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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Physician recruitment doesn’t add up

Nova Scotia’s family physician recruitment plans don’t add up. The Government and Nova Scotia Health Authority don’t seem on the same page.

The Nova Scotia Health Authority’s list of “career opportunities” suggest it seeks to hire family physicians on a one-for-one basis. A physician retires or moves, the NSHA posts an opening. Hiring on a one-for-one basis only exacerbates the province’s doctor shortage. The rule of thumb in Nova Scotia is that most family physicians care for 2,000 patients. Longer-practicing doctors have almost double that number of patients. My personal physician, in his early 40s, has 3,800 patients.

New doctors are being recruited with work-life balance in mind. To that end, new recruits are expected to handle a patient load of 1,350 people. That’s one third fewer patients than the bulk of family physicians in Nova Scotia see.

On April 6, at a community event I mentioned this to an MLA and suggested we should be hiring 1.5 doctors for every opening. He responded by saying, “We should be hiring TWO doctors for every one that leaves.”

On April 27th, in responding to a television reporter’s questions about the provincial doctor shortage and Inez Rudderham’s video about her journey with cancer in Nova Scotia, Premier McNeil said his Annapolis riding was losing six doctors and “we should be hiring twice that number” of doctors.

What the Government is advocating is not what the NSHA is doing.

The Premier’s comment means the NSHA should be hiring 12 family doctors for Annapolis County. The NSHA is only advertising for three physicians. In Kings County, which lost nine family physicians between June 2017 and February 2018, but is getting three doctors in November, the NSHA is looking for five full-time and one part-time family physician.

The net loss of family doctors in those two counties is 12, but the NSHA only sees the need for 8.5 physicians.

That part-time physician opening is one of 19 part-time positions across the province. This is curious because Doctors Nova Scotia says they haven’t a definition for a part-time physician. The best guess is that this would be half of a full-time physician’s patient load, so 675 people. Whatever a part-time physician’s duties are, the NSHA appears not to have transmitted them to DoctorsNS.

Adding up the patient loads of the 12 Annapolis and Kings County doctors who have left or announced their departure means 33,000 patients are seeking a family physician. However, the NSHA recruitment goals would only provide a full-time family physician for 11,475 people. That leaves 21,525 “orphaned patients”. This doesn’t include those residents who didn’t have a family doctor before these departures.

The question remains: if new doctors are expected to see one-third fewer patients than those they replace, why aren’t we advertising more open positions? And why are the Government and NSHA so far apart on our needs?

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Gabrielle Horne speaks

Finally, Dr. Gabrielle Horne is speaking up about the hell Nova Scotia health care put her through. Her story is a warning to potential medical professionals thinking of working here as well as to Nova Scotians, about who to trust, and to those politicians who continue to shield the guilty.

This is an important read:

https://www.theglobeandmail.com/opinion/article-physician-heal-thyself-the-potential-crisis-of-conscience-in/?fbclid=IwAR0bVqSyyl_S6KRYmJDZUK1gYfmoZzYsEoxUqYIg01uUWiESmv2I4gdfKmY#comments

In the reader comments two writers wrote:

MG59 said, “In the interest of fairness, I would be curious to hear the other side of this story.

“I’m not saying that she is necessarily misrepresenting things, but anyone with life experience dealing with powerful people in high level organizations knows that there are two (or more) sides to these internal conflicts, and she seems to be alleging conspiracies and dark dealings among a large number of people.

“Count me a bit skeptical.”

AceMcFool added, “I guess I’ve been around too long to reaily (sic) believe in such one-sided perspectives, especially when so many people are involved.”

This article is Dr. Horne finally speaking after a decade of persecution and litigation in which that unheard ‘other side’ spent in excess of $10 million taxpayer dollars to try to silence her and protect the vanity and professional reputations of those who were in the wrong.

In Nova Scotia we reward resumes, not results.

While the original complainant may have been a male physician, the harm was carried out – and funds approved to do so – by women. Specifically, former CEO of the Capital District Health Authority, Chris Power, who is now CEO of the Canadian Patient Safety Institute. Power was in charge when the spurious accusations were made against Dr. Horne. Then, when the Nova Scotia Health Authority was formed, CEO Janet Knox, a long-time friend and colleague of Power, approved a multi-million appeal against the initial court ruling for Dr. Horne.

In the interest of public health, better health and fairness, the public needs to remember that the courts TWICE found in favour of Dr. Horne.

