Behind the backlogs: waiting and waiting some more for health care

2022-07-27 14:30:37 By : Ms. Windsor Li

An independent, adversarial news site in Halifax, NS

July 27, 2022 By Ethan Lycan-Lang and Yvette d'Entremont Leave a Comment

A worker places a sign on the gates of the Halifax Public Gardens on Tuesday, July 26, 2022. Photo: Zane Woodford

Ever heard of girdling? You might know it by another name: ring-barking. For those unfamiliar, it’s the act of removing a strip of bark from the entire circumference of a tree trunk or branch. This creates a bark-free ring on a tree; everything above that ring will eventually die. So if you girdle a lower part of the trunk, that will lead to the death of the whole tree.

Sometimes foresters will girdle trees to thin out forests. Sometimes small rodents (think beavers, obviously) or birds girdle trees when they feed. And sometimes people girdle trees when they get the irrepressible urge to be inconsiderate jerks.

Take this latest case of vandalism at the Halifax Public Gardens, as Zane Woodford reported on Tuesday.

Workers collect bark cut off a tree at the Halifax Public Gardens on Tuesday, July 26, 2022. Photo: Zane Woodford

On Tuesday morning, staff at the park found someone had broken in overnight and stripped bark from roughly 30 trees, some of them more than 100 hundred years old. The park was closed, police were called, and a little faith in humanity was lost.

Woodford has the full report on the ongoing investigation and what municipal staff are doing to try to save these damaged trees.

As someone who used to live a few blocks from the Public Gardens, and frequented it to read, picnic, date, stroll, and just generally laze about by the greenery, can I just say one thing. We live in a world of heightened security and expensive experiences. On the rare instance where something’s beautiful, free, and wide open to everybody, can we just enjoy it, not destroy it?

(Copy link for this item)

Education Minister Becky Druhan (centre) introduces legislation to turn down a pay raise for MLAs. Photo: Jennifer Henderson

Last week, an independent panel recommended a pay raise for MLAs, but Premier Tim Houston promised he wouldn’t be accepting those recommendations and MLA salaries would remain the same as they’ve been since January 2013.

“When inflation is at a 40-year high, gas prices are at historic levels, and many hard-working Nova Scotians are struggling to make ends meet, it is not the time to increase the pay of MLAs,” he said at the time.

As Jennifer Henderson reported on Tuesday, Houston got one step closer to delivering that promise officially.

The Houston government introduced amendments to the House of Assembly Act that would allow the province to reject the pay raise recommendations ⁠— current legislation makes the panel’s recommendations binding ⁠— and they are expected to pass with support from all parties later this week. From Henderson’s story:

“Now is not the time to increase compensation for MLAs,” said Education Minister Becky Druhan Tuesday as she introduced the amendments. “Nova Scotians are facing record high inflation and many people are having a hard time financially. As elected officials, our compensation needs to reflect the current state of the economy.”

Also in the bill: the premier will take a voluntary pay cut of just over $11,000.

Click here to read Henderson’s full breakdown.

(Copy link for this item)

Left to right: Premier Tim Houston, Business Minister Suzanne Corkum-Greek, Public Works Minister Kim Masland, and Service Nova Scotia Minister Colton LeBlanc. Photo: Jennifer Henderson

Five of the province’s government agencies are consolidating into two, reports Jennifer Henderson.

The Progressive Conservative government will officially create two new Crown corporations, Build Nova Scotia and Invest Nova Scotia, this fall. Premier Tim Houston made the announcement Tuesday.

Build Nova Scotia will replace Nova Scotia Lands and take over the work of Develop Nova Scotia. Those agencies supervised things like construction of health care infrastructure, the remediation of Boat Harbour, waterfront development, and rural high-speed internet delivery. Build Nova Scotia will also absorb Harbourside Commercial Park in Sydney.

Invest Nova Scotia will do the work of Nova Scotia Business Inc. and Innovacorp, providing loans and services to local businesses and attracting new companies to the province.

