'Scotch Tape and wet paper': Healing fragile B.C. health system is key election issue

Ambulances parked at the central reporting station in Victoria, B.C., on Thursday, Nov. 9, 2023. (THE CANADIAN PRESS/Chad Hipolito)

Mike Goetz has added bill collector to his list of responsibilities as mayor of Merritt in British Columbia's Interior.

In June, Goetz sent the province an invoice for $103,831.87, the cost, he said, for closures of the Nicola Valley Hospital emergency room.

He said the bill for the 19 closures last year and the first five closures this year includes a partial refund of what the city paid for hospital services, as well as the cost when firefighters respond to medical calls because paramedics are busy transporting patients to Kamloops, about 85 kilometres to the northeast.

And GST, of course.

Goetz said the costs would be equivalent to a one-per-cent increase in taxes for the community, unless the province picked up the tab, and came on top of the more than $600,000 the municipality already pays the province annually for its hospital.

"That's unacceptable to ask our taxpayers to pay for this system twice. We've paid for it once, we expect 365 days of coverage, because that's what you charged us for," he said.

The mayor isn't alone in his frustration with the state of B.C.'s health system. Temporary emergency room shutdowns have hit rural and urban hospitals, hundreds of cancer patients have been sent across the U.S. border for radiation therapy, and there's a shortage of nurses and doctors.

It's a central issue ahead of the Oct. 19 provincial election, with the B.C. Conservatives offering sweeping changes and at least one major change promised by the governing New Democrats not set to be fully implemented until after the election.

Dr. Rita McCracken, a family doctor and assistant professor at the University of British Columbia, said fixing the province's health-care system will require systemic changes, beyond hiring more employees.

"We don't have enough people doing the jobs, but at the same time, we have a system that is made out of Scotch Tape and wet paper that we're trying to graduate people and hire people into," she said.

B.C. Conservative Leader John Rustad made health care the focus of his first major platform commitment in July, long before Opposition Leader Kevin Falcon suspended his BC United Party's campaign and threw his support behind the Conservatives.

The Conservatives say that if elected they will pay to send more people outside the province for health care and expand the use of private clinics. Rustad has also promised to compensate health workers who lost their jobs for refusing to get the COVID-19 vaccine.

"Our health-care system in B.C. is in crisis. More than that, it is failing. More money into the system is not the solution," Rustad said in July.

Rustad faced criticism Monday over a video, circulated by the NDP, in which he tells a group of former public service employees who lost their jobs for refusing to be vaccinated against COVID-19 that he wishes he hadn't received three shots of the "so-called vaccine."

In the video from June, Rustad said he'd realized vaccination campaigns weren't about trying to stop the spread of COVID-19 but rather were "around shaping opinion and control on the population."

The BC Greens have said they want to establish community health centres in all 93 ridings in B.C. to replace the current network of urgent and primary care centres, saying they had failed to retain staff and provide patients with primary care connections.

Leader Sonia Furstenau said the plan would put "timely, comprehensive care all in one place" and streamline referrals by giving access to doctors, nurses, mental health professionals and specialists within a patient's community.

As health minister, Adrian Dix has acknowledged the province's struggles with health-care staffing that he said was a problem across the country.

In an interview with Global News over the Labour Day long weekend, when several emergency rooms were closed, Dix said the government was "doing absolutely everything we can" and that "we don't consider it ever acceptable" for emergency rooms to close.

The province does not compile a public tally of emergency room closures but there have been dozens over the summer, in the Interior, north and elsewhere.

In the Interior Health region alone, there were 66 emergency room closures in the first half of 2024 because of a lack of either nurses or doctors.

Dix has said the province added 250,000 nursing hours "in the last number of years" and had 831 net new family doctors.

The NDP is promising that if re-elected it will expand when pharmacists can prescribe medications, reduce paperwork for doctors, add more physician assistants and expand the range of services they provide.

Leader David Eby said a re-elected government would provide immediate provisional licences for doctors, nurses, and midwives trained in Canada who stepped out of the system, and offer the same licences in six weeks for professionals trained in some regions outside of the country.

But McCracken said whoever wins in October will have more to worry about than hiring. She said the next government has to do a better job of quantifying exactly what is required, and understanding the system so that doctors want to stay where they are most needed.

"We haven't really been addressing — and it echoes over into nursing and emergency rooms and in all the different places — that we have not created a sophisticated-enough assessment of what we need to be providing care," she said.

Ahead of the election the The BC College of Family Physicians and BC Family Doctors published a series of requests for its members from the next government, including access to extended health and dental benefits, sick days and a pension plan.

They say the government needs to reduce paperwork and fund additional supports like nurses in family medicine clinics.

The organizations estimate more than 700,000 British Columbians don't have access to a family doctor and nearly 40 per cent of family doctors are set to retire or reduce clinical hours within five years.

McCracken said under the NDP government there had been "some very significant shifts in the right direction," pointing to a new payment model for doctors launched in 2023, but added such moves represented "the first two or three steps of probably 100 that we need to take in order to stabilize the system."

Adriane Gear, president of the BC Nurses' Union said working in an emergency room was a particularly challenging role.

"Nurses have tried their very best to hold up the system. But you can only work short staffed so often. You can only know that you're actually not providing the care that people need so many times. And then you look around and you go, 'you know what? This is killing me,'" she said.

She said the union wanted a promise from political leaders to continue working on meeting nurse-patient ratios.

In March, B.C. announced it would be the first province to implement such a policy, something Gear said had helped retain and recruit nurses in other countries.

In the days leading up to the election campaign in September, the NDP government announced a series of agreed-to ratios including one nurse to three patients for general emergency room visits, 1:1 for trauma, and 1:4 for short surgical stays.

It said implementation would begin this fall.

Gear said she wanted a similar promise from the other party leaders if they are elected.

McCracken described health care as "whack-a-mole these days" with multiple serious issues popping up that affect voters.

"When you're having a health crisis and you realize you need to drive for 3 1/2 hours in the middle of the night, that just brings up a lot of feelings, and I think it's going to get transmitted to active discussions during the campaign," she said.

In Merritt, Goetz said in an interview near the end of August that he had not received a response to the bill from Dix. But if he doesn't get one, he said he was "sending it to collections."

"I've called it a house on fire, and that's exactly what it is," he said.

This report by The Canadian Press was first published Sept. 24, 2024.