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The acute doctor deficit in Kings County should concern all Nova Scotia

Nova Scotia’s health care shortages are almost biblical: no room at the inn, or hospital, clinic or doctor’s office.

Common-sense, backed up by research, says that having a family physician improves health. The physician-patient relationship means illnesses are caught earlier, when it is faster and cheaper to treat, thereby improving health and reducing emergencies. Hospital over-crowding comes from sicker patients who don’t have a family physician as well as a shortage of long-term care beds (some of which might be unnecessary with better access to doctors).

The whole system seems bogged down a type of creative accountancy seemingly designed to spare us from the hellish truth and cover years of inaction by health care executives.

A front-page article (Doctor shortage takes toll on Nova Scotia specialists) focused on the problems faced by specialists and ER doctors at Valley Regional Hospital in Kentville.

https://www.thechronicleherald.ca/news/local/doctor-shortage-takes-toll-on-nova-scotia-specialists-291329/-

The most succinct summary of the situation in Kings County is a sign posted on the door of the walk-in clinic in New Minas. In a classic Catch-22 situation the walk-in clinic is so overwhelmed it can no longer accept walk-in patients.

DSCN1299

This notice is on the door to the walk-in clinic in New Minas, Kings County. (Allan Lynch Photo)

Kentville is a bell-weather community for the state Nova Scotia health care. First, the Valley Regional Hospital was built as a medical hub where the bulk of specialists in SW Nova are located. Secondly, for the 10 years before she became CEO of the Nova Scotia Health Authority, Janet Knox was president and CEO of the Annapolis Valley District Health Authority. Former NSHA VP of Medicine Dr. Lynn Harrigan was also with the AVDHA, as was Tim Guest, NSHA vice president of integrated health services. They know this hospital and this community intimately, and should know its problems at Valley Regional better than anyone.

The article said 4,752 doctorless patients visited Valley Regional ER in 2018, up from 1,302 in 2013. It’s going to get a lot worse. There’s an easy parallel for understanding this.

Officially, the NSHA’s family physician waitlist has 51,119 people on it. Since November 2016 the NSHA says 75,645 people found a physician. Perhaps they have, but focusing on the official NSHA figures is like jogging on quicksand.

Adding up those waiting for a doctor with those who found a doctor equals 126,764 people. However, an October 2016 Freedom of Information request revealed that 155,415 Nova Scotians didn’t have access to a family physician. The FOI numbers said 20 percent of HRM (78,019) and 14 percent of rural residents (77,396) didn’t have a family physician. Subtracting the official NSHA figures from the FOI number shows 28,651 unaccounted for potential patients.

The population of Kings County in 2016 was 60,600. Fourteen percent of 60,600 is 8,484 people without a family physician. Between June 2017 and February 2018, seven family physicians in Kentville, Kingston, New Minas and Berwick closed their practices. Two other GPs closed their practices and relocated out of the county. One of the departing physicians also held clinics two days a week in Berwick, so his loss was both to his patients (I was one) and the Berwick walk-in clinics. We also lost an eye-ear-and-nose specialist. A common, conservative figure used for average patient loads for established family physicians is 2,000. However, two of the seven had long-time practices which had in excess of 7,000 patients. If you can keep up with the math that means in nine months 21,000 Kings County residents lost their family physician. Add on the 8,484 FOI number and we see that 48 percent of the population of Kings County (29,484) are without a doctor.

A Nurse Practitioner has been found for Kentville and two GPs and a psychiatrist have announced plans to open a New Minas clinic in November. Using NSHA new guidelines for patient loads this gives 3,200 people access to a primary care professional, leaving 24,284 without.

It’s been over a year and up to a year-and-a-half since these seven doctors left their practices. They would have given several months’ notice of closure and yet, the NSHA has failed to hire replacements. The “employment opportunities” listed on NSHealth.ca on March 16, 2019 shows openings for family physicians in Berwick, Kingston, New Minas, Kentville, Canning (full- and part-time), as well as a pediatrician and two anesthesiologists in Kentville, and a Family Practice Department Head – Western Zone.

On top of the physician openings, the Western Zone – Valley, South Shore, Yarmouth – doesn’t have a Zone Medical Executive Director. The job description says, “The Zone Medical Executive Director is accountable for developing physician leaders as well as utilizing resources in an efficient and sustainable manner. Working with a provincial set of policies and standards, the position has zone-level responsibility for the following areas: physician engagement, integration and performance management; privileging and credentialing; appointment and oversight of physician leaders in compliance with the medical bylaws; physician resource planning; coordination of residents and medical students, and physician professional development. In addition, the Zone Medical Executive Director is responsible for integrating provincial programs in the Zone.”

