More deadly failures of care

The lead story in today’s Chronicle Heraldis heart-breaking and infuriating.

http://thechronicleherald.ca/novascotia/1570575-‘the-wound-was-the-size-of-your-fist’

There should be no using the bullshit privacy defense for such an egregious failure of care. Those people paid to deliver the care, paid to supervise it and manage the facility should be named, shamed and prevented from working in a care situation again.

This is one story, the article references five more, showing that it is not unique. From September 3, 2009 until June 3, 2010 I spent 6-to-14 hours a day, every day, at Valley Regional Hospital in Kentville. Valley Regional was then overseen by Janet Knox and Lynn Harrigan. Knox was president of the local health authority and Harrigan was vice president of medicine.

There was a woman in the next room whose bedsores/ulcers were so extreme that she – sorry for this graphic – basically had no heel. Her condition had been so neglected that it became a life-threatening, hellish existence. She had no life. She was kept heavily sedated, her family maintaining a type of living wake around her bed, day-after-day, month-after-month.

In addition to the pain medication her bed was outfitted with a special air cushion to keep anything from touching this painful, open, festering wound. The air cushion was operated by a pump that hung on the edge of her bed and sounded like a vacuum cleaner.

The constant sound of the machine was upsetting and so annoying that it frayed every nerve you had. It made it impossible for anyone to share a room with this patient. I don’t know what impact it had on her, if she could comprehend it from her drug-induced state, but it shortened tempers and tolerance of those patients the hospital tried to have share the room.

Pressure sores happen. I had a nickel-sized one develop during a surgery. A wound expert came in and provided a bandage. In a few days it was gone. How do pressure sores/ulcers grow to the size, scale and seriousness of the case cited in the Herald or what we saw in Kentville? How could care givers ignore it and not react? And if no one understood the seriousness of it, who is being hired, who is doing the hiring, and where is patient management? How can we trust those in authority when such stupid, preventable problems are allowed to go untreated?

The Nova Scotia Health Authority’s response that it could take one or two years to investigate the problem and solutions illustrates the vacuousness of this organization’s leadership. Pressure sores and ulcers are not new. Health care executives, medical professionals have known about this issue for decades and failed to act. That is unacceptable.

This is a ridiculous waste of lives and resources for something which starts out as a petty annoyance. Heads should roll. And potential charges should be investigated.

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More meaningless sounds from the NSHA

The one thing the Nova Scotia Health Authority excels at is making comforting sounds. And why not, they have a public relations army in their employ. It’s ironic because their response to any query is to throw up the patient privacy wall as a reason not to respond.  If only the NSHA hired as many doctors as they do communications people.

The NSHA’s latest meaningless, comforting sounds were delivered to the widow and family of Jackie Deveau. Deveau was long-time military veteran who had been a patient at the Cape Breton Regional Hospital, suffering from post-traumatic stress disorder. On March 11, 2017 he walked away from the hospital and was killed in by a hit-and-run driver.

His widow received a letter which said a review was conducted and that one of the recommendations was to establish a clear communication protocol for serious events in an in-patient setting, including who should be notified, how the notification should happen and an expected timeline of communication.

The story is here:

http://www.cbc.ca/news/canada/nova-scotia/jackie-deveau-death-creates-change-in-hospital-protocol-1.4653995

The NSHA communication sounds reasonable if you don’t think about it. But why is a review needed? Why isn’t there already a clear communication protocol? It’s not brain surgery. They already have that information. No one is a patient of a hospital or long-term care facility or even a walk-in patient for blood work or other medical test, without staff confirming next-of-kin and their phone number. Why not use what you already have? Why don’t hospital staff attempt to stop a patient who is suffering from a mental incapacity or pressure from leaving a hospital?

Why do we have to establish another protocol? This is just a buying time to ride out bad headlines.

Do we have to conduct a study at every hospital and clinic for every incident? We have a unified health care system to deliver standardized levels of and access to care as well as uniform procedures. Not to apply them is yet another example of the poor management at the NSHA.

Mr. Deveau was not the first patient to wander away from a hospital. It’s been a long-standing problem at the East Coast Forensic Hospital in Dartmouth and other facilities.

