Summer is a characteristically difficult time to properly staff hospitals. But chronic staff shortages on Vancouver Island had persisted for years before the 2023 summer holiday season began.
The ongoing crisis caused nurses to rally outside Victoria General Hospital earlier this month after Island Health recently announced overnight closures at nearby Saanich Peninsula Hospital that will last until September. There, the problem has been a shortage of emergency room physicians after doctors retired early or left for health reasons, according to Dr. Jeff Unger, an emergency physician at Saanich Peninsula.
“We’ve been actively trying to hire for 1.5 years to fill the void of a previous COVID-related early retirement and [the] loss of three other part-time physicians,” Dr. Unger said. “[The] physician staffing crisis was the ultimate final straw, but all staff are short — nursing, clerks, unit aides, lab techs, imaging techs, cleaners. Over the last two years we stayed open despite inadequate nursing staff.”
The escalating staffing crisis at Victoria hospitals has led to ongoing operating room closures and surgery delays for hundreds of patients.
According to documents obtained by The Tyee via a freedom of information request, planned operating room closures at Royal Jubilee Hospital and Victoria General Hospital began in fall 2022. Staffing shortages continue to impact the provision of health-care services and surgical capacity today.
Documents reveal that a top Island Health executive was informed by directors of surgical and ambulatory services in a closed meeting on Oct. 27, 2022, about the need to plan for long-term operating room closures at Royal Jubilee and Victoria General hospitals. This came after over a dozen nurses left their positions to work at a newly acquired daytime surgical centre.
“A total of 19 employees left their perioperative positions at RJH [Royal Jubilee Hospital] or VGH [Victoria General Hospital] for daytime positions at SISC [South Island Surgical Centre],” reads a briefing note presented at the meeting.
“Since the beginning of September 2022, there have been ad-hoc closures of some operating rooms at RJH and VGH due to this critical lack of staffing.”
Between Sept. 6 and Dec. 16, 2022, operating rooms at these two hospitals were closed for a total of 69 days.
Around the same time, from Sept. 1 to Dec. 3, documents suggest at least 141 surgeries were postponed across Island Health, the majority at VGH and RJH. However, a large number of redactions and inconsistencies in the 119 pages of FOI documents make it difficult to calculate exactly how many patients were impacted by operating room closures.
Across Vancouver Island and at RJH and VGH in particular, the memo noted that Island Health was “off track” to meet the B.C. Health Ministry’s surgical goals for April 2022 to March 2023 because of a shortage of nurses in perioperative and inpatient units, as well as a surge in patients.
These goals include having no one wait longer than 52 weeks for surgery, finishing at least 80 per cent of urgent procedures within four weeks, and rescheduling all surgeries that were postponed due to the pandemic.
As part of the plan to get back on track, the directive offered two options.
The first option was to proactively close an operating room at each hospital until March 31. The second option has been redacted under a discretionary Freedom of Information and Protection of Privacy Act exemption. A section highlighting the challenges and risks associated with the first option was also redacted.
Neither the Ministry of Health nor Island Health have answered The Tyee’s repeated requests for interviews and answers to questions about current operating room closures and surgical capacities.
‘What suffers is the high-complexity places’
When employees leave their jobs in one hospital department, it has a “domino effect” on the rest of the system, said Dr. Sanjiv Gandhi. The pediatric cardiothoracic surgeon resigned from his former role as the chief of cardiac surgery at BC Children’s Hospital at the end of last year to become the B.C. Green Party’s second deputy leader.
“The lack of OR [operating room] staff is a particularly problematic situation in that not being able to do certain operations or a certain number of operations limits what the hospital can see in the ER, what kind of patients can be admitted,” Dr. Gandhi said. “[It] directly impacts people on the waitlist for operations, which necessarily becomes longer, even if the people required to do their specific procedure are still present.”
Last spring, B.C. and Vancouver Island health officials announced an $11.5 million deal to buy two private surgical centres — one of these, formerly known as the View Royal Surgical Centre, is located next to Victoria General Hospital — from Surgical Centres Inc. The move was meant to “increase capacity and reduce wait times for people who need surgery,” Health Minister Adrian Dix said at the time, announcing that combined, the two private centres would add the capacity for 2,300 surgeries and 2,300 endoscopies a year.
