Castlegar Mayor Lawrence Chernoff and city council expressed their outrage at discovering that the Emergency Department at the Castlegar and District Community Health Centre was closed on Saturday, Feb. 4 due to staffing shortages.
In a press release handed out at council meeting on Feb. 6, Chernoff said, "It is unacceptable to council and our community that the Emergency Department was closed without prior notice being given to other emergency services in Castlegar. The City of Castlegar requests an explanation and an assurance from Interior Health Authority that this situation will not happen again."
Chernoff is planning to meet with Interior Health Authority (IH)administrators to find out why the ER was closed and how to avoid it happening again.
"We're going to go to IH administrator Diane Gagnon and find out what happened and how do we resolve this issue," said Chernoff to the Castlegar News. "We never want this to happen again. We need to clearly understand what the plan is, if they've developed a plan. Nobody was notified. I didn't find out until just before 8 p.m. because someone phoned me. That was the first call I received. I don't think anyone in the community was aware unless you went down there. We need to find out what was happening."
Several council members did use social media to get the word out Saturday that the health centre was closed using a picture (shown above) of the sign on the front doors of the centre that read, 'Emerg Dept. closed for today (Sat. Feb 4). Please go to Trail or Nelson Emerg Dept.'
Councillor Deb McIntosh urged people to contact Premier Christy Clark and voice their complaints to Clark's government email or website.
"We need to find out what they're doing. She's (Diane Gagnon) responsible for what they're doing," said Chernoff. "That's what it comes down to. We'll have a conversation. My emphasis is that 'this will not happen again'. I need to put that emphasis on IH. What happens if this happens again? what will you do? We need to see a policy of how they fill the gaps. My understanding was that they didn't have staff to carry on beyond 12 noon."
With the ER being closed and the city having no ambulance service on Christmas day, many residents are wondering what is happening with the city's health services.
"We're working to solve those issues," said Chernoff. "We'll hopefully have a meeting on the 23rd of this month with IH to solve some of these issues. It's a slow process but we've got to work through it. We want to work for the benefit of everybody not just one community. That's our goal to resolve these ambulance issues. There's training issues and retention issues and when you have an incident like this it pushes everything to the front. Now is it an incident or is it a constant? My opinion is that it's an ongoing problem that we need to solve."
Kootenay West MLA Katrine Conroy has been busy in the last several days fielding questions and concerns from local constituents about the hospital closure.
"From my perspective, it's totally unacceptable," she said. "I've talked to people in IHA and people that work in IHA and what it seems like is that they don't have enough nurses. IHA said they went through all the proper protocol they're supposed to go through when they're calling somebody in. They found out later on Friday night that they didn't have a nurse for Saturday afternoon. Apparently, they had a nurse for Saturday up to noon. I think there has to be something seriously wrong that they can't get a nurse, who's qualified to work in the ER, to come in when they have at least 12 hours notice. I'm worried about what that says, they said it's the first time, but is it going to happen again? How are they going to stop it from happening again? And do we have enough nurses hired? I would think we don't."
Conroy said there are many reasons why it is difficult to attract and retain nurses in the West Kootenay area but chief among them is the fact that local nurses are hired as casual, not full-time."
"I was in Kelowna last week and was told that nurses that come out of school there go to Alberta because they get hired full-time," she said. "They get a higher wage and they have a full-time job. When you go to school for four or five years and you get out and have loans to pay - you need a full-time job. You can't depend on casual employment. We need to ask IHA - they just hired three nurses, but they're all casual, so they can go anywhere in the area. When you're on casual you can pick and choose where you go to work. You also don't have permanent work which makes it difficult. Any nurses I talk to - there's very few that just want to be casual. The majority want full-time work. They want to get the skills so they can work in the ER."
It's also very important to hire nurses with the training and skills to work in the ER, said Conroy.
"I'm really concerned about it," she said. "I'm glad it's only the first time. But it begs the question: if it happens once does that mean it'll never happen again? I think there is an issue with qualified nurses staying in our area because they need full-time work."
Conroy lamented the lack of communication from IHA in regard to letting people know the ER in Castlegar was closed.
"There was no media on it, no letting people know," she said. "In this day and age it's not a bad idea to get the message out that 'sorry, we're closed.' I don't even want them to look into notifying people that they're closed. I want them to make sure that it doesn't happen again. It can't happen again. It would be like shutting down the pulp mill because you don't have the millwright to run it properly. This is our hospital system. It just doesn't make sense. It just begs the question: what the heck was going on that they couldn't get an RN in? That there wasn't one in the whole region that could come and work for eight hours? I hope it wasn't that it was just easier to shut it down.
I hope that's not the case."
The Interior Health Authority has also been busy since Saturday, fielding questions and working hard to determine how to prevent future shut-downs.
"It was closed Saturday, for part of the day, due to a staffing shortage," confirmed Gagnon, community integrated health services administrator for the Kootenay Boundary.
The Health Centre Emergency Room baseline staff is two RNs for the 12 hour shift (8 a.m. to 8 p.m.).
"We did an extensive call out and there was no one available," she said. "From a staffing perspective we try to call staff out on regular, and then overtime. We also have a back-up plan for the Castlegar site where we have LPNs orientated to the service. Sometimes we reassign nurses from within the system and pull them from another service to cover. All of those options were looked at Saturday and there was no success."
Gagnon said that Interior Health has a standard ER contingency plan for issues such as the one that took place Saturday in Castlegar.
"We go through a process where managers on call are notified in the system," she said. "Once the decision is made to do a closure we also contact BC Ambulance and let them know the Emergency Department is going to be closed so they can take any patients they pick up to the next nearest emerg department. We also contact that receiving hospital so they know they can expect more activity and the ambulance will be coming their way.
"In the case here Saturday with the closure of the Castlegar ER Department we went through that usual protocol where BC Ambulance was notified and also where Kootenay Boundary Regional Hospital, the emerg department, received notification that this was going to happen. What we try to do in these cases is to ensure that people can get service and that the system can be responsive to them."
Interior Health is currently reviewing what happened on Saturday in Castlegar.
"Every time something like this occurs we have a review," said Gagnon. "That started here Monday morning. We're constantly doing things like adjusting our casual list, seeing if we do have enough RNs on casual. If it looks like we have a shortage we put up expressions of interest and we reorientate more folks into the department. That's an ongoing, weekly to month, piece of work that the managers are involved in. And now with what's occurred here in Castlegar, we are again reviewing that process."
Gagnon said that IHA has just recently hired five new nurses for the Castlegar ER in the last three months. Despite the new nurses, IHA was unable to fill the spots at the ER on Saturday.
"They were already on the (casual call-out) list," she said. "But they weren't available. They had made other plans for the day or weren't at home and didn't return the phone calls."
Gagnon said they do have several full-time RNs at the Castlegar ER Department.
"When we run into trouble is when we can't get vacation coverage or when there is a short call in for sick time," she said.