The West Block – Episode 17, Season 12 – National


Episode 17, Season 12

Sunday, January 15, 2023

Host: David Akin


Dr. Michael Howlett, Canadian Association for Emergency Physicians

Dr. Alika Lafontaine, Canadian Medical Association

Tim Houston, Nova Scotia Premier


Ottawa, ON


David Akin: At the breaking point with overcrowded emergency rooms and long wait times to get a family doctor or to get a surgery. Is Canada’s health care system broken and how do we fix it?

I’m David Akin. Welcome to The West Block.

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Health care emergency after two Nova Scotia families say their loved ones died after waiting hours for treatment in hospital ERs over the holidays. We talk to two doctors who say the system has reached a breaking point.

And Nova Scotia Premier Tim Houston campaigned on a promise to fix health care, so why doesn’t it seem to be working? We’ll ask him how he plans to address the health care crisis facing his province.

Access to health care when you need is something Canadians expect from our health care system, but that system is being tested like never before and it’s often playing out in emergency departments across the country. Of course the most recent case happened over the holidays, when Gunter Holthoff took his wife Allison to the hospital in Nova Scotia with stomach pains. They waited more than six hours before she was treated, but by then it was too late.

Gunter Holthoff (wife died in hospital): “She said I’m—I feel like I’m dying. They’re going to let me die here. And, and I just told her like no, that’s why I got you in the hospital. We’re here to get you fixed up and we’ll just be here…we might be here a day or two, but then we’ll go back to normal. No big deal.”

David Akin: Holthoff says he’s speaking out because he doesn’t want his wife’s death to be in vain. He says something needs to change. So, what would that change look like? It’s a big question and we hope to get to that right now.

Joining us now is Dr. Michael Howlett. He’s an emergency medicine physician and the president of the Canadian Association of Emergency Physicians. He’s in Beaverton, Ontario. And Dr. Alika Lafontaine, he’s an anesthesiologist and the president of the Canadian Medical Association, the CMA, and he’s in beautiful Grand Prairie, Alberta. And thank you both gentlemen for joining us, and I said there’s a lot to talk about. I know both your associations have been talking a lot about a lot of the problems in our health care system, but Dr. Howlett, let’s start with you as representing the country’s emergency room physicians. We heard about those problems in Nova Scotia, but we’ve heard about emergency room problems in Ontario, in Alberta, B.C., you name it. What are some of the common denominators? What is some of the key problems that your physicians are finding in our emergency rooms these days?

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Dr. Michael Howlett, Canadian Association of Emergency Physicians: The problems that we’re facing are actually national and international in scope. The International Federation of Emergency Medicine and our own national organization, all of my colleagues in pretty well every province in the country are experiencing the same thing and that is, we have large numbers of patients who are admitted to hospital who can’t get out of the emergency department and into inpatient beds and that creates a backlog, so that emergency department crowding is the number one issue. It also results in a lot of stress on the staff and because we are short in nursing staff, and in some places physicians as well, we have many more patients being taken care of by too few caregivers. And of course, that creates a stress on the system being able to bring people in and see them in a timely way, make sure they get inpatient care in a timely way and making sure that the staff feel like they’re doing their job as well as they possibly can.

David Akin: Dr. Lafontaine, I want to come at it just a slightly different way and we heard from Dr. Howlett that one problem was getting patients out of the ER and possibly into a bed somewhere else in a hospital, but why are so many people showing up in ERs in the first place? Sometimes it may be a GP is just overwhelmed and saying, go to the ER. Doctors themselves may be sending too many people to an ER. But let’s start at that point. Why are so many people trying to go to an ER for everything from a headache to a sprained ankle?

Dr. Alika Lafontaine, Canadian Medical Association: So you know the way that we access care does not work the same way that it did in the past. You know, if you are a patient with a problem, you’d sit back and say, you know, I had to my community family physician. If you weren’t assigned to a family doc, you’d go to a walk-in clinic. You’d access virtual care and you’d kind of pull back to accessing emergency rooms unless you really needed to because you couldn’t access those other three streams, or you knew that your problem was so acute that you had to go to an emergency room.

