Nova Scotia tried decentralized health care: it didn’t work

During the 1993 federal election campaign, Prime Minister Kim Campbell said that a 47-day campaign was not long enough to discuss the changes she envisioned. This was shortened to the infamous: “An election is no time to discuss serious issues”.

With Campbell’s candour in mind, I was disappointed to read Jim Vibert’s piece in the July 24thChronicle Herald where the leader of the Progressive Conservative party promoted the return to de-centralized health authority.

Having interviewed PC leader Tim Houston Vibert writes, “They [the PC Party] don’t like the Nova Scotia Health Authority and want more decision-making decentralized to the regions and communities that know their health-care priorities better than bureaucrats in Halifax. That does sound right.”

Sounding right and being right are not the same thing. Nova Scotia has been there, done that and it didn’t work.

While it sounds reasonable, this is a spreadsheet solution that doesn’t factor in human nature. Spreadsheets have been the downfall in provincial health care because people muddy up theory.

Memory is selective, which coupled with current anger and disappointment, clouds the history of failure with our past. Nova Scotia had a decentralized health care system, which was so piss poor that the 2013 provincial election was fought on the idea of a centralized health care system, which was more streamlined and less bureaucratic. That election sent the NDP to defeat and the Liberals to a majority.

Prior to 2013 Nova Scotia had nine district health authorities plus the IWK. In the easy fantasy world of ‘things-were-better-then’ some people believe health care was better when health care was left to these nine sets of local executives to administer. I suggest anyone who thinks that didn’t need or experience health care at the time.

Here’s what happened when we had nine local health authorities:

1.    We had an army of executives duplicating the work across the province. The idea behind a provincial health authority was to streamline the process, reduce duplication, have fewer high-paid executives and funnel more money to front-line patient care. The failure was we built a new system and put old thinkers in charge. Old thinkers brought up from the regions.

2.    Nine health authorities competed for money and staff. It was unfair to smaller, rural places because larger population areas as well as those authorities run by executives who were better connected, got Halifax’s attention.

3.    There was uneven service and access to care between the various health authorities.

4.    Separate health authorities added to wait times because there was no coordination for resources. We had numerous under-utilized assets. Patient care was to be delivered within 100 kms of the person’s home. If a specialist lived outside that catchment area patients couldn’t automatically be referred. Secondly, while surgical wait lists grew, a number of operating rooms across the province were dark. Pictou lost their surgeon and his GP wife when in frustration he left the province because he couldn’t get OR time. The reason for this? It was a budget-stretching device by the local health authority. The operating rooms in Amherst were another under-utilized asset. Once the NSHA was functioning hip and knee patients across the province were given the choice of waiting up to 24 months for care at home or travelling to get surgery within two weeks.

5.    Physician and specialist loss. I detail the losses in this June 2016 post: https://helphealthcare.wordpress.com/2016/06/13/a-quick-scorecard-for-physician-loss

6.    Unhappy employees. When surveyed, 52 percent of front line health care workers (doctors, nurses, specialists and others) distrusted their employers. Working conditions were so bad that a surgeon told me the head of their health authority “was so stupid they lowered the IQ of any room they entered.” See this 2013 post for details: https://helphealthcare.wordpress.com/2016/06/13/a-quick-scorecard-for-physician-loss/

7.    Slower delivery of care. Because each health authority was a kingdom until themselves, it was a challenge to get care in another authority. There may have been a process in place, but the reality was a series of frustrating – sometimes fatal – delays in getting the right help.

8.    Cronyism. Local board members told me they weren’t heard or listened to. Local boards were populated with friends of the executives, who oversaw the appointment process. Several board members from different health authorities told me they often felt bullied, silenced, disregarded, dismissed and ignored. 

9.    Hidden failure. Because of the multitude of regional health districts it was easier to hide failure of care. Patient families were often told they didn’t understand the situation or that it was an one-off. But with a province-wide health authority we could begin to see systemic problems, like the proliferation of bed sores across a wide spectrum of facilities. We also saw uneven sanitization and ambulance wait times.

10. Lack of purchasing power. A centralized purchasing department can achieve efficiencies of scale in pricing not available to smaller organizations. Plus, given shortages of certain drugs and treatment materials, a larger buying organization has more sway with suppliers.

Nova Scotia has done well during the COVID-19 pandemic. How would we have acted if we also had to coordinate our responses, reporting, testing, treatment and vaccinations between 10 separate health districts? A centralized system – as imperfect as it is – managed to do better than other provinces, states and nations.

Reorganizing the delivery of health care in Nova Scotia away from a centralized authority to regional bodies is a two-year process, which would divert hundreds of millions of dollars from patient care to a system which does not guarantee better health.

 

 

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Official COVID-19 hypocrisy

Over and over we are told the COVID-19 recovery is a marathon, not a race. We’re told the end is insight. We’re told to be patient. To be kind. To be understanding. We have been, but the way leaders act tests our patience.

The G-7 meeting this weekend in Cornwall is an example.

Looking at how the G-7 leaders have acted is a shining example of the hypocrisy of privilege. No doubt they are all vaccinated. Host British MP Boris Johnson who almost died of COVID-19 appeared in official photos with the other leaders observing social-distancing. Official welcomes showed leaders, including Justin Trudeau, touching elbows in greeting. BUT once the official photos were taken the leaders clustered together, shoulder-to-shoulder, maskless to watch Britain’s Red Arrows fly past. Then, these same leaders lined up, close together, in a pre-pandemic style for a beach barbecue.

Images are here:

https://www.dailymail.co.uk/news/article-9682735/Big-weddings-ban-Barbecue-world-leaders-G7-summit-sparks-hypocrisy-claims.html

The host of an Australian morning TV show, echoed by a London host, asked why citizens can’t gather like that if they are fully vaccinated? She asked, ‘do we trust the vaccines and what our leaders have told us or don’t we?’

More mixed messages from those who are supposed to lead by example. Do what I say, not do as I do was never acceptable and less so now.

