Solutions to Alberta's health-care system woes could lie outside the system

WATCH ABOVE: The problems facing Alberta's health-care system are clear to see, but the solutions are not. Morgan Black reports.

A mother who took her two-year-old son to the local children’s hospital emergency department after he started coughing up blood ended up waiting 15 hours to be seen by a doctor.

Edmontonian Karen Khurshed took her son Malix to the Stollery Children’s Hospital at around 5 p.m. and ended up staying overnight. She described the experience as traumatic, as they had to wait with other stressed and concerned parents doting over sick kids in an overfull waiting room.

Unfortunately, that is not an uncommon story late into the third year of the COVID-19 pandemic.

“Now I’m questioning when should I not go and how bad does it have to be for me to endure that much wait and mini trauma?” Khurshed told Global News.

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“It just doesn’t feel like Canada anymore,” she added. “Our government is not doing what we need to do for our health care and they’re failing us.”

Stollery medical director Dr. Carina Majesic said that the children’s hospital is seeing “unprecedented” levels of demand.

“We’re full. We’re full, but we also make extra space when we are full,” Majes ic said.

“We have what they call surge plans and other plans in place so that if one area is full, then we can swell into other areas.

“And you can see that across the country, as well. We’re not the only hospital that is experiencing this. All the children’s hospitals are feeling the pressure of this year’s viral infections where we are well over our normal level in terms of how many patients we’re seeing and how many are patients we’re admitting,” Majesic said.

“There’s nowhere in health care that’s good right now,” a paramedic told Global News.

For fear of losing his job, the paramedic spoke with Global News anonymously.

“When you talk about other places in health care, when they’re not doing well, they all end up with a 911 call. And then we’re in that cycle of the emergency side of health care,” he said.

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“When people pick up the phone and call 911 and it’s an immediate emergency, they have this expectation that we’ll be there quickly. And maybe that used to be the case, but now it’s not.”

The long-time Edmonton-area paramedic said the building demands on the EMS system and the lack of investment over the past decade has resulted in longer than ideal response times.

He said burnout in the career has accelerated after officials started structuring 12-hour workdays away from what seems like reasonable workplace accommodations.

“You let them go home on time – that seems really simple. You give them a break somewhere in the middle of their shift where they can actually sit down and eat a meal and not get dragged out, having to microwave their food three times in a day.

“Really simple things like that would actually go a long way.”

Despite the recently-fulfilled promise of 10 new ambulances in both Calgary and Edmonton, the paramedic said the new trucks aren’t helping.

“I can tell you they’re not rolling. This is just stuff on paper. We don’t have the physical people to staff up those trucks.”

Systemic solutions

Dr. Peter Brindley has kept an I.D. badge from every hospital he’s worked at over the past 20 years. He’s worked across Canada, the United States and in Africa.

In all those years, the critical care physician says health care has never been simple.

“We’ve always run the system somewhat close to the red line. I work in the intensive care unit, also known as the ‘expensive care unit,’” he said. “You can never do enough. In other words, there’s always more to occupy your time.

“There’s always other things you can be innovating. There’s always other people you could be helping.”

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The search for a solution has persisted for years, made more challenging by COVID-19 and other problems.

“The system has become a bit more corporate,” Brindley said. “The advances keep coming, and that’s wonderful. But that means you need more facilities, more beds, more time and time is one of the most important resources.”

Staffing levels are frequently brought up as a problem in health care, but Brindley said it’s not as easy as a mass hiring.

“You can’t just say ‘Let’s get more ICU nurses.’ Those ICU nurses take years to train. If you want a nurse today, well that’s four years of nursing and then all sorts of extra training,” he said.

“If you want an intensive care doctor… that’s about 14 or 15 years.”

The Canadian Medical Association issued a prescription to address health care systems nationwide ahead of the early November meeting of health ministers in Vancouver. Part of that formula includes a pan-Canadian workforce licensing and planning strategy, creating a virtual health care strategy to improve access to primary care, and streamlining immigration and credentialing for internationally-educated health professionals.

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The Alberta Medical Association (AMA) has highlighted the deficit of care in a number of areas, including in women’s health, care for the elderly, emergency departments, drug poisoning and pediatric mental health. Through the contract negotiation process, they have advocated to be a part of the solution to an integrated, publicly-funded health care system.

As part of the 2022 budget, the Alberta government announced a number of measures intended to address the health care system, including adding those ten ambulances to each of Calgary and Edmonton, part of a $600 million increase in funding to the province’s health annual spending.

