How NS Health drives people in chronic pain to ”The Street”

Can someone tell me where to find “The Street”?

I mean the place where drug addicts go when they can’t get opioids from the health system. I’ll pay cash, but I want quality stuff, preferably stolen from a pharmacy, hospital or somebody’s home. The pills should be properly marked and unadulterated, because they’re for my friend, “M” and she doesn’t want anything dangerous.

M is not an addict. Her issue is relentless pain — a lot of it. If she’s an addict, then so are people who need insulin or Advil. But the government of Nova Scotia is determined to force M to “The Street” for relief.

She’s been suffering from chronic pain for 20 years, beginning with fibromyalgia, a disease that on its own can change a person’s life forever. I know of a sufferer whose wife once found him on the floor in a fetal position. His pain was so great and so pervasive there was nothing else he could do.

M also has widespread osteoarthritis, and stenosis of the neck and spine. She has endured four joint replacements, one of which was a do-over on her hip. It didn’t work, so that source of pain is back — amplified, of course, by fibromyalgia. M’s bad luck is compounded by her allergy to a class of drugs know as non-steroidal anti-inflammatories (NSAIDs), such as aspirin and Advil. So opioids are all she’s got. Even worse, M has a high tolerance of opioids, which means she needs a lot more than most people to manage her pain. An emergency room doctor treating M once said to me: “I’ve never given a patient so much morphine with so little effect.”

M is “ashamed and embarrassed” to be taking opioids, so it’s a secret. For important occasions, she’ll take an extra pill to get through the event and manages to appear pain-free. Some people see that and suspect she’s not really sick.

So now, as M languishes on the long waitlist for joint surgery (second hip do-over), the provincial government has stepped in to make things worse — a health department unit called the Prescription Monitoring Program (PMP) has forced her doctor to reduce her painkillers to about half of what she needs because — without ever meeting her — they feel she is being over-medicated. (Note to government: M is never pain-free. The drugs just make life bearable.)

The PMP bills itself as “Promoting the appropriate use, and reducing the abuse and misuse of monitored drugs in Nova Scotia.” It sounds nice but belies a casual cruelty.

One thing it does well is violate patient confidentiality. If you’ve ever received a prescription for one of almost 100 drugs monitored by the PMP, you and your drug become part of its database. The PMP looks for those who work the system to obtain unnecessary drugs and practitioners judged to write prescriptions too freely. In the latter case, the PMP has ways of making them co-operate. The harshest is a referral to their licensing board, which is wickedly stressful and possibly even career-ending.

It’s a curious policy for a health department trying to overcome a chronic shortage of physicians — would you want to practice in Nova Scotia if you knew this was going on?

So you may think you have a confidential relationship with your doctor, but if you live in Nova Scotia, the PMP is right there with you the instant your doctor takes out the prescription pad.

The cops are there, too.

Last year, the PMP processed 33 queries from law enforcement, noting in its 2019/2020 Annual Report — perhaps wistfully: “Law enforcement requests remain steady; however, there has been a decline in recent years as a result of the need for reasonable grounds to be demonstrated … The Program remains willing and able to support local law enforcement.” But the PMP is neither willing nor able to support people in pain. No one from that unit has ever — not ever — contacted M to learn about her condition or assess her needs. It seems their algorithm has coughed up her doctor’s name and it’s case closed. M is collateral damage.

Nothing in the PMP’s annual report assesses whether it is accomplishing the fuzzy objective mentioned above. However, elsewhere on the province’s website there is a rough indicator in a chart of “Confirmed and probable acute opioid toxicity deaths in Nova Scotia.” In 2011, six years after the PMP was created, the number was 56. In 2019, the last year before Covid, it was 56. (The official numbers are subject to change.) It makes “The Street” a tempting alternative for people in pain.

In other words, not much has been accomplished. And I wonder how many other people are suffering needlessly at the hands of the PMP. M is tough, so she won’t be resorting to illegal sources for relief. Instead, she’ll endure a drastic reduction in the quality of her life. Others, however, will do what the PMP purportedly wants avoid: they’ll get help from “The Street.”

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Note: this piece was written by me and first appeared in the National Post on Oct. 6, 2021 – BT.

Yes, we have no data today

The public focus of COVID-19 in Nova Scotia has been the catastrophe at Northwood’s Halifax campus, where 53 residents died from the disease over 33 days. That’s 84 per cent of the 63 COVID-19 deaths in the province. It’s five percentage points above the Canadian average for long term care facilities (LTCs), which itself compares poorly with the average of 42 per cent among other wealthy countries.