This is a pattern of contemptable behaviour. In Alberta, Premier Jason Kenney was criticized for hosting a “working dinner” on the balcony of the so-called “Sky Palace”. This dinner seemed to contravene the province’s COVID regulations. No one was wearing masks, people were not socially distanced, they weren’t from the same household, the numbers appeared to exceed provincial limits, the table was covered in shared items from wine bottles to small dishes. There were people coming and going to the table. The optics were so bad that two of Kenney’s own cabinet ministers called for an apology.

A political science professor said this was reminiscent of a rash of foreign travel by senior government officials. An Alberta cabinet minister went to Hawaii for the holidays. The Premier’s chief of staff went to the U.K. A parliamentary secretary went to Hawaii. A member of the provincial treasury board went to Arizona. Other MLAs went to Las Vegas and Mexico.  All of these trips violated travel prohibitions.

Ontario’s Finance Minister spent his holidays in the Caribbean. Saskatchewan’s highways minister went to Palm Springs. Quebec provincial politicians went to the Bahamas and Peru.

Federally we had MPs who went to Seattle for a funeral, Delaware to visit a sick relative and another went to Greece for an urgent family situation. Non-elected Canadians haven’t been allowed to visit their sick and dying relatives, nor have most of us been able to hold funerals. For a year we were barred from visiting nursing homes.

Other MPs took foreign holidays in Portugal, Ireland, Mexico and the U.S. One MP said his repeated trips to his U.S. vacation property were for essential maintenance issues.  A senator went to Mexico. 

The heads of several major hospitals as well as the CPP pension board made personal foreign trips in contravention of travel restrictions. These people have at least lost their jobs. Several are suing. 

The question remains how difficult is it for those who make the rules to follow them? They have every perk and privilege available. In return we ask them to obey the rules and regulations they set for us. 

We do what they ask for us, but they don’t do what they ask of us. That is simple hypocrisy.

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The VG: toxic water, toxic accountability

The water situation at the VG has become a renewed topic of conversation. 

In February, The Chronicle Herald ran a news story about a microbiologist’s shock at the unsafe water conditions at the region’s largest hospital. The professor then wrote an op ed piece about fighting cancer and the right to clean water. Letters to the editor followed. 

What is surprising is that a microbiologist living within an hour’s drive of the hospital would be surprised by this. He wrote, “I was shocked by what I can only describe as a situation more generally seen in the Third World – there is no capacity to take a shower at the VG, as the water system is decrepit and has been so for over 10 years now. This significantly increases the risk of infection for the most vulnerable in the province and this is unacceptable both from a human and logistical standpoint.”

The professor is wrong – or too modest – when he says the water situation has been a problem for over 10 years. It has been a problem for more than 40 years! That’s how long the previous health authority, current health authority and Conservative, NDP and Liberal governments have known that the VG’s water system contained Legionnaire’s bacteria. For all those years the hospital’s water has only been suitable for flushing toilets. You can’t even scrub the floors with it.

Prior to the pandemic I asked the Nova Scotia Health Authority (NSHA) how much they spend for water at the VG. I was told that in calendar 2019 the NSHA distributed 40,161 1 litre bottles of water to the VG, Centennial and Dickson buildings for a cost of  $70,545.17. That seems both outrageous and yet somehow modest. It makes me question how I phrased my question and if this accounts for all water purchases for cleaning, sterilization and such? 

Distributing 40,161 plastic water bottles also isn’t exactly green. It undercuts the province’s goal to reduce our carbon footprint.

In the decade since I started this blog, I’ve written numerous times about the VG’s water problem for this blog, for The Herald and spoken on CBC and News 97 about it. 

I first wrote about the VG’s water problem October 2013:

https://helphealthcare.wordpress.com/2013/10/06/navigating-capital-healths-dangerous-waters/

In 2013 I asked how the water problem could go on for so long? If this was a hotel, restaurant, apartment or office building the Department of Health would have closed it. So how can a hospital continue to function with a toxic water supply?

In January 2016 I referred to a CBC report by Jean Laroche who was able to reach many previous health ministers about the VG water problem. Laroche found that for 14 health ministers the VG water issue wasn’t a high priority. Ministers act on the advice of their deputies and the health executives hired to run the day-to-day operations. Decade-after-decade toxic water wasn’t an urgent action item for anyone in charge.

How can this happen? It’s a combination of situations. I blame the laziness of the public who have no memory of on-going problems and only learn of issues when personally faced it with them. Secondly, is a tendency to automatically dismiss a problem like this as a sign of the incompetence of a government they don’t support (an excuse undercut by having had all three parties form government). Thirdly, is the lack of accountability of those in charge. I mean deputy ministers and health executives. Voting someone out of office just prolongs the problem and gives more cover to those bureaucrats and executives who fail to perform.

Nova Scotia is quick to protect the reputations of senior executives and bureaucrats, whether deserved or not. We are told that so-and-so has had a stellar career, so earn the benefit of the doubt whenever questions arise. But had those questions not been dismissed those protected careers and reputations might not have been so stellar. The tarnish would show. 

If we look across society we see examples of failure to perform, poor choices and outright criminal acts conducted by people who have risen to positions of power and trust. For example, there are the church sex scandals, and just within the last month the Chief of the Defense staff had to step aside. Before him, the Governor General left her post. On and on and on it goes.

Yet in Nova Scotia health there doesn’t seem to be any accountability for those who fail in their performance or don’t live up to what we are lead to believe their roles are. 

A prime example occured in 2002 when the Capital District Health Authority reduced the privileges of Dr. Gabrielle Horne. Dr. Horne was a cardiologist engaged in cutting-edge research and a rising medical star.  There was a disagreement with a hospital director and the health executives came down on the director’s side. Dr. Horne fought back and took the health authority to court. Capital Health and its successor organization, the Nova Scotia Health Authority, spent 14 years and $8 million defending the director. The courts found for Dr. Horne and awarded her $1.4 million – the largest such award in Canadian history. The NSHA, refusing to admit wrongdoing, appealed. The NSHA spent another $2 million to lose a second time. They did succeed in having Dr. Horne’s award reduced to $800,000. The bottomline is Dr. Horne was unfairly treated by the NSHA. She lost years of research. Patients lost out because her research was impeded. However, the director did not suffer. He continued on in his position, collecting his pay, enjoying his perks and building his pension. So did the health executives who backed him.

