The Decibel - Canada’s emergency room crisis is worse than we thought

Episode Date: July 7, 2025

Ever since the pandemic, emergency room closures have become more common in Canada, especially in rural communities. This can leave people in dangerous situations that can require them to drive an hour or more to access emergency medical care. When time is of the essence, emergency room closures can be deadly.Because there’s no centralized data on how common emergency room closures are across Canada, it’s challenging to parse out how bad that problem is. As part of the Globe’s Secret Canada series, health reporter Kelly Grant, investigative reporter Tu Thanh Ha, and data editor Yang Sun analyzed data on emergency room closures across Canada. Kelly and Ha are on the show to talk about how widespread these closures really are, what it means for people living in those communities, and what kinds of solutions are possible.Questions? Comments? Ideas? Email us at [e-mail]

Derek Maloney is a 51-year-old resident of Bonavista, which is a really lovely town of about 3,000 people, about three and a half hours from St. John's in Newfoundland. That's Kelly Grant. She's a health reporter for the Globe and Mail. He works in the construction industry, and one day in April of this year, he and a coworker went outside to cut down the last of the birch wood from the property. And he was swinging a log into a bin. So imagine he's kind of piling up the birch wood into this bin.

And his hand, his left hand swung into his co-worker's chainsaw. It ripped his hand open all the way from his pinky up past his wrist and he could see bone and there was quite a bit of blood. So he and his co-worker hopped in a pickup truck and they raced to the Bonavista Peninsula Health Center which is the town's only hospital. When he arrived, he found that the doors to the emergency room were closed. So we're right to the emergency. Couldn't get in there, they locked the side, was I locked? So then we went out front to the emergency, that was locked.

But I happened to squeeze into the, where they go us in and sees patients, and I got in that way. He knew that there would be somebody inside because the hospital keeps inpatients. So he was fortunate to find a nurse who was able to help stanch the bleeding in his hand. And then they put him in an ambulance to the next major town with a hospital which is called Clarenville. It's about an hour and 15 minute drive away and he made it to the hospital, had emergency surgery and fortunately has recovered and is doing well. Emergency room closures have become more common in Canada. It can leave people like Derek in difficult or even dangerous situations.

But the risks of ER closures aren't the same across the country. like Derek in difficult or even dangerous situations. But the risks of ER closures aren't the same across the country. And there's no central data that brings this information together, which makes it hard to know how bad the problem is. That's why health reporter Kelly Grant and investigative reporter Duthan Ha looked into this.

Today, they are here to explain what their investigation found about how widespread these closures really are, what that means for the people who live in those communities, and what can be done about it. I'm Maynika Ramen-Wilms and this is The Decibel from The Globe and Mail. Kelly, huh? Thank you both so much for being here. Thanks for having us. Hi, thank you. So we heard off the top about this one man, Derek Maloney, who needed an ER for his chainsaw cut and then the ER was closed. Kelly, you actually went to Bonavista, Newfoundland,

where this happened. How common are ER closures at this hospital? So if we're looking at the last four or so years, there was a point when the closures were quite common. Things were very bad in 2023. That year really saw the most closures for this town. Things have gotten better since then, but in this year so far, as of April 30th, which is as far as the data collection we did goes, there were full or partial day closures

on nine days in Bonavista so far in 2025. And of course, one of those days was when Derek Maloney needed the ER. That's bad luck for him then, yeah, to show up on one of those days, unfortunately. You said 2023, though, was particularly bad. How bad are we talking? Well, if I want to take just one example, in February 2023, the ER was closed for 560 hours, according to our data. That works out to just a little bit more than 23 of the 28 days that

month. So that was really the peak of the problem. And things have gotten better since, but there is not a guarantee that the doors will always be open 24-7 in that town and in many towns in Canada. Yeah. Well, when you just say those stats, I mean, those are from a couple years ago, but 23 out of 28 days, though, I mean, those are from a couple of years ago, but 23 out of 28 days. I mean, that that sounds pretty bad. Did residents in this part of Newfoundland have better access at an earlier stage?

