NSHA hospital closures and rationalizations

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

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2 Responses to NSHA hospital closures and rationalizations

  1. peter loveridge says:

    I can’t help commenting here, I am increasingly irritated by “experts” from Halifax who haven’t got a clue about what they are pontificating on.

    The concentration of hospitals in industrial Cape Breton has vexed ministers of health for decades, but I have to correct some of the statements of the Halifax specialist.

    The “hour” was not pulled out of a hat, it wasn’t an hour either, it was 30 minutes. It was part of a comprehensive plan to improve rural health delivery under Ron Stewart. He formed a committee to put forth recommendations for same. I was a member, as was Bob Martell and I think Bernie Buffet. The rest have moved on, retired or died.

    I’lI have less irritation with this sort of comment when residents of Halifax are told they’ll have go to to Windsor or Lunenburg for primary care. If this isn’t good enough for them why the hell is it good enough for us. 5 1/2 hours to get a trauma case to the ER? then why do trauma surgeons all over the world talk about ” the golden hour”

    Can’t staff small ERs? Well, when they’re paid half of that in a regional hospital what do you expect?

    Can’t do tests and X-rays, again 20, or even 10 years ago you could. The reality is that every rural area of the province has had progressive cuts in services over the last thirty years, and before anyone squawks about these places all being on welfare I will remind you that my rural municipality, and the one just to the east of me, are the biggest per capita contributors to the GPP in the province and virtually none of it comes from government. We deserve better.

    As the head of the Cape Breton Regional hospital ER said not long ago “the last thing we want is another 30 patients a day coming from Northside”. Smaller community hospitals, if properly supported take a lot of the load off the bigger places. Will closing these two places help in the end? Anyone’s guess, especially given the manifest incompetence of the NSHA. But I can guarantee that medical recruitment in North Sydney and New Waterford is going to be very difficult for the foreseeable future, and that a number of the present incumbents likely to retire or leave.

    • Before we got “professional” rural hospitals seemed to work better and the people seemed to be healthier. Remember when we had teaching hospitals? Kentville had both the BFM and NS Sanitorium. Both taught nurses. And local doctors shared being “on call”. Now, at Valley Regional Hospital the “on call” doctor can be in Bedford!?!

      At Valley Regional medical supplies aren’t kept on-site at the hospital, but across town in the Industrial Park. That is considered more convenient for servicing Valley Regional in Kentville and Soldiers Memorial in Middleton. Except that after a certain hour ER teams can’t access devices in storage – or even know if any are available – because the staff person has ended their day. This was an innovation under Janet Knox’s term as CEO of Annapolis Valley Health.

      As for ER doctor payment, a local warden, who has medical knowledge suggested turning the payment pyramid upside down. Now the rural ERs pay the least, while the city pays the most. The warden felt that rural ER doctors who had to do more for the patient and had smaller teams to rely on should be paid more. The exception is Annapolis Royal, where I am told ER doctors from Halifax come in to keep that ER open and have weekends where they see three patients. The specialist I spoke to said the payment works out to $1,000 a patient. Neither of us could recall Annapolis Royal’s ER ever being closed.

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