The Triage Doctor Role is a CRISIS and DISASTER protocol and when it is instituted, the whole health system is in crisis. The ER is "The Canary in the Coal Mine" and the Canary is Dead!. When the Premier says “it takes two parties to negotiate,” Albertans deserve full context. Over a two week period, out of approximately 500–600 emergency physicians who cover Alberta’s hospitals 24/7, and are there when you need us most, a small number recently documented 35–40 anonymized cases from across the province, including: • Patients who left without being seen and later died • Cardiac arrests occurring in hallways • Septic shock patients waiting 7–8 hours in waiting rooms • Aortic dissections and STEMIs managed in non-monitored spaces • Seniors in septic shock waiting 8 hours before assessment On February 1, Minister @MattJonesYYC announced immediate implementation of triage liaison physicians to protect patients in overcrowded emergency departments. It is now March 2, and the roles remain unfilled and Alberta's emergency departments are still in crisis. This is what delayed execution looks like. The TLP role is high-risk harm reduction: active surveillance of unstable patients in overcrowded waiting rooms. It is not a fix to the system FLOW crisis that remains unsolved my Minister @JasonNixonAB unable to move an adequate number of ALC's out of the hospital to get the system out of crisis. The TLP role requires: 1. A private, safe assessment space, not a hallway chair in front of 50–100 people. Albertans deserve privacy, dignity, and safety. 2. Dedicated nursing support (RN/LPN). Emergency medicine is team-based; physicians cannot safely do this alone. 3. Clear medico-legal structure. 4. Fair compensation in 2026 dollars for high-risk overtime work, not 2009 dollars. Seventeen years ago (2009-2014), emergency physicians performed this role at roughly 70% of their standard ER clinical rate. The proposal today mirrors that nominal rate despite dramatically increased system strain and risk. Emergency physicians are not refusing to help. Many are willing to step in and work overtime shifts at reduced rates, as we did before. There are many physicians who perform high-risk, after-hours work: ICU physicians, trauma surgeons, neurosurgeons, emergency physicians, etc. High-risk emergency care in the middle of the night is not compensated at 70% of weekday daytime rates from 17 years ago. If you call a plumber at 2 a.m., you don’t expect to pay weekday rates from 2009. In fact, they are offering the ER doctors close to the plumber's actual evening and weekend rate today. This is not about greed. It is about safety, structure, liability clarity, and sustainability. When patients arrest in hallways and septic patients wait 8 hours, negotiation delays are dangerous and they carry human consequences and legal risk for taxpayers. The broader issue is governance. Operational staffing, resourcing, and compensation models should be designed by hospital leadership and clinical experts, the people hired to run emergency departments safely, not directed through political offices. If a government announces a safety intervention and cannot operationalize it during documented patient harm, that is not a negotiation problem. That is a mismanagement problem and It is a leadership problem! Albertans dying in waiting rooms is tragic, but that is what happens when media personalities pretend to be experts in front line healthcare and interfere in day to day operations. Alberta has normalized unsafe access to emergency care. That is the crisis and Alberta families should be very concerned @ABDanielleSmith @nenshi @PfParks @JMeddings @ryanjespersen @TheBreakdownAB @cspotweet @Albertadoctors @UCPCaucus @Alberta_UCP @albertaNDP

PLEASE REPOST this important reply to Jason Nixon: Minister @JasonNixonAB, I listened to part of your press conference and I commend your efforts to move long-stay ALC patients out of hospital. Thank you. But there are factual inaccuracies that matter. These numbers were given to me by the Premier @ABDanielleSmith on Dec 11 and from AHS August 2025 data. DATA & FACTS: 1. Alberta has ~8,800 acute care beds. 2. Edmonton has ~2,486 adult acute medical beds (not counting pediatrics). 3. Your Dec 11 data shows ~655 ALC patients in Edmonton. Can we agree on that? 4. 655 ÷ 2,486 = 26.3% of Edmonton’s acute beds are occupied by ALC patients. (For context: Grey Nuns + Misericordia together have ~700 adult medical beds.) 5. Edmonton has ~275 ER beds and, two weeks ago, ~255 admitted patients were boarding in those beds, sometimes for days. 6. #YEG receives ~4× the out-of-town transfers compared to #YYC, as it serves a massively underserved Rural North. 7. ERs and major trauma centres are now running out of even a handful of stretchers and hallway chairs. 8. ER bed counts: UofA ≈65, RAH ≈65, Grey Nuns ≈55, Misericordia ≈55. 