We can go through a lot of senior positions to find reputations which shouldn’t be protected by the public purse. 

Another example is the senior health executive who spent office time looking for sex. Normally, one’s sex life is private. Until you make it public. You do that when you 1) post a profile (with photos) on an on-line sex site, 2) your profile lists “hook up info, when: evenings, weekdays, weekends” and 3) list where you like to engage in public sex!

Being available for sex on “weekdays” is our time. That’s time we paid $223,006 a year for. Not only was this executive available for sex, they were actively on-line during office hours looking for it (the site posts a green icon when an individual is on-line). And when they travelled for business, they posted where they were staying and what they were looking for. That’s how I knew that for the week of February 4, 2019 this executive was attending a convention at the Lord Elgin Hotel. I assume the convention costs were on the public tab. [There were days when this executive was on-line for two-to-four hours at a time, presumably from their NSHA office, using NSHA technology and servers. Is there a government and NSGA policy about such use? In other situations wouldn’t that be considered contributing to a toxic workplace?]

I have struggled with this knowledge since 2011. I learned of it when I was in line to pay a bill. In small communities people chat to you, whether they know you or not. In this small line-up a man joked that since I was interested in health care perhaps I could get an invitation to the hot tub sex parties this executive hosted. I thanked him and said no. I wasn’t so much surprised that someone was having sex parties in a hot tub as I was that someone with such a high profile in a small community would think no one knew. Or perhaps they didn’t care? I kept silent about it because it was private. But when this individual posted their workweek availability they made it the public’s business. 

I mentioned it to a friend who was a webmaster. He made a few clicks and found their profile. Over the years, whenever that executive’s name was mentioned in the media I checked on-line. Their career progress made them bolder and bolder on-line. Their pay grew by 50%, they earned a long term service bonus greater than the average income of most Nova Scotians, received a $40,000 separation package and grew their pension account and enhanced their resume.

During this executive’s tenure there were serious questions about their department’s performance. I’ve always wondered if CEO Janet Knox was aware of these daytime diversions or if she preferred to turn a blind eye to them?

This kind of cover up goes to the failures in the system. Executives say they are doing as well as they can with the money they have. But could they do more if we had their full attention? Could care delivery and hospitals be better if there were actual financial, reputational and career consequences for under-performance and failure? 

Pay, perks and privileges should come with real accountability. Unfortunately, it doesn’t in health care. Otherwise, the VG wouldn’t have been allowed to jeopardize the health of patients and staff by exposure to toxic water for four decades.

Accountability only comes when we stop deceiving ourselves that changing the party in power will make a difference. It hasn’t. Accountability has to be personal and apply to everyone who accepts a public paycheque, not just the political figureheads. The bottomless public purse shouldn’t be used to silence critics and bolster resumes and pays.

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Questions about automatic opt-in for organ donation

On January 18 The Nova Scotia Human Organ and Tissue Donation Act comes into effect. That means that, unless people specifically opt out, any or all organs and tissue can be harvested for transplant purposes. 

This may seem like a benign, apple-pie idea, with no downside since it can help many people on waiting lists. For some civic-minded people opting out seems mean-spirited. But I don’t think this has been well-enough communicated to the public. It may be one of the issues shuffled to the government back-burner by the more immediate needs of dealing with the pandemic.

As I think about this I wonder if you become too old to donate? Is it wise to put the healthy lungs or heart of a 70-year-old in a 30-year-old? 

Are there automatic exemptions for adherents of religions which require bodies be intact and unaltered to have burial in their faith and cemeteries?

And then I wonder about disease transmission. We had a family member who, in retrospect we realized received tainted blood. At the time of the transfusion and to the end of their life no one spoke of tainted blood. It was only after their death did that scandal make headlines and begin to explain the rapid decline and multiple illness which dominated their final years.

If blood can carry diseases and illnesses, can organs and tissues also be carriers? The province should address this.

The province directs those with questions to the Canadian Blood Services (CBS) website for answers. CBS has a page titled the ABCs of eligibility to donating blood. Find it here:

https://www.blood.ca/en/blood/am-i-eligible/abcs-eligibility

CBS only requires you to be at least 17 years old and meet certain height and weight measures to donate blood. There is no top age for donation.

And you can’t be drunk when you donate blood, but there is no mention of the eligibility of those dealing with long-term alcoholism to be organ and tissue donors.

There are a number of illnesses and geographic reasons which might prevent you from being eligible from donating blood for specific periods – if not forever. Travel to certain countries or for prolonged periods to parts of the UK, France and Europe between 1980 and 1996 can make you ineligible as a donor. How many residents, students who studied abroad and immigrants will think to check this to see if it applies to them or their family?

Where I live we employ thousands of migrant workers to harvest the crops. Should they have an accident and die, would their organs and tissue be automatically entered into the transplant pool? I’m not saying they aren’t healthy, but there is much about their medical history we wouldn’t know and their countries of origin, their travel and other issues might render them ineligible to donate blood. So who is monitoring the tissue and organ harvest?

The CBS website has a separate heading for HIV/AIDS. The Red Cross stepped into a PR problem early in that AIDS pandemic when it automatically banned gay men from donating blood. Now CBS says:

“You should not donate blood or plasma if you:

  • Have HIV
  • Ever had a positive HIV test
  • Have done something that puts you at risk for becoming infected with HIV.

“Several activities put people at a high risk of acquiring HIV/AIDS. These can indefinitely defer a person from giving blood. Examples of HIV high-risk activities include, but are not limited to: 

  • A person who has taken money or drugs for sex since 1977.  
  • A person who has used intravenous street drugs. 

“If you have participated in any of the above-mentioned examples of high-risk activities, you are not eligible to donate blood or plasma.  

