Palliativecare doctor pulls services
Dr. Bob Martel says supports lacking but he will continue to treat existing patients
A Richmond County doctor who has treated terminally ill patients for the past 16 months says he’s been forced into retirement due to the province’s slow response to its own palliative-care strategy.
Dr. Bob Martel, who lives in West Arichat, will no longer provide acute palliative care services for the Strait-Richmond area as of July 15.
He will continue on caring for the six patients he currently has — two in hospital and four being cared for by family at home.
Martel said there are too many gaps in service when it comes to endof-life care in the rural, rapidly aging municipality.
He said Richmond is one of three counties in the province without palliative-care nursing services on weekday evenings and on weekends.
Other than Martel working as a full-time palliative-care doctor, he said medical palliative-care consultations are only available from out-of-town physicians every three to four weeks.
“We’ve been doing as best we can with what we have but I’ve reached a point where those services cannot continue,” he said in an interview Thursday.
“I think it’s misleading to be offering home-based palliative care when after 4 o’clock there’s no nursing service available and basically I’m doing 24-7 coverage for these individuals.”
The level of service is not where it should be compared to other regions of the province, he said.
There are other resources lacking such as a full-time social worker, dedicated fieldbased palliative-care nurses, physicians and nurse practitioners, Martel said.
It has resulted in Richmond County having fewer homebased palliative-care deaths “than virtually every other jurisdiction in Nova Scotia,” according to Martel.
The province is in its second year of implementing the Nova Scotia palliative-care strategy.
Responsibility for the strategy has been turned over to the Nova Scotia Health Authority from the Department of Health and Wellness.
Provincial palliative-care coordinator Cheryl Tschupruk admitted there are gaps in palliative care service but the strategy is working to “build capacity” in a primary healthcare setting.
“I think it’s been a collaborative effort in working with managers in every community together to look at what things we should be doing the same across the province and what will be things that will be different in communities,” she said.
The strategy points to the hire of two part-time social workers in 2014-15 to handle senior care in Guysborough, Antigonish, Richmond, and south Inverness counties.
Emergency Health Services paramedics are now able to provide palliative care support in the home, Tschupruk said.
She said paramedics are able to provide support within their scope of practice while keeping the patient at home if possible.
Patients receiving palliative care can enrol through discussions with their health care providers in the EHS special patient program.
“It’s not the only solution but it’s one part,” said Tschupruk.
Where possible, the goal should be to allow a patient to die at home if desired, she said.
“It’s about working together as health providers and community members to look at how we can work together to sort of fill some of these gaps and make sure at the end of the day the patient is getting the care they need.”
However, there remain too many patients entering palliative care in the final stages of an illness, Martel said.
He said he’s not seeing a coordinated approach between health-care professionals and the health authority.
“The bottom line is they don’t know best. They would only know best if they had proper information from the frontlines and how can they when they’ve never even been here.”
Martel, who turns 65 today, had planned to set up a palliative-care program “sensitive to local needs” and eventually pass it over to a younger doctor in a couple of years.
His plan has now been shelved and he will likely retire.