B.C. emergency department physicians say their situation has reached a crisis point.

An article published today on the website of the Canadian Medical Association Journal says the doctors think it will cost $10 million to solve the problem. The article said, in part:

The ongoing overcrowding in British Columbia's emergency departments (EDs) has reached a crisis point, with physicians now calling for a $10-million investment in solutions.

Between January 2010 and April 2012, there were 40 000 more patient visits to 19 EDs than they were staffed to handle, according to data from BC health authorities.

"I come on at midnight and sometimes the first patient I see has been waiting there for six hours," says BC emergency physician Dr. David Haughton. "There's no telling who will explode. It's taking risks."

"We have no ability to do anything," adds Haughton. "It's not fair; it's not holding the people in control accountable."

Haughton is president of the British Columbia Medical Association's (BCMA) emergency medicine section, which represents all emergency doctors in the province. He developed the remedial plan with the section and presented it to the BCMA Board of Directors on Feb. 8. The board approved the plan, thus garnering the support of BC's 10 000 doctors, Haughton says.

The plan to bring in more emergency physicians and tools to decrease wait times and increase government accountability was announced publicly on Feb. 23.

BC Minister of Health Margaret MacDiarmid stated in an email that the ministry has been in talks with emergency doctors and is committed to improving care in EDs, but "there is no new money available" to fund this new plan.

The proposed solutions, which include hiring more physicians and enforcing standards on how long a sick person has to wait for a bed, would cost $10 million. The hiring costs would be added on to the $90 million that the ministry has agreed to pay for all physician services from April 2012 through to March 2016. MacDiarmid says funds could be reallocated, but Haughton says money for the plan cannot come out of other priorities, but requires a new investment.

Overcrowding is, in part, the result of "access block" -- when patients wait on stretchers in the ED instead of being moved to in-patient care. This prevents doctors from treating more incoming patients. Access block is the biggest issue facing EDs in BC and across Canada, according to the Canadian Association of Emergency Physicians.

Dr. Jodie Turner is an emergency physician at the East Kootenay Regional Hospital in Cranbrook, British Columbia, which, in a little over a year, has seen a 10% increase in patients while facing decreasing staff numbers.

She says she'll never forget coming in for a shift during the long weekend in February and within an hour facing a rapid succession of five serious cases, including trauma, stroke, chest pain and respiratory distress.

"Those five patients don't include everyone else in triage," she says. "I was the only emergency doctor working." It isn't always this busy, but the issue of overcrowding is always there, she says.

There are two main schools of thought in BC when it comes to measuring ED needs and allocating funds.

The plan urges the province to adopt the workload model, which predicts how many staff are needed based on the volume of admitted patients and the level of care required. Under this model, most of the province's EDs would qualify for additional physicians.

The Alternative Payment Program (APP) provides additional funding only to those EDs that file a submission. That process, finalized in December, helps health authorities to identify where funding is needed the most, according to the ministry.

The only recent reference to emergency services on the Ministry of Health website is a Feb. 18 news release on a proposed Emergency and Health Services Act, "which will enhance the co-ordination of emergency health services in British Columbia."

Crawford Kilian is a contributing editor of The Tyee.