(No) Doctor in the House
No sense either
In the largest hospital in Newfoundland and Labrador, dozens of empty beds, medical equipment, and garbage bins line the corridors. They are broken or surplus and rather than move them out to storage or repair or sale or recycling, the province’s Borg Cube of a health authority jams them into the hallways on the floors where patients are trying to get better.
Why they are there no one knows. Perhaps the space in the basement where stuff used to get stored is now filled with dead bodies caught in the limbo of the morgue. What will become of them no one knows. Perhaps there’ll be a chunk of the hospital’s underground parking taken to store them in next to the dead bodies that pile up and whose numbers are now officially considered a state secret such that the health minister who is also the Attorney General refuses to speak of them.
People trying to get around, including the family and friends of patients who supplied this picture, sometimes jam up getting by one another. It is certainly an evacuation hazard in the event of an emergency. The fire commissioner might be concerned about it. The beds appear modern and new so it is amazing they are just sitting idle. The effect is demoralizing on everyone and gives the place the feeling of being far more run down and derelict than it actually is.
The beds piled in the hallways at the Health Sciences are as much a symbol of the neglect and wastefulness of the government’s health bureaucracy as is the manager’s scam in central Newfoundland. They leased - illegally, and with the approval of other health authority officials who are supposed to police and prevent this sort of corruption - their own rental properties to contract nurses brought in at high price to fill gaps in staffing due to the chronic bungling of the human resources division. The Borg HR boss gave the managers a pass on their illegal scheme once it had been made public, saying the Borg policy is that theirs is a no fault workplace. She meant no one is ever responsible or accountable.
No one will ever repay the money gotten illegally by the managers. No one will be fired, either, as the most senior officials have cooked up an excuse that makes this sort of corruption not merely excusable but normal and acceptable. Many will get promoted or if they leave government, like many of those involved in the breast cancer deaths scandal, they will be welcomed back with higher salaries later on, as just happened with the massive expansion of bureaucracy that is the Health Accord. The Auditor General will produced a report some years hence on the rental scam and whoever is then running the health monstrosity will promise that it will never happen again, even as it or something like it or something worse, does.
Give yourself a gift this holiday season. Become a subscriber.
The Health Accord is the current government’s excuse for whatever is going on in health care. The Accord has many goals, none of which are about or will deliver even if only by accident any improvement in health care in Newfoundland and Labrador at a cost lower than it is or has been. That’s what you get when you bring all the people and organizations responsible for the mess of health care to date - the mess as described by the guy who led the Accord - and ask them to fix what they’d already shown they could not run.
And to be clear, that the whole thing would not work is a point the people who appointed the guy heard *before* they did. The analysis that the Accord as proposed and organized was a waste of time and money - a fool’s errand or a con job, take your pick - was based not on some random guess or contrariness but decades of evidence of previous exercises in exactly the same thing in this province. Centralization and concentration of power at new and higher levels of bureaucracy and cost produce less effective care. All the earlier exercises in “reform” ended the same way. The Accord is no exception.
Whatever the politicians and Pat Parfrey thought they would get out of the Accord,what they got was what the bureaucrats they’d invited - one of them co-chaired with Parfrey - wanted, which is to say the greater concentration of power in a few hands and a greater increase in the empire to be ruled over. It is an old and simplistic story that is the inevitable result of bureaucracy unless it is carefully tended and periodically pruned. All the things thee bureaucrats and their friends say are the benefits of the latest scheme - centralization of purchasing, a common information system and so on - were all achievable before. There is no good excuse for why they weren’t.
One of them - the health information system - is now 30 years or more out from the first promise of it before the creation of the busywork factory called NLCHI. Yet for all the busy work and for all the supposed genius of whoever has worked there over the ensuing decades, very little got done as in delivered or finished. When some average computer hackers collapsed the whole system, they had no trouble because typical security was woefully lacking and each of the province’s health authorities ran a different, out-of-date version of the same software. While no one will officially say so, the scope of the privacy breach is likely far worse than anyone outside the system imagined and the delays in giving bonuses to some senior nurses likely had to do with the corruption and destruction of files by the hackers.
What the bureaucrats wanted was a bigger bureaucracy and Pat Parfrey, Sister Liz Davis, and Andrew Furey have delivered in spades. Their monster now eats well over half of the government’s annual income, not counting the 20% of spending that comes from new debt. Eats it all burps, wipes its chin, and screams for more. What they also wanted was the end to family doctors working for themselves. The bureaucrats who already control 75% of the provincial health budget want that last 25%, the bit that gets paid through the Medical Care Commission to doctors delivering meaningful care to patients but doing it out of the control of health bureaucrats.
In place of doctors delivering needed care efficiently and effectively as they have for centuries, the Borg want to control a pile of buildings they own and where all the people working there are employees of the Big Health Authority. One Big Bureaucracy in One Big Building can only conceive of other things that look just like it, so these FCTs, urgi-centers and what have you are just little bureaucracies in littler buildings. No one will have a family doctor or a nurse practitioner for that matter. They will instead be assigned at birth to one of two or three dozen maintenance centres called community care teams or family care teams or eventually Carehouses. The evolution of the name is inevitable.