Like, when did it get so bad? It has not always been like this in Bonavista. I talked while I was there to several older members of the community who've been fighting these E.R. closures and also to a nurse who had worked at the hospital for decades. And they all told me that in their memory, they didn't ever recall the doors to the ER being locked. The change really came about post the worst of the COVID-19 pandemic. And that's not just the case for Bonavista, it's a case for a lot of the smaller towns and rural areas

that have seen this problem grow worse since COVID. This, of course, is not just a problem in Newfoundland. Ha, let's bring you in here. When you looked at the ER closures elsewhere in the country, too, what did you and Kelly learn about how widespread a problem this is? Well, one thing we should mention is that we're not the first media outlet to start

collecting this kind of data because this problem has started emerging in the last five, six years. But we wanted to take a look across the country because one of the challenges with writing about healthcare is that often things happen in provincial silos, and it's hard to get an overall picture, especially since there's no formal, systematic way of keeping this information across Canada. Of course, yeah, provincial jurisdiction when we talk about health care.

So that's probably why it's so siloed, it sounds like. Yes, but at the same time, we also want to know what is going on across the country and whether this is a widespread problem and how it affects people in various parts. And there was some observations that we made, but we wanted to make sure that the premise was accurate, which is that, for example,

things got worse because of COVID, but have they improved since, and also that it mostly affects rural, small town hospitals. Okay, so mostly rural hospitals, it sounds like. We had that one example of Bonavista. Are there other places in the country that you looked at that, I guess, show how bad the situation is? Well, we started contacting every province

and every territories. The territories actually don't have any reports of such problems. And so every province had this issue. For some of these provinces, numbers jumped out of us. For example, in Manitoba 70% of hospitals had some temporary closure or some disruption in services. 66% of ERs in Nova Scotia, 57% of emergency services in Saskatchewan. These are high numbers to look at the number of closures

that are actually happening here. Yes, and if you look at some specific places, there's some closures that are just for a few weekends during the summer in some places. And other places, these are closures that last weeks or even years. Wow. OK, so I guess the big question here then is,

why is this happening? Kelly, Ha mentioned that this is primarily affecting rural emergency departments. So why are these departments closing more often? I think I would start by saying that even though our understanding is that this problem wasn't as bad prior to the pandemic, it still existed. I think it's always been very difficult to try to attract enough healthcare workers to some very remote and very rural or small town parts of Canada.

So this is not like a problem that came out of nowhere. The way I had one doctor in Pinscher Creek, Alberta describe things to me was he said that in the years leading up to COVID, people were basically just killing themselves and working around the clock to keep these places open. Then COVID hit and it caused all kinds of different staffing problems, right? I mean, doctors, nurses, other kinds of staff really worked to the point of exhaustion during the pandemic. And then when they emerged from sort of that really terrible phase, there were many of them who chose to retire early or they chose to

cut down to part-time or they chose to move away from some of these smaller places where they perhaps don't have the kind of support in terms of a large team of colleagues or the kinds of support in terms of like the most modern technology. Some of them chose to move away to bigger cities where they often have more support and are less the kind of relied upon as see the only doctor or the only nurse in town. And when you add all that up, what it meant was that staffing problems meant there were many days when these hospitals couldn't safely keep their emergency room doors open. Okay. So it sounds like, as you said,

it was an issue before the pandemic. But after the intensity of that period of time, health care workers were just feeling so burnt out, so strained that it just got so much worse then. I think it also made health workers, like everybody, think differently about how they live their lives. I think that was true for many people coming at the worst of the pandemic who looked around

and said, do I want to work 100 hours a week or do I want to spend time with my children and my husband and my friends or volunteer or contribute to my communities in different ways? I think it made many people think differently about how they work and healthcare workers were no different. So, Hal, if we look at kind of the state of things now and the state of things during the pandemic, have we gotten to a better place now in terms of ER closures or how has that shaken out?

It seems that things have gotten better. The worst year from the numbers that we have seems to have been around 2023. So in 2023, in the Interlake region in Manitoba, just north of Winnipeg, Arborg, in the town of Arborg, the hospital was shut down for 292 days out of 365. So that's about 80% of the year there was no emergency service at the hospital. Another town, Eriksdal, the ER was closed for 323 days. So that's like almost 90% of a year. Those are astonishing numbers. Yeah, I talked to like some local people there. And for example, one person in Aarburg mentioned that instead, like, she had to do a one-hour drive to Selkirk to have access to ER.