“Men who have had sex with a man more than 3 months ago, and who meet other screening criteria, may now be eligible to donate blood or plasma. Learn more about our policy on HIV/AIDS risk-related activities reading our Men Who Have Sex with Men info page.”

CBS has cleaned up their wording so they don’t sound homophobic. HOWEVER, their three-month celibacy requirement seems a subtle way of saying thanks, but no thanks to gay and bi-sexual men as well as those men who don’t consider themselves gay or bi-sexual, but who occasionally have sex with other men.

What people do and who they do it with is up to them, but if you can’t donate blood, shouldn’t the province clarify whether or not you should opt out of being an organ/tissue donor? 

Not everyone has a family physician, so medical records may not be complete. And even those with a personal physician may not have discussed their sex life with their doctor. Married men having an affair or occasional sex with other men are not likely to advertise or share that with their doctor. And they certainly wouldn’t share this information with their spouse, so are we introducing a flood of normally disqualified body parts to the transplant pool? Extending this a bit more, if a partner in a relationship is cheating, doesn’t their exposure extend to their partner/spouse?

I think someone needs to mount a massive – and quick – information campaign to inform people of the many issues to consider before allowing automatic opt-in to the donor program. 

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No noses!

Once upon a time women’s breasts and all human genitalia were not to be seen in public. During the COVID-19 pandemic noses are part of the list of body parts not to be exposed to strangers.

But whether I’m at the Farmers’ Market, grocery store, bank, pharmacy or elsewhere I see noses peering out over the top of masks. Even at a Covids pop-up testing site in Wolfville I saw a worker improperly wearing her mask. It started out delicately balanced on the tip of her nose, leaving gaps on the sides of the nose for air to freely flow. Then it slipped down to mid-nostril, further enhancing air flow.

Proper mask wearing means covering the nose. And yes, as a glasses wearer I know that can cause lens to fog up. Foggy lens should serve as a second-by-second example of the need to cover your nose in public and indicate how successful mask-wearing is in thwarting unintentional spread of the virus.

Too many people are not wearing their mask properly. It may be comfortable to hang it under your nose, but masks are not only to cover your mouth. For the most part we aren’t mouth breathers, we breathe through our noses and thus can inhale or spread the virus through the nose. So cover it! 

Stop going commando with your face. 

A Postscript:

As we have seen in the storming of the Capital Building in Washington some people don’t know how to win friends and influence people. 

So it is with some commentators to this site. People don’t have to agree with me, but they have to do better than toss out Trumpian reasonings and conspiracy theories or ideas rehashed multiple times from foreign and right-wing sites. For example, I don’t believe the current pandemic and virus are some plot by liberal (small ‘l’) governments to seize greater control and undermine the Charter of Rights and Freedoms. 

If you look, this is happening to every country and every government is reacting. It is not something manufactured by a provincial or federal government you don’t like. It seems to me that those jurisdictions which are doing the worst in managing the pandemic are those with conservative-leaning governments. Quebec just announced a province-wide curfew. Ontario and Alberta are not managing soaring infection rates. Nor does the UK and USA.

Conservatives talk a good line about fiscal responsibility and balanced budgets, but they don’t walk the talk and deliver on those budget dreams. In Nova Scotia, Canada, the US and USA conservative governments have added the most to the public debt. The US deficit has gone from $585 billion to $7.2 trillion. John Buchannan was a lovely man, but blew up the provincial finances. Mavis Buchannan famously said in an interview with Atlantic Insight magazine, “John’s a brilliant man, but he has no common sense.”

Stephen Harper is falsely given credit for saving the Canadian economy from the 2008 economic downturn. That’s wrong. Paul Martin was the politician, who as finance minister, said no to the Bank of Montreal and Toronto Dominion banks when they asked to have banking regulations changed so they could compete on the world stage against the US banks. 

As a self-made billionaire who understood money and finance, Martin said no to the Canadian banks. He said depositors and investors needed the protection. That no saved our economy from the crippling effect of the 2008 downturn. The elegant chairman of the BOM took a $48-million golden handshake and went to London where he took control of Barclay’s and Lloyds banks, did what he wasn’t allowed to do in Canada and turned these centuries old companies into penny stocks.

Back on our shores Harper added more to the national debt than any other government. He had the flexibility of running up the debt because for the previous 12 years Martin’s surpluses went to paying down the debt.

So the failed economic theories of these conservatives have been transposed to managing the pandemic. Conservative premiers, presidents and prime ministers claimed they wanted to support businesses by keeping them open. Unfortunately infection rates soared because of the mixed messages and fear of regulation. They created yoyo openings and closings that have done even more harm to businesses, employment and health care.

I also won’t allow my site to be used as a platform to promote fundraising for social media celebrities and causes.

And I’m not going to debate whether wearing masks are effective or what type of mask is effective. Around the world medical researchers and leaders tell us that mask-wearing is effective. How effective your mask is is up to you. Mask-wearing is a small personal concession in the fight against the pandemic. If nothing else it shows our support of our community.

As for forced mask-wearing being a violation of your Charter rights, the precedent has been established. We have all manner of safety/health-based rules and regulations which are in line with Charter Rights. For example, we are required to wear seatbelts when travelling in a vehicle. We are prohibited from texting or talking on a hand-held device when driving. We are not allowed to smoke in any vehicle which may also be used to carry a person under the age of 16. Our vehicles have to be licensed, safety-inspected and insured. There are limits to how much a person can drink before driving. A town near me has a by-law which makes it illegal to smoke within five meters of a doorway, window or air-intake system. Wearing a mask around others is no more of a loss of rights than these.

As for your right to go maskless, others have the right to refuse to associate with you. You must respect the rights of property owners to stipulate what is acceptable dress and behaviour for people frequenting businesses on their property. Business owners have the right to require patrons wear a mask in an attempt to protect other shoppers, staff and reduce liability and fines for being in violation of temporary emergency measures. The property and business owners don’t have to believe in the effectiveness of mask-wearing or agree with government, but make the business decision to reduce the potential for fines and litigation. That’s their right. Stay home and order in.

