B.C. Health Minister faces mayors concerned about closed ERs, ambulance response

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Mayors in rural British Columbia are criticizing a speech by Health Minister Adrian Dix on the future of health care as a defensive screed that made no new promises and failed to grasp the urgency of the crisis unfolding in the province’s small towns.

Mr. Dix was the opening speaker in a plenary policy session at the Union of BC Municipalities convention titled Re-envisioning Health Care in B.C. The annual convention gives mayors and councillors an opportunity to network, meet with B.C. government officials, debate resolutions and present a unified voice on common issues.

The convention comes amid a continuing health care crisis that in recent months saw several deaths – including that of an infant – attributed to long waits for ambulances.

The Health Minister opened his 20-minute speech saying the province has been in a health care crisis since the beginning of the COVID-19 pandemic in March, 2020, and before that, in 2016, when B.C. declared a public-health emergency owing to surging toxic drug deaths.

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He spoke of challenges including the shortage of family doctors, nurses and ambulances, and the increasing complexity of care that comes with an aging population. The Health Minister made no new promises to the ballroom of delegates, as some had anticipated, but reiterated work in progress: making new hires, changing the way family doctors are paid and dismantling barriers to bringing in internationally educated physicians.

Ashcroft Mayor Barbara Roden said it struck her as an effort to focus on the good, rather than the unfolding emergency.

“I would have liked to see some acknowledgment of how scared people are in rural communities and how the province realizes there is a crisis in rural B.C. health care that is not due to COVID or opioids,” she said. “It’s lack of recruitment and training, poor working conditions, toxic workplaces, too many layers of management, centralization that has strip-mined small hospitals.”

Ashcroft – a village of about 1,650 people, 100 kilometres west of Kamloops – once had a full-service hospital, complete with operating theatre, maternity suite and 24-hour emergency department. Ms. Roden said they were “chipped away, one by one” over the past 10 to 15 years, leaving the village now with just 29 hours of emergency service each weekend. People requiring emergency services outside of these hours are asked to go to Kamloops. At least two people are reported to have died in Ashcroft this summer after having gone into cardiac arrest with no ambulances available.

“The thing that I’m scared of is that other communities look to us and think, ‘Thank goodness that isn’t happening in my community.’ It could happen in your community,” she said.

Clearwater Mayor Merlin Blackwell said it seemed the Health Minister had braced to address a room full of delegates highly critical of the system.

“He was trying to cut us off at the pass,” Mr. Blackwell said. “It was an angry, pre-emptive speech against people who want to help. We all know health care workers are heroes in this. … He came across like we would be critical without being empathetic to the people in the system.”

Clearwater’s emergency department has had to close and divert ambulance arrivals more than 60 times so far this year. That has meant that some people who required emergent care waited until the emergency department reopened in the morning, or had to drive more than an hour to a neighbouring community.

“It’s a nightmare,” Mr. Blackwell said. “We keep waiting for some incredibly serious accident to happen when there’s limited ambulance coverage and no ER.”

Kamloops Mayor Ken Christian had gone into Tuesday’s plenary hoping to hear an update on the recruitment and retention of family physicians. He estimates that between 30,000 and 40,000 residents in his city do not have a family doctor, leading to increased pressure on emergency departments. Kamloops also receives patients who have been diverted from Clearwater and Ashcroft.

“We need a better strategy about retaining the [doctors] that we have, and a recruitment strategy that might involve more student spaces and a more streamlined review of candidates coming from universities and elsewhere,” he said.

Mr. Christian said a new $417-million patient-care tower at Royal Inland Hospital, completed in March, has made little difference in wait lists, emergency department wait times and other pressing issues because of short staffing.

He credited Mr. Dix for speaking on reviewing pay, retention, physician attachment and better processing foreign credentials, but said the problem is getting worse.

“I’m from forest fire country,” Mr. Christian said. “The speech was like dealing with an out-of-control forest fire: Lots of talk about what we’re doing on the southern flank; meanwhile, the north, west and east flanks are raging out of control.”

Speaking with reporters after the panel, Mr. Dix said the event was not a platform for announcements but rather an opportunity to hear from delegates and engage in discussions. He said there has been significant progress in several key areas, and that announcements would be forthcoming.

“We have a significant amount to report,” he said. “In the case specifically of ambulances, we likely would have done that in advance of the conference but for the very sad passing of the Queen.”

Health care groups have long called for an overhaul of the way family doctors are compensated in B.C. Most are paid a basic rate of about $32 per patient visit, regardless of the complexity of the patient’s issue, and their practices are operated as businesses, with physicians handling administrative tasks paying for overhead costs, such as rent, utilities and staff that can cost more than a third of a doctor’s pay.

Mr. Dix announced last month that a new compensation model is being developed, and that family doctors are eligible for an average of $25,000 each to assist with operational costs until the new model is announced in the fall.