How safe is our drug supply?

A Facebook – and real world – friend just alerted me to this article, which details how the U.S. drug supply has been outsourced to China.

This is a surprise to him, me and all our Facebook friends. Is this another area where we have become too complacent about health care?

I have smugly assumed that the drugs prescribed in Canada are crafted in sterile, modern laboratories by highly paid professionals situated either in Canada or Europe. Now I am not so sure.

What other false or overly-trustworthy assumptions are we guilty of?

Read it and weep:

https://www.nbcnews.com/health/health-care/u-s-officials-worried-about-chinese-control-american-drug-supply-n1052376?fbclid=IwAR0qQvt_ud-5TFLQjrFvcvdoDQVvY9bhpcrwIv3TBwUv096-nox1TorOUIU

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The misallocation of Nova Scotia ambulances

Once again Nova Scotia’s ambulance service is in the headlines. This time a widow is questioning whether the response time – which appears non-existent – contributed to her husband’s death.

Problems with our ambulance system are an on-going issue which health executives have consistently failed to resolve.

In the fourth quarter of 2011-12 the former Capital District Health Authority reported taking 144 minutes to off-load patients from ambulances instead of meeting the 20-minute provincial requirement. Capital Health promised then Health Minister Maureen MacDonald to improve performance by 10 percent per quarter. Capital Health’s self-imposed deadline gave them until September 2015 to meet the provincial requirement.

On March 21, 2019, when ambulance line-ups outside Halifax hospitals dominated the headlines I asked Minister Delorey who in his department monitored Capital Health’s progress and if the Halifax hospitals ever met their self-imposed targets. Neither the Minister or anyone in his department responded.

The Minister has called for a review of the circumstances which caused this recent death. But what is the point if no one is held accountable and nothing changes?

The availability of the emergency services is impaired by our misallocation of assets. A great percentage of the calls EHS ambulances and paramedic teams make are non-emergencies. EHS are operating an expensive taxi service, transporting patients between medical facilities as well as residents of nursing homes and long-term care facilities to and from hospital.

Patients moving between hospitals need the safety and security of medical expertise provided by paramedics. However, most long-term care residents don’t. They may need to go to hospital for a treatment, appointment, procedure or medical test, like an x-ray. These are necessary trips, but no more of a medical emergency than that of the person who drives themselves to hospital for similar reasons. The reason an ambulance is used is either due to physical impediment (like being bed-ridden or confined to a wheelchair which can’t fit in a regular vehicle), lack of alternative transportation or a fear of litigation.

The Department of Health and the NSHA seem populated with people fixated on ‘what if’ scenarios. What if the resident needs help while being transported? Well, what if there is a real medical emergency and there are no ambulances and paramedics available? That seems to have been the situation this week.

At a March meeting about changes to the Valley Regional Hospital’s ER in Kentville, I asked the ER manager how many patients arriving by ambulance are emergencies. He said, “Anecdotally – and I don’t want to be held to this number – 50 percent of ambulance deliveries are an emergency.”

That means 50 percent aren’t an emergency.

Nova Scotia has 180 ambulances based across the province. Terry Chapman, business manager for local 727 with the International Union of Operating Engineers, which represent paramedics, says the employer’s data shows 162 ambulances are available each day. According to data compiled by Andy Muise, Project Coordinator, EHS Ambulance Operations Management, the service received 182,452 calls in 2018. Of these, 72,933 calls, or 40 percent of volume, fell under their urgent-need/emergency call breakdown.

So the bulk of ambulance and paramedic time is devoted to medical transportation.

NSHA and the Department of Health will tell us that scheduling ambulances are a complicated operation. It may be, but where is the proof anyone has moved on the problem?

According to someone familiar with the ambulance industry, most of the world has one ambulance per 8,000 people. Nova Scotia, because of our geography, has one ambulance per 7,000 people. HOWEVER, my source says, “Unfortunately as our population ages more long term beds are required and the lack of these resources in the rural areas force more transfers toward Halifax and make the pile up worse.”

“The wait time to unload is not an ambulance problem. It is the result of not having any place for the patients in the hospital so they pile up in emergency causing a backlog.”

Those transfer pile ups are also growing at regional health centres, like Kentville, where the bulk of hospital patients seem to be waiting for alternative accommodation.

