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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NSHA fudges the facts

Whenever the Nova Scotia Health Authority promotes an idea or cancels a service they crow that their decisions are “evidence based”. They don’t do anything without examining and studying it closely.  Their evidence-gathering process is so cumbersome that it pretty much impedes progress. It took them over two years to even consider beginning the doctor recruitment process!

Now, the CBC has done the leg-work to further show how flawed the NSHA’s “evidence-based” decision process is. The CBC traced the process for deciding not to participate in the annual Rural and Remote Medicine Course. This April event in St. John’s is an annual recruiting opportunity for health authorities to meet over 600 medical students and family doctors. Every province and jurisdiction in Canada attended, except for Nova Scotia. A two-hour flight wasn’t in our budget.

When the news originally broke about NSHA’s failure to attend this event, executives claimed the cost didn’t make sense based on previous un-favourable results. BUT the CBC’s investigation raises the question of truth and accuracy in what NSHA says. The NSHA’s evidence-based decision making relied on eight-year-old information! The NSHA didn’t exist the last-time anyone from Nova Scotia attended the event. And the NSHA fortress mentality prevented them from checking with colleagues across Canada to see how useful the event was or consider if a better message delivered by a new recruiter would make a difference. Maybe the executive lack faith in their recruiters?

The Nova Scotia Health Authority fudged their facts. They have misled the people, the Premier and the Health Minister. What else have they been purposely wrong or misleading about?

Read the CBC report here:

http://www.cbc.ca/news/canada/nova-scotia/doctor-recruitment-healthcare-nsha-health-authority-rural-1.4711174

The NSHA executive seem to embrace a White House-like casualness towards facts. Yet again Nova Scotians are left to wonder how can we trust them?

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More medical incarcerations

News that some patients at the East Coast Forensic Hospital haven’t been discharged because of a lack of community resources seems a throw back to Dickensian era where people were locked up and the key thrown away for being perceived of having a mental weakness, or being poor.

http://www.cbc.ca/news/canada/nova-scotia/patients-institutionalised-intellectual-disabilities-1.4692147

The idea that 19 people are kept locked in a hospital for one-, two- five- and six-years beyond treatment needs shows the cavalier attitude of the Nova Scotia Health Authority towards patients and the public purse. How much does it cost to keep these patients in hospital and is that not wildly more expensive than providing support in their home communities? And does this forced stay not harm their recovery and deprive them of freedom of movement and association?

Beyond the hospital costs – in terms of hard dollars and wasted resources – this could be an expensive an embarrassment to the province. Since this is a secure facility, where patient movement is restricted, could these individuals have a case for violation of their Charter Rights? What if they sued? How much would that cost? Win or lose, the money would come from public.

Two years ago we had the case of a young Nova Scotian man incarcerated because his guardians used ancient statues, which included descriptions of “lunatics” and “insane or dangerous idiot”, to argue he was incapable of making decisions for himself. Is this recent round of medical incarcerations more of the same?

Is this false economy or another example in the litany of failures of the NSHA executive?

 

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More deadly failures of care

The lead story in today’s Chronicle Heraldis heart-breaking and infuriating.

http://thechronicleherald.ca/novascotia/1570575-‘the-wound-was-the-size-of-your-fist’

There should be no using the bullshit privacy defense for such an egregious failure of care. Those people paid to deliver the care, paid to supervise it and manage the facility should be named, shamed and prevented from working in a care situation again.

This is one story, the article references five more, showing that it is not unique. From September 3, 2009 until June 3, 2010 I spent 6-to-14 hours a day, every day, at Valley Regional Hospital in Kentville. Valley Regional was then overseen by Janet Knox and Lynn Harrigan. Knox was president of the local health authority and Harrigan was vice president of medicine.

There was a woman in the next room whose bedsores/ulcers were so extreme that she – sorry for this graphic – basically had no heel. Her condition had been so neglected that it became a life-threatening, hellish existence. She had no life. She was kept heavily sedated, her family maintaining a type of living wake around her bed, day-after-day, month-after-month.

In addition to the pain medication her bed was outfitted with a special air cushion to keep anything from touching this painful, open, festering wound. The air cushion was operated by a pump that hung on the edge of her bed and sounded like a vacuum cleaner.

The constant sound of the machine was upsetting and so annoying that it frayed every nerve you had. It made it impossible for anyone to share a room with this patient. I don’t know what impact it had on her, if she could comprehend it from her drug-induced state, but it shortened tempers and tolerance of those patients the hospital tried to have share the room.

Pressure sores happen. I had a nickel-sized one develop during a surgery. A wound expert came in and provided a bandage. In a few days it was gone. How do pressure sores/ulcers grow to the size, scale and seriousness of the case cited in the Herald or what we saw in Kentville? How could care givers ignore it and not react? And if no one understood the seriousness of it, who is being hired, who is doing the hiring, and where is patient management? How can we trust those in authority when such stupid, preventable problems are allowed to go untreated?

The Nova Scotia Health Authority’s response that it could take one or two years to investigate the problem and solutions illustrates the vacuousness of this organization’s leadership. Pressure sores and ulcers are not new. Health care executives, medical professionals have known about this issue for decades and failed to act. That is unacceptable.

