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Marketplace - Season 53 Episode 8 -
In Critical Condition
In Critical Condition
Category
😹
FunTranscript
00:00Emergency care is in crisis.
00:06It's been eight hours.
00:07Twelve hours.
00:08We're tracking wait times across the country.
00:11Who's the longest right now?
00:13About 36 hours.
00:15Patients desperate for help.
00:17It makes me feel like your system is broken.
00:19How often then are you seeing a patient and thinking,
00:22I should have seen you hours ago?
00:25Oh, every shift.
00:26For some, the consequences of a stressed system are deadly.
00:29We trusted the system to take care of our son.
00:33And that is a trust that is forever gone.
00:36This is your Marketplace.
00:40We're at two of this country's busiest emergency departments.
00:44Spending a day shift inside one.
00:47And a night shift outside another.
00:50Following doctors.
00:53Talking to patients.
00:55And tracking their wait times.
00:57Getting an up-close look at an emergency care system in crisis.
01:02It's early morning at Sunnybrook Hospital's ER.
01:06And the chief, Dr. Justin Hall, is starting his shift.
01:10Morning, Mike.
01:12Many of the patients he's about to see have been waiting overnight.
01:18I'm just going to turn the light on, sir, if that's alright.
01:24John's been here since 2 a.m.
01:27Can you tell me what's brought you in today?
01:29Well, I have difficulty finishing a breath.
01:36Okay.
01:37Waiting for seven hours.
01:39And as Dr. Hall orders more tests.
01:42Can I, um, can we do a walk test for him?
01:46Yep.
01:47He'll likely be here for much longer.
01:50This Toronto hospital is the largest trauma centre in the country.
01:54Roughly 200 people come through daily.
01:58Last year, the median length of stay for patients was eight hours and 13 minutes, meaning half waited even longer.
02:07It is the longest in Ontario.
02:10Data shows wait times across the country are getting higher.
02:15We've been tracking, and the numbers are stark.
02:19PEI's hospital with the longest wait is five hours and 19 minutes.
02:24And it just goes up from there, all the way to 13 hours and three minutes.
02:30That's Quebec's longest wait.
02:32Behind the data, there's damage.
02:35Eight hours and 22 minutes.
02:38What does that length of time mean to you?
02:40It's a number I hate now.
02:43And it's eight hours of 22 minutes that Finley had to suffer.
02:57In February last year, 16-year-old Finley Vanderwerken had severe abdominal pain.
03:04His parents, Hazel and GJ, rushed him to the nearest emergency room in Oakville, Ontario.
03:10I was so scared. I was just full of fear and wanted Finley to get seen immediately.
03:16Finley was triaged at level two on the Canadian Triage and Acuity Scale, meaning his case was emergent.
03:24Guidelines say he should have been seen by a physician within 15 minutes.
03:29Instead, he waited for hours.
03:32I had to go up several times to the nurse's desk and ask for them to come and see Finley.
03:42He was having problems breathing and he was in so much pain, he was crying out.
03:46Hospital records show every time Finley's vitals were taken, his oxygen saturation kept dropping.
03:55Eight hours and 22 minutes after he arrived, Finley finally saw a doctor.
04:01Then everything changed. There were lots of people involved.
04:07The doctor knew at that point that something was wrong and action had to be taken.
04:13By then, Finley had sepsis, his body's reaction to pneumonia.
04:17He went into cardiac arrest. His organs began to fail.
04:22You want your kid to be the miracle kid.
04:26And asking, is there a chance of a miracle?
04:31But there wasn't.
04:34This small comfort in us knowing that we tell our kids we love them every day.
04:49We know that Finley knew.
04:58But what can you say in those last moments?
05:03You've both had to injure something that no parent should have to deal with.
05:09Do you think that his death was preventable?
05:13Yes.
05:14Yes.
05:19Dr. Fraser Mackay is with the Canadian Association of Emergency Physicians.
05:24They've been sounding the alarm about long wait times for years.
05:29We know we work in a system that is falling apart.
05:32So how often then are you seeing a patient and thinking to yourself,
05:37Boy, I should have seen you hours ago.
05:39Oh, every shift. Every shift. Undoubtedly.
05:43His own ER in New Brunswick is no exception.
05:47And so he avoids going into the waiting room altogether.
05:50When I have 40 pairs of eyes on me and they just want eye contact because they want to be seen.
05:57They want me to know that they're waiting to see me and they're suffering.
06:01I know that. Of course I know that.
06:03And that's a really hard thing to do.
06:05I don't know which of them is going to have a devastating diagnosis.