After the Kentville update on ER improvements an ER nurse, stopped in the parking lot to scream, “We’re working in chaos in EVERY shift! Why aren’t we using former hospitals in Berwick and Wolfville for bed space!?!”

Hers is a valid question. Those former hospitals are mostly occupied by government offices, like school boards, which could easily relocate to other buildings. We should do a quick inventory to identify all empty or underused provincial property to see what could wiftly be rehabbed into long-care facilities.

For example, the former Colchester Regional Hospital inTruro has been vacant for five years. A former minister told me the building has asbestos. Well, it had asbestos when it was a hospital. Government House had asbestos and we found $8 million to remove it and make necessary structural changes. Whether the former Truro hospital is to be sold or demolished, the asbestos will require an expensive removal and disposal process. Using the example set by buildings of similar square footage, like St. Pat’s High School in Halifax, the cost of demolition would be in excess of $3.5 million. How much could that go to making the building useful again? Why not bring it up to code and offer a sweetheart deal to a proven nursing home operator as an incentive to add 150 new long-term beds to inventory?

As for freeing up ambulances so they are ready for real emergencies, why not invest in local services like Kings Point-to-Point Transit, which services those with mobility issues. To mitigate liability and provide patient support, make an CNA or LPN available to travel on non-emergency transfers and supervise the hospital handover. That’s a cheaper alternative to using a paramedic team and ambulance.

My industry advisor says, “The problem we have is not the ambulances. In my view our problem is the management and structure. We should consider “farming out” the management to someone like the CEO of a corporation and apply basic business principles to the problem(s). Now we have a health system run by government using the only tool they know: throw more people and more money at the problem.”

All more money and people have done is buy time for those in charge. It’s time for new service-oriented thinkers, with clear performance targets to meet, to take charge.

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Dementia misdiagnosis?

I don’t normally write about medical treatments. There are so many websites of dubious background and knowledge promoting cures or mis-informed warnings based on little more than some celebrity musing.

Then there are the coffee shop experts who usually know somebody whose neighbour’s cousin had the same thing and this is what was done to fix them … I still believe in those who invested the time to earn their medical degree.

This is about a misdiagnosis. My family previously suffered from a misdiagnosis which our health authority refused to acknowledge, probably for fear of litigation. And I have a friend in England whose daughter had been diagnosed with bi-polar disease. For 10 years she was in and out of expensive clinics (£10,000-a-week) and treated with various antipsychotic drugs. But, as extraordinary as it sounds, after a decade the doctors realized this young woman had a thyroid condition! She was decades ahead of when such a condition normally impacts women and this, coupled with the drugs she received, enhanced her anti-social, self-destructive behaviour. Once her thyroid condition was recognized and treated ‘normalcy’ returned to her life.

Below is a piece I believe rates consideration. It is by a reputable writer from a legitimate media organization, who would have fact-checked and used first-hand, original sources about this new Canadian therapy. I believe this is worth sharing to expand the conversation of the provincial medical community:

https://www.ctvnews.ca/health/new-clinic-treats-patients-with-reversible-condition-often-mistaken-for-dementia-1.4525349

 

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More doctor losses

Four months ago the walk-in clinic in New Minas posted a notice that they were no longer accepting walk-in patients. A month ago they announced the impending closure of the walk-in clinic. The clinic has closed. These signs are in the entrance of what was that clinic.

This illustrates the absolute desperation in the delivery of health care in Nova Scotia.

Further to this are the unfathomable actions of the Nova Scotia Health Authority under the leadership of president and CEO Janet Knox. On Thursday, June 27, a Valley physician told me he knew of four physicians who were interested in establishing family practices in the Kings-Hants County area (Kentville to Windsor). Three of those physicians were only offered half-time practices by the NSHA and the limitations on the fourth were such that none of these doctors could make a living here!

These four doctors have moved their search for host communities for their medical practices outside of Nova Scotia.

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A new low in the politicalization of health care

On the morning of June 28, 2019 the Province of Nova Scotia sank to a new low in the politicalization of health care.

The Minister of Health announced that as of July 1st the government will cover breast augmentation surgery for transgender women in Nova Scotia.

