On Friday, a handful of Nova Scotia doctors accepted an invitation from Dr. Rob Miller to participate in a Zoom meeting to discuss their obligations as medical professionals and citizens to speak publicly about health issues. 

Miller was home to Nova Scotia after working several months in British Columbia. He was part of a trio of emergency room doctors who no longer work at the Valley Regional Hospital after speaking out publicly about overcrowded conditions in the spring of 2019. “Make Emergency Great Again” was their tongue-in-cheek slogan of a gofundme campaign to finance more nursing home beds. 

Emergency Room doctors protest on Barrington Street, June 15, 2019. Photo submitted

“The issue centers around frontline health care workers having a right to voice concerns with regards to the healthcare system in Nova Scotia”, said the invitation issued by Miller. “This right includes a range of matters such as Emergency Department overcrowding, shortages of family doctors, and inadequate long-term care bed numbers in Nova Scotia. Authoritarianism has failed this province and real accountability is required more than ever before.”

Miller noted a precedent was established last month by a Saskatchewan court which overruled a decision by the College of Nurses to strip a registered nurse of her licence for speaking out on social media about the care her father received in a nursing home. The judge ruled her comments were “free speech” under the Charter of Rights and could lead to positive change in the healthcare system.

Dr. Rob Miller, from the Zoom call

Miller and the handful of doctors who participated in the Zoom meeting Friday want to see a process established that will protect health care workers who raise concerns or advocate for improvements in patient care. Doctors who experience conflict with their bosses have no grievance procedure through their professional association (Doctors Nova Scotia) and provincial “whistleblower” legislation isn’t designed to address this problem. 

“At the moment we are caught between our professional obligation to advocate and the threat of overt and covert retribution from administration as demonstrated by the way the NSHA has treated Dr. Jeannie MacGillvray, Dr. Rebecca Brewer, and others including Dr. Gabrielle Horne,” said Miller.

The shared experience of these doctors suggests by having spoken out, they became the target of complaints by other staff as well as administrative changes (adjustments to schedules or work loads) which added stress and affected their ability to keep working. 

Nova Scotia has already lost a surgeon (Dr. Jeannie MacGillivray of Antigonish) and an ER doctor, Rob Miller, as a result of conflicts with the Nova Scotia Health Authority. Cardiologist Dr. Gabrielle Horne spent 15 years fighting to restore her reputation after the former Capital District Health Authority blocked access to patients needed for her publicly funded research based on complaints from a colleague that were unfounded.

Horne never got an apology. Instead she took the Health Authority to court and won. The Nova Scotia Supreme Court and Appeal Court ruled the actions of the Health Authority were made in bad faith. Horne claims she spent $1 million in legal fees and that Nova Scotia taxpayers paid many times more to defend an institution she described as “out to destroy me” and accountable to no one, including elected officials. Horne’s complaint went unresolved by five department heads and five CEOs.

 “If the government doesn’t hold people responsible in the Health Authority, no one will be,” said Horne. “If you can’t fire a CEO over what happened to me, how can you enforce any accountability?” Horne continues to work as a cardiologist and has written a book (awaiting publication) about her experience.

Working conditions

Dr. Jeannie MacGillivray joined the Zoom call from the state of Washington, where she moved after leaving a community surgical practice in Antigonish. It took 15 months to find someone to replace her. MacGillivray — who is a single parent of teenagers — had raised the issue of burnout. She managed to find another doctor with whom she could share the practice at no additional cost to the public. The Nova Scotia Health Authority rejected the arrangement and for the first time in 20 years, MacGillivray was informed that complaints had been filed against her. None of them went as far as the College of Physicians and Surgeons, which licenses doctors. But MacGillivray resigned and worked a series of locums at eight Nova Scotia hospitals before finally moving to the United States.

“After I resigned,” MacGillivray told the others on the call, “people came up to me in the hallway and told me stories of their misery. I was shocked at how many people were suffering in silence. There needs to be a cultural shift within the Health Authority before we lose more doctors but that will take engagement by government.” 

Dr. Jeannie MacGillivray, from the Zoom call

A similar pattern emerged at Valley Regional Hospital. Dr. Rebecca Brewer was elected head of the Emergency Physicians Association and after speaking out about overcrowding, the Health Authority created a new job in a supervisory capacity that was filled by the previous head of that Association. Miller says immediately following this action, he and Brewer were informed of complaints being made against them on an almost weekly basis. Miller says they were not allowed to read those anonymous complaints but eventually got a summary through a lawyer with the Canadian Medical Protective Association (CMPA). Miller described the complaints against him as “erroneous at best and malicious at worst.” He says he’s unable to pursue it because his former boss at the Valley hospital is also a doctor and the CMPA won’t take on a dispute when it involves two physicians. 

Dr. Keith MacCormick, who now practices emergency medicine in the Central Zone after also leaving Valley Regional, emailed this suggestion to the group concerning conflict-of-interest:

We in the medical profession have a duty to our patients that comes before politics. In this era of rapidly increasing tension between the political side that provides the resources, and the healthcare side that demands the resources for its patients, it is more important than ever that clear boundaries are enforced. 

Even the best leaders are in conflict if they try to represent both sides of the tug-of-war. I believe that one of the first steps towards better healthcare, better credibility, and less tension, would be for both sides to stop allowing their senior managers and directors from acting in a similar capacity for the other side. For example, a physician who takes on a role as manager for the health authority should not be allowed to also act as a representative for a medical staff association or the provincial physician membership.

Prescription for change

So what’s the solution? It may require legislation with more teeth than the current whistleblower act to protect health care workers from being jerked around by their employer for speaking up. 

