Knox needs to explain herself

Janet Knox needs to explain herself.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Is the NSHA anti woman?

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

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

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

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

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

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

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

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

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

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

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

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

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

The story is here:

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

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

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

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

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

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

 

 

Doctor prescribes change of leadership at NSHA

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

Go here:

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

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

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

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

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

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

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

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

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

Nothing new in senior care paper

 

Tuesday an “expert panel” released a study into senior care in Nova Scotia.

https://www.thechronicleherald.ca/news/local/long-term-care-homes-in-nova-scotia-need-more-staff-expert-panel-recommends-275910/

Is there anything here we didn’t know? Nope.

This situation has been the reality for the decade since my family first faced it and it probably predated our exposure by decades.

The reference to one nurse to 30 residents is curious. Is that the availability of one RN per 30 residents in general or one RN-to-30 residents per shift? I knew of an RN responsible for 110 residents during each overnight shift. One person could barely keep up with the needs of so many people. If there was a medical emergency that requirement put all other residents in jeopardy. Nonetheless, we continue to operate facilities on a hope and prayer that the odds are in favour of short staffing.

In Tuesday’s report, one researcher complained that the province doesn’t have data on staff working long-term care. That’s absurd. The Department of Health could have several staff members take a day to call or email every facility manager in the province asking for specific staffing and resident numbers. We could have those in a day. Failure to have such information should spur the dismissal for cause for whoever is responsible for senior care within the department. Not knowing such numbers shows a willful desire to be conveniently ignorant. It’s the deniability factor health care so often utilizes to cover their shortcomings. The question is who are the Department of Health being ignorant for? Is it for the sake of the political optics around the budget or to aid the commercial interests of facility owners?

Back when the Conservatives formed the government, they had the data to say the province needed 1,800 more long-term care beds. They added 1,000 beds before they were replaced by the NDP. When the NDP formed the government they halted development of new long-term care beds. That seemed to be against the basic tenets of their political philosophy.  The Liberals haven’t added any, preferring to service people in their homes, regardless of the cost, inconvenience, impracticability and misunderstanding of what seniors really want.

These studies remind me of an observation by former NDP finance minister Graham Steele. “Politically, studies are useful. Nobody can complain about a government getting more information and expert analysis. Every stakeholder hopes and believes the study, when finished, will see things their way. Best of all, the government has a perfect answer — “We’re looking at it” — to every complaint. For a politician with no clear agenda, that’s gold.”

Nova Scotia’s agenda seems to be to run out the clock. Get the government to the next election and a NSHA bureaucrat to a comfortable retirement – with lucrative consulting contacts enabling them to pop back in long enough to protect their reputation from a more effective and innovative replacement.

 

 

Would you work for the NSHA?

Would you work for the Nova Scotia Health Authority?

Doctors Nova Scotia have issued a position paper on the value of family physicians. It is an unprecedented paper. The fact that the organization which represents family physicians felt the need to do so illustrates the adversarial situation which exists between front-line physicians, the Nova Scotia Health Authority and Nova Scotia Department of Health and Wellness.

One point which jumps out is this:

Research has shown that patients with access to care over the years from the same physician have fewer hospitalizations and better health outcomes, based in part on the relationship and trust that patients and their family physician have established over time.

Read the paper here:

https://doctorsns.com/sites/default/files/2019-01/next-steps/Role-of-Family-Physician-position-paper.pdf

This website has been and is a promoter of a single, merged health care system. The theory is that it should standardize care, streamline decision-making, redirect administrative costs to the front line and allow for better coordination of skills, assets and needs. Unfortunately, in selecting the right system for Nova Scotia health care the government installed the wrong/weak leadership. The job went to someone who had been the head of a health authority, but on reflection, other than climbing the corporate ladder, it’s a stretch to find any history of innovation and success in delivery of care.

The impediments to practice in Nova Scotia include:

1. Pay

At $259,378, Nova Scotia has the lowest pay for family physicians in Canada. A doctor in New Brunswick can average $293,636 and in Prince Edward Island that rises to $305,091. Nova Scotia pays 13-17 percent less than neighbouring, less prosperous provinces. Even Newfoundland pays doctors 5 percent more. In 2017 a Halifax-based family physician told me that after deducting practice costs, their taxable income was $60,000!

Click this:

https://www.cbc.ca/news/canada/nova-scotia/family-doctors-health-care-the-search-pay-models-1.4520132

2. Trust

There has long been a trust issue in health care in Nova Scotia. CIHI accreditation reports have shown a low of 48 percent and a high of 52 percent when staff are asked if they trust their managers.