Then there is the accusation I was afraid of what the commentator said. Nope. The “crickets” you heard are no doubt fed by your inner conspiracy theories. I didn’t have the time. We had an elderly relative in another province who had to go into emergency care. Because of travel restrictions family couldn’t be there in person to deal with this. Then on Dec. 9th a gentleman who has been a long-time resource for me died. Dec. 10th a friend’s father died. Dec. 11th a family-friend died. I was trying to be as supportive as pandemic regulations would allow. Additionally, I had my own work to do as well as dealing with all of the commitments around a confused holiday. This year I lost five long-time friends. I have a schoolmate who is palliative. And in nine days in August we lost a long-time neighbour and four members of my immediate family, including my sister and uncle. 

Fear of what someone says hasn’t silenced me. It’s simply a matter of life’s priorities.

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Pump up pandemic punishment

Watching Premier Stephen McNeil and chief medical officer Dr. Robert Strange at COVID-19 press conferences we see their frustration and bewilderment with those who flout regulations meant to restrict the potential spread of the virus. 

They, like other premiers, can’t understand why some people don’t take the risk seriously. Last week in Nova Scotia we heard of private parties of 60 people. The week before Ontario reported a case where someone hired a storage unit to host a party for 100 people! And on Saturday, The Daily Beast reported on a secret wedding attended by 10,000 members of an Hasidic community in New York.

These aren’t mere social gaffs where an attendee brings an unexpected guest along. These are purposeful acts. Some people may believe the pandemic is over-hyped and that their immune system is strong enough to keep them safe, but these are extraordinary times which require everyone to suffer some personal inconvenience. 

The problem is the inadequate consequences for those who break the rules. They haven’t the bite to be a deterrent. In Nova Scotia jaywalking carries a $697 fine. Host a 60-person party and you may be fined $750-$1,000. I understand that on arrival at several Valley parties guests contributed to a pot for any potential fine. Basically, they treated it like an admission charge.

The fines for this irresponsibility should reflect the economic damage done by these potential community spreader-events. Businesses are closed or open for reduced hours and/or operate under heavier, costly restrictions. Small business owners are losing their dreams and life-savings. Those people who are paid by the hour – which includes retail, bar and restaurant staff, personal trainers and others – lose income. Community and service groups who normally host fund-raising events lose revenue-making opportunities which limit how they give back to the community. 

Breaking the temporary restrictions on gatherings are not just a health risk, they should be considered an economic crime. Those who disobey this emergency should be charged with a Criminal Code offense. That applies to host(s) and guests. Their names should be published (for the benefit of future employers) and they should be liable for damages caused to businesses forced to close because of their actions.  

Hosting a party for 60 or 100 or more people should be a greater offense than jaywalking.

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Piss poor hospital maintenance

Valley Regional Hospital in Kentville is one of the main medical centres in Nova Scotia. It is the largest and leading medical facility in South West Nova, or the parlance of the Nova Scotia Health Authority, the Western Zone.

Valley Regional has the largest collection of specialists and services available in seven counties (Kings, Annapolis, Digby, Yarmouth, Shelburne, Queens and Lunenburg) west of Halifax.

So it should be a leader in health care. But is it?

To fight the COVID-19 pandemic we are told to cover our faces, wash our hands, socially distance and to be careful of what we touch. We are to reduce touching our faces because that is a fast track to transmission. Every building or store we enter we are invited or urged to sanitize our hands. Valley Regional does this and also questions people attempting to enter on their health and potential exposure to the virus.

Private business are scrupulously cleaning objects and surfaces to discourage the potential exposure to the virus, which we have been told can linger on surfaces for days.

So why is the Nova Scotia Health Authority so shitty on maintaining the physical plant for our hospitals? Valley Regional has piss poor maintenance – I don’t blame the maintenance department, I blame those executives who defer maintenance and micro-manage the actual maintenance specialists.

I say it’s piss poor maintenance because throughout the hospital are broken surfaces, worn coverings, damaged furniture and holes in walls. Those places which have received attention have been covered in duck tape, as if TV’s Red Green Repair Team had been called in.

Duck tape leaves uneven surfaces which are impossible to disinfect. Aside from that, some of the “temporary” repairs represent a hazard to those who are unsteady on their feet, which in a hospital is quite a few people.

How long does it take to approve a repair? A case in point is the main corridor leading from the central atrium of the hospital to Medical Units A and B, the chapel, to Physical Therapy, X-ray and MRI departments and eventually to the back-end of the Emergency Unit, as well as the nurse manager’s office and a few other departments.

At the start of this corridor is a growing patch of loose tiles held in place by duck tape. It would seem like a temporary fix except that these titles have been loose since 2009. Between September 3, 2009 and June 3, 2010 I was at Valley Regional every day. I remember how the loose titles clicked when walked on. After an eight-year break from hospital visits, I found the same loose tiles still not repaired. They are still held in place by duck tape. The patch of loose titles has grown. And keeps growing. And more and more duck tape is used to secure the titles.

But that’s not the only “temporary” fix. Throughout the entrance atrium are another six spots where duck tape covers holes, uneven edges and lifting linoleum or loose titles. Further down that main corridor is a spot where the subfloor seems to have failed, creating a gap under the floor covering which sags under weight. This is problematic for someone using a cane or a crutch. The sag can put them off balance and send them flying. In recent years an edge of this flooring failure has been covered with duck tape.

Then we get to patient rooms which seem riddled with holes. Forgetting the cosmetic appearance of these holes and gashes, is the hazard presented by uneven surfaces. Uneven surfaces can’t be disinfected so they can become breeding grounds for bacteria and viruses.

So the question is: how beaten up must a hospital get before some executive in the elegant, safe, germ-free NSHA corporate headquarters authorizes a real, long-term repair?

What are our other hospitals and clinics like? Remember the Victoria General, which is our largest hospital complex, has had toxic water running through its pipes for over 30 years. The VG water is only good for flushing toilets. The NSHA currently spends $70,000 a year buying water for that facility. So over the decades the health executives have spent millions of dollars not correcting a water problem.

