NSHA’s failed doctor recruitment

There’s a theory that numbers don’t lie. However, their interpretation can colour the message.

Over the years, great minds have questioned numbers and facts used to promote an idea. In 1891 a letter writer penned, “It has been wittily remarked that there are three kinds of falsehood: the first is a ‘fib,’ the second is a downright lie, and the third and most aggravated is statistics.”

The following year, a writer to The Economic Journal said there are “three types of unreliable witnesses: a liar, a damned liar, and an expert.”

Later Mark Twain added his take: “Figures often beguile me, particularly when I have the arranging of them myself; in which case the remark attributed to Disraeli would often apply with justice and force: ‘There are three kinds of lies: lies, damned lies, and statistics.'”

Lies, damned lies and statistics sums up Nova Scotia doctor recruitment.

The lie is one of omission. The Nova Scotia Health Authority let Nova Scotians believe doctor recruitment was one of their first and on-going action areas. The NSHA was formed in April 2015. While the initial planning for the merged health system started under the NDP government of Darrell Dexter, who refused to admit it was an idea whose time had come, the NSHA was created after the Liberals won an election in October 2013. The two prime election planks of that election were re-aligning health care AND providing a family physician for every Nova Scotian.

Based on the election campaign and promise, Nova Scotians thought hiring doctors was job one for the new health authority. We were wrong. It is thanks to Auditor General Michael Pickup that we learned the NSHA didn’t put a doctor recruitment plan in place until the spring of 2017! Doctor recruitment wasn’t a priority for or even on NSHA CEO Janet Knox’s radar. In November 2017 Knox appeared on CBC Information Morning.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.”

That exchange is a prime example of the disconnect Knox has with the reality of health care delivery in Nova Scotia. Knox lives buffeted from the public and any unpleasantness by an army of VPs, senior managers and communications professionals who provide the distance on which her deniability is based.

The damned lies are the confused doctor recruitment numbers the NSHA has published. In April 2017 a communications person from NSHA sent me a list of 177 new medical recruits. However, a political operative told me those numbers varied from the 133 the governing party’s numbers showed. Around the same time the NSHA pointed to their success in doctor recruitment for Cape Breton. A Cape Breton doctor quickly challenged that success and said he had recruited some of the doctors the NSHA took credit for. Other hires were double counted – his became theirs, while his and theirs created ‘ours’.

The statistics fall into a wave of positive numbers around physicians accepting new patients. On June 2ndthe Department of Health and Wellness said since April 1st 319 provincial doctors had accepted a financial incentive to take on 4,904 patients. Seemingly good progress. Then we are told that because doctors took on patients from multiple zones the number of physicians in the program “equals 322”. Really? This is only a difference of three, but is the type of statistical bullshit favoured by bureaucrats and do-nothing executives. It is meaningless in delivering care to people. There either are 322 living breathing doctors treating patients or there are 319 doctors. Three doctors can mean the difference to 4,050 patients.

Whether you’re treated by an actual doctor or some sort of medical hologram, there are still a hell of a lot of Nova Scotians without any family physician.

In October 2016 a Freedom of Information request found there were 155,415 Nova Scotians in the “orphaned patients” category. That means without a family physician.

To address the lack of doctors, the NSHA launched the Need a Family Practice registry where people seeking a doctor could register by calling 8-1-1. Good luck getting through to that line. Many people have written letters or called radio programs to complain about the challenge of getting through to the line and then not hearing anything back.

In spite of the dissatisfaction of the public, the NSHA happily announced that in the first year of operation the physician resource line found matches for 10 percent of patients who registered.

Read about the NSHA success here:

https://www.cbc.ca/news/canada/nova-scotia/nova-scotia-physician-wait-list-matches-10-per-cent-patients-first-year-1.4380999

But the success of this registry is short-lived. Here’s its history in numbers:

Sept. 1, 2017  – 36,000 people registered for a doctor

Oct. 1, 2017     – 37,339 people were registered

Oct. 1, 2017     – NSHA reports that 4,331 people had been matched with a doctor

Jan. 1, 2018     – 41,877 people are registered on the doctor wait list.