Many doctors question the levels of bureaucracy in the health care system, but this posting shows that no one is in charge in SW Nova. If we are to believe all the layers of executives serve a purpose, then the situation in the Valley can be likened to an orchestra without a conductor. The fact that the NSHA has trouble filling executive posts – Cape Breton is also short a Zone Medical Executive Director as well as 15 other vacant management positions – suggests no one wants to work for this organization. Or at least not under the current executive.

With nearly half of Kings County without a doctor, the walk-in clinic and Valley Regional are bound to be swamped by people seeking medical attention. How serious their need is relative because just getting a prescription refill requires authorization by someone with a medical degree. (BTW, doctors aren’t paid for renewing prescriptions.) If you don’t have a family doctor, if the walk-in clinics no longer accept walk-in patients, the only option is the ER. That is a situation foisted on people by the NSHA’s cavalier physician recruitment plans.

Kentville and Kings County are a health care bell weather situation because they are such highly attractive places to live and work that the NSHA prominently features their position as the heart of Nova Scotia wine country in recruitment marketing. If the poster place for recruiting struggles with a net loss of physicians and ever-growing numbers of orphaned patients, how bad is it the further from Halifax you live and work?

We have heard of the dissatisfaction in Cape Breton. We have heard of the problems in Kentville. A physician in Yarmouth tells me they’re next. By June Yarmouth General will be down to one anaesthetist, which he says makes surgeries almost impossible. The NSHA is looking at a replacement from South Africa but that anaesthetist is still in South Africa and not here. The majority of the residents who were trained in Yarmouth either left the province or became hospitalists elsewhere. And another town doctor is moving his practice to Kelowna. In 2011, six local doctors closed their practices, so the problems aren’t new, they just haven’t been fixed.

In a rebuttal piece about the Kentville situation (Valley patients not in peril while waiting for surgery) Guest said they have teams working hard to address operating room resources, bed flow and human resources. “Our multi-year hip and knee action plan included approval to recruit four additional anesthesiologists for the province.” That’s confirmation of approval to start recruitment, which isn’t the same as having hired someone. The need is not new.

Guest’s rebuttal is here: https://www.thechronicleherald.ca/opinion/counterpoint-valley-patients-not-in-peril-while-waiting-for-surgery-291599/

In response to Guest, local resident Bob Levy, who is a former NDP MLA for Kings South and retired judge, wrote this: https://www.thechronicleherald.ca/opinion/letter-to-the-editor/counterpoint-nsha-blame-shifting-292255/

The NSHA attitude towards doctor recruitment is casual in the extreme. We have been bleeding doctors long before the NSHA was formed. The Physician Resource Plan published in 2012, and which family physicians complained was outdated when it was published, said we needed 100 new physicians a year to maintain a status quo which was already stretched to breaking. The PRP predicted that by 2021 our medical needs will equal those of 1.1 million people. That need is based on age, not an actual growth in provincial population.  The increased needs of our aging population is a popular excuse for NSHA problems, but not something they or their predecessor authorities seem to have addressed.

Nova Scotia’s Auditor General, Michael Pickup, highlighted the NSHA inaction on November 27, 2017 when he revealed that a physician recruitment plan for the province wasn’t put in place until the spring of 2017! That was two years after the NSHA was officially created. Further, he said that the recruitment efforts of the Nova Scotia Health Authority and Department of Health weren’t coordinated. Which perhaps explains by the NSHA skipped medical recruitment fairs.

After these revelations, NSHA CEO Janet Knox was interviewed on CBC Information Morning. Then-host Don Connelly said to Knox, “I suppose that every conversation you have or hear is about doctor recruitment.” Knox responded, “No, it’s only been in the last year that has been a topic.”

This is a surprise because physician recruitment, retention and loss has been a long-running, hot topic in Nova Scotia. It was the key issue the 2013 provincial election was fought on. Politicians, professional associations and the Physician Resource Plan have long urged action. More and more doctors have been speaking publicly about the declining conditions in our health care system. It boggles the mind that NSHA executives can claim to be surprised by the complaints.

This is not a system failure, it is a management failure. We don’t need more studies, we need to find executives who will act on existing studies, recommendations and needs rather than talk about them.

 

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Knox needs to explain herself

Janet Knox needs to explain herself.