These photos of VRH show what I mean.

This is the main corridor to the medical units and specialized services at Valley Regional Hospital in Kentville. While some titles have been replaced, three areas are long-term temporary fixes using duck tape.

This set of tiles were loose as far back as 2009. Because I thought it was a temporary fix I didn’t photograph it then. However, this image was taken November 20, 2019.

This photo of the same trouble spot was taken January 20, 2020.

The duck tape repair grows more elaborate as more tiles become loose. This photo is from August 25, 2020.

More of the on-going temporary atrium floor fixes at Valley Regional Hospital.

This is the weak spot in the main hospital corridor.

These gashes and holes in patient rooms are breeding grounds for bacteria and viruses. As are the broken edges of patient room furniture.

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The NSHA is busy, try again

Dr. David Zitner wrote an op ed in The Chronicle Herald titled NSHA seems to specialize in inconveniencing patients. Zitner is bang on.

Zitner wrote, “If there’s any way to inconvenience patients and embrace antiquated methods, the Nova Scotia Health Authority will find it.

“Ask the sick patients who are trying to arrange appointments with specialists, or for imaging tests or for blood work.

“Most enterprises try to encourage and support increased consumer access to worthwhile services. Not the Nova Scotia Health Authority!

“Try to book an appointment for an X-ray or blood tests. In the past, you were given a requisition. For most tests, your doctor’s office made an appointment, or you just marched off to the hospital or laboratory, waited for a long or short time, and then had the test.

“Now, in the Internet age, you’re given a phone number to call to book blood tests or imaging investigations.” And the NSHA’s phone system makes it a herculean effort to reach them.

The NSHA’s senior director pathology and laboratory medicine, Shauna Thompson, told the CBC on September 14 that the phone system was “incredibly frustrating”. She also said, “our number one priority is to improve the patient experience…” She ended her interview by saying an on-line booking option is coming … by end of year!

We are eight months into this pandemic, how is that not enough time for the NSHA to have identified the problem and resolved it? And even after eight months the NSHA needs three or four more months to offer a better way to contact them. That’s absurd.

The NSHA’s cavalier attitude is amplified by a June 24th, 2020 post to their website. The post NSHA working to address issues with blood collection appointment telephone booking process says “Nova Scotia Health Authority (NSHA) is working to address issues and delays people are currently experiencing when they call to book a blood collection appointment.

“We know patients are having difficulty getting through our phone lines to make an appointment for blood collection,” said Shauna Thompson, NSHA Senior Director, Pathology and Laboratory Medicine. “This is very frustrating for callers. We sincerely want to apologize for these current delays, and ask for your patience while we work to address the issue, and improve the appointment booking service.”

Make comforting sounds and hope people don’t pay attention to their lack of action is how the NSHA operates.

In the three months since the NSHA posted their empathetic message what have they done? How is it that a vital service like the health authority seems to use an archaic phone system? And why can’t their provider do an immediate upgrade? How is there not an off-the-shelf phone solution?

The NSHA is always “working on”, “looking into”, “investigating” solutions, but we see precious little in the way of results. If the NSHA can’t find a fix for their phone system first in four months, then after eight months what else can’t they do?

Unbelievably the NSHA’s phone system doesn’t always accept you into a call-waiting queue. With the NSHA you can get a busy signal or a message to call again later!

My first-hand experience attempting to book an appointment shows patients need a level of tenacity that may be beyond most people’s patience.

On August 18 I had to book an appointment to have blood drawn at Valley Regional Hospital. On my third call I started to write down what was happening:

Calls 1 & 2 – busy signal

Calls 3 & 4 – message to try later

Call 5 – busy signal

Call 6 – message to try later

Calls 7, 8, 9, 10, 11 – busy signals

Calls 12, 13, 14, 15, 16, 17, 18 – message to try later

Call 19 – busy signal

Call 20 – message to try later

Calls 21, 22 – busy signal

Call 23 – message to try later

Calls 24, 25 – busy signal

Calls 26, 27 – message to call later

Call 28 – managed to get into a phone queue. It took 1 hour, 29 minutes before I spoke with a person who booked an appointment for August 31. In total I was on the phone for two hours and 11 minutes.

And then on August 31 when I arrived at VRH I was told they had no record of the appointment! And couldn’t fit me in!! I eventually got an appointment for September 11! That’s 25 days to have a blood test. How many people can become seriously ill in such delays?

Since the Nova Scotia Health Authority can’t handle the call volumes, the solution is block booking appointments. Rather than call the NSHA, I suggest people call your MLA’s office and have them create lists of constituents needing appointments. MLAs and their staff could make one or two calls a day on behalf of dozens of constituents needing medical appointments then confirm details with constituents.

That would reduce call volume and ease frustrations. And provide a further back up for lost appointments like mine.

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Advocates call for public pandemic inquiry

Last week my sister died. She has been in a long-term care facility since December 2019.

Her residency in a facility means we have not been able to see her beyond weekly Skype meetings facilitated by a bubbly young woman at her home. We were thankful to have those meetings. The downside to them is we only saw her from the neck up. Some visits were better than others. Because she was not technically proficient, I wonder how she and others in her generation comprehend the technology utilized for a digital visit? Did they enjoy it or were they confused by it?

The pandemic prohibitions also meant residents like my sister lived without touch. Certainly she was cared for by staff. And as kind as they were to her, theirs is a type of industrial touch. They were paid to touch her. It was professional. It was not the touch by and of those you love and who love you. For me that translates into a vacancy or void, which is amplified by the extreme intimacy with end of life.

While we are saddened by her death, we are grateful to the facility doctor who engaged in extensive conversations with her husband and me. His candor and time helped our family – her daughters, husband, myself and an aunt – to understand her condition and come to terms with her sudden passing.

Thanks to these conversations I was comfortable that he knew her as a person and not just a collection of conditions. When questioned he didn’t have to go back to his files, he knew the answers because he knew her.

But how many other families have had this level of involvement, commitment and communication?

