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Monsters Under the Beds (Or in the ERs)

Last week, Nova Scotia Liberal MLA Dave Wilson appeared at a news conference along with an ER physician claiming that the emergency room system in Nova Scotia is in crisis. According to Wilson, the Liberal Health Critic,

"In 2006, ERs in Nova Scotia were closed for over 3,700 hours - that's 154 days. That is almost 1,600 more hours than the year before," he says. "In fact, since 2001 ERs in this province have been closed for a total of almost two years. That is unacceptable."

Wow, that does sound excessive. Is the system failing Nova Scotians?

Wait, that's really the point, isn't it - IS the system failing us?

The trouble with this particular iteration of monster-shouting is that the information presented lacks any sort of context to prove that this is, in fact, a particularly dangerous or even unusual state of affairs.

Has anyone died or suffered debilitating disease due to a lack of ER services? Has anyone been turned away because the ERs were closed? There is no indication either way according to the information we are presented with. Is the solution to this problematic condition to keep all emergency rooms open 24-7?

I needn't tell anyone with a modicum of fiscal intelligence how impractical that idea is. Smaller communities, while needing some degree of emergency response and treatment facilities, lack the population density to have the type of constant demand that exists in larger centres. I, for one, don't think the Liberal critic would be any happier if these small-town ERs were staffed constantly, because it would be an obvious waste of money, and without any indication of how the situation is negatively affecting the citizens of the province, it would be completely irresponsible in many other ways, as well.

While I agree that there needs to be much more encouragement for medical students to enter into emergency medicine (a stressful specialty, to be sure), and for our local med school graduates to remain in the province, without the evidence of harm or even actual need, this 'crisis' is constructed from nothing but fear.

The press conference was clearly designed to elicit the anxiety of the public, and serves no one's interests except those of the Liberal party. I'm not equipped to dispute the information presented, but if you're going to convince me that this is nothing more than cynical exploitation of the fears of the elderly and the infirm, you'll need to show me some proof.

That goes for any of these types of assertions - can you prove to me that beds that are closed in small hospitals are actually needed, or are you playing on the fears of older citizens, who will then ask themselves, "But what if they are needed?" You can't govern or budget according to what if's. As my boss says, "What if a Martian lands and asks for something?" It's an illustration of how absurd the 'what-if's can get.

The way I see it, the political script goes like this:
1) create anxiety where there is none
2) exploit the anxiety for political gain
3) get elected
4) continue making decisions or investments in the same way
5) repeat as necessary

This type of blatant politicking, if you'll pardon the expression, makes me ill. Wow, lucky I don't live in a rural area, isn't it?

Stirring base emotions is not solving problems or shedding light on truth, it's pure politics, which, quite frankly, our health care system could use a little less of. Show us proof, Mr. Wilson, or shut up.


So, are you saying that there is nothing wrong with emergency health in Nova Sotia? Or are you just upset that someone other than the invisible NDP are talking about it?

Sorry...I mean Flash.

I'm not saying there is or there isn't, I'm not qualified to do anything other than share my opinion. I'd just like some proof either way. Tell me the facts, don't play on people's fears.
This is more of an expression of frustration at a political process that is bound to breed cynicism. To be fair, I've had personal experiences with members of the NDP and the Tories in the past year that I can't be specific about (they relate to my job), but they, too, were incredibly frustrating. The facts were irrelevant, the political points that could be scored were paramount. No party is any better than any other in this respect, I've just reached the limit of my patience with it.
Anyway, long reply short, it wasn't intended to be partisan, just peevish.


Thanks for the comment, and for reading. I figure assuming it was Kevvyd was a pretty safe bet - he's usually the political expert 'round these parts. This was a rare exception.


Ummmmm... Isn't your quote a fact? "ERs in Nova Scotia were closed for over 3,700 hours" -- that is a fact. I don't know what you want...

