Weeks before a photo showing an elderly woman asleep on chairs in the Health Sciences Centre emergency department went viral and sparked public outrage, the St. John's hospital was struggling to find places to put patients.

That's according to internal Eastern Health documents obtained by CBC News through access to information.

They provide a behind-the-scenes look at a recent time frame that saw Newfoundland and Labrador's major hospital deal with overcrowding issues, before they spilled into public view.

The emergency department at the Health Sciences Centre in St. John's. (CBC)

Code 111 issued

On March 6, the Health Sciences Centre in St. John's issued a Code 111 — the most serious level of overcrowding.

Three ambulances were unable to offload, more than 25 people were waiting in the emergency department, the hospital was short beds in medicine and surgery, and staff were unable to keep diverting patients to St. Clare's Mercy Hospital.

"A Code 111 is called at Eastern Health when overcapacity at a site requires a regional response," the health authority said in a statement.

A teleconference was set up among managers of different departments to try to arrive at a plan with the "ultimate goal to resume flow."

The roof of the Health Sciences Centre in St. John's. (Fred Hutton/CBC)

"This may include supporting an expedited plan for discharge home, diverting appropriate patients to other sites or expediting patients' transfers to other facilities (e.g. patients waiting for rehabilitation services or transfer back to hospitals in the region or province)," Eastern Health noted.

On March 6, the plan was to move 11 patients — 10 that day and one the next — freeing up space at the Health Sciences Centre and St. Clare's.

More shifting

Two days later, there was more shifting, but the plan this time was to open four cardiology beds within Health Sciences.

Rooms were available, but they didn't have beds or other furniture. So staff started searching.

The emergency services entrance at the Health Sciences Centre. (CBC)

"I am at a standstill," regional director of cardiology Darryl Cooze wrote at noon. "Direction is appreciated."

The furniture had previously been sent to another department to help open up beds there.

I am at a standstill. - Darryl Cooze

Officials continued looking, checking with other employees. But three hours later, Cooze replied: "Stand down, no beds or over beds available."

There was no email explaining what happened to the affected patients.

'Closed beds'

Eastern Health explained that "closed beds" and rooms without furniture "may be spaces in the hospital that are not typically used as a bed space but can be converted when needed."

They are used "during periods of high acuity in the emergency department," according to the health authority's statement.

"These beds/bed spaces are utilized for a very short period of time, until flow is restored in the emergency department."

Eastern Health has jurisdiction over the Health Sciences Centre. (CBC)

Closed beds operate on an as-needed basis, outside of the regular number of budgeted beds normally allocated to each of the hospital's units.

The Health Sciences Centre has a 28-bed emergency room for 16 hours of the day. At midnight, the department loses its fast-track area, and five of those 28 spaces.

Increased wait times

When emergency department spaces are tied up with admitted patients waiting for beds in other units, the number of beds available in the ER decreases.

That means, as a result, emergency room wait times can increase.

Another Code 111 was issued a month later, on April 10.

There were eight patients in the waiting room who were medically stable, but should have been seen within 30 minutes, according to medical guidelines.

Eastern Health says "closed beds" are spaces in the hospital that are not typically used as a bed area, but can be converted when needed to help alleviate pressure in the emergency department. (CBC)

There were already "14 left" in ER while those relatively high-need patients sat in the waiting room, according to an internal email from Eastern Health's director of clinical efficiency, Elizabeth Kennedy — meaning half of the ER spaces were filled with admitted patients.

Plus, Kennedy predicted, "at least another 10 admissions … based on average admission volume."

Eight extra beds — if we can get the staff — will be needed for sure. - Elizabeth Kennedy

The strategy, again, was to open beds.

"Eight extra beds — if we can get the staff — will be needed for sure to keep our admission volumes going, especially with [gynecology] beds not available," Kennedy said.

Four beds were then opened on the hematology/oncology floor.

It's unclear from the emails whether more became available.

Overall, according to Eastern Health's own numbers, there are now longer wait times for in-patient beds, after a patient has been admitted through the ER.

That wait time has jumped from 7.3 hours last fiscal year to 9.2 hours in March of this year.

Haggie answers

"These two events were isolated, 24-hour episodes unfortunately related to a significant spike in flu cases this year," Health Minister John Haggie said when asked about this story during question period Thursday.

"It is due to an acknowledged failure from scientists of one component of this year's flu vaccine. All these extra cases were down to vaccine efficacy," he said, adding this flu season was the worst in five years.

Haggie also said construction was complicating things but the situation is back under control and that all beds at the Health Sciences Centre are now "on the roster."

During March and April, elective surgeries had been postponed.



But according to Haggie, all of the patients who were delayed have now had their surgeries completed.

After quoting Cooze saying he was at a standstill, David Brazil, the leader of the official Opposition, asked about the province's cardiac services.

"We actually have an outside reviewer looking at data … suggesting there may be some problems there," Haggie replied.

"It is not clear yet whether that is problems with data collection or problems with the service itself."

Haggie said he anticipates the report within the next couple of weeks.