In June 3, 2015 a mental health patient at Valley Regional Hospital walked away without his family’s knowledge. He walked 15 kilometres in socks.

A hospital representative blamed the incident on an ER doctor, then hid behind patient confidentiality to avoid answering hard questions about how mentally compromised patients can wander off. In March 2010 I saw a man wearing a johnny shirt tucked into his underwear walk away from Valley Regional. Hospital staff stood in the main doorway laughing and making fun of him. No one attempted to stop him or call next of kin. Another time I informed hospital staff about a young man I found standing outside an aunt’s hospital room. He was a mental health patient and his presence near an frail, elderly woman later at night concerned me.

Later, the balcony level at VRH was enclosed by glass. I was told that was because one of the mental health unit patients threw himself over the railings. Enclosing the balcony was to discourage others from attempting it.

In January 2015 a potentially dangerous man drove away from the East Coast Forensic Hospital. After his “escape” a hospital rep said, ““We review every incident with regards to what led up to that and if we need to make changes or adjustments to how we practice, then we would do that arising from the reviews,”

http://www.cbc.ca/news/canada/nova-scotia/mark-baltzer-escape-from-east-coast-forensic-hospital-to-be-probed-1.2898589

Inspite of their review another patient left the Forensic hospital in June 2017 and ended up in Charlottetown where he flashed two young girls.

This article itemizes five examples of patients walking away from the Forensics hospital. One walk-away resulted in the murder of gay rights activist Raymond Taavel.

https://www.ctvnews.ca/canada/n-s-psychiatric-hospital-criticized-over-unescorted-patients-going-missing-1.3641017

These are the incidents we know about. How many others have there been and have been swept under the privacy carpet to spare the system from lawsuits and preserve underserved reputations of managers?

Both Janet Knox and Lynn Harrigan should have developed a plan for such incidents by now. They were in charge of the Annapolis Valley District Health Authority, when several of these incidents took place. It’s not like they’re unaccustomed to patients wandering off. They have had decades to form a protocol that could have been implemented across the system before the merger of the health authorities and certainly in the years since. Their failure to do suggests either disinterest or laziness. So lacking action, the NSHA once again makes comforting sounds to wait out the public attention span.

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Lax leadership at the NSHA

Once again we have dynamic proof of the lax “leadership” of the Nova Scotia Health Authority. I use the word “leadership” loosely. I don’t mean to imply vision, inspiration or success in the role, merely referencing those at the top of the corporate pyramid.

Currently the Premier and Health Minister, as well as many Nova Scotians, are upset that the NSHA didn’t send a representative to a physician recruiting event in St. John’s which was targeted to the practice of rural medicine.

NSHA’s explanation/excuse is that they haven’t done well at it in the past and it’s too expensive. As excuses go that’s a bit rich. This executive have a reputation for spending. When they headed the Annapolis Valley District Health Authority (AVDHA) their administration costs were three percent above the national average. As a perk, which is on-going, they provided subsidized lunches to 160 white collar workers toiling away in the corporate bunker. This involves employing two catering staff on-site at the executive offices, trucking morning and afternoon snacks as well as a hot and cold lunch entrée the five kilometres across town from the hospital. This was/is considered a reasonable cost for these executives. One assumes that a subsidized lunch program has been introduced for the NSHA corporate offices in Halifax. Which hospital kitchens provide it?

The decision not to travel the great distance from Halifax to St. John’s seems like they’re trying to hide their past failures by inaction.

Interestingly, every other province and territory had recruiters at this event. The recruiter for the Yukon told the CBC that she had developed “60 soft leads” from the event and expected those to become “10 hard leads”. The Yukon, like others, used this as an opportunity to develop relationships with medical students, which they maintained throughout the students’ years of study. The Yukon knows who is ready to graduate and makes offers before others.

