'It’s lunacy': B.C. nurses told to call 911 when no ER doctors on shift

One of B.C.’s health authorities had a plan to keep a hospital emergency room open despite having no physicians to cover the department by demanding family doctors attend to any of their patients and ordering unsupervised nurses to call 911 for those in medical distress.

CTV News has obtained a memo sent to doctors and administrators at the Bulkley Valley District Hospital in Smithers on Friday titled “No physician BVDH ER Coverage Mitigation Plan.” It includes instruction to call “the responsible family physician of all attached patients that present” to attend them in the hospital when there would be no doctors on shift.

Nurses alone in the emergency department “will be able to provide comfort measures and some first aid…or phone 911 if the person presenting is in immediate medical distress.” 

When CTV News asked to speak with a senior official about the situation, a Northern Health spokesperson replied via email, saying the unfilled shifts are now covered and that hospital's emergency department had remained open as closing it is a “last resort” they are working to avoid.

“Recruitment and retention in rural communities continues to be a challenge, and we recognize that shortages of staff – especially those are trained in providing emergency department care – is affecting many communities across B.C.,” they added.

Just last week, a shortage of hospitalist doctors resulted in some Nanaimo patients receiving a letter from staff informing them that even though they had a bed, nurses alone would be caring for them as there wasn’t a doctor available to oversee their care.

NURSES UNION SHOCKED, WORRIED

The B.C. Nurses Union learned of the plan when contacted by CTV News and the president said she’d be canvassing her members to see if anyone had to resort to calling 911.

“That is shocking news to me,” said Aman Grewal. “It’s the first I’m hearing of this and I will be looking into it further.

Nurses have expressed concern that they may be the target of further anger from patients frustrated to be waiting even longer without seeing a doctor, while fearing they could lose their licence after being unsupervised by a responsible physician.

The BC College of Nurses and Midwives pointed out that their members have the right to refuse work outside their scope, noting that in the wake of persistent and worsening staffing shortages, “when reviewing and investigating complaints, the standard of care expected of nurses is always considered in context.”

Grewal emphasized that not only are patients likely to experience sub-standard care in a situation like the one facing Smithers, nurses are distressed when unable to tend to patients properly, doing their part alongside their physician colleagues. 

“It's a collaborative team effort, and if you don't have one piece of your team there, the system is going to fail,” she said.

NDP GOVERNMENT IN THE HOT SEAT

The opposition parties were stunned when contacted about the plan by CTV News, expressing dismay and frustration that the health-care crisis in British Columbia continues to worsen without substantive efforts or policies to reserve the trend.

“It's lunacy. It's not something that should ever happen in the Canadian medical system,” said Dr. Sanjiv Gandhi, a former pediatric heart surgeon and current deputy leader of the BC Green Party. “I’m incredibly worried about the upcoming respiratory season.”

The official opposition health critic suggested the New Democrat government has to answer tough questions about issues that are causing people to lose faith in the health-care system, particularly in northern and rural communities.

“The premier, (Health Minister) Adrian Dix, I would love to hear their explanation for how a nurse in an emergency room may have to call 911 to support a patient who presents with an emergency situation,” said Shirley Bond, Prince George MLA for BC United.

They offered short- and medium-term solutions including expediting credentialing of foreign doctors and nurses, allowing physicians assistants as most Canadian provinces do, and making it easier for all doctors to help in hospitals.

“It's absolutely not about money,” said Gandhi. “They've offered ridiculous amounts to cover this shift and that shift and still have hundreds of ER closures and in-patient shortages.”

While there have been no emergency department closures in the urban centres, Lower Mainland hospitals like Surrey Memorial have faced major issues driven, in part, by a bizarre situation: while family doctors’ contracts and compensation are negotiated by one province-wide deal, health authorities hammer out deals with doctors in each hospital, restricted by provincially-dictated maximums.

Low morale and other issues unique to Northern Health are likely contributing to the exceptionally dire staffing in Smither. No staff are speaking publicly with fears of professional retaliation a major concern.

That situation, like the one in Nanaimo, only care came to light only after documents were leaked to CTV News, leading Bond to speculate such crisis-level responses are “probably happening in many more places than we think.”

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