N.B. nurse double assigned over ‘limited resources’ on night of ER death, documents show | Globalnews.ca

New details are emerging about the death of a patient at the Dr. Everett Chalmers Regional Hospital in Fredericton last July, which are revealed through documents obtained by Global News.

At the time of the death, which occurred on July 12, 2022, emails from Horizon Health Network indicated the licensed practical nurse (LPN) assigned to the waiting area was also assigned to the department and “couldn’t commit to the regular checks.”

“They were doing the best they could with limited resources as usual, and checks on patients in the waiting room were being done by LPNs that had assignments in the Department, so they could not commit to regular checks like our waiting room LPN would do on days or evenings,” according to an internal email sent by Neil Gabriel to Margaret Melanson, Nathan Wickett and Jessica Cernivz, who all work within Horizon Health Network.

A submission by the New Brunswick Nurses Union to Horizon Health Network corroborated the circumstances the LPN experienced on the night in question.

The local union representative, who is not identified in the documents, said that the LPN assigned to the waiting room should not also be assigned to the department, and that 30-plus people “is too much for one person to take care of alone.”

During the quality process review, it was determined that “the lack of consistent patient monitoring and the inability to meet standards in the emergency department waiting room decreases the likelihood for early recognition in a patient health decline.”

Further emails revealed that since the Oromocto Hospital had reduced its hours, due to both nurse and doctor shortages, it was common for patients to be waiting up to two hours for a patient could be triaged.

The incident was described in emails between staff at Horizon Health Network as “truly unfortunate” and staff were “upset by the situation.”

Documents that were submitted by the New Brunswick Nurses Union say that on the night the patient died, 17 people were admitted to the emergency department, and 29 people were registered in the waiting area.

The union said in its submission that’s more than “patients admitted to an in-patient unit.”

“The nurse to patient ratio is alarmingly high and is unquestionably at an unsafe nurse to patient ratio,” the submission reads.

Direct aftermath

The patient’s death would result in Premier Blaine Higgs replacing then-health minister Dorothy Shephard, and firing the boards of both regional health authorities and Horizon Health Network’s CEO.

At the time, officials from Horizon Health said it would be investigating the incident. Higgs later said during a news conference that he would call for an external review if “he was not satisfied with the results” of the internal investigation.

The eyewitness timeline

John Staples, a witness to the death, told Global News in July he arrived at midnight — making it July 13. He noticed a male in “physical discomfort” sitting in a wheelchair in the emergency department waiting area.

After an hour, around 1 a.m. on July 13, a nurse emerged to check on patients in the waiting room. It was at that time Staples said he noticed the patient wasn’t breathing.

He said he knew an hour had passed because he had watched two half-hour television shows on a monitor in the waiting room.

The nurse sought the help of others and shortly after, a code blue was called — meaning there was a medical emergency. Horizon Health Network later confirmed that the patient died in the waiting room.

“Horizon thoroughly reviews any unexpected deaths that occur in our facilities to determine what took place and whether further action is required,” said then-CEO Dr. John Dornan in an emailed statement back in July.

Documents reveal an internal quality process review was initiated on July 25, 2022, just shy of two weeks later. Many of the documents relating to the patient’s circumstances are redacted for privacy reasons.

Horizon Health Network declined to provide an interview with its current CEO, Margaret Melanson, for this story.  

Horizon says staffing stable

 The regional health authority said in an email statement, after declining several requests for an in-person interview, that “staffing is stable at all sites and improving at all sites.”

Steve Savoie, administrative director and co-lead of Horizon Emergency Services, said that Dr. Everett Chalmers Regional Hospital has made progress on the issue of nurses splitting their focus between the ER waiting area and the department. 

In August, a month after the first patient died in the waiting area, the hospital unveiled “wait room monitors” who would commit to checking on patients in the time it takes them to be triaged and to be seen by a physician.

Those ER monitors was reported as a direct result of the death in July.

“This is now a permanent initiative, feedback has been overwhelmingly positive and these staff members, through their skill and compassion, have played a critical role in improving the experience for many patients,” Savoie said, responding to questions by email from Global News.

He said Horizon has also made progress on hiring triage nurses to alleviate the stress on the staff already working in the ER, but didn’t say how many nurses had been hired, or how many had been lost to retirement or burnout.

“Horizon has successfully recruited a number of RNs to our EDs in recent months, and is also successfully utilizing travel nurses where needed, which has helped enhance available staffing resources,” he said.

Despite saying staff levels were stable and improving, Savoie said that when “staffing levels are forecasted to be low on a certain shift, Horizon takes actions to redeploy support staff to assist with the delivery of care in the ED.”

Paula Doucet, president of the New Brunswick Nurses Union, said she is encouraged by the effort to recruit more nurses into the system and that the pressures facing the emergency departments in New Brunswick are many.

“It’s going to take time and it’s going to take time for those who have showed up every day to heal,” she said.

Doucet said she hasn’t heard anything through the union on whether the ER wait-room monitors program is doing what it was designed to do.

 As for those advocating for a better health system, what’s been done is seen as a band-aid.  

Bernadette Landry, of the New Brunswick Health Coalition, said the lack of staff doesn’t stop at the emergency department, but begins there.

“There are just not enough people to take care for patients who are in the hospital,” she said.

Landry said it’s both a matter of retention and recruitment, which is allowing people to fall through the cracks. She believes the solutions are not a matter of whether there is enough money, but a lack of political will.

“It’s really tragic, it means people who really need to be cared for are not being cared for,” she said.