Defend Public Healthcare

Ambulances and their patients waited outside London, Ontario emergency rooms (ERs) for more than 685 hours in March — that’s an average of one working paramedic crew unavailable for emergencies for every hour of every day that month, according to the London Free Press .  Based on Ontario’s 2009 benchmark figures of $146/hour/ambulance unit, the cost to sit and wait in that month alone exceeded $100,000. As usual, the blame is put solely on too many alternative level of care (or "ALC" ) patients in hospital beds, as if the ER backlog was simply a problem of bad management rather than government policy to squeeze hospitals.   No mention is made of bed cuts or dangerously high hospital bed occupancy levels.  But this is not simply a bad management problem.  It exists around the province at too many hospitals for that.   So, on the same day as the London report, a Durham report  indicates that ambulance 'off-load delay' in that region increased from 16,00

A staff report going to Hamilton's Emergency and Community Services Committee next week will report 94 Code Zero events in 2010 - where one or less ambulances  are available to respond to an emergency.  This is an increase from 43 in 2009, 66 in 2008 and 44 in 2007, according to the Hamilton Mountain News. In other words, a 114% increase in 2010 over 2009.  As noted earlier,  there are concerns that hospital restructuring (where the McMaster emergency room will  close to adults) will make the matters worse by requiring more transfer time. OPSEU paramedic president Mario Posteraro told the News : " The elastic has been stretched and will break, unless there is an infusion of needed dollars. "  Forced overtime and missed meal breaks are already pushing Hamilton paramedics to their limit, and patient service could suffer with the added pressures expected after the restructuring on April 4, according to Mr. Posteraro. dallan@cupe.ca

A Hamilton City Councillor  is demanding the Local Health Integration Network (or the local hospital) pick up the tab for extra Emergency Medical Service (EMS) costs associated with hospital restructuring in that city. Councillor Tom Jackson says a consultants report predicts it could cost an extra $1.5 million in EMS (ambulance) costs. This sort of cost download is likely happening with a lot of the centralization of hospital services going on around the province.  Emergency Medical Services are increasingly required to move patients from one hospital to another, so that patients can get access to the variety of services they need at the specialized sites providing those services. From the province's point of view, this is a winning proposition: while they fund almost all hospital expenses, they only have to pay 50% of   approved EMS costs.  But for municipalities charged with providing Emergency Medical Services, hospital centralization creates new costs (and demands) for

The provincial government has slowed down the implementation of the new response time standards for emergency medical services. A revised provincial regulation now allows municipalities two more years before they must report on response times and their response time plans. On September 17, 2010 Regulation 368/10 came into effect, amending the earlier Regulation (257/00) on response times. Under Regulation 257/00, municipalities were required to submit a response time performance plan to the government by 1 October 2010 for the following year.   Under the revised regulation, municipalities will now have until 1 October 2012 to do this. When filed with the Ministry of Health these plans will be publicly available. Given the overcrowding in hospitals and the attendant backups in Emergency Rooms and  "offload delays" for paramedics , the government probably appreciates putting off the reporting of the local plans until after the next election (now less than a year away).

Under the title of "Improving ER Services In Rural And Northern Ontario," the provincial government has asked "a group of leading health care experts to examine and develop recommendations for improving emergency services in small and rural communities." The new "Emergency Room Task Force" will develop recommendations for emergency rooms in rural and northern areas to adapt to staffing challenges. The government notes:  "minor staffing challenges -- a doctor's unforeseen family emergency or a nurse's unexpected illness, for example -- can impact a hospital's emergency services." The Task Force is certainly high powered: six of the fourteen panel members are either Ministry or LHIN leaders, including two Assistant Deputy Ministers.  The Task Force is supposed to submit a final report to the government in the spring. The government claims that "there have been no unplanned ER closures in Ontario since 2003." What it doe