06:08I don't know which of them is going to get called in in five minutes.
06:11We're starting the clock on a 12 hour overnight shift outside St. Michael's Hospital in downtown Toronto.
06:19Tracking how long patients who have come to this ER will wait.
06:23Hey man, how you doing? My name's Chris. I'm a reporter with Marketplace.
06:27Right away, we meet Anthony, who's just arrived by ambulance.
06:31What did you come for?
06:33So I've been sitting in pain for two days. My foot's small, double twice the size.
06:36So, you know, I hope I don't need pins.
06:40Well, I hope your wait isn't too long, but stay connected and we'll keep in touch.
06:43All right. Thank you.
06:44Time passes. As we wait for an update from Anthony, we meet Jen, whose husband is inside.
06:53How long have you been waiting here for your husband?
06:55We've been here for eight hours now.
06:58Why did you and your husband have to come here to the ER today?
07:01So he just has some lower back pain problems that just came out of nowhere.
07:07We were getting ready for my sister's wedding.
07:09This is not how you were expecting to spend your sister's wedding day.
07:12Definitely not. No, he's missed the entire thing.
07:14It's now just before midnight.
07:16And as Jen heads back inside, we find Jonas in a lot of pain.
07:21I have probably my back.
07:23Oh, your back. Okay.
07:25I guess they didn't give you any idea how long you might have to wait?
07:28No, he don't say nothing. He say you need to wait.
07:32And so she does.
07:35What does it feel like when you think about all the patients that are out in that waiting room
07:40and you can't get to them quickly and treat them the way that you want to?
07:45This is such a huge overwhelming problem.
07:48It's when it's the individual patient.
07:51That's when it hits.
07:52It sticks with you.
07:53Yeah.
07:54Yeah.
07:55It sticks with you.
07:56And it's because it makes you question, are you good enough?
08:02And are you in the right job?
08:04And that's hard.
08:05Is crisis the right word to use when we describe the system right now?
08:11Crisis is a great word other than the fact that it implies sudden.
08:17We've been very clear for many, many years.
08:21We know these problems. We know they're getting worse.
08:24The problem is complex. Burnout is leading to staff shortages.
08:28And a lack of family doctors is pushing more people to depend on Emerge.
08:33But experts say the biggest issue causing long wait times is what's called boarded patients or bed block.
08:41ER patients who have been admitted to another unit in the hospital, but that unit is full.
08:46So the patient is left waiting in the ER.
08:49A few hours into Dr. Hall's shift inside Sunnybrook, we watch that unfold.
08:56We have 31 patients who are admitted to the hospital but are remaining in the emergency department because there's no bed.
09:03That's roughly half of your overall patients.
09:06It is.
09:07Just here waiting.
09:08Right now that's about half.
09:09Correct.
09:10Okay.
09:11That sounds like a big problem.
09:12It is.
09:13It's a big problem.
09:14And right now this is sort of earlier in the day, but as the day goes on, this problem becomes more challenging.
09:19We start to see that number creep up.
09:21Who's the longest right now?
09:23The longest right now, who's still in the department, looks like about 36 hours.
09:3136 hours.
09:32Yeah.
09:33Dr. Hall gets back to the patients who have yet to be seen.
09:37I'm just going to sneak behind you.
09:40Hello.
09:41Hello.
09:42And I understand you guys have agreed to have the team here as well.
09:51My name's Justin.
09:52I'm one of the emergency physicians.
09:53It's nice to meet you.
09:55But shortly after, an interruption.
09:58Apologies.
09:59Just give me one second.
10:01An urgent update from our first patient, John, who's been in the ER for nine hours now.
10:08Okay.
10:09Thanks for your help.
10:10Bye for now.
10:11So, John doesn't get to go home?
10:14No.
10:15So, John's going to stay.
10:17He's got a few things going on.
10:19I'm concerned about his breathing.
10:20So, now essentially he's a blocked patient?
10:22He will be.
10:23So, as we were chatting about earlier, now I think we have 33 admitted patients from what I can see.
10:28I've now just added one more patient to that.
10:31So, he will get seen by our specialist colleagues, likely admitted here shortly.
10:37And then he will wait for a bed.
10:39So, John stays waiting.
10:42Back outside St. Michael's Hospital, an update.
10:46It's 1am now, and I just got a text message from Anthony.
10:50He's one of the first patients that we met.
10:52He came in with a foot cast, complaining of swelling and pain.
10:56And he's just texting me to say that he's waiting for surgery now, still in the ER, some seven and a half hours into his wait.