The COVID-19 pandemic is an extraordinary event. Aside from those who were medically stricken with it is the emotional and psychological toll taken on long-term care residents who grew ill and sometimes died without the support of their loved ones. There is the helplessness of family members kept at a distance and who had to rely on third-hand reports from exhausted workers. (This is compounded by the fact that people have different communication skills.)

And then there is the daily fear of infection. Sadly a few facilities seemed to be ground zero for COVID-19 related deaths in Nova Scotia. Nova Scotia has 65 deaths (as of August 31, 2020) from COVID-19. Of those, 53 deaths were in one facility.

I don’t believe that cluster of deaths were malicious or represent a lack of caring on the part of the management or staff. But were they fueled by budgetary belt-tightening or indifference to recommendations? I believe we must have a full, public inquiry into what happened. A review isn’t sufficient. We need a process that finds fault and attaches specific changes to deadlines. A review allows those who have failed to act in the past to continue on their leisurely path to a comfortable retirement. That is not acceptable.

Nova Scotia is the province of Westray. A report from the public inquiry into the deaths of 26 Westray miners said the mine was mismanaged, miners’ safety was ignored, and poor oversight by government regulators led to the disaster. Poor oversight by government, unclear responsibilities, confusion are conditions which seem to repeat in this province. That is why I believe the Advocates for the Care of the Elderly (ACE), who have worked for over 14 years to bring the issues in long term care to governments’ attention, are right to ask for a full, public inquiry into the pandemic.

Outside of war, the loss of so many seniors in long-term care is the greatest collection of deaths in provincial history. If you study medical history very few of the last 100 years have not had a epidemic or pandemic. A full-on inquiry would put us in a better position for future viruses and medical events.

A call from ACE for a public inquiry:

The ACE Team

Halifax B3V 1C1 

Call for a Northwood Inquiry

August 26, 2020

Hon. Stephen McNeil                                            

Premier of Nova Scotia                                        

                                                              

Hon. Randy Delorey                                                      

Health and Wellness Minister

Nova Scotia

 

 

Premier, Minister,

 

The purpose of this letter is to firmly state the necessity for an inquiry instead of a simple review, regarding the loss of fifty-three lives at Northwood Long-Term Care facility during the height of the COVID-19 pandemic earlier this year.

It is an insult to expect the resident families and the people of Nova Scotia to accept they will receive transparency, closure or any sense of justice. Those families and the people of Nova Scotia trusted that our loved ones were in safe conditions. We learned otherwise in what is one of the largest non-war death tolls in provincial history.

Since 2006 the ACE Team has been meeting with various provincial governments advocating for a secure, compassionate environment for long-term care residents, particularly the elderly where life should be added to years instead of a place to die.  Since that time we have been shown promises of long term plans to make that happen but none have ever materialized. 

Since 2006 we have met with every Premier, Health and Wellness Ministers and deputy ministers and their bureaucrats stating there are plans in the works to improve the quality of Long-Term Care.

After the creation of a Conservative Ten-Year Long-Term Care plan that was to be completed by 2014, we have had nothing but freezes and cuts for Long-Term Care funding. The first-year policy of this of this government clearly stated, No more money for bricks and mortar for new long-term care beds.”  

While economists have praised this government’s austerity measures and back-to-back surpluses, they have forgotten or over-looked that $8 million came from cuts in staffing and salary freezes to low paid front line workers in Long-Term Care as well as reductions in food budgets which have left those in care dining on $5-a-day meal budgets. 

No more money for bricks and mortar for new long-term care beds have led to multiple occupancy rooms and is the direct result of the 53 deaths at Northwood because infected COVID patients were being housed with non-infected patients.

The past seven years have shown steep declines in our health care system with the most noticeable declines happening in Long-Term Care, to the point, where advocates, unions and the public have been declaring health care in a crisis, resulting in ER hallway medicine and doctors begging for more long-term care beds. We have also seen the waitlist for people without a doctor grow to 150,000.

Since 2016 The ACE Team has been witness to;

  • The promise of five-year long-term Care Plan that has yet to come to fruition. 
  • A $250,000 Dementia Strategy – which never materialized.
  • A $2.2M Expert Advisory Panel Report where only five of 22 recommendations have been implemented which have had no improvement for long-term care.
  • Last, because of the COVID-19 outbreak, we have a long-term care review for the entire Provincial Long-Term Care System going on behind the Northwood Review.  

The ACE Team feels after fourteen years of meetings with governments and promises of Five-Year Long-Term Care plans, a Dementia Strategy and a dismissed $2.2M Expert Advisory Panel Report that a simple review will reveal nothing and not rebuilt trust and respect for the system. NOW is the time for an inquiry to bring closure and a sense of justice to the families of the 53 dead as well as being foundational to create an environment that reflects human dignity for the care of the elderly and add life to years.

 

Gary MacLeod

Chair, The ACE Team

Advocates for the Care of Elders

 

 

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Pandemic politics and long-term care

I haven’t been posting during the height of the COVID-19 pandemic because we needed to have a single focus to deal with the virus and rebuild the economy. Now that we are crawling back to health I shall be more active.

During the pandemic closures, one of my real-world friends and colleagues posted on Facebook, “I’ve been thinking furiously of late about the life cycle and how and where we live toward the end of our lives. My generation (approaching 70) will do everything we can NOT to end up in a seniors’ residence, where, as we have learned with this crisis, conditions are often horrific and (this is the most heartbreaking part) many people are dying alone and uncared-for.

“My generation, the boomers, is large in numbers and outspoken. Things must change. I hope fervently that this crisis will provide the impetus, but how tragic that this is what it takes to make society consider how we treat our elders.”

Her post was one of many about the situation in long-term care facilities across Canada. I can’t count the number of people who posted on social media: ‘this is terrible, someone should do something’.

It is terrible. But to those who have paid attention or experienced it prior to this pandemic have long known the problems and issues. It’s part of why I launched this blog.

