Reopen the electronic records bid process

Paul Schneidereit has written a staggering investigative piece in The Chronicle Heraldabout the bid process for a new electronic health records system for Nova Scotia. Read it here:

https://www.thechronicleherald.ca/news/local/bid-process-stunning-management-of-multimillion-dollar-nova-scotia-health-records-contract-questioned-253235/

Schneidereit’s work raises enough questions to call for the current bid process to be halted and restarted.

The fact that EPIC Systems Corp., a strong, experienced industry leader, was excluded from consideration because their submission was delivered to the wrong office in the right building seems morally wrong and not in the best interests of Nova Scotians.

According to the article the submission arrived ahead of deadline. Workers who discovered the delivery mistake made multiple attempts to contact the Nova Scotia Procurement Office to arrange pick-up of the documents. EPIC’s proposal was rejected because Nova Scotia Procurement said it was late. However, it was only late because no one in the Procurement Office bothered to return their phone messages. How is it in the public interest to have a key industry supplier rejected because some bureaucrat wouldn’t answer their phone or walk to a neighbouring office?

This could be a billion dollar expenditure for the taxpayer. How do we trust that we are considering the best system when a key player is excluded because of bureaucratic pettiness? Who is responsible for this failure to act and do they still have a job? And if so, why?

Further, what assurances have we that rejecting a supplier on such a thin basis doesn’t reduce competition and increase our cost?

If we are to believe that the Nova Scotia Health Authority and the Department of Health are working in the best interest of Nova Scotians this bid process should be cancelled and restarted so that the people of Nova Scotia can trust that what we are buying is truly the best system for us. Under the current conditions we cannot have that faith in the process or NSHA. Executive platitudes about due diligence and evidence-based decision-making doesn’t cut it anymore.

And in the interest of transparency, the 32 people from the NSHA, IWK, Department of Health, Internal Services, Finance & Treasury Board and Transportation & Infrastructure Renewal, who are overseeing this process should publicly declare that they have no shares, bonds, mutual funds or other investments in the companies being considered.

 

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NSHA show some compassion

As the world is fixated on the alleged sexual misdeeds of a nominee for the US Supreme Court it is worth thinking about this on a local level.

Recently in Nova Scotia we heard from a young woman who went to the Colchester East Hants Hospital to seek help after being sexually assaulted. That help consisted of being handed a pamplet and sent out on her own into the dark night after midnight! After being assaulted!

A week later another Nova Scotian woman came forward with a similar experience

Each of these examples show a cavalier, callous and cruel disregard for these specific victims of sexual assault.

Working on the well-founded theory that what happens to one (or two), happens to others, we can extrapolate that what has happened to two has no doubt happened to many other victims of sexual assault in this province.

While the Republicans in the U.S. Senate fight the optics of being an all-male panel (they hired a female lawyer to question the female accuser to mitigate their image), the Nova Scotia Health Authority lead my CEO Janet Knox has no such excuse.

Of the ten-person NSHA “Leadership Team” seven are women. Until September it was an 11-member team with eight women in charge. http://www.nshealth.ca/about-us/executive-team

So where is the compassion and understanding we expect from medical professionals? Where is the understanding and compassion we expect from women in charge of a health organization?

The Nova Scotia Health Authority has only been in existence since 2015, but sexual assault isn’t a new issue. It isn’t a woman’s issue, it’s society’s issue. That said, you would expect an organization lead by women would have this covered.

Janet Knox was the long-time CEO of the Annapolis Valley District Health Authority, prior to heading the NSHA. Surely she or her colleagues at the other health authorities had a protocol in place for dealing with sexual assault victims that didn’t further put them at risk by abandoning abused, single young women to the night?

Where is the compassion?

 

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NSHA executive change

The unofficial news is that Dr. Lynne Harrigan is finished with the NSHA as of September 4th.

Harrigan is vice-president, medicine and integrated health services for the NSHA.

