There should be no football tax on health care

The proposal to bring a professional football team and stadium to Halifax raises many questions.

Since the proponents of the stadium want the Province to contribute money and concessions on ownership of former federal lands, it’s fair for people outside HRM to be concerned and need clarification.

One of the proposed revenue sources is a two-to-four percent levy on hotel bills.

I wonder about the impact of this entertainment tax/levy on health care. HRM is the region’s medical centre with the greatest concentration of medical specialists.

So, like medical pilgrims, people come to Halifax for appointments, tests, treatments and surgeries. They bring their sick kids to the IWK. The bulk of these people travel with a family member or friend, who often need a place to stay. Every day hundreds of hotel, inn, lodge and B&B rooms in HRM are occupied by people who are here for medical purposes. A levy on their accommodations is a type of tax on health care.

While $4-$8 a night may not seem much to some, to families whose main income earner is ill or who have to take time off work, this adds up. In the U.S. this type of surcharge is called “drip pricing” and is getting push-back from the corporate community as well as being the subject of lawsuits in Nebraska and Washington, DC.

When thinking about this I discovered a similar hotel levy had been proposed to pay for sporting infrastructure in Glendale, Arizona. Glendale is a city of 230,000 a few miles outside of Phoenix. A federal judge rejected the levy on constitutional grounds.

We are a different legal system, but it is worth studying the Glendale experience since one of their former team owners is also a backer of the Halifax stadium proposal. The proposal for Halifax seems to mirror the deal the owners of the Phoenix Coyotes had with the city for managing the Gila River Arena. This link provides details of a similar-sounding proposal:

The Super Bowl Comes To Glendale, The City Ruined By Sports

I understand a passion for sports, but in Canada and Nova Scotia we have expensive sporting history to consider. An example is the exuberant former Montreal Mayor, Jean Drapeau, who famously said, “The Olympics can no more run a deficit than a man can have a baby.” Well, Montreal’s 1976 Olympics were so costly – 13 times over budget – that it took the city 40 years to pay off the Games’ debt.

In 2008, Glendale invested $14 million to host The Super Bowl. They lost $1.6 million.

More recently and more local was Halifax’s winning bid to host the 2014 Commonwealth Games. The public was told the games would cost $785 million, generate $2.4 billion in economic benefit, increase the province’s annual GDP, create 18,000 jobs and leave a legacy of “world-class sport facilities and programs”. Proponents said, “We are not going to see the kinds of overruns that other games have seen.”

But investigative reporting later learned that the real budget for the Games was $1.72 billion and would be closer to $2 billion. A consultant hired by the organizing committee criticized the organizational structure, business plan, proposed ticket prices, budget projections and said the positive assumptions – like higher attendance and ticket prices – were based on a “we are different” concept.

If Halifax is to host a professional sports team and stadium, perhaps we should look at the model provided by Green Bay, Wisconsin. Green Bay is a city of 109,000 people so it is smaller than HRM, yet is home to the Green Bay Packers, the winningest and most successful football franchise in the NFL. The Packers have no public money involved in the team or stadium, nor do they have a single owner. For lack of a better description, they’re sort of a cooperative.

The Packers are a community-owned team. They sell shares to the public and have 360,000 shareholders. Their last share offering in 2011 raised $67.4 million. In 2003 the Packers’ home, Lambeau Field, underwent a $295-million redevelopment that increased capacity to 80,000. The Packers’ organization paid for that.

It’s out-of-the-box thinking to raise money for professional sports by selling shares to fans and supporters, but it doesn’t divide the community and doesn’t put an extra burden on those who have to travel for health care.

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The NSHA needs more executive cuts

The Nova Scotia Health Authority announced some paring of their executive ranks, but it isn’t enough.

https://www.thechronicleherald.ca/news/local/ns-health-authority-cuts-vp-positions-pledges-to-give-local-zones-more-power-380091/

The article says three vice president positions have been cut. Whether those former vice presidents go or stay in some other capacity isn’t enough. The NSHA has not lived up to its mandate. I can say that because merging the province’s nine health authorities under one umbrella organization was my idea.

In 2009 my mother had a small stroke while having blood work done at Valley Regional Hospital in Kentville. Another health problem occurred and over nine months of daily visits to VRH I saw and heard many things that didn’t make sense. As a former newspaper publisher/business owner I saw ridiculous organizational and communications problems.

Prior to our family’s exposure to the system I used to believe everything would be great if only government gave health care enough money. I have since learned that no one in health care has any idea of how much money is enough to make the system work.