Houston picked two entrepreneurs he considers friends, Wayne Crawley and Tom Hickey, to run the new agencies, replacing the boards of directors of five Crown corporation agencies. This prompted journalists to ask about the independence of the new agencies from political control; the boards of directors being replaced traditionally operated at arm’s length from legislators.

“The new CEOs will be accountable to the minister,” said Houston. “We have a situation in the province right now where there’s really no accountability except to a board that’s not elected. What we are doing is building accountability into the system.”

The two will operate as executive chairs of their respective agencies until two new CEOs are recruited to replace them long term. It’s similar to the dismissal of the Nova Scotia Health Authority’s board of directors last September. Karen Oldfield was put in as executive chair and still holds that position almost a year later.

Houston also said the restructuring will save money in the budget and guarantee a more efficient government. He wouldn’t say whether civil service jobs would be lost in the shuffle.

The change-up was the result of a large review of government Crown corporations that also affects hospitals, Nova Scotia Gaming, the Municipal Finance Corporation, and the proposed waterfront Art Gallery of Nova Scotia.

Read Henderson’s full report for all the details on those, as well as the response from opposition parties.

(Copy link for this item)

Todd Leader has had his registration as a psychologist suspended for six months. Photo: Twitter

This item written by Yvette d’Entremont.

A Nova Scotia psychologist who also taught part time at Saint Mary’s University has received a six-month license suspension for “engaging in persistent and unwanted communications” with a female student. 

In a summary decision dated June 15, the Nova Scotia Board of Examiners in Psychology (NSBEP) outlined how complaints were filed in July-August of 2017 against Todd Leader by two psychologists who were treating a student taking one of his classes. 

The student, referred to as Student X, also filed a complaint in January 2018.  

All three complainants focused on text, Facebook, and email messages sent to the student by Leader. They alleged he “failed to act within professional boundaries, causing harm to a student who he was aware was suffering from mental health issues.”

The investigation committee had access to communications between Leader and the student, as well as to correspondence he sent to the student, her mother, and one of the student’s psychologists. The decision notes that Leader voluntarily offered the information to one of the complainants. 

Among the six allegations of professional misconduct to which Leader admitted, it was found that despite knowing the student was vulnerable and suffering from mental health issues, he failed to mantain appropriate professional boundaries by “engaging in persistent and unwanted communications with her, including unsolicited sexually oriented comments, and professions of love and admiration.”

The board said that while investigating the complaints, its committee became aware of medical issues which, combined with other mental health issues, may have impacted Leader’s conduct. 

“Mr. Leader admitted that his conduct was inappropriate, but that he thought he was providing support to Student X,” the decision read. “In meeting with the Committee, Mr. Leader expressed remorse and shame for his conduct.”

At Leader’s request, details of his mental health were outlined in the decision. At the time the events occurred, he was being treated for depression and was also on medication (Pramipexole) for another medical condition.

In its decision, NSBEP said they learned the medication he was taking in 2017 caused “disinhibition, compulsive behaviour and a lack of insight.” 

“An assessment found that when combined with underlying personality and emotional variables that were operant at the time, the medication likely disinhibited Mr. Leader’s control over his behavior resulting in his actions before the Board,” it said. 

In a personal statement reflecting on his conduct as part of the settlement process, Leader said he was deeply sorry for his communications with the student and for the difficulty he caused her, acknowledging that his communication and interactions in question were “inappropriate and engaged in clinical areas which are outside the scope of practice of his teaching role and his registration as a community psychologist.”

Among the allegations of professional misconduct, Leader was also found to have “created a risk of serious harm” to the student by discouraging her from following her family doctor’s advice when told to go to the emergency department because she was suicidal.

The board’s decision noted that Leader attempted to manipulate the student, her mother, and her psychologist to avoid consequences of his misconduct, and that he allowed his personal needs to take priority “over due sensitivity to her vulnerable condition and appropriate consideration of how his conduct would benefit and not harm her.” 