There has been no public announcement of Harrigan’s departure or replacement, nor is there any reference on the NSHA site to suggest she’s going or gone.

If true, this is a major change in management of the NSHA and of interest to ALL Nova Scotians. Has someone been hired to replace her? If so, who? If not, is there a search underway and how long will that take? And is this the start of a larger change at the top for NSHA?

What also concerns me is that often newly retired health executives in Canada become highly paid consultants for the hospitals/authorities they left. They’re paid at “market rates” as if there was some mythical private sector comparison position. The typical consultant rate usually works out to 1.5x their previous pay, for a casual, lesser-stress job.

The argument for retaining retired executives is to capitalize on their experience and knowledge. However, the cynical view is that it stifles innovation and progress by retaining old thinking and ideas.

It’s great for the retired executive/new consultant because it keeps them in the loop so no replacement can come in, solve problems and show them up. And is a good little money-maker. They have a pension @ 80% of previous pay ($326,941 in 2017-18, with an 8% raise in 2018-19 to $356,091), plus 1.5x pay. It’s less work, more money and offers opportunities to pop in on other projects and provinces as well as earning speaker fees at conferences held in exotic locations.

For the number two person in the provincial health authority to leave her position with no prior public announcement looks suspicious and further illustrates the bunker-like mentality of Janet Knox. Knox has a history of parcelling out snippets of information as if it were her property. She is and has always been oblivious to the fact that she is a public servant, who owes her position and wealth to the people of Nova Scotia.

If the news of Harrigan’s departure is true, should we also expect to soon learn of Knox’s imminent retirement?

Confirmed: Janet Knox has confirmed that Dr. Harrigan has quit the NSHA. The Chronicle Herald writes, “Knox didn’t provide a reason for Harrigan’s departure. In an email response to The Chronicle Herald, Harrigan said that she would not be speaking to the media.”

That’s the typical arrogance we can expect from these executives. Someone takes $5 million + in public money and feels they are above speaking to the employer. With that attitude it is time for Knox to also head for the door.

Private conversations have described this as “…leaving a sinking ship.”

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NSHA rape failure

This an outrageous failure of the Nova Scotia Health Authority.

http://thechronicleherald.ca/novascotia/1593958-truro-hospital-turns-rape-victim-away

How can an organization whose senior executives – CEO Janet Knox and VP Medicine Dr. Lynne Harrigan – are female be so cruel, so uncaring, so dysfunctional towards sexual assault victims? How can these two executives be so disconnected from the harsh reality of violence against women?

And how is it that only certain hospitals have rape teams?

I hope every Nova Scotian sends this link to their MLA. That young woman could be anyone’s daughter, granddaughter, niece, neighbour, friend, work colleague – even if she’s a stranger, no one deserves to be dismissed like this. For hospital staff to send any young woman, let alone a rape victim, out into the night alone boggles the mind.

Please, contact your MLA, regardless if they are in government or opposition. This must stop! Obviously the job of running the NSHA is above what those in charge are capable of managing. It is time for a change at the top.

 

Postscript: Since publishing this piece, one retired physician in Nova Scotia wrote:

“It’s part of the ongoing efforts (perhaps not intentional) to reduce access to personalized care.

“For the first 30 years of my practice emergency departments called the person’s family doctor who would respond, or the person in their call group. Most doctors had their phone numbers available to patients.  Although these “on call” services were free, the fees for paid activities was sufficient so people could cross subsidize work that was not financially rewarded, but where the rewards were professional.

“Now, most primary care docs cannot provide much in the way of free services because excess administrative demands leave them little free time, and their fees for useful work are inadequate.”

 

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Time to reorganize the Nova Scotia Health Authority

Pioneer House, March 4, 2017.

Pioneer House, November 4, 2017.

