No beds, no care

October 7, 2021 – 11 am. I have just returned from my second trip this morning to Valley Regional Hospital in Kentville.

My first trip at 8:20 was to drop a friend off for a “procedure”. My second at 10:40 was to take him home. He was prepped, in the operating room with an IV in his arm when the procedure was cancelled. The OR nurses were there, the surgeon was there, the anesthesiologist was there. 

What wasn’t there were empty hospital beds. 

The procedure required anesthesia. Anesthesia requires that he be monitored for 24 hours. As the surgeon told him, it’s the fear of litigation if something goes wrong.

Since he lives alone, an overnight in hospital is required to absolve the medical team from liability. But with no free bed they couldn’t operate. They will call him in a couple of weeks when there is an opening in the surgical schedule – no doubt due to another cancellation. This means he has at least two more weeks of life-altering discomfort, which prevents him from working or doing anything outside his home.

This cancellation is not only personally costly to my friend, it is also hugely costly to health care. The surgeon, surgical nurses, anesthesiologist all have to be paid. The OR had to be reserved and prepped for his procedure, then has to be re-sterilized before it can be used again. And will whoever is next scheduled for that OR get their procedure done or will it also be cancelled? Will there be a hospital bed available when the next opening is found in the surgical schedule?  

What this does is double or triple treatment costs since my friend still has to undergo this procedure. Outside of the hospital costs are additional costs of VON home care. To help quantify this, if the procedure cost $1,000, then the aborted one plus the yet-to-be-scheduled replacement one plus the weeks of home care make this a $2,500+ cost to the NSHA. Thinking about how wide-spread this type of situation is means we’re wasting two-thirds of our surgical budget on delays and cancellations.

The lack-of-beds situation is not new.

For nine months in 2009-10 and for seven months in 2019 – 20 I was at Valley Regional every day visiting family members. In both situations, once a medical condition was addressed, we waited six-to-eight months for long-term care beds to become available. As recently as 2020 50 percent of the beds in VRH’s two medical units were occupied by people waiting to go into long-term care. I not only did my own head count, I confirmed that figure with two hospital doctors. At the same time another doctor confirmed that 40 percent of the beds in the Yarmouth hospital and 50 percent of beds on the South Shore were occupied by people waiting long-term care placement.

Across the province on any given day over 700 acute care hospital beds are occupied by people who are well enough to leave hospital, but not well enough to live on their own. That means many others who have pressing medical issues can’t get care and treatment because of this bed shortage. My friend is one example. Not building new long-term care beds is a false economy since we are bleeding money on postponed, multiple treatments, which often lead to sicker patients. 

The bed shortages have been with us for over 20 years. Health care executives like to say it, like everything else, is a complicated issue. In reality it is a shared failure of politicians and health care executives. 

We need more long-term care beds. We have known this since the 1990s. Demographer David Foot wrote his best-selling book, Boom, Bust & Echo in 1996 and Boom, Bust & Echo 2000 in 1998. These were international best-sellers which predicted the impact of aging on health care. In my international travels I have seen resorts – from the Ritz Carlton in the Caribbean to ski hills in Banff – change their operations and focus because of Foot’s research. Nova Scotian politicians and health care executives appeared not to read about demographic change and needs. Foot’s research, like most of the health studies done, are “received with interest” and shelved, unread and not acted on. A Google search will show you how consistently Nova Scotia’s Auditors General complain about NSHA inaction on their recommendations.

While we focus on the need for long-term care beds for the elderly, we ignore an even greater need. In the fall of 2019 Moody’s Analytics said the declining health of millennials “have serious long-term consequences for the performance of the U.S. economy.” Blue Cross Blue Shield’s The Health of America Report^® issued at the same time found “millennials are more likely to experience major depression, hyperactivity, high cholesterol and Type II diabetes, among other behavioral and physical conditions.” 

The chief economist at Moody’s told CBS News these medical problems “often require costly, long-term care.” 

