Patient wall erected between provincial borders

Invermere doctor calls out inter-provincial struggle facing medical system

Dear Editor:

This is an open letter to Prime Minister Trudeau and all levels of government in B.C. and Alberta who can facilitate medical access to care.

Dear Prime Minister Trudeau,

I wish to bring to your attention the building of a “wall” that surely trumps that planned by President Trump. This is not a solid wall but effective, none the less, in preventing the movement of persons across our provincial boundary between B.C. and Alberta. To make matters more dire, these are sick people who are being denied access to medical care. I have been under the impression that the Canada Health Act should not let this happen. Let me enlighten you on the progressively derisive divide that is occurring.

I am a rural Family Physician who has lived and worked in Invermere, B.C., situated on the border of B.C. and Alberta. Tonight, covering the emergency department at our local hospital, I spent two hours on the phone trying to transfer a sick patient to Calgary for surgery. I spoke with the dispatcher for transport, the transport physician, the transport RN, two specialists and the dispatcher for RAAPID South, Calgary’s medical coordination centre. Despite this effort, the patient’s transfer was denied. They remain in the Invermere Hospital waiting for resolution of this impasse with the very real risk of further deterioration in their health. I am exhausted and frustrated.

Historically, patients have been treated across this border, regardless of their provincial health care card. I know as I have been doing this job for 30 years. In the last few years the wall has slowly emerged. We are advised we must try to transfer our patients to a centre in B.C. that can provide whatever medical service is needed. The problem is that that centre is Kelowna which is twice as far as Calgary and difficult to get to for most families. Patients must wait for a plane to transfer them to Kelowna. The ambulance trip would be six hours and is too long to undertake. The wait and air transfer take hours. Calgary will only agree to accept patients that are critically ill. Their criteria is so strict that one of my patients was downgraded from critical when she had a heart attack and her initial condition was stabilized with “clot buster” type medication. This meant waiting for a transfer to Kelowna during which time the clot reformed and she had a cardiac arrest. Thank God the staff at our little rural hospital were able to resuscitate her.

Patients forced to be transferred to Kelowna are not brought back to Invermere. My lady with her heart attack and any patient who can walk are discharged to the street in Kelowna to somehow make their own way home. This is with no bus service, a six hour drive over 2 mountain passes, if family or friends can come to pick them up, or a commercial flight to Cranbrook which is still 1 1/2 hours drive south of Invermere.

And it is not just Invermere with this problem. Cranbrook is an intermediate size centre south of us with some specialists. When one of my paediatric patients developed Appendicitis he was to have surgery in Cranbrook. Unfortunately his appendix ruptured. Instead of a transfer to Alberta Children’s Hospital in Calgary, about four hours away, he was transferred to Vancouver. This was in the winter and the family was forced to drive all the way to Vancouver to be with him and bring him home: over a 10 hour drive one way.

Invermere actually has a very busy rural emergency. Being only 3 hours from Calgary our population swells to over double in the summer with visiting Calgarians, many with second homes. On a typical day in ER at least half the patients will be Albertans. We treat them all equally. In fact, I think one would find that Albertans enjoy visiting communities all across B.C. and account for a much larger number of medical visits to B.C. hospitals than border town British Columbians make visiting Alberta hospitals. Despite this, Calgary medical bureaucrats have declared that no B.C. patient will be able to have surgery in Calgary after December 31st, 2018.

If Albertans do get sick or injured in Invermere, it is no more easy to repatriate them for care to Calgary. I often am told to transfer Calgarians to Cranbrook for treatment by the Calgary dispatch system. This generally comes as quite a surprise to these unfortunate pawns in a politicized medical system.

Invermere lost 4 of 11 doctors last year. We are exhausted trying to manage transfers against such adversity. We are still down two physicians and struggling to find replacements. Despite our rural isolation, we are still faced with all conceivable medical conditions and injuries presenting for care. There are no specialists in rural hospitals and patients must be transferred who need specialist care. I believe they should have access, as Canadians, to the closest place providing the care they need. In a large proportion of cases for us in Invermere, that place is Calgary. Please take down the “wall” and allow us that access. It is clearly in our best interest medically.

Maria Dibb,

BSc, MD, CCFP, FCFP

Invermere

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