A memo obtained by CBC News says Tracey Burkhardt, the executive director of the planning, alignment and engagement division, and Jeff McCarthy, the executive director of innovation and eHealth Services, had "left the Department."

Ellen Delange, a senior policy adviser, was also gone, according to the memo by deputy minister Eric Beaulieu.

Meanwhile, Jennifer Elliot, the assistant deputy minister for public health and integrated community care since August 2021, was demoted to executive director of public health, a less senior role.

In the memo, Beaulieu said that "a revised organizational structure" was being finalized for the department and would be presented to staff Aug. 22. 

He said the new structure and approach "are meant to focus energies on initiatives that will bring the most benefits to citizens, staff and the system as a whole."

Previous sweeping changes

The changes come four weeks after Premier Blaine Higgs replaced his health minister, fired the CEO of Horizon Health and replaced the Horizon and Vitalité health authority boards with trustees.

In a series of tweets Friday that did not mention the latest firings, Higgs said the "changes to the governance model" of the two health authorities — which he described last month as temporary — will allow reforms to speed up.

That would allow ideas from frontline staff to "rise quickly to the level of strategic decision making," so they can be piloted and implemented. 

The move comes four weeks after Premier Blaine Higgs fired his own health minister, and the CEO of Horizon Health. (Pat Richard/CBC)

"Unleashing the wisdom of these professionals is key to driving the change we need," he wrote.

Earlier this week, Fredericton emergency department doctor Yogi Sehgal said he sent Higgs a 10-page report on problems in the province's hospitals and possible solutions. 

He said in an interview he hadn't seen any improvements since the premier's first round of firings and changes on July 15.

On Thursday, the New Brunswick Medical Society issued a statement saying many doctors are facing "severe burnout and exhaustion" and the system needs more doctors, and more spending on health care.

But in his Twitter thread Friday, Higgs said said his government had already "funded the change we need" with a $168.5 million increase to the health budget this year, the largest since 2008-09.

On a recent night outside the Moncton Hospital, as many as 15 units were tied up. Waiting times on June 27 ranged from 52 minutes to nearly 14 hours, according to Ambulance N.B.

What is less visible is how this impacts smaller communities. Crews in towns and villages then may be called up to work in larger centres, leaving stations like the one in Blackville unstaffed. 

"This is a result of everything that is going on in the health-care system," said Chris Hood, executive director for the Paramedic Association of New Brunswick.

• Long waits provoke Blackville to survey public on ambulance service

Patients can't be abandoned before they are transferred fully into hospital care, he said. 

"At least one of the two paramedics is at the patient's side, actively monitoring them."

Rarely are patients cooped up in the back of the vehicle. It's more common, he said, for patients to spend hours on ambulance stretchers, parked in a hospital hallway or some kind of hospital holding area.

Meanwhile, first responders know the calls keep coming in.

"Just think of the dilemma those two paramedics feel … when they know that [they] might be able to make a difference in that person's life," Hood said.

They're thinking, "I'm sitting here because the system is broken and I'm not able to respond."

                                    Denver Brennan, the deputy mayor of Blackville, says he took this photo of the Blackville ambulance station on Aug. 4. On that day, an ambulance was parked inside but no staff were on site. When units are called from Miramichi, it's a 30-minute drive, he says. (Submitted by Denver Brennan )

They also hear the ripple effect as ambulances have to be dispatched to emergencies that are farther and farther away. 

Hood said a call in Fredericton could be answered by an ambulance from Saint John or Grand Falls. 

Typically, he said, ambulances are taken from smaller communities and redeployed to bigger centres. 

"We can use Blackville, for example. That leaves those communities uncovered because that's not typically where the next call is going to come from."

Blackville meeting

Village councillors in Blackville have been so concerned about how often their ambulance resources get pulled away, they hosted a meeting earlier this week with Ambulance N.B. managers.

Deputy Mayor Denver Brennan said it felt productive to have a discussion, and going forward, the two sides hope to meet every three months.

Brennan said offload delays, especially at the Moncton Hospital, and the repositioning of resources were identified as part of the overall problem. 

Councillors were also informed that staffing was an issue. 

Ambulance N.B. says it has three vacancies at the Blackville station, including two full-time positions and one part-time position.

While recruiting is a priority, the service says vacancies in rural areas are more difficult to fill. 

