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.