Dr. Robert Martel: Nova Scotia government is 'tone deaf' to ER problems

This year is most likely my last year in an emergency room after 33 years in the trenches.

It certainly has been a bittersweet experience.

I wish I could say that in these 33 years, solutions have been found to some very fundamental problems. But despite millions of dollars spent studying the problem, innumerable ministers and deputy ministers of health, we remain challenged to provide the most basic service of all: assessment and proper disposition of a loved one who presents with a predictable illness requiring hospital-based care.

Why is it a yearly revelation that flu patients are going to be a burden to the system? Especially this year, when it was known in October 2014 that the vaccine would be practically ineffective.

Physicians and nurses have done their due diligence by developing protocols and care plans that have dramatically raised the bar for admission to a hospital bed in this province.

More needs to be done, but compared to what has been done by managers of the system to make it more efficient and accountable, I would venture that the efforts are not equal.

I have had the privilege of working in one of the world's best health-care systems — despite its warts — in 12 different emergency departments in three provinces.

Interspersed with that hands-on clinical experience was an opportunity to experience health care's challenges as a national health-care consultant — thereby gaining a perspective which has etched a certain degree of cynicism in my views of what is working well and what is not. 

In the trenches

This week, I listened to my colleague, Dr. Sam Campbell, a veteran of the same trenches, attempt to articulate the problems he faces as an administrator of the emergency department as it struggles to fulfill its role as the only tertiary care centre for almost a million people in this province.

The emotion he tried to keep under check — unsuccessfully — during the interview was evident and likely misrepresented the real level of stress workers experience trying to manage the workload.

A few years ago, Dr. Campbell's much lauded and newsworthy colleague, Dr. John Ross, occupied the same role. He, too, frustrated by system inefficiency, called a "Code Orange" — aka we have an emergency in the emergency room — one memorable day for exactly the same scenario faced by Dr. Campbell.

The CEO and the management team of the day admonished Dr. Ross for his comments and blamed the staff, shirking all responsibility as the managers of the facility they were charged with running.

Comments from the Minister of Health at the time were equally ill-informed and unhelpful.

Fast forward to this week's interview with the deputy minister of health, who, apparently devoid of ideas for fixing the problem, defaulted to the age old excuse: primary care is failing to deliver on its mandate.

Predictable events not accommodated

Clearly, he and his advisers were tone deaf to what Dr. Campbell and every other emergency room director is saying: patients who are lined up 13 stretchers deep in the QEII emergency department are not there because primary care is failing, they are there because they need care primary care physicians cannot provide.

Furthermore, they are on stretchers because three times as many patients are already admitted on other stretchers within the department, unable to go upstairs because beds are full. In their haste to cut costs, successive governments have removed all elasticity in the system, such that even predictable events like flu-related illness can no longer be accommodated.

What is to happen when those baby boomers start to demand advanced care? By the way, this is also a predictable event.

I agree that primary care needs reform and that the health system needs resetting to a model where preventative medicine and individual ownership of problems become hallmarks of an efficient and accountable delivery model.

However, there is a crisis facing people who have paid for their health care: they are not receiving timely, evidenced based care when they need it.

Rome is burning

Dr. Peter Vaughn, the deputy minister, Health Minister Leo Glavine and Premier Stephen MacNeil need to understand that patients do not choose to block emergency departments, their illness demands they show up there and it is for the managers of the health system to find a way to meet their needs.

We all appreciate that the province's finances are limited but we have to be able to deliver basic care to residents above all else.

If not, then Mr. MacNeil, as leader of this government, must come clean with Nova Scotia taxpayers and outline exactly what is not covered in Nova Scotia despite what the Canada Health Act says.

Rome is burning and the managers of the system are fiddling with unions and governance structures.

Premier MacNeil needs to push the reset button on health care and listen to what front-line workers like Dr. Campbell have to say as ultimately he will be judged for grandma dying on a stretcher waiting for assessment of her pneumonia.