11:03And we'll keep checking in.
11:05Coming up, patients fed up with waiting, walking out of emergency departments without care.
11:15From what I know now, I did put myself in jeopardy.
11:18That's after the break.
11:20We're outside Toronto's St. Michael's Hospital, tracking how long ER patients are waiting.
11:35It's 2 o'clock in the morning, and we meet Joyce, who had a sewing needle lodged in her foot.
11:41We have been waiting out here for hours.
11:43We've heard from at least two people who mentioned the girl who was screaming with the needle inside of them.
11:49And so I just can't even imagine how much pain you must have been in.
11:53I was in so much pain.
11:54Yeah.
11:55I was in so much pain.
11:56I'm so sorry.
11:57Yeah.
11:58What do you think of this seven hour wait that you have?
12:00It's insane.
12:01Jen and her husband, who came in with lower back pain, are finally cleared to go home.
12:05Jen, my goodness.
12:06Yes.
12:07At the end of the day, how many hours was it?
12:09It's been 10 hours in total.
12:1110 hours.
12:12How do you feel about this?
12:14Exhausted.
12:15Yeah.
12:19But Jonas, who's also been here for hours with back pain, is leaving without seeing a doctor.
12:25What are you doing right now?
12:26I go home.
12:28Too many people wait inside.
12:31St. Michael's Hospital tells us they've experienced higher than normal demands for urgent care in recent months.
12:38They say they see the sickest people first, but see all patients as quickly as possible.
12:45I can tell you're in a lot of pain, so I want to let you go.
12:48Okay.
12:49But thank you.
12:50You're welcome.
12:51I hope you're feeling better.
12:53Okay.
12:54It's a growing number of Canadians leaving emergency rooms without being seen by a doctor.
12:59Last year, in Ontario and BC, about 5% of patients walked out.
13:04In Nova Scotia and Newfoundland and Labrador, 10%.
13:08It's about 12% in Quebec, Nunavut and New Brunswick.
13:12And two provinces, Manitoba and PEI, have an even higher rate.
13:17It's rare that a shift will go by where one of the patients I'll see isn't someone that was there yesterday or the day before and couldn't handle the weight and left.
13:27And now they come back and now they're that much sicker.
13:30In New Brunswick, where Dr. Makai works, that breaks down to nearly 60,000 patients who walked out of Emerge just last year.
13:38We're on the road to meet one of them.
13:41It was chaotic.
13:42It was loud.
13:43There was a lot of people that are just really upset about waiting.
13:48Susan Gordon arrived at the Moncton ER by ambulance this past June.
13:53She'd been vomiting repeatedly and had sharp stomach pain.
13:57You know how they always ask you your pain out of a scale of 10?
14:01I was at a 15 about that night.
14:03Oh my God.
14:04But after more than three hours in a crowded waiting room, she gives up and walks out.
14:10And when you made that decision to leave, do you think you put your health in jeopardy?
14:14From what I know now, I did put myself in jeopardy.
14:17After leaving the ER, her pain intensifies until she collapses and ends up back in Emerge.
14:24She said it's your appendix. I needed to have surgery and they were doing it immediately.
14:28So you went in with what you now know is appendicitis.
14:31Yes.
14:32And you didn't end up getting care.
14:34How does that make you feel?
14:35It makes me feel like her system is broken.
14:38Horizon, the health authority that runs the Moncton Hospital ER,
14:43tell us they don't want any patients to leave without being seen
14:47and say the long waits are a result of blocked patients waiting for beds in overcapacity hospitals.
14:53They add they're trying to find solutions under these challenging circumstances.
15:00New Brunswick's Ministry of Health tells us they're taking steps to improve patient flow
15:05and increasing access to primary care to reduce pressure on ERs.
15:11Inside Sunnybrook Hospital, Dr. Hall is trying to prevent patients from leaving before they're seen
15:18by increasing overnight coverage using private donor dollars,
15:22ensuring Sunnybrook will always have at least two doctors working the night shift,
15:27something that's not possible in many hospitals across the country.
15:31Typically in the later evening and overnight were some of our longest wait times.
15:35He says the time patients spend waiting before a doctor sees them has gone down by about 30 minutes.
15:42Why is that so important, that metric of initial assessment by a physician?
15:47So when someone's been triaged but they haven't been seen potentially by the physician yet,
15:53that is a bit of a grey zone or a black box.
15:56We don't know what's there and some patients might be getting sicker during that time.
16:00So the earlier we can see patients, the better that it is.
