Nova Scotia’s emergency departments are facing a “complete unravelling” | The Coast Halifax

Nova Scotia’s emergency departments are facing a “complete unravelling”

More than 2,900 people have died seeking care in Nova Scotia’s emergency departments since 2017.

If you visited a Nova Scotia emergency department for a health concern in December, your odds of leaving the hospital alive were the lowest they’ve been in the past six years. That’s according to Nova Scotia Health numbers recently obtained by the NS NDP through a Freedom of Information request. About one in 666 Nova Scotians who went to the ER last month ended up dying there, the report reveals. Those numbers—along with a pair of high-profile deaths in recent weeks that have shocked Nova Scotians—have prompted some MLAs to call for an inquiry into Nova Scotia’s emergency department deaths, and emergency room nurses to raise alarms about a state of “chaos” in our province’s hospitals.

What the numbers say

Just shy of 3,000 people (2,949) have died seeking care in Nova Scotia’s emergency departments since 2017. While that represents a small share of total patients—from 2017 to 2022, about 0.09% of ER trips in Nova Scotia (or one in 1,111) ended in a patient’s death—it’s a number that’s on the rise. Each month for the past three months, the ER death rate has surpassed the six-year average—from 0.12% in October, to 0.11% in November, to 0.15% in December.

That’s worrisome to Claudia Chender, leader of the Nova Scotia New Democratic Party. She’s calling for an inquiry into ER deaths across the province after both 37-year-old Allison Holthoff and 67-year-old Charlene Snow died in recent weeks following seven-hour waits for care in Amherst and Cape Breton, respectively.

“Now more than ever,” Chender tells The Coast, “it’s crucial that we understand what’s happening to turn this tide—and that we see progress. And right now we don’t have a window into what’s happening, other than assurances that things are improving when we know they’re not.”

“Whatever it is that this government [has] tried, or is trying, we are not seeing any evidence of success.”

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Chender points to premier Tim Houston’s earlier firing of the Nova Scotia Health Authority’s leadership—“which is designed to be an arm’s length body”—and the appointment of former PC chief of staff Karen Oldfield, who’d never served in a health administration role, as interim Nova Scotia Health CEO as creating a “predictable” outcome.

“All of the metrics right now are trending in the wrong direction,” she says. “And so whatever it is that this government [has] tried, or is trying, we are not seeing any evidence of success.”

NS emergency departments ‘bursting at the seams’

Those working within Nova Scotia’s health-care system are beginning to speak out. Last week, the Nova Scotia Government & General Employees Union—which represents more than 3,200 nurses across the province, primarily at the Halifax Infirmary—wrote a letter to Nova Scotia Health, premier Houston, health and wellness minister Michelle Thompson and provincial Liberal and NDP leaders, calling for changes to “stop the hemorrhaging” of experienced hospital staff and address patient safety concerns.

The letter quotes one Halifax Infirmary nurse who describes the ER situation as one of “chaos,” adding that their department is “understaffed almost every shift.” In all of the past year, the nurse counted just 32 shifts where their department was fully staffed. That echoes what’s happening across the province: As of Sunday, Jan. 15, per Nova Scotia Health’s public reporting, hospitals across Nova Scotia were operating at 96.4% capacity for all inpatient beds. (In Dartmouth, that figure was 113.4%.) Other ERs have simply closed: Eastern Shore Memorial Hospital’s emergency department is closed for all of January. Lunenburg’s Fishermen’s Memorial Hospital was operating on reduced hours for Monday, Jan. 16.

The numbers don’t come as a surprise to Hugh Gillis, first vice-president of the NSGEU. As far back as 2013, he tells The Coast, his union’s members have been advocating for “safer staffing levels” in the province’s hospitals.

“Nova Scotia emergency departments have been bursting at the seams for years,” Gillis says. “And it seems that those seams have finally let go.”

‘I do feel like she was neglected’

click to enlarge Nova Scotia’s emergency departments are facing a “complete unravelling”
Arbor Memorial
Allison Holthoff, 37, died on New Year's Eve after waiting for care in the Cumberland Health Care Centre's emergency department.

The wake-up call for most Nova Scotians came with the death of Allison Holthoff, 37, on New Year’s Eve. A mother of three from Tidnish, Holthoff had been complaining of pain on the morning of Dec. 31, 2022, when her husband rushed her to the Cumberland Regional Health Care Centre (CRHCC) in Amherst. There, the family waited hours for care. Holthoff’s husband, Gunter, told CTV News it wasn’t until around 6pm—seven hours after they’d arrived—when Allison started screaming in pain that he “felt like someone was paying attention” at the hospital. A CT scan showed internal bleeding, but it was too late. Holthoff died in the hospital that evening. Gunter told CTV News he feels his wife “was neglected” in receiving her care.

Nova Scotia’s emergency departments are facing a “complete unravelling”
Dignity Memorial
Charlene Snow, 67, died on Dec. 30, 2022 after waiting 7 hours to be seen at the Cape Breton Regional Hospital.

Three hundred kilometres away, Charlene Snow, 67, had gone to the Cape Breton Regional Hospital a day earlier complaining of pain in her jaw. She’d been sick in bed for days, her daughter-in-law, Katherine, told Global News, but she “mustered up the energy” to make the hospital trip in spite of her worries about overcrowding. The ER was so full, “there weren’t any seats for anyone to sit down,” Katherine recalls her mother-in-law saying. Snow waited seven hours to be seen before giving up and calling for a ride home. Her plan was to try an outpatient clinic the following day. Instead, she died an hour later.

The twin deaths of Holthoff and Snow have rippled across a province already grappling with an ever-burgeoning health-care crisis. Independent MLA Elizabeth Smith-McCrossin has called for a seven-point emergency plan at the CRHCC, including “immediately reallocating” nursing staff to maintain safe ER staffing levels. Sydney resident Jennifer MacDonald has organized a March of Concern outside Cape Breton Regional Municipality City Hall on Jan. 21.

NSGEU makes 59 recommendations

If there are myriad contributors to Nova Scotia’s health-care crisis, staffing issues lie at the heart. Last week, health minister Thompson told CBC’s Information Morning that the province “could accept 1,500 nurses today.”

“That points to a crisis,” the NSGEU’s Gillis tells The Coast. “But the question is, how can we have so many vacancies? It’s working conditions; it's poor salaries—because you’re competing not only in the province, you’re competing across the country and internationally. So we have to pay nurses what they’re worth, and we have to be training more of them.”

The union provided Nova Scotia Health with 59 recommendations for addressing the crisis in emergency departments, including increased wages for staff, 24-7 social work coverage for patients and more education around what health issues are appropriate for patients to visit the ER with.

Gillis says the province has acknowledged the letter and “they’re reviewing it.”

Meanwhile, Chender says that in the week following her call for an inquiry into ER deaths, she’s “heard nothing” from the premier’s office.