The Chronicle Herald (Provincial)
Outspoken docs decry being outcast
If health-care professionals see a problem that hurts the quality of patient care, shouldn’t they be free to discuss it publicly?
The answer, obviously, is yes, even if doing so puts some bureaucratic noses out of joint.
In Nova Scotia, however, when doctors dare to publicly criticize the way things are done, all too often they may face blowback that can derail their careers.
So, understandably, many stay silent.
Remember Drs. Rob Miller, Rebecca Brewer and Keith Maccormick?
In spring 2019, those three emergency medicine physicians at Valley Regional Hospital in Kentville decided to dramatize the desperate need for nursing home spots in this province — which, in a domino effect, causes critical overcrowding of ERS — by launching a Gofundme to raise money for more longterm care beds in Nova Scotia.
That didn’t go over well with Stephen Mcneil’s Liberal government or Nova Scotia Health Authority bureaucrats.
Over the rest of 2019, as Drs. Miller, Brewer and MacCormick continued to push for better ways to deal with problems such as chronic hospital overcrowding, they say they were ignored, maligned and bullied by NSHA officials.
By early January of this year, they had had it.
So they decided to publicly protest what they called the NSHA putting bureaucracy ahead of patient care, by withdrawing or sharply reducing their services at VHR. Their move made the news. Within days, Drs. Miller and Brewer — who intended to keep doing a few ER shifts a month at VRH — say they were hit with a series of mysterious, anonymous complaints, allegedly made by members of the nursing staff.
Notifications of those complaints came from Dr. Lois Bowden, the local NSHA head of emergency. That’s the same person the Valley Regional Emergency Physician Association (VREPA) had unanimously voted to replace as head of their group in March, 2019, the three ER doctors said. Dr. Brewer was elected as new association president at that time.
The complaints accused Dr. Miller and Dr. Brewer of ignoring patients by spending too much time behind closed doors and on their cell phones.
The doctors say the allegations were untrue, spurious and constituted harassment.
“I was not allowed to actually see the complaints, or know who was making these complaints,” Dr. Brewer told me when I recently caught up with the physicians on a video conferencing call. They didn’t make sense, she said; the timing, structure and other elements “just don’t add up.”
Neither had ever received a complaint before, they said. Dr. Miller had been at VHR for 14 years, Dr. Brewer for six.
The doctors engaged a lawyer through the Canadian Medical Protective Association. After correspondence between the NSHA and their CMPA representative, the complaints seemed to go dormant. But they were never formally dropped, said Dr. Miller.
Both decided continuing to do any shifts at Valley Regional would not be prudent. At VRH, “we were questioned so much, we became questionable,” said Dr. Brewer.
They heard privately from many doctors who agreed with what they were trying to accomplish but stayed quiet, she said. “For good reason.”
So, what’s happened since then?
Since leaving VRH, both Drs. Miller and Brewer have worked at ERS in Charlottetown, out west in B.C. and occasionally at smaller community hospitals in Nova Scotia.
“I find myself on the road a lot more than I used to be,” Dr. Miller said. ER doctors are needed everywhere, but over the winter, it can be dangerous.
Dr. Brewer said when she’s working in Nova Scotia, she spreads her shifts around so she’s never anywhere long enough to let “the dysfunction” get to her.
Meanwhile, Dr. Maccormick, who made a clean break from Valley Regional, also worked in P.E.I but now does shifts mostly in bigger centres in Nova Scotia’s central zone.
He said he felt tension but didn’t face the same harassment as the others. For the most part, he has kept his head down and done his shifts. “Since last winter, I certainly go to work with a big piece of duct tape over my mouth,” Dr. Maccormick said.
One of the most insulting things said about their departure from Valley Regional by local NSHA officials was that they were “burnt out,” he said.
“Absolutely misinformation,” said Dr. Maccormick. They’re all experienced ER doctors, used to the pace. The problem was political.
“That’s what drove us away. We realized that our practices, the practice of emergency medicine that we had been so proud of at Valley Regional, was being interfered with by politics,” he said. “That’s the problem I see. I think, around the province, doctors aren’t being allowed to do what they’re good at.”
Among other improvements, Dr. Maccormick wants better enforcement of conflict-of-interest policies and a respectful grievance reporting system.
Dr. Miller has enjoyed working in other parts of Canada, especially B.C.’S Fraser Health Authority, where physician wellness is a priority.
“It’s been eye-opening how much better it can be.”
But that’s also motivated him to continue to try to work for change in Nova Scotia. If there’s a will, why not here, he asks?
“I want to make things better here. I want to have a voice here,” said Dr. Miller. “I want to be able to speak without facing repercussions from the quote unquote authority, which has no authority over me because I’m not an employee.”
Dr. Brewer said she hopes change can come to Nova Scotia, but it will take more physicians coming together and speaking up. If that doesn’t happen, when the pandemic’s over, she’ll likely leave. She’s received multiple offers, from places in both Canada and the U.S., to relocate.
“I’d be happy to settle anywhere where advocacy is welcomed.”
Drs. Miller, Brewer and Maccormick all said they’re speaking out now because they want to safeguard physicians’ ability to publicly advocate for better patient care while encouraging doctors in Nova Scotia to fight for that right.
A recent decision by Saskatchewan’s highest court strongly affirmed it’s in the public interest for health-care professionals to be free to criticize the health-care system.
“I’m not looking for personal justice,” said Dr. Brewer. “I don’t want this to be a case of sour grapes and have the more important issues of the broader picture of issues of accountability be sort of overshadowed or taken away from by my own personal experiences.
“In my view,” she said, “the Nova Scotia Health Authority’s lack of accountability is the major problem that leads to all the other problems, including the conflict of interest things that we’ve run into … It’s an entity that seems to focus on defending its leaders, right or wrong, and will go to the Nth degree to do so, even at the cost to patient care and staff.”