Doctors and nurses at Valley Regional told me their problems and issues, then connected me to their colleagues across the province. I learned universality of their issues. One issue was how medical talent and assets where under-utilized. While Halifax surgeons couldn’t keep up with the need, operating rooms in Windsor, Middleton, Pictou and other hospitals were dark. Surgeons were leaving the province because they couldn’t get operating room time.

In 2010 I started writing about health care on this blog and for The Chronicle Herald. I proposed merging the nine authorities into one to reduce duplication of management, streamline delivery of care, redirect CEO and VP compensation to front-line workers and utilize all provincial assets to speed up the delivery of care to produce better patient outcomes. Previous articles on this site highlight the extent of the executive duplication.

In February 2013, long before the writ was dropped for the October election, the former Leader of the Opposition, former health critic and a member of the Liberal Party office met me in a Wolfville coffee shop to discuss a vision for a merged health authority. Meanwhile former Health Minister Maureen MacDonald and Premier Darrel Dexter rejected the concept and repeatedly said they weren’t going to import chaos to NS health care.

When the Liberals took office they were astonished to learn how advanced the Department of Health’s planning was for a merged health authority. While the NDP publicly decried a merged system, behind the scenes they were working on the very idea.

In the last six months I have been at two public meetings in the Valley where people have wishfully mused about returning to more responsive local health authorities. They forget how poorly served we were under the previous nine health authorities.

Under our previous nine-authority system the goal was to treat patients within 100k of their home. This resulted in backlogs in some places and under-utilized facilities and medical expertise in others. If you were a patient in Windsor, because that was under Capital Health, you would have to go to Halifax rather than Kentville, which is closer. Nine health authorities were territorial.

The problem with the NSHA isn’t the system, it’s the management. We hired the same people who frustrated us when they managed the smaller health authorities to run a much larger organization. And perhaps stung by Opposition criticism of her spend-thrift ways at the Annapolis Valley District Health Authority (AVDHA), where administrative expenses were 8.3 percent of budget which was 60 percent above the national average, NSHA CEO Janet Knox kept a tight reign on information about provincial health. So tight was the information flow that the NSHA executive offices are constantly referred to as Fort Knox by Valley Conservatives and front-line medical workers.

Staffing is one of the great NSHA secrets. The NDP government introduced the Nova Scotia Public Sector Compensation Disclosure Act, which requires publicizing the name and compensation figures for anyone receiving $100,000 or more from the taxpayer.

The purpose of the compensation disclosure act was to give taxpayers a type of public oversight of expenditures.

Originally, most of the health authorities, universities and other organizations covered by the Act listed the names, titles and compensation of the province’s 1 percenters. Even the AVDHA provided this information. However, when the NSHA was formed job titles were dropped from the compensation report.

Retired Halifax physician and Dalhousie Medical School lecturer Dr. David Zitner often says, “you can’t manage what you don’t measure.”

Without job titles there is not real transparency in management of the NSHA. Without job titles, the compensation disclosure is merely a prurient act. Having job titles would allow us to see if organizations, like the NSHA, are top heavy in managers and executives. It could provide insights into problem areas in staffing and help the public understand how our money is spent.

This year’s public compensation numbers are a prime example of this transparency failure by the NSHA and government.

In fiscal 2017-18, the NSHA filing listed 884 names. However, fiscal 2018-19’s filing contains 2,699 names! This wasn’t a massive, across-the-board pay raise, but the distribution of public service award distributions, which for senior executives ranged from $49,441 to $132,183. For privacy reasons this isn’t detailed in the filing.

If we can read an individual’s name and compensation, how is it more invasive to know that part of the package was a one-time payment? How is it more intrusive to know their job title or area of responsibility? This level of secrecy doesn’t make sense.

The NSHA has a spreadsheet – which they provided – showing the names, job titles and amounts paid to these thousands of staff. John Gillis, director of content and media relations wrote in an email, “Regarding inclusion of titles in the reporting, the audited document posted complies with what’s directed in legislation, but acknowledging the value of understanding the roles of the people identified, we have always made available on request a version that includes that information.”

What is troubling is that of the 2,699 people paid over $100,000 this year by the NSHA, 725 were vice presidents, directors, managers, coordinators, consultants, advisors, analysts, and some other managerial title holder. Other managers and executives earning $99,999.99 aren’t listed.

The raison d’etre for merging nine health authorities into one organization was to streamline management and direct money from the executive suite to frontline care. These executive numbers show the NSHA is not keeping with the vision for merging health authorities. Not enough heads have rolled at the NSHA.

When I wrote my first book, Sweat Equity, Atlantic Canada’s New Entrepreneurs, I learned that government and civil servants love process. The disconnect is that entrepreneurs – and the public – focus on results and outcomes. This is the problem with the NSHA. They’re health bureaucrats who love “process”.