That’s bad enough, but it gets worse. At least four more people in smaller LTCs have succumbed to the virus, for a total of 57 deaths or almost 91 per cent of the provincial total.

This information comes not from the province, but Ryerson University in Toronto. The NS Department of Health and Wellness (DHW) stopped responding to my questions about the other LTCs a week ago. Reporters got similar treatment, but I have more time than they do and found the National Institute on Ageing at Ryerson. The NIA has been tracking the pandemic across the country using news stories and sources of their own. I’ve pasted a screenshot of their site below. The actual map is interactive. The web address and advice on getting the best results are in the caption.

Screen capture of an interactive map maintained by the National Institute on Ageing, Ryerson University, Toronto. The green pins denote affected LTCs. Hovering over them produces data site-specific data and clicking yields more detail. Go to https://ltc-covid19-tracker.ca/, but do not use the Safari browser.. Chrome works, although it’s a little cranky. PC users may get the best results.

You can see Ryerson’s data in tabular format below.

Name of LTCLocationOwner/OperatorResident InfectionsStaff InfectionsResident Deaths
(NB: no staff deaths recorded)
Magnolia ManorEnfieldStevens Group230
Drummond HallHalifaxShannex 010
Lewis HallDartmouthShannex 010
Harris HallDartmouthShannex 010
Bissett CourtCole HarbourShannex010
ArbourstoneHalifaxShannex010
MaplestoneHalifaxShannex100
R.K. MacDonald Nursing HomeAntigonishNon-profit society010
Ocean View Continuing CareEastern PassageNon-profit society230
Northside Community Guest HomeNorth SydneyNon-profit society401
Admiral Long Term CareDartmouthGem Health Care Group2111
Harbourstone Enhanced Care  Sydney RiverShannex302
Northwood Halifax campusHalifaxNon-profit society2469953
Subtotals26012257
Plus 10 infections reported but not not linked to a specific LTC
Total LTC infections, Staff+Residents392
NS infections to date1,067
% infections related to LTCs36.7%
% of deaths related to LTCs90.5%
Ryerson data in table format

On May 6, DHW switched to reporting active cases at LTCs instead of a cumulative count, making it impossible to accurately understand what was happening in the sector. Perhaps it was a well-intentioned mistake but, if so, it could have easily been corrected anytime during the following 75 days.

None of this is scandalous, but it makes me wonder whether the government is acting in good faith at a time when trust is vital.

Your email is important to us

The midst of a deadly pandemic seems like an odd time to bury facts about its spread. As I went through news stories to verify Ryerson’s data, I found recurring complaints about DHW’s refusal to provide detailed information. Online news “briefings” restrict each reporter to one question and one follow-up, whether or not the question has been answered. Further, the government decides how much time is allotted for questions. Premier Stephen McNeil bristles and fires off a rebuke when someone asks about a verboten topic such as the need for an inquiry into the Coronavirus deaths or the human slaughter that began in Portapique. He forgets he’s an employee, not a boss. As someone who came to politics from business, he may not understand the difference.

As an obedient citizen I, unlike pushy reporters, would never ask a question the premier didn’t want to hear, but here’s what I politely requested from DHW via email more than a week ago:

  • Name of each LTC stricken by COVID-19
  • # Resident infections at each
  • # Staff infections
  • # Resident cases Resolved
  • # Resident Deaths
  • # Residents who died in LTC
  • # Staff deaths
  • # Number staff cases resolved
  • Date of first case
  • Date of most recent case
  • # Active Cases

I got nothing in reply, so yesterday I began calling LTCs and this morning I coincidentally got an email reply from DHW. It turned out staff are “unable to easily pull” the information I wanted.

If that’s true, then we’re in more trouble than we thought. I know people who could pull that information from an Excel spreadsheet in about 20 minutes. And DHW uses a database that is reputedly better-suited to the task.

Me, I’m thankful we have universities in Toronto backing us up.

Information about births and deaths are part of the glue that holds a society together. In a pandemic, details about deaths are vital if you want people to understand the risk they face. For example, it’s easy to ignore a report that a number of anonymous people died in some anonymous place. We do it all the time. But if instead you read that your long-forgotten college roommate died from COVID-19 at the other end of the province, you pay attention. Suddenly it has become more real, more personal, and you might even be inspired to wear a mask inside public spaces.