No doubt using notes carefully prepared for him and vetted among public relations officers the Minister said and is quoted in press releases saying, “I can appreciate the distress transgender people can experience during their transition, and I thank those who have advocated for this change. We are now providing more support and more equitable coverage for transgender women.”

There was no mention of how many years people have advocated for this service. Nor an explanation for “why now?” The simple answer is: tokenism.

This is Pride Month, so jump on the inclusivity bandwagon to look caring and like you’re doing something for the LBGTQ community.

This is offensive.

People who have medical needs deserve to have those needs addressed asap. Decisions about and delivery of medical care should not be dependent on political opportunism and advantage. It cheapens government, governance and our trust in those who hold public office.

This type of opportunism and demeaning of trust in decision-making leaves a bad taste. What happens to people with other medical issues? Do they need a month and photo opportunity for government to consider them?

Legitimate medical needs should be addressed on the basis of that need and urgency for those afflicted, NOT for the political agenda of a government and the Nova Scotia Health Authority.

I have no position on the need or urgency of this. I am offended by the political manipulation. This is a disingenuous initiative which should offend everyone.

For those who many benefit, information is here:

https://novascotia.ca/dhw/gender-affirming-surgery/?utm_source=halifaxtoday.ca&utm_campaign=halifaxtoday.ca&utm_medium=referral

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Why is the NSHA recruiting for positions in Kenya?

Why, I wonder, is the Nova Scotia Health Authority hiring people to work in Nairobi, Kenya?

The NSHA can’t find people to work in Nova Scotia, so why would they be staffing overseas? And this is not hiring staff overseas, but for overseas. Below is an ad the NSHA has run on-line.

Sure, it’s a mistake. At least one hopes it’s a mistake, but how has no one at the NSHA discovered it? Why haven’t they corrected it or taken it down?

How many other simple things do they screw up? How do they get Nairobi out of any Nova Scotia destination?

The NSHA add: 

Family Practice Department Head – Nairobi

Company Name: Nova Scotia Health Authority

Company Location: Nairobi, KE 

This job is no longer accepting applications

Job applicants: 
Entry level

Company: 10,001 employees
Hospital & Health Care

Job description

Expression of Interest

Context 

The Nova Scotia Government has outlined a vision for health care called Putting Patients First – Developing solutions so all Nova Scotians get the care they need when they need it. Overall goals are to improve the health and wellness of Nova Scotians, provide safe and quality person centered care, and to create a sustainable, effective and affordable provincial health system.

A critical step in enabling this vision was the consolidation of the nine existing district health authorities into one provincial authority, the Nova Scotia Health Authority (NSHA), with the IWK remaining as a separate authority. A streamlined health system provides many opportunities to put resources where most effective to meet population needs, build a system that focuses on people and patients, ensure a provincial approach to planning and integration of services, and reduce duplication.

The NSHA was created by legislation on April 1, 2015. A new zone leadership team was recruited for this organization including a Head, Department of Family Practice for each of the four administrative zones.

The Department Of Family Practice

  • Represents more than 1000 family physicians in Nova Scotia
  • Focuses on topics that are relevant to family physicians and family practice
  • Supports a collaborative approach to primary health care
  • Strengthens communication and relationships between family physicians and specialist colleagues at NSHA to improve patient care and access
  • Provides a learning and social network for the family practice community

Mandate

Reporting to the Zone Medical Executive Director and working within a co-leadership model with an Administrative Co-lead (Director Primary Health Care, Western Zone) the Zone Department Head of Family Practice provides strategic and operational planning and service leadership in collaboration with health system stakeholders for the Eastern Zone Department of Family Practice.