3. Respect

The way this executive have acted as the NSHA and in predecessor authorities doesn’t show much respect for medical professionals. In 2013 Dr. Andrea Veljkovic, who was an orthopedic surgeon specializing in diabetes-related foot and ankle care in South West Nova, quit the province when the Annapolis Valley District Health Authority headed by Janet Knox (now NSHA CEO) refused to find funds to pay her. The authority’s explanation was that Valley Regional Hospital had five orthopedic surgeons and that was enough. Dr. Veljkovic travelled the region performing surgeries in Kentville, Yarmouth and Bridgewater.

Then we had the on-going litigation against Dr. Gabrielle Horne. Dr. Horne was a rising medical star who had her hospital privileges reduced and research thwarted after a manufactured dispute with a hospital director at the former Capital Health Health Authority. Dr. Horne’s professional standing was harmed by the manager’s claims. The result was 16 years of litigation in which Dr. Horne prevailed. Capital Health, continued by NSHA, spent over $10 million of taxpayer money to avoid taking responsibility for the actions of their management team. In the end the courts found for Dr. Horne. All that NSHA did was spend several millions more to cut a $1.4 million damage award to $800,000. The managers who caused this problem remained at work and rose in the organization.

Last month, NSHA showed their on-going disrespect when they cancelled hospital privileges of Dr. Jennie MacGillivary. Dr. MacGillivary is a surgeon who performed surgeries at two provincial hospitals. She asked for help to deal with professional burn out caused by her workload and lack of support. She lost her job. So much for a NSHA being a compassionate employer.

https://www.cbc.ca/news/canada/nova-scotia/health-care-surgeons-doctors-hospitals-inverness-antigonish-1.4965010

Another example of the NSHA disrespect for medical professionals was a meeting called by a NSHA provincial health zone manager where the 42 doctors in attendance were told they had no concept of realty and “were living off the fat of the land”. Really?

4. Practice Restrictions

The NSHA has been careful not to say a doctor can’t practice wherever they wish. They know those cases limiting practice have been lost in the Supreme Court. However, the NSHA has used credentialing as the club preventing doctors from establishing practices wherever they wish and to drive new doctors to join a collaborative care practice. Without “credentials” doctors can’t bill for services, can’t order tests, prescribe drugs or even admit a patient to hospital. I have been told of a physician who was prevented from opening a practice in a suburb of Halifax, another was prevented from taking over his parent’s city practice, another city-based doctor couldn’t turn his existing practice over to a new doctor. Two young doctors were prevented from establishing a rural practice because it was within the 100-km catchment area of a community care practice.

Here are some unedited NSHA employee ratings posted on-line in connection to a job competition in October 2018:

Very little room for advancement / Allied Health (Current Employee) –  Sydney, NS – 15 May 2018

Advancement is only given either by seniority but more commonly by nepotism. System is failing due to ineffective management who are not above asking illegal requests. Union violations occur frequently, but the union has no teeth in protecting the employees and retribution within the rules of the contract does occur.

Salaries are fair for the region and job security is very high, but individuals who should never work within healthcare are never removed.

Pros Decent wages, secure job

Cons Poor management, overworked, understaffed, not interested in changing / 2 stars

 

Good place if you’re looking for a good job / Senior Systems Analyst (Former Employee) –  Halifax, NS – 25 March 2018

Steady work, low expectations. Organization has low technical competence and fear of technology, relying on external consultants to make decisions. Internal expertise is not fostered, nor welcome.

Take your job, do your hours, for interesting stuff, find a side project.

Pros Not concerned with IP constraints

Cons System change not welcome / 3 stars

 

Fun work place / Utility Worker (Current Employee) –  Halifax, NS – 14 March 2018

Great company and all co workers are treating respect to each other. Company giving good benifits loke medical dental and pension plans. Also we have vactions and sickness time.

Pros Free Uniforms

Cons Long hours / 5 stars

 

sexist managers / Registered Nurse (RN) (Current Employee) –  Halifax Regional Municipality, NS – 28 February 2018

if you are male, you wont (for the most part) get hired here. they have the odd token male but it is a non-male dominated workforce and they arent letting go.

i have seen qualified male candidates declined over new grads. managers will look for someone that kowtows to them. these same managers are unbelievably rude and condescending to male staff called in from local agencies.

i have been watching this for years and it is disheartening to see so many (but not all) men head elsewhere as soon as they can.

Pros that the men get to escape

Cons everything / 1 star

 

is a stressful environment / Mental Health Nurse (Former Employee) –  Halifax, NS – 13 February 2018

There is a divide between management and staff, trust is a huge issue. When issues are brought to their attention nothing is done. it can be a toxic work environment.

