With seven ambulances parked outside, Scarborough General Hospital emergency room supervisor Louise LeBlanc was doing her juggling act:
The psychiatric patient would have to wait in radiology with the young basketball star and his broken finger. A pregnant woman was exiled from the exam room to the corridor--but not too close to the woman with a bowel infection who should have been in isolation. In the critical-care room, there was a swap of heart-attack victims--the one who was stabilized for the one who was not.
With the evening rush, Scarborough, along with every other hospital in Toronto, was forced to put itself on "critical care bypass," or the No Vacancy list. All around the city, ambulances were circling, waiting for an emergency room somewhere to open up. Then, the red line rang: A rush-hour accident on the 401. Okay, LeBlanc told the ambulance driver, bring her in.
"What can you do?" she said, shrugging her shoulders.
It was another trying day for LeBlanc, Scarborough Hospital and for the vaunted publicly funded Canadian health system. From Vancouver to Halifax, the complaint is the same: Not enough hospital beds. Not enough nurses. Not enough doctors. Not enough of the latest equipment that everyone seems to want or need.
In Quebec, they've sent more than 250 cancer patients over the border to the United States this year to get treatment and still there are 350 who have waited more than eight weeks for radiation or chemotherapy (waiting more than four weeks is considered medically risky).
And in Ontario, the waiting list for MRIs is so long that one Ontario resident booked himself into a private veterinary clinic that happened to have one of the machines, listing himself as "Fido."
Residents flocking to Alberta often have to contact scores of doctors before they can find one who is accepting new patients, while the local nurses association has launched a program to lure back the 6,000 Canadian nurses who, largely out of frustration, have fled to the United States.
"Those nice little things you used to be able to do for your patients are gone entirely now," said Stuart Williams, who quit his nursing job at Vancouver General Hospital this fall after a decade in its emergency ward. "We are fighting now just to perform basic levels of care. And we're not always winning."
Certainly patients are noticing. A recent poll found that 75 percent of Canadians, citing declines in service, now believe their health system is in crisis. And this week Ontario hospitals released the first-ever report card showing patients in the Toronto area rated hospitals such as Scarborough as average or below-average in their service. Even the federal minister of health has been warning that the need for significant and fundamental changes to the system is "urgent" and "beyond debate."
What there is not is any consensus of what to do about it.
Some, like Alberta Premier Ralph Klein, want to move away from a public system to a mix of public and private insurance.
Others, like Canadian Medical Association president Hugh Scully, argue that the federal and provincial governments have to add another $1 billion a year to health-care budgets that, even with recent increases, are still at 1995 levels.
But most academic experts say that while more money might alleviate the shortage of advanced machinery, hospital beds and medical school slots, it will only be a matter of time before the demand for medical services once again overtakes the willingness of voters to pay for it.
The big problem, explains George Pink, a professor of health administration at the University of Toronto, is that nobody really manages the Canadian system. The government annually assigns separate budgets for hospitals and doctors and laboratories and nursing homes in a highly political process that breeds inefficiency and defies coordination.
At the same time, there is no check on how much health care individual Canadians consume--and with no deductibles to pay or managed-care plans to negotiate with, they are inclined to use even more.
"Canada has U.N.-managed care," said Pink.
While politicians and experts debate the long-term solutions, most of the short-term imbalances show up in emergency rooms such as Scarborough's, where the focus is simply getting through the day.
"You feel like you're in a war zone," said Wendy Kearns, the emergency room's nursing supervisor, with 20 years of experience. "You keep working harder and harder and get farther and farther behind." Already this year, 18 of her colleagues have quit in frustration--six times the normal turnover--and only half have been replaced.
Later in the evening, Dr. Shafik Dharamshi was just getting around to putting a few stitches in the nose of a teenager who banged it on her school locker at about noon.
And in the hallway, Brendan Curran, weak and pale with an intravenous tube feeding a saline solution into his arm, was going on Hour 26 in his wait for a suitable ward bed upstairs.
"I'm 55 years old, this is my first time in a hospital," said Curran. "I'm shattered."