TORONTO - The death of an Ontario teen while being rushed to hospital should be a wake-up call for Canadians that emergency care standards are needed across the country, said a group representing ER doctors.
Injured in a car crash, 18-year-old Reilly Anzovino died Dec. 27 just as the ambulance carrying her reached the hospital in the southern Ontario town of Welland, about 20 kilometres from the accident scene.
Her grieving family and others believe her life may have been saved if she had received help in Fort Erie, some five kilometres closer. The emergency room in that city was closed last year as part of a controversial hospital restructuring plan.
Ontario isn't alone in grappling with tough decisions about closing emergency departments, and national standards are needed to help guide those decisions, said Dr. Alan Drummond, a spokesman for the Canadian Association of Emergency Physicians.
"Really, this could happen anywhere," said Drummond, who has managed the emergency department at Perth and Smith Falls District Hospital in eastern Ontario.
"Why don't we take this opportunity of this tragic death to say, 'Look, let's re-dedicate ourselves to planning effectively. Let's not make health-care decisions based on budgetary constraints within regional health authorities.' "
All levels of government should sit down with health-care workers and develop a "template" that would lay out what's needed for an effective emergency health-care system, he said.
It could set down guidelines, such as how many hospitals should have emergency rooms and how they should be staffed, funded and equipped, he said.
"Let's decide what we as a nation are going to accept in terms of time and distance to effective emergency care, because that doesn't seem to be defined by anybody," Drummond said.
"I mean, is it OK to have to drive an hour to an emergency department? Or should you be able to access an emergency facility within half an hour?"
The idea was first floated with provincial health ministers in 2002, when a Quebec man died after he was turned away from a Shawinigan hospital because the emergency room was closed due to a staffing shortage. He died of cardiac arrest en route to another hospital in Trois Rivieres, about 30 minutes away.
"We need to talk about this because this has happened in a pretty progressive society in Quebec and it's going to happen elsewhere," Drummond said.
British Columbia is the only province that's developed such standards, which have helped guide the province's health regions in their planning since 2002, said Tom Closson, president of the Ontario Hospital Association.
In B.C., where the number of people living in urban centres compared to rural areas is virtually the same as Ontario, the province has stipulated that 98 per cent of residents in a region should be able to get access to an emergency department within an hour, Closson said.
"Whether Ontario should have that same standard of one hour is, I guess, a question for Ontario to answer," he said.
Each province should make those decisions based on their resources, geography, where people live and the number of emergency doctors and nurses, among other factors, Closson said.
There is a need for standards, but they must be set by elected officials, not by regional authorities like Ontario's Local Health Integration Networks, which gave the green light to closing the Fort Erie emergency room and another in nearby Port Colborne, said provincial Opposition Leader Tim Hudak.
"In this circumstance, the LHINs were merely following the orders of the minister of health who told them to cut some $15 million out of the Niagara Health System," he said.
"As a result, the emergency rooms at Fort Erie and Port Colborne hospitals were closed."
But the coroner must first call an inquest into whether the ER closures played any role in Anzovino's death, said Hudak, who was born and raised in Fort Erie with members of the girl's family.
"Having a daughter of my own, I can't imagine the depths of what they're going through," he said.
"And the family rightly needs answers. Did the closure of the emergency room prevent their daughter from getting care that may have saved her life?"
Premier Dalton McGuinty has said that he still supports the decision to close the ERs, which he said was done under the advice of the LHIN.
His government, which has warned of smaller funding increases to hospitals amid an unprecedented $25-billion deficit this year, set up 14 LHINs across the province four years ago to make local health-care decisions and dispense government cash.
