Nothing new in senior care paper

 

Tuesday an “expert panel” released a study into senior care in Nova Scotia.

https://www.thechronicleherald.ca/news/local/long-term-care-homes-in-nova-scotia-need-more-staff-expert-panel-recommends-275910/

Is there anything here we didn’t know? Nope.

This situation has been the reality for the decade since my family first faced it and it probably predated our exposure by decades.

The reference to one nurse to 30 residents is curious. Is that the availability of one RN per 30 residents in general or one RN-to-30 residents per shift? I knew of an RN responsible for 110 residents during each overnight shift. One person could barely keep up with the needs of so many people. If there was a medical emergency that requirement put all other residents in jeopardy. Nonetheless, we continue to operate facilities on a hope and prayer that the odds are in favour of short staffing.

In Tuesday’s report, one researcher complained that the province doesn’t have data on staff working long-term care. That’s absurd. The Department of Health could have several staff members take a day to call or email every facility manager in the province asking for specific staffing and resident numbers. We could have those in a day. Failure to have such information should spur the dismissal for cause for whoever is responsible for senior care within the department. Not knowing such numbers shows a willful desire to be conveniently ignorant. It’s the deniability factor health care so often utilizes to cover their shortcomings. The question is who are the Department of Health being ignorant for? Is it for the sake of the political optics around the budget or to aid the commercial interests of facility owners?

Back when the Conservatives formed the government, they had the data to say the province needed 1,800 more long-term care beds. They added 1,000 beds before they were replaced by the NDP. When the NDP formed the government they halted development of new long-term care beds. That seemed to be against the basic tenets of their political philosophy.  The Liberals haven’t added any, preferring to service people in their homes, regardless of the cost, inconvenience, impracticability and misunderstanding of what seniors really want.

These studies remind me of an observation by former NDP finance minister Graham Steele. “Politically, studies are useful. Nobody can complain about a government getting more information and expert analysis. Every stakeholder hopes and believes the study, when finished, will see things their way. Best of all, the government has a perfect answer — “We’re looking at it” — to every complaint. For a politician with no clear agenda, that’s gold.”

Nova Scotia’s agenda seems to be to run out the clock. Get the government to the next election and a NSHA bureaucrat to a comfortable retirement – with lucrative consulting contacts enabling them to pop back in long enough to protect their reputation from a more effective and innovative replacement.

 

 

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Would you work for the NSHA?

Would you work for the Nova Scotia Health Authority?

Doctors Nova Scotia have issued a position paper on the value of family physicians. It is an unprecedented paper. The fact that the organization which represents family physicians felt the need to do so illustrates the adversarial situation which exists between front-line physicians, the Nova Scotia Health Authority and Nova Scotia Department of Health and Wellness.

One point which jumps out is this:

Research has shown that patients with access to care over the years from the same physician have fewer hospitalizations and better health outcomes, based in part on the relationship and trust that patients and their family physician have established over time.

Read the paper here:

https://doctorsns.com/sites/default/files/2019-01/next-steps/Role-of-Family-Physician-position-paper.pdf

This website has been and is a promoter of a single, merged health care system. The theory is that it should standardize care, streamline decision-making, redirect administrative costs to the front line and allow for better coordination of skills, assets and needs. Unfortunately, in selecting the right system for Nova Scotia health care the government installed the wrong/weak leadership. The job went to someone who had been the head of a health authority, but on reflection, other than climbing the corporate ladder, it’s a stretch to find any history of innovation and success in delivery of care.

The impediments to practice in Nova Scotia include:

1. Pay

At $259,378, Nova Scotia has the lowest pay for family physicians in Canada. A doctor in New Brunswick can average $293,636 and in Prince Edward Island that rises to $305,091. Nova Scotia pays 13-17 percent less than neighbouring, less prosperous provinces. Even Newfoundland pays doctors 5 percent more. In 2017 a Halifax-based family physician told me that after deducting practice costs, their taxable income was $60,000!

