Nove Scotia's ER Crisis (Aug 23, 2007)

Province doesn’t get rural health care crisis

In my other life on these pages, I write a weekly Sunday column called Kimber’s Nova Scotia, which is my slightly skewed take on all the news that’s fit to comment on from around the province. As part of my research, I spend a lot of time reading the stories making news in communities outside of Halifax — from the Yarmouth Vanguard to the Cape Breton Post, and every other provincial publication in between.

It’s fascinating — and eye-opening — to see that what matters in smaller communities are often not the issues that make the front pages of our city newspapers.

Take health care, for example. While we in Halifax take comfort in the government’s recent, though long-overdue announcement of a $17-million expansion of the QEII Health Centre’s emergency department, the more pressing concern in many pockets of Nova Scotia this summer us the absence of local emergency service at all.

Since I began writing the Nova Scotia column back in April, hardly a week has gone by without news of one ot more, of ER closure. The Digby General, the Roseway in Shelburne, the Lillian Fraser in Tatamagouche…

The Liberal party claims health officials have already announced 4,700 hours worth of ER closures this year, a fourfold increase over last year.

Even in those hospitals that haven’t shut down ER service completely, there are other problems. On at least five occasions, the Yarmouth General declared a Code Purple. It does that when its regular nursing units are so over-stuffed with patients — usually seniors waiting for scarce nursing home beds who shouldn’t be in a hospital — that others needing care end up stacked around the emergency room like a sky full of jets waiting for permission to land.

The lack of beds and the increased pressure that puts on ERs has had a tsunami effects on already too-high regional health care costs. The Cape Breton District Health Authority reported this spring it spent $1 million in overtime costs for emergency room care last year — double its budget — mostly because of lack of beds, and will probably do so again this year.

There are real problems in the health care system in rural Nova Scotia.

Perhaps most significantly, too few new physicians want to work in small communities, and too many older ones are retiring. I’ve counted at least half a dozen key retirements or resignations just since June. Since some carried huge caseloads — Dr. Roy Harding in Digby, for example, had more than 2,000 patients, about twice the recommended number — it will often require two new docs to replace one old one. Since many of those rural physicians also did regular stints in the local emergency room, their leaving becomes a double whammy — there’s no one to staff the ER, and their patients, who no longer have a family physician, seek medical help at the local ER.

Complicating matters is the still critical shortage of nursing home beds to accommodate our aging population.

I wouldn’t claim the government is doing nothing to deal with this crisis, It belatedly — and only after it was pushed hard by the NDP — announced plans to build more (but still too few) new nursing home beds, and it is funding some important local initiatives, like hiring nurse practitioners in Digby, to ease demand for doctors — but the reality is that Premier Rodney MacDonald and Health Minister Chris d’Entremont still don’t seem to get it.

In Digby — where d’Entremont cancelled one meeting last spring to discuss their crisis, then didn’t show up at a save-our-hospital rally and initially didn’t even bother to reply to a letter from Roy Harding, the retiring doctor who’d requested a face-to-face meeting to discuss “this unsatisfactory situation” — the situation has become so acute local councils are pooling resources to hire professional doctor recruiters.

“It is too bad we have to do this, too bad the government doesn’t provide packages in rural areas,” laments Digby mayor Frank Mackintosh. It is.

Earlier this week, I was talking with South West Nova Health Communications Director Barbara Johnson and Operations VP Anthony Muise about the specific issue of whether we actually need so many emergency rooms — another subject for another day — when it struck me how multifaceted the problems are, and how unfocused the province seems.

You may not want to answer this, I began, but is the province doing enough to deal with all these problems.

Barbara Johnson laughed. “You’re right,” she said, “we don’t want to go there.” She later emailed me to clarify that there are ongoing discussions with the provincial government to address the “difficult discussions that face health care.”

But the reality is that this government hasn’t “gone there,” at least in terms of the big picture, and it’s long past time that it did.

Stephen Kimber is the Rogers Communications Chair in Journalism at the University of King’s College.

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