Leader told NSBEP that he received the required psychological and medical treatment to address the underlying issues — including no longer taking Pramipexole. He also said he has re-established his mental health, gained insight into his actions, the hurt caused, and measures required “to prevent any further behaviours like this in the future.”

In addition to the six-month suspension of his license, Leader must follow the advice of his health care providers regarding ongoing counselling and medication. At the beginning of each term, he must also advise his class in writing that while he’s a registered psychologist, his role with students is strictly as a university professor.

Leader must also advise any university where he teaches about the settlement agreement and the requirement to clarify his role in writing.  A 2017 Saint Mary’s University Alumni Facebook event notice where Leader was discussing his 2016 book It’s Not About Us; The Secret to Transforming the Mental Health and Addiction System in Canada notes that Leader and his team “transformed the mental health and addiction system in the South Shore of Nova Scotia” by bringing adult wait times from eight months to one month and giving adolescents same-day to same-week access.

(Copy link for this item)

Dr. Afua Cooper. Photo: Matthew Byard.

“We don’t find Black people, whether as teachers or students or researchers, well represented in STEM,” Dr. Afua Cooper told Matthew Byard for an article on an upcoming symposium that will encourage Black students to study disciplines like science, technology, engineering, and math after high school.

Cooper is a Dalhousie professor and serves as lead for A Black People’s History of Canada Project, which is hosting the symposium that runs through Thursday. The project, and the symposium by extension, explores Black Canadian history and considers how it can be integrated into STEM education. The idea is to combine Black history with more science-based disciplines. To show past Black representation in those fields, and perhaps inspire future students to follow the footsteps of other African Canadians. African Canadians like Dr. Clement Ligoure, Nova Scotia’s first Black physician, who cared for wounded survivors of the Halifax Explosion and pushed for Black representation in Canada’s military.

Dr. Clement Ligoure Photo: Queens University Archives

“He was one of the co-founders of the No. 2 Black Battalion — he was a medical doctor. And he was the hero of the Halifax Explosion,” Cooper said, talking about Black history’s potential to inspire future STEM students. “This is history but it’s medical history. It’s the history of civil rights, it’s the history of racism, and it’s the history of science and technology, in this case, medicine.”

“You may have a child who is not interested in history, who’s not interested in math, but if you put forth to that child a figure like say Clement Ligoure, the child may find it exciting.”

Read more about the history of African Canadians in STEM fields, as well as the symposium and what Cooper hopes it will accomplish, here.

(Copy link for this item)

Even when there’s not a pandemic, Crystal Crescent Beach can get crowded. Photo: TripAdvisor.

There’s been a misconception abroad that Canada is an endless frozen tundra where a large portion of the population dogsleds from igloo to igloo. That misconception has never seemed bigger.

Wildfires, which have become perennial as the grass they torch, are raging in the Yukon and near still-recovering Lytton, BC. 

This week has had heat warnings in BC, all four Atlantic provinces, Ontario, and Quebec. Our own Greenwood, I’m told, was the hottest place in Canada Thursday. It was 35 degrees without humidity. Hotter than hell with it. 

The other day, while I tried to confirm what I’d heard on the radio about Greenwood’s record heat, I stumbled on this old 2005 puff piece from the Globe about Canada’s climate. An Environment Canada scientist’s study, looking at weather charts from 1971-2000, found that Nova Scotia was the warmest province in Canada.

Seventeen years later and we’ve still got it, baby.

You might expect BC to be the warmest. It doesn’t snow in Vancouver and the rest of it’s on fire half the year, so it’d make sense, right? But the 2005 study found our average year-round temperature was a few notches above the west coast.

“Although the Maritime province doesn’t have hot summers, it also doesn’t have brutally cold winters, which gives it the highest average temperature,” the article read, ridiculously.

“Doesn’t have hot summers.” 

It’s apparently been a long time since 2005.

As we suffer through this humid heat wave, I think about the small affects of the changing climate here.

