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. 

The letter, 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. 

CBC News has asked the Northwest Territories Health and Social Services Authority (NTHSSA) — which is responsible for operating the hospital — for an interview. 

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.

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 8 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."