Mission residents had the chance to ask questions and share comments with Fraser Health leadership at the health authority’s public board meeting on Wednesday (April 22).
The meeting at Best Western Plus Mission City Lodge came amidst 51 consecutive nights of reduced hours at Mission Memorial Hospital’s emergency department.
Board members provided updates on staffing, finances, and quality of care for the broader Fraser Health region before Mission Memorial Hospital interim executive director Trena Caning, site medical director Dr. Paul Theron, and medical health officer Dr. Rahul Walia presented about healthcare in Mission.
Approximately a dozen people had an opportunity to share feedback and ask questions after the presentation.
Maternity ward, staffing among public questions
Terry Wilkinson asked about the potential for a maternity ward in Mission in the future.
Theron said that the province is experiencing staffing challenges with obstetricians and some departments have implemented temporary maternity closures.
“I wouldn’t go so far as to say that it’s impossible that it could ever happen again, but … from a budget and planning perspective, I think we have to be … realistic with short term expectations. That where we have to put our dollars right now is to stabilize services that are really challenged to provide the foundational care. And expansion comes later,” Theron said.
Candace Koch asked if Fraser Health has assessed the impact of recent budget cuts on smaller sites like Mission compared to larger ones like Abbotsford.
“Given that Mission Memorial Hospital has lost all care aides in the ER department, key site coordination support and multiple temporary LPN positions, what specific steps are you taking to address the resulting impacts on patient care?” Koch asked.
Fraser Health president and CEO Dermot Kelly replied: “I don’t think it is a secret to anybody that as a province and as a health system and as a health authority, we are facing financial pressures. And there are difficult decisions that need to be made in order to maintain service and delivery to the best of our capabilities – to provide that care and service and the best possible experience to the people that we have the responsibility of serving. But it’s extremely important that we hear back what the impact of those decisions are, and are there opportunities for us to be able to learn from some of those decisions and perhaps modify or change some of those … in time. But we do not unilaterally look at a particular site or service area or facility. We do take an approach across the system.”
Another question asked about a lack of relief nurses and float nurses at Mission Memorial. Fraser Health human resources vice president Ken Casorso acknowledged there’s “work to do” but a rollout of relief nurses is on the way.
“We want to have more stable and regular relief, and that is on our work plan, and some of those units will be going live in the coming months,” he said.
Leslie Dycke, one of the residents who spoke, said there are a number of problems with the system, but a number of solutions as well.
He said the majority of problems are system issues — not people — and added that optimizing the whole system and measuring what actually matters is a path forward. Dycke listed a range of problems and solutions and received positive feedback from the board.
Board member Harinder Singh Sadhra said “I’m pretty sure that everybody on this side of the table is clapping inside while you were speaking the entire time, because those are actually the conversations we’re having all the time.”
Waterfront rally to keep E.R. open
Mission residents also gathered at a rally on the waterfront organized by H.S. Kenny Braich prior to the board meeting. Attendees signed Abbotsford-Mission MLA Reann Gasper’s petition to the province to keep the Mission emergency room open.
Mission Self Advocacy Group Jean-Pierre Maher was among those who attended the rally and signed the petition. He said the reduced hours impacts members of the group, many of whom have disabilities and/or rely on public transit.
“Transit buses would not be running later at night. So (if) somebody had a medical emergency at 11 p.m. – how would they get to the Abbotsford Regional Hospital? Or how would they get to Maple Ridge if they did not have a ride? So this is unacceptable. Any member of the government that hears this, may you please do your best to fix this immediately, please,” Maher said.
Theron said if someone comes to the hospital and has an urgent need that has to be addressed right away, the hospital can call an ambulance at no charge to the patient.
“It’s not necessarily that we want to say we can transport any patient anywhere at any time, but we have funding and resources to be able to provide taxis and transport services to patients to either take them home if they came to the hospital if they don’t have their own transport (or) we have the ability for some patients that don’t need to be admitted, but need recurring services at the hospital to book transport for them on a pre-planned basis. So there are resources available. I don’t want patients to feel that ‘If I can’t afford to come to the hospital, I might have to forego my medical need.’ Come to the hospital and we’ll handle it at that point and do it in the most patient-centric way possible,” Theron said.
