A letter from the Town of Middleton addressed to Premier Tim Houston and dated June 19, 2023.

This story has been updated with a response from Nova Scotia Health.

The mayor of an Annapolis Valley town penned a letter to Premier Tim Houston after an inpatient at the local hospital died last week when there was no doctor at the hospital.

Sylvester Atkinson, the mayor of Middleton, wrote the letter on June 19, four days after the patient died. The letter is posted on the town’s Facebook page:

On Thursday, June 15, 2023 around 9:00pm the Middleton Fire Department and EHS were paged to a cardiac arrest. The address given was Soldier’s Memorial Emergency Department. Since the ER was closed at this time, our Fire Department assumed that someone arrived at the hospital with chest pain and Emergency Services were called. However, when the Fire Department arrived on scene, they were taken upstairs to the medical floor. The patient in cardiac arrest was an admitted patient at the hospital. Our Fire Department was informed that there was no doctor on site, nor was there one on call. However, a doctor was on the way from Kentville (30+ minutes away).

While waiting for the doctor to arrive, the Middleton Fire Department responders assisted EHS with chest compressions on the patient. They continued to provide life saving measures until the doctor arrived. Unfortunately, the patient did not survive, and the doctor called the time of death when they arrived on the scene.

Mayor Atkinson’s letter continues:

Fire Services are a municipal responsibility. Health care services are a provincial responsibility. The fact that our fire department had to respond and provide care to help save patients in our hospital is frightening. As a municipal body with much responsibility on our shoulders, we are not okay with this. This is simply wrong on so many levels. The province needs to step up and take accountability for this and take action to prevent it in the future.

A two storey red brick building with a flagpole in the grassy area.
Soldiers Memorial Hospital in Middleton. Photo: NSH

In an interview with the Halifax Examiner on Tuesday, Atkinson said the premier has “reneged” on his election promise to fix the health care system.

“The whole condition of the hospital here with the emergency department closed, no one at the switchboard, you name it… and things really are not in the condition they should be,” Atkinson said. “They reneged on a promise that they were going to fix the health care system and so on. We’ve had people come in and talk, but nothing happens.”

“I was told the person on call was not even in Kentville, but was in Wolfville, which is further away,” Atkinson said. “We’re talking about a half hour or more away.”

Atkinson said the emergency department at Soldiers Memorial Hospital is only open certain hours, and on some days it is not open at all.

Atkinson said he hasn’t spoken with the family of the patient who died.

‘There does not appear to be any headway being made’

The first two paragraphs of Atkinson’s letter address another letter the town sent to the Department of Health and Wellness regarding the closures of the emergency department at Soldiers Memorial. That letter did get a reply and a meeting was held with Atkinson and other town officials and staff from the health department on May 11.

Atkinson wrote that while there was a “healthy discussion” at that meeting, he and town staff felt there wasn’t a strategic plan in place to address the emergency department closures. Atkinson wrote that the town wasn’t given any timelines and was told the hospital requires five to seven doctors to have the emergency department open 24-7.

“We understand that work is very likely being done behind the scenes, however, to our residents, and to us, there does not appear to be any headway being made,” Atkinson wrote in that earlier letter.

On Tuesday, Atkinson told the Halifax Examiner the health department officials were two hours late to that May meeting.

“You do have other commitments and to be a couple hours overdue, without sending word that we’re on the way,” Atkinson said. “There have been other meetings with them and so on, but again, nothing seems to be happening,” Atkinson said.

Atkinson said the shortage of doctors at the hospital and the closures of the emergency department are especially concerning given the ageing population of the town.

“The census will tell you that we are a town that has the oldest mean population,” Atkinson noted. “To be 30 minutes away from the regional hospital in Kentville and to have the emergency department here not opened, with an older population without transportation of their own and so on, it’s like being out on an island and one resident has a float.”

Response from Department of Health and Wellness

The Examiner contacted the Department of Health and Wellness, and received this statement from Michelle Thompson, Minister of Health and Wellness:

My heart goes out to the family of the person who passed away at Soldiers Memorial Hospital last Thursday. I just learned about this incident today, and it concerns me greatly. I have asked for more information from NSH [Nova Scotia Health], who are currently investigating the incident. I can’t say any more until I get details, but I will reiterate my sincere condolences to the family.

We also contacted Premier Tim Houston’s office and will update this story if we hear back.

Atkinson said he’d like to see a response that goes well beyond a reply to his letter.

“I would like to see something happen. It’s not the matter of hearing from someone. Let’s get on with things. I feel sorry for the family, the loss of this person, but let’s try to see that this type of situation doesn’t continue.”

Response from Nova Scotia Health

The Examiner received this response from Nova Scotia Health spokesperson Brendan Elliott about the incident Atkinson described in his letter to the premier.