How many more Nova Scotians will grow up skating on rivers and ponds? The skating season already feels shorter than when I was a kid. Forget Hockey Canada’s current scandal (actually, don’t forget it, it’s a disgustingly heartbreaking story), warmer winters could be a big hit to hockey’s popularity in this country. If you don’t have access to free outdoor ice, and it’s sunny and mild, why go to a rink?

That might seem like a silly thing to think about, but it’d be a huge cultural shift brought on in only a few generations by the weather. 

Hotter summers might mean less outdoor activity for the more vulnerable among us. It could mean less camping, with more ticks. Whatever it means, it really feels like new generations could soon be growing up in a different Nova Scotia than kids of the past ⁠— if they aren’t already.

We’re still the warmest, though. Some consistency is nice.

(Copy link for this item)

The emergency department at Cobequid Community Health Centre. Photo: Yvette d’Entremont

Staffing shortages, bed shortages, COVID cancellations, backlogs, and burnout. Canada’s universal health care, the keystone to our ability to smugly look down on America, is crumbling. Problems exacerbated and exposed by the pandemic have persisted. In many cases, hospitals and health care workers are at the breaking point.

Nova Scotia’s thinly stretched health care system is something the Examiner’s covered since the start of the pandemic: long ambulance wait times and worker fatigue, hospitals pushed to the brink of capacity, emergency rooms closed for lack of staffing, and surgeries delayed or cancelled.

The surgery waitlist alone is cause for alarm. (I guess anything I listed above is cause for alarm, but I’ll focus on surgeries). An estimated 27,000 Nova Scotians are waiting for operations that have been put off by staff and bed shortages, as well as COVID precautions.

But interminable waitlists and backlogs and over-stressed health care systems aren’t unique to Nova Scotia.

The Ontario Medical Association estimates 22 million medical services have been backlogged during COVID, about a million of which are surgeries. There’d better be a lot of reading material in the waiting rooms of that province.

Further west, British Columbia’s Supreme Court ruled last week that patients don’t have the right to access private care when waits for public care are excessive. With about 88,000 people waiting for non-urgent surgeries there, the ruling might seem cruel, but it’s meant to protect British Columbian’s from pay-to-play health care.

“The justices said the laws that [Dr. Brian] Day objects to are meant to ensure equitable provision of health care, and prevent the creation of a two-tier system where access to potentially life-saving treatment depends on wealth,” Bethany Lindsay reported for CBC.

Here at home, Premier Tim Houston’s appointed Health System Leadership Team has considered how more private clinics could help put a dent in the backlog. That’s something I wrote about, and pushed back against, in April.

But people in BC have been paying for health care to jump the queue. They’ve just paid for it elsewhere. Medical tourism is growing, for those who can afford it.

Dr. Sarah Jurek, an orthopedic surgeon in Seattle, told the CBC  in May she’s seen a small uptick in Canadian clients during the pandemic.

“I never had a Canadian patient before and I’ve had three [in the past eight months].”

Provincial governments have even considered paying to send patients to other medical jurisdictions. Alberta’s provincial government — the waitlist there is 72,000, according to the Calgary Herald — had plans of sending some surgery patients BC’s way to alleviate its own backlog. Not sure how much luck they would’ve had had they followed through.

I could keep listing backlog numbers and providing repetitive systemic problems and solutions different governments have looked at (the feds have promised $2 billion to help provinces catch up on surgeries) but it’d get redundant fast.

The current state of the health care system, across the country, is deeply concerning. I’ve placed this piece in the Noticed section because I want to briefly draw attention to some of the stories behind the waitlist numbers. These so-called non-urgent surgeries can restore quality of life, relieve pain, and prevent future life-threatening operations.

“[P]atients are losing their jobs,” Dr. Cassandra Lane Dielwart, president-elect of the British Columbia Orthopaedic Association, told CBC recently, “These patients are getting narcotic addicted, these patients are living in pain, they’re getting depressed, and they are the ones who bear the burden of this problem.”

Right now, if I discovered a tumour, I’d almost hope it wasn’t benign so I could get some immediate treatment. An exaggeration, yes, but rooted in truth.