Click this:

https://www.cbc.ca/news/canada/nova-scotia/family-doctors-health-care-the-search-pay-models-1.4520132

2. Trust

There has long been a trust issue in health care in Nova Scotia. CIHI accreditation reports have shown a low of 48 percent and a high of 52 percent when staff are asked if they trust their managers.

3. Respect

The way this executive have acted as the NSHA and in predecessor authorities doesn’t show much respect for medical professionals. In 2013 Dr. Andrea Veljkovic, who was an orthopedic surgeon specializing in diabetes-related foot and ankle care in South West Nova, quit the province when the Annapolis Valley District Health Authority headed by Janet Knox (now NSHA CEO) refused to find funds to pay her. The authority’s explanation was that Valley Regional Hospital had five orthopedic surgeons and that was enough. Dr. Veljkovic travelled the region performing surgeries in Kentville, Yarmouth and Bridgewater.

Then we had the on-going litigation against Dr. Gabrielle Horne. Dr. Horne was a rising medical star who had her hospital privileges reduced and research thwarted after a manufactured dispute with a hospital director at the former Capital Health Health Authority. Dr. Horne’s professional standing was harmed by the manager’s claims. The result was 16 years of litigation in which Dr. Horne prevailed. Capital Health, continued by NSHA, spent over $10 million of taxpayer money to avoid taking responsibility for the actions of their management team. In the end the courts found for Dr. Horne. All that NSHA did was spend several millions more to cut a $1.4 million damage award to $800,000. The managers who caused this problem remained at work and rose in the organization.

Last month, NSHA showed their on-going disrespect when they cancelled hospital privileges of Dr. Jennie MacGillivary. Dr. MacGillivary is a surgeon who performed surgeries at two provincial hospitals. She asked for help to deal with professional burn out caused by her workload and lack of support. She lost her job. So much for a NSHA being a compassionate employer.

https://www.cbc.ca/news/canada/nova-scotia/health-care-surgeons-doctors-hospitals-inverness-antigonish-1.4965010

Another example of the NSHA disrespect for medical professionals was a meeting called by a NSHA provincial health zone manager where the 42 doctors in attendance were told they had no concept of realty and “were living off the fat of the land”. Really?

4. Practice Restrictions

The NSHA has been careful not to say a doctor can’t practice wherever they wish. They know those cases limiting practice have been lost in the Supreme Court. However, the NSHA has used credentialing as the club preventing doctors from establishing practices wherever they wish and to drive new doctors to join a collaborative care practice. Without “credentials” doctors can’t bill for services, can’t order tests, prescribe drugs or even admit a patient to hospital. I have been told of a physician who was prevented from opening a practice in a suburb of Halifax, another was prevented from taking over his parent’s city practice, another city-based doctor couldn’t turn his existing practice over to a new doctor. Two young doctors were prevented from establishing a rural practice because it was within the 100-km catchment area of a community care practice.

Here are some unedited NSHA employee ratings posted on-line in connection to a job competition in October 2018:

Very little room for advancement / Allied Health (Current Employee) –  Sydney, NS – 15 May 2018

Advancement is only given either by seniority but more commonly by nepotism. System is failing due to ineffective management who are not above asking illegal requests. Union violations occur frequently, but the union has no teeth in protecting the employees and retribution within the rules of the contract does occur.

Salaries are fair for the region and job security is very high, but individuals who should never work within healthcare are never removed.

Pros Decent wages, secure job

Cons Poor management, overworked, understaffed, not interested in changing / 2 stars

 

Good place if you’re looking for a good job / Senior Systems Analyst (Former Employee) –  Halifax, NS – 25 March 2018

Steady work, low expectations. Organization has low technical competence and fear of technology, relying on external consultants to make decisions. Internal expertise is not fostered, nor welcome.

Take your job, do your hours, for interesting stuff, find a side project.

