N.W.T. health authority says closing Stanton's emergency room is 'not an option'

The Northwest Territories Health and Social Services Authority says closing the emergency department at Stanton Hospital is "not an option" — after doctors warned such closures were a possibility because of severe staff shortages. 

Dr. Courtney Howard and other doctors spoke to a territorial committee on behalf of the N.W.T. Medical Association last week, saying there was a desperate need for the territory to increase pay for locum doctors to keep the emergency room staffed for the next four to five months.

Howard, an emergency room doctor herself, said the ER could close as early as the May long weekend. 

CBC News asked Health Minister Lesa Semmler for an interview. Her office did not make her available, saying it was an "operational" issue and that the health authority would respond instead.

Dan Florizone, the public administrator of the health authority which operates the hospital, told CBC News on Wednesday morning that a "closure of the emergency department is not an option. It's not something we would actively pursue." 

He did say, however, that services and staffing at the hospital "might be affected" and that "triaging will be important."

Florizone said new incentives to be announced later on Wednesday were part of the short-term plan to avoid closure. He didn't provide more detail about the nature of those incentives. Florizone said the health authority was also working with the Northwest Territories Medical Association on medium- and long-term plans as well. 

He said the association has made two other asks, on top of incentives, that the health authority is working on. Those include interest-based bargaining, in which a union and an employer talk about their needs instead of staking out their positions, and using new technologies — such as artificial intelligence and virtual care — to make jobs in the North more attractive.

Florizone said the Department of Health and its minister had been "quite clear" that access to the emergency room is a "key priority" and that the health authority would "do everything we have to" to avoid closing it. 

On Wednesday, Florizone spoke with the host of CBC's The Trailbreaker, Hilary Bird. This interview has been edited for clarity and length. 

What is the authority doing to make sure that this closure doesn't happen? 

This is a challenge that is faced right across the country with position recruitment and retention for a whole host of health professionals. I've had a chance to meet Dr. Howard and the medical association several times now. We're meeting again in about a week. We're working through several of the requests of the association and we're very pleased with progress that's being made. What we're working on right now has culminated in — and I don't want to prelude too much — but an announcement that's coming today around locum physician recruitment and some incentives that have been called for by the association.

Dr. Howard says that at this point, we offer less money — that locums coming up here have to essentially take a pay cut from other positions across Canada. Are you looking to increase the salary for locums coming up here?

Yeah. Without getting into the details, that's certainly part of the package. We're also looking at the staffing situation. So there are really three asks that the association has put forward that we're very intrigued by. The first is to move to interest-based bargaining. So putting their interests in advance of talking about a long-term monetary package.

They're talking about incentives. So in the short term, what can we do around recruitment and retention on both of those items?

It's important to point out that the authority, the role that I play, is certainly supportive, but we're not the main bargaining agent for physicians.

The third, which we're really intrigued by as well, is enabling technology. So everything from AI to virtual care, those kinds of assistive technologies that make these careers in the North more attractive. So we're working on all three fronts. And as you could imagine, there's short-term, medium-term and long-term goals at play here.

We've been hearing about staffing shortages for months, if not years. And we've seen the health authority introduce other incentives to get doctors to come up here. How is it that we got to this point?

Well it's interesting. For every move we make, some southern authority makes another move. So it's a bit of a ratcheting up that's occurred across the country. What's unique about this situation, and I'll take a southern kind of perspective on this, is that, where in the past our challenges have been rural and remote, now they're urban. So we're competing with the large centres for a very precious resource.

Now, I've got to say, in just the short time that I've been here in terms of being oriented and onboarded and meeting the leadership, I've been truly impressed by the physician leaders, Dr. Howard and her team with the association, and their commitment to this place. But that can only go so far. We need to do our part to make the practice of medicine, the team-based primary care that's being delivered, as attractive as possible and we're working hard behind the scenes to do that.

Dr. Howard says that given the staffing levels, we could see the emergency room close in as little as four weeks during the May long weekend. Do you think there's enough time to actually make progress here?

The closing of the emergency department isn't like the South where you just simply go down the road. Of course that is the last thing we would do. We rely on locums, we rely on incentives, we rely on agency staff. We'll do whatever we have to do to maintain an emergency department.

Now, that doesn't mean that services or staffing might not be affected and triaging will be important, but we're going to work very hard and with the association to avoid that. So closure of the emergency department is not an option. It's not something that we would actively pursue.

But what if it does happen? What are the plans if you do have to close the emergency room?

The plan is to avoid the closure. So staffing up and enhancing short-term incentives, seeking out our network of locums, the announcement that's being made today around compensation. All of those are intended to avoid any type of closure. These are short-term responses. We also have mid-term and long-term plans that we're actively working with the association on. So I'm really highly committed, as is the authority, to using our full suite of options and alternatives. And the Department of Health, the minister of Health has been quite clear with us: access is a key priority of this government and we will do everything we have to do to avoid any curtailment of those services.

What is the long-term plan to ensure we don't end up in this situation again?

We certainly have seen an aging of the population in Yellowknife and we've seen a lot of people through medical travel flowing from our more remote areas into Stanton and in fact South. So this not only places pressure on a hub like Stanton, it also creates a situation where patients are congested in that centre.

If we can provide more care at home or closer to home, that's going to be part of the long-term strategy. So I'm actively working from the perspective of health cabins to health centres to hospitals outside of Stanton to make sure that the patient journey is such that we can avoid the crisis that causes the emergency room visits in Stanton, that causes the travel that's necessary. We're going to work with the association on those assistive technologies. Just as one example of that. We're also going to be working on primary care and chronic disease management.

We're absolutely committed to avoiding the crisis that caused the emergency room visit in the first place. That's no small feat. But if we could avoid travel because we avoid the crisis, if we can start focusing in on chronic disease and chronic disease management, we can start to reduce the pressure on Stanton Hospital.