Should some rural ERs close permanently if better supports are in place?

Plastic covers new chairs in the pristine waiting area of the Carleton Place and District Memorial Hospital's newly constructed, 'state-of-the-art' emergency room (ER), which officially opens for residents in this rural eastern Ontario community in January.

The next challenge will be keeping the doors open. And that hinges on the availability of nurses.

Brad Harrington, the CEO of the Mississippi River Health Alliance, is taking an "if you build it, they will come" approach.

"It's an absolute key strategy for us in regards to recruitment and retention going forward," said Harrington.

A CBC data analysis found Carleton Place is one of at least 38 Ontario hospitals whose ER or urgent care centres have experienced closures — about one-fifth of the 176 publicly funded facilities over the past three years.

The data shows more closures in rural and remote areas. The majority — more than 85 per cent — were due to nursing shortages.

One ER in Minden, Ont., about 300 kilometres west of Ottawa, closed permanently in 2023. Others in the southwestern Ontario towns of Chesley, Clinton and Durham are currently closed every evening and all night. 

Physicians who spoke to CBC both on and off the record wonder if ERs that are only open for part of each day can really be considered an ER. Some suggest more permanent closures, done in concert with establishing better support services such as urgent care clinics and advanced paramedic care, could help remedy inconsistent emergency services in some areas.

For Tim Vine, president and CEO of North Shore Health Network, managing three hospitals in the remote rural area along Lake Huron comes with constant uncertainty in terms of finding enough physicians and nurses to keep ER doors open.

Since 2022, the three hospitals Vine oversees have endured the frequent risk of ER shutdowns, which happened this fall at Thessalon's hospital and in Richard's Landing. 

"We need help from policymakers and from planners within the system to determine whether or not there ought to be an emergency department in a particular location. I've got my answer and it's an unequivocal yes, but if that's to be the case, we need to be funded in order to deliver that service," Vine told CBC, noting his network too often gets temporary, stop-gap funding.

Permanently closing ERs in remote areas is a difficult call when the next closest emergency department is an hour or two away. But in rural areas some hospitals are much closer.

"Those days of every small town having an emergency department are regrettably over until we can develop some resilience in our health-care system," said Dr. Alan Drummond, who has practised emergency and family medicine in Perth, Ont., for decades. 

Perth's Great War Memorial Hospital's emergency department had to shut down for three straight weeks in 2022, shocking residents.