Pros Not concerned with IP constraints

Cons System change not welcome / 3 stars

 

Fun work place / Utility Worker (Current Employee) –  Halifax, NS – 14 March 2018

Great company and all co workers are treating respect to each other. Company giving good benifits loke medical dental and pension plans. Also we have vactions and sickness time.

Pros Free Uniforms

Cons Long hours / 5 stars

 

sexist managers / Registered Nurse (RN) (Current Employee) –  Halifax Regional Municipality, NS – 28 February 2018

if you are male, you wont (for the most part) get hired here. they have the odd token male but it is a non-male dominated workforce and they arent letting go.

i have seen qualified male candidates declined over new grads. managers will look for someone that kowtows to them. these same managers are unbelievably rude and condescending to male staff called in from local agencies.

i have been watching this for years and it is disheartening to see so many (but not all) men head elsewhere as soon as they can.

Pros that the men get to escape

Cons everything / 1 star

 

is a stressful environment / Mental Health Nurse (Former Employee) –  Halifax, NS – 13 February 2018

There is a divide between management and staff, trust is a huge issue. When issues are brought to their attention nothing is done. it can be a toxic work environment.

Pros great staff / 3 stars

It seems the only solution to make the Nova Scotia Health Authority a welcoming place for professionals to work is a change at the top. The executives are entrenched in their “rightness”, believe the rest of us don’t understand the issues, and maintain their comfortable status quo. Other places have to be more welcoming to new talent than this crowd.

The Nova Scotia Health Authority embraces all the words and phrases du jour, but by their actions we see they don’t implement them. Beware.

 

 

 

 

The real cost of private health care

On Boxing Day a friend, who is spending the winter in the United States, suffered a stroke. Fortunately, it was a mild event and she bounced back in less than three days. It was not the major episode an earlier stroke was.

Her brief hospitalization was $52,000 USD!

As shocking as both the stroke and bill were, she managed to negotiate a 75 percent reduction in payment! That’s $39,000 off the bill! She is still paying $11,000 for her treatment and care, which still provides the hospital with a profit, and makes this is an important teaching experience.

The first lesson is never go to the U.S. without health insurance. The second lesson is for those who promote the advantages of a for-profit-model for health care. For-profit health care only works for those who have the resources to pay, otherwise, profit is a barrier to care. And the fact that the hospital would reduce the bill by 75 percent ($39,000) illustrates the level of profit built into the U.S. health care system.

 

Snooping in NSHA patient files

Earlier in November, Nova Scotia’s Privacy Commissioner, Catherine Tully, revealed that health officials had been caught “snooping” on 335 patient health records.

This is such a serious invasion of privacy that it is a prosecutable offence.

Tully’s annual report said an investigation into the Nova Scotia Health Authority (NSGA) revealed “a dangerous and insidious culture of entitlement” into viewing records. Anyone who has dealt with the NSHA knows that “culture of entitlement” extends well beyond patient files.

Curiously, the commissioner noted that the NSHA had co-operated with the investigation. Did they have choice? Could they have refused?

Read the article here:

https://www.thechronicleherald.ca/news/regional/officials-caught-snooping-on-health-records-nova-scotia-privacy-commissioner-says-259358/

After the story broke Colin Stevenson, vice president of quality and system performance at the NSHA wrote a letter to the editor of The Herald to explain how seriously the authority takes personal privacy. He, like the rest of the crew at the NSHA, did not say they were sorry patient privacy was violated. This was no doubt done on the advice of lawyers who caution to never apologize lest it be seen as an admission of guilt. But guess what? The commissioner already said there is guilt.

Stevenson’s letter spoke of “the failure of an employee…” except this wasn’t the failure of one employee, it was six employees at multiple sites in the NSHA’s Central Zone (that’s head office area). This raises numerous questions:

1. Were these employees, who the commissioner liken as “health officials”, doing this for personal prurient interest ?
2. Was it revenge?
3. Since six health officials in one area were involved, was this a coordinated action?
4. If it was coordinated, to what purpose? Was it personal gain, some political objective or in connection with some criminal enterprise? (There have been instances across Canada where patient files were illegally accessed for the purpose of acquiring drugs.)