Details also promote accountability. Friends and relatives of a deceased person can easily spot mistakes and lies when they can see a name attached to them. It’s why the courts are reluctant to hide the names of people involved in criminal trials. Judges know their credibility rests on transparency. Information vacuums are inevitably filled with misinformation, distrust and conspiracy theories.

If anything good came out of the Northwood tragedy, it was the way it heightened our understanding of how serious the disease is and how close it came to being out of control.

McNeil’s “review” of what happened at Northwood is supposed to help all concerned improve their policies and procedures. No doubt. But if you want to know what his government did, or failed to do, for LTCs; or why it rejected Northwood’s pleas for help as far back as 2017, you’ll want a public inquiry that names names.

But you won’t get it.

And if you want answers about RCMP actions in Portapique, or lack thereof, you can just pound sand.

One question, one follow-up. Next please.

And shut the blazes up.

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Email to Nova Scotia’s chief medical examiner

Further to yesterday’s post, if you’re inclined to send an email to the chief medical examiner, the following might be of use.

Address it to justweb@gov.ns.ca .

NOTE: I’ve received conflicting advice from varying sources about the correct email address. I recommend using the one above, which comes from the department web site, and addressing your message to Dr. Bowes’ attention. Justice Dept. staff will redirect it to the right mailbox. I’m sorry for the confusion.

Request to Chief Medical Examiner for fatality investigations

Dear Dr. Bowes,
I am requesting your office to conduct fatality investigations into the COVID-19 deaths at the Halifax campus of the Northwood Centre and the homicides committed by Gabriel Wortman beginning in Portapique, NS, on the night of April 18, 2020.
I believe the Fatality Investigations Act gives you grounds these inquiries.
You can find more information on Bill Turpin’s blog at https://wp.me/p6FgqN-1gb .

How citizens can force inquiries into Northwood and Portapique

The Short Version

Nova Scotians who want inquiries into the tragedies at Northwood and the RCMP’s response to psychopathic killer Gabriel Wortman should contact our chief medical examiner, Dr. Matthew Bowes. The address is justweb@gov.ns.ca. NOTE: I’ve received conflicting advice from varying sources about the correct email address. I recommend using the one above and addressing your message to Dr. Bowes. Justice Dept. staff will redirect it to the right mailbox.

Nova Scotia Medical Examiner Service
Dr. William D. Finn Centre for Forensic Medicine

51 Garland Avenue
Dartmouth NS B3B 0J2

Phone: 902 424-2722
Toll Free Phone (NS): 888-424-4336 Fax: 902 424-0607
Toll Free Fax (NS): 866-603-4074 

 

The Long Version

Over 35 days beginning April 17 Nova Scotia endured two mass casualties that killed 75 people. Fifty-three victims were residents of Northwood’s long-term care home in Halifax. Even more helpless were the 22 who died in Gabriel Wortman’s insane shooting and fire-setting rampage.

Northwood’s management of COVID-19 and the RCMP’s response to Wortman both need public inquiries. We are already past the point where memories begin to change and records mysteriously disappear. Still, Premier Stephen McNeil — who is surfing a wave of popularity and has two years before he has to call an election — has done nothing.

But Nova Scotians are barking up the wrong tree if they want those inquiries. Instead we need to demand action from Dr. Matt Bowes, our chief medical examiner.

Bowes has the legal authority to launch inquiries and, I would argue, two ethical imperatives for doing so: the Canadian Medical Association’s professional code and the oath he took on accepting his job “to faithfully perform all such duties as devolve upon me in the office of chief medical examiner … for the Province of Nova Scotia without fear, favour or partiality and according to the best of my knowledge and ability”.

Those duties include Section 26 of the Fatality Investigation Act, which says Bowes can “recommend” that his minister launch a “fatality inquiry”. And in very next section the law says that upon receipt of Bowes’ recommendation the minster “shall” make the inquiries happen.

This means Citizens contacting the CME could create a lot of consternation for the premier. True, McNeil could probably find a way to shut Bowes down, but recent experience shows a heavy-handed response to a well-intentioned civil servant can be a highly visible and politically ugly business.

Further, Bowes’ minister is Mark Furey, a retired RCMP officer, which is akin to being a retired priest — you’re never really off the force. If he buries a recommendation from Bowes he’ll have to explain to us not only why he’s breaking the law, but also why he is not in a conflict of interest.

The one person I feel a little sorry for in this scenario is Bowes. If he gets enough demands for an inquiry from Nova Scotians, he’ll be caught between his duty as CME and a couple of very angry political bosses. But that’s why he gets the big bucks. Very big, actually, by Nova Scotia standards.

