“The situation is dire, and it is not safe for patients… people in this community are absolutely terrified.”Joanna Krynen
Hank Krynen was a tough old cowboy near Williams Lake, who at the age of 90 was still chucking around 50-pound bales of hay to feed his horses.
When he got shingles last year, he turned to Cariboo Memorial Hospital for help, a facility his late wife nursed at for four decades. Within a month he was dead — but not without suffering the indignity of being left hours alone, covered by his own jacket, on a stretcher in an unheated children’s playroom, and, eventually, being diverted to Kamloops for tests on a machine that also existed at Cariboo Memorial, but where there wasn’t enough staff to operate it.
“Better care would have prevented the death of a man who had a lot of life left to live,” said his daughter Joanna. “It’s hard. As a family, we have to live with that.”
Krynen’s journey through the system, from an understaffed Cariboo Memorial all the way to the opposite end of the health authority a three-hour drive away, is emblematic of the health care challenges facing rural B.C., where the shortage of doctors, nurses and health care staff can have a dire impact on local service.
“My dad is probably not the only case that if the situation was different wouldn’t be dead,” said Joanna. “The situation is dire, and it is not safe for patients… people in this community are absolutely terrified.”
Nearly half residents have no family doctor
The South Cariboo and Chilcotin region is suffering a particular shortage of doctors, with two of eight family physicians ending their practice (one is retiring, the other moving).
That’s left 8,000 to 10,000 people — a staggering near 50 per cent of the region’s population — unattached to a doctor.
The impact would be different in Victoria or Vancouver, where large hospitals employ enough internal medicine doctors (called hospitalists) to care for any admitted patients. But small rural hospitals like Cariboo Memorial rely on local doctors to work the wards in the hospital and care for their own patients after they are admitted.
Cariboo Memorial is now on the verge of rejecting a person for admission if they don’t have a family doctor, and instead diverting them to 100 Mile District Hospital, the Dr. Helmcken Memorial Hospital in Clearwater, or Royal Inland Hospital in Kamloops (the latter two hospitals’ emergency rooms are frequently closed due to a lack of staffing, while Royal Inland is three hours away).
It hasn’t happened yet, but everyone in the community is talking about it being imminent.
Interior Health took extraordinary measures last weekend, and again during the coming Easter long weekend, to bring in outside locum physicians to keep service from collapsing.
“It is certainly something we are paying attention to,” said Diane Shendruk, vice-president of clinical operations for Interior Health’s northern region.
“I cannot say today it’s not a possibility that we may need to provide care at another site for someone who requires admission, but we are doing the very best to keep the local services here within the community.”
‘It’s absolutely cruel’
Cariboo-Chilcotin MLA Lorne Doerkson said rumour and fear about hospital care is rippling through his riding, with few answers from Interior Health or the provincial government.
“It’s absolutely cruel,” he said. “What if it’s your kid, who falls off a horse and breaks an arm in Redstone? You are 2.5 hours out from Williams Lake. They aren’t likely to send a helicopter. You come to Williams Lake, are treated in emergency, and then they ship you somewhere else.”
Transporting patients hours away to another site ties up ambulances and other health care personnel, in addition to leaving patients in pain and worsening their recovery.
“The system really is a bunch of dominos coming down on itself,” said Doerkson.
Interior Health is trying to recruit more doctors to the region, but it is difficult, said Shendruk.
“I would say probably three additional physicians (are needed) to help support our inpatient unit,” she said.
Doerkson said health care workers in the community are fearful of reprisal from Interior Health and the B.C. government if they speak out. His own doctor is one of the two leaving, and Doerkson himself worries about not being able to access local hospital in-patient care.
“This is not just a doctor issue, our nurses are feeling that they are under an unbelievable amount of pressure — cleaning staff, maintenance staff, I’ve talked to so many people in the hospital that are just very fearful of what is happening right now and why there doesn’t seem to be solutions coming forth,” he said.
Rural physicians are ‘foundational’
Rural physicians are the foundational element of health care in small communities because they are the family doctors, maternity doctors, palliative care doctors, emergency room doctors and inpatient doctors, sometimes all in one, said Dr. Joshua Greggain, president of Doctors of BC.
“When you lose a service, whether it be a physician, or a nurse, or in some cases a lab or x-ray technologist, you suddenly lose the whole ability to look after the system,” said Greggain, who practices in the rural community of Hope and is on staff at the community’s Fraser Canyon Hospital.
“I think it speaks to the fragility of the system,” he said.
“We need more physicians, that is very evident across this province. When you can recruit one or two, or even a part-time position, to a community it makes a big difference.”
Billions of dollars, but change not fast enough
The B.C. government is pumping billions of dollars into the health care system to try and fix the shortage of doctors and nurses.
It has opened new training seats, announced a new medical school in Surrey, rewritten the physician pay model, introduced a nurse-to-patient ratio, accelerated acceptance of foreign-trained health care professionals, boosted rural and remote incentives and, in some cases, pumped extra money into remote regions to craft specialized health care stabilization and recruitment plans.
But many of the measures will take years to result in extra personnel. Meanwhile, the situation on the ground in small, rural and remote communities can be dire.
“The fact is, this is an issue through all of rural B.C.,” said Doerkson. “That’s not going to be a surprise.”
For Joanna Krynen, who is still seeking answers from Interior Health over her father’s sudden death, it’s particularly hard to see the remaining nurses and doctors at Cariboo Memorial struggle under the unrelenting workload.
Her mother Julie retired there as a nursing supervisor many years ago, was for a time the local chapter president of the registered nursing association, and held annual appreciation parties at the ranch for everyone who worked at the hospital.
She died in 2019, but Hank and Joanna held that year’s appreciation event in her honour for hospital staff.
Joanna never imagined her family – whose lives were so intertwined with Cariboo Memorial – having to see her father stowed away for hours in the facility’s children’s playroom, freezing, without medical care.
Cowboy Hall of Fame inductee was ‘exceptional man’
Hank lived a long and hearty life before he died in Kamloops hospital. He came from Holland, after watching Canadians liberate his family during the Second World War. He made his way west, to the wild interior, forged a life, ranched, and was even inducted in 2016 into B.C.’s Cowboy Hall of Fame.
“He was an exceptional man,” said Joanna. “They never asked anything of anybody and constantly gave. He was not a man to end up in hospital.”
The cruelty of the failure of the health care system in rural B.C. is it takes the strong, independent ranchers and folks in the resource sector and diverts them to hospitals where nobody knows them, and they are alone, isolated from their families, where they waste away from the people they were, said Joanna.
“It has created a totally unsafe environment for the patient,” she said.
“It’s very concerning. And it needs to be addressed now.”