Briefing Note on ER Overcrowding

When emergency room doctors at New Westminster's Royal Columbian Hospital complained about the impact of overcrowding on morbidity and mortality, Minister of Health George Abbott responded by telling the Legislature: "We have been reviewing that suggestion with the Fraser Health Authority, with the Ministry of Health and with the Canadian Institute for Health Information. We have been unable to find any indication of accelerated morbidity, mortality as a consequence of conditions in ERs." It would be a mistake to interpret Abbott's comment as meaning that the Ministry of Health was consulting to determine the consequences of ER overcrowding. All it did was to put the burden of proof on those who complained and concluded that they didn't prove their case. For reasons of both liability and protection of privacy, it is not surprising that the doctors did not point to specific patients who were made worse as a result of ER overcrowding, but when ER doctors say there is a problem, the government should do more than criticize the messenger.

It took from April 28th to December 7th to obtain the Ministerial briefing note that Abbott used when he made those remarks. Although the Freedom of Information and Protection of Privacy Act gives government 30 days to respond to requests, users know that 7 months is relatively quick for the Campbell government. The information request asked for any correspondence, emails or other exchanges between the Ministry and the Canadian Institute for Health Information (CIHI) regarding morbidity or mortality related to emergency room service. On July 25th the Ministry responded with a letter from CIHI to BC's Deputy Minister of Health which discussed the Hospital Standardized Mortality Ratio. There was nothing in the letter that mentioned morbidity or mortality related to emergency room service; however, the letter made it clear that CIHI considered it a major breakthrough to simply be able to compare mortality rates between hospitals on a consistent basis. That suggests they are a long way from being able to link conditions in one department, e.g. ER overcrowding, to mortality in another. The July 25th response from the Ministry also included emails, mostly blanked out, which discussed the Hospital Standardized Mortality Ratio, again with no reference to ER treatment.

The July 25th response also included a Ministerial briefing note in which the advice to the Minister was blanked out with the claim that it was exempted by application of Section 13 of the Act. That section allows advice to a minister to be withheld; however, factual information cannot be withheld, nor can a variety of other types of information. Upon appeal to the Office of the Commissioner, in December the Ministry finally provided the full briefing note. The note doesn't mention CIHI, but it did reveal the shift in burden of proof when it said: "The report by ER doctors with respect to Royal Columbian contains no evidence that people have been dying on stretchers waiting for care." The briefing note said nothing about any effort of the Ministry to determine from its own research whether ER overcrowding was likely to have negative consequences, but it did admit that: "Patients who are appropriately being cared for in the ER also experience delays in diagnostics, consultations - speeding these processes up is also a focus of our work and requires cooperation of all personnel and professionals." If the Legislature was sitting the Minister could be asked whether that work has produced any improvements, in the meantime the physicians at Royal Columbian might be interested in the briefing note that was prepared for the Minister following their complaint.