NSHA hasn’t done a stellar job in recruitment among local medical students, so why should we think they could woo students studying in Newfoundland? The biggest impediment to practicing medicine in Nova Scotia has been the NSHA. In pursuit of its collaborative care masterplan the NSHA has discouraged physicians from practicing where those physicians were interested in practicing. It has dictated unacceptable terms and conditions. And then it just basically treats people like shit. The most recent example is the $10 million spent to litigate the case of Dr. Gabrielle Horne – which Dr. Horne won. That’s not a positive message for any professional considering relocation.

Speak to anyone in Nova Scotia’s health care system and you don’t hear happiness. What you hear are people counting the months until they can retire and get away from the bullshit. I wonder if this count-down has seeped into the executive suite. CEO Janet Knox and Vice President Dr. Lynn Harrigan are around 24 months from retirement age. Have they adopted a don’t-rock-the-boat position as they wait for their numbers to add up?

Another disincentive for action is the fashion in health care for new-hires to reward those who gave them their positions with lucrative consultancies, thus doubling or tripling the executive’s retirement income.

But why would we expect this leadership to perform? In the nine years of covering health care in Nova Scotia I have not heard from a politician, physician, patient, nurse, front-line worker, supplier, other health executive or union representative who had positive impressions about the system or those in charge. No one has pointed to any example of success or innovation in the careers of these executives. Those who work in the system are unhappy. Those who use the system are unhappy. And politicians – in and out of government – are unhappy.

Given how this leadership has performed, why would any young professional with a world of choice, choose to work for the Nova Scotia Health Authority?

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NS Health tries to reinvent the wheel

For several weeks the CBC have been reporting about the successful doctor recruitment program exercised by Nanaimo, B.C. and Goderich, Ontario. Both communities have sold doctors on the idea of living and working in each place.

Both communities made their recruiters available to answer questions and arrange services on the ground. Goderich and Nanaimo sold their destinations as desirable places to live and work. This is somehow considered a revolutionary idea. It’s only revolutionary to reporters who don’t hire people and overly bureaucratic operations, like the Nova Scotia Health Authority, which lacks people skills.

This is a 4,000-year-old Roman wheel. It’s round and still rolls. NSHA would have to study the theory of a wheel before accepting its functionality.

Once again, health care executives try to re-invent the wheel.

In my 40+ year career it was and is standard practice for an employer to help a new hire transition into the community. As an employer if we hired someone from outside the community or if I was recruited to move, accommodation leads were provided. I was told about the community and what it offered. I was taken around and introduced to people. Banks used to rotate young staff throughout their system as part of the training process, so the banks maintained an inventory of suitable accommodations for their staff. It’s not rocket science, it’s a version of the Welcome Wagon.

In 2013 I added a page called Doctor Recruitment (see above). As an example of what companies do to attract and keep staff, I wrote: “Earlier in my career I was publisher of The Kings Country Record in Sussex, New Brunswick. While I was there, Denison Mines decided to develop a potash mine in the neighbouring community of Penobsquis. Denison’s vice president of human resources flew from Toronto to meet with me. He did that because of my age and marital status. I was a single executive in my 20s. He wanted to know about life outside the office. He said, “If I’m going to ask people to transfer from Toronto with all the nightlife and cultural options they have there, what can I promise these highly-motivated professionals?””

Health care is supposed to be about people. So why is it so thick, so unresponsive, when it comes to human resources? The NSHA and its executives don’t have a good record for recruitment, retention or respect. When health executives speak of “patient-centred care” that’s not a philosophy, but a reminder to them of their media training and speaking points.

This week the government announced it was topping up doctors’ pay by $39.6 million. That’s positive. What is less positive is the fact that just before this we learned the NSHA was comfortable spending $10 million to litigate a losing case against an individual doctor.

And last week I ran into a just-retired front-line health worker. She had worked for the Annapolis Valley District Health Authority for 28.5 years. She had over 1,000 banked sick days – days she could have taken off, but didn’t – and at the end of her career no one from the health authority said good bye, gave her a card or in any way acknowledged her three decades of service or retirement. She ended her shift and walked out the door. Period.

Hers is a telling experience because health care is riddled with early retirements of people who love their work, love making a difference to patients, but are fed up with the shit they take from disconnected, inconsiderate and inconsistent executives.

Given our history it makes you wonder why anyone would work for this crowd.

