Life lines: Health-care professionals discuss challenges in communities on Lake Huron's north shore

This is the second story in CBC Sudbury's Lifelines series exploring access to health care in the communities of Lake Huron's North Shore. You can read the first story here.

Dr. Nick Jeeves takes a rare moment to sit and reflect in a corridor at the Blind River Hospital, a small facility off Highway 17 along the scenic and sparsely populated north shore of Lake Huron.

It's part of the North Shore Health Network (NSHN)

His light grey scrubs and salt and pepper hair are coupled with a quiet demeanour as nearby nurses stay intent on their duties and a patient rolls through the hallway in a motorized wheelchair.

Only eight of the 18 beds at the hospital hold patients today and the emergency room is quiet, recovering from a busy period.

The hospital provides a critical safety net here as the next closest emergency room is a 45 minute drive away on Highway 17 in Thessalon, and the closest major health hubs are in Sudbury and Sault Ste. Marie, an hour-and-a-half away in either direction.  Both of those hospitals are struggling with wait times and overcapacity.

The rural hospital has its own challenges — one is that the old-fashioned idea of the country doctor is fading.

Jeeves is chief of staff in Blind River and one of four doctors who will retire in the next couple of years. That's half of the physician staff of eight at the hospital.

He said one of the problems is the expectations for rural generalists have changed and the profession is in flux.

"It's changing even faster as time goes by," he said. "The rate at which new information comes up and new ways of treating things, new ways of diagnosing, imaging, etcetera. All those things are changing and in very quick order, and expectations of practitioners change as well."

He said he has loved being a rural physician, but it's increasingly difficult to convince young people to accept the demands of the job and to live in the area.

After a quick chat, his rest is over and it's time to get back to work.

NSHN CEO Tim Vine said staffing and human resources are always in his thoughts, with a heavy reliance on a visiting, temporary doctors to cover shifts 60 per cent of the time.

According to the Ministry of Health, there is an Emergency Department Locum Program (EDLP)  which provides doctors on short-term stints as backup coverage and a last resort for hospitals facing challenges to temporarily cover ED shifts.

The focus of the EDLP is to support EDs in small and rural hospitals that are typically covered by a single physician. 

The Temporary Locum Program (TLP)has been negotiated between the Ontario Medical Association (OMA) and the ministry. It's available to eligible hospitals in rural and northern Ontario to help maintain 24/7 ED services.

A ministry spokesperson said there will be an announcement soon on the future of that program.

Still, Vine is always worried about the locums making it to town.

"We're one missed plane ride away from a possible closure, which is a fragility that urban places don't experience to the same extent," he said, noting that visiting locums often fly in from bigger communities.

The Thessalon site had to be closed temporarily four times last year, Vine said, due to a hiatus in the temporary locum program.

So far this year, Vine said, there have been no closures at the three sites.

The ministry provided information about recent emergency room closures in hospitals across the province.

"From May to September in 2023, there were 37 individual hospitals with reduced emergency department hours, and so far, this summer, May to July, there have been 13 individual hospitals with reduced emergency department hours," wrote Hannah Jensen in an email.

At the Thessalon site, Dr. Amy Vine said last year's closures were "terrifying".

Vine, who is no relation to CEO Tim Vine, is a former nurse and nurse practitioner from the area who graduated from NOSM University in 2022 and came home to practise, making her a home-grown talent with roots in the community.

"I know we provide good care with what resources we have and I hesitate and worry about what will happen if if something changed and we weren't here."

The facility used to include four in-patient beds but those were closed in 2020 because there was no ability to conform to COVID-19 protocols.

Vine said emergency services have since expanded into those rooms, remarking there's now space for an ultrasound and that a geriatric program has been added.

She said if it wasn't for the clinic, a patient who attended with anaphylactic shock last week might not have survived.

Today, her challenge is to decide how to deal with an elderly patient with dementia who had fallen.

The Thessalon site does not have a CT scanner and she has to decide if a scan is warranted.

She said it's challenging to mentally balance the resource management,

"Who do I send out for higher levels of care?" she said. "Who do I send out for more imaging? Because I know that that takes resources away from here, she said. "And the only ambulance that's on will be taking our patient and be gone for three hours. So that means if someone in town calls 911, it's going to be a long time and they're going to be frightened trying to care for whatever is going on. And so that's a big weight on me deciding who gets to go where and when."

In this case, the woman was not sent for a scan.

Making sure patients in the area get where they need to go falls on the staff of the Algoma District Paramedic Services.

Chief Jeffrey Pulvermacher said they cover 45,000 square kilometres with vehicles at eight stations.

He said 60 per cent of their work is transferring patients for tests and treatment, with 40 per cent responding to emergencies.

Pulvermacher said urban areas generally use private transportation for transfers, freeing ambulances for emergencies, but paramedics in rural areas are responsible for all calls.

He said it's becoming more common that there are emergency calls when all vehicles are tied up with patient transfers and no one is free to respond.

It's called a Code Black.

Pulvermacher said that's happening four to five times a month now and it makes him very anxious.

"Right now we're in a crisis," he said. "When we started, the COVID pandemic ... our staffing levels were sufficient. Throughout the pandemic, we started losing more staff and started doing increases in transfers out of town."

He said if the trend continues, there'll be trouble ahead.

The province and municipalities share the funding for their ambulance services.

Ontario Ministry of Health responds

As staff continue to weigh their responsibilities to people in the rural communities and face the challenges of recruiting and meeting expectations, the Ministry of Health said it continues to work with its hospital partners to make sure they have the tools they need to continue to deliver the care that patients deserve.

As for training more doctors in the region, spokesperson Hannah Jensen said the government is expanding medical seats to 44 undergraduate and 63 residency positions at NOSM University

She added that in rural and northern communities, the government has expanded the Learn and Stay Grant, which provides students in nursing, paramedic, and medical lab technologist programs with tuition and other education costs if they spend time in a community that needs it most. 

Earlier this month, the health minister announced new funding aimed at helping over a thousand nurses in rural and remote hospitals to develop new skills to provide emergency department care.

Tomorrow: The second instalment of our look at rural health care on the north shore of Lake Huron: 'Lifelines,' we hear from community members and patients who who are worried that rural health care is waning.