But the acquisition had a different effect on surgical capacities in hospitals.
The View Royal Surgical Centre being turned into an Island Health-operated facility caused “a big impact on staffing levels” at RJH and VGH after 19 perioperative nurses left to work there, according to the FOI documents.
Between Sept. 5 and Oct. 31, 36 operating room slates were closed due to critical staff shortages as a result. These closures impacted 162 patients, according to the memo.
Hospital staff leaving to work at a less stressful job is a known phenomenon, for reasons shared by both Dr. Unger and Dr. Gandhi.
“The reality is that many frontline health-care workers are burnt out, so more predictable and stable work environments without nighttime hours are very appealing,” Dr. Unger said.
“It's easier for people to leave these high-complexity jobs and still feel like they're making a difference and go to a place where they can just do stuff 9 to 5 and not have to worry about losing patients. What suffers is the high-complexity places,” Dr. Gandhi said.
The Health Ministry has not answered questions about how many surgeries have been completed at the South Island Surgical Centre in the past year.
A report from the ministry this March shows B.C. has nearly caught up on surgeries that were postponed between March 2020 and February 2022 due to COVID-19 cases and measures.
Across B.C. in the past year, this report says 33,473 urgent scheduled surgeries were completed within four weeks; it does not state how many of these types of surgeries were completed in total, and it doesn’t state how many surgeries were postponed last year.
The report also notes that 30,886 patients waited more than double the target time for non-urgent scheduled procedures.
If you can’t schedule, you can’t cancel
According to Dr. Gandhi, the practice of closing operating rooms is part of a problematic strategy to avoid publicly reporting surgery cancellation data.
“If you can’t schedule a case, you can’t cancel it,” he said, noting the same tactic was used last fall for cardiac surgery cases at BC Children’s Hospital. “Our wait list got longer but they didn't really report that data, they just reported cancellations and they're allowed to report less cancellations because we couldn't schedule them.”
Across B.C., health-care workers have been embroiled in ongoing cycles of illness and burnout, the cumulative effect of surges in COVID-19 and other respiratory illness patients, dangerous staff shortages, and the ensuing pressure on hospitals and patients.
Hospitals in rural parts of Vancouver Island have regularly been closed overnight and in crisis mode since the pandemic began. Earlier this year, Island Health announced 18 new hires and in some cases meted out thousands of dollars in bonuses to staff emergency departments in smaller communities.
The problem seems to have persisted, however.
According to Dr. Gandhi, the health authority has been sending email blasts to doctors this month asking for emergency coverage of shifts at Port Hardy Hospital, as well as other hospitals across Vancouver Island.
Dr. Unger says Saanich Peninsula Hospital had been requesting — and were subsequently denied by the B.C. Health Ministry — enough physicians to keep pace with growing demand in 2018, 2019 and 2020. Things got worse during the pandemic.
“Pandemic-related and other primary care capacity and access issues have now left the ED in 2023 in crisis with volumes up another 40 per cent in the last three years alone,” Dr. Unger said.
“At the same time, despite recruiting few new locums, there’s been a net loss of emergency physicians, so we are now at a net loss and short seven physicians — in a group of 16 — and existing staff have been working far beyond sustainability.”
The FOI documents also revealed that critical shortages of anesthesiologists at Nanaimo Regional General Hospital led to operating room closures and patients being diverted to other hospitals from at least August until November last year.
In the closed meeting on Oct. 27, the vice-president of clinical operations for the south island for Island Health was asked to also consider ways to meet employee needs, “i.e. challenging child-care situations that impact work.”
Island Health has not answered the question of how or whether these needs have been addressed.
“The ripple effects of any staff departures are wide-ranging, as health-care delivery is an incredibly interdependent phenomenon,” said Dr. Unger.
“With hospitals — and community and long-term care for that matter — already over capacity, the impact of one more loss in the system is magnified.”