As part of ongoing provincial cutbacks, the Niagara Health System hospital closed the Emergency Departments (EDs) in two of its smaller sites last year, converting them into Urgent Care Centres (UCCs).  The hospital now recognizes that it "has been experiencing serious issues with off load delays" at its three remaining EDs despite a policy for ambulances to bring at least some patients to the converted UCCs (and the maintenance of similar patient volumes at the UCCs).  Nevertheless, sicker patients are now being brought to the EDs. The hospital notes: At the same time while our volumes in the Emergency Departments in Welland and Niagara Falls have remained relatively stable the acuity level of the patients presenting are higher. As the acuity increases the resources required to manage these patients expands, resulting in more diagnostic testing and physician assessments. This causes an increase in the “time in the ED” hence increases congestion, crowding and potential

With hospital cuts, there has been some problems with ambulance offload delay, as paramedics wait longer to offload their patients to overloaded hospital staff.  As noted earlier , Niagara region reports a 68% increase in offload delays This in turn puts pressure on EMS response times as paramedics are forced to wait in ERs. Some municipal leaders have mused about sending more fire trucks to EMS calls, as a way to respond to this problem.    But fire trucks are among the most expensive items for municipalities. The 2007 Performance Benchmarking Report (from the Ontario municipal Chief Administrative Officers and City Managers) reports that  each fire vehicle cost $281 per in-service hour in Hamilton, $284 in Toronto, $239 in London, $270 in Thunder Bay, and $207 in Ottawa. The median cost for urban municipalities was $239 per hour, the same as the Toronto rate. In contrast, one hour of in-service ambulance time cost $147 in 2007. With a $92 differential that means a savings of

With the elimination of hospital emergency rooms (ERs) and the reduction in hospital beds, ambulance "offload delays" (where overflowing hospitals and ERs make it impossible for paramedics to transfer their patients to hospital staff) are once again growing . This is reminiscent of the ER problems about a decade ago after the cuts to hospital services occasioned by the Harris government.  At that time,  ambulances were turned away from backlogged hospitals, infamously resulting in the death of a young asthma sufferer, Joshua Fluelling. Fluelling, 18, was having a severe asthma attack in January 2000 when his ambulance was redirected from the closest hospital, Scarborough Grace Hospital, and sent to Markham-Stouffville Hospital, more than twice the distance away. Scarborough Grace was on critical care bypass and not accepting new patients the night of Fluelling's attack. On route to Markham, the teenager suffered respiratory failure and brain damage. He died later in

A new report from Niagara EMS suggests that hospital cutbacks, including the closure of two hospital Emergency Rooms in Fort Erie and Port Colbourne, has resulted in longer "offload delays" for paramedics, as they wait to transfer their patients to hospital staff at the remaining three ERs in the area. In fact, the offload delays are projected to increase 68% in 2010, reaching 10,000 unit hours for paramedics. Since the restructuring of hospital ERs last year and the resulting increase in patient arrivals by ambulance to the three remaining ERs, "off-load delays have increased significantly and have now surpassed the previous peak of 7,075 unit hours set in 2008." Niagara Falls Liberal MPP Kim Craitor said he had heard ambulance off-load delays are increasing and he's concerned about the situation. "I don't disagree with anything they say in that report."  Without sufficient beds to move patients into, the problem will not be resolved, he a

Amidst the storm of criticism of Local Health Integration Networks (LHINs), the Minister of Health and LTC, Deb Matthews, has now said that bringing doctors and health units under the LHIN umbrella will likely be discussed when a much-anticipated legislative review of the LHIN system eventually takes place.  (This review, previously scheduled for this year, has now been put off until after the next election.) The LHINs have, slowly but surely, taken over responsibility for hospitals, nursing homes, home care, community health clinics, and other community health services.  But doctors, public health units, and ambulance services remain outside of their dominion. The doctors probably won't tolerate having to put up with the LHINs -- they will want to deal directly with the province (the people with actual political power, not just the flak catchers). The public health units (currently under municipal control) are more of a question, to my mind. They already get 75% of their app