Cracks in local healthcare system

Recent news stories have once again highlighted the shortcomings in the province’s healthcare system, and in particular, how services are delivered in the Strait area.

Just before the end of the year, St. Martha’s Regional Hospital in Antigonish and the Inverness Consolidated Memorial Hospital lost general surgeon, Dr. Jeannie MacGillivray, following her resignation after multiple years of clashing with the Nova Scotia Health Authority (NSHA) over her work-life balance.

Dr. MacGillivray said she moved back to her hometown 12 years ago to be close to her family and get the benefits of living in a community, even though she can earn more elsewhere.

In December, Dr. MacGillivray sent notice to her patients that she would be unable to perform her scheduled procedures.

Her resignation came despite the health authority’s recruiting policy that promotes the quality of life in Nova Scotia, a trade-off for lower rates of pay to provide care in predominantly rural areas.

Inverness MLA Allan MacMaster charged that Nova Scotia has a doctor shortage and the Liberal government is doing nothing to keep a rural surgeon who wants to practice in the Eastern Zone.

He said the public suffers because of this failure in healthcare management where a surgeon praised by her patients was run-off by the NSHA.

After her resignation, Dr. MacGillivray then faced the sudden withdrawal of her privileges to do surgeries at the hospital, putting some of her patients in limbo.

In the weeks after MacGillivray issued her letter, she received an enormous amount of support from her former clients, other doctors, both locally and provincially, and community members from Antigonish to Inverness, who called for the NSHA to act on the matter.

MacMaster said Nova Scotians are tired of a faceless health authority making bad decisions that are impacting people’s quality of life. He added that it is up to Health Minister Randy Delorey to fix what his health authority has broken.

To provide “clarity and context,” to the stories, comments and opinions about Dr. MacGillivray’s resignation, the NSHA issued a statement on January 11.

NSHA Eastern Zone spokesperson Greg Boone said Dr. MacGillivray “worked a limited surgical schedule for more than a year,” and when a physician resigns, they also give up any hospital privileges.

Usually, there are three full-time general surgeons as part of the team at St. Martha’s Regional Hospital. Members of this team may also provide surgical services at other hospitals in the zone, including Inverness Consolidated Memorial. The NSHA said these surgeons provide general surgery, including sharing on-call responsibilities to support continuity of care and work-life balance for the team.

Dr. MacGillivray’s former patients, who have less urgent issues, are directed back to their family physician for referral to another surgeon, while urgent or emergency cases are being referred directly to the other surgeons for follow-up.

The NSHA is now actively recruiting for a full-time surgeon based at St. Martha’s Regional Hospital.

Not long after the doctor’s departure went public, it was announced that a crucial service providing pregnant women the necessary support, care and advice during pregnancy, labour and the postpartum period, which had been regularly offered at St. Martha’s , was suspended.

Sally Loring, the senior director of maternal and child health with the NSHA told The Reporter that they needed to temporarily suspend the midwife program because one midwife took a leave of absence, another is on an educational sabbatical, and the third had to leave the province for personal reasons.

Loring responded that rumours of funding cuts to the program aren’t true and it was unforeseen circumstances that led to the departure of the midwives.

She said a major problem is that midwives are not trained in Atlantic Canada, so those being recruited are not from this part of the country. With the support of the Department of Health and Wellness, the NSHA is looking to see whether a midwifery training program can be started in the Atlantic provinces.

In the meantime, the NSHA is recruiting new midwives to fill the three vacant positions to get the program up and running again.

Loring acknowledged the cancellation was disappointing for the 22 affected patients, some of whom were approaching their due dates. However, the NSHA noted that no woman, nor unborn babies, were put at risk, and all women under the care of midwives were transferred to the care of family physicians.

Tammy Martin, the NDP’s health critic, charged that women’s health services are suffering under the McNeil Liberals, as they have cut or abandoned several services impacting women’s health care in Nova Scotia. Claiming there is a “healthcare crisis” in the province, Martin explained that midwives are an important part of the health care system and take the pressure off family practices.

Martin highlighted the lack of action on midwifery and the cancellation of prenatal classes is contrary to the government’s stated aims for maternal health.

Not long after, it was confirmed that the emergency departments at Strait-Richmond Hospital and St. Ann Community and Nursing Care Centre, less than 50-kilometres apart, were closed a total of 1,279-hours during 2017-18, according to the annual Accountability Report on Emergency Departments, published by the Department of Health and Wellness.

The number of emergency department closure hours is on the rise throughout the province but the report indicates a 15 per cent increase in closure hours throughout the Eastern Zone from 2017-18. In this region, there was a total of 13,979 emergency department closure hours, including 9,741 scheduled and 4,238 temporary closure hours.

Hospitals experienced temporary closures as a result of the unavailability of emergency department staff (nurses, physicians or paramedics).

Emergency departments with no scheduled closure hours saw, the Strait-Richmond in Evanston with 828 temporary closure hours, St. Ann in Arichat had 451 hours, while Guysborough Memorial Hospital had seven.

PC Health and Wellness critic Karla MacFarlane said in a press release that the data contained in the report is shocking. Since Stephen McNeil became Premier, she said there is a 96 per cent increase in closure hours and in the last year alone, it increased by an astonishing 19 per cent across the province.

Although MacFarlane claimed the government is “ducking accountability” on the issue, Tanya Penney, the NSHA’s senior director of critical care and emergency programs of care said staffing emergency departments is a significant commitment for family physicians who already have busy practices. Then there are other doctors who choose not to work emergency duties.

Penney said it is hard to align doctors who have other competing priorities and other doctors who don’t feel comfortable to work the emergency department.

Nova Scotia’s 38 emergency departments is the most per capita of any other province in the country, and Penney highlights the NSHA isn’t in a unique situation as other provinces such as Alberta, Saskatchewan and Northern Ontario all face issues in rural areas.

Brett MacDougall, NSHA executive director operations for the eastern zone, spoke about the NSHA’s successful recruitment of a new infection practitioner after losing an infection specialist a little over two years ago.

Both Penney and MacDougall agreed they would rather see an emergency department be temporarily closed rather than not having the service at all.

In all cases, there has been a critical breakdown somewhere in the system and it was only detected when it was too late; Dr. MacGillivray’s struggles with the NSHA went on for years, the midwives did all not leave at the same time, the emergency departments have been experiencing closures for years now, and physician recruitment has been a local priority for decades.

These incidents have allowed the political opposition to tee-off on the government, with data in hand, and have made the Liberals look unprepared, mean-spirited, and worse of all, unable to properly manage the healthcare file.

Obviously, not all the ills in the system can be pinned on the current provincial government. It took decades of inaction or half measures by Progressive Conservative and New Democratic governments to get to this point. The Liberals have inherited this mess, but they are in power and the buck stops with them.

Whether they are up to this daunting challenge, remains to be seen. Perhaps the answer will come in the upcoming provincial budget.