And she goes there and there's five people from Aarburg in the waiting room. So, so many people have had to make that journey. Yeah. And people, like, keep a printout of the schedule to know, like, days of the ER is closed. And one of the activists there, he calls it highway medicine, which you know, like as opposed to the problem we have in larger urban areas when it's hallway medicine. This is you have to drive down the highway to actually get to the ER department that's open then. Yeah, and that's the given. Although as we have seen from our example earlier with our friend from

Newfoundland, sometimes in an emergency, people just go to the local facility, even though it's closed, perhaps they're not aware that it's closed and they go there and they hope that they will find some kind of care. It happened in Hardesty in Alberta and a local woman came down there because she was feeling ill. The door was closed, she sat down on a bench, she passed out and when she came back she found out that she had been flown to Edmonton for a nine-hour surgery. So she needed immediate care obviously then. Yes and this is like cases where people

were fortunate that even though VEI was closed, there was medical personnel who were able to transport them and relocate them to another facility. I mean, I'm glad you brought up that experience of that woman, Ha, because we've been kind of talking about a lot of numbers, days closed. But really, this is impacting people who are in these communities who don't have access

to this kind of care. Kelly, we talked about the story of Derek Maloney up the top of the conversation. Are there any other examples we can point to? Like, what do these closures really mean for people? Well, I think one sad case I would point to is that in the same town, Bonavista, in that very bad month of closures in February 2023 that I discussed, there was a case of one gentleman named Charles Marsh who was 78 years old and had bad asthma and had been to the hospital to try to see if he could get some help for his asthma. He found it closed and he also found the notice that it was going to

be closed for a couple of days. And so he went home for the night and tried to get through the night with his, you know, puffers and other medication. He got up the next morning and called an ambulance to take him to the closest open ER, which was in the town I mentioned earlier, Clarenville, about an hour and 15 minute drive away in good weather. And he wound up dying on the road between Bonavista and Clarenville. And I spoke, when I visited Bonavista, I spoke with his daughter, Shelley, and Shelley, you know, told me that she talked to her father the night before and he mentioned his worries about what might happen to somebody with the ER being closed.

And he said, Oh, I just came from the hospital and it's closed. And he said, someone is going to die over this. And the next day it was him. We'll be right back. So Kelly, it sounds like this issue of ER closures really comes down to staffing. But if these communities had been able to staff emergency departments in the past, at least, you know, kind of adequately, what's really changed? Like, why is it so difficult now to have enough healthcare workers in these smaller communities? I think there are a lot of larger trends in medicine that have made it more difficult

to convince health workers to either move to or stay in some of these smaller communities. I mean, one is just that like the demographics of who is a doctor has changed. So I think when you looked at 30 or 40 years ago, I mean, who is the typical solo practitioner in a small town, your country doctor who did family medicine and covered the ER, I mean, that person tended to be a man with a stay-at-home wife who could work 100 hours a week. And now women have flooded into medicine and both men and women work differently.

They tend to work shorter hours. Many people I've spoken to about the difficulty with trying to attract doctors have talked about how this new generation badly wants work-life balance. And that's very important to them. They still work much more than the average Canadian in other professions, but perhaps in comparison to the older doctors, they work a little less and they take on fewer patients.

And then you add that the patient population they're seeing now is just more difficult and more time consuming. We have this aging population with multiple chronic illnesses. And medicine itself has become much more complex. You know, there's a huge number of treatments and procedures that doctors have to learn and sort through. And there's a large administrative burden, especially for people who work in family medicine. And an important thing to understand is that in almost all small towns, the family

doctor also is the ER doctor and covers the ER. So when I talk about the admin burden in family medicine, that winds up affecting ERs. And if you go to a rural place where there's only a handful of doctors, like, it's very hard to take a vacation. It's very hard to have the weekend off. You're constantly under this pressure where if one of your other doctors get sick, you have to step up. And if you don't, then, you know, there's the possibility of the ER closing. Yeah, it's a lot of pressure on someone. Yeah. You know, I had one doctor who I spoke with in Northern Ontario who mentioned to me that you know if the ER

was closed she wouldn't want to be seen mowing her lawn or at the grocery store because everybody in town knows she's the doctor and the ER's doors are closed. So I think all of those factors add up to making it harder to recruit and retain in some of these towns than it was in the past and it was always tough. Like, I do want to say that it's always been easier probably to convince doctors to work in Toronto or Montreal or Vancouver than it is in smaller towns. But these are interesting points to kind of look at kind of the changing dynamics here and how that might play into this. Beyond just, you know, not being able to access emergency care, which is obviously important,

are there other kinds of impacts that this recruiting challenge actually has on these small towns? Yeah. I spoke with Richard Fleet, who was an emergency doctor in Nelson, BC, and now deals a lot with small town emergencies as a researcher in Quebec City. And he mentioned that, you know, these are places where people were born. This is a place where their children are born. This is a place where their children are born. This is a place where their parents passed away.