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The way that we access care now, and the way that works for patients, is that all of these places are completely overwhelmed now and so people really only have the option of going to the emergency room because a lot of these other places that they used to access care just don’t have room anymore. And, you know, the experiences of patients really are that they don’t know how to navigate the system now. You know, and one of the stories that happened in Nova Scotia, you know, they talked about how they drove to the hospital instead of calling, you know, an ambulance because they knew an ambulance would take six hours and they wanted to have it as short as possible ride into the emergency room. And, you know, patients are trying to navigate the system, it’s just very, very confusing to them. It’s very frustrating on a provider side as well.

David Akin: We want to talk about solutions and how we fix things, and sometimes if you sort of watch the TV newscast or read the headlines, you would think, well if the federal government just gave the provinces more money, everything would be alright. I know it’s not that simple. So again, Dr. Lafontaine, maybe I’ll start with you from sort of the CMA viewpoint. What might be some productive and yet relatively quick areas to pay attention to, to try to improve our health care system and of course, this is a huge topic. We’re talking long-term care homes, to emergency rooms, to the family physician. What would be some useful ways to move the ball down the road here?

Dr. Alika Lafontaine, Canadian Medical Association: You know I’ll start off within the emergency room itself. You know, we are having the same sort of demand, it’s all just being redirected at the same point and we’re having little spikes that happen as we have disease processes make their way throughout the system. You know, we talk about the triple pandemic that’s been going through with flu, COVID, as well as RSV for kids, you know, the same sort of flu acute spike is going to happen for adults, too, not too soon from now. And so we have to focus on stabilizing acute care centres like emergency rooms, making sure that folks have an opportunity to work their way through burnout, which I think is at an all-time high right now, which really means fixing working environments. You know, one of the side effects for burnout that I don’t think we talk about too much is that a lot of our senior personnel are leaving for other places in the health care system and as a result, the people that we leave behind are really struggling because they tend to be more junior as far as their experience. Now, as far as fixing primary care in the community and other places, you know, a shift towards how we do things differently, moving away from siloed care towards team based care, can help us to increase capacity and that’s really about redistributing workload. You know, there’s an enormous amount of stress in work that rolls downhill towards people who work in the front line, and patients are really starting to see the effects of that in their day-to-day interactions when they need care. 

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David Akin: Dr. Howlett, I’ll put essentially the same question to you, of course, perhaps with a focus on emergency rooms, but what are some solutions for fixes?  

Dr. Michael Howlett, Canadian Association of Emergency Physicians: I would have to agree, first of all, 100 per cent with what Dr. Lafontaine has said about primary care in the community and the need to emphasize or prioritize making sure the resources are in place for primary care, community care. I also want to emphasize that our acute care facilities, which is where we work, don’t seem to have enough capacity to manage all of the acute care that’s coming into our hospitals. But in reality, part of that is the lack of community care and long-term care out in our towns and in rural areas and in urban areas as well. So what happens is, because we lack the long-term care capacity in the community, is people who are in hospital who have multiple health problems and their acute care is finished being treated, they then have to go to the community and their functional problems are great enough that the community doesn’t have the resources. We haven’t planned well enough over the last 20 to 30 years to make sure that these people can get out of hospital, so they languish for weeks and months. In any given day, 10-25 per cent of hospital beds are taken up by people who don’t need acute care and in fact, they get worse if you leave them in acute care. And that’s really what’s preventing us from getting our acute care people into hospital is the other end of the pipeline is plugged. And so emphasis and priority on creating resource for community care on both ends, going into hospital and coming out of hospital, is actually part of the answer. And then what Dr. Lafontaine said about essentially the moral distress that happens in caregivers, physicians, nurses, etc., when they want to give good care and they can’t because they have to see patients on stretchers, their department is overloaded with admissions. So you have a nurse who’s not only managing the emergency care, she’s also managing the inpatient care on people. She’s doing some long-term care because people have come in with social and functional issues. The workload is too great, so that backs up people in the waiting room. That backs up people for admission and it creates this moral distress as I’ve said that means the caregivers get demoralized about not being able to work up to what they feel is a good standard. And that’s when they start getting ill or start wanting to leave and go and work elsewhere, and we’ve seen this mass exodus.

