‘Staggering’ number of Ontario emergency department closures revealed by Star analysis

Hospital emergency departments across Ontario were forced to close 158 times in the past year, resulting in some 4,430 hours — the equivalent of 184 days — when the urgent care needs of many communities could not be met locally.

The Toronto Star has tallied Ontario ED closures announced by hospitals or referenced in local media coverage to provide, for the first time, an overview of the impact on urgent care of staffing shortages, exacerbated by COVID-19 and other respiratory viruses.

The 158 closures the Star found took place between February 2022 and February 2023 and were spread among 24 hospitals serving primarily rural areas of the province. Most closures were between 12 and 14 hours, representing overnight shutdowns, but several were for 24 hours. Since the Star last reported on ED closures in September, one ED experienced a closure that lasted more than a month.

“The scale of emergency department closures we’ve seen in the last year is completely unprecedented. There has never been anything remotely close to this. It’s staggering,” says Natalie Mehra, executive director of the Ontario Health Coalition, a non-partisan public health-care watchdog. “These closures are, without question, a risk to the lives and health of people. No one can deny that.”

“The number of days an emergency department is ever closed should be zero,” said Dr. Rose Zacharias, president of the Ontario Medical Association and an emergency physician who worked at community-based EDs for 20 years.

“These numbers are astounding. … This is wrong. This is not doing right by our patients.”

Since many closures are only announced locally and not widely publicized, the Star’s tally is likely an undercount. It did not include partial shutdowns of EDs, nor closures of urgent care centres, which often handle patients who would otherwise go to emergency departments. Bed reductions in EDs are also not included in the Star count.

The ED to suffer the most individual shutdowns in the past year was at Glengarry Memorial Hospital in Alexandria, Ont., with 38 overnight closures. The next was Chesley Hospital ED with 30 closures. This was followed by Seaforth Community Hospital ED with 13 closures. St. Marys Memorial Hospital experienced eight ED closures, while Clinton Public Hospital’s ED had seven.

Robert Alldred-Hughes, president and CEO of Glengarry Memorial, told the Star the hospital has not been required to close its ED since October thanks to staff working additional hours, agency nurses being brought in and a continued focus on recruiting nurses to fill vacancies. He noted that staffing “does remain fragile.”

“Our future focus is to invest in supporting internationally educated nurses to work here by supporting their supervised practice experience with the College of Nurses, as well as hiring clinical externs, which are unregulated health-care providers who are current nursing students,” he said.

The cumulative 4,431.5 hours of closures the Star found included several prolonged shutdowns that are each counted as one: The Perth and Smiths Falls District Hospital ED closed for three weeks straight in July; beginning in October, the Chesley Hospital ED closed for about 55 days; also in October, Campbellford Memorial Hospital’s ED closed for one-and-a-half days and two nights; and Chesley’s ED closed again for three days and four nights over Christmas. In some of these cases, the nearest alternative emergency department is more than an hour drive away.

In almost every case, the reason given for the closures was a lack of adequate staffing.

Ontario Health, the provincial agency that oversees health-care delivery in the province, said it was aware of 19 hospitals that have experienced ED closures since June. The Star asked the agency for the names of these hospitals but did not hear back.

“Our government knows emergency rooms have faced capacity pressures year after year. We know the status quo is not working,” said Hannah Jensen, a spokesperson for Health Minister Sylvia Jones.

She said the government’s “Your Health” plan will connect Ontarians to care closer to home in settings such as pharmacies, community surgical and diagnostic centres and even within people’s homes, to avoid “unnecessary” trips to the ED and to help ease pressure on hospitals.

“Since our government took office in 2018, over 60,000 new nurses and nearly 8,000 new doctors have registered to work in Ontario,” added Jensen, noting 2022 alone saw the addition of 12,000 new nurses.

She said the province is working with the College of Nurses to break down barriers for internationally educated health-care workers and is adding more than 450 new undergraduate and postgraduate seats across the province.

A Star investigation last fall revealed Ontario Hospital Association data showing that rising turnover and retirement rates in nursing and an increase in the number of beds and associated positions for more nurses has resulted in more vacancies in the profession.

NDP health critic France Gélinas said she “never thought” Ontario would see ED closures reach such high numbers.

“This is really, really bad and it talks to the health-care workers crisis,” she said, adding that she speaks regularly with nurses in her northern Ontario riding (Nickel Belt) who say they feel disrespected by the government’s controversial Bill 124. “They’re discouraged and burnt out.”

The legislation, passed in 2019 and that caps the wages of many public-sector workers, including nurses, to annual increases of one per cent for three years, was struck down by the Ontario Superior Court as unconstitutional last November. The government is appealing the decision.

“This data is heartbreaking testimony to the mismanagement of the health-care system under Doug Ford and Sylvia Jones,” said Liberal health critic Adil Shamji, who is also an emergency physician. “If this is not the definition of a crisis, I simply don’t know what is. There can be no more conspicuous failure of our health-care system when we cannot even keep our emergency departments open.”

Dr. Alan Drummond, an emergency physician in Perth and co-chair of public affairs for the Canadian Association of Emergency Physicians, said given that most of these closures affected smaller and more rural communities, for the people who live in these areas, “This is indeed a crisis.”

“The problem with rural departments is that we’re vulnerable on a good day in terms of the number of people we have staffing,” Drummond said, noting that if one doctor or nurse goes off sick at a large urban hospital, it is relatively easy to find someone to fill in. “But in rural communities, if one doctor or one nurse goes off, we’re left scrambling.”

Dr. David Gomez, a general surgeon at St. Michael’s Hospital in Toronto who has studied how ED closures can influence potential access to emergency care in Ontario, says the provincial government has tied the hands of hospital administrators with legislated caps on nursing wages.

“It’s already difficult to recruit young nurses and physicians to work in rural areas and significantly limiting the capacity of hospitals to recruit with additional financial incentives and higher wages, significantly limiting the capacity of increasing wages for nurses, leaves those nurses who are working in these areas in a precarious situation,” he said.

Gomez and some colleagues recently published a paper in the Canadian Journal of Emergency Medicine that looked at the number of people at different travel times from EDs who lost access to care with recent closures.

“Time in a small proportion of emergency department cases can lead to additional complications or loss of life and you overwhelm adjoining emergency departments,” he said.

“There are a lot of downstream effects of closing one emergency department.”

Correction — March, 3, 2023: This story has been revised. An earlier version stated that Kemptville District Hospital’s emergency department had 12 overnight closures in the past year. The actual number is six. As a result, the facility is no longer among the five hospitals in Ontario with the most closures.

Kenyon Wallace is a Toronto-based investigative reporter for the Star. Follow him on Twitter: @KenyonWallace or reach him via email: kwallace@thestar.ca