16:04Patients like Finley Vanderwerken, who waited more than eight hours at the Oakville Hospital.
16:10Do you think if a doctor set eyes on Finley sooner, the outcome would be different?
16:17Yes.
16:18Yes.
16:19When we see the hospital record, I want to read you a note from the doctor
16:25who finally assessed Finley that morning.
16:28Unfortunately, there have been long wait times overnight.
16:31Current wait times are over 10 hours.
16:34He had waited eight hours to be assessed.
16:37What do you think when you hear that note back from the doctor?
16:40Anger.
16:41Anger, frustration.
16:43If this is known, why is it still like that?
16:46There's an acceptance.
16:48There's an acceptance that this is just how it is.
16:51But they refuse to accept it, filing a lawsuit against the hospital and some of its staff.
17:00Halton Healthcare has filed a statement of defense denying negligence.
17:05They tell us they've improved scheduling so there's more doctor coverage during periods of high patient volume and add that in the past eight months,
17:14the time it takes for that physician initial assessment at the Oakville location where Finley went has decreased by more than 32%.
17:24But Hazel and GJ are advocating for greater change, including maximum wait times for children in the ER, calling Finley's Law.
17:34And calling on lawmakers to listen, starting with local city councillors urging them to put pressure on the provincial government and council agrees.
17:43This region, this province and country let Finley down, let us all down.
17:50By not paying attention to the data, everything that pointed and screamed that our healthcare was failing.
17:57So I say to you all, the time for action is now.
18:04Do not dismiss me or ignore me.
18:08Ontario's Minister of Health is Sylvia Jones.
18:11And after months of asking, Hazel and GJ get a private meeting with her.
18:17We catch up right after.
18:20Are you satisfied?
18:23I don't think we are satisfied just yet.
18:26I was glad to hear the minister acknowledge that she's the one responsible for restoring the faith that we lost.
18:38So it's a good step, but more conversations will be needed.
18:49Coming up, we go searching for answers from Ontario's Minister of Health.
18:54Minister Jones, I'm Chris Glover with CBC Marketplace.
18:57That's after the break.
19:03Got a story you think Marketplace should investigate?
19:05Reach out to us at marketplace at cbc.ca.
19:09We're finding wait times in Canadian ERs are climbing, and the consequences are too.
19:24I lost a son, and it didn't need to happen.
19:28For weeks, we asked multiple times for an on-camera interview with Ontario's Health Minister, Sylvia Jones.
19:37We call, email, and text, but her office declines.
19:42Then we learn she's attending a Remembrance Day dinner in her riding, so we approach her outside ahead of the event.
19:49Minister Jones, I'm Chris Glover with CBC Marketplace.
19:52Finley, we've been trying to talk to you, and Finley Vanderwerken's parents tell us that you took responsibility for restoring their faith in the emergency department system in Ontario.
20:04We're just going in.
20:05How are you planning on doing that?
20:06Guys, I'm going into a Remembrance Day service.
20:09We know this is an important day, but we've been trying to talk to you and get to you through your office for weeks.
20:15So contact my staff.
20:16We already did, and what we can tell you is we spent time in emergency departments as well as talking to patients.
20:22I'm going to remember.
20:24We take her lead and follow up with her staff, asking again for an interview, but they never grant one.
20:32Her office sends a statement saying they've made record investments in healthcare in the past three years, including $44 million to tackle emergency department wait times, and they recognize there's more work to be done.
20:46But they still haven't responded directly to our findings, so we're here at the Ontario Legislature to try one more time.
20:53But she doesn't show up to question period.
20:58So we are left without answers.
21:03At the end of our shifts inside Sunnybrook and outside St. Michael's, an update on the patients we met at the start.
21:11After 12 hours in Sunnybrook's ER, John still hasn't moved up into the hospital.
21:17So he wouldn't be getting a bed on the ward probably anytime soon, just based on what I'm seeing.
21:22And after some monitoring, he's offered the choice to stay and wait or go home.
21:28He decides to leave.
21:29Sometimes patients will make the decision and say, actually, I'm going to go home now.
21:33But outside St. Michael's, Anthony doesn't get that choice.
21:37Anthony is still waiting.
21:40He just texted me now.
21:43I am still waiting for surgery.
21:46He's still in the emergency department.
21:4812 hours and counting.
21:51Some continue to wait for care and change.
21:55He was just an amazing kid.
21:57And the world is not a better place for him not being in it.
22:05And it's our job now to use his voice to turn things around.
22:15.
22:21.
22:25.
22:26.
22:28.
22:29.
22:31.
22:35.
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