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David Akin: Dr. Lafontaine, because you’re, you know, relatively close to the B.C. border, and we’ve heard over the years, you know, B.C.’s trying to poach nurses from Alberta. Alberta’s trying to hold onto people. Alberta’s poaching from Saskatchewan. In the last week, we saw the British Columbia government offer some new packages to recruit nurses. On the east coast, we’re going to talk to the Nova Scotia Premier Tim Houston about recruiting people. Is it a problem that provinces are essentially trying to poach from other jurisdictions to get people? Do we need a national strategy to recruit from out of country? We’re talking about foreign trained nurses and doctors coming in and perhaps having fast tracks. Are there some solutions there to taking a look at the way we recruit and retain health care workers, maybe on a national basis rather than these provincial silos, each province competing against each other?

Dr. Alika Lafontaine, Canadian Medical Association: You know, you described the situation pretty accurately. We have a competitive model versus a collaborative model. We really have 13 health care systems that are working in isolation for the most part, unless they choose to overlap. You know, we don’t even know how many nurses we have in the country as far as an agreed upon number notwithstanding, you know, how many family physicians or other types of specialists have. There are lots of different databases that have lots of different numbers and it’s often difficult to find even that number of what actually represents what’s going on in the system right now. And so, you know, what do we need? We need these collaborations across provincial and territorial jurisdictions to work with the federal government so not only can we track problems, we can also track the needs of patients and match those things in a more reasonable way. You know, we’ve run into these problems just like Dr. Howlett was saying because we’ve done a lot of cuts in the health care system that have decreased our capacity and it’s because we did not know, because we did not have the data. We were not collecting or sharing it, just how dire the situation would be right now. So now that we’re in the situation, what’s the solution? It’s collaboration across the country.

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David Akin: Dr. Alika Lafontaine of the Canadian Medication Association; Dr. Michael Howlett of the group that represents emergency physicians across the country. Thank you both, gentlemen and I’m certain we’re going to pick this conversation up down the road. Thank you again.

Dr. Alika Lafontaine, Canadian Medical Association: Thank you very much.

Dr. Michael Howlett, Canadian Association of Emergency Physicians: Thank you.

David Akin: Up next, Nova Scotia’s health care system under fire after long wait times and overcrowded ERs may have led to the deaths of two women over the holidays. We asked Premier Tim Houston what he’s going to do about it. 


David Akin: The Progressive Conservatives in Nova Scotia won a surprise majority government in 2021, with a promise to fix the health care system. But with hospital emergency departments overwhelmed and 130 thousand people still waiting for a family doctor, did the PCs live up to those promises to fix health are? Well, joining us now is leader of the party, of course, and the Premier Tim Houston. He’s in Pictou County. Premier Houston, it’s great to have you with the program. I want to start with the tragic events of last week, those two deaths. And I know there are some investigations going on to determine the cause but still, there may be people who are now afraid to go to an emergency room in Nova Scotia. What do you say to those Nova Scotians who are anxious about the care they might get in an ER?

Tim Houston, Nova Scotia Premier: Thanks for having me. I appreciate the opportunity for sure and certainly, you know it’s a tragic situation when we lose any Nova Scotian, any Canadian, particularly those that are, you know, interacting with the health care system. But what I would say to people is we have an incredibly talented, dedicated, compassionate people working in our health system and you’ll get good care when you get in the system. Now the reality is that, you know, there will, sadly, people will not make it when they interact with the [00:01:18]. That’s the ER system, I mean that’s the very nature of the emergency rooms and it’s sad when it happens. But what I want Nova Scotians to know is we have incredibly talented people working in our health care system. They’re under pressure, like no different here than anywhere else in the country. Our medicare system across the country is under pressure, but the Nova Scotians should not be nervous at all. They will get good quality care when they get in the health care system when they get to the emergency room.

