A crucial twenty-four minutes

Ambulance delay shows fragile state of rural health-care system in Clearwater Condition Critical | A Daily News Special Report


November 30, 2012 at 6:34 PM

A crucial twenty-four minutes

Ambulance delay shows fragile state of rural health-care system in Clearwater Condition Critical | A Daily News Special Report
Keith Anderson

CLEARWATER — Travelling at the speed limit, a typical 50 km/h, it takes about six minutes to go from the B.C. Ambulance Service station on Clearwater Village Road to Brookfield Mall, less than three kilometres away.

On a sweltering summer day, when the tourist season is at its peak, Doug Bonar shuffled through the parking lot of the village's commercial centre. At precisely the wrong time — on Aug. 11, shortly after 11:30 a.m. — a red F-350 pickup, one of the largest passenger vehicles on the road, backed out of its parking space.

Several onlookers said the driver didn't appear to immediately notice the impact. But when it became obvious, he and horrified onlookers called 911. Bystanders rushed in to administer first aid.

"We did ABC — airway, breathing, circulation," said one witness who ran to Bonar's aid. He is a government employee and agreed to speak on condition that he not be identified.

"He had a lot of broken parts. We tried to be careful. It happened so quick."

Bonar was slammed to the ground, suffering severe trauma in an instant.

Gina Walchuk, manager of Clearwater's credit union, was one of those who rushed to help Bonar, whom she knew.

"I just remember thinking at one time, 'Where is the ambulance?' " said Walchuk.

Bonar lay on the asphalt for 24 minutes before paramedics arrived — nine minutes longer than average in Clearwater, according to B.C. Ambulance Service, which has undertaken a review of the incident.

"Our thoughts are with the family who was impacted by this event as well as the bystanders who witnessed the incident," said B.C. Ambulance Service media relations manager Kelsie Carwithen in response to a Daily News inquiry.

"Following this incident, BCAS began a review of the call; the findings could result in a change that may enhance future patient care and safety. Preliminary results of the review have shown that due to staffing challenges, full ambulance coverage in Clearwater was not available on August 11."

Soon after arriving, paramedics pronounced Bonar dead.

It would be another two hours before the B.C. Coroner's Service arrived to investigate the death.

In those two hours, tourists and residents did banking at RBC, picked up beer from the government liquor store and bought groceries from Safety Mart.

Bonar lay covered where he was struck, the area roped off amid the packed parking lot. An RCMP member stood by.

"I tell you, it was a long time for him to lay there," Walchuk said. "It feels like your resources are strapped."
Bronwyn Barter, president of the Ambulance Paramedics of B.C., called the incident "unacceptable" but not rare in rural communities.

Paramedics are scheduled on shift for days in a row and paid $2 an hour to wear a pager so they are available for immediate response. Depending on training, they are paid $15-$20 an hour if they are dispatched.

"They have a passion for it and care about their communities, patients and the public," Barter said. "It's just there's nothing to sustain them there."

Neither the bank manager, nor the government worker blamed Clearwater's paramedics or coroner, dispatched from Merritt.

While it's speculation, witnesses said even a swift response wouldn't have helped Bonar due to his age and the extent of his injuries.

But the agonizing wait served as a reminder about the fragility of B.C.'s health-care system in their town.

"What if that was a child? asked the government worker.

* * *

Little more than a month later, Clearwater Mayor John Harwood chaired a Monday night council meeting when he experienced severe pains in his chest.

"I'd been shooting up on nitro (nitroglycerin, used to treat angina in people with heart disease)," Harwood said.
Harwood was rushed to Dr. Helmcken Memorial Hospital, where Dr. John Soles was on call. Harwood estimates it took about four hours for the veteran rural physician to stabilize him using medication.

Unlike many small towns in the Southern Interior, Clearwater's emergency room has never shut down for lack of physicians.

"I'd never have made it to Kamloops in a car," Harwood said.

The next day after Harwood's admission to Dr. Helmcken Memorial, a B.C. Ambulance medevac helicopter landed in a sheep field in Clearwater. The high acuity response team (HART) on board transported him to Kelowna, where he received heart surgery, a stent for a collapsed artery.

* * *

Of all rural communities surrounding Kamloops, Clearwater has the newest hospital. Built in 2002, it has six acute-care beds; the emergency room is open 24/7.

"It's a beautiful little hospital," said Soles.

"We have a tremendously active auxiliary. It's probably one of the best small hospitals as far as equipment goes."

But despite the facility and efforts to recruit, it has suffered from the same doctor shortages as other rural communities.

"Today we have two physicians who are full-time," Soles said in a telephone interview. "Me, for 23 years, and

Dr. Stuart for a year and a half or so."

The veteran rural doctor and recent immigrant from South Africa are supported by a revolving cast of locums — substitute doctors who rotate in an out of the community, staying at nicely furnished apartments supplied by the village.

"We couldn't get people to Clearwater," said Shelley Sim, a municipal councillor who has tackled the health-care file looking for answers.

"We were putting people in rented motels. We weren't attractive to people."

The village shares cost of the apartment with the Interior Health Authority.

Traditionally, doctors leaving small towns would recruit to fill their positions. But when that became increasingly difficult, the health authority began recruiting efforts of its own.

It hired a physician recruitment leader in 2007. The department began marketing and tracking candidate referrals, working to fill spaces both in family practice and specialities.

Today it has three staff members who work with HealthMatch B.C. to fill positions throughout the region.

Efforts to recruit and retain physicians and other medical professionals include:

* A rural incentive fund of up to $20,000 for doctors to fill a vacancy in a rural community.

* Loan forgiveness for nurses, nurse practitioners, medical residents and other health-care professionals of student loan repayment of 33 per cent of debt a year (paid off after three years).

* Rural education funding for professional development; locum support to allow vacations.

* Incentives from Family Physicians for B.C. to recently graduated physicians to establish in under-served communities.

While Clearwater officials are gratified their emergency room has never closed, they are dependent on a steady stream of locums — with rates so high that in some cases compensation far outstrips earnings doctors would make if they were established in the community.

Those locums also come with no guarantee the next doctor in line will replace them.

"Commitment now is six months long," said Sim who, like other Clearwater residents, is seeking stability and support from rural physicians who don't seem interested in setting up in the picturesque town.

* * *


Population of Clearwater: 2,300

Main health facility: Dr. Helmcken Memorial Hospital, built in 2002.

Number of beds: 10 acute care; 21 residential beds.

Number of Clearwater patients admitted to RIH in 2010/11: 176

Number of Clearwater patients admitted to RIH in 2002: 229

Number of family physicians in Clearwater: in 2002, five; in 2012, two, plus revolving locum support.

Emergency services: 24/7

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