There’s a serious human toll behind these numbers. Surgery limbo doesn’t just require a little extra patience. Here’s a brief snapshot of Canada’s national waiting room from reports around the country.

Buck Shannon, a 71-year-old BC resident, told CBC his knee replacement was cancelled twice just days before his surgery in Kamloops. He was also supposed to have a shoulder replacement half a year ago. Instead he’s been living with a pain I’ll let him describe:

I’ve been shot. I’ve been stabbed when I served in Vietnam. Nothing can compare to what I’m going through right now in my left shoulder.

How about closer to home? In New Brunswick, teacher Cindy Gaudet waited a year and a half for one knee surgery. She’s still waiting for another. It’ll be at least a year. She told Global:

My concern is I need to go back to work. Do I trust my other knee? Because I’m going down the stairs and my new knee is doing a fantastic job, but my old knee decides that it doesn’t want to cooperate and it collapses on me. I need my strength and I need my mobility to do a good job at work.

In Toronto, where one would expect hospitals to have the most resources and capacity, Global reported yesterday on a woman who had a brain tumour discovered on July 1. Tina Grazos-McNeil and her husband went to the hospital after she had a spell watching TV:

“Her right arm and right leg started twitching like nothing I’ve ever seen and she collapsed on the floor,” her husband said. Now they’ve been waiting for a biopsy so they can determine how to treat the tumour. Daily calls to nearby Sunnybrook Hospital garner the same response: beds aren’t available.

“Until we get that biopsy done,” her husband continued, “we’re just spinning our wheels here, and I’m watching my wife deteriorate.”

For individual stories of waits in Ontario’s emergency rooms, I’d recommend this piece from Mike Crawley at CBC.

Up north, where access to health care can be limited at the best of times, CBC reported on a 17-year-old boy flew with his father from the Northwest Territories to Edmonton (comparable to a flight from Halifax to West Ontario) for an elbow surgery that was cancelled last minute due to record COVID hospitalizations. The father, Tyrone Raddi, told CBC the territory “needs to look after its residents instead of sending them down on trips where they know nothing is going to happen.”

Those COVID hospitalization delays are the biggest reason I worry about ending almost all COVID regulations in Nova Scotia last month. As badly as I want to return to normalcy, and start to treat COVID like the flu, we don’t seem to have the infrastructure or workforce to handle a large number of serious cases. At least, not without adding to health care gridlock.

Here, I point to an article in Maclean’s this week from Dr. Kashif Pirzada, an ER doctor in Toronto with 15 years of experience.

It’s not unusual to come into a shift these days and see that you’re down one third of your usual staffing complement. That means you can’t staff the beds that you have, and you see more and more patients in fewer spaces. When a wave happens, like right now, it starts knocking people out for sickness. They’re off for seven to 10 days with symptoms. And then you cross your fingers wondering who’s going to get long-term symptoms after that.

When we’re stretched too thin, paramedics can’t offload patients because there’s no one to take care of them, so we have 10 to 15 teams of paramedics practising what we call “hallway medicine” before someone can resume care. So you have basically a huge chunk of your active EMS staff sitting in a hallway in the hospital.

The other thing is that people wait much longer to get help. When the patients do get to us, they’re understandably very upset. I can’t blame them. But we take the brunt of their feelings, and that leads to people burning out and wanting to leave the field. So all of it comes together into a perfect storm. There’s real moral injury from watching a system fail and collapse when much more could be done to shore it up. The system has never been the greatest with ER and specialist wait times, but it’s significantly worse now.

I recently saw someone who had a brain hemorrhage and needed surgery. Since we don’t do brain surgery at that particular hospital, usually we would quickly send them to a neighbouring hospital with an escort of our own staff. This time, we just didn’t have any staff to spare. We had to wait for a special team to do the transfer. They were delayed too, so this person ended up waiting to get urgent surgery. A few years ago, they wouldn’t have waited at all. This kind of thing is happening more and more. And not only are patients waiting — they’re waiting to see someone who’s already overworked that day.