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David Akin: I mentioned off the top your election victory from 2021 and you know this, but for our viewers outside Nova Scotia, big come from behind victory. You were behind in the polls at the start and you won a majority. And I think you hit the sweet spot in your campaign messaging, focusing so much on health care and clearly tapping into voter’s anxieties about health care. But can you say now, a year and, you know, a few months in, the system seems worse off now than when you took over in the fall of 2021.

Tim Houston, Nova Scotia Premier: Well the system’s under pressure, there’s no question about that and I think Nova Scotians will know that I was always very up front with the status of our health care system. I was always very clear with Nova Scotians that it would take money and it is, a significant, significant investments in the health care system and we’re definitely not—nobody would accuse us of cutting corners, that’s for sure. It’s going to take money for sure and it will take time. This is the health care system. The status of the health care system today is something that’s developed over, you know, years, decades really. We’ve been on this crash course for a long time, so it would take time to fix it. Those are two things I was very honest. And I was also very clear, it’ll probably get a little bit worse just because of the negative momentum we had in the health care system, and it is taking money and it is taking time, and it is under significant pressure right now. But what I want Nova Scotians to know is it’s the people working in the health care system, the health leadership team, the minister of health, right up to the premier’s office, we are completely focused on fixing this health care situation and our resolve is stronger now than it ever was. We know that there’s a lot of pressure but we know we can get there, too.

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David Akin: And you’re right, I mean a lot of these problems, you inherited them. They’re going to take time and money, but we had this situation, people are still thinking about it in these emergency rooms last week. Are there things that you can do next week? Bring in the Red Cross. Do something to make sure that doesn’t happen again. And can you take accountability saying, I want to see this on my desk. This is, I know Minister Thompson, your health minister’s going to get onto this, but do you want to take personal accountability and get something done next week?

Tim Houston, Nova Scotia Premier: Oh, I do take it very personally, very, very personally. I think the status of the health care system is certainly on my desk. It’s on—it’s never anywhere away from my mind. I’m very, very focused on it and I take it very personally. And when we lose somebody, the tragic situations we’ve, you know, we’ve heard about recently, I carry that very heavily, very heavily on a deeply personal level. But we also—I mean look; we’ve been in office for a little over a year. We released the Action for Health Care plan, very detailed plan. It’s available online. Nova Scotians can see the plan that will move us to fixing the health care system, statistics about what’s actually happening in our health system. They’re online, very transparent. Nova Scotians can see that. And there are a number of things that will happen next week, but there’s a number of things that have been happening over the last few weeks with, you know, pilot projects around emergency rooms and now we can have the data and expand them out. So for the patients, I think in the next couple weeks, you know, they’ll see some noticeable changes from the patient side, from the customer side, if you will, and also supporting those health care professionals who are in there every single day trying to save lives. And there are a lot of lives saved in the emergency room. I mean, I heard a number of stories just this week of situations where people came to the emergency room in dire situations and got care and really had lives saved. So, you know, we—nobody likes—we’re all filled with sadness when we have a negative outcome in the emergency room, but at the same time, you know, we also have to understand that, you know, there’s the people in there, are dedicated to saving lives and they’re doing their very best and they are saving lives. They just can’t save them all. That’s the, you know emergency rooms are of that nature.

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David Akin: We’ve got a couple of minutes left and I want to see—to broaden this discussion of the federal government, the federal-provincial relationship. One of the things I think the federal government may be nervous about when they get asked for more money for health transfers is they want to make sure it’s spent on health. They don’t want a government to give tax breaks or something like that. This—last week rather, Doug Ford in Ontario said he’s be prepared to [00:05:59] some sort of accountability, some strings attached in exchange for cash. Where’s Nova Scotia on that? Would you accept some specific conditions in exchange for additional health transfers?