Accountabilities

Department Administration

  • In collaboration with the Medical Executive Director ensures that the Department medical staff activities are consistent with the overall strategic and operational direction of the Department and aligned with NSHA strategic imperatives;
  • In partnership with the Department leaders, ensures the effective, efficient utilization of Department resources – human, financial, space, physical and clinical;
  • Participates in the development, oversight and reporting of Zone Department’s objectives, planning, budgeting, resource allocation and utilization;
  • Develops a schedule of physicians to ensure coverage of the unit and appropriate medical administration;
  • Makes recommendations regarding physician resource needs for the Zone Department, in collaboration with the Zone Medical Executive Director, the Vice President of Medicine and Integrated Health Services, the Medical Site lead(s) and, where applicable, the Zone Division Heads; Quality and Utilization Management
  • Working with appropriate representation from the geographic location of the health care facilities, sets the standards/guidelines for health services for the assigned Department; develops systems for monitoring performance to these standards; develops and executes mitigation and improvement plans in the areas of non-performance and develops action plans for issues.
  • In collaboration with the Zone Medical Executive Director, addresses any standards of medical practice including issues regarding performance and behaviors of department members aligned to the Department and works to resolve complaints regarding care/services provided by medical staff within the Department.
  • The Zone Medical Department Head coordinates regular utilization reviews and assists with bed management issues as required.

Leadership 

In collaboration with other physician leaders, leads the planning and development of policies that support the integration and standardization of the Department.

  • Must be a member of Zone Medical Advisory Committee (ZMAC) and as such, advise ZMAC on the quality of care and treatment provided to patients and the fulfillment of teaching and research responsibilities within the Zone Department. If the Zone Medical Department Head and the University Department Head are not the same individual, the Zone Medical Department Head is responsible for the organization and implementation of clinical activities and works with the University Department Head for the academic review within the Department.
  • Serves as the Academic Lead for medical students and residents for the Zone Department.
  • Identifies potential liability issues and legal problems within the Department and provides advice to Zone Medical Executive Director and legal counsel for specific cases/files, as required.
  • Participates in performance appraisals as directed by the Zone Medical Executive Director and implements the NSHA’s process for continuing professional development and evaluation related to the Zone Department.
  • Undertakes professional development in management and leadership as agreed with the Medical Executive Director.
  • Holds regular meetings with members of the Zone Department, Zone Division heads within the Department, Zone Network Leads, and medical site leaders and ensures consultation and compliance with the current Health Authority and departmental objectives, policies and rules and regulations.

As the organization matures, areas of responsibility may change to create needed alignment of Departments and networks.

Eligibility

MD (with or without specialty) with evidence of past and ongoing leadership training.

Application Deadline:Posted until filled.

Compensation: Range $125,000 – $175,000 – individual compensation will be set based on previous leadership experience.

Seniority Level: Entry level

Industry: Hospital & Health Care

Employment Type: Full-time

Job Functions: Other

 

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Absent policy cruel for seniors

A front page article, “Keeping couples apart ‘cruel’” is sad for the family and an unnecessary situation.

https://www.thechronicleherald.ca/news/local/keeping-couples-apart-cruel-halifax-veteran-separated-from-wife-in-her-last-days-319112/

The desire for Mr. and Mrs. McCabe to spend their last years together is not unique. Nor is it the first time that the spouse of a veteran placed in the Camp Hill Veterans Memorial Hospital been denied the right to be together.

In June 2018 Bryce and Hazel Gibson from Halifax, who had been married for75 years, were separated when he went to Camp Hill and she to another long-term care facility.

Forceful breakups of long-standing marriages is such an epidemic in that October 2016 the Progressive Conservative Party of Nova Scotia introduced a bill guaranteeing couples could stay together in long-term care homes. Former party leader Jamie Baillie told the CBC he had been approached by a family about a situation where only one spouse could stay in a federal facility. Sound familiar?

At the time former Health Minister Leo Glavine, who had dealt with five similar cases, said, “When the day comes for [the couple] to go into a nursing home in Nova Scotia, they will go as a couple.”

A spokesperson for the Department of Health said the issue would be addressed in a continuing care strategy. That was 33 months ago. Where’s the strategy?

What is so confusing is the federal government, through Veterans Affairs, allows the Nova Scotia Health Authority to use discretion to fill the empty beds at Camp Hill. Year-after-year Camp Hill consistently has empty beds. So the impediment to keeping elderly couples together is the NSHA.

Over and over again, Nova Scotia’s aging population is highlighted as the root cause of the problems faced by government and health care. For all those excuses we don’t hear solutions. Government and the NSHA have had time to factor that aging population into all their decisions. They haven’t.

Separating elderly couples is not a new or unique issue. This has been an on-going issue since 2015. How long does it take the NSHA and Department of Health to address a problem?

This is the failure of health bureaucrats and executives to anticipate and act.

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