By now you’ve got the picture. Be kind to health care workers, now and always. And try to stay healthy as possible right now. That’s my best advice.

(Copy link for this item)

Heritage Advisory Committee (Wednesday, 3pm) — virtual meeting

Past/Future: African Canadian History, Arts and Culture in STEM Education (Wednesday, all day, Rowe Building) — second day of a three-day “symposium of action and possibilities that explores Black Canadian history, and further investigates how it can be integrated into STEM education.” More info here. $100/$50

Past/Future: African Canadian History, Arts and Culture in STEM Education (Thursday, all day, McCain Building) — last of a three-day symposium; more info here. $100/$50

Better Living Through Ungrading: practical approaches that improve instructor and student experience (Thursday, 11am, Room 226, Chemistry Building) — Erika Merschrod from Memorial University will talk

Halifax 05:00: Atlantic Sea, ro-ro container, arrives at Fairview Cove from Liverpool, England 06:00: Oceanex Sanderling, ro-ro container, arrives at Pier 41 from St. John’s 10:30: MSC Rossella, container ship, sails from Pier 42 for sea 11:00: MSC Santhya, container ship, arrives at Pier 42 from Montreal 13:00: Oceanex Sanderling moves to Pier 36 17:00: Atlantic Sea sails for Baltimore

Cape Breton No arrivals or departures.

Halifax Regional Police need to get the Lorax on the phone.

We have many other subscription options available, or drop us a donation. Thanks!

Filed Under: Featured, Morning File Tagged With: backlogs, CBC, climate change, doctors, Environment Canada, Ethan Lycan-Lang, Globe and Mail, health care, health care worker fatigue, hockey, Hockey Canada, hot summers, It’s Not About Us; The Secret to Transforming the Mental Health and Addiction System in Canada, Jennifer Henderson, Maclean's, Matthew Byard, mental health, Nova Scotia, Nova Scotia Board of Examiners in Psychology (NSBEP), nurses, psychologist, Saint Mary's University, surgery backlogs, Todd Leader, wait lists, Yvette d'Entremont, Zane Woodford

You must be logged in to post a comment.

PRICED OUT is the Examiner’s investigative reporting project focused on the housing crisis.

You can learn about the project, including how we’re asking readers to direct our reporting, our published articles, and what we’re working on, on the PRICED OUT homepage.

All of the Halifax Examiner’s reporting on the mass murders of April 18/19, 2020, and recent articles on the Mass Casualty Commission and newly-released documents.

In 1995, Brenda Way was brutally murdered behind a Dartmouth apartment building. In 1999, Glen Assoun was found guilty of the murder. He served 17 years in prison, but steadfastly maintained his innocence. In 2019, Glen Assoun was fully exonerated.

Halifax Examiner founder and investigative journalist Tim Bousquet has followed the story of Glen Assoun's wrongful conviction for over five years. Now, Bousquet tells that story as host of Season 7 of the CBC podcast series Uncover: Dead Wrong.

Click here to go to listen to the podcast, or search for CBC Uncover on Apple podcasts, Spotify, or any other podcast aggregator.

Author Andre Fenton returns to the show with a new book, The Summer Between Us: It’s a complex, empathetic YA story about teens on the cusp of adulthood in the under-examined summer between high school and university, an expansion of the characters explored in his debut, Worthy of Love. He reveals his writing process, how his personal mission to unpack toxic masculinity dovetails with his hero’s, and what inspires him to write. Plus the lead track from the brand-new Aquakultre album out this week.

Listen to the episode here.

Check out some of the past episodes here.

Subscribe to the podcast to get episodes automatically downloaded to your device — there’s a great instructional article here. Email Suzanne for help.

You can reach Tara here.

Sign up to receive email notification when we publish new Morning Files and Weekend Files. Note: signing up for this email is NOT the same as subscribing to the Halifax Examiner. To subscribe, click here.