Pros great staff / 3 stars

It seems the only solution to make the Nova Scotia Health Authority a welcoming place for professionals to work is a change at the top. The executives are entrenched in their “rightness”, believe the rest of us don’t understand the issues, and maintain their comfortable status quo. Other places have to be more welcoming to new talent than this crowd.

The Nova Scotia Health Authority embraces all the words and phrases du jour, but by their actions we see they don’t implement them. Beware.

 

 

 

 

The real cost of private health care

On Boxing Day a friend, who is spending the winter in the United States, suffered a stroke. Fortunately, it was a mild event and she bounced back in less than three days. It was not the major episode an earlier stroke was.

Her brief hospitalization was $52,000 USD!

As shocking as both the stroke and bill were, she managed to negotiate a 75 percent reduction in payment! That’s $39,000 off the bill! She is still paying $11,000 for her treatment and care, which still provides the hospital with a profit, and makes this is an important teaching experience.

The first lesson is never go to the U.S. without health insurance. The second lesson is for those who promote the advantages of a for-profit-model for health care. For-profit health care only works for those who have the resources to pay, otherwise, profit is a barrier to care. And the fact that the hospital would reduce the bill by 75 percent ($39,000) illustrates the level of profit built into the U.S. health care system.

 

Snooping in NSHA patient files

Earlier in November, Nova Scotia’s Privacy Commissioner, Catherine Tully, revealed that health officials had been caught “snooping” on 335 patient health records.

This is such a serious invasion of privacy that it is a prosecutable offence.

Tully’s annual report said an investigation into the Nova Scotia Health Authority (NSGA) revealed “a dangerous and insidious culture of entitlement” into viewing records. Anyone who has dealt with the NSHA knows that “culture of entitlement” extends well beyond patient files.

Curiously, the commissioner noted that the NSHA had co-operated with the investigation. Did they have choice? Could they have refused?

Read the article here:

https://www.thechronicleherald.ca/news/regional/officials-caught-snooping-on-health-records-nova-scotia-privacy-commissioner-says-259358/

After the story broke Colin Stevenson, vice president of quality and system performance at the NSHA wrote a letter to the editor of The Herald to explain how seriously the authority takes personal privacy. He, like the rest of the crew at the NSHA, did not say they were sorry patient privacy was violated. This was no doubt done on the advice of lawyers who caution to never apologize lest it be seen as an admission of guilt. But guess what? The commissioner already said there is guilt.

Stevenson’s letter spoke of “the failure of an employee…” except this wasn’t the failure of one employee, it was six employees at multiple sites in the NSHA’s Central Zone (that’s head office area). This raises numerous questions:

1. Were these employees, who the commissioner liken as “health officials”, doing this for personal prurient interest ?
2. Was it revenge?
3. Since six health officials in one area were involved, was this a coordinated action?
4. If it was coordinated, to what purpose? Was it personal gain, some political objective or in connection with some criminal enterprise? (There have been instances across Canada where patient files were illegally accessed for the purpose of acquiring drugs.)

Stevenson’s letter can be found here:

https://www.thechronicleherald.ca/opinion/voice-of-the-people-nov-20-2018-260824/

Ironically, the identities of the officials accused of illegally accessing patient files have been protected as has any action taken against the staff.  The NSHA is good at working privacy rules to protect themselves.

This is not the first time health officials/employees have improperly/illegally accessed patient files.

In October 2018 a six-year-long violation (2005-11) of 120 patient files at the Hants Community Hospital was revealed. At the time Capital Health described this as “inappropriate access”. This resulted in a $400,000 settlement to patients.

A 2012 violation of 707 patient files at the Roseway Hospital came to light in 2017. That cost Nova Scotia taxpayers a $1 million settlement, plus legal costs as well as administrative and investigative costs.

Interestingly, a previous substantial violation and the most recent one were done by employees working in the former Capital Health Authority’s facilities, which is now the NSHA’s Central Zone. That’s significant because these violations were done right under the noses of senior management. This wasn’t done at some distant location executives never set foot in. If they don’t know what’s happening under their noses, how can we trust that they are on top of every day operations across the province? Have there been consequences for executives who fail to monitor those in their employ?

Each time a violation is uncovered, the health authority du jour issues a statement that it takes “its commitment to personal privacy seriously and it’s essential that patients can trust their personal information is protected.” Yet violations continue.

Platitudes aren’t good enough. The public deserves a detailed explanation for why these NSHA staff were looking at patient files.

There is no legal right to privacy for an accused. We need to know their name, their position and the purpose of their violations. And what consequences there are for them, the patients and the taxpayer.