It's the same place. There's a sense of continuity. It's very much woven into their community. It's emotional connection, it sounds like. Yeah. And the other thing too is that the town's survival and its importance is also very much wrapped around the availability of medical services. And people always mention, well, we're only 5,000 people.

But in the summer, our population doubles and triples. We want to make sure that for economic opportunities, for tourism, that there is a full-scale availability of health care. So these are all the people from the cities kind of going into the countryside or cottage country in the summers. That's how you're saying like the population can triple in these smaller areas then. Yes, and it often coincides with a moment when emergencies are also most short on staff too.

Oh, because I imagine doctors also want to take vacation. Yes. All right, let's talk about how some of these communities are then responding to these closures. How you reported on a town in Quebec, Rivière Rouge, that fought to keep their ER open. Tell us about that. So it's a town like about two hours and a half northeast of Montreal. It's in cottage country. And late in 2023, they were faced with a threat of a nighttime closure in the ER at their

hospital. And the town was really up in arms. They were like people were really upset that town hall meetings. And right away, people started saying, you know, is there any legal options that we could do? They went to court and they got an injunction. At first, the courts were not convinced because usually, you know, like they give a benefit of a doubt to administrators who said that we need to trim down on services

because we don't want the hospital's operations to be affected. But the town appealed and they produced like a number of doctors and nurses to testify on your behalf. And one of the key thing that happened is that a cancer patient testified in an affidavit and explained how because of her condition, if she had a fever, she needed to be at an ER as soon as possible to make sure that she was not in danger. And so they suspended the order to close the ER at night. And then afterwards, after having pitted themselves against the hospital administrators, the town

people then started working hand in hand with them. How does this work though? If they're short staffed, like how can they just file an injunction and then keep the ER open? So for a while, they had to do things such as mandatory overtime for the nurses. And they had to just like, you know, they told me that it was one nurse who practically was camped on a cot bed in the hospital. But then the town people started working hand in hand with hospital administrators who recruit people and they help in their effort to retain the staff there.

As Kelly mentioned, one of the big problems is not just having people, recruit people and they help in their effort to retain the staff there. As Kelly mentioned, one of the big problems is not just having people making sure that they want to live in a small town environment. So they wanted to make sure that it was appealing to people. There was like a citizens group that got involved, but it wasn't just volunteers. They rather cleverly also made sure that they tagged themselves onto a local charity, a local nonprofit there, so they could have like a permanent staffer to help coordinate. And they created something that they call themselves the Godparents, people who help

greet these newcomers who've been recruited mostly from French speaking countries such as Cameroon, Rwanda, Haiti, because this is Quebec. And so these godparents, they pick up people at the airport, they help them with the paperwork, they help register kids to school. They provide them with a furnished apartment, they show them around. I went to the local grocery store there

and the shop owner had stocked it with items at the suggestions of the newcomers so that they would have the kind of food that they're more familiar with so that you could find okra, plantain, instant fufu, croaker fish. This is amazing. Wow. So the community really stepped up in this example to try to remedy the situation with the ER. Yes. It's a certain segment of a population which is very much into

that. And like a part of it is somewhat endearing. Like you go there and they were telling me like, no people really should understand like, you know, how beautiful it is here and you come here away from the stress of Montreal. And so far they've recruited 68 employees. This is a really interesting story then from Rivière Rouge in Quebec about how this community kind of changed the situation for themselves. I guess I wonder how other provinces and other places are dealing with this.