Brennan was concerned when Ambulance New Brunswick told the village that problems affecting ambulance service could last five to 10 years. (Village of Blackville)

Meanwhile Ambulance N.B. continues to monitor patient satisfaction through surveys conducted twice a year by a third party. 

According to the latest results from June, 95 per cent of respondents were satisfied.

Brennan said the part of the meeting that bothered him most was a caution from Ambulance N.B. that the crisis could continue for another five to 10 years. 

"I don't think we can let this go on for five to 10 years," he said. "And it's much more than a municipal issue. Looking at the numbers across the country, it looks like a national issue."

• Ambulance NB paid millions to hit targets biased against rural areas, auditor finds

CBC requested an interview with Ambulance New Brunswick but was provided instead with a written statement from Jean-Pierre Savoie, the vice-president.

 "We really appreciated the opportunity to meet with the Blackville Municipal Council yesterday. It gave us a chance to update them on some important initiatives we've been working on, discuss some of the challenges we've been facing, and answer any questions they had.

"Questions from council members included topics ranging from staffing shortages, recruitment challenges and potential solutions. We felt it was a very important discussion and we've offered to meet with them on a recurring basis if that would be helpful."   

Bernard Thériault says pediatric and obstetric services in Miramichi, Bathurst and Campbellton should be centralized in a single location at the Chaleur Regional Hospital in Bathurst.

Thériault, a former provincial cabinet minister and former chief of staff to a Liberal premier, says it's unworkable to have three specialist teams in three hospitals serving an ever-shrinking population. 

"We've seen in the last few years that it's a constant battle to keep some staff there," he said. "But by only keeping one, you don't have to have three obstetricians standing by at the same time"

Bathurst would be 'super-regional' centre

In his model, Campbellton and Miramichi would continue to offer other services, but those most often affected by shortages would exist only in a "super-regional" hospital in Bathurst. 

"It's a matter of volume, and the population is not there anymore. Those three regions combined together hardly pass the 100,000 mark, which is not even considered the number for a regional hospital. And we're dealing with three here."

The summer of 2022 has seen a wave of temporary service shutdowns at various hospitals around the province. 

• Bathurst hospital without pediatric services for another 5 days

In Bathurst, what was supposed to be a four-and-a-half day closure of pediatric services starting in late July has now stretched into its third week.

"The shortage of nursing resources is currently exacerbated by the summer period, the pandemic and staff burnout," the Vitalité Health Network said in news releases announcing the initial closure and the extension.

Thériault compared the sporadic shutdowns to a game of musical chairs.

"Right now you have three systems that don't work. Every single day one of them is shut down. .... Let's make sure we're dancing on chairs that are solidly installed, in one regional service." 

Vitalité's vice-president of medical affairs, Dr. Natalie Banville, told CBC's Shift New Brunswick that the challenge with pediatrics is that it requires specialized nurses who can't be easily replaced from elsewhere on the staff if someone is sick or on vacation.

She said a decision to merge services from several hospitals would not be made by the health authorities alone. 

"It's not under us. It has to come from the government, through consultation with the public, with everybody. … It's out of my field."

In a statement to CBC, Vitalité's CEO Dr. France Desrosiers said the staffing issues are happening across the country, and the network "must work collaboratively with all communities" to find solutions.

"To that effect, we look forward to engaging Mayor Thériault on the subject," she said.

Thériault said he pitched his idea a few months ago to the then-health minister Dorothy Shephard and to Gérald Richard, who was co-chairing a provincial task force on the province's health plan.

Richard was appointed trustee of the Vitalité last month, replacing its board of directors.

   Dr. Natalie Banville, Vitalité’s vice-president of medical affairs, says decisions about merging services could not be made by health networks alone. (Government of New Brunswick)

Thériault said Richard was "very positive to that approach of centralizing." 

The Department of Health did not respond to a request for comments on the mayor's suggestion.

In July, Premier Blaine Higgs suggested a "bureaucratic stalemate" and management procedures, not staff shortages, were to blame for long emergency wait times and service interruptions.

He said he wanted to see hospitals work together more closely to co-ordinate services.

"I don't believe this has anything to do with — and I'm just stating an opinion here — anything to do with the nurses on shift or the people on shift," Higgs said July 15. "I believe it is a management issue. I believe there is no co-ordination of activity." 

Hospitals are sacred cows, mayor says

Thériault said he expects a negative reaction to his idea because hospitals are sacred cows in their communities.