9. Site-specific ALC numbers: • Aug/25: UofA 158, RAH 192, GNH 69, MIS 120 • Dec 11/25: UofA 163, RAH 118, GNH 80, MIS 75 10. Cause and effect: please explain to Albertans how ALC occupying over one-quarter of acute beds is not driving ER/EMS access block, surgical delays, prolonged waits for critically ill patients, and preventable harm and deaths in waiting rooms. 11. You state ALC is down 15–20%. I’ve confirmed patients were moved, and that is good. 12. BUT many were also reclassified as “acute.” Reclassification does not change ER flow; it moves the goalposts. 13. Ask any paramedic, ER nurse, or ER doctor about “Eviction by 911”: assisted-living and home-care facilities call EMS, patients arrive labelled “failure to thrive,” and providers will not take them back. 14. They then become ALC admissions through the ER, where they rapidly decondition and acquire acute illness. For frail seniors, hospital is often the most dangerous place. Solutions and Advice to Minister (Free of charge): A1. Create a 24/7 multidisciplinary community team linked to ERs to prevent admission of “failure-to-thrive” patients. Care cannot run banker’s hours. A2. When a patient is declared ALC, they must be immediately moved to transitional, rehab, or enhanced home-care pathways (e.g., CHOICE, respite, hospital-at-home). A3. Change the funding model so RNs are on duty 24/7 in assisted-living facilities, connect NPs within PCNs to those facilities, and bring mobile lab and X-ray services to provide higher-level care: like the auxiliary hospitals of the past. Delay converts temporary need into permanent placement. Denmark does this extremely well. Minister, this is not personal and not political. It is math, flow, and patient safety. But incomplete policies are putting the entire acute-care system: rural and urban Alberta at risk. I am unsure why Minister @MattJonesYYC took full responsibility when much of this lies within your portfolio. I welcome an in-person debate on the numbers and the solutions: ANYTIME...ANYPLACE. Healthcare workers: agree or disagree, and please add other solutions. These are only a few low-hanging, low-cost fixes to begin repairing the system. Please pass this on...to encourage respectful debate. @pfparks @JMeddings @BradenMannsYYC @NightShiftMD @raghu_venugopal @TheSGEM @nenshi @TheBreakdownAB @ryanjespersen @cspotweet @DonBraid @RickBellwrites @Alberta_UCP @albertaNDP #AbHealthCrisis #StateofEmergency #ALC #PatientSafety

Premier @ABDanielleSmith ,please declare a State of Emergency for the Edmonton Zone as recommended by the AMA. You appointed me as Chair of the Health Quality Council of Alberta. We faced a major access crisis in February 2025, and the system has been operating at >100% capacity continuously, before flu season began. The emergency departments are the safety valves of the hospitals and the community and we are not able to deliver the excellent care we are capable of in a timely fashion for the hundreds of critically ill patients we see everyday. THE REALITY: • Acute care in Edmonton is in crisis • Hospitals are full of acutely ill and ALC patients • Emergency departments are boarded with admitted patients. Yesterday there were 255 admitted patient in 275 #YEG hospital ER beds • Basic emergency-care standards are not being met • Two, maybe three potentially preventable deaths occurred in one hospital, on one shift on Dec 22nd. WHERE THE SYSTEM IS BROKEN: • The bottleneck is at the exit, not the entrance • In Edmonton about 650 ALC patients are stranded in hospital beds (that is almost two hospitals, GNH & Mis) • This blocks ER access, ambulance offload, and timely care for new emergencies WHY THIS MEETS THE THRESHOLD FOR A STATE OF EMERGENCY: • Demand exceeds safe clinical capacity • Normal operational rules are causing predictable harm • This meets the medical definition of a disaster WHAT EMERGENCY POWERS ENABLE: • Rapid ALC decant within 24–48 hours • Incident-command hospital flow management • 7-day and after-hours discharges • Transitional care • Real-time, transparent data reporting Edmonton serves a massively underserved northern catchment, accepts approximately 4X more out-of-town transfers than Calgary, and is absorbing pressure from surrounding communities with intermittent ER closures, all amid population growth. This is not political. It is for the safety of Albertans that you have been entrusted to lead. You have full political and bureaucratic control of the health system and with that comes great responsibility and duty of care and possibly blame for failure to act. Below is the data as of August, 2025. Emergency powers can prevent further avoidable delays in care, suffering and deaths. @MattJonesYYC @JasonNixonAB @nenshi @AdrianaLaGrange @PfParks @NightShiftMD @charlesadler @ryanjespersen @globalnews @CBCNews @CTVNews @Albertadoctors @UnitedNurses @Alberta_UCP