May 1, 2018    – 47,669 people are registered for a doctor

June 1, 2018    – 50,024 people are registered

July 11- a story in the Chronicle Herald says more than 52,000 Nova Scotians are listed on the registry.

These represent the “official” number of Nova Scotians waiting for a doctor. The NSHA maintains it doesn’t know how many Nova Scotians are doctorless and the Department of Health and Wellness ignores the number given in the Freedom of Information request.

What neither the NSHA or Department address is how or why the registry numbers keep climbing in the face of the announced new doctor hires and expanded practices. Of course, when any new doctor is hired or a new residency is announced, there are caveats. It’s never now. It’s in the fall, in a year, in four years when students graduate …

The Province and NSHA are celebrating the creation of 10 new family doctor residencies – starting in July 2019. The Province and NSHA are mute on the loss of 10 doctors in Truro THIS year. They are equally silent on the 10 doctors Kings County lost between June 2017 and February 2018. And then there were all the solo practitioners around the province who stopped practicing.

The 2012 Physician Resource Plan, which was outdated when it was accepted, said that 1,100 Nova Scotian doctors would retire between 2012 and 2022. We are not keeping up with recruitment or training for the 100 doctors a year we need just to replace the retirements. There is no consideration for doctors who get sick, die or quit the province in frustration. Nor is there consideration for increased demand created by population growth. In the three years the NSHA has been in existence it is more than 200 doctors behind in physician recruitment. A clear fail. But not a number they would ever mention.

Lies, damned lies and statistics rule.

 

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Unbearably hot hospitals

There’s more trouble at the Victoria General Hospital in Halifax. Today we learned that the fan which powers the cooling system for the VG’s Intensive Care Unit broke. In the week since it broke staff had to jury-rig solutions, like moving smaller air conditioning units into the ICU. Adding units isn’t an ideal situation because of the clutter and potential noise they bring to an environment which is already space challenged and needs serenity for recovery.

Reports say the main cooling system’s fan broke. That happens. Equipment breaks. But the executive in charge says it’s not an off-the-shelf piece, it has to manufactured so it will be some time in August before a replacement arrives.

That’s a very calm attitude, but then one suspects this executive works in an air conditioned office. I question whether the Nova Scotia Health Authority or Department of Health take the impact of extreme heat into consideration for patient comfort and recovery, as a hazard to health, and for the comfort and efficiency of front-line staff.

In the last seven days 54 Quebeckers have died from the extreme heat. New Brunswick has issued heat warnings for the province. Nova Scotia? Nothing.

In 2012 a Toronto-based Nova Scotian executive complained to the management of the Valley care facility his mother was in and when ignored he approached the Department of Health. He wrote, “My mother had been moved there [the care facility] after discharge from VRH to recover from a stroke. The first day there was one of those hot and humid Valley scorchers with the temperature well into the thirties. There was no air conditioning in the building and I was told by the administrator that I shouldn’t be concerned. “Old people don’t mind the heat.” This was the same summer that thousands of elderly died in European heat waves. I took it to a senior official with the provincial ministry concerned with standards of care in nursing homes. Speaking to me from her climate-controlled office in seaside Dartmouth, she seemed unaware that it actually gets quite hot in parts of the province. She assured me her team took care to enforce the rules requiring sufficient heat in the winter, but summer heat–well that’s not a real problem. Very dismissive and out of touch. I installed our own air conditioner in the room.”

Our reality is that health care executives move with sloth-like speed when it comes to maintenance and repair. For decades the water at the VG was so toxic you couldn’t even wash your hands in it. And while Janet Knox was CEO of the Annapolis Valley District Health Authority, numerous problems with VRH occurred and took months to repair, whether it was a hot water tap to the revolving front door of the hospital – which breaks on an annual basis. The hot water tap took 19 weeks to replace! If you can’t fix a tap, why would we trust you with whole buildings and a system full of real estate?