A Kentville doctor confirmed he and his colleagues are seeing millennials present these illness at VRH. The doctors had considered this as just poor lifestyles on the part of individuals and only realized it was a generational trend when I brought these studies to their attention.

The bottom line is millennials are going in to care before their Baby Boomer grandparents and will be in care for twice as long.

The pressure on long-term care beds is multi-generational. It’s another health care trend  Nova Scotia isn’t aware of or ignores. Meanwhile, the leisurely contemplations of those who populate the NSHA executive suites will continue to negatively impact the health and well-being of all Nova Scotians.

Delaying the creation of more long-term care beds is not fiscally prudent nor is it a solution to current and future needs. It also hampers the ability of the system to deliver timely medical care to all Nova Scotians.

Curious COVID count and conditions

Today, September 14, the Province of Nova Scotia said 72.2 percent of the population was fully vaccinated. That is lower than the 75 percent required for the province to go to the fifth stage in the recovery.

Since the vaccination count was specific enough to include the .2 percent, I question our numbers. Nova Scotians who received a vaccination – either one or both shots – outside the province haven’t been counted. That’s because we currently have no way of confirming their vaccinations. Or we don’t accept any confirmation from any jurisdiction outside Nova Scotia.

Given the number of people who seem to have received vaccinations, whether travelling on business or to see family or who spent winter at their southern vacation homes (and I know a number of people in these categories who received vaccinations in Ontario, Alberta, BC and Florida) could we have met that 75 percent criteria if these people were counted? 
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My second concern is the curious impediment we have to vaccinating people. For some reason hospitalized Nova Scotians are unable to be vaccinated while patients. I know someone who had two hospitalizations in the last month. They spent a total of 14 days at Valley Regional Hospital in Kentville. While a patient he asked about getting his second vaccination and was refused. He was told it would have to be done at a vaccination clinic. There was no mention of getting a vaccination at a pharmacy.

Since pharmacies can also administer the vaccination I don’t understand why a fully accredited hospital with doctors, RNs and pharmacists in-house can’t vaccinate a patient. There are several thousand people in hospital on any day of the week. Vaccinating them would also raise our numbers. It would also seem to make sense. So why isn’t this done?

To fix the NSHA start with corporate governance

Nova Scotia’s new Premier, Tim Houston, and Health Minister Michelle Thompson are to be congratulated for their swift action on health care. Less than 20 hours after taking their oaths of office they fired the Nova Scotia Health Authority CEO and dismissed the board of directors. 

One can only image how many years our new health minister, a former nurse, has been thinking about what she would do if it were up to her. Let’s hope this era of change is more front-line driven.

I was skeptical about the election campaign platform to re-organize health care. In the last 20 years we have had two major reorganizations of health care. We have also studied, tweaked, changed and modified all aspects of it. And the same problems and issues persist. The one constant has been the health care executives, who have survived changes in government regardless of their on-going performance failures. Until now. So starting with a clean slate is a positive step.

What is worrisome is devolving management to local areas because our history shows an uneven level of and access to care. As I have previously said, localized health authorities were fiefdoms, where the health executives controlled, some suggest stacked, the health boards. Members of three of the previous nine boards told me they were bullied, disregarded and silenced. Plus, with a decentralized system bad decisions are more easily hidden when they are localized.

With this accelerated pace of change, I and those in the medical community I consult, have two ideas for the Minister’s consideration.

The first comes from one of the province’s senior surgeons, who suggests we make health care a Crown Corporation. Ideally, it would be a national organization, but given how impossible it is for the federal government, 10 provincial governments and three territories to accomplish anything (the 2003 National Health Accord they all supported went nowhere) we could scale his idea down to a provincial crown corporate structure. 

This doctor is frustrated by the lack of universal governance in health care and how political decisions factor in to how and where health care is delivered. 

A Crown Corporation for health care is a radical idea, but the doctors and health consultant I mentioned this to are supportive. A retired family physician said, “The current ethical problem and source of difficulty is that government assesses, regulates and insures the services government is said to deliver.” A rural practitioner felt “it certainly bears thinking about.” And a health care consultant said, “It really does reframe the concept.” All were excited by the idea.

