By Richard Bell
The Nova Scotia Health Authority’s (NSHA) surprise announcement that the emergency room at Eastern Shore Memorial Hospital (ESMH) in Sheet Harbour would be closed for the entire month of January stunned the community, generating a flood of social media posts going as far as questioning whether the province might close the entire hospital down.
The announcement followed shortly on the release on December 23, 2022, of NSHA’s “Annual Accountability Report on Emergency Departments” covering the period from April 1, 2021, to March 31, 2022, that showed ESMH had the worst record in the province for the period (30% open), with Musquodoboit Valley Memorial Hospital (MVMH) in 2nd place (35% open). Twin Oaks Memorial Hospital (TOMH) finished at 86% open.
At the January 4, 2023, monthly meeting of the Sheet Harbour Chamber of Commerce and Area Affairs, MLA Kent Smith and two health officials and a nurse waded through what led up to the month-long closing, and what the province was doing to address the problem, both in the short term and the long term. The two officials were Roberta Duchesne, Nova Scotia Health Director of Community and Rural Sites and Amy Donnelly, Nova Scotia Health Services Manager for ESMH and Harbourview Lodge Continuing Care Home. ESMH assistant nurse Christina Chapman also participated.
For anyone facing a medical emergency, the most important message of the evening was that even if the local ER was officially closed, the hospital was still open, and the nursing staff were still on duty, ready to deal with some problems, or to assist on getting to the nearest open ER.
“Even with no physician in the building, there is a lot we still can do,” Donnelly said. “The same nursing staff are there, whether the ER is open or closed. We’re not telling people that the doors to the hospital are closed.” Donnelly said she was struggling with what to say on the sign to let people know that the ER was closed, but the hospital was still open for service.
In response to a question about how to find out which ERs were open, MLA Smith emphasized the importance of calling 911, where staff are up to date about which ERs are open or closed. As to any plans to close the hospital, Smith, Duschene, and Donnelly were all emphatic that there were no such plans.
At the operational level, for a hospital emergency room to be classified as “open,” there has to be an emergency-room certified doctor at the hospital. For many months, there has only been one doctor on staff with the necessary qualifications, which accounts for the ER being open only about one-third of the time. Things got a little better in the fall, when the hospital contracted for “locums,” doctors who could come out to the hospital and fill some of the empty shifts, moving the needle up to the 40-50% range.
But then less than two weeks before the end of the year, the one certified staff doctor, who’s been with the hospital for more than 30 years, announced that he would be taking his vacation time in January. And for reasons that the two officials were not altogether clear, the locums decided to stop coming out, leaving the hospital with no one for the month of January.
200% Emergency Room Doctor Pay Differential
Why has it been so hard to get certified doctors to work at ESMH? Smith shocked the room when he laid out the Master Agreement between Doctors Nova Scotia and the province. Under this agreement, hospitals are classified into Levels 1, 2, 3, and 4, plus CECs (collaborative emergency centres) and UTCs (urgent treatment centres).
Smith said ESMH is a Level 4- hospital. Under the Master Agreement, emergency room doctors at Level 4 hospitals are paid $77.18/hour. Twin Oaks Memorial Hospital, roughly one hour west of ESMH, is classified as a CEC. Emergency room doctors at CECs are paid $151.92/hr.
There were audible gasps through the room when people learned about the roughly 200% differential between the two facilities.
Smith said that he started working with NSHA officials on getting the classification of ESMH changed in December of 2021, so that the hospital would be able to offer a more attractive salary to emergency room doctors. But he cautioned that it was unlikely that any changes could be made in the Master Agreement.
Loan Forgiveness for Doctors in Rural Areas
The federal government has a loan forgiveness program for doctors and nurses who agree to practice for a year or more in rural areas. For doctors, the program allows for up to $8,000 per year for 5 years, or up to $40,000; for nurses, the program allows up to $4,000 per year for 5 years, up to a total of $20,000.
In 2019, the Cooperator reported that the Canada Student Loan Forgiveness for Family Doctors and Nurses would not accept applications from doctors and nurses practicing at ESMH, MVMH, or TOMH because they were part of the Halifax Regional Municipality and were therefore not “rural.” MP Sean Fraser began corresponding with various federal agencies to correct this problem in 2019; PC Mental Health Critic John Lohr raised the issue in the Assembly in 2019; and Minister of Employment, Workforce Development and Labour Patty Hajdu wrote to Fraser on April 25, 2019, saying she was looking into the matter.
But nothing has ever happened. Smith told the Chamber meeting that the federal government was finally about to make the necessary change to allow doctors and nurses at HRM’s three rural hospitals to be eligible for this loan forgiveness program.
New Nursing Category
Duchesne and Donnelly also discussed some changes that were already underway that would broaden what a new category of nurses, RN Prescribers, can do. According to NSHA, “RN Prescribers in Nova Scotia are authorized to prescribe from an approved and limited list of relevant medications, devices, and tests. They are not authorized to prescribe systemic therapy for cancer (STC), or controlled drugs and substances, such as narcotics, exempted codeine products, benzodiazepines, or other targeted substances.” One RN Prescriber is already practicing at Twin Oaks, and there are nurses at ESMH who are interested is getting trained.
Duchesne note that making changes in the Nova Scotia health care system was not easy. “Nova Scotia is a very conservative province. It takes a long time for us to try something new before we agree that it is the way things need to be. And unfortunately we are very cautious at bringing on new designations in nursing or expanding the scope of practice. This is probably going to take a long time for prescribing to be part of the regular training for nurses.”
Donnelly said that staffing could also be a problem. If a nurse goes to Dalhousie to get the necessary training, the hospital would have to have another nurse as backup.
There were also some brief remarks about the exploratory work going on around developing methods for allowing off-site doctors to supervise nursing staff using video links.
Community Advisory Committee Recruiting Doctors
A group of residents set up a Community Advisory Committee last spring to work on recruiting more doctors. The CAC has since become a subcommittee of the Chamber. CAC Chair Greg Cross reported that Nova Scotia Health was preparing a glossy recruitment brochure for the hospital. On a more substantive level, Cross said they had applied for an $80,000 grant to support the CAC’s recruitment campaign. The money would pay for the CAC going to physician job fairs, upgrades to its social media, creation of a welcome guide focusing on the benefits of living in the area, and other marketing materials.