Yes. It is a fact.
But, did this have an effect, positive or negative, on the health of the people of Nova Scotia?
Have any deaths been directly attributed to ERs not being open?
Facts are fine, but without context, they don't mean anything.
Hypothetically, if I tell you that I've never seen snow, certain conclusions could be drawn from that. If I then tell you I'm visually impaired, the context changes, and most of the explanations would be potentially invalid.
What I want is enough information to indicate the number of days an ER is closed is correlated with poorer health outcomes. The information presented doesn't come close to doing that.
And don't talk to me about 'common sense says', common sense is often incorrect. Show me proof.
I'm just skeptical about a news conference called in order to tell us "it's time to panic!"
I've read your blog, I know where you're coming from - I'm not picking on the Liberals in particular, I think all parties do it.


The fact is that emergency rooms have been closed for 3,700 hours. I think it goes without saying that it has had, at least, some negative impact on the availability of health care. I would be open to hearing any situation where closing an emergency room would be of benefit to Nova Scotians.

There is also the fact that the Conservative government and NDP opposition have been promising to improve the availability of health care in the province.

My point is that it does not and should not ever 'go without saying'.
I don't care what the Tories and the NDP do either, I seriously don't. It's all the same - photo-op politics, with no substance, regardless of the party or the topic.


Some things go without saying... If someone hits you in the face with a bat, it goes without saying that it will be a negative thing for you. If your annual salary is cut in half, it goes without saying that it will be a negative thing for your financial situation.

If emergency rooms around the province are closed, it goes without saying that it will be a negative thing for access to health care. In other words, there would be better access if they were open. I don't think that is much of a stretch.

All I want is proof. When the stretching means millions of dollars spent, I think it does make a difference.
In my opinion, it's not necessary for all ERs to be staffed all the time. My time working at the NS Dept. of Health taught me that demographic patterns and variant levels of demand dictate that all services are not available in all areas for a reason. The system is rife with inefficiencies, and having ERs open and staffed when it is not necessary is inefficient and irresponsible when demand can be met in other areas.
The question I'd like to ask is: how many person-hours of work in Emergency Medicine was performed?
I think, given the geographic distribution of the provincial population (concentrated primarily in two municipal units), a figure that shows the proportion of these hours to the total population would be a useful figure, and one that could be compared across provinces.
Context is what is missing.


It goes without saying - that having all ER's in the province open 24/7 would improve the system;

It goes without saying - that having more doctors on staff in Nova Scotia would be of benefit;

It goes without saying - that additional equipment such as MRI's and PET Scanners would be a good thing.

Since you've suddenly become a self-proclaimed "healthcare expert", maybe you'd like to answer this question - given limited resources, if the government could only afford to fund one of this initiatives, which one would be best?

Secondly, don't you think it's rather disengenuous of you to lay the blame for the present problems with the health-care system with the Tories and the NDP, while absolving the Liberals, both Provincial and Federal, of any responsibility? Actually, now that I think of it, it's not only disengenuous, it's downright insulting to the intelligence of the readers of this blog and frankly, smacks of partisan hackery.

If I read Flash right (and do correct me if I'm wrong), all he's saying is that there needs to be an intelligent discussion on the health-care system, free of photo-op hysteria, and yet you've seen free to attack him for no reason that I can see. I can only assume one of two things:

1. You really do think that all the health care system needs to work is for the ER's to be open 24/7, in which case you're overly simplistic.

2. You believe that anything any Liberal politician says is 100% Truth and cannot be questioned, and you're attacking Flash for the sin of apostacy, in which case we're back to your being a partisan sycophant.

either way, personally, you're not part of the solution, you're part of the problem.

I agree with Flash and Dan. It's not enough to simply say the ERs have been closed.

I work in healthcare. The reality is that it's not realistic to deliver the standard of healthcare we have today.

You can stand on all the soapboxes you want, and scream as loud as you want, but let's call a spade a spade. We spend about 50% of our tax dollars on health care NOW. And the baby boomers aren't even at their peak senior years. Do you really think it's the best use of time and TAXPAYER'S money to kick up dirt about ER closures when we have an impending crisis?

Sure, maybe it'll get a politician some votes come election time, but I don't know of any taxpayer who would want to choose between paved highways and hip replacements.

