NDP's promise to reopen 3 Winnipeg ERs would require hundreds of workers, restoring support departments

The Manitoba NDP's election promise to reopen emergency departments at three Winnipeg hospitals would likely require hiring hundreds of workers in the middle of a staffing crunch and restoring support services cut from the hospitals, says one ER physician.

"You can call it an ER or an urgent care or chopped liver or whatever you want, it doesn't matter. It's really what's beyond the emergency department that's important, and they've taken away all those services and they'd have to replace them if they wanted to go back," said Dr. Alecs Chochinov, who works in St. Boniface Hospital's ER.

The New Democrats are counting on voters in the Oct. 3 provincial election to see them as the party to fix an ailing health-care system they accuse the Progressive Conservatives of ruining.

But Chochinov believes the public discussion surrounding the NDP promise has largely ignored the other supports required for three more functioning acute-care hospitals.

The Victoria, Concordia and Seven Oaks hospitals must bring back a number of specialty services, ranging from general surgery to internal medicine units — and hire the necessary staff — to reopen the ERs the Progressive Conservatives converted to urgent care centres from 2017-19, said Chochinov.

"This isn't just about making more emergency positions, it's making more gastroenterologists and urologists and ICU doctors and intensivists," he said, listing examples of what those hospitals may need.

The NDP says it would take eight years to build the emergency departments, starting with the Victoria Hospital in south Winnipeg, and they wouldn't break ground until necessary staff were in place.

Their first step would be hiring 300 nurses in Winnipeg, according to the NDP.

Vacancies to fill

The new ERs would have to be staffed in a health-care system that is already suffering from vacancies. The Manitoba Nurses Union says there are more than 2,000 nursing vacancies, while the advocacy group Doctors Manitoba says the province needs at least 400 more physicians.

NDP Leader Wab Kinew has called the decision to close the three emergency departments the "biggest mistake" the Tories made in office, and his party has announced a $500-million health-care recruitment plan.

The PCs say Manitoba is dealing with staffing shortages being felt across the country. While in government, the Tories promised $400 million for their health-care human resources plan.

• Read full coverage of the 2023 Manitoba election here

Chochinov estimates reopening the three ERs with the required support services would require "dozens of doctors and hundreds of nurses," which he believes is "completely unrealistic," because many health-care workers are near retirement and the competition to hire staff from elsewhere is stiff. 

The staff "don't exist, or it would take asking the existing call teams at the hospitals to cover more hospitals, and they just don't have the energy or inclination or ability to do that," he said. "That's why we did consolidation in the first place."

Even if the three ERs are reopened, they wouldn't have the breadth of services of Winnipeg's main tertiary hospitals — Health Sciences Centre and St. Boniface — said Chochinov.

"If we wanted to replicate those services for Victoria [Hospital, for example], it would be impossible to do. We don't have the workforce, the medical workforce to do it, and we never did," he said.

If more staff were hired, they would need to be grouped into teams to provide constant support.

For example, multiple general surgeons are needed to support a surgical program in which someone is always on call. 

"And you can multiply that by whatever specialities you want to have there," Chochinov said.

Former WRHA CEO confident plan will work

The NDP's plan also includes new step-down, or high-care monitoring beds, at the Victoria Hospital for patients who are sick but don't need an ICU. Six of those beds are also slated for Concordia, which would enable surgeons to perform some of the complex surgeries they lost the ability to conduct when the ER closed, the NDP said.

The party is also planning to make around-the-clock dialysis care available at Seven Oaks.

The NDP isn't planning to build intensive care units at these three hospitals, which the facilities had before consolidation. 

Dr. Alan Drummond, of the Canadian Association of Emergency Physicians, hopes the NDP isn't letting politics influence its plans for health care.

"Either a community needs an emergency department or they don't. It should be on its own merits, based on the population, the geography, the industrial imperative," he said.

"It should not be an issue of whether a party wants to gain one seat in an election."

But Dr. Brian Postl, a former CEO of the Winnipeg Regional Health Authority, has publicly endorsed the NDP's plan.

In an interview, he said the health-care system has buckled under the Tories' reforms and years of austerity. Recruiting and retaining more staff will serve as the foundation for repairing the system, which he also recognizes will take years. 

"It'll take expansions of our training programs. It'll take a different view of how we bring international medical graduates into the structure. It's maybe needing some different approach to the use of physician assistants and nurse practitioners."

He's confident it'll work, though, "because I have a lot of faith in our medical professionals."

'Let's do it right this time'

A key stated objective of the PCs' hospital reforms was to streamline and concentrate resources, rather than spread them over multiple sites.

The consolidation was also meant to cut wait times, but at some hospitals the average wait time this summer is double what it was before the restructuring began. Staff remain overworked and many have quit. 

In 2016, the Tories enlisted Chochinov to co-chair a task force that examined emergency wait times and proposed solutions. The report urged caution before proceeding with the emergency room changes the PCs were already planning.

Looking back, Chochinov, who is also the chair of a national task force looking at the future of emergency care, said he never advocated for closing all three ERs, but he doubts reopening all of them is the right approach.

He'd ask whichever government is in power in Manitoba to conduct an assessment of what's required.

"I think we blew it the first time — the first time being between the release of the report [in 2017] and where we are now. Let's do it right this time and let's not go back."

The PCs also relied on the advice of doctor-turned-consultant David Peachey, who called for closing three emergency rooms in a 2015 report the former NDP government commissioned but never acted on. 

He returned to Manitoba in 2019 to assess the overhaul the PCs were in the process of implementing and found "confidence has been lost," staff were exhausted and surgeons were threatening to walk.

Peachey, who has continued to keep tabs on the province's health-care system, said it's a "little frustrating" the years-old consolidation plan is still an election issue.

"We still believe strongly in the timeliness of our recommendations back then, but in the absence of having a data refreshment and reanalysis, it's hard to say whether it would be the same today," he said.

The provincial government said the various players in the health-care system must provide regular updates, but didn't say whether the overhaul itself is being evaluated. 

The NDP's Kinew said his party has spoken to front-line health-care workers in drawing up its plan to reopen the emergency departments. Peachey said he hopes the NDP is also using quantitative data in its assessment.