There was a time during the pandemic — I think it was during the Omicron surge, but it’s all blurred together somewhat — when it became uncomfortably clear that our doctors and other health-field experts were very, very worried.
That’s something of a statement of the obvious, admittedly. Of course they were. They had been for years. But this time was different. They were worried not about what COVID-19 might do to patients and the system, but about what it had done. People were exhausted and leaving. Demand was rising. Delays in diagnoses and treatments meant that many patients were entering the system already sicker than would have been true a few years earlier. And for a few weeks there — in private conversations I was a part of and also just broadly on social media, in full view of the public — medical experts I’d been counting on as trusted, measured voices throughout the crisis were increasingly wondering whether the system had collapsed.
It was an interesting time: What does a collapse mean? Does it mean that some performance metric has dropped below a certain arbitrary point? Is it some specific increase in mortality or wait times? Or is it something more like what had happened in India during the Delta wave, when hospitals simply became incapable of treating the large volume of arriving patients and people died atop cars in the parking lots before their bodies were tossed into a river because the mortuary services were overwhelmed?
We avoided that kind of collapse in North America, but the fact that our health-care experts spent one of the latter phases of the pandemic trying to suss out precisely what “collapse” would mean in the North American context was itself an interesting observation. It was, more to the point, an alarming one.
This week saw the release of the auditor general’s annual report. The 2023 edition covers the usual array of topics. The one I opened immediately was the report on the state of Ontario’s emergency rooms. My family recent had a health scare (ultimately, a minor one that was happily and swiftly resolved) that did require an emergency-room visit, and the process, on the medical side, was smooth and satisfactory. It took a long time, but all went well. As always, though, the experience left me curious. How is the system doing overall?
Not great! So reports the auditor general, at any rate. There is little good news to be found. Though he noted that there was a wide variation by region and even specific hospitals, key performance metrics were down. The government is throwing money at the problems, but we’re still waiting longer to be let into the ER, put into an in-patient bed from the ER (if necessary), and seen by a physician once admitted. (These stats are compared to pre-pandemic periods, as is appropriate.) Perhaps most alarming to me is that the number of people getting fed up with wait times and simply walking out is also increasing. A lot of those people will probably be fine. Some of them won’t be.
The biggest takeaway from the report, though, at least to my eye, is the number of unplanned emergency-room closures that hit Ontario last year. Many of these made the news, especially as they got closer to large urban areas — a series in the outskirts of Ottawa got a lot of attention a few months ago. The overall big-picture number was still startling, though. Between July 2022 and June 2023, the annual reporting period, there were unplanned emergency-room closures just over 200 times. This added up to more than 5,000 hours of closed ERs over the reporting period.
I stress this point: these were unplanned closures. This wasn’t a staffing issue that was identified early and adjusted for at another facility. This wasn’t an emergency room that needed new floors put in or the breaker panel replaced. These were ERs that were supposed to be open and serving the public but had to close because staffing levels did not permit them to remain open. Other nearby hospitals would be forced to take the surge in patient demand, and in northern Ontario, or even central Ontario, the next nearest hospital may be a long way off indeed. Imagine rolling into a hospital parking lot with a serious injury or illness and only then finding out that the local ER was closed and that you’d have to continue on to the next place down the road.
There is a lot of stuff in the AG report that should be alarming, and much of it is the more mundane stuff that AG reports would have flagged even before the pandemic. There’s lots of stuff about monitoring outcomes and optimizing processes and that kind of thing. And that’s good. The purpose of the AG is to keep an eye on these things and make sure we are getting value for money, using best practices, and avoiding duplication and inefficiencies.
And then remember where this column started: medical experts debating the nuances and the ins and outs of the word “collapse.” It’s not that I think the rest of the stuff the AG found is unimportant. Far from it. It’s important to have AGs doing exactly this kind of work, and it’s important to gather all the info and stats in one place so people like me can go and read them.
But I keep going back to those dual stats: more than 200 unplanned emergency-room closures, totalling 5,000 hours. I don’t think we ever settled on what precisely would count as a collapsed health-care system as compared to a “merely” struggling one. But would a system that can’t keep its front-line emergency facilities open on a consistent basis, thereby losing thousands of hours of service, not be a pretty good workable definition? It may not be the kind of collapse we were worried about a few years ago, but it’s the kind we’ll all have to live with … by the look of things, perhaps for a good long while.
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