Happily, there’s an easy way out: the premier can publicly commit to holding both inquiries as soon as possible, without musing about whether the RCMP is a federal responsibility. Nova Scotia has a 20-year contract for RCMP services worth roughly $2 billion, so we’ll do our own inquiry, thanks very much.

Caveat

Sadly, although I can read statutes, I am not a lawyer. Don’t let that stop you. Tell your friends.

Covid-19 in NS by the numbers April 2/20

New CasesTotal Cases to DateIn HospitalRecoveries to Date
20193516

A goverernment map and graphic presentation of the case data is now available at https://novascotia.ca/coronavirus/data.

As you can see above, the province of Nova Scotia is now providing a graphical resprentation of the Covid-19 data. Further, the province has real laboratories, one of which processed an astounding 900 tests on Wednesday.

If journalists and lab technicians have the time, I think this is an accomplishment that derserves some coverage.

Turpin Laboratories, which is imaginary, will now find something else to do. Our staff are simply too exhausted to compete with the province.

Lastly, young whippersnappers take note: The province’s site has a breakdown Covid-19 cases by age group. You can no longer say you weren’t warned.

Above are the data used to create the charts and graphs you’ll find below. The cell highlighted in red shows when I last updated them.
Above: “Positive cases to date” reflects confirmed cases of Covid-19 in Nova Scotia, e.g., 147 on March 31. Negative results and the total number of tests administered in the province are also shown. The rightmost cell shows the total for tests as a percentage of the population.
The chart above (New cases reported by day) shows the number of Covid-19 cases reported each day by NS public health. For example, the first three cases were reported on March 15, two more were reported on March 16 and another two on March 17. The chart below (Running total) shows what happens when you add those number up. For example, the number corresponding to March 17 below is seven, the sum of March 15,16, and 17 above (3+2+2=7). You can find the news releases on the government’s searchable database at https://novascotia.ca/news/.
The chart above is the result of summing all the available results as of date on the horizontal axis. The number 147 does not mean 147 cases were reported on March 31: rather, it’s the total of all 17 reports from March 15 to March 31, inclusive. As you can see on the bar chart, only 20 new cases were reported on March 31.

Covid-19 in NS by the numbers

Update: April 1, 2020

This post contains NS data on the Cover-19 outbreak here and will be updated regularly. You can see that as of April 1 a total of 173 cases had been reported. (Please note the name of this blog, Turpin Laboratories, was a tongue-in-cheek choice made during happier times. I am not a laboratory and possess no scientific expertise.) Everything below is presented for your reference only. Drawing conclusions from these data is is ill-advised unless you’re an expert. Further, you can see from the way the numbers jump around that predictions would be meaningless — especially, to paraphrase Yogi Berra, if they’re about future.

Above are the data used to create the charts and graphs you’ll find below. The cell highlighted in red shows when I last updated them.
Above: “Positive cases to date” reflects confirmed cases of Covid-19 in Nova Scotia, e.g., 147 on March 31. Negative results and the total number of tests administered in the province are also shown. The rightmost cell shows the totals tests as a percentage of the population.
The chart above (New cases reported by day) shows the number of Covid-19 cases reported each day by NS public health. For example, the first three cases were reported on March 15, two more were reported on March 16 and another two on March 17. The chart below (Running total) shows what happens when you add those number up. For example, the number corresponding to March 17 below is seven, the sum of March 15,16, and 17 above (3+2+2=7). You can find the news releases on the government’s searchable database at https://novascotia.ca/news/.
The chart above is the result of summing all the available results as of date on the horizontal axis. The number 147 does not mean 147 cases were reported on March 31: rather, it’s the total of all 17 reports from March 15 to March 31, inclusive. As you can see on the bar chart, only 20 news cases were reported on March 31.

De Adder gets the treatment

The offending political cartoon.

Cartoonist has met the enemy and he is us

The social media scolds bagged some big game last week, extracting an apology from cartoonist Michael de Adder for an innocuous cartoon (above).

The cartoonist was calling out Prime Minister Justin Trudeau and his cronies for their treatment of former attorney general Jody Wilson-Raybould.

A boxing ring was the perfect setting, because Trudeau gained notoriety as an amateur boxer by knocking the stuffing out of domestic-assaulter Sen. Patrick Brazeau in a charity match.