In a province that has an acute shortage of doctors, nurses and other medical professionals, why does Knox constantly squander surgeons?

Situations like that of Dr. Jeannie MacGillivray, who when facing burn out found a solution that worked for her, another surgeon and patients, and was forced to to resign don’t make sense.

Rather than support a doctor who recognized her stress, who found a workable solution, the Nova Scotia Health Authority not only said no, but made her work environment untenable.

Read the latest here: https://www.thechronicleherald.ca/news/local/surgeon-says-proposed-compromise-led-to-nsha-ultimatum-forced-resignation-283921/

Dr. MacGillivary’s situation isn’t unique. What’s different is she spoke up. Her experience should be a warning to physicians thinking of practicing in the province. (See Is the NSHA anti-woman below.)

As someone with a family physician, I am concerned about losing him. A year ago my previous physician closed his practice due to work-related stress. I was able to scramble and get on with his former practice partner. What worries me is that I am one of 3,800 patients this physician sees. He has asked for help from the NSHA, he’s asked for a locum or a Nurse Practitioner to support his practice, and been refused. I am concerned because how long before he either burns out or out of frustration moves from Nova Scotia to practice elsewhere?

My previous doctor was one of 10 who closed their Kings County practices in a 12-month period. Since then we have had over 30 of physicians in Cape Breton and the mainland Eastern Zone give up their practices.

In September 2017 the hot topic in provincial health care was physician burn out. A year and a half later, nothing seems to have changed.

The impediment to physician health and happiness lands squarely at the Nova Scotia Health Authority. Janet Knox is the CEO. She is in charge. The buck stops at her desk. In January Dr. Bob Martel called for a change in leadership. He is not the first to say that, just the first to put it in print.

We have done everything to change and improve health care for Nova Scotians. The government boldly changed the management structure by merging nine health authorities into what was supposed to be one cohesive unit. The government has invested close to a billion dollars in expanding HRM facilities as part of a staged, re-imagining cluster of care in preparation for replacing the Victoria General complex.

While we have a new system and a new vision we placed it under the care of old thinkers and an absentee/passive board of directors.

Bricks and mortar help, but don’t replace the skill and dedication of front-line medical professionals. There is no evidence that Knox’s tenure at the head of the NSHA has been successful. So why does the government continue to support her? Is it because of the expense of terminating her employment contract? (I was told hat was why we didn’t eliminate as many health executives as originally planned with the merger.)

The situation with the NSHA reminds me of a situation which existed in Canada’s military. In the 1970s it was discovered that Canada had more officers than enlisted men. Is this to be the fate of Nova Scotia health care: more executives than doctors and nurses?

What is the Government’s justification for keeping this executive in power?

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Is the NSHA anti woman?

A rash of resignations within the ranks of doctors makes me wonder if the Nova Scotia Health Authority is anti-woman?

I know the CEO Janet Knox is a woman, but that doesn’t mean anything. I don’t subscribe to the theory that women are more benevolent bosses. Think Golda Meir, Margaret Thatcher, Indira Gandhi, Aung San Suu Kyi et al.

The American author Maya Angelou said, “When people show you who they are, believe them.” I think we can judge the NSHA by its actions towards female doctors.

In 2013, while Knox was CEO of the Annapolis Valley District Health Authority, she and then-VP of Medicine Dr. Lynn Harrigan, refused to find funds to pay for Dr. Andrea Veljkovic’s services. Veljkovic is an orthopedic surgeon who specialized in treating foot and ankle issues caused by diabetes. She travelled around SW Nova performing surgeries in Kentville, Middleton, Yarmouth and Bridgewater. Knox said Kentville was allocated five orthopedic surgeons and Veljkovic made six. Basically funding Veljkovic’s practice broke a quota. So there was no money for a sixth surgeon. There was obviously the patient-need, but not the executive imperative.

Dr. Veljkovic was forced to leave Nova Scotia. Her husband, who was a respirologist, left with her.

This was silo-thinking. At the same time orthopedic surgeons in Halifax were complaining of having 13,000 people on their surgical wait-lists.

The next long-running issue was how Capital Health, followed by the NSHA, abused Dr. Gabrielle Horne. The two health authorities spent over $10 million taxpayer dollars fighting Dr. Horne in court. Dr. Horne prevailed in her first case, then the NSHA went back to court to fight the damages Dr. Horne was awarded. The NSHA spent several million to save a few hundred thousand dollars. Dr. Horne received a little less, but was still found by the court to be the injured party. The NSHA didn’t explain why they felt the imperative to prolong this legal case. The cynical suggest it was to prolong Dr. Horne’s pain and inconvenience. (The story is here: https://helphealthcare.wordpress.com/2018/02/27/how-much-does-this-saving-cost/ )

In June 2018 Dr. Stephanie Langley stepped down as site lead at Northside hospital.

