N.W.T. health-care bodies say relying on virtual doctors in emergency room is unsafe

Yellowknife's hospital will staff its emergency room with a virtual doctor, and will regularly schedule doctors to work 12-hour shifts this summer to deal with a personnel shortage, according to three health-care organizations in the territory that have decried the situation as dangerous. 

The Northwest Territories Medical Association, the Union of Northern Workers and the College and Association of Nurses of the Northwest Territories and Nunavut issued a joint media statement Thursday afternoon calling on the territorial government to do whatever it takes to make sure there's an in-person doctor in Stanton Territorial Hospital's emergency room at all hours. 

"This is simply unacceptable for a level 3 trauma centre," said Dr. Courtney Howard, an emergency room physician in Yellowknife and the president of the medical association — in part, she said, because Stanton serves the entire territory, is a hub for a "structurally disadvantaged population" and has agreements to provide a standard of care to the Kitikmeot region of Nunavut as well. 

CBC News asked the Northwest Territories Health and Social Services Authority (NTHSSA) — which is responsible for operating the hospital — for an interview. A spokesperson said no one was available for an interview Friday, but issued a lengthy statement on behalf of its CEO, Kimberly Riles. 

In that statement, Riles said no changes are being made to the way service is delivered at the hospital, and that virtual care is one of the options the health authority is exploring to support contingency planning. It did not say when virtual care might start being offered.

"It's only one of several ideas under consideration and would never be viewed as a replacement for in-person care, but rather a contingency approach that could be used in the event of a severe shortage scenario," she said. 

Riles said contingency plans are needed to deal with unexpected vacancies — like sick calls or travel disruptions — and known vacancies — like not being able to backfill leaves.  

The joint media statement from the three organizations, which calls on the territory to be more competitive to attract doctors, is the latest development in the struggle to adequately staff Stanton's emergency room, which is the result of a doctor shortage throughout the country. 

Howard and the medical association told a territorial committee in April that if the government doesn't find a way to attract more doctors, there would be closures at the emergency room in the summer. Back in 2022, the medical association also railed against a bill that would let out-of-territory doctors do virtual consultations.

Howard said the 12-hour shifts and the virtual ER appear to be the NTHSSA's solution for the problems they discussed earlier this year. She said she's seen gaps in the upcoming ER schedule and that a policy about virtual care was sent out to staff for their input on Wednesday because there was a possibility of having to rely on a virtual doctor for a shift this weekend. 

That shift, she said, has since been filled by a locum. Locums are generally southern doctors who travel north to fill gaps.

The NTHSSA, meanwhile, said draft information about contingency planning — which included virtual care — was sent out to staff to gather feedback and that it wasn't a finalized plan. Riles said it was also "unfortunate" that it was made available to the public before it was ready. "This only causes more confusion and can be misleading to the public," she said. 

Howard said virtual emergency rooms have been used in rural settings where a few patients may trickle in during an overnight shift. "Even in those circumstances, they are well thought through," she said, and they usually have stable infrastructure like video equipment and a button on a wall that immediately links the patient to the doctor. 

But that's not the case at Stanton, she said. 

"We have an iPad on wheels," Howard said.

"I don't know if we can even make that work for a couple of hours on a quiet day." 

Howard said having doctors work 12-hour shifts is also unsafe. "We have decided as a group, and many locums have told us the same thing, that the minimum safe amount of staffing is three [doctors working] eight-hour shifts." That means there's at least one doctor in the emergency room at all times, though there's no overlap in those shifts. 

"Really, by the time you leave a busy shift, your brain is mush after even eight hours. So 12, we just feel is dangerous. And we've said if that needs to happen as a result of a last-minute sick call or something, then we would do our best to work with it. But it certainly shouldn't be something that is scheduled." 

Howard has been calling for the territory to do what she says many large emergency rooms in Canada are already doing — provide a generous amount of money to doctors to travel to the North, and as empty emergency room shifts draw closer, offer more money to locum doctors to cover them.  

Howard compared it to the way seats on a plane increase in price the closer you get to the date of travel. 

She added there are two paths the territory can take now: deciding it's OK for the department to close or achieve a different level of care versus deciding to keep it open no matter what market forces demand. 

The NTHSSA, meanwhile, said addressing challenges in health and social services is never easy. 

"As we explore new ideas and implement them, we recognize that not all of them will succeed, and that's okay. What matters most is that we keep moving forward," Riles said. "Tackling complex challenges requires us to be open to trying new approaches. What won't change is the NTHSSA's commitment to the health and safety of our staff and residents."