The overall issue is that the combined needs of the residents plus the summer visitors has overloaded the existing facility. There is particular concern over the unsuitablitity of the Treatment Room for patient treatment, and the access to this room with a stretcher for emergency cases. The existing clinic building was constructed over 30 years ago, in a more simple era in terms of the population served, the age spectrum, the state of the medical arts, the number of visitors and their activities.
Other issues involve privacy, security of information and an inefficient layout.
For the building itself, the washroom is not designed for handicapped use, nor is access to the treatment room.
When the Doris Savoie medical clinic for Hornby Island was built 30 years ago, the island population was about 350 composed mainly of young people and young families. In 2009, the permanent population is over 1000 persons. The median age is now 59 years, ten years older than for Vancouver Island (49) or for all of BC (also 49). (BCStats 2006 Census Profile). This change occured over time, with the increase in population coming with subdivisions in the 1970's and the skewing of the age profile in the 1990's as a result of rising real estate prices.
The local elementary school enrollment which peaked at 143 in 1992, is now 41. In place of the cuts and scrapes of a rural community, we now have the need to treat the diseases of aging and the cuts and scrapes of over-achieving jock boomers on vacation.
In addition to the 1074 permanent residents recorded in the 2006 census, our medical needs include looking after up to 4000 visitors at a time through the summer. The figure of 4000 is based BC Ferries loading data, and assumed an average stay of 3 days. In the same time frame as the increase in the permanent population, the ferry capacity essentially doubled - the 16 vehicle MV Albert J. Savoie was replaced by the 30 vehicle MV Kahloke. The lineups have not gone away, so we must assume the number of visitors has also doubled. And, as the fare increases have driven away the day trippers, the average length of stay has increased as well. The figure of 4000 may be a conservative estimate.
The summer visitor incidents run the range from biking falls to jellyfish stings, as well as more conventional medical conditions. The visitors are hiking, biking, diving and sunning to a degree that many do not normally do. The intensity of exercise has increased - a bicycle on the back of a car was once a rarity, but is now standard equipment. Hornby has long had the reputation among the mountain biking fraternity as one of the best terrains in the province, but that is now of interest to more than the hard core racers.
The sound of screeching breaks and laughing mountain bikers have been echoing down the slopes of Mt. Geoffrey since the early eighties. Here, a small group of locals and summertime visitors have woven a bit of trail heaven into a relatively small area. In my opinion, the single track on Hornby is perfect.
- Darrin Polischuk, Mountain Biking, British Columbia, 1996.
Hornby Island is the only Gulf Island which rates its own chapter in this book.
The top of Mount Geoffrey is 1000' above sea level.
On the supply side, following are the users of the Hornby Island medical clinic:
- one medical doctor with clinic hours Monday to Friday, and on call 24/7.
- emergency services to a greater than normal degree, since the nearest hospital emergency room is two hours away, beyond the moat.
- laboratory sampling on Thursday mornings by LifeLabs, with a typical patient load of 30 persons per week.
- other occasional users.
Layout sketch to be inserted here,
The existing clinic building has a footprint of about 1000 sq. ft and contains five rooms, plus a bathroom.
- There is a waiting room with a "shoes off" area and seating for 7 persons. The receptionist formerly sat facing the front door, but aside from being too drafty in winter this location offered no privacy for documents on the desk or for phone calls.
Of the other four rooms, two are for the use of the physician on duty and two were originally for a physiotherapist. There is no longer a physiotherapist on the island, so one of these two rooms are now used as the receptionist's office and the other for secure storage and general purposes such as the weekly visit by the LifeLabs nurse. The doctor has a office/consultation room, and a small procedures room, where critical cases would be treated. There is no separate and secure office space for the doctors.
The bathroom does not meet the requirements for handicapped access. The only amenity in the bathroom for handicapped users is one grab bar. The room is not large enough to be made compliant.