Stevenson’s letter can be found here:

https://www.thechronicleherald.ca/opinion/voice-of-the-people-nov-20-2018-260824/

Ironically, the identities of the officials accused of illegally accessing patient files have been protected as has any action taken against the staff.  The NSHA is good at working privacy rules to protect themselves.

This is not the first time health officials/employees have improperly/illegally accessed patient files.

In October 2018 a six-year-long violation (2005-11) of 120 patient files at the Hants Community Hospital was revealed. At the time Capital Health described this as “inappropriate access”. This resulted in a $400,000 settlement to patients.

A 2012 violation of 707 patient files at the Roseway Hospital came to light in 2017. That cost Nova Scotia taxpayers a $1 million settlement, plus legal costs as well as administrative and investigative costs.

Interestingly, a previous substantial violation and the most recent one were done by employees working in the former Capital Health Authority’s facilities, which is now the NSHA’s Central Zone. That’s significant because these violations were done right under the noses of senior management. This wasn’t done at some distant location executives never set foot in. If they don’t know what’s happening under their noses, how can we trust that they are on top of every day operations across the province? Have there been consequences for executives who fail to monitor those in their employ?

Each time a violation is uncovered, the health authority du jour issues a statement that it takes “its commitment to personal privacy seriously and it’s essential that patients can trust their personal information is protected.” Yet violations continue.

Platitudes aren’t good enough. The public deserves a detailed explanation for why these NSHA staff were looking at patient files.

There is no legal right to privacy for an accused. We need to know their name, their position and the purpose of their violations. And what consequences there are for them, the patients and the taxpayer.

 

 

 

Reopen the electronic records bid process

Paul Schneidereit has written a staggering investigative piece in The Chronicle Heraldabout the bid process for a new electronic health records system for Nova Scotia. Read it here:

https://www.thechronicleherald.ca/news/local/bid-process-stunning-management-of-multimillion-dollar-nova-scotia-health-records-contract-questioned-253235/

Schneidereit’s work raises enough questions to call for the current bid process to be halted and restarted.

The fact that EPIC Systems Corp., a strong, experienced industry leader, was excluded from consideration because their submission was delivered to the wrong office in the right building seems morally wrong and not in the best interests of Nova Scotians.

According to the article the submission arrived ahead of deadline. Workers who discovered the delivery mistake made multiple attempts to contact the Nova Scotia Procurement Office to arrange pick-up of the documents. EPIC’s proposal was rejected because Nova Scotia Procurement said it was late. However, it was only late because no one in the Procurement Office bothered to return their phone messages. How is it in the public interest to have a key industry supplier rejected because some bureaucrat wouldn’t answer their phone or walk to a neighbouring office?

This could be a billion dollar expenditure for the taxpayer. How do we trust that we are considering the best system when a key player is excluded because of bureaucratic pettiness? Who is responsible for this failure to act and do they still have a job? And if so, why?

Further, what assurances have we that rejecting a supplier on such a thin basis doesn’t reduce competition and increase our cost?

If we are to believe that the Nova Scotia Health Authority and the Department of Health are working in the best interest of Nova Scotians this bid process should be cancelled and restarted so that the people of Nova Scotia can trust that what we are buying is truly the best system for us. Under the current conditions we cannot have that faith in the process or NSHA. Executive platitudes about due diligence and evidence-based decision-making doesn’t cut it anymore.

And in the interest of transparency, the 32 people from the NSHA, IWK, Department of Health, Internal Services, Finance & Treasury Board and Transportation & Infrastructure Renewal, who are overseeing this process should publicly declare that they have no shares, bonds, mutual funds or other investments in the companies being considered.