Fast forward to April 2015: hundreds of surgeries were cancelled because of a problem with a Halifax surgical sterilizer. The problem was identified on April 11th, yet two weeks later, on the 24th the senior director at the QEII couldn’t tell the CBC where there were other sterilizers and how long it would take to repair or replace the suspect unit. Two weeks into the problem and she didn’t know how many sterilizers existed in the province or their location! As I pointed out she could have checked neighbouring hospitals in Halifax and Dartmouth as well as the medical and dental schools at Dalhousie. and various research facilities in the city. In their bureaucratic way, the NSHA had only started to “reach out” to others. Had one executive stooped to placing a few phone calls that could have been answered in an hour and hundreds of procedures could have taken place as scheduled.

In November 2017 VRH’s dishwashers broke. The hospital went several months calling in staff to hand-wash dishes before that was solved.

And now NSHA is prepared to wait a month or more to replace part of a cooling system in the hottest time of year during what is predicted to be the hottest summer in years. There’s never any sense of urgency or out-of-the-box thinking with the NSHA.

For instance, anyone with appliances to repair knows it’s cheaper to replace the whole unit than trying to find someone to fix it. Has the NSHA looked at that option? As for having a new fan manufactured, are they dealing with the original supplier or considered going local? Nova Scotia has an extensive ship-building and ship-repair industry. There are fabricators who could quickly craft a fan, which is not that different from a propeller. Has the NSHA looked to Lunenburg or other ship-building centres for a fast fix? Couldn’t they ask a company like the Irving shipyards, a few blocks away, for a fast favour? If we can build a battleship from scratch, surely we craft a part for a fan.

The NSHA does not appear to be a solution-driven organization.

 

 

 

 

 

 

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Is separating seniors policy?

Once again some officious little turd at the Nova Scotia Health Authority is harassing the elderly. Today’s news is of the separation of Bryce and Hazel Gibson. They are a Halifax couple who met 85 years ago. Bryce is 95, Hazel is 93. They have been married for 75 years.

Because he’s a veteran Bryce is in the Camp Hill Veterans Memorial hospital. Hazel is not a veteran so has to stay at another long-term care facility. Hazel is allowed to make day visits to Bryce. The madness is that Camp Hill has empty beds, but private facilities across the province are bursting at the seams. If Hazel could be moved to the Camp Hill, not only would the couple be happier, which would contribute to better health, it would open a bed for another senior in need.

The federal government, through Veterans Affairs, allows the NSHA to use discretion to fill the empty beds. So why not allow Hazel to move in with Bryce? The impediment is the NSHA. The NSHA hasn’t made the bed request. Why? Like everything to do with the NSHA they claim it’s a complicated process. Bullshit! This is not a new or unique issue. It’s just the failure of bureaucrats to anticipate and act.

Read about Bruce and Hazel here:

http://www.cbc.ca/news/canada/nova-scotia/veterans-long-term-care-hospitals-1.4726219

Over and over again, the public is told about the problems Nova Scotia’s aging population presents to government and health care. In all those excuses we don’t hear solutions. Government and the NSHA have had time to factor that aging population into all their decisions. Except they don’t. They piss away time, seemingly hoping death will solve problems for them.

This is not the first time separating married seniors has become headline. In April, Edwin and Marjorie Crossland, another couple in their 90s, were forced to live apart. The NSHA determined that Edwin was too healthy to live in the same facility as Marjorie. There was no concept that keeping the couple together was best for them and that Edwin’s presence could be a comfort for Marjorie and his participation in her care may have helped maintain his health. It could also have relieved the stress on care givers.

Their family believed “a deeply flawed” NSHA assessment contributed to the problem. Flawed assessments and misdiagnosis are a growing issue with the NSHA. I know a person who suffered a stroke. The NSHA’s documents list “vertigo” as the diagnosis.

Read about Edwin and Marjorie here:

https://www.cbc.ca/news/canada/nova-scotia/couple-reunited-nursing-home-1.4607086

In December 2017 New Brunswickers Herbert Goodine, 91, and Audrey Goodine, 89, married for 69 years, were separated by New Brunswick’s health authority.

Their story is here:

https://atlantic.ctvnews.ca/decision-to-separate-n-b-elderly-couple-sparks-widespread-backlash-1.3728401

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, for which there is no completion date. That was 21 months ago. Where’s the strategy?