Tim Houston, Nova Scotia Premier: Oh, absolutely. I mean, we’ve been very clear on that. In fact, a number of premiers are. I think that’s kind of a situation that’s been kind of I don’t know, misrepresented maybe in some sense, let’s say. There are a lot of premiers that just want to—we just want to partner with the federal government. And if the federal government has some conditions and some things that they want a direct funding to, that’s the way it works with the federal government on every file and health care should be no different. And we certainly—look, we’re not shy about making investments in the health care in this province and people would see it in the first budget we tabled that we’re making significant investments. We will continue to invest in health care for sure. We just want the federal government to—we’re hopeful that they’ll be there as a partner. And if they have specific outcomes, specific targeted funding they want, that’s okay, too, because we are going to spend on primary care. We are going to spend on emergency care. We are going to spend on seniors. We’re going to spend on addictions and mental health. We’re going to spend in all of these areas, so we just want the federal government to be there as a partner. We still call for a meeting with the prime minister to talk about some of these things and then just look each other in the eye. But look, we’re there. We’re focused on health care and the federal government is too, so let’s get around the same table and make it happen.

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David Akin: When the federal government wanted to do child care deals, it went around the country and did one-on-one deals with each province. Is that a model to help fix the health system? Would you accept that if, for example, the prime minister did a one-on-one deal with Premier Eve in British Columbia and them came to you and did a one-on-one deal for Nova Scotians? Is that a model?

Tim Houston, Nova Scotia Premier: Well look, my focus is on Nova Scotians for sure. But look, this is a national issue. You won’t go—there’s no community in this country where the headline story is not about something in the health care system. Our medicare system across the country is on the ropes. And I believe in the public system and I think that we can work together as provinces with the federal government to salvage our system of medicare. You don’t have to do that one-on-one. Just do it as a nation. Let’s keep the nation together and let’s get going. We take great pride in this country on our health care system with the public system. I want that, and I think Canadians want that. So the federal government should be—you should be looking at this as a national issue.

David Akin: And for our final, about 30 second seconds, issue a private sector delivery of health care, although maintaining the single payer system? It’s come up a few times as a potential solution. Where does the Houston government stand on allowing private sector delivery but maintaining that single payer?

Tim Houston, Nova Scotia Premier: Absolutely. Let’s do it. Matter of fact, we just in this province, for certain types of surgeries, we’re doing that, more and more surgeries, you know, using—look, people just want the care that they need and if it’s going to be the single payer system, we’ll—I believe in that system, but we want to tap all the resources, mobilize ever single resource. This was part of my campaign pledge on addictions and mental health, the universal mental health care. It’s the same concept. If there is somebody that can provide the care, then let’s get that care provided to them. We’re doing it now. We’ll continue to.

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David Akin: Excellent. Tim Houston is the Premier of Nova Scotia. Thank you so much for joining us, we very much appreciate it.

Tim Houston, Nova Scotia Premier: Thanks for having me, appreciate it.

David Akin: Up next, more fallout from travel chaos over the holidays. And the deputy prime minister heads to the World Economic Forum in Davos, Switzerland.


David Akin: Transport Minister Omar Alghabra is promising to strengthen air passenger protection regulations after airlines left Canadians stranded over the holidays.

Omar Alghabra, Transport Minister: “It’s clear that there is further room to improve and clarify these rules.”

David Akin: At the federal transport committee, airline CEOs apologize for the travel chaos, but they are not the only ones facing blame. Over the holidays, trains were stuck for almost 20 hours between Ottawa and Toronto. The head of VIA Rail is expected to appear at the transport committee soon, to tell Canadians how that happened. We’ll be watching that story closely.

And, Deputy Prime Minister Chrystia Freeland is heading to Davos, Switzerland for the World Economic Forum this week. Inflation is sure to be a hot topic, with a new report warning that the cost of living will be “the most severe global risk for the next two years.”

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Well, that’s our show for today. Thank you for watching. For The West Block, I’m David Akin. Have a great week.

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