 

NSHA show some compassion

As the world is fixated on the alleged sexual misdeeds of a nominee for the US Supreme Court it is worth thinking about this on a local level.

Recently in Nova Scotia we heard from a young woman who went to the Colchester East Hants Hospital to seek help after being sexually assaulted. That help consisted of being handed a pamplet and sent out on her own into the dark night after midnight! After being assaulted!

A week later another Nova Scotian woman came forward with a similar experience

Each of these examples show a cavalier, callous and cruel disregard for these specific victims of sexual assault.

Working on the well-founded theory that what happens to one (or two), happens to others, we can extrapolate that what has happened to two has no doubt happened to many other victims of sexual assault in this province.

While the Republicans in the U.S. Senate fight the optics of being an all-male panel (they hired a female lawyer to question the female accuser to mitigate their image), the Nova Scotia Health Authority lead my CEO Janet Knox has no such excuse.

Of the ten-person NSHA “Leadership Team” seven are women. Until September it was an 11-member team with eight women in charge. http://www.nshealth.ca/about-us/executive-team

So where is the compassion and understanding we expect from medical professionals? Where is the understanding and compassion we expect from women in charge of a health organization?

The Nova Scotia Health Authority has only been in existence since 2015, but sexual assault isn’t a new issue. It isn’t a woman’s issue, it’s society’s issue. That said, you would expect an organization lead by women would have this covered.

Janet Knox was the long-time CEO of the Annapolis Valley District Health Authority, prior to heading the NSHA. Surely she or her colleagues at the other health authorities had a protocol in place for dealing with sexual assault victims that didn’t further put them at risk by abandoning abused, single young women to the night?

Where is the compassion?

 

NSHA executive change

The unofficial news is that Dr. Lynne Harrigan is finished with the NSHA as of September 4th.

Harrigan is vice-president, medicine and integrated health services for the NSHA.

There has been no public announcement of Harrigan’s departure or replacement, nor is there any reference on the NSHA site to suggest she’s going or gone.

If true, this is a major change in management of the NSHA and of interest to ALL Nova Scotians. Has someone been hired to replace her? If so, who? If not, is there a search underway and how long will that take? And is this the start of a larger change at the top for NSHA?

What also concerns me is that often newly retired health executives in Canada become highly paid consultants for the hospitals/authorities they left. They’re paid at “market rates” as if there was some mythical private sector comparison position. The typical consultant rate usually works out to 1.5x their previous pay, for a casual, lesser-stress job.

The argument for retaining retired executives is to capitalize on their experience and knowledge. However, the cynical view is that it stifles innovation and progress by retaining old thinking and ideas.

It’s great for the retired executive/new consultant because it keeps them in the loop so no replacement can come in, solve problems and show them up. And is a good little money-maker. They have a pension @ 80% of previous pay ($326,941 in 2017-18, with an 8% raise in 2018-19 to $356,091), plus 1.5x pay. It’s less work, more money and offers opportunities to pop in on other projects and provinces as well as earning speaker fees at conferences held in exotic locations.

For the number two person in the provincial health authority to leave her position with no prior public announcement looks suspicious and further illustrates the bunker-like mentality of Janet Knox. Knox has a history of parcelling out snippets of information as if it were her property. She is and has always been oblivious to the fact that she is a public servant, who owes her position and wealth to the people of Nova Scotia.

If the news of Harrigan’s departure is true, should we also expect to soon learn of Knox’s imminent retirement?

Confirmed: Janet Knox has confirmed that Dr. Harrigan has quit the NSHA. The Chronicle Herald writes, “Knox didn’t provide a reason for Harrigan’s departure. In an email response to The Chronicle Herald, Harrigan said that she would not be speaking to the media.”

That’s the typical arrogance we can expect from these executives. Someone takes $5 million + in public money and feels they are above speaking to the employer. With that attitude it is time for Knox to also head for the door.

Private conversations have described this as “…leaving a sinking ship.”