There is always a doctor on call for inpatient care at Soldiers Memorial Hospital (the mayor’s letter was incorrect about no one being on call). Assignment to the hospital can be either on site or nearby. That doctor will be called upon to provide advice, consults, or any other care deemed necessary at the time by hospital staff. These services can be provided remotely or in person.

Should an inpatient require immediate care beyond what in-hospital staff can provide, as was the case in this situation, there are specific protocols staff will follow. When additional immediate assistance is required, and a physician is in transit, protocols include calling 911. In the meantime, staff will do everything possible, including commencing CPR, if necessary.

The 911 operator will determine next steps and can dispatch first responders, based on the unique circumstances of the call.

Nova Scotia Health senior administrative staff in Western Zone have conducted a thorough review of the details surrounding this situation and there is no doubt the outcome was not what anyone wanted. However, staff performed admirably given the circumstances and protocols.

The process followed at Soldiers Memorial Hospital is consistent with the process followed in many Nova Scotia Health sites without after-hours, hospital-based physicians.

Nova Scotia Health extends its deepest condolences to the patient’s family and friends.

Suzanne Rent is a writer, editor, and researcher. You can follow her on Twitter @Suzanne_Rent and on Mastodon

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  1. The fact that no doctor was available is beyond my logic for a hospital. Even worse is the fact that there appears to be not a single staff person that could administer CPA in an obvious emergency. No nurse or assistant available or trained? How about an orderly? The cleaning staff? Back in the day all staff in a hospital new CPR. Heck, I can do CPR in a pinch.

  2. A pretty callous response: oh we did everything right and no one should complain even though it’s tragic and we offer condolences to the family. blah-blah.

  3. Until reading this I never contemplated that a hospital would have inpatients and literally not one doctor physically in the facility. That to me is shocking.

  4. Re: “They reneged on a promise that they were going to fix the health care system …” This is a shocking, unacceptable death, but we need to manage our expectations. Nova Scotia’s health care system was 20 years in the breaking and it’s going to take more than 22 months to fix it.

  5. “Atkinson said the premier has “reneged” on his election promise to fix the health care system.”

    That campaign promise was obviously not credible at that moment, regardless of which aspiring Premier confidently uttered it.
    Enough voters liked it, and apparently believed it. That’s on us, the citizens.

    Providing the expected or even stable level of healthcare is a massively complex and long-term problem (well beyond the next election) with many built-in incentives to keep the deteriorating status quo. Healthcare demand is also a broader barometer of the general health of society (education effectiveness, poverty levels, civic engagement, happiness levels, citizen lifestyles, confidence in institutions).

    Citizens like me have almost no ability to assess what needs to be done, let alone while constrained by our limited resources. We can only hope that it is solvable and that the players with any agency are able to make effective and hard choices that lead to incremental improvements that are eventually recognizable to citizens in their collective experience and outcomes.

    Perhaps most concerning, a system that is so visibly failing and worsening is vulnerable to solutions that are not in the best interests of most citizens…thank you for reading this unintentionally long comment! 🙂

  6. Kudos to Mayor Atkinson for sharing Middleton’s council’s frustrations with the health care offered to citizens of that area. Some questions having read Suzanne’s piece:
    1. What does it say about the professionalism of the “staff from the health dept.” who were two hours late for a scheduled meeting and gave no forward notice that they were going to be late? These staff need to be schooled on respectfulness and how it connects to courtesy. 2. Isn’t it about time that the names of government staffers be shared with the public-along with their contact information? 3.Do municipalities keep minutes of these meetings for their later perusal and follow-ups with citizens and provincial government staff?
    So, why these questions?

    Eight years ago, then Auditor General Michael Pickup said this about government staff in the various departments: “If promised change does not happen, the Nova Scotia Legislature and citizens NEED TO KNOW (my emphasis) who did not deliver;why and WHAT THE CONSEQUENCES ARE. This is accountability at its core.” Pickup said this very well; his observations then mirror the observations by Mayor Atkinson today (June, 2023). Eight years have passed and we are no closer to such accountability than we were in November of 2015.

  7. There is, apparently, money for infrastructure (hospitals, schools, twinned highways, etc.) but it seems little thought has been given to staffing and maintaining them. Perhaps, more accurately, thought has been given and privatization is the goal. To justify privatization the government needs to ensure the public system collapses. It’s happening here, in other provinces, and in the UK.

    1. I think it’s time we accept there is no strategic plan to staff ERs in the traditional way. It’s about adequately staffing clinics and pharmacies to provide 24/7 primary community care. Hospitals will be there for surgeries and the least amount of post op care possible. We will be turning out lots of LPNs and Nurse Practitioners in the next few years to take on this work.