Read about that here:

https://globalnews.ca/news/3013674/ns-pc-bill-guarantees-couples-can-stay-together-in-long-term-care-facilities/

I don’t believe this government is anti-marriage, in spite of how it acts towards seniors who have been married long enough to qualify for congratulatory messages from The Queen. But what does it take for this government and the Nova Scotia Health Authority executives to act? This is an on-going issue that has been recognized since at least 2015. Just how long does it take them to address a problem? Such inaction leads the public to conclude that separations of seniors is policy.

If the job is too much for her, perhaps Janet Knox could take early retirement and allow someone with energy and ideas to take over the NSHA.

 

 

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NSHA hospital closures and rationalizations

Nova Scotia is closing two hospitals in Cape Breton. This is not a surprise. Doctors have been talking about it for some time. People should be braced for more closures or “rationalizations”. How these two closures go will determine how quickly the NSHA moves on other hospital closures and conversions.

In July 2017 a Halifax-based specialist asked, “Why are there five hospitals in the Sydney area. I don’t care that New Waterford is not Sydney, it’s half an hour away. You don’t need that. We’ve gone through this and the amount of waste is absolutely staggering. Way beyond what people would imagine.”

This specialist’s belief is that with larger hospitals you have greater volume of procedures being done, which makes for better medicine and delivery of care and better outcomes. Doctors are more practiced and faster. He cited an announcement from the hospital in New Waterford that they were no longer going to deliver babies. “No #@$!ing kidding, they did two deliveries last year. Do you want a place to deliver you when they’ve done two deliveries?”

“The problem is the public get educated by the Department of Health and the Department is telling them what they think they (the public) want to hear. They’re not being educated by the people who are in there working.”

One of the issues for this specialist is the idea that care should be delivered within an hour of a person’s home. “That’s not based on anything. It’s a mythology.”

The belief by many in health care is that location of a hospital is primarily a political optic. Voters see a hospital in their community and feel that equates to better care. This specialist disagrees. He sees too much time wasted going through the motions of doing something in the community. “To people who say we don’t want to have to drive more than an hour away, okay, but when you go to that little hospital that’s half an hour away, you’re not going to be able to get the treatment and not get an informed opinion as to what the treatment should be. So you’re going to get back into your car or an ambulance and get transported three hours (to a larger, better equipped and staffed hospital). So that stop didn’t help. In fact, it hurt you because it slowed down your care, made it longer and ultimately placed roadblocks in there that are not helpful.”

[I personally know a younger man who was a passenger in an Acadian Lines bus that plunged into the Tracadie River in January 2010. He had neck injuries that, if not treated correctly, could have left him paralyzed. He was taken by ambulance to five hospitals in Cape Breton. There were no doctors present who felt comfortable treating his injuries, so he was driven to Halifax for treatment. In total, he spent seven hours on a board in an ambulance, being driven around Cape Breton and then across the province before being seen by a doctor.]

While the public believes proximity to a hospital is critical, the specialist I spoke with said, “the average amount of time for somebody who has a car accident to get into the OR on the OR table for definitive treatment is five hours. Trauma is one of the more acute events in people’s lives, if that’s how long it’s been taking (five hours) then maybe an hour is very unrealistic.”

It’s not only Cape Breton hospitals which this specialist mentioned. He is frustrated by the lack of services provided by Twin Oaks Hospital in Musquodoboit Harbour and Roseway Hospital in Shelburne. “They can’t do labs, can’t do x-rays after a certain time.” They also struggle to keep their ERs open. “Close it. They don’t do anything. I get calls there ‘Oh, we can’t get blood work, it’s after 5’ or ‘We can’t get an x-ray it’s after 5’.” He sputters, “Well what are you doing then? That’s not a hospital.”

Many of the smaller rural hospitals are essentially down-graded to a type of walk-in clinic. And as we see in Cape Breton, are set up to be replaced by Collaborative Care Practices. He also questions keeping the Annapolis Community Health Centre in Annapolis Royal open as a hospital, which is a short distance from the larger Digby General Hospital. (The NSHA have taken the position that residents of Weymouth should travel the 33.4 km to Digby for medical treatment; Annapolis Royal is 32 km from Digby, so should also fall under its care.)

