Emergency room death highlights Canadian healthcare crisis

Waves of respiratory diseases, staff attrition and an older population are taxing Canada’s overburdened hospital system

When Allison Holthoff entered a crowded Nova Scotia hospital at the end of December, the intense pain in her abdomen worsened with each hour she spent waiting for treatment. With the emergency room under renovations, overwhelmed staff triaged a stream of incoming patients in a makeshift treatment area.

“‘I feel like I’m dying. They’re going to let me die here,’” Holthoff told her husband, Gunther.

After more than seven hours of waiting, she went into cardiac arrest. She was resuscitated three times by health professionals, who spotted internal bleeding on an X-ray, but staff determined her organs had sustained too much damage and it was unlikely she would survive.

“It was a terrible situation for my wife, for my kids and a lot of people in the community,” Gunther Holthoff told reporters earlier this week at a press conference, saying his wife had been “neglected” as her condition deteriorated. “I’m just lost.”

While no cause of death has yet been identified, the case has nonetheless prompted calls by local politicians for an investigation into the Canadian province’s emergency room backlog. But Holthoff’s death is also the latest fatality to expose a mounting crisis in the country’s hospitals, which have been worn down by waves of respiratory viruses and exacerbated by a chronic staffing shortage.

Last summer, many emergency rooms in rural communities shut down. In larger cities, people waited dozens of hours for emergency care. At Canada’s largest children’s hospital, SickKids, a four-year-old child was separated from his family and flown more than 350km (217 miles) for treatment of a near-fatal sepsis infection amid overcrowding.

“Emergency rooms are the barometer for our healthcare system,” said David Carr, a physician and professor of emergency medicine at the University of Toronto. “We’re facing the ‘perfect storm’ – we’ve been thrown a virus that is crippled our healthcare system and while we’ve managed to get ahold of it in many ways, what we have not [is] coming to grips with is the sheer attrition of nurses and healthcare team members.”

While the winter months are typically the worst times for emergency rooms as respiratory viruses take hold, Canada’s shortage of health professionals – and the rising rate of burnout – is making a bad problem worse.

Nurses at Humber River hospital’s intensive care unit in Toronto, Canada, in April 2021 during an influx of Covid cases.

Photograph: Cole Burston/AFP/Getty Images

“Clearly the cracks have been exposed,” said Carr, pointing out that colleagues in other provinces often share “frightening numbers” that lay bare the overflowing waiting rooms and a struggle to allocate limited beds.

Further compounding the staffing shortage, healthcare systems across the country are experiencing a “geriatric tsunami” of ageing patients whose care requires a growing share of healthcare budgets and efforts.

In recent months, these crises have brought healthcare systems to a breaking point. As medicine falls under provincial jurisdiction – but is funded by the federal government – political leaders at various levels of government have feuded over fixes to a languishing system.

Amid a shortage of family doctors, more cases that should be addressed earlier are ending up in the country’s emergency rooms.

“Sometimes you will hear stories of terrible outcomes happening in emergency department waiting times. But what often isn’t seen is the effect of those delays,” said Carr. “The press picks up on these terrible catastrophes that happened in the waiting room. But they missed out on the morbidity of conditions that happen as a result of delay of care, of people not being able to assess a primary care physician.”

Making the shortage worse, Canadian medical students who study abroad are often unable to practice medicine when they return home due to arduous licensing requirements.

“I tell parents of prospective medical students, if you send your kid away, there’s a reasonable chance that he or she will never come back if they train abroad, even if it’s in the United States,” said Carr.

Provincial premiers recently floated a proposal that would make it easier for foreign-trained nurses and doctors to earn Canadian credentials. But experts warn the move cannot be made quickly and requires more resources than simply rubber-stamping paperwork.

Without a single factor alone breaking the emergency rooms, Carr fears no quick solution is possible – and worries political leaders remain unable to fix a crisis that healthcare workers have long warned was looming.

“I feel like for years, our complaints have fallen on deaf ears,” he said. “And now I worry that we’re facing a pandemic of significant mental health challenges in our healthcare community. We have a compounding threat that needs to be addressed today, not tomorrow.”

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