In 2018, Ford promised to end hallway health care. Not only has it worsened; it is now institutionalized.
Ontario voters should consider the record of the Doug Ford government and your hospital’s local emergency room. The ER is for unplanned illness and injury requiring the rapid diagnosis and treatment of time-sensitive problems. We have betrayed this objective.
For starters, the ER must be open. Before the Ford administration, ER closures were practically non-existent. There was one unplanned closure between 2006 and 2022. Things have changed for the worst. The 2023 Auditor General Report cited 203 closures involving 23 mostly rural hospitals between 2022 and 2023. Ghost Gurney (a citizen-led monitor) counts 19,717 lost ER hours in 2023 and 25,436 hours in 2024 — the worst year in Ontario history for ER closures. COVID-19 without a doubt severely hampered improvements in health care, but things have gone from bad to worse.
This leaves thousands vulnerable to needless suffering, disability and death. In northern Ontario, people travel hundreds of kilometres in search of care. For the most part these ER closures are due to nursing shortages wrought by the Ford government’s mishandling of our nursing colleagues; their plea for adequate working conditions to provide safe, high-quality care; and lack of a strategy to prevent closures. The fallout is desperate hospitals using predatory staffing agencies to fill gaps, costing taxpayers dearly (some nurses cost $160/hour).
Many of our patients need to be seen in seconds or minutes. That’s impossible if the ER is shut.
Many of our patients need to be seen in seconds or minutes. That’s impossible if the ER is shut.
ER overcrowding is rampant, dangerous and miserable. In 2012, the wait time was 14 hours. Ontario’s Health Quality data shows the average wait time now for a hospital bed for an admitted patient is 20 to 23 hours (the target is eight hours). This serious situation has seen zero improvement since 2022. We see patients warehoused up to five days in the ER — receiving inadequate care and loss of human dignity. Ontario geriatrician Dr. Samir Sinha labelled what we do to senior citizens tantamount to “torture.”
The reality is hallway medicine and ER overcrowding kills. We see it happen. Canadian ER researchers highlight that between 8,000 and 15,000 Canadians die prematurely as a result of ER overcrowding. Ontario contributes to this grim statistic.
The result of ER overcrowding is the inability to see new patients in a reasonable space. Patients are instead seen on EMS (emergency medical service) stretchers and inappropriately wait in chairs. Tests and treatments are delayed. Patients leave without being seen. In 2018, Ford promised to end hallway health care. Not only has this worsened; it is now institutionalized. The situation has deteriorated into waiting room care, chair care, and standing care.
ER overcrowding leads to patients having soiled undergarments changed in the open hallway. Staff don’t have an option. The erosion of privacy and decency is disgraceful.
Wait times to actually see a physician are often awful. Publicly accessible ER dashboards routinely cite six-to-12 hour wait times. Health Quality Ontario shows the average wait time is about two hours but this doesn’t account for the wide variation of patient experience.
In October 2024, Ford scolded patients like “little Johnny” with a possible broken leg and laceration for attending the ER. Ford “guesstimated” that 50 per cent of ER patients should not be there, but the reality is they don’t have other options. When 10 major Ontario hospitals were asked about patient acuity (that is, the severity of the patient’s situation), they said 77 per cent to 93 per cent are triaged as resuscitation, emergent or urgent. So widespread “ER abuse” is a scapegoating myth. Meanwhile, too many people have no other place to get their prescription refilled or their ODSB food voucher signed.
Your ER is making you wait longer than before. Ontario Health since 2008 monitors the length of stay among those in the 90th percentile (this percentile means 90 per cent of patients stayed less than this time and 10 per cent stayed more). The last three years were the worst among the last 17 years. In other words, the length-of-stay for all types of ER visits, for waiting for a hospital bed, to see an ER physician and to be offloaded from an EMS crew was at its worst from 2021 to 2024.
Short-sighted legislation makes this all worse. Bill 115 expanding alcohol sales and Bill 223 shutting down safe consumption sites will drive up ER visits and use of EMS. The impact of Bill 124 illegally withholding public sector salaries crushed nursing morale and cost hospitals $1 billion in catch-up pay. Inaction on housing and shelters fills ER waiting rooms with unsheltered, homeless people.
Your ER is a barometer of the health-care system. We argue this is the top election issue. We fail Ford. It is yet unclear if other political parties can change this situation, and we will be watching and holding them to account.
Dr. Raghu Venugopal and Dr. Alan Drummond respectively practise emergency medicine in Toronto and Perth. X: @raghu_venugopal @alandrummond2