Pioneer House, June 18, 2018.
Pioneer House has been abandoned by the management of the Nova Scotia Health Authority. Note the upstairs windows haven’t been touched. A can on a window sill remains in place in all three photos. Curtains hang partially closed in all photos in all seasons. The note in the front door window has not been changed. And what is the status of the white shipping container sitting in the drive? Does the health authority own it or rent it? Why? Judging by the undisturbed weeds the container has not been opened in months, maybe years. What is its purpose, why is it there, what does it cost? (Allan Lynch Photos)

Directly behind Valley Regional Hospital in Kentville, at the entrance to the executive parking lot sits Pioneer House. It is 100 metres from the back of the VRH and 50 metres from the hospital maintenance department.

Pioneer House, the VRH heating plant and the brick Provincial Building next to the hospital are the last remnants of the former Nova Scotia Sanatorium in Kentville. Pioneer House had been home to the Sanatorium’s head surgeon and the medical director. It was quality construction. It has hardwood floors, a fireplace, basement garage and a large deck has been added in the last decade. For a while Pioneer House was used as a clinic. But for the last several years it has been empty. It hasn’t been heated in winter and the upstairs windows are left open year round. For at least the last 17 months the upper drive has been filled by a white shipping container. Since March 2017 I have not seen indicators, like footprints in snow, disturbed leaves or a shoveled walk or anything to suggest anyone has been inside this house.

The open windows indicate either a lax attitude towards the property or a plan for it to deteriorate to a state where executives can justify demolishing it.

Because I publish helphealthcare.ca last March a hospital worker came to my door on behalf of a surgeon wondering if I could help find accommodations for medical staff and nurses when they are storm-stayed at VRH or prevented from returning for their next shift because of the weather. Staff and patients are frustrated that surgeries and procedures are cancelled because of weather.

For the sake of patient care and to prevent weather-related cancellations Pioneer House would seem to present a ready-solution to stranded and exhausted staff. It may not house everyone, but it could at least be a resource for the surgical team. In summer, it could provide accommodation for medical students and those filling in for staff vacations. If neither of these solutions are doable, it could be converted into a medical museum. The Government of Nova Scotia is trying to build trade with and encourage investment from China. China reveres Norman Bethune. The fact that Norman Bethune came to the Nova Scotia Sanatorium to be treated for tuberculosis before he went to assist in the Spanish Civil War and to help Mao Zedong’s revolutionary forces would elevate China’s interest in the province. Opening a house that Bethune might have been a guest in, surrounded by woods he may have walked, as a medical museum would help accomplish some of the political and economic goals of the Government.

Leaving a substantial property like this to rot is an unacceptable waste of a public asset. It is disrespectful to the people of Nova Scotia. An NSHA executive should be held accountable for this neglect. But, sadly, there is no accountability in health care for poor property management or anything else.

Across rural Nova Scotia employers complain that a lack of housing hinders their ability to hire. We have seniors and young families, as well as people fleeing abusive domestic situations who need a place to live. That a property like Pioneer House is left to deteriorate is unconscionable.

Why should we expect executives, who trained to be doctors and nurses, to be competent at managing real estate? Where in their courses did they learn about construction or building and systems maintenance? Given their other responsibilities, isn’t it too taxing to expect them to hire and monitor staff, keep abreast of medical changes, deliver prompt health care and oversee a property portfolio that has 99 hospitals, clinics, medical centres and office complexes across the province?

Since winning election in 2013 and 2017 the Government has initiated bold changes in provincial health care. First, they merged nine health authorities into one unified authority, the NSHA. Then, in preparation for developing a replacement for the Victoria General Hospital the Government is investing over $125 million in expanded facilities throughout HRM and as far away as Windsor. Last month the Premier announced the closure of two Cape Breton hospitals and the expansion of services at two others.