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Problems off-loading ambulances continue…

Poor public memory contributes to poor health care.

The news this evening was of long delays in off-loading patients at Halifax hospitals. On Monday there were 17 ambulances backed up at the Halifax Infirmary emergency department. One waited up to 10 hours for patient to be accepted into the ER.

The Nova Scotia Government and General Employees Union (NSGEU)

blames the current government for staff shortages that cause longer wait times. The executive medical director for the central zone of the Nova Scotia Health Authority, Dr. Mark Taylor, claimed that a higher volume of ambulance calls – 53 versus their normal 45 – was the cause for the delays.

Taylor said while it’s true that the number of ambulances waiting at the Halifax Infirmary emergency department peaked at 17, he said, “Most of them were under two hours so they were rotating through.”

https://globalnews.ca/news/4080008/halifax-infirmary-emergency-department-has-reached-dangerous-tipping-point-nsgeu/

Apparently Dr. Taylor doesn’t know that the provincial standard for off-loading patients from an ambulance is 20 minutes. We shouldn’t be surprised because Capital Health, now the NSHA, have failed to meet the standard for the last eight years.

This is not a new problem. It first surfaced in 2010. At the time the Capital Health Authority told the then NDP government they would improve their standards by 10 percent per quarter to reach the provincial requirement. The then health minister allowed this.

No one mentioned how long that would take. In theory it gave the authority until September 2016 to meet the provincial requirement. It was a totally bullshit target designed to remove the problem from the minister’s desk and let the health authority ride out public memory and the government mandate.

It’s cynical, but it works for the executives. Here we are eight years later and nothing has improved.

So, with each news story the public expresses outrage, and they and the unions say the government should do something. The health authority pretends it’s a unique situation. Everyone forgets that this issue was in the news in February, when a one per cent rise in call volume had paramedics waiting for hours for their patients to be seen. That time the NSHA trotted out a different executive – we don’t want to repeat faces and names in the news or the public might remember this is on-going problem – they put their senior director of acute medicine, Madonna MacDonald, before the media to explain that the health authority was trying a number of approaches to address the “complex” problem.

In October 2017 CBC reported that hospitals were struggling to meet standards for off-loading patients. That time two QE2 ER doctors were left to speak to the situation.

http://www.cbc.ca/news/canada/nova-scotia/ambulance-offload-times-patients-wait-hospital-paramedics-1.4350598

http://www.cbc.ca/news/canada/nova-scotia/health-care-ambulance-offload-delays-paramedics-hospitals-1.4345855

I’ve raised the issue in October 2017:

https://helphealthcare.wordpress.com/2017/10/10/slow-ambulances-nothing-new/

and April 2012:

https://helphealthcare.wordpress.com/2012/04/26/capital-healths-poor-performance/

and January 4, 2012:

https://helphealthcare.wordpress.com/2012/01/04/if-it-happens-in-ontario-is-it-happening-here/

and July 30, 2014:

https://helphealthcare.wordpress.com/2014/07/30/health-care-whats-in-a-name/

and February 7, 2015:

https://helphealthcare.wordpress.com/2015/02/07/why-arent-ambulances-included-in-universal-care-coverage/

and March 16, 2015:

https://helphealthcare.wordpress.com/2015/03/16/a-worrisome-timeline-for-change/

and June 12, 2015:

https://helphealthcare.wordpress.com/2015/06/12/how-fast-is-health-care/

and on November 6, 2016

https://helphealthcare.wordpress.com/2016/11/06/health-cares-five-and-seven-year-timelines/

The public and unions can blame the government du jour, but the real villains in this story are the health care executives who fail us, year after year, decade after decade, government after government.

Better care will only come when the public make the effort to remember who is responsible for this consistent failure. Those people aren’t in Province House, they’re at the secretive bunker containing the offices of the Nova Scotia Health Authority.

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Stinky health care spending

The stink surrounding questionable executive expenditures at the IWK is growing.

The details are laid out here:

http://www.cbc.ca/news/canada/nova-scotia/iwk-tracy-kitch-auditor-general-stephen-darcy-1.4555146

The details seem to be adding up to a type of abuse that most of us have felt was unbelievable in a small place like Nova Scotia where everyone knows everyone.