While the idea may cause traditionalists in the NSHA corporate headquarters to spit out their coffee, it seems an interesting idea for front-line care givers.

The second idea on reorganization of the NSHA is also about governance. We need an activist board of directors. I wonder how often, if ever, the previous directors said “no” to the health executives? Or have they just been cheerleaders lending legal credence to the wishes and actions of the executives?

The new NSHA board should look less like members of a country club and more like the province. Political parties work to ensure women, Acadians, the First Nation and African-Nova Scotians are represented in the Legislature, so should the NSHA board. We should have dedicated board seats for a registered nurse, a doctor (either in practice or recently retired) and someone from the patient perspective, whether a former patient or involved family member. We need these frontline voices to counter the glowing spreadsheet solutions presented to the directors.

And we should pay directors for their time. It is absurd to put billions of taxpayer dollars in the hands of volunteers. We don’t even trust film classification to volunteers. 

The NS Film Classification Board pays movie reviewers $50 per half day, plus expenses. That rate, like the rates for all of the Province’s agencies, boards and commissions, was established in the 1970s. It’s ironic that the province’s largest single expenditure is overseen by people working for free. We don’t trust film classification to volunteers, so why would be put our health care system, the province’s largest expenditure, in the hands of people who couldn’t review a movie?

By compensating NSHA directors we open up the board to a wider cross section of the province and not just the well-connected. We could bring in the self-employed, for example. Effective boards are more than nice lunch on a quarterly basis, interrupting the rush through an agenda. Corporate directors have four or five days of prep work for each board meeting. That time and commitment should be recognized. And for something as important as health care we need more than the usual generic background of usual government appointments.

As we look for a new NSHA board let’s look outside the small, semi-incestuous pool of Halifax-based directors and recruit people with ideas, questions and experience delivering and receiving health care in this province. We have seen that you get what you pay for.

Senior advocates expect Tory government to honour their promises

A press release from the Advocates for the Care of the Elderly (ACE) congratulates the new Progressive Conservative government for their election win. And as a reminder of the Party’s promise to seniors summarizes those campaign details.

The press release says in part: “In every election change is promised but it is not often that major commitments are made to senior citizens living in Nova Scotia’s overcrowded, understaffed Long – Term Care system” says Gary MacLeod of The ACE Team ( Advocates for the Care of the Elderly). Post horrendous Covid 19 deaths in LTC the Progressive Conservative Party and Premier – Elect Tim Huston have made significant measurable promises of 2,500 single bedrooms, 2,000 new health care staff, 4.1 hours of care each day and the necessary funding to produce a generational change in how Long-Term Care is provided in Nova Scotia. “There will be relief today among the 400 seniors waiting in hospital for a Long-Term Care Placement. I can image a few tears shed by the 1,000 seniors and their adult children providing care while they live alone at home in precarious situations. For the 20,000 expected to need LTC by 2030 I’m sure they’re seeing this as a good first step” say MacLeod.

Good governance is reliant on political party’s matching their election promises with budgets, legislation and policies. “Thankfully the Progressive Conservatives have provided measurable Long-Term Term Care  commitments and timelines which all Nova Scotians can hold them accountable to” says Paul Jenkinson of The ACE Team.

“The ACE Team is looking forward to working with government  to measuring government progress on commitments made and to advocating for other improvements in Long-Term Care” says MacLeod. End of press release.

ACE are not newcomers to the long-term care issue. They have been involved for almost 15 years. They have first-hand experience, extensive research and a multitude of practical ideas for making the lives of those in care better. A new government would be wise to listen to them, to engage with them and not waste time on more studies of known facts and situations.

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

August 2, 2021 – 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 24^thChronicle 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.

 

 

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.

COVID-19: Questions raised after Kenney, cabinet ministers dine on ‘Sky Palace’ balcony in Edmonton

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.

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.

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. 

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. 9^th a gentleman who has been a long-time resource for me died. Dec. 10^th a friend’s father died. Dec. 11^th 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.

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.