Should some rural ERs close permanently if better supports are in place?
Chronic closures due to staffing shortages worse in rural areas, CBC analysis finds
Plastic covers new chairs in the pristine waiting area of the Carleton Place and District Memorial Hospital's newly constructed, 'state-of-the-art' emergency room (ER), which officially opens for residents in this rural eastern Ontario community in January.
The next challenge will be keeping the doors open. And that hinges on the availability of nurses.
Brad Harrington, the CEO of the Mississippi River Health Alliance, is taking an "if you build it, they will come" approach.
"It's an absolute key strategy for us in regards to recruitment and retention going forward," said Harrington.
A CBC data analysis found Carleton Place is one of at least 38 Ontario hospitals whose ER or urgent care centres have experienced closures — about one-fifth of the 176 publicly funded facilities over the past three years.
The data shows more closures in rural and remote areas. The majority — more than 85 per cent — were due to nursing shortages.
One ER in Minden, Ont., about 300 kilometres west of Ottawa, closed permanently in 2023. Others in the southwestern Ontario towns of Chesley, Clinton and Durham are currently closed every evening and all night.
Physicians who spoke to CBC both on and off the record wonder if ERs that are only open for part of each day can really be considered an ER. Some suggest more permanent closures, done in concert with establishing better support services such as urgent care clinics and advanced paramedic care, could help remedy inconsistent emergency services in some areas.
Can all rural towns have an ER?
For Tim Vine, president and CEO of North Shore Health Network, managing three hospitals in the remote rural area along Lake Huron comes with constant uncertainty in terms of finding enough physicians and nurses to keep ER doors open.
Since 2022, the three hospitals Vine oversees have endured the frequent risk of ER shutdowns, which happened this fall at Thessalon's hospital and in Richard's Landing.
"We need help from policymakers and from planners within the system to determine whether or not there ought to be an emergency department in a particular location. I've got my answer and it's an unequivocal yes, but if that's to be the case, we need to be funded in order to deliver that service," Vine told CBC, noting his network too often gets temporary, stop-gap funding.
Permanently closing ERs in remote areas is a difficult call when the next closest emergency department is an hour or two away. But in rural areas some hospitals are much closer.
"Those days of every small town having an emergency department are regrettably over until we can develop some resilience in our health-care system," said Dr. Alan Drummond, who has practised emergency and family medicine in Perth, Ont., for decades.
Perth's Great War Memorial Hospital's emergency department had to shut down for three straight weeks in 2022, shocking residents.
Known for his blunt commentary on health-care issues, Drummond said given the reality of scarce human resources, it doesn't make sense right now to try to maintain every ER.
He notes that while in some cases small ERs can stabilize a patient, most inevitably seek diagnostic tests or specialized care in larger centres.
"You have to drive another half an hour, but there you're guaranteed that the service is going to be open, that the staff is going to be well-trained," said Drummond.
While he can't fathom the closure of his own ER in Perth, he will muse about the future of Almonte General Hospital's emergency department, especially now that Carleton Place, just 12 kilometres away, will offer a bigger, better service.
City patients arrive at rural ER
CBC's data analysis found that while the Carleton Place hospital had no unplanned ER closures in 2024, it needed to close for at least part of 25 days in 2022 and 2023 due to a lack of nurses.
Meanwhile, the Almonte hospital, also managed by the Mississippi River Health Alliance, had 36 full- or partial-day emergency closures since 2022, including two last month.
But the brand new ER in Carleton Place won't lead to the eventual phasing out of Almonte's ER, said Harrington.
"That's not a viable solution. Our model is two strong hospitals going forward," he said.
That's echoed by Dr. Melanie Fortune, chief of staff at Almonte, who sees the ER as the "soul of the hospital".
"I'm not concerned about the risk of permanent closure whatsoever," said Fortune.
Almonte, about 50 kilometres from Ottawa, also sees its share of city residents seeking emergency care, she said.
"We've never seen more patients coming for care," said Fortune. "Many city patients will come to smaller hospitals in the region because they know that our wait times are shorter here."
WATCH | The situation Carleton Place's new ER opens in:
In Ontario, 2.5 million people are without a family doctor, which leads to more pressure on every emergency department, according to a new study from the Canadian Institute for Health Information.
Drummond said that doesn't mean people with minor health issues are increasing waits.
"The reason we have a crowded emergency department is because we have a crowded hospital," said Drummond. "Most Canadian hospitals, small and large, function at over 120 per cent bed capacity. So we have no place to put our patients."
'I'm not going anywhere'
Last week, Ontario's Health Minister Sylvia Jones was asked if she's worried about the increase in scheduled ER closures in rural Ontario.
"It was concerning to us, yes. We continue to work with our partners through Ontario Health to make sure they have sufficient staff, health, human resources, whether it's physicians, whether it's RNs," said Jones, who noted her government is investing in training more nurses and doctors.
Keeping emergency room doors open in Ontario will largely depend on hospitals attracting and retaining those nurses.
Like so many rural areas, the Carleton Place community is committed to its hospital. Residents there raised $5 million to help build and equip the new ER. The province provided the other $15 million.
Registered nurse Iris Rawlings has worked in the old emergency for 26 years and is helping set up the new space. Over the past few years, she's worked consecutive weekends and many hours of overtime to help keep the doors open.
"So sometimes living here a little bit," said Rawlings.
Despite it all, she said this new ER is where she wants to be, and she hopes it will draw others.
"It's made for families, it's made for our community," she said. "I'm not going anywhere."
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With files from Valérie Ouellet