These are all preparatory moves for what will be a seven-to-ten-year time frame to demolish, design and redevelop the VG. Currently cost guestimates for a new VG are in the $2.5 billion range. But given Nova Scotia’s propensity to be late and over-budget on capital projects, it wouldn’t be surprising for a new VG to become the most expensive building in Canada. Do we want to hand such an expensive project over to in-experienced executives?

Nova Scotia hasn’t a good track record on capital projects. That dates back to the construction of Government House. In 1800 Whitehall gave Governor and Lady Wentworth £10,000 to build a governor’s mansion. The Wentworths spent £30,000. A 2009 refurbishment of the mansion took longer and cost twice what was budgeted. More recently the 2017 repair of the Legislature steps was 55 percent higher than the consultant’s estimate and three weeks past deadline. The Bluenose II restoration was 70 percent over the estimate and two years late. In the 215 years since Government House was built I have found no capital project which has come in on budget or to schedule, and yet, century after century bureaucrats and politicians express surprise when every project doesn’t come in as projected.

Our history with hospital construction and maintenance is equally troubling. In 1978 the new Yarmouth Regional Hospital opened with doorways that were not wide enough to accommodate hospital beds. It cost $400,000 to rectify. In 1987 the new Camp Hill Hospital became known as the sick hospital. It took two years to realize the problem was the side-by-side placement of exhaust and intake fans. Then when the QEII Health Sciences building opened we had to spend $1 million correcting a problem with the laboratories, which were designed without input from the lab technicians.

Simpson Landing at the Nova Scotia Hospital in Dartmouth opened five years late and was 48 percent over budget. And then there was the two-year-delay in opening the Colchester East Hants Health Centre, which was 78 percent over budget. That prompted the Auditor General to lament that the hospital project was overseen by executives with no construction experience. In an understated damning observation he also said that information provided to Cabinet should be factual.

Meanwhile, the health authority pays $1.2 million a year to maintain the empty former Colchester Regional Hospital in Truro. The authority is waiting on an action report that is four years late. In total, health executives and Department of Health have had 12 years to consider what to do with the hospital and failed to do so.

The problems with hospital construction seem systemic across Canada. For example, the new $1.3 billion McGill University Health Centre in Montreal opened with 14,000 deficiencies! It is being sued for $172 million for cost overruns and the former CEO fled the country to avoid charges of conspiracy, money laundering, fraud and accepting $22 million in bribes.

In Ottawa, the new Heart Institute is wrapped in controversy after it was revealed that a health executive accepted“luxury fishing trips”from a contractor who was later awarded several $100 million contracts. Lawsuits were launched.

In addition to our construction problems, were the on-going maintenance issues at the VG. For 30 years the water was so toxic it couldn’t be used for more than flushing toilets. No other building would have been allowed to remain open under those conditions. The Department of Health and NSHA say the VG must be torn down, but various letter writers to The Chronicle Herald have questioned that assessment. People with engineering backgrounds have asked if the shell can’t be preserved and the buildings gutted and rebuilt. There is a lack of trust by the public in assessments of properties that bureaucrats clearly don’t want. Pioneer House is a modest example of that.

In Ontario, an agency of the government called Infrastructure Ontario, handles all construction projects. Infrastructure Ontario’s focus is overseeing construction vs our habit of taking civil servants away from their daily work to dabble in multi-million-dollar projects.

Given our poor history with new hospital design, construction and maintenance I believe it is more efficient and effective to separate the real estate holdings from the NSHA. I propose a Nova Scotia Health Trust to own and maintain health care facilities. The NSHA would become the NSHT’s tenant. The Trust would also oversee construction projects.

The NSHT would be run by executives with real world experience in construction trades, contract negotiation and an understanding of what are reasonable project delays and cost overruns. They could also hold the lid on expensive, last-minute wish-list additions. The Trust executive positions could be tied to meeting specific performance targets.

Removing the burden of project oversight and facility maintenance would lighten the load on health executives and let them focus on delivery of care vs reacting to broken pipes and the myriad other problems buildings can have.