And now the Canadian Institute for Health Information has used COVID-19 statistics to confirm the poor situation in Canadian long-term care. In Canada 81 percent of COVID deaths were in long-term care facilities, while world-wide the average is 42 percent! In Nova Scotia 97 percent of all COVID deaths were in long-term care! We beat Alberta, Ontario and Quebec, where 70 percent of deaths were in care.

In Nova Scotia, the Advocates for the Care of the Elderly (ACE) have been lobbying for better facilities, more staff and improved care for over 14 years. Conservatives, New Democratic and Liberal governments have heard ACE’s complaints, concerts, predictions and recommendations, and have allowed the problems to continue under the guise of “studying” the issue. Well, when do you have enough study? When do you act?

Former NDP cabinet minister Graham Steele in his book, What I Learned About Politics: Inside the Rise-and-Collapse of Nova Scotia’s NDP Government, told us that politicians and organizations love to say something is being “studied”. Study sounds like something is being done, when the real purpose of any study is to give cover for inaction.

Any premier or health minister who claims to being surprised by the conditions under which our parents, grandparents, older relatives and friends are living is being dishonest. They know what’s happening. However, they have insulated themselves from direct front-line contact to have a layer a deniability built in.

As for the comment that someone should do something, it is uncomfortable to hear, but we need to look in the mirror. We are the someone and the solution. The problems in long-term care exist because of complacency and how many families use these places as warehouses for the elderly.

People claim they would do more, but are so busy. Well, are you too busy to love? Social media is great for launching go-fund-me campaigns for strangers and petitions for all manner of causes, but beyond a few clicks and digital transactions, how involved do people get with the lives of their older family members, former friends or neighbours?

My mother was in a nursing home for eight months. I went to see her every day. A granddaughter who lived nearby went several times a week. My sister went in weekly. We let her know she wasn’t forgotten. And the facility management knew we were involved in her life and care. In those eight months I saw many residents who had no visitors. The only people who touched and talked to them were the staff.

Another family member is currently in care. The facility was on our watch list based on the experiences of others we know. Until the pandemic locked us out, her husband took two meals a day with her. I went in four or five times a week and one of her daughters also visited. (The others live too far away.) Again, we were/are present and involved in her life and had no problem with how she was treated. But again, management knew we were involved. So many of the other residents I see strapped into chairs in front of television sets day-after-day have no one to visit them and no one to pay any interest in them beyond professional obligations.

The problem is equally shared by the public, politicians, and bureaucrats.

The bureaucrats and provincial ministers who have legislative and legal over-sight of these facilities and responsibility for those in care, have turned blind eyes to failures in care and building maintenance. They have hidden behind crown immunity and bogus interpretations of privacy regulations to protect themselves from real responsibility. They receive the pay, perks, privileges and pensions regardless of their performance.

One of the most telling examples of the laissez farie attitude of bureaucrats was the death of Gilles Duceppe’s mother. Duceppe is the former leader of the Bloc Quebecois. You would think his national profile and political connections would assure his mother is well cared for. But in January 2019, the 93-year-old Mrs. Duceppe got up in the middle of the night and accidently wandered outside into -35 degree weather wearing only her nightdress. The door locked behind her. The official cause of her death was listed as hypothermia. In reality it was neglect.

When Mrs. Duceppe went outside an alarm rang. A staff member turned off the alarm and didn’t bother to check why it sounded. No one did a bed check to see all residents were safe. Mrs. Duceppe was outside for six hours in plain view of a security camera that no one monitored. There was no need for her to die. Not then, not that way. Her family are suing the facility.

If that can happen to the mother of a high-profile politician, what hope is there for the rest of us?

There are numerous other problems in long-term care facilities, like acts of violence, which are discounted and covered up. Each act is considered a one-off incident, when in reality there are thousands of acts of violence in Canadian long-term care facilities each year. This is resident-on-resident, resident-on-caregiver and caregiver-on-resident violence. I don’t have the number at my finger tips, but a few years ago I was told the level of violence was over 4,000 acts a year! Much of this is hidden under the cloak of privacy or given a pass on the assumption the offender is of diminished capacity. That’s not acceptable.

So what can we do?

First, visit the person you know in care. If you’re at a distance call them or call the home to discuss their health and care plan, and for regular reports. Then ask someone else to visit.

Secondly, write, email or call your MP, MLA/MNA/MPP to express your concerns about senior care, about a specific home and individual if you know one.

Thirdly, insist on better pay for care givers.  The people who work the front lines are only paid $18/$20 per hour for physically and emotionally demanding work. They burn out, which creates high staff turn-over. This turnover is upsetting to residents and is inefficient for facilities which have to spend an inordinate amount of time and money recruiting and training new staff about the residents and procedures.

Fourth: we need real inspections done on a regular basis by inspectors who have the authority to force facilities to act asap to correct their deficiencies.

Fifth: we need more long-term care beds. In Nova Scotia over 700 hospital patients aren’t actual patients. They were, but now they are waiting for a long-term care placement. This volume represents up to 60% of acute care beds in most rural hospitals. Collectively these 700 occupied beds are equal to the largest hospital in Atlantic Canada. If we had more long-term care beds we could save the expense of building a $4 billion new hospital in Halifax. That is a massive, political planning failure.

I suspect government planners have resisted creating more long-term care beds because they figured the problem would die out.

Those planners have overlooked the new demographic in need: millennials. Two 2019 studies in the U.S. found millennials are in worse health than their grandparents and are going into care decades earlier than other generations and will be there for many more decades than their grandparents.

So, in building long-term care beds we need to develop separate facilities to accommodate younger residents. Right now anyone needing long-term care goes to a facility occupied by the elderly. That isn’t fair to teenagers and other younger people who may be paralyzed by an accident, born with a genetic disorder or have another need. It’s also a different type of care, so is unfair to the care giver.

Until we sort out long-term care and do so meaningfully, we should immediately stop talk of replacing the VG in Halifax. If we emptied those 700 acute care beds we might not need a replacement hospital.

Better long-term care, better healthcare, better government starts with us. We are the ‘someone’ to do something.

 

 

 

 

 

 

 

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