Every story in this health series has a thread running through it. A provincial border that doubles the administrative burden, splits every system in two, and creates problems no other community in Canada has to solve. The health assessment says so. It has been saying so for years.
There is a line running through the middle of Lloydminster Hospital.
It does not appear on any floor plan. No sign marks it. No wall separates the rooms on one side from the rooms on the other. But it is there in every staffing decision, every patient transfer, every discharge plan, every lab result, every prescription, and every mental health call that goes to police at 2 a.m. because the hospital on the Saskatchewan side is not a designated facility under Alberta’s Mental Health Act.
The Lloydminster Health Service Needs Assessment calls this the dual-jurisdiction reality. The document devotes an entire section to its operational impacts. What that section describes, across four subsections and dozens of specific examples, is a health system designed for a city that does not exist, operating in a city that does.
Two mental health acts
When a person in Lloydminster experiences a mental health crisis, the first question is not what they need. It is where they are standing.
“Mental health care delivery in Lloydminster is governed by two distinct legal frameworks: the Alberta Mental Health Act and the Saskatchewan Mental Health Services Act,” the assessment states. “These acts differ in their provisions for involuntary admission, legal documentation, timelines, review processes, and designated authorities.”
In an emergency, first responders and clinical staff must determine which legislative framework applies based on where the individual was apprehended and their province of residence.
“This requirement introduces procedural delays and legal uncertainty, particularly when rapid clinical decisions are required,” the document states.
If someone in crisis meets the criteria for involuntary admission, they cannot be admitted to Lloydminster Hospital. It is not a designated mental health facility under either province’s legislative framework.
“The closest Alberta-designated facilities are in Ponoka, approximately 300 kilometres away, and Edmonton, approximately 250 kilometres away,” the assessment states.
Staff must be trained in both Alberta and Saskatchewan mental health legislation, including distinct forms and detention criteria. A procedural error due to jurisdictional ambiguity, the assessment notes, “may result in legal exposure or compromised continuity of care.”
Two continuing care systems
Alberta’s Continuing Care Act, effective April 1, 2024, designates spaces in three categories. Saskatchewan’s continuing care framework does not have comparable prescriptive classifications.
“There is no equivalent to Type B spaces in Saskatchewan, leading to system challenges, with Alberta providing a service that does not exist in Saskatchewan,” the assessment states.
Continuing care facilities serving a mixed-resident population frequently face pressure to adopt Alberta-level standards even when licensed in Saskatchewan to meet expectations for Alberta-funded clients.
“However, funding levels do not always align with these standards,” the document states.
The operational result: long-term care homes operating at Alberta-standard service levels while receiving Saskatchewan-level funding. Families reporting confusion about eligibility criteria, fee structures, and care expectations. Staff required to navigate two sets of policies depending on which side of the border their employer operates on.
Two licensing systems
Every regulated health professional working in Lloydminster, including nurses, physicians, and allied health staff, must hold licensure in the province where care is provided.
“This dual requirement increases administrative burden, delays onboarding, and presents a barrier to recruitment and retention, particularly for new graduates or internationally trained professionals unfamiliar with the complexities of cross-provincial practice,” the assessment states. “These practitioners may choose to work elsewhere in order to avoid the dual licensure and administrative requirements.”
That sentence is the recruitment crisis summarized in one sentence. Lloydminster is competing for health professionals in a national shortage, offering the same pay as single-province communities and twice the paperwork.
Dual licensure adds cost and time commitments for individual staff and human resources departments. Scopes of practice, college requirements, and regulatory expectations differ slightly between provinces, complicating the development of consistent clinical roles. Managers must tailor scheduling and deployment strategies to align with licensing requirements, reducing flexibility in staffing.
Two information systems
Alberta and Saskatchewan operate under separate privacy legislation, referral networks, and health information systems.
The practical consequences appear throughout the assessment in every service area. CT scans performed at Lloydminster Hospital are not automatically uploaded into Alberta’s NetCare system. Lab results from the Alberta Precision Laboratories site are not accessible through Saskatchewan’s electronic health record systems. Discharge reports do not flow automatically between providers on different sides of the border. Duplicate testing occurs because one province cannot see what the other province has already done.
“Administrative staff are often required to duplicate records or translate information to satisfy both provincial standards,” the assessment states. “In some cases, patients or families are required to bring their own medical records to different providers. Staff have developed workarounds in many service lines, such as manual transmission of patient information; this additional labour and time is not typically resourced and takes away from patient care.”
Patients carrying their own records between appointments. Staff faxing information that should transfer automatically. Time spent on workarounds that could be spent on care.
The agreement that lapsed
Under a past service agreement, Alberta provided funding through AHS to SHA to deliver acute care, primary care, and mental health services to Alberta residents living in Lloydminster or accessing services at Lloydminster Hospital.
A new agreement was developed in 2020. It was never formally signed.
“AHS and SHA continued to operate under the terms of the draft agreement, which officially expired on March 31, 2025,” the assessment states.
The foundational funding agreement governing how two provinces share the cost of running one hospital expired in March 2025. The assessment was delivered to both governments in December 2025. Neither government has publicly acknowledged that the agreement lapsed or announced a replacement.
Twelve years and counting
The 2013 assessment commissioned by the same two governments identified the dual-jurisdiction system as a barrier to care. It called for action on professional licensing, mental health service coordination, and information sharing.
The 2025 assessment finds the same barriers. In several cases, more acute.
“Jurisdictional complexities affect frontline operations across multiple areas,” the 2025 assessment states. “The day-to-day reality for health care providers, support staff, and facility managers is often complicated by the need to navigate two distinct provincial systems.”
That sentence was true in 2013. It was true in 2025. Two governments have known it for at least twelve years.
The assessment does not say these problems are unsolvable. It says they require coordination, resourcing, and political will. It was delivered to the people with the authority to provide all three in December 2025.
Government response
BorderPulse contacted the Saskatchewan Ministry of Health and the Alberta Ministry of Primary and Preventive Health Services with four specific questions about dual-jurisdiction failures in Lloydminster’s health system. Dale Hunter, Senior Media Relations Consultant with the Saskatchewan Ministry of Health, responded on behalf of both provinces.
Hunter confirmed the foundational service agreement governing health care delivery to Alberta residents in Lloydminster has lapsed but said both provinces are continuing to operate under its terms.
“Alberta and Saskatchewan continue to work and offer services in good faith under the expired Services Agreement and are committed to renewing the agreement,” Hunter said.
No timeline for renewal was provided.
Hunter said work is underway on information sharing and acknowledged dual licensure and mental health as areas for improvement.
“Health information, privacy and digital health staff from both provinces are committed to working together to identify opportunities to improve ways of sharing electronic health records between provincial systems,” Hunter said.
The ministry said the assessment identifies opportunities including improving interprovincial reporting and decision making, dual licensure and certification of health professionals, and appropriately managing mental health presentations.
BorderPulse asked four questions. The response addressed parts of three.
The ministry did not address the absence of a mental health facility designation for Lloydminster Hospital under either province’s Mental Health Act, which requires individuals in crisis apprehended in Alberta to be transferred to facilities up to 300 kilometres away. It provided no timeline for renewing the expired service agreement. It offered no specific plan for reducing the dual-licensing burden beyond acknowledging it as an area of opportunity.
This is the second last story in the series. Tomorrow, we put it all together in the 13 recommendations they didn’t want you to know about. They didn’t want you to use to hold them accountable.
Read the full series to this point – Lloydminster Health Needs Assessment investigation