The specialist’s ultimate frustration is that many of the “cottage hospitals” are like medical day cares. As a placebo people are admitted to hospital overnight before being sent home or forwarded to Halifax – if the case merits it. He specifically mentioned one hospital in Zone 3 which is (in)famous for bed blocking. “Family doctors fill these beds up, they get paid because this patient is under their care, but patients get a pass to go do something.” In essence, patients are admitted to hospital, but allowed to go home at night to sleep in their beds and return in the morning to “hang out” at the hospital. Another example he cited are “patients who, their kids are going away for a week on a cruise, bring mommy to the ER and get her admitted while they’re gone. It’s a babysitting service. That’s expensive.”

Others have suggested our higher death rates from cancer can be attributed to time lost in local non-treatment and “tinkering” in smaller hospitals.

These practices might be something for the Auditor General to investigate and quantify the cost to the patient, system and taxpayer.

We should be prepared for more closures. Politically you can’t take away and rebuild in one part of the province without a counter-balancing action on the mainland.

 

 

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NSHA fudges the facts

Whenever the Nova Scotia Health Authority promotes an idea or cancels a service they crow that their decisions are “evidence based”. They don’t do anything without examining and studying it closely.  Their evidence-gathering process is so cumbersome that it pretty much impedes progress. It took them over two years to even consider beginning the doctor recruitment process!

Now, the CBC has done the leg-work to further show how flawed the NSHA’s “evidence-based” decision process is. The CBC traced the process for deciding not to participate in the annual Rural and Remote Medicine Course. This April event in St. John’s is an annual recruiting opportunity for health authorities to meet over 600 medical students and family doctors. Every province and jurisdiction in Canada attended, except for Nova Scotia. A two-hour flight wasn’t in our budget.

When the news originally broke about NSHA’s failure to attend this event, executives claimed the cost didn’t make sense based on previous un-favourable results. BUT the CBC’s investigation raises the question of truth and accuracy in what NSHA says. The NSHA’s evidence-based decision making relied on eight-year-old information! The NSHA didn’t exist the last-time anyone from Nova Scotia attended the event. And the NSHA fortress mentality prevented them from checking with colleagues across Canada to see how useful the event was or consider if a better message delivered by a new recruiter would make a difference. Maybe the executive lack faith in their recruiters?

The Nova Scotia Health Authority fudged their facts. They have misled the people, the Premier and the Health Minister. What else have they been purposely wrong or misleading about?

Read the CBC report here:

http://www.cbc.ca/news/canada/nova-scotia/doctor-recruitment-healthcare-nsha-health-authority-rural-1.4711174

The NSHA executive seem to embrace a White House-like casualness towards facts. Yet again Nova Scotians are left to wonder how can we trust them?

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More medical incarcerations

News that some patients at the East Coast Forensic Hospital haven’t been discharged because of a lack of community resources seems a throw back to Dickensian era where people were locked up and the key thrown away for being perceived of having a mental weakness, or being poor.

http://www.cbc.ca/news/canada/nova-scotia/patients-institutionalised-intellectual-disabilities-1.4692147

The idea that 19 people are kept locked in a hospital for one-, two- five- and six-years beyond treatment needs shows the cavalier attitude of the Nova Scotia Health Authority towards patients and the public purse. How much does it cost to keep these patients in hospital and is that not wildly more expensive than providing support in their home communities? And does this forced stay not harm their recovery and deprive them of freedom of movement and association?

Beyond the hospital costs – in terms of hard dollars and wasted resources – this could be an expensive an embarrassment to the province. Since this is a secure facility, where patient movement is restricted, could these individuals have a case for violation of their Charter Rights? What if they sued? How much would that cost? Win or lose, the money would come from public.

Two years ago we had the case of a young Nova Scotian man incarcerated because his guardians used ancient statues, which included descriptions of “lunatics” and “insane or dangerous idiot”, to argue he was incapable of making decisions for himself. Is this recent round of medical incarcerations more of the same?

Is this false economy or another example in the litany of failures of the NSHA executive?

 

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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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