So far, so good, but de Adder made the mistake of portraying JWR as gagged and bound, symbolizing the fact she was (maybe) legally gagged by solicitor-client privilege and (perhaps) bound by cabinet solidarity. I don’t feel bad for de Adder. He dishes it out and he should be able to take it. But I can’t help wondering about the scolds.

Their reaction is pretty much summed up here in a Tweet that appears to be from John Cleese.

Well, de Adder’s drawing wasn’t doing that. If you enjoy violence against any gender, I recommend the entertainment industry, including best-selling books.

Below are some possible explanations for de Adder’s scolds.

• Because they interact with him on Twitter, de Adder has become an extension of their egos. With this cartoon, he has damaged those egos and must be brought into line.

• The cartoonist is part of an “elite.” This offends those who believe themselves to be intellectually or socially superior. They, like the rich, believe they have achieved their status through merit. By contrast, they see de Adder is a one-trick pony, unworthy of his status. He must therefore be humbled.

• Think of it as psychosomatic, a restricted vision caused by existential adherence to beliefs or causes. The scolds can only see the lower left corner of de Adder’s drawing, causing them to believe the artist is making light of violence against women.

• Others can see the entire cartoon, but cannot grasp its context.

• Or, they are aware of the context but choose to ignore it because willful blindness enhances their cause.

• This is closely related to the propagandist tactic of erecting a straw man and attacking it with full force. In this way, one can inspire outrage against de Adder without having to address substance.

• The above tactic is typically supported by constant reinforcement lest the targets get a chance to think for themselves. For this, Twitter is the best tool in the box.

• De Adder is a journalist, and journalists are seen by many as know-nothing, would-be intellectuals. But even would-be intellectuals, we’re told, are enemies of the people and common sense. Therefore they must humbled. (See Stephen Harper, Donald Trump, the Khmer Rouge et al.) NB: I say this with greatest respect for the broader know-nothing community, which has always been a source of fellowship and inspiration.

Lastly, de Adder is a threat to authoritarians from the entire political spectrum. So, in time, he may regret his insouciance still more. Let us hope his apology will be enough to keep his head from sitting atop a pike or rolling into a wicker basket designed by Louis Vuitton.

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Exxon’s criminal negligence: lock’em up

Canada progress climate change
Propagandists for ExxonMobil were almost certainly a factor in Canada’s poor record of fighting climate change.
The figure shows that Canada’s greenhouse gas emissions projections under a “with current measures” scenario are projected to be 768 megatonnes (Mt) CO2 eq in 2020 and 815 Mt CO2 eq in 2030. It also shows the expected range of the same projections under different economic and energy price and production scenarios. For 2020, the expected range of emissions could be between 749 Mt and 790 Mt. For 2030, the expected range of emissions could be between 765 Mt and 875 Mt. It must be noted that these projections do not include contributions for the land use, land-use change and forestry sector (LULUCF), as analysis of alternative accounting approaches remains ongoing. (Graph by Environment Canada)

IT SEEMS there’s never a law around when you need one. 

I’m thinking of climate criminals, people who undermined climate change science for decades when they knew it was valid and were well aware that ignoring it meant human catastrophe. They’re getting away with murder. (Climate criminals do not include the ignorant. Ignorance is not a crime.)

But what about people like Rex Tillerson, the former chief executive officer of ExxonMobil and U.S. secretary of state?

Exxon was the corporate Joseph Goebbels of the losing war against climate change, sowing confusion and doubt about climate science. Doubly damning, the company did so despite research, from its own scientists, going back to 1977 about  the reality and deadly implications of climate change. 

Tillerson began his career with Exxon in 1975 and quickly rose to the company’s upper ranks. He cannot pretend he didn’t know about the vile propaganda his company was spreading or that he couldn’t have done something about it.

I like to think a Canadian criminal court could jail Tillerson under Section 219 of the Criminal Code:

Criminal negligence

219 (1) Every one is criminally negligent who

(a) in doing anything, or

(b) in omitting to do anything that it is his duty to do,

shows wanton or reckless disregard for the lives or safety of other persons. (Emphasis added.)

The maximum sentence when lives are lost is life in prison .

Rex_Tillerson_official_portrait
Former Exxon CEO and U.S. secretary of state Rex Tillerson (Wikipedia)

It’s reasonable to argue that Tillerson’s collaboration in a disinformation campaign against climate change science shows a “wanton disregard for the lives or safety of others”.

On the other hand, you could argue that investigating one of the world’s 10 largest companies is too much of an undertaking for our tiny country. However, much of the groundwork