So, back to the crux of the discussion. Tell us what the consequences have been. Perhaps some of those ERs do not need to be open 24/7. Perhaps there are other alternatives. Perhaps, just perhaps, we are running healthcare in such an antiquated way that we are NOT being strategic OR visionary in how we deliver healthcare services.

MAYBE we should be looking at what OTHERS do with similar circumstances, and MAYBE some healthcare dollars should be invested in finding new ways to deliver services and NOT in simply responding to rah rah and cries from people who can't substantiate what they really mean.

And no, there are no magic bullets to solve the problems in healthcare, but why can't we look at what other provinces do and see where we can gain some efficiencies? Just one example, New Brunswick has a 1-800 number that citizens can call if they are sick, it is staffed by RNs, and it helps them determine if they should go to an ER or whether they can wait to see their family doctor. Perhaps a solution like this is one that we could implement. Not only would it be a great service for the public, it would help get RNs who can't physically nurse anymore off the LTD system and back to work. Then ER visits could geniunely be for those who NEED emergency care and we'd have less burnt out doctors working ERs and perhaps more doctors willing to staff rural emergency rooms as a result.

So a bit of innovative thinking is in order here, don't you think?

I think you have hit on the problem here. If I may briefly quote Python: "Argument is an intellectual process. Contradiction is just the automatic gainsaying of any statement the other person makes." This was not intended to be a political argument, just a practical one. If Devin is unable to lay that aside, we have no potential for meaningful dialogue.

Excellent example with the NB phone line - I think we would benefit greatly from something similar. The issue in my mind boils down to essentially this: health care needs to be provided on the basis of NEED, not WANT. Your 50% figure is accurate, and I would add that the system is expected to continue and accelerate the drain on the province's coffers until, at its present level of (in)efficiency, it will consume the entire budget of the province by 2012 or so, if I remember correctly.

Thanks for reading, and for commenting. And that DOES go for you too, Devin.

Another thought:
Jennifer - do you think the 'innovative thinking' might actually include emphasizing preventative population health initiatives? I'd like to see the Determinants of Health taken more seriously in Ottawa and Halifax.
The problem is, the political payoff will be given to the government in power 10 years from now, which is currently not an option from a political perspective - it's either the quick payoff or nothing.

Yes, I think some investment in preventative health would be prudent.
However, at the same time, you are right, political payoff is long term for something of this nature.
Politics always seems to circumvent what the actual needs of the public are.
That is our downfall and probably why our health care system will never be as good as it can be.

Interesting conversation, and one in which I have nothing of import to add but a couple of questions. There are other nations in the world that are known to be healthier than we. What is it that they do to improve the health of their citizens? Are they spending more money per capita on prevention than we? Do they legislate food differently? Do they provide incentives to promote activity and better habits?

That's all one question, believe it or not. At least it started out that way :)

Question 2 -> In what way is the federal government responsible for this health care crisis through deminished health care transfers? If I remember correctly, the feds currently pay something on the order of 15 or 16% of the provinces' health care budgets, a portion that diminished throughout the 80's and 90's. Yes, Devin, that means under the Liberal reign, too. I am sure that there is some statute somewhere that says the federal government will pay this or that percentage of the health care budget, and I'm willing to bet that whatever that value is, we're well under it.

In short, have we let the federal government balance the budget at the expense of our own health?

The Canada Health and Social Transfer was slowly whittled away during the '90s from something on the order of 25% to the present levels. Even the splitting of the transfer payments into the Canada Social Transfer (primarily for Social Services and Post-Secondary Education, among other things) and the Health Transfer have not, as some believed while lobbying for this change, improved the situation on either side of the coin.
In response to your mini-series-like question: I would suspect that Scandinavian countries like Sweden and Finland have strong incentives geared toward physical activity in particular, as well as the more indirect causes of ill health like income and housing.
It's only peripherally related, but I know the elderly in Scandinavian countries are allowed to retain their autonomy for a considerably longer time that in North America. There are no 'homes' in Sweden, for example, just collective complexes where decisions related to health care are made by the residents - they seem to respect the faculties of the elderly more than we do. Variations between cultural priorities like this are the reasons for differential health outcomes across the world.
(Ok, maybe not mini-series, but certainly Movie-of-the-Week-Length.):)

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