Overnight ER service at GMH stops

Down to two doctors, 24-hr service can’t be maintained

By Lois Ann Dort, Local Journalism Initiative reporter    
July 8 2020

Last Friday, news broke that the emergency department at Guysborough Memorial Hospital would close overnight starting July 9. The reduction in hours is due to a physician shortage. This closure will result in emergency patients travelling to St. Martha’s Regional Hospital in Antigonish from both the Guysborough and Canso areas, a 45- and 90-minute drive respectively, as the ER at the Eastern Memorial Hospital in Canso has been closed overnight since May 2019.


MLA responds


Lloyd Hines, MLA for the area, spoke to The Journal about the ER closure shortly after the news came on Friday. He said he understood the situation was due to the need for more physicians in the area and that he had been working with the Nova Scotia Health Authority for more than two years on that problem, which unfortunately plagues most rural hospitals in the province.

“I have four of these community hospitals in the riding. It is very difficult; every one of them is hanging by a thread in terms of physician availability. It is a difficult situation all around,” said Hines.

On Friday, Hines said he had already been in contact with the Minister of Health about this recent development, “to see if we can step-up the process to see if there is the possibility for locum doctors to come in and fill in… At this point in time, all I know is that the folks in the Nova Scotia Health Authority and the Department of Health are working very hard to try and get physicians into rural communities.”


Hospital Foundation not surprised


Guysborough Memorial Hospital Foundation Chair Bill Innis told The Journal on Friday he was not surprised by the announced closure of the ER. The current situation at the hospital, with only two doctors covering office visits, inpatients, the nursing home and the ER was not sustainable, he said. It’s also why the foundation has been doing everything it can to recruit doctors to the area, but those efforts have been frustrated by COVID-19 in recent months.

“We have worked with NSHA to recruit physicians to the community…but it is beyond our capabilities at the moment. We have done many, many things; we did a video, we have attended numerous recruitment forums in the province and across Canada.

“Last fall we got desperate and we engaged the services of a private physician recruitment company,” said Innis. “They were successful in bringing us locums to the community to help out, but it was very expensive. We spent in excess of $40,000 on those services and it was a success to bring locums in, to bring relief to doctors Bell and Ranjini for periods of time – but those people came from out of province and sometimes out of country—and then COVID hit and they could no longer come in because they needed to self-isolate for two weeks. So, we’ve had no locum help since COVID-19 struck.”

And while locums offer a break, he says what is needed are long-term doctors, people who want to stay in a rural setting. Innis explained, we need physicians who would, “welcome the breadth of practice that they will receive in a rural area because you will see everything that comes through the door.”


Competition for doctors


The biggest stumbling block to securing new physicians is not the area’s rural setting, not the scope of practice required, but the job market; doctors are in demand the world over and it is this fact that makes recruitment extremely difficult.

“The single biggest problem to physician recruitment is that every community in Nova Scotia is facing the same problem we are,” said Innis. “Every community has a shortage; we are competing with everyone. Whereas before, when we faced the idea of physician recruitment, it wasn’t as difficult because there were physicians out there looking for work and we could provide it but now it is a dream for physicians because they can go anywhere they want to and know they’ll have a job.”

The province has taken steps to increase physician numbers in the province, said Innis, noting that they have created more seats at the Dalhousie Medical School and have encouraged physicians to stay in more rural areas by placing residencies in smaller hospitals, but these actions haven’t been enough to fill the need.


Government initiatives 


The Department of Health and Wellness is aware of the current situation in rural emergency departments including those in Guysborough and Canso. Heather Fairbairn, a media relations advisor for the department responded to The Journal’s inquiries directed to the Minister of Health in an email on Tuesday stating, “We have been working hard to address this and want to reassure Nova Scotians our regional hospitals are always open and 911, 811 telecare services and mobile mental health line are always available.”

Fairbairn went on to detail the various actions the department has taken to address doctor shortages which include: a Locum Incentive Program and emergency shift premium to help cover emergency department shifts by making it more financially attractive; a new four-year agreement with doctors which includes an increase of $135 million making the province’s emergency, family and anesthesia doctors the highest paid in Atlantic Canada; the launch in 2018 of a physician immigration stream; 16 new seats at Dalhousie University’s Medical School and 25 more residency spaces.

In addition to these measures Fairbairn added, “Government is also trying to reduce the number of unnecessary trips to the emergency department by ensuring Nova Scotians are getting the care they need in the right place. We are creating and expanding collaborative family practice teams across the province, connecting more people to providers. We are also providing more options for people to access care by working with pharmacists, paramedics and nurse practitioners to deliver more services they are trained to do.”


MODG disappointed in province


The Municipality of the District of Guysborough, which is home to both the Eastern Memorial Hospital and Guysborough Memorial Hospital, issued a scathing response to the news of the ER’s nighttime closure on Friday. In the release, MODG warden Vernon Pitts stated, “The closure of overnight emergency room services is totally unacceptable. The Municipality has gone above and beyond to assist with doctor and nurse recruitment and have provided substantial financial support for hospital expansion and upgrades as well as direct financial incentives for doctor and nurse recruitment.”

