When Allison Holthoff entered a crowded Nova Scotia hospital in late December, the intense pain in her abdomen was getting worse with every hour that she waited for treatment. With the ER undergoing renovations, overwhelmed staff sorted through a stream of incoming patients into a makeshift treatment area.
“‘I feel like I’m dying. They’re going to let me die here,'” Holthoff told her husband, Gunther.
After more than seven hours of waiting, he went into cardiac arrest. Health professionals revived her three times and detected internal bleeding on an X-ray, but staff determined that her organs had suffered too much damage and she was unlikely to survive.
“It was a terrible situation for my wife, for my children and for a lot of people in the community,” Gunther Holthoff told reporters earlier this week at a news conference, saying his wife had been “abandoned” as she his condition deteriorated. “I’m just lost.”
While the cause of death has yet to be identified, the case has prompted calls from local politicians for an investigation into the backlog of cases in the Canadian province’s emergency room. But Holthoff’s death is also the latest fatality to expose a growing crisis at the country’s hospitals, which have been worn away by waves of respiratory viruses and exacerbated by a chronic staff shortage.
Last summer, many emergency rooms in rural communities closed. In the largest cities, people waited tens of hours for emergency care. At Canada’s largest children’s hospital, SickKids, a four-year-old boy was separated from his family and flown more than 350 km (217 miles) to receive treatment for a near-fatal sepsis infection amid overcrowding .
“Emergency rooms are the barometer of our health care system,” said David Carr, a physician and professor of emergency medicine at the University of Toronto. “We are facing the ‘perfect storm’: a virus has been thrown at us that has crippled our health care system, and while we have managed to control it in many ways, what we have not [is] facing is the total burnout of nurses and members of the healthcare team.”
While the winter months are often the worst times for ERs as respiratory viruses take hold, Canada’s shortage of healthcare professionals — and rising burnout rate — is making a serious problem worse.
“Clearly the cracks have been exposed,” Carr said, noting that colleagues in other provinces often share “shocking numbers” that expose overflowing waiting rooms and struggling to allocate limited beds.
To further compound the staffing shortage, health care systems across the country are experiencing a “geriatric tsunami” of aging patients, whose care requires an increasing share of health care budgets and efforts.
In recent months, these crises have brought healthcare systems to breaking point. With medicine falling under provincial jurisdiction but funded by the federal government, political leaders at various levels of government have scrambled over solutions to a languishing system.
Amid the shortage of family doctors, more cases that should be seen sooner are ending up in the country’s emergency rooms.
“Sometimes you will hear stories of terrible outcomes that occur in emergency department wait times. But what you often don’t see is the effect of those delays,” Carr said. “The press picks up on these terrible catastrophes that happened in the waiting room. But they missed out on the morbidity of conditions that occur as a result of delayed care, of people not being able to see a primary care physician.”
To make the shortage worse, Canadian medical students studying abroad are often unable to practice medicine when they return home due to tough licensing requirements.
“I tell parents of prospective medical students that if they send their child away, there is a reasonable chance that he or she will never return if they train abroad, even if it is in the United States,” Carr said.
Provincial premiers recently tabled a proposal that would make it easier for foreign-trained nurses and doctors to obtain Canadian credentials. But experts warn that the move can’t be done quickly and requires more resources than just rubber stamp paperwork.
Without a single factor breaking ERs, Carr fears no quick fix is possible, and he worries that political leaders remain incapable of fixing a crisis that health workers have long warned was coming.
“I feel like for years, our grievances have fallen on deaf ears,” he said. “And now I am concerned that we are facing a pandemic of significant mental health challenges in our health care community. We have an aggravating threat that must be addressed today, not tomorrow.”
