Another patient dies in busy New Brunswick ER waiting room

A man in his 70s died in the waiting room of the Edmundston Regional Hospital's emergency department Wednesday, when the ER had a "high level of traffic and long wait times," but the Vitalité Health Network does not believe there's any connection.

The patient was triaged, monitored and cared for according to established protocols, Dr. France Desrosiers, president and chief executive officer of the regional health authority, said in a statement Thursday.

His condition was deemed stable during triage.

"At this point in time, no cause-and-effect relationship between the level of traffic and the death has been established," said Desrosiers.

"A thorough analysis is underway to accurately determine what happened and to make any required improvements."

The release did not specify whether the patient died waiting for care, as was the case of the father of five who died two weeks ago at Horizon's Moncton Hospital, when the ER was in a "critical overcapacity state," and the patient, described by a witness as a senior in a wheelchair, who died in the waiting room of Horizon's Dr. Everett Chalmers Hospital ER in Fredericton in July.

A Vitalité spokesperson confirmed to CBC News late Thursday afternoon the patient died in the waiting room, but did not say how long the patient had been waiting.

The hospital was also dealing with a "high occupancy rate" on Wednesday, according to the release.

The results of the review will be shared with the man's loved ones, said Desrosiers. She did not say if the results will be made public.

No other information about the patient or his condition during the ER visit will be released, she said, citing privacy.

ER deaths on rise

The Edmundston Regional Hospital has seen a rise in emergency room deaths this year, compared to the previous three years, according to data released by the Department of Health.

The number of patients who died was not provided, only the rate of patients who died per 1,000 patient registrations.

The rate was 1.13 per 1,000, as of August. That's up from 0.94 for all of 2021, 0.38 in 2020, and the pre-pandemic rate of 0.53 in 2019.

Anyone who died upon arrival is excluded from these numbers.

No causes of death are provided.

Highest rates in Tracadie

The figures show several New Brunswick hospitals have had higher incidents of death in their emergency rooms than average this year, especially in the city of Moncton and throughout northern francophone communities.

Mortality data released by both the Vitalité and Horizon health authorities show an overall increase in deaths occurring among those visiting ERs in 2022 over 2021, but with several specific areas accounting for most of the upswing.

In Tracadie, figures show 2.09 of every 1,000 people who visited the local emergency department between January and August died — the highest rate recorded anywhere in New Brunswick over the last four years. It's also double the rate of deaths the same hospital experienced in 2019, the last full year before the arrival of the COVID-19 pandemic.

Among major hospitals, Moncton's Dr. Georges-L.-Dumont University Hospital Centre reported deaths in 1.79 per 1,000 people who visited its emergency department during the first eight months of 2022. That's double the average rate it posted over three prior years.

The Moncton area was also the site of the highest emergency room death rates posted by Horizon, although it did not provide results for individual hospitals, instead combining numbers from both the Moncton and Sackville emergency departments. Horizon reported a total of 45 deaths in these two ERs, as of Aug. 19.

That's a rate of 1.34 deaths per 1,000 visits, which is higher than its prior three-year average, and between 52 and 127 per cent higher than rates recorded by Horizon's other hospital groupings centred in Saint John, Fredericton and Miramichi.

But deaths in Horizon hospital emergency rooms trailed well behind a number of smaller francophone hospitals, including those in Sainte-Anne-de-Kent, Bathurst and Caraquet which all saw mortality rates of 1.74 per 1,000 visits or above between January and August, well above their prior three-year averages in each case.

In total, Horizon reports 174 people who visited one of its 12 emergency departments died, as of Aug.19, which would project out to about 275 by the end of the year, if rates stay the same.

Vitalité provides only rates, not the actual numbers of deaths. But based on traditional patient numbers visiting the Dr. Georges-L.-Dumont University Hospital Centre's emergency room of about 60,000 per year, that one hospital alone could see up to 107 deaths in 2022, based on reported numbers to the end of August.

Vitalité ER death rates by hospital from Jan. – Aug. 2022 compared to all of 2021:

• Dr. Georges-L.-Dumont University Hospital Centre — 1.79 per 1,000, up from 1.04.
• Stella-Maris-de-Kent Hospital—1.93, down from 2.13.
• Grand Falls Hospital— 0.41, down from 0.58.
• Edmundston Regional Hospital — 1.13, up from 0.94.
• Hôtel-Dieu Saint-Joseph de Saint-Quentin — 0.12, down from 0.49.
• Campbellton Regional Hospital — 1.35, down from 1.81.
• Chaleur Regional Hospital —1.83, up from 1.15.
• Enfant-Jésus RHSJ Hospital — 1.74, up from 0.85.
• Tracadie Hospital — 2.09, up from 2.07.

Horizon ER death rates by region Jan. – Aug. 2022 compared to all of 2021:

• Moncton area — 1.34 per 1,000 patients (45 patients), down from 1.37 (73 patients).
• Saint John area — 0.77 (59 patients), down from 0.83 (87 patients).
• Fredericton area — 0.88 (60 patients), down from 1.10 (105 patients).
• Miramichi area — 0.59 (10 patients), down from 0.88 (22 patients).

Severity increasing

Health Minister Bruce Fitch said every death is "a tragic situation."

He said he can't comment on specific cases, but he met with the CEOs and trustees of Vitalité and Horizon on Wednesday to discuss the latest patient's death and was told the acuity, or the severity, of the cases showing up in emergency rooms is "getting greater and greater and that is causing some of the backlog."

"Some of the outcomes are unavoidable," he said.

"But we can manage the things that we can manage and, again, endeavour to have better outcomes in the future."

Fitch said the Health Department and regional health authorities are doing "many, many things" to help alleviate some of the" pressures and stresses" in emergency rooms, such as recruitment, improvements to patient flow, and trying to make sure beds are open.

Pressed for details about what is being done to specifically address patient deaths in emergency rooms, Fitch said the regional health authorities gave him a list of about 20 things that have occurred "in trying to alleviate congestion and also treat patients in a timely manner." He did not elaborate or discuss their success.

People are 'terrified'

Green Party health critic Megan Mitton called the Edmundston death "really concerning."

She said she realizes there are going to be cases where people die when they go to the hospital.

"However, what we're seeing is people showing up to the hospital and not getting the care they need when they need it."

She cited the case of a woman from Memramcook who arrived at the hospital in an ambulance, waited 14 hours and required emergency surgery. "She was dying. That is not OK," said the MLA for Memramcook-Tantramar.

Mitton contends doctors, nurses and paramedics are doing everything they can to save lives, "but patients aren't always getting the care they need in time to save their lives."

"Patients are seeing their safety at risk," and they're "terrified," she said.

CEO 'saddened'

In a news release after the death in Edmundston, Desrosiers said she was "saddened by this turn of events" and offered condolences to the patient's family and loved ones.

She also thanked the emergency department team members for their "exemplary dedication and assured them of her full support."

This is the second death at the Edmundston hospital ER Vitalité has announced in four months.

On July 24, a patient "lost their life under unforeseeable and exceptional circumstances."

The health authority said it could not release more information in that case but said staffing levels and wait times were normal, and triage processes were completed properly.

At the time, the health minister said the circumstances of that case were much different from the Fredericton patient death, which triggered a major shake-up in health-care leadership in New Brunswick, but he didn't say how.

In the wake of the Fredericton death, Premier Blaine Higgs appointed Fitch as the new health minister, replacing Dorothy Shephard, fired Horizon CEO Dr. John Dornan, and replaced the boards of both health authorities with trustees. Desrosiers maintained her position as the head of Vitalité.