This is a ridiculous waste of lives and resources for something which starts out as a petty annoyance. Heads should roll. And potential charges should be investigated.

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More meaningless sounds from the NSHA

The one thing the Nova Scotia Health Authority excels at is making comforting sounds. And why not, they have a public relations army in their employ. It’s ironic because their response to any query is to throw up the patient privacy wall as a reason not to respond.  If only the NSHA hired as many doctors as they do communications people.

The NSHA’s latest meaningless, comforting sounds were delivered to the widow and family of Jackie Deveau. Deveau was long-time military veteran who had been a patient at the Cape Breton Regional Hospital, suffering from post-traumatic stress disorder. On March 11, 2017 he walked away from the hospital and was killed in by a hit-and-run driver.

His widow received a letter which said a review was conducted and that one of the recommendations was to establish a clear communication protocol for serious events in an in-patient setting, including who should be notified, how the notification should happen and an expected timeline of communication.

The story is here:

http://www.cbc.ca/news/canada/nova-scotia/jackie-deveau-death-creates-change-in-hospital-protocol-1.4653995

The NSHA communication sounds reasonable if you don’t think about it. But why is a review needed? Why isn’t there already a clear communication protocol? It’s not brain surgery. They already have that information. No one is a patient of a hospital or long-term care facility or even a walk-in patient for blood work or other medical test, without staff confirming next-of-kin and their phone number. Why not use what you already have? Why don’t hospital staff attempt to stop a patient who is suffering from a mental incapacity or pressure from leaving a hospital?

Why do we have to establish another protocol? This is just a buying time to ride out bad headlines.

Do we have to conduct a study at every hospital and clinic for every incident? We have a unified health care system to deliver standardized levels of and access to care as well as uniform procedures. Not to apply them is yet another example of the poor management at the NSHA.

Mr. Deveau was not the first patient to wander away from a hospital. It’s been a long-standing problem at the East Coast Forensic Hospital in Dartmouth and other facilities.

In June 3, 2015 a mental health patient at Valley Regional Hospital walked away without his family’s knowledge. He walked 15 kilometres in socks.

A hospital representative blamed the incident on an ER doctor, then hid behind patient confidentiality to avoid answering hard questions about how mentally compromised patients can wander off. In March 2010 I saw a man wearing a johnny shirt tucked into his underwear walk away from Valley Regional. Hospital staff stood in the main doorway laughing and making fun of him. No one attempted to stop him or call next of kin. Another time I informed hospital staff about a young man I found standing outside an aunt’s hospital room. He was a mental health patient and his presence near an frail, elderly woman later at night concerned me.

Later, the balcony level at VRH was enclosed by glass. I was told that was because one of the mental health unit patients threw himself over the railings. Enclosing the balcony was to discourage others from attempting it.

In January 2015 a potentially dangerous man drove away from the East Coast Forensic Hospital. After his “escape” a hospital rep said, ““We review every incident with regards to what led up to that and if we need to make changes or adjustments to how we practice, then we would do that arising from the reviews,”

http://www.cbc.ca/news/canada/nova-scotia/mark-baltzer-escape-from-east-coast-forensic-hospital-to-be-probed-1.2898589

Inspite of their review another patient left the Forensic hospital in June 2017 and ended up in Charlottetown where he flashed two young girls.

This article itemizes five examples of patients walking away from the Forensics hospital. One walk-away resulted in the murder of gay rights activist Raymond Taavel.

https://www.ctvnews.ca/canada/n-s-psychiatric-hospital-criticized-over-unescorted-patients-going-missing-1.3641017

These are the incidents we know about. How many others have there been and have been swept under the privacy carpet to spare the system from lawsuits and preserve underserved reputations of managers?

Both Janet Knox and Lynn Harrigan should have developed a plan for such incidents by now. They were in charge of the Annapolis Valley District Health Authority, when several of these incidents took place. It’s not like they’re unaccustomed to patients wandering off. They have had decades to form a protocol that could have been implemented across the system before the merger of the health authorities and certainly in the years since. Their failure to do suggests either disinterest or laziness. So lacking action, the NSHA once again makes comforting sounds to wait out the public attention span.

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Lax leadership at the NSHA

Once again we have dynamic proof of the lax “leadership” of the Nova Scotia Health Authority. I use the word “leadership” loosely. I don’t mean to imply vision, inspiration or success in the role, merely referencing those at the top of the corporate pyramid.

Currently the Premier and Health Minister, as well as many Nova Scotians, are upset that the NSHA didn’t send a representative to a physician recruiting event in St. John’s which was targeted to the practice of rural medicine.

NSHA’s explanation/excuse is that they haven’t done well at it in the past and it’s too expensive. As excuses go that’s a bit rich. This executive have a reputation for spending. When they headed the Annapolis Valley District Health Authority (AVDHA) their administration costs were three percent above the national average. As a perk, which is on-going, they provided subsidized lunches to 160 white collar workers toiling away in the corporate bunker. This involves employing two catering staff on-site at the executive offices, trucking morning and afternoon snacks as well as a hot and cold lunch entrée the five kilometres across town from the hospital. This was/is considered a reasonable cost for these executives. One assumes that a subsidized lunch program has been introduced for the NSHA corporate offices in Halifax. Which hospital kitchens provide it?