In December the story broke that Dr. Jennie MacGillivary, who had been performing surgeries at St. Martha’s Regional Hospital in Antigonish as well as procedures at Inverness Consolidated Memorial Hospital for 12 years was suddenly out of a job. At both facilities. The NSHA and Department of Health turned a deaf ear to MacGillivary’s complaints about job burnout.

In September 2017 Doctors Nova Scotia warned the NSHA about physician burnout. At the time of that warning, former NSHA VP of Medicine Dr. Lynn Harrigan said, “The first thing is to recognize that physicians are subject to burnout, there’s no question about that physicians are overworked. Physicians are stressed and so you have to look individually at the cause for burnout and also if there is a systematic problem for burnout, we have to address that as well.”

In MacGillivary’s case the NSHA addressed it by removing any hospital position for her.

On February 5th, the public and professionals in Cape Breton learned that Dr. Carol Critchley had resigned as lead for family medicine at the Cape Breton Regional Hospital. The previous month Dr. Meaghan Keating quit as zone leader for family medicine.

A colleague said Critchley, who had held her position for several years ‘received little compensation or recognition in return for the extra administrative work’.

The story is here:

https://www.cbc.ca/news/canada/nova-scotia/family-doctor-carol-critchley-quits-health-authority-position-1.5005482

When Dr. Jeanne Ferguson criticized the declining access to care in Cape Breton, her comments were dismissed as “inflammatory”. Ferguson maintains that likening the situation in Cape Breton to Third World conditions was “somewhat understated”.

Male physicians haven’t seemed to generate headlines and hard feelings on the scale of these female doctors.

I asked several Nova Scotian physicians if they thought the NSHA was anti-woman.

One physician thought the women are “being targeted” for speaking out. Another thought the NSHA might be “indifferent”. A third said, “If anything, I suspect the men just put up and shut up and move on.”

The NSHA may be a woman-run organization, but that doesn’t mean it’s a women-friendly place to work. Otherwise we wouldn’t be losing so many accomplished professionals.

 

 

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Doctor prescribes change of leadership at NSHA

Dr. Bob Martel has written an important piece about health care in Nova Scotia. The Herald posted it to their website, but I fear too many people may have missed the notice and link to Martel’s piece.

Go here:

https://www.thechronicleherald.ca/opinion/dr-bob-martel-four-reforms-that-could-reboot-health-care-delivery-277181/

Dr. Martel’s four solutions for the sickness that is Nova Scotia health care and the Nova Scotia Health Authority starts with this:

  1. The current leadership at the NSHA needs to change. They have had four years or more to communicate a strategy and operational plan to change the trajectory of health care. They have failed, and so they must go.

I whole-heartedly agree. In the last two decades we have twice changed how health care was organized in this province. We have altered every aspect of the delivery of health care, the duties of various providers and professionals, collective agreements, everything has changed. Except for the executives.

We still have wait-lists, we have denied care, poor patient outcomes, closed ERs, over-worked medical professionals, and on-going dissatisfaction of the public as well as doctors and nurses with the quality of care and what it takes to access it.

The failure of this version of health care in Nova Scotia comes down to two things: either we have the wrong people running it or we hired people with the wrong skill set (which means we have the wrong people in charge). There is a quotation misattributed to Albert Einstein which says, “Insanity is doing the same thing over and over again and expecting different results.” Welcome to Nova Scotia health care. We can not achieve change will old thinkers.

There is no chorus urging the government to maintain this executive. Dr. Martel is among the first to call for a change in executives. How long before other voices join him in calling for a swift change? Is the government so committed to this executive that they will overlook our unhappy reality and jeopardize their potential for a third mandate?

There is political theory that drives governments not to admit mistakes. Politicians are advised that admitting an error or realizing a policy/action didn’t work shows weakness and arms your opposition. Politicians overlook the fact that these advisors tend to keep their jobs regardless of whether a government survives.

Merging Nova Scotia health care into one organization was a bold move. It was handed to people who haven’t lived up to that boldness and vision. For it to work, we need change at the top. Will that be change in Province House or the NSHA HQ?

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