N.B. doctor describes seeing patients in 'every little nook and cranny' of overflowing ER

It was three days after Christmas when emergency room doctor Yogi Sehgal wrote a warning on social media to the residents of the Fredericton region that the Dr. Everett Chalmers Regional Hospital emergency department was at 360 per cent capacity.

Anyone not considered “life-or-limb-threatening” would likely not get seen until the next day, he said.

After working almost every day the two weeks since then, he shared with CTV Atlantic what that shift – and the ones after it – were like.

“Patients everywhere in the hospital, especially in the emergency room, I mean, people were doubled up in rooms that are designed for one. We were seeing people in every little nook and cranny we could, in hallways, in chairs, back hallways, everywhere you could,” he said. “We had at one point 30, it was over 30 admissions in the department, and we only have space for 30, roughly, spaces to see people. So all of our spaces to see people were taken up by inpatients that were admitted upstairs.

“Plus we had 40 people in the waiting room. Plus we had I think it was a dozen, I can't remember the exact numbers, 12 or 13 ambulances in the back hallway waiting to offload their patients into the department. So it was just an absolute disaster, a non-functional hospital at that point.”

He clarified that anyone with life-threatening needs were seen immediately. But sometimes they’d have to move a patient – who needed to be in a bed – to a chair in order to make room.

Dr. Sehgal says it was a perfect storm: a flood of RSV, flu and COVID-19 cases, the usual winter-related falls and broken bones, primary care offices were closed because of the holidays, and several social admissions – mostly elderly patients whose caregivers were extra stressed.

There were no beds available in other hospital departments, which meant no space to move any patients coming into the emergency room.

“So we were actually looking after the inpatients, you know, a full ward of inpatients – 30 patients is basically a full ward – plus emergency room patients that are already there, plus trying to get more people in, plus dealing with the major traumas and heart attacks and that kind of thing. So we're trying to do five or six jobs, plus there's no room in the ICU or the CCU,” he said.

For a short time, the closest ambulance was in Woodstock because the rest were tied up at the hospital, waiting to offload their patients.

It has improved slightly since then, but he says they’re still admitting 15-to-20 people each day. According to the Canadian Institute for Health Information, the Chalmers has roughly 315 total beds.

Dr. Sehgal does remain hopeful, saying he understands changes are coming, but he’s frustrated at the time it’s taken to make those improvements.

“I keep hearing from politicians, it's the same everywhere across Canada. That's a cop out to me. I mean, realistically, we're not every other province. We've known this for 20 years,” he said. “What matters is what can we do to make things better at this point, looking forward rather than looking backwards.”

Dr. Michael Howlett, president of the Canadian Association of Emergency Physicians, says there hasn’t been a lot of movement across the country on the issue, which means health-care workers are left making difficult decisions every day.

“You have three stretchers and you have six people that need it. I mean, what do you do it? And then, you know, in six months time, it's eight people that need it. And I mean, it's just spiraling,” he said. “My colleagues and physicians and the nurses who treat these people are generally an altruistic bunch and they're not easily persuaded to give up. But some people, you know, have enough moral injury from dealing with it that they do end up retiring or moving to a job where they don't have to face it.”

Long-term care should be made more of a priority, says Sehgal

Eighteen months ago, Dr. Sehgal spent several months gathering input and ideas from his colleagues, the general public, and his own experiences, on how to help alleviate the stress on New Brunswick’s health-care system. He penned a report with roughly 50 concise ideas, ranging from emergency room changes to how to better utilize staff. The work was done “unfunded and independently of any political or health-care organization."

One of those ideas: to move nursing home patients in hospital into nursing home beds, no matter their location.

“This could start immediately—if needed to remove bureaucracy, a state of emergency can be declared similar to the beginning of the pandemic, as we are in more of a crisis now than at the beginning of the pandemic,” the report reads.

He says not much has been done since he released that report.

Earlier this week, Horizon Health said about 35 per cent of its beds across its hospitals were occupied by “ALC” – alternate level of care – patients, often seniors waiting for a long-term care bed.

Dr. Sehgal says the situation has been exhausting, but he tips his hat to the nurses.

“They’re hired to be emergency room nurses and they're doing nursing home care and ICU medicine and inpatient care and security because there's so many wandering and chaotic patients with either delirium or dementia or things like that that are creating havoc in the department, not of their own making, of course, because they're ill,” he said. “But it has been really hard on the nurses and then you have so many new nurses on top of that and that's their first exposure is coming into a department like that. So retaining them is not so easy.”

The health authority has been working on scheduling an update on the emergency department situation – but a date hasn’t been set yet.

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