More residents voiced concerns at the public board meeting.
Tammy Sampson, PAC chair at Heritage Park Middle School and PAC secretary at Mission Secondary School, said emergency department coverage is important for the youth of the community.
“Mission Hospital needs to be able to cover and protect the students and the kids involved in community sports with at minimum basic health care – things like ultrasounds and X-rays and being able to repair broken bones. I understand some more heavily-needed healthcare has to go to Abbotsford or Maple Ridge, but Mission needs to be open 24/7 to cover all of that basic health care,” Sampson said.
She said on a recent trip to the emergency department for her daughter’s ankle injury, she saw a lot of people turned away at the door at 5 p.m.
“It was heartbreaking. I followed up with one family – they were in Abbotsford Hospital for 12 hours and turned and left in the middle of the night and returned to Mission on Monday morning. And it was sad that their child had to wait over the weekend to receive healthcare that they should have received right away,” Sampson said.
Fraser Health’s approach to reduced emergency hours, staffing challenges
During a presentation about healthcare in Mission, Theron said nearby hospitals haven’t seen a meaningful statistical increase in patients while Mission’s emergency department experiences reduced hours.
He said during the service adaptations, the Mission E.R. sees an average of approximately 10 patients during overnight hours.
“The majority of these patients are redirected to either a family physician or (Urgent and Primary Care Clinic) or another point of care the same or the next day. A small number of those patients do end up being diverted to Abbotsford, predominantly, but Ridge Meadows (is) supporting us as well,” Theron said.
Emergency-trained nurses remain on sight after 5 p.m. during the service interruptions.
“I think it’s important to remind everyone one more time that although the emergency department might not be open to see physicians for patients after certain points in time, we’re never closed. We have nurses on site around the clock that are always there to triage any patient that might present to the hospital,” Theron said.
Canning said the $18 million renovation of the emergency department expected to finish by spring of next year will increase its capacity by 35 per cent.
Prior to the flood, Theron said the emergency department would see approximately 85 patients per day. In the temporary space which has about a third of the previous space, he said that number has dropped slightly to roughly 75 per day.
However, it’s more than the 40 patients per day when Theron joined Mission in 2012.
“This growth doesn’t come without growing pains. As we expand services and look to expand emergency services, inpatient quality of care — we obviously see some of the gaps springing up. And this is not unique to Mission. We’re at a unique crossroads in terms of the flooding that we had in our emergency department. I think most of the public is aware of that … and we can see our challenges starting after that, where physicians choose to work in other departments,” Theron said.
He said family physicians are the backbone of healthcare in Mission and the Mission Division of Family Practice is a cornerstone of recruitment to the community.
While recruitment efforts have borne fruit, Theron said turnover also has an impact.
“As much as we can recruit in, we do have physicians that will leave the department to either retire or work in other clinical programs within the hospital or in the community, and sometimes leave the community. So that does lead to the gaps in staffing stability, which we’re working very hard to circumvent,” Theron said.
In her first public meeting as Fraser Health board chair, Cindy Oliver addressed the ongoing service adaptations at the Mission emergency department. She said construction on the expansion is being expedited to support the community as soon as possible.
“I know this is a significant concern for the community. Reliable access to emergency care matters deeply for the Mission community. When the emergency department operates with limited hours, it has a real impact on patients, families and care teams. This is not the standard we want for Mission,” Oliver said.
Theron said there’s a “reasonable expectation” that staffing will improve when the doors to a new emergency department open.
“We’ll have to see when that comes. This is still on the background of a provincial challenge with staffing … so opening a new department doesn’t automatically mean stable service, but it does give us a meaningful tool in terms of recruitment,” he said.
Theron was surprised at how many people from the community came out to Wednesday’s meeting and was sad for the people that didn’t have a chance to ask their question.
“The main takeaway for me is community advocacy reaps dividends. The advocacy that we’ve seen – in terms of opening UPCC, bringing a CT scanner to the hospital, around the ED expansion – that’s where we got commitment from the government (and) got funding for it. So I don’t want people to feel disconnected because services are challenged right now. This is really the point where we want to see people lean in, really advocate, really ask difficult questions of the government,” Theron said.