The other problem with our health executives and decision makers is their disconnect with front-line care. When Knox was head of the Annapolis Valley District Health Authority, she worked from the corporate headquarters in the industrial park in Kentville. In the nine months I made daily visits to Valley Regional I only knew of three visits she made to the hospital. I knew that because I heard nurses groan, “What is SHE doing here? She only shows up when something’s wrong.”

The NSHA headquarters is again an anonymous glass office building in an industrial park in the HRM. Once again, health decision makers are disassociated from the front lines. They don’t see patients, doctors, nurses, other health workers or the worried, concerned looks of patient families. Health executives need more than a spreadsheet relationship with what medicine in this province looks like.

A post script:

The former Chief of Staff to the NDP Premier of Nova Scotia has written The Chronicle Herald to praise part of what I wrote and disagree that the NDP were working behind the scenes to merge health authorities. He wrote, “The NDP respected local decision-making. And yes, there were detailed plans for more efficiency in the backroom, to free up funds needed to ensure everyone had access to a family doctor.”

But the CoS claims this was not about merging the nine authorities. That’s his historic perspective of his party’s actions. The Liberal government found the organization done under the NDP so advanced it saved them a year of planning. That assessment came from the top levels of the current government. It boils down to: he said, he said.

Believe which version you want. I’m sticking with the Liberal story because our family’s experience under NDP health care was so hellish. Health care under the NDP was not great. It was so poor that it inspired me to launch this website.

 

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A system held together by tape

The state of Valley Regional Hospital in Kentville illustrates the frustrations the public have with the Nova Scotia Health Authority, government and the state of provincial health care.

Valley Regional Hospital is one of the province’s newer facilities. It’s a critical element in making Kentville one of the province’s four main medical centres. And as the main health facility in Nova Scotia wine country it’s a recruitment star. Yet, it seems to be falling apart.

Everywhere you look is duct tape. I’ve been going to Valley Regional on an almost daily basis since mid-June. In six months the only fixes I’ve seen are the application of new pieces of duct tape on existing problems. Thinking back, some of these duct tape fixes have been in place for years.

In addition to floor tiles taped into place, are gashes in walls of patient rooms. Some holes have tape on them, some show a start to a dry-wall fix which was not completed, others are ignored. Then there is the chipped furniture both in patient rooms and nurses’ stations as well as stuffing busting out of split upholstery in nurses’ chairs. Nova Scotia may not be the richest place in North America, but we’re not a Third World country. Our leading hospitals shouldn’t look like we are. It’s untidy looking and a health hazard.

This is troubling because loose tiles or degraded under-floors are a hazard to patients, visitors and staff. The holes in walls and nibbled-away furniture are places which can’t be cleaned and therefore become breeding spaces for bacteria and superbugs, thus making

Inside Valley Regional’s main entrance, just past the information desk and leading to the business offices is this loose, duct-taped-in-place tile.

patients less safe.

I don’t fault the maintenance staff for this. The blame is squarely on hospital management. Either they haven’t given the maintenance department the money or authority to fix these things or the executives are blind to the problems. That’s not surprising given how rarely hospital and health care executives are ever on-site.

Since the NSHA can’t look after those facilities in its care, they shouldn’t be given more to manage. Our needs seem to be above the abilities of the NSHA executives.

Top of the steps leading to the cafeteria from the main atrium of Valley Regional Hospital are these loose tiles.

Taped tiles in the main atrium of Valley Regional Hospital.

Another tape fix at Valley Regional’s main atrium.

This cluster of duct-taped tiles in the corridor leading to Medical Units A & B are so loose they click when stepped on.

Another main corridor tape fix at Valley Regional Hospital.

This duct tape is over a weakness in the floor. There are layers and layers of tape. Wheel a gurney or wheelchair over this or step on it and the area just beyond it and the floor sags. If someone were on crutches they could go flying. The underfloor has failed. The only thing holding this section of floor up is the linoleum. This is between Medical unit A & B.

There is a thin line of red tape around the admissions window at Valley Regional’s ER. The linoleum has a long-existing, never-fixed problem with the seam between two pieces of flooring.

Duck tape covers a corner in a room in a holding unit.

Different room with damaged corner. No duct tape yet applied.

A different patient room gash in wall.

Same patient room, different hole in wall. Both are breeding grounds for disease.

This unfinished dry wall repair is in a different room in the same medical unit.

This is a hall station where the dry wall finish has been eaten away by hand cleaner.

Nibbled away door bottom for yet another room. How does this happen?

The corner of a patient night table has crumbed away. Another rough, unwashable surface on which gems can breed?

The construction of a new dialysis unit – the one announced in 2012 – has blocked off an emergency exit for Medical B.

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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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