The release went on to say that the MODG was disappointed in the province, the Nova Scotia Health Authority, and the Department of Health for not taking “the necessary steps to address this chronic doctor shortage in our area.”

The municipality said it would make solving this crisis a top priority and “will work to ensure the province takes the necessary corrective action to reopen all services at our hospitals full time.” 


NSHA says COVID-19 slowed recruitment


On the afternoon of Monday, July 6 the NSHA issued a media release addressing the situation at Guysborough Memorial Hospital. It stated, “Due to a shortage of physician coverage, the ED will now operate daily from 7 a.m. to 7 p.m. Two physicians will continue to provide 24-hour coverage for the inpatient medical unit, the long-term care facility and manage their family practices.”

The release from NSHA went on to explain that the closure was the physicians’ decision, with a comment from Madonna MacDonald, Vice-President, Operations, Eastern Zone, saying, “We understand their decision and appreciate the commitment they had made to keep the ED operating 24 hours daily while physician recruitment efforts were ongoing.”

The NSHA release stated that they, the hospital, the hospital foundation and the municipality have been and will continue to work towards recruiting “both locum and permanent physicians to Guysborough Memorial Hospital…(although) this work was slowed due to the COVID-19 pandemic, the commitment to have stable, reliable health care services for these communities remains.”

In that vein, NSHA representatives will be meeting with MODG council on Wednesday, July 8 to, “discuss the recruitment efforts,” the release said.


Local residents worried


While the Health Authority and various stakeholders discuss the problem of physician recruitment and the nighttime closures of both emergency departments in MODG, local residents are experiencing fear and anxiety.

Linda Gerrior of Lundy has lived with serious, life-threatening health issues for many years and has had the security of knowing that help was nearby, but that is no longer true. She told The Journal on Monday, “It makes me scared and very nervous. With my condition, I've been seen before and was told that if I have any symptoms, or even a little cold, that I had to be seen ASAP in the ER. So, with the ER being closed, it scares me to think what would happen to me.”

Donna Marie Wallace lives in Canso and has been dealing with the nighttime ER closure there for more than a year. She knows this latest closure is not only bad for Guysborough, but worse for Canso. “The closure of Guysborough ER means that people in Canso are now at more of a risk. It means that if an emergency should happen between the hours of 7 p.m. and 7 a.m., then we wait a minimum of 1.5 hours before we even see a doctor. And I say minimum, because what about those days where we have no ambulance coverage in our area, so first we wait for them, then the 1.5-hour drive to Antigonish hospital.

“What does this mean for those that take massive heart attacks, have strokes or those ladies that go into spontaneous labour? And that’s just to name a few scenarios,” Wallace wrote in an online interview with The Journal on Monday.

“Life is not perfect. We can’t plan our accidents around hospital hours. Who takes the blame when your neighbour has a heart attack and dies or, god forbid, a child falls off the playground equipment and bleeds out on the way to a hospital? It’s unacceptable that we should even be considering this let alone doing it,” wrote Wallace.

Cooks Cove resident Nancy O’Regan also finds the situation untenable. In an online interview with The Journal she wrote, “I am not surprised that we have arrived at the same situation that many rural communities in Nova Scotia have faced. It was inevitable. I am however, deeply distressed by the lack of provincial planning and flexibility that has led to this situation. Our hospital foundation has done everything short of stand on their heads to recruit physicians, yet here we are.

“Can emergency services not be provided by nurse practitioners? Can the role of paramedics and other health professionals using new technologies not be enhanced for special circumstances such as this? I hope in the days to come NSHA, the NS Dept. of Health and Doctors Nova Scotia provide some answers. As a citizen with an elderly parent, relatives and a large family of children and grandchildren I am deeply concerned and anxious about how their needs will be met. As a community member involved in addressing housing for vulnerable populations, I see this as just one more weakening link in our social fabric,” O’Regan wrote.


Doctors lauded


And while everyone has been reacting to the news of the nighttime ER closure, many have not forgotten the two doctors that have been providing dedicated service to the community for more than a decade and especially over these past few, very difficult months – Dr. Barbara Bell and Dr. Ranjini Mahendrarajah.

“They have worked endless hours of providing physician coverage for the hospital, the office patients, the nursing home and to staff the emergency room,” says Innis. “It has been a crushing workload that they cannot sustain, and we have known that for quite some time and they have continued on in the hopes that we would be able to find someone to help out but it has just not happened. Something had to give. I know the reason why they’re doing this. They are thinking of their patients. They are scared, they’re tired, they’re very fatigued and they are scared they are going to make a mistake.”

“What I would encourage the public to do is contact their elected representatives -- be it our MLA and Minister of Health -- and put pressure on them to get the focus of NSHA and Department of Health on physician recruitment because that is what we need,” says Innis.