at them, the chance of making any progress is very limited.”
Growing, aging population
While this is an issue across the country, Nova Scotia has some key challenges.
Katherine Fierlbeck, the chair of the department of political science at Dalhousie University in Halifax, said the COVID-19 pandemic has strained the provincial health-care system, which was already stricken with an aging and sick population.
Despite this, the pandemic drew more people to the region, with Nova Scotia’s population surpassing one million people in 2021.
“The population has really exploded and our infrastructure really has not been able to keep up with this,” Fierlbeck said.
She said improvement is possible, but it will require long-term structural changes between the federal and provincial governments.
“Basically, the best advice I can say is, just don’t get sick, don’t have accidents, and if you do, make sure it’s serious enough that you get seen first and not so complicated though they can’t figure it out quickly.”
Working on recruitment, retention
As of Tuesday, there are 12 physician positions vacant within emergency departments across the province, two of which are at the Cumberland Regional Health Care Centre in Amherst.
For registered nurses, there is an average vacancy rate of nearly 32 per cent across regional health care centres and the Halifax Infirmary as of the end of November, according to data from Nova Scotia Health.
The highest vacancy rate is at the Yarmouth Regional Hospital, where it’s 57.2 per cent. Cape Breton Regional Hospital follows with a 43.9 per cent vacancy rate.
Nova Scotia Health Minister Michelle Thompson said there is “a significant gap in our province for nursing.”
“At Nova Scotia Health, we could accept 1,500 nurses today,” she told CBC Radio’s Information Morning Nova Scotia Tuesday.
Thompson said critical care nursing is a subspecialty with a smaller pool of candidates.
“We are looking at not only training our own workforce, but also how we can work through immigration streams to bring people into our province to work through our health-care system,” she said.
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