NWT health bosses are preparing to experiment with a Yellowknife hospital emergency room staffed only by “virtual” physicians at times this summer, three workers’ groups and two doctors with knowledge of the situation say.
Health minister Lesa Semmler and the territorial health authority’s public administrator, Dan Florizone, previously pledged to keep the doors open at Stanton Territorial Hospital’s emergency room despite staffing shortages.
But the Union of Northern Workers, NWT Medical Association (representing physicians) and nurses’ group CANNN now say part of that plan involves physicians appearing virtually, for example by video link.
Two NWT-based physicians with knowledge of the situation independently confirmed the existence of that plan to Cabin Radio. They requested anonymity to discuss sensitive details of their work.
One said the plan would mean periods during which no emergency room physician is physically present at the hospital. Nurses in the building would instead assist a physician dialling in from elsewhere in the country.
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“Staffing plans now include regular 12-hour physician shifts and an untested ‘virtual ER’ model where no physician is physically present,” the three workers’ groups said in a Thursday afternoon statement.
The groups called that approach “unsafe” for a hospital that serves the entirety of the NWT and Nunavut’s Kitikmeot region, a total of some 50,000 people.
The NWT’s health authority has been approached for comment.
“In addition to receiving medevacs, the ER physician provides phone support to physicians, nurses, and lay people serving as health cabin workers,” stated the UNW, NWTMA and CANNN of the role an emergency physician normally performs at Yellowknife’s Stanton Territorial Hospital.
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“As a result, this failure significantly impacts people living in other communities.”
The groups called the existence of a doctor physically inside the emergency room “non-negotiable” and said three eight-hour shifts in the ER per day should be the minimum standard.
One doctor said some staff have begun working 12-hour shifts, which the health authority had suggested was a possibility earlier this year in a bid to work around a lack of staff.
The doctor said the idea of a virtual physician was “fine for health centres and places like Hay River, at the largest, but not for a level three regional hospital that serves a town of 20,000 plus a large catchment area.”
‘Legal liability, moral distress’
The dates on which the NWT’s health authority currently expects a virtual physician to cover the emergency room have not been made public. Nor is it clear where the health authority will find physicians to perform that role remotely.
Cabin Radio was told by two physicians that gaps in the emergency room schedule currently exist on multiple days in both July and August.
“Across Canada, when emergency departments face collapse, provinces step up with surge funding, competitive compensation, and dedicated locum support. In the NWT, we need equal action immediately,” the NWT Medical Association stated.
The UNW said the “expectation being put on our members by the employer to go over and above not just their job description and statement of duties, but also potentially what they can legally do, is a threat to worker and public safety.”
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CANNN said that “without in-person physician backup, emergency nurses and nurse practitioners are placed at unacceptable risk, pressured to manage situations beyond their scope. This creates legal liability, moral distress, and direct threats to patient safety.”
Previously, territorial health authority administrator Florizone told Cabin Radio there “will be no closure of emergency departments” this summer.
“An emergency department would be the last thing we’d want to close … We’re going to do everything we have to do, and can do, to avoid that,” he said.
The NWT would not be the first part of Canada to use virtual physicians to keep emergency rooms open.
In January, the CBC’s White Coat, Black Art medical news show documented a physician in Kelowna, BC serving as the virtual physician for an emergency room hundreds of kilometres away in Mackenzie, BC.
But the communities the CBC examined – Mackenzie and Musquodoboit Harbour, Nova Scotia – have populations of just 3,000 and 2,000 respectively, compared with Yellowknife’s 20,000 and Stanton’s status as the major hospital for all of the NWT and part of Nunavut.
“We call on the premier, the minister of finance and minister of health to intervene immediately,” the three workers’ groups stated on Thursday.
“Staffing gaps are already upon us and continue through the summer. We need immediate policy change to provide leadership with the tools required to guarantee 24/7 in-person emergency physician coverage this summer.”
