After working a long shift at the Abbotsford Regional Hospital, Dr. Susan Cooper says she often leaves the facility carrying the weight of moral distress.
The kidney specialist says she thinks about the patients in the overcrowded emergency room, many waiting several hours — even days — on stretchers and recliner chairs, with little to no privacy.
“My heart is broken,” says Cooper, who has worked at the Fraser Valley’s largest hospital for almost 15 years. “These are not conditions you would expect to see in a developed country.”
Her concerns are echoed by several of her colleagues, who say they feel demoralized due to worsening congestion at the hospital, where patients are routinely treated in hallways in most wards.
Abbotsford Regional Hospital, located about 65 kilometres east of downtown Vancouver, has been operating at 128 per cent capacity over the 2023-24 fiscal year, according to data provided by the Ministry of Health.
That figure exceeds other major hospitals in British Columbia’s Lower Mainland — including Royal Columbian, Surrey Memorial and Vancouver General — and has steadily risen since 2019-20.
“Our hospital is just in crisis, bursting at the seams,” said Dr. Terry Leung, a general surgeon who has worked at Abbotsford Regional for 13 years.
“Morally, it’s hard because I feel like sometimes maybe it is better off that my patients go somewhere else. Maybe they would get faster care.”
There’s particular concern about congestion in the emergency department and medical wards, where patients are admitted with complex and chronic medical concerns including heart and lung diseases, neurological conditions, cancer and kidney issues.
Doctors say the congestion is getting worse for several reasons, including not enough beds or space, staffing shortages, and a growing and aging population in the Fraser Valley.
Fraser Health, the regional health authority, says there are also surges in winter months due to factors including respiratory illnesses and accidents.
Doctors are calling for resources including more beds and space, and for leadership to better address what they describe as a “crisis” for patient care in their hospital. Ultimately, they say, congestion challenges are compromising patient privacy, safety and dignity.
“I just feel that nothing’s being done,” said Cooper, who added that she’s had multiple meetings with regional and provincial health leaders.
Fraser Health says it fully recognizes the strain that wait times and congestion are causing and is working on several ways to improve staffing, congestion and equipment at the hospital.
“They are valid concerns, and certainly we have significant demands as a result of many complex issues,” said Dr. David Liu, the site medical director at the hospital overseeing physicians and some operations.
The concerns in Abbotsford come after calls for more resources from doctors elsewhere in B.C. This includes dozens of physicians at Surrey Memorial Hospital, who signed letters last year highlighting understaffing, dire emergency room waits, and demands for change in leadership.
The provincial Ministry of Health says like other jurisdictions in Canada, B.C. is experiencing more people visiting emergency departments and higher acuity patients in hospitals.
“More complex medical conditions and health-care staff shortages across the country are additional factors that affect hospital capacity, and illustrate the need for increased care planning,” it said in a statement to CBC News.
It notes that high occupancy rates are driven by “alternate level of care” patients, who no longer require hospital services but are waiting to be admitted to another care facility or require additional support after discharge.
Overcrowding, lack of privacy in ER
Dr. Michael Newton, an emergency room physician with 32 years of experience in Abbotsford hospitals, says congestion is now the worst he’s ever experienced, with some patients waiting eight to 12 hours to see him.
“It’s causing an enormous amount of distress for patients, but also for physicians,” Newton said.
The amount of time admitted patients spend in the emergency department has also been increasing. Data from the Canadian Institute for Health Information found 90 per cent of patients admitted to the emergency room are spending up to 114.9 hours there, an increase from up to 87.2 hours in 2019.
Newton explains that prolonged stays in a noisy, crowded ER can lead to longer hospitalizations or poorer outcomes by, for example, causing confusion and delirium in elderly patients.
He describes patients packed into cubicles, with some having to use commodes in front of others.
“Because of the crowding, it’s very hard to ensure privacy for the patient,” Newton said.
Fraser Health says it has expanded the hospital’s emergency department to create a more comfortable and efficient experience for patients, but doctors say this hasn’t solved the problem.
Newton acknowledges congestion problems are complex and says staff are trying their best. “Patients have to go somewhere, and we can’t send people home,” he said.
Doctors at the Abbotsford Regional Hospital say they feel demoralized due to worsening crowding in the emergency and medical wards at the Fraser Valley’s largest hospital. Fraser Health says it is aware of the strain and is working on finding solutions.
Packed hallways
Sitting in her office, Cooper further breaks down the impact of overcrowding felt by her patients and some colleagues on the front lines.
“[Patients] will use words like I’m demoralized … my dignity has been taken away … I feel like I’m cattle,” she said.
Almost on a daily basis over the past year, she says, between 80 and 100 patients admitted to the emergency department and medical wards have been kept on stretchers.
She cites studies that show prolonged hospital stays on a stretcher pose significant health risks, including pressure ulcers, infections, falls and the increased risk of death.
Cooper further highlights the severity of the situation in one of the hospital’s busiest wards, Baker 2, that she says is designed for 40 beds. She said since May it often has up to 58 patients, including as many as 15 in the hallway.
She says a shortage of privacy screens in this ward has meant nurses have had to change hallway patients with their genitals exposed as people walk by.
When CBC News asked Fraser Health’s Liu specifically about these concerns, he acknowledged the work environment is “quite challenging” with the increased demand.
“We’re trying to make do with every single space that’s available to us … we’re certainly trying to improve the work environment,” he said.
Liu said in challenging circumstances, staff prioritize finding rooms for life-threatening diseases.
“We need to find capacity for those, and those will get priority. And unfortunately, it means putting some patients in the hallway,” he said.
In a statement, Fraser Health said when patient volumes are exceptionally high, it may use alternative care spaces, such as hallways, vacant surgical day beds, and outpatient areas to help meet demand.
The health authority says the hospital has 275 acute care beds. It says since the 2016/17 fiscal year, 28 beds have been added in total.
The average acute bed occupancy, which includes medical wards and the emergency room, is around 347 in the current fiscal year, Liu said.
Calls for expansion
Doctors stress the importance of prioritizing the Abbotsford hospital, given its role as a regional facility that provides more specialized care compared to other hospitals in the area. It’s also a no-refusal site, meaning no one is turned away.
Among their key demands are more beds and space such as a separate building or tower to care for patients who don’t need to be admitted for day procedures.
Fraser Health said it’s invested almost $30 million in the past five years at Abbotsford Regional Hospital and Cancer Centre, and over $22 million to expand staffing with the addition of 236 full-time staff.
It’s also planning a new long-term care facility at the hospital that will add 91 net new beds, which it says will help free up more acute care capacity. The health authority says the plan is in the design phase with construction expected to begin in 2025 and be complete in 2027.
It also says it’s working to identify mid-and longer-term expansion strategies for acute and community services within Abbotsford and the wider Fraser East health service delivery area.
“We’re doing everything we can to build capacity and certainly provide the best patient care,” Liu said.
The province says it’s closely monitoring capacity and performance at hospitals and will continue to work with health authorities to advance more initiatives to manage hospital capacity.
Cooper says she still has pride in the hospital and the dedication of her colleagues, but urgent action is required.
“If we want our hospital to be able to continue to recruit other physicians and to provide patient-centred care, that means taking care of patients’ human rights.
“People in Fraser East are suffering.”