We note in the building code a requirement that hospital corridors down which beds may be moved must be 8' wide. This suggests a gurney should require 7'. In fact a stretcher barely fits through the doorways and tight spaces which must be traversed - see comment below.
The island must be able to handle, from its own resources, emergency situations befalling any of the 4000 visitors, as well as any of the 1074 year-round residents. The closest BC Ambulance station is on Denman Island, which is a ferry trip away. There is no scheduled ferry service from 7:00 PM (later on Fridays) until 8:00 am the next morning. The medical doctors or the 9-1-1 operators can request a call out of a ferry crew for a special passage, but it takes time to muster the and make a round trip, assuming the ambulance is available. If there is a need for immediate treatment, the patient must be transported by our First Responders to the Clinic, to po0ssibly be transferred to the BC Ambulance when it arrives.
Our volunteer fire department, recently renamed Hornby Island Fire and Rescue, has geared up to meet this need, with a rescue vehicle for extricating people in distress, and a real ambulance for transportation. The percentage of medical callouts compared to fire callouts has been steadily increasing and in 2008 was 74%.
The medical clinic has not grown with this need. The floor space in the Treatment Room is 9'-6" square and contains an examination table, such accoutrements as an oxygen bottle and a defibrillator, as well as cupboard space. Following is a description, by one of the First Responders, of the dance required to move a patient out of Treatment Room to, say, an ambulance.
Here's the situation: if a patient needs to be transfered from the treatment room, you must weave the stretcher around several tight corners, push the gurney the patient is lying on over to the side, and - using the thinnest First Responders on the squad, since there is barely room for the stretcher in there, let alone the stretcher bearers - transfer the patient to the stretcher. Then back around those tight corners, through a narrow door and immediately down a step. In other words, just at the point where you can no longer roll the stretcher and must carry it, you no longer have room at all four corners of the stretcher. That last part, especially, makes it difficult for FR's to achieve our goal of moving patients swiftly and smoothly.
Minor annoyances are the gravel of the parking lot, which makes a bumpy ride for the patient unless we half-carry the stretcher; the patient's exposure to the elements during the transfer (we don't always have an extra person to hold an umbrella over the patient); and, if the parking lot is full of cars, the tight quarters for the three-point turn needed to get the vehicle back out.
The photo shows the "emergency entrance".
The crowding in the Treatment Room is unsafe, particularly when there are more than two persons (e.g. child patient, parent and physician) are present.
There is only one consultation room which serves for both patient interviews and as the doctor's office. Consultation and treatment of one patient must be complete before another can be admitted to the area.
The receptionist's office is inadequate, by half, for the number of files, and its current myriad functions. It also provides no physical barrier between the receptionist and the occasionally less-than-happy patients.
The receptionist cannot see the entry door, nor monitor the waiting area.
Patient consultation takes place in what is essentially the doctor's office, as noted above.
The receptionist's office is used as a passageway when anyone, such as the LifeLabs nurse, is using the general purpose room, potentially compromising the security.
The soundproofing between rooms is inadequate.
There are old files kept in the waiting area, albeit in locked cabinets, but this is not a good optic.
Some users complain of a mouldy smell. The source of this has not been identified.
The waiting room layout is inefficient. There is seating for only eight persons. It is frequently overloaded on Thursday mornings when the LifeLabs nurse takes samples. She typically treats 30 patients each week, in a 3 hour period.
Parking is becoming more congested, as more facilities (Arts Council, Hope Kitchen) are clustered around the clearing. The emergency vehicle access might well be blocked during clinic hours./p>
Everything is possible, but it would not be simple. The building cannot be extended to the front because it faces right on the parking area. This photo shows the ground profile at the rear of the building.
The practical way to extend the building would be to build a new addition at the rear, move the operations into it, where they would still be cramped, then renovate the existing portion and combine them into an entity.
It would make no sense to build a complete new building to the rear and then demolish the present building. If a whole new building is to be built, the Sollans Road location is a better choice. In any case such a building would impinge on the RCMP site.