The decision not to travel the great distance from Halifax to St. John’s seems like they’re trying to hide their past failures by inaction.

Interestingly, every other province and territory had recruiters at this event. The recruiter for the Yukon told the CBC that she had developed “60 soft leads” from the event and expected those to become “10 hard leads”. The Yukon, like others, used this as an opportunity to develop relationships with medical students, which they maintained throughout the students’ years of study. The Yukon knows who is ready to graduate and makes offers before others.

NSHA hasn’t done a stellar job in recruitment among local medical students, so why should we think they could woo students studying in Newfoundland? The biggest impediment to practicing medicine in Nova Scotia has been the NSHA. In pursuit of its collaborative care masterplan the NSHA has discouraged physicians from practicing where those physicians were interested in practicing. It has dictated unacceptable terms and conditions. And then it just basically treats people like shit. The most recent example is the $10 million spent to litigate the case of Dr. Gabrielle Horne – which Dr. Horne won. That’s not a positive message for any professional considering relocation.

Speak to anyone in Nova Scotia’s health care system and you don’t hear happiness. What you hear are people counting the months until they can retire and get away from the bullshit. I wonder if this count-down has seeped into the executive suite. CEO Janet Knox and Vice President Dr. Lynn Harrigan are around 24 months from retirement age. Have they adopted a don’t-rock-the-boat position as they wait for their numbers to add up?

Another disincentive for action is the fashion in health care for new-hires to reward those who gave them their positions with lucrative consultancies, thus doubling or tripling the executive’s retirement income.

But why would we expect this leadership to perform? In the nine years of covering health care in Nova Scotia I have not heard from a politician, physician, patient, nurse, front-line worker, supplier, other health executive or union representative who had positive impressions about the system or those in charge. No one has pointed to any example of success or innovation in the careers of these executives. Those who work in the system are unhappy. Those who use the system are unhappy. And politicians – in and out of government – are unhappy.

Given how this leadership has performed, why would any young professional with a world of choice, choose to work for the Nova Scotia Health Authority?

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NS Health tries to reinvent the wheel

For several weeks the CBC have been reporting about the successful doctor recruitment program exercised by Nanaimo, B.C. and Goderich, Ontario. Both communities have sold doctors on the idea of living and working in each place.

Both communities made their recruiters available to answer questions and arrange services on the ground. Goderich and Nanaimo sold their destinations as desirable places to live and work. This is somehow considered a revolutionary idea. It’s only revolutionary to reporters who don’t hire people and overly bureaucratic operations, like the Nova Scotia Health Authority, which lacks people skills.

This is a 4,000-year-old Roman wheel. It’s round and still rolls. NSHA would have to study the theory of a wheel before accepting its functionality.

Once again, health care executives try to re-invent the wheel.

In my 40+ year career it was and is standard practice for an employer to help a new hire transition into the community. As an employer if we hired someone from outside the community or if I was recruited to move, accommodation leads were provided. I was told about the community and what it offered. I was taken around and introduced to people. Banks used to rotate young staff throughout their system as part of the training process, so the banks maintained an inventory of suitable accommodations for their staff. It’s not rocket science, it’s a version of the Welcome Wagon.

In 2013 I added a page called Doctor Recruitment (see above). As an example of what companies do to attract and keep staff, I wrote: “Earlier in my career I was publisher of The Kings Country Record in Sussex, New Brunswick. While I was there, Denison Mines decided to develop a potash mine in the neighbouring community of Penobsquis. Denison’s vice president of human resources flew from Toronto to meet with me. He did that because of my age and marital status. I was a single executive in my 20s. He wanted to know about life outside the office. He said, “If I’m going to ask people to transfer from Toronto with all the nightlife and cultural options they have there, what can I promise these highly-motivated professionals?””

Health care is supposed to be about people. So why is it so thick, so unresponsive, when it comes to human resources? The NSHA and its executives don’t have a good record for recruitment, retention or respect. When health executives speak of “patient-centred care” that’s not a philosophy, but a reminder to them of their media training and speaking points.

This week the government announced it was topping up doctors’ pay by $39.6 million. That’s positive. What is less positive is the fact that just before this we learned the NSHA was comfortable spending $10 million to litigate a losing case against an individual doctor.

And last week I ran into a just-retired front-line health worker. She had worked for the Annapolis Valley District Health Authority for 28.5 years. She had over 1,000 banked sick days – days she could have taken off, but didn’t – and at the end of her career no one from the health authority said good bye, gave her a card or in any way acknowledged her three decades of service or retirement. She ended her shift and walked out the door. Period.

Hers is a telling experience because health care is riddled with early retirements of people who love their work, love making a difference to patients, but are fed up with the shit they take from disconnected, inconsiderate and inconsistent executives.

Given our history it makes you wonder why anyone would work for this crowd.

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