Doctors walk away from ER that limits care they’re allowed to give

Dr. Rob Miller (left), Dr. Rebecca Brewer and Dr. Keith MacCormick, all emergency physicians at Valley Regional Hospital in Kentville [ Photo: Paul Schneidereit ]

THE OLD MAN WAS HURTING, HUNGRY AND MAROONED IN THE ER. No one wanted it that way. But that’s how it often is at the Valley Regional Hospital in Kentville, NS. That’s why three ER doctors at the hospital are set to walk away.

No one has worked harder than Dr. Rebecca Brewer, Dr. Rob Miller and Dr. Keith MacCormick to improve ER care at the VRH. But the Nova Scotia Health Authority (NSHA) remains adamant that it is the authority alone that knows how best to deliver better health care. It’s a conviction that can backfire—and often does. Like the day Dr. Brewer came upon the old man “acting out” in her hospital ER.

Making matters worse

It turns out the man was left stranded by paramedics. New NSHA policy does not allow them to wait while patients have tests. The paramedics can now spend no more than 30 minutes per ER dropoff. As a result, once his test was complete, the man was no one’s specific responsibility. He was left parked in emergency for hours, without food or water, just waiting for another ambulance to retrieve him.

“This patient’s lying there, in pain and can’t move,” Dr. Brewer said. “All of a sudden, he starts to lose it, because he’d reached the end of his rope.”

Dr. Brewer happened by and wrote orders for food and pain medication.

The man ended up in deep distress and staying in the ER for 12 hours waiting for an ambulance because of a NSHA rule that is supposed to fix the problem of bottlenecks in ERs.

Administrators reject doctors’ input

The three doctors believe they know a lot more about how things work—and don’t work—in an ER than NSHA bureaucrats. The doctors have a combined 41 years of service in the VRH emergency room. They have written letters and briefs, lobbied elected officials, mounted pubic protests, worked within the Valley Regional Emergency Physician Association (VREPA) to get to the root of the problem of overcrowded and inefficient ERs.

As VREPA chair, Dr. Brewer said she tried to initiate a few simple, easy-to-implement changes to improve patient care.

Hospital administrators wouldn’t co-operate, the three doctors said.

The only concession Nova Scotia Health Authority (NSHA) made was to hire outside experts to carry out an external review of VRH’s ER. The November report validated many of the three doctors’ concerns.

In addition the report noted some NSHA and zone leaders were themselves “uncertain” and “unclear” about many aspects of their own of responsibilities.

The report recommended the NSHA staff and VREPA leadership to try to “move forward in a collaborative, positive manner.”

Rather than reconcile with VREPA, the doctors claim NSHA’s local leadership has sought to dissolve the elected executive and reorganize the doctors own association.

Enough is enough

After a year of outspoken efforts to make positive changes, and the constant conflict with the NSHA it brought, the doctors say they’ve had enough.

Beginning in February, Dr. Brewer and Dr. Miller will drop from a dozen or more ER shifts a month at VRH to just two, and perhaps ultimately none. Dr. MacCormick will stop working there, period.

All three said they’ll easily find ER shifts in other hospitals in Nova Scotia and even P.E.I.

But none of them felt good about the situation.

Unable to practice good medicine

“Does that mean I’m abandoning my patients, who I’d like to be able to represent and give voice to? I don’t know. But I can’t accept the way that they’re making us practice medicine and treat people,” said Dr. Brewer.

“I’ve tried. So many things that I’ve done over the last year to try to help in any way I could, and I keep hitting stone walls.”

Dr. Miller rejects the notion he’s abandoning anyone. “I cannot work in an environment that will not allow me to advocate for good patient care,” he said.

Doctors Brewer, MacCormick and Miller clearly want to deliver the best care they know how to. If they are not allowed to do that at VRH, they will do it somewhere else.

“If you can’t talk about the problems, you can’t fix them. And that’s the real problem here,” Dr. Miller said. “There’s this feeling that anybody who talks about problems is a troublemaker and needs to be marginalized.”

Come February the ER at Valley Regional Hospital in Kentville, NS will be minus three “troublemakers” and three committed doctors who care too much to put up with limits to the care they’re allowed to give.

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*** This story is based on reporting by Paul Schneidereit originally published in The Halifax Chronicle Herald…

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