He pointed out the Higgs government was almost toppled in a no-confidence in early 2020 over its plan to close the emergency departments at night in six small hospitals around the province, including Caraquet's.

"'Don't touch my hospital' is still very, very highly pronounced," he said.

But he added: "Even if people from my area may not be happy about that, I'm saying it's not only the best way to do it, it's the only way to make it work."

Campbellton Mayor Ian Comeau said Thériault's suggestion is unacceptable and is based on a subjective look at health care in northern New Brunswick.

Bathurst may be the centre of an area that covers Campbellton to Miramichi, but Comeau said people in Saint-Quentin and Kedgwick also use his city's hospital. Leave out Miramichi, and the "central" location is Campbellton, he said.

Campbellton's hospital serves 25,000 people in health zone 5 and another 15,000 across the river in Quebec, with that province's government paying New Brunswick for the service.

Comeau said rotating some services throughout the north may work but he'd resist anything more.

• 'Scary' state of health-care system prompts Fredericton ER doc to compile rescue ideas

"Even if we have to look at having services one week here, one week there, that would be good, but I'm certainly not in favour of totally centralizing things to the Bathurst area." 

Comeau added that Thériault was part of two Liberal governments that either cut health services or didn't do enough to head off predictable staff shortages.

"He should look himself in the mirror and say, 'What went wrong?' and 'Why did we do such things?' I think it's coming to haunt him now."

New Brunswick's health-care system is in "crisis," and Dr. Yogi Sehgal says political and health-care leaders need to act immediately before the exodus of staff reaches a "critical mass" that leads to widespread hospital closures.

"You could see the system kind of steadily circling the drain over the last few years and in the … last year, a lot of people have been leaving on a daily basis, and they tell me the reasons for it and those reasons haven't changed at all.

"It's scary to go to work and see people having panic attacks at work and actively looking for other jobs on their breaks."

Sehgal said the problems facing the province's health-care system have become so dire that he was inspired to gather his own recommendations and those of his colleagues.

 Sehgal says nurses and doctors are having panic attacks at work because of high stress caused by problems in the system. (Joe McDonald/CBC)

On Wednesday, he emailed copies of a 10-page report he wrote to Premier Blaine Higgs, Health Minister Bruce Fitch, Social Development Minister Dorothy Shephard, and leaders within the Horizon and Vitalité health networks.

The laundry list of recommendations covers how emergency departments could be better staffed and operated, better compensation and more protection for nurses, and boosting incentives to recruit physicians, nurse practitioners and physician assistants for improved access to primary care.

Speaking to CBC News on Thursday, Sehgal said the problems facing the province's health-care services are systemic, with problems in one area having knock-on effects in others.

However, he said one of the biggest problems is the lag in having eligible hospital patients transferred to nursing homes.

"If you just remove those patients out of hospital, you now have a whole bunch of space and potential staff that you can use in other ways, so that's a big one for me," he said.

"And of course, the nursing home patients will get better care in a nursing home than in the hospital."

Promised improvements falling flat

Last fall, the Department of Health released its plan for improving health-care, which is referred to as being in crisis.

The plan set timelines for providing primary care access to all New Brunswickers and offering more supports to help seniors remain in their own homes and out of hospital beds.

More recently, Higgs has promised improvements by way of removing the boards of directors for Horizon and Vitalite and replacing them with trustees tasked with making quick, decisive changes in light of the death of a man while waiting in the emergency department waiting of Fredericton's hospital.

Sehgal said he's aware of those commitments, but he hasn't seen any material difference.

"You can see things getting just a little bit worse all the time, and it just takes that critical mass [of staff] to be gone and then we're in real trouble," he said.

"Like you just won't be able to get the system back up, and then you'll be shutting down hospitals and you'll be, you know, you'll be making very difficult decisions of who gets care and who doesn't, which is, you know, that's unfortunately coming. That the outcome I think we're trying to avoid."

Sehgal's recommendations to officials are "bang-on," said Anthony Knight, CEO of the New Brunswick Medical Society.

"He understands from the front lines as an emergency room physician the challenges confronting our health system, the difficulties patients are facing, and the frustrations family physicians and other health care workers are experiencing on a daily basis," Knight said.

New Brunswick Medical Society CEO Anthony Knight says Sehgal's recommendations for improving the health-care system are 'bang on.' (Zoom/CBC)

Knight said the medical society have already advocated some of the recommendations, adding that he encourages Fitch and other leaders in his department to review the document and work on implementing them.