Coming on the heels of this expanding questionable expense scandal are the legal costs incurred by Capital Health and the Nova Scotia Health Authority to defend themselves against a legal action by Dr. Gabrielle Horne.

Jim Vibert, writing in The Chronicle Herald, says legal experts believe the health authorities spent $10 million of taxpayer money on their defence!!

http://thechronicleherald.ca/opinion/1550008-vibert-justice-demands-full-accounting-for-dr.-horne’s-ordeal

This gobsmacking number is unacceptable. It is too great an expenditure to not be publicized and questioned. Who authorized this? And how is it acceptable to piss away so much money on such a questionable case? The health authority managed to have the monetary award for Dr. Horne reduced, but they were still found guilty. They were wrong. And we, their employers, are left holding the bag while they spend unlimited amounts to protect their reputation and income.

Dr. Horne spend $1.3 million to defend her reputation, so with the $800,000 award granted by the appeals court, she is out money, and patients were deprived of her skill and research. Where is the penalty for the people who failed in their obligations, who were judged in the wrong by the court? What penalty or suffering or inconvenience did they endure?

The Horne case should inspire a provincial cap on how much a government agency, board, commission and minister can spend on legal fees. Allowing public officials and executives to treat the public purse as a bottomless resource for them to hide behind and cover their failures is wrong and immoral and, in this case, doesn’t contribute to better medicine in Nova Scotia. We need fixed limits on legal budgets. The NSHA won’t like it, but tough, it may be the only way to make this super secret authority truly accountable.

The questionable expenses and outrageous legal bills stink to high heaven.

When someone in the public employ behaves badly, does something illegal and/or actionable, they, not the taxpayer, should pay. It is unacceptable that the public health care system is left to pay for these wrong, and perhaps illegal, actions.

Many times a case like this would have been settled privately without the necessity of going to court. It’s ironic that a body as secretive as the NSHA would do something so publicly, which raises the question: was this action about an issue or vanity and vengeance?

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How much does this saving cost?

Halifax cardiologist Dr. Gabrielle Horne has had a $1.4 million damage award downgraded to $800,000.

In 2002, Dr. Horne, who was a rising medical star, had her hospital privileges reduced after a dispute with a hospital director of the former Capital District Health Authority.

Fourteen years later, in July 2016, after a 33-day trial into administrative bad faith a jury awarded her $1.4 million. It was the largest such award in Canada for damages to reputation and career.

The health authority appealed the award. So did Dr. Horne.

The health authority may feel they saved $600,000 with the decision of the Nova Scotia Court of Appeal, but at what cost? How much more was spent on lawyers for this appeal? How much staff and executive time was eaten up by this? And more critically, how much has this cost Nova Scotia and the Nova Scotia Health Authority’s reputation?

As we try to recruit new doctors what does the appeal say to prospective physicians about how we value and respect medical professionals?

Dr. Horne has still prevailed. It took her 14 years of fighting an unsympathetic system and she won. Two years later, she may have less money coming from the NSHA, but the court hasn’t questioned the facts: she was wronged!

The message is simple: this is a health regime that doesn’t value doctors. Of all the places in the world to practice medicine, why would a doctor choose to come to work among an executive class who won’t admit a wrong and will use the weight of the public purse against them? The only hope to salvaging the province’s and NSHA’s reputation is for a change at the top.

How much as this saving cost us?

 

A Post Script: This article in The Chronicle Herald tells us how much the lawsuit cost Dr. Horne.

http://thechronicleherald.ca/novascotia/1549558-dr.-gabrielle-hornes-14-year-legal-battle-cost-a-staggering-1.3-million

It’s a safe bet that the corporate costs for Capital Health and NSHA were far greater. Thinking about the higher costs of government actions, it wouldn’t be surprising if the NSHA/Capital Health legal costs were between $2-$3 million. Put another way, that could buy several mid-range or one top-of-the-line MRI machine. Or it could have paid the salary of a family physician for eight-to-12 years.

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