The province also signed an agreement with the AMA this year after former health minister Tyler Shandro tore up the master agreement with Alberta physicians in early 2020. And late in 2022, Health Minister Jason Copping announced it was lifting the cap on the number of patients a doctor could see in a day and increased the rate doctors are compensated by one per cent, to help improve access to primary care doctors.

But the provincial health authority saw a recent shakeup that the Opposition leader said created “chaos.”

Premier Danielle Smith, came to the role in mid-October on a campaign of “significant reforms” to a supposedly-underperforming AHS, the provincial health authority.

A month later, Smith summarily fired the 11-person AHS board and replaced them with a single “official administrator,” Dr. Jon Cowell.

“This new round of chaos Danielle Smith is inflicting on health care will likely make the situation worse,” Alberta NDP leader Rachel Notley said.

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One of those fired board members took aim at the decision in an open letter, calling Smith “Alberta’s disruptor premier.”

“Sadly, the premier ignores the grueling 30-month ‘best efforts’ made by the AHS board, management, clinical leaders, staff and trainees for managing through the tragic COVID calamity,” Tony Dagnone wrote.

The open letter said the premier’s words accusing the AHS board of mismanaging the health care system allowed other provinces to recruit health care workers from Alberta, as seen on social media by Children’s Hospital of Eastern Ontario CEO Alex Munter.

“Why would any self-respecting graduate pursue their healthcare vocation in a province lead by an anti-science premier?” Dagnone wrote.

Beyond the hospital’s walls

There has long been a debate north of the border about what the appropriate mix of public and private health care services looks like.

Health policy expert Lorian Hardcastle said, despite appearances, there’s more private health care in the mix in Canada.

“The only portions of our system that are really almost entirely public are hospitals and physicians, and many other OECD countries fund many more health services than we do publicly,” she told Global News.

Hardcastle pointed to recent debates at the federal and provincial level about pharmacare and dental care, changes that could bring Canada in line with other countries’ public health care systems.

She added there’s a problem with calls for a parallel private health care system for procedures like surgeries.

“I think the fundamental problem with that argument, though, is that with a finite number of health professionals, we have two choices: we can either have them in the public system treating patients based on their need, or we can have them divided between the public and the private system, where you will then have people able to purchase their way to faster access,” Hardcastle said.

“But I don’t think those public/private debates are likely to go away any time soon.”

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As part of the announcement introducing Cowell as AHS administrator, Copping announced a number of strategies AHS was looking at to reduce wait times for surgeries, EMS care and emergency departments.

Some of those strategies include allowing non-doctor health-care professionals to make treatment decisions, diverting non-emergency calls from 911, and using chartered or underused surgical facilities.

“How do we improve the general flow from emergency departments to inpatient to the alternate levels of care? What can we do to make sure we’re doing better triage?” Copping told Global News of the lens his ministry is using to improve health care.

The health minister said a key metric for the success of Cowell replacing the AHS board is reducing wait times “in a meaningful manner,” a challenge as the system is seeing patients who have delayed treatement while waiting for the pandemic to abate, in some cases making them more ill.

“We know we need to get the times down,” Copping said.

“We are investing in our overall system in terms of the dollars, and then ramping up the number of people that we have in the system to be able to address that.”

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Many in the medical field said the solution isn’t found inside a hospital. Among them are Brindley and Dr. Sandy Dong, who point to the potential relief produced by significant investment in things like housing, mental health and addictions could help to make long-term change.

Brindley said that would help take pressure off emergency departments.

“It’s a big deal for everyone if the system fails ahead of us.”

Dr. Sandy Dong, an emergency physician in the Edmonton area, said reducing demand on emergency departments will help the part of the health care system that has become a catch-all as more and more people seem to be coming in sick, either as a result of new infections or as a result of delaying seeking medical care.

“The emergency department seems to be the focus of everyone’s attention. But the solutions to the emergency department aren’t really in the emergency department,” he said. “The solution is to avoid the emergency department, and that’s primary care, housing, mental health resources, the drug poisoning crisis, and long-term care.”

Hardcastle said those investments could be a difficult trade-off, especially when Albertans see so much need in the system now, like adding or retaining staff or addressing long wait times.

“It’s hard to shift people’s focus to preventative measures that would prevent those needs from arising in the first place,” she said.

She also pointed to the political capital needed to make such structural changes, especially with a provincial election in less than a year’s time.

“As a politician, it’s much easier to address immediate needs than it is to invest in something that might not pay off until way down the road,” she said. “(They) would no longer be the one in power to benefit from those changes and those investments.”

© 2022 Global News, a division of Corus Entertainment Inc.

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