"There are health, human resource shortages throughout New Brunswick, and this places additional strain on those who are able to or continue to work in the province, and his recommendations really capture several of the new initiatives that need to be taken action on immediately by government."

Minister 'happy' to hear from doctor

In an email statement to CBC News, Health Minister Fitch said he was pleased to receive  Sehgal's recommendations.

"I am happy that we are hearing from him and others who are offering solutions," Fitch said.

"It is important for us to hear about actions and improvements that people working in the system see as crucial to improving our health-care system and to build upon the incredible work and care being provided to New Brunswickers every day."

Health Minister Bruce Fitch says he's happy to have received the report from Sehgal. (Ed Hunter/CBC)

Fitch said he just began reviewing Sehgal's document, which he received late Wednesday night but noted that several items align with priorities in the provincial health plan, including allowing staff to work to their full scope of practice, improving access to primary health care and addiction and mental health services.

"I will be speaking to staff with the Department, the trustees from the regional health authorities (RHAs) and Extra-Mural/Ambulance NB (EMANB) about all the ideas we are receiving to see how we can take action that will lead to improvements in our health system that benefit New Brunswickers."

Health networks review recommendations 

In an email statement to CBC News, Dr. France Desrosiers, president and CEO of Vitalité Health Network, thanked Sehgal for his report and said the network plans to follow up with him.

"At Vitalité Health Network, we have been working for several months on improvements in various sectors, including emergency services," she said.

"Our efforts continue and we look forward to share some of our early results in the weeks to come," she said, adding that health-care staffing challenges aren't unique to New Brunswick.

Horizon Health Network is focusing on the patient experience and patient flow within its emergency departments, as well as "creating the best possible work environment" for staff and physicians, and recruiting new team members, said interim president and CEO Margaret Melanson.

Melanson said Horizon recently consulted leaders at the Dr. Everett Chalmers Regional Hospital in Fredericton, and is now working on creating a "patient flow centre" at the hospital.

Also, to improve access to surgery across its hospitals, Horizon recently announced a new medical co-lead and a new administrative co-lead for surgical services.

"These leaders will engage with staff to hear their ideas on how to improve this crucial aspect of the health care system.

Melanson said Horizon leadership values the input of its physicians and staff as they work together to address health-care challenges, which are being seen across the country.

"We believe engagement and consultation with our staff is an essential means of generating important discourse and new ideas, as well as a way to receive feedback from those on the frontline. We have received Dr. Sehgal's correspondence, and it will be reviewed in accordance with our processes." 

In a news release sent Wednesday, the health authority said services at the unit, which provides care for sick children, won't resume until Wednesday, Aug. 10 at 8 a.m.

Vitalité said the disruption is due to a shortage of nurses.

"Service interruptions are always a last resort," Vitalité said in the news release. 

"We are actively seeking solutions with the people on site to boost the resilience of our teams during these difficult periods. "

Vitalité first suspended services at the unit on Friday, saying at the time there was a plan to have pediatric services back by Wednesday, Aug. 3 at 8 a.m. 

In Wednesday's news release, Vitalité said patients requiring pediatric care should go to the emergency department at the Bathurst hospital.

The suspension will not impact obstetrical services.

Vitalité did not immediately respond to a request for comment.

Other hospitals impacted

Meanwhile, pediatric services are still suspended at the Edmundston Regional Hospital.

The temporary suspension began on July 25, and the hospital will be without pediatric services until Friday Aug. 5 at 8 a.m. due what the health authority said is a lack of pediatricians. 

Obstetric services are affected by the suspension at the Edmundston hospital, and Vitalité is directing pregnant women to another hospital for delivery, unless they're in need of urgent care. 

Vitalité said in a news release a chronic shortage of pediatricians is affecting hospitals across the country, including several in New Brunswick. 

Both pediatric and obstetric services at the Campbellton Regional Hospital have been suspended by the health authority for more than two years, starting in April 2020.

In June of this year, Vitalité CEO Dr. France Desrosiers said those services won't be back anytime soon.

Also in June, pediatric services were suspended for a week at the Dr. Georges-L.-Dumont University Hospital Centre due to a shortage of medical staff.

The Edmundston, Moncton and Bathurst hospitals are the only Vitalité hospitals that offer pediatric services.