Doctor withdraws in-patient coverage

GLACE BAY — Another doctor has notified the Nova Scotia Health Authority that he will no longer provide in-patient care to new patients admitted to the Glace Bay Hospital beginning this week, the Cape Breton Post has learned.

The domino effect means more patients who need to be admitted will have to go to the Cape Breton Regional Hospital emergency department, exacerbating an overstressed situation there, Dr. Margaret Fraser, the president of the Cape Breton Medical Staff Association, said Thursday.

“The regional hospital emergency department is working in dangerously overcrowded conditions every single day,” she said.

“That has been ongoing for months and nobody seems to really care . ... The time for action was months ago and there has been a little movement on this, but not enough.”

The Post asked to speak to someone from the NSHA about the Glace Bay situation, but received a statement from spokeswoman Carla Adams, who confirmed the doctor's decision.

“We are working on a solution and may have more to share in coming weeks,” Adams wrote. “That's all there is to share for now.”

That leaves three physicians providing in-patient care at the Glace Bay Hospital currently, but only two continuing to admit new patients.

The decision by some doctors to withdraw from providing inpatient coverage at community hospitals due to a pay inequity has been an issue locally in Glace Bay and North Sydney. Without the in-patient coverage, there has been additional pressure placed on the emergency department at the regional hospital.

“Unfortunately, it means that even more patients are going to have to be admitted to the Cape Breton Regional Hospital instead of going to their home hospital and that is going to be difficult,” Fraser said, adding she doesn't blame the physician involved “in the slightest.”

The pay inequity issue arose after the introduction of hospitalists — family doctors who work out of hospitals, seeing patients who have been admitted that don't have family doctors, and have a maximum number of patients they see. The province offered the hospitalist line to family doctors serving regional hospitals, but not those working in community hospitals. Doctors have said that ties the hands of people working to recruit new physicians to community hospitals.

There seems to be a general lack of understanding about the many issues at play, Fraser said.

“Even some of my nursing colleagues, they say, ‘Well, why don't doctors just go out to Glace Bay to round on those people,'” she said. “It's not that simple. You have to take calls, you have to be within 20 minutes of that hospital during the whole time that you're on call. It would tremendously limit your mobility, your freedom of movement to take that call.”

And given the geographic realities of the region, many doctors would not be able to meet the 20-minute window.

“If you've got a patient who has had a cardiac arrest, 20 minutes is a long time,” she said, adding that if that is stretched to 30-40 minutes because a doctor has to travel farther to respond to a call, “That's a really long time. That literally is the difference between life and death in some cases, and it's not safe.”

Fraser said the hospitalist service is strained in covering its own in-patients at the regional hospital.

“To take somebody out of that service and put it into another service is robbing Peter to pay Paul,” Fraser said.

A fix to the overall problem would involve ensuring Glace Bay was properly staffed, she said, and if physician vacancies there are filled it may apply some relief.

There was a proposal to provide a hospitalist line in Glace Bay, however it wasn't feasible given the current situation in Glace Bay, Fraser said.

George MacDonald, who represents Glace Bay on Cape

Breton Regional council, said Thursday he didn't know about the doctor's decision until he was contacted by the Cape Breton Post.

“I'm shocked to hear that,” he said. “It's a grave concern to me that that's happening. … The calls that I've been getting, people are certainly not satisfied.”

It's one serious issue among many in local health care, MacDonald

said, noting there is generally a shortage of family physicians, long waits to see doctors and closures at community emergency departments due to doctor shortages.