Kelly, how else have we seen places deal with this issue of ER closures? Not every story that we encountered was as feel-good as the story of Rivière Rouge. What we're seeing in a lot of other places, and this is an important way of explaining why the closure situation has on paper gotten better in some places, a lot of other places are doing things that mean they're changing the types of services that are offered in these communities. So rather than have a constant unpredictable stream

of unplanned temporary closures, some health authorities in some provinces have chosen to either permanently reduce hours, so they've taken what was once a 24-7 ER and turned it into a nine-to-five operation. Some have done things like out and out changing the ER to what they call like an urgent care clinic that only takes patients by appointment and does not take ambulances and it functionally becomes a community clinic. And one place that's done this

that's had a long-standing problem is Nova Scotia. What they have decided to do is turn some of these small hospitals that they were having trouble keeping open, turn their ERs into these urgent care or urgent treatment centers, but ensuring that everybody understands that there's a regional hospital within an hour's drive. And, you know, people in the small towns may feel differently, but like the provincial government's contention is, it's better for people to know what to expect and to have a reliable regional hospital that's within a reasonable drive away. Another thing that we saw in Newfoundland, for example,

is they are moving in a lot of cases to virtual ERs. What does that look like? Yeah, so the way that looks is your ER would be staffed with nurses and either a respiratory therapist, an advanced care paramedic or an NP that's capable of doing any kind of treatment that keeps your airway open, airway management. COLLEEN O'BRIEN And nurse practitioners and NP there, yeah?

AMT. SONIA SRIKANTH, M.D. Yes, a nurse practitioner, you're right. But there wouldn't be a doctor on site or on call. Instead there would be a doctor available somewhere else in Canada virtually and then the nurse or other health professional on the ground would sort of act as the hands and the eyes and the ears using a lot of virtual equipment that would allow the doctor who's far away to say listen to somebody's heart or look in their ear.

But that is one way that they are choosing to keep the doors open when they cannot attract a doctor to full a shift. So that's been happening a fair bit, especially in Newfoundland, but in some other parts of the country as well. Okay, so there are some creative solutions here, but as you started off saying though, this is a way then for on paper for these closures to look not as bad because they've kind of done all of these other things instead. In a lot of ways it to me reflects health authorities accepting the reality that there will be some places where they are going to constantly struggle to keep the ER open. And some of them are having to make these really hard and very unpopular decisions to change the hours or close the hospital or change the type of service that's available on the ground

because they just think this is like not a problem that we're going to solve. And are they really better off to have a hospital in a place like some of the locations Haw's been talking about in Manitoba where, you know, the hospital's closed for 200 days a year. I mean, in those kinds of situations is a time for health authorities to say not every small town that always had a hospital should have a hospital forever. – I imagine that's a pretty hard pill for a lot of communities to swallow though. – People are very angry when there is discussion of changing hospital services, reducing it, or outright closing a hospital. And that's because of the reasons Hall mentioned earlier, that people in small

towns are very attached to what these hospitals symbolize. And then from a practical perspective, they just look around and say, people aren't going to want to retire here, right? If you have any kind of health condition that you think requires regular medical care, if you feel as though it's not easily available in the town you live in, there's plenty of people who feel like that's a disincentive to people staying and it's a disincentive to trying to attract people. So, I mean, before I let you both go, it does sound like there's a lot of really big problems

to tackle here. Was there anything though in your reporting when it comes to, you know, attracting people to these rural communities? I guess anything that stood out as you know a positive action that we're starting to see actually work here. One thing I really love is the efforts that both nursing schools and medical schools are making to really focus on recruiting people who grew up in rural Canada and saying, you know, we're going to set up residency programs in rural areas, right? We are going to expand nursing school seats in schools that are located in smaller places. From what I

understand from people I've spoken to all across the country in the health system, it is generally much easier to recruit and retain somebody in a small town or rural part of Canada if that is their hometown, right? There are some programs that I think are really exciting on that front and I think, you know, the Northern Ontario School of Medicine I think does really great work and really focuses on training people in the north and recruiting from the North. And I think focusing on trying to find health workers of all kinds who come from these parts of Canada

is probably the best long-term bet, along with, of course, recruiting from overseas. But that's always a challenge. And in both cases, like, this is stuff that's gonna take time for it to really work Kelly, huh? Thank you both so much for this reporting and for taking the time to be here. Thanks, Monica. Thank you for having us That was health reporter Kelly Grant an investigative reporter do than hot That's it for today. I'm Monica Ramon Wilms. Our producers are Madeleine White, Michal Stein, and Ali Graham.

David Crosby edits the show. Adrian Chung is our senior producer, and Angela Pacenza is our managing editor. Thanks so much for listening, and I'll talk to you soon.