By Vanessa Broadbent
South Okanagan General Hospital’s (SOGH) emergency department has needed to temporarily close its doors several times due to a lack of staff, and a doctor is worried that more cuts to service are on the horizon.
Dr. Peter Entwistle predicts that the low staff retention rates at SOGH’s emergency department could lead to not only more temporary closures, but regular nightly closures and eventually a potential cut to all acute care.
The former chief of staff resigned from the position in March of 2017 to protest budget cuts from Interior Health (IH), specifically the wages of SOGH emergency department’s doctors, which are lower than their colleagues’ in the region.
Entwistle believes the issue is not being properly addressed by the authorities involved.
“Planning for effective emergency health care in our communities is truthfully very frustrating and a longstanding issue that truly no one in authority appears to be looking to address honestly, and it just appears that politicians and health administrators look to blame someone else, usually the local doctors, and take no ownership of the issue.”
While Interior Health may not have direct plans to close the emergency department (ED) or acute care, he says they are “simply waiting for physicians to lose patience with being disrespected and neglected and step away from feeling exploited.”
Serious discussions are already being held to close the emergency department at night, only to open for life-threatening emergencies and with a lower number of nurses on staff, Entwistle said.
“At all times our health authority will wash its hands and claim no responsibility or ownership of the problem.”
Petra Veintimilla, an Oliver Town councillor who sits on the Okanagan Similkameen Regional Hospital District and has been advocating for the wage increase, said there are “lots of issues” with this change and it should only be done as a last resort while IH continues to negate responsibility of staffing the emergency department.
“Making this drastic change to service levels is not something that should be done without consultation and public engagement, nor is it a change that should be done because the local ED physicians are running out of options. If reducing services at SOGH is something that is in the plan then IH should be forthcoming about that, and we as a community should be made aware of the intentional plan to do so.”
Dr. Madia Smallwood, SOGH emergency department’s current chief of staff, said stakeholders are working to keep services.
“There are planned ongoing discussions with IH, the town council and ER physicians to work towards a solution to maintain full-time services for the Oliver ER.”
Interior Health did not respond to the Chronicle’s request for a comment on the potential cuts to services.
However, in March IH announced plans to move forward with a $970,000 upgrade to the emergency department, which would include a new waiting and triage area, a separate public entrance and the relocation of admitting and administration services.
• Read more: ER closure in 2017
Former IH president Chris Mazurkewich visited the hospital just before the announcement in February and addressed both the expansions and lack of staff.
“Why would we ask the provincial government and local governments to spend a million dollars if we were thinking of closing it?” he said at the time. “That doesn’t make any sense whatsoever.”
Mazurkewich also said “four or five” doctors moving to Oliver prevented more closures.
At the time, an application for an APP (alternate payment plan) which advocated for increased wages for emergency department doctors was awaiting approval from the Ministry of Health.
The application was denied shortly after, in early April, and Entwistle is one doctor who feels the decision is unfair.
The emergency department has closed twice since August this year, and twice in 2017 as well.
To Entwistle, the correlation between the closures and doctor’s wages is obvious.
“It’s not rocket science there is a discrepancy between the remuneration that physicians working at Oliver emergency department receive and what they could get working in their offices or in other emergency departments,” he said.
He credits the low wages as the dominant reason many doctors hired to work in the department don’t stay on very long. So does his successor, Dr. Jaco Bellingan, who also resigned from the position in the spring when the APP proposal was denied.
He was one of several doctors advocating for increased pay that put a “massive” amount of time and effort into the application.
“Our message has been clear that we have a record of excellent recruiting but terrible retention due to high workload and inferior pay, and we predicted during all these meetings that if we do not get the APP, we will lose physicians again,” Bellingan said.
A letter from Joni Magil, director of physical compensation from the Ministry of Health, obtained by the Chronicle, says the challenges faced in Oliver are acknowledged, but aren’t enough to justify a wage increase.
“Your application is focused on ED services rather than the full scope of all medical services provided in the community. As such, the ministry is not in the position to approve the APP application submitted for the South Okanagan Hospital ED,” Magil writes.
However, Health Minister Adrian Dix visited SOGH in November of 2017, citing the emergency department closures as the reason for his visit.
“They’re developing some proposals and I think they’re supposed to be ready to move forward, so we’re going to take a look as well,” Dix said at the time.
Boundary-Similkameen MLA Linda Larson told the Chronicle Dix’s visit focused on support staff for the emergency department and the reason for a difference in pay within the region is that other hospitals, including Penticton’s have doctors who are “just for emergency services and have extra certification for that.”
• Read more: IH faces many questions about Oliver hospital
Larson said she presented the issue to Dix again last week.
“He said this is still a work in progress and announcements about changes to how primary care is done in the South Okanagan are still in discussion.”
Veintimilla said she remembers hearing that the province was considering developing a provincial strategy instead of addressing similar issues on a case-by-case basis.
“If the APP was indeed denied for being too focused on ED services then I would be interested to know what it is that the province is actually looking for,” she said.
“The whole reason this conversation even came about is to attempt to fix staffing issues at the SOGH ED, therefore the application would have needed to focus on this.”
Bellingan’s predictions of losing staff were right and shortly after the Ministry of Health’s decision to deny the application in April, one of three contracted doctors working 80 hours every month chose not to renew their contract and resigned.
Another full-time emergency department doctor reduced their hours from full time to 75 per cent, and two more family physicians, including Bellingan, decided to reduce their number of emergency department hours as well.
“We have (again, as always) recruited new doctors, but currently we cannot fill all the shifts and what we predicted is now happening.”
At this point it’s unclear what the future of SOGH’s emergency department looks like. The only thing that’s certain is limited services are likely.
Bellingan said there’s about 30 unfilled shifts until April.
“Expect more closures,” he said emphatically.
Oliver’s new Mayor Martin Johansen told the Chronicle last week that he intends to learn more about the health care situation at SOGH.