Health critics from both the NDP and PC political parties were also invited to the Zoom call. Barbara Adams is the Progressive Conservative Health critic and a physiotherapist who worked 18 years for the Health Authority. She says she ran for political office because as a health care professional, she experienced the same feelings of frustration and powerlessness at being unable to make change from within the health system.

“This is happening at all levels and it is impacting the health and safety of our patients,” said Adams, MLA for Cole Harbour Eastern Passage. “Whistleblower legislation applies to really egregious, illegal things. There is no protection for us if we speak up and our supervisor writes something negative in our HR file. I could tell you stories of people who have been fired or went off on sick leave never to return. A lot of attention is paid to silencing people in all departments.”

Normally, I would call or write the communications person at the Nova Scotia Health Authority and ask for a response to these concerns. However, the problem is the CEO and the administrators who are in positions of authority today are different from the people in charge 18 months ago when the Valley and Antigonish docs were embroiled. Whatever disputes or “free speech” conflicts are simmering now are likely to stay in the pot for the same reasons the doctors have outlined previously. Fear of reprisals. And no real system for resolving problems or making change internally. 

Missing from the call was the voice of well-known family physician and TV personality, Dr. Ajantha Jayabarathan or “Dr. AJ” as she is better known to Nova Scotians. Never one to duck a fight, Dr. AJ wrote this message to her colleagues:

I believe all health care workers should be enabled and supported to speak their truth, without fear of retaliation and reprisal. Currently the office of the ombudsman is available to us all, however doctors have indicated that they were threatened with College complaints and/or were financially audited, then threatened that the auditing process would be ongoing….even after the doctors proved their case.

The solution that we create, must ensure transparency of process and ongoing transparency, so that the health care professional can reach out if they are being pursued/harassed/intimidated by such real threats.

Clearly it’s time for some open discussion on how to fix a problem that affects patients as well as staff.

Jennifer Henderson

Jennifer Henderson is a freelance journalist and retired CBC News reporter.

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  1. Since the NS Healthcare system is a monopoly paid for with tax dollars, citizens are totally dependent on that system and have no choice. There is now a disturbing trend in this system and that is intimidation and also a disregard for personal health.

    First we are told by the Strang Regime that there are medical exemptions to masking but that we should not go to the system to get such exemptions. So, you are self diagnosing your own health situation. I suspect that if one did obtain such a medical exemption you might be labeled a dissident and refusenik and that this might influence the healthcare provided to you. This is dangerous territory indeed.

    Secondly, and in the same category as the above is Strang’s Organ Harvesting Mandate. It is well known that Strang and the Medical Establishment want your organs. There have been numerous scandals around the globe regarding Organ Harvesting. Under Strang’s system you must Opt Out, an abusive practice used by major corporations to deprive citizens of their normal rights. So, if you do opt out of Organ Harvesting it is recorded on your Health Card and available to all medical staff many of whom want your organs. Like paragraph one, this puts the patient in a difficult position indeed.

    On Covid19, there is a complete lack of transparency by the Strang Regime regarding this virus. In addition, there are numerous experts contradicting the position adopted here on how to deal with the virus. Much of this alternative/contrarian expert opinion is being censored.

    One example is at
    https://www.corp-research.org/pfizer
    which gives the criminal record of vaccine developer Pfizer. You can also find similar info on AstraZeneca and Johnson&Johnson. In mainstream stories promoting vaccines I have yet to see any mention of this past malfeasance. Indeed, when we come to the vaccine propaganda campaign Governments and Big Pharma will generate, there will be no mention of these Corporate Rap Sheets. A complete violation of the principal of Full Disclosure.

    Good luck to all Nova Scotians trying to navigate this Healthcare Minefield which you have paid for with your tax dollars. This system works very well for them and belongs to them not to Nova Scotians.

  2. Before the pandemic, our broken “healthcare” system was a frequent topic for local articles, op-ed’s, and protests. Since March, I haven’t seen much re healthcare that isn’t COVID-19 related. But the issues still remain. Thanks for covering this.

  3. You would think that doctors working on the front lines, see what works and what doesn’t !
    With threats of job loss, you leave them no choice, to shut up and keep working OR lost your job !
    If that is not hindering free speech and trying to make a broken system better, then I don’t know what is !
    Egos in upper management have taken precedence, with threats of job loss, is any doctor speaks out !!
    Sounds like a communist society and a bit Trumpish ! Do what I say you can do – if not You’re Fired

  4. Dohw, msi and pharmacare are opaque institutions with little input from practicing physicians and almost no dialogue.

  5. Well past time for accountability at the level of the NSHA and Government. We DO know better, and there needs to be transparency and resolutions, moving forward.
    This Province can do better. Be better.

    Authoritarianism has failed our frontline healthcare workers and the Province as a whole.

  6. How is that we are once again leading the country in the wrong way? The highest award EVER for workplace abuse and harassment in Canada was issued in Nova Scotia against the Health Authority.

    What did we do?

    We gave the abusers even more power… then turned a blind eye ensuring the abuse continues. What will this cost us in the end? Financially, medically, morally, socially?

    A public inquiry into the NSHA is as warranted. Why don’t we demand one?

    Is it because it is easier to apologize for bad acts done by others decades or centuries ago rather than accept that it is us perpetrating them today? Is it because it is easier to say “never again” to some action we already addressed rather than admit we’ve still got a problem now?

    If we don’t spend the time and money to address this immediately and demonstrably, I predict that in 10-25 years we will spend far more than what we have already paid Dr. Horne in damages (not to mention the 10+ million we’ve spent on lawyers fighting her).

    The courts told us what went on. The doctors tell us it continues.

    We know better. We NEED to do better.

    Rather than cluck your tongue and talk about this decades from now, ask yourself what YOU – yes YOU as individual are willing to do NOW ….