To make that work and helped by the shortage of family doctors, the health department squeezes the family docs any way they can. They fighting with the medical association over the latest contract. The doctor payment system hasn’t been overhauled since 1969, when it started. MCP audits nickel and dime doctors over billings and the health bureaucracy refuses to modernise the payment scheme as they have long ago in other provinces to let family doctors create care teams of their own more efficiently and effectively than the bureaucrats can. Family docs are constrained in what tests they can order, partly to inconvenience them and make them frustrated, but mostly because there is such a shortage of people doing basic tests like x-ray and MRI that managers have to pulls shifts to fill the gaps and patients now have to wait three years for an non-urgent scan and upwards of a year for an urgent one. The same nickel and dime nonsense is true for blood collection and other services that could all be done more effectively in the private sector working collaboratively with the publicly operated system.
The Borg also offer huge bonuses to people willing to join the new primary cubes, the Carehouses. The scheme worked in Corner Brook perfectly as intended. A family doctor is shutting her practice in frustration. Melissa O’Brien is burnt out trying to see patients during the day and keep on top of the paperwork at night and on weekends. She tried a collaboration with another doctor but he took the bonus and joined a Carehouse leaving her unable to attract anyone else to her overloaded practice.
As CBC reported, “O'Brien has been actively seeking a replacement, someone to take over her practice and her patients. She hasn't had any luck finding someone. She says she can't compete with N.L. Health Services incentives and bonuses that the government is dishing out right now.”
“The community family clinics [like mine] that are working so hard to maintain the primary care for their patients are being ignored,” O’Brien told CBC. The Borg Authority disagreed but could not offer CBC any example of how they did so in O’Brien’s case or any other. It’s no accident the Borg also couldn’t offer a live person to make an actual comment on a human tragedy. Like all government bureaucracies in Newfoundland and Labrador these days, the health authority issued a cold, impersonal, sinister written statement that said nothing, approved by layers of bureaucracy before it arrived at CBC.
O’Brien works for the health authority, incidentally, and will continue to do so part-time. Lots of family doctors in private practice pull shifts in emergency clinics or in other fill-in jobs. Collaboration between the publicly and privately delivered care has always been a hallmark of medicine in Newfoundland and Labrador. But this is not about health care. It is about power and power doesn’t care. Eventually, O’Brien will likely be assimilated into the collective, which is what the bureaucratic goal has been all along. But given the shortage of health professionals, the Carehouses will struggle to find people even after they’ve cannibalized what’s there already.
Politically, the goal isn’t better care or sound financial management either. That’s why Premier Andrew Furey has announced Carehouses, urgent care warehouses, centres of excellence, institutes, hospitals, and gymnasiums but without the money or people to staff them. They are props in his re-election campaign. Nothing more. It’ll be years before anyone finds out none of it works.
That’s why Furey’s administration announced recently the government would buy two more Positron Emission Tomography computed tomography (PET-CT) scanners, one in St. John’s in addition to the one already there and another for the new hospital in Corner Brook that was built and opened unable to meet the existing patient load after almost 20 years in the building, design, and finally construction.
The PET for Corner Brook was part of the original design, promised by an earlier version of the crowd currently running the place and has been backed by every Premier since Danny Williams first promised to put everything in Corner Brook there was already in Sin Jawns even if Corner Brook didn’t need it or couldn’t support it.
Not be outdone by the Danny Cool Kids he longed to be one of, Dwight Ball’s Liberals promised the scanner in 2014 and quietly reneged on the promise once in office. Desperate to get re-elected, the Andrew Furey Liberals will spend any amount to buy votes anywhere even if, as in the case of a PET scanner in Corner Brook there is no valid reason to put it there.
The problem is that there is a struggle to find qualified people to run the scanners anyway. There is the perpetual issue of isotope supply and Corner Brook does not offer the patient population in its catchment area to make the thing practical on any level. Operators will need expensive supplementary training elsewhere to keep up their professional accreditation. These are all well known problems but the promise has now been made again and so it will be delivered, despite all sense.
Local politician Ed Joyce rightly pointed out that it will take years to get the scanner installed and accused the government playing politics. He’s right but it also doesn’t matter just as the practical value of the scanner has no meaning in a place where the value is all in the announcement and someone else will pay the price for stupidity years from now.
Some others noted that the system cannot run its existing medical imaging properly, hence the bureaucratic obstacles to care that delay scans for up to three years. Still others note that with one PET scanner in St. John’s, Newfoundland and Labrador already exceeds both Canadian (one per million people) and international (WHO: two per million people) recommendations for patient access to care. Three for a province with half a million people who are already the most heavily indebted population in the country is absurdly, stupidly wasteful.
All true.
All no matter.
