What follows is a letter to Six Mountains from Dr. Simon Fox — General Internal Medicine, on behalf of the Cowichan District Hospital General Internists:

"I am writing to make you aware of the current situation at Cowichan District Hospital in Duncan. Internal Medicine is now in imminent danger of collapse within the next 6–8 weeks.

"Unless there is urgent intervention, we are likely to reach the point where patients must be diverted directly from the Emergency Department to other hospitals, surgical services will have to be cancelled or severely curtailed, and normal acute medical care at Cowichan will become unsustainable.

"In these circumstances, it will not be possible to open the new Cowichan hospital in any functional manner.

"Letters setting out this situation are being sent to all relevant provincial candidates, community leaders and other parties with a direct interest or responsibility in the future of hospital services in Cowichan. I wanted to ensure that you were also aware of the seriousness and immediacy of the situation.

"By December, we will be reduced to only three internal medicine specialists in Cowichan. Internal medicine provides emergency department and hospital consultations, medical care of the 7-bed intensive care unit and 6 high-acuity medical beds.

"In addition to this, we provide a cardiac assessment service and community specialist consultation services. The service has already experienced serious gaps in coverage in September, with further disruptions anticipated in October and November and substantially larger, multi-day gaps expected from December onwards.

"These are expected to result in periods of closure of our Intensive Care Unit to admissions and the necessity of transferring the most critically ill patients to other sites. The resulting risk of serious patient harm is substantial.

"We are preparing to open a very expensive and substantially larger regional hospital in Cowichan in 2027 to meet the rapidly growing demands of our community. It is intended to have expanded critical-care capacity, including 6 ICU beds and 8 HAU beds under internal medicine oversight.

"As it stands, it will not be possible to open this hospital with a functioning intensive care unit and internal medicine service. A significant portion of the new hospital's expanded capacity will not be usable as intended; we will be unable to safely care for critically ill patients locally and services dependent on acute medical and critical-care support, including surgery, will face significant operational disruption.

"The practice of internal medicine in Cowichan is particularly broad, including a substantial critical-care and out-of-hours burden. In comparison with the other regional hospitals on Vancouver Island, Cowichan has roughly one-third to one-half the number of general internists despite being approximately 40% larger by beds and handling roughly 75-80% more emergency department presentations.

"Despite this greater workload, the present funding arrangements are materially less favourable than those available at comparable Island Health hospitals. Physician remuneration is approximately 40% lower under the current arrangements.

"The combination of these factors has made recruitment and retention impossible.

"Our principal concern is patient safety. Recurrent and prolonged periods without internal medicine coverage create an increasing risk of serious patient harm and have significant consequences for the emergency department, surgery, anaesthesia, hospitalists, nursing and other hospital services.

"We are not criticising Island Health or local medical leadership; those involved are working very hard within the resources available to them.

"We urgently need our local political and community leaders to advocate at a provincial and ministerial level to draw attention to the imminent threat to patient safety in our community and help prevent it.

"Moving forward, we want to secure a durable and equitable solution that allows Cowichan and other community hospital sites within Island Health to recruit and retain physicians with the broad and distinctive skill set required to provide the community internal medicine services that our communities need.

"I feel it is important to make you aware of this problem, and I am therefore urgently asking for your help to prevent significant patient harm."

Kelvin So, public affairs officer for the BC Ministry of Health, said in response Thursday: "Due to the ongoing election campaign, government is in a temporary caretaker mode and communications are limited to critical health and public safety information."

Island Health said in a statement: "What we can say is that Cowichan District Hospital is and will continue to be a safe place for people to seek care. Island Health does not anticipate any changes to emergency department services and people should not hesitate to seek emergency care if they need it.

"Island Health has comprehensive contingency plans to support safe patient care and required transfers during a potential temporary disruption to on-call Internal Medicine services at Cowichan District Hospital."

Six Mountains has asked all four candidates in the provincial riding of Cowichan Valley to comment on this issue: Debra Toporowski, NDP; Justin Douglas, BC Green Party; Bert Chen, Conservative Party; James Chumsa, Communist Party of BC.

The NDP responded with a statement, saying, in part: "These are critical services for people in our community. A re-elected BC NDP government will work with the health authority and these doctors to come to a solution that ensures care continues for patients.

"The BC NDP is making record investments in stronger healthcare in the Cowichan region with the new hospital opening next year.

"We're not going to let those healthcare services here be put at risk.

"And we're taking action to expand recruitment for more healthcare workers: tripling our US recruitment campaign, opening a new medical school in the province, and speeding up international credential recognition."

Chumsa said: "I fully support increasing provincial funding to maintain and expand the Cowichan Valley's public healthcare infrastructure as well as increasing pay for medical staff and paramedics."

The party's platform, including on health care: https://cpcbc.ca/our-platform/

The provincial election is October 24.

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— Larry Pynn, Oct. 8, 2026