History shows us that public officials haven’t got a good handle on construction or maintenance costs. The example of Pioneer House shows how easily health executives mismanage our holdings. Meanwhile, older, large, high-traffic properties like The Westin Nova Scotian and Lord Nelson Hotel, both built in 1929, are shining examples of how well private sector expertise is at maintaining properties and extending their life spans.

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New NSHA compensation numbers

As is tradition with Nova Scotia’s Public Sector Compensation Disclosure, the latest pay figures for bureaucrats are published in the middle of summer when it’s figured no one is paying attention. It’s the half-hearted, insincere attempt to comply with “accountability and transparency in the use of public funds”.

If true accountability and transparency were the goal, this government wouldn’t have weakened the NDP regulations, which required the name, title and compensation for each of those in the $100,000 club be published. Including the titles of those compensated allows the public to judge whether bureaucracies have become bloated. Or in the case of Registered Nurses if they are being overworked to the point of endangering their health or shortening their career.

Take the Nova Scotia Health Authority. When we had 10 separate authorities most complied with the requirement to list the job title or occupation of those on the list. Since the merger of nine authorities into one, those details have disappeared. One of the motivations for the merged health authority was to streamline the bureaucracy and decision-making process, and to reduce the number of executives and redirect those savings to front-line care. That goal has been bastardized by the very people who promoted it. Shame on them.

Looking at the NSHA compensation numbers shows that some executives are well ahead of inflation. This year the NSHA executive have all benefitted from an 8 percent increase in income. One had a 41 percent increase in pay. Since the NSHA’s formation in 2015, several executives have seen incomes soar by $70,000-to-$115,000 a year.

In theory that might suggest recognition of greater responsibilities, but the actions of some suggest their workload isn’t affected. Or not at least as much as their bank balance is. The question for the health unions and public is if this establishes the precedent for raises in the next round of contract negotiations.

NSHA CEO Janet Knox’s compensation for 2017-18 was $369,013  vs $352,478 in 2016-17. That’s a $317-a-week raise.

VP Medicine Dr. Lynne Harrgan received $326,941 in 2017-18 vs $302,957 the previous year. A $461-a-week raise.

For the vice presidents: Tim Guest, Patricia Cochrane and Carmelle d’Entremont received $223,006 over $206,657 last year. (A $314-a-week increase.) Paula Bond is up  $584-a-week to $250,672 from $232,321. Allan Horsburgh is at $234,329 up from $217,119 ($330 a week more) and Lindsay Peach has risen to  $228,881 from $212,419 ($316 a week more). Colin Stevenson’s income jumped 41 percent ($1,172 a week) to $208,418 from $147,433. The lack of detail doesn’t say if this represents a much greater area of responsibility or if his previous year wasn’t a full 12 months. Or if he received a bonus from the CEO.

Fees for some doctors, who are paid like a factory worker on a per piece/patient service basis (unless the patient only needs a prescription top up, which is one of many uncompensated services doctors are expected to provide) rose 5.6 or 10 percent. Unlike NSHA executives whose compensation is 100 percent theirs and who have offices, technology and support staff provided by the taxpayer, enjoy tax-payer-subsidized lunches, work regular hours, receive paid holidays and pension contributions, doctors pay 30 to 50 percent of their gross income to cover practice costs. Even with these increased fees, Nova Scotian physicians remain the lowest paid in Canada.

To illustrate how well the NSHA executives did this year, we can look at other compensation reports. One person at the Art Gallery of Nova Scotia and the head of Nova Scotia Business Inc. received 4 percent raises. The CEO of Trade Centre Ltd. and the three executives at the Halifax Dartmouth Bridge Commission received a .5 percent pay increase.

The list of public disclosure reports can be found here:

https://www.novascotia.ca/finance/en/home/publications/PSCD/default.aspx

You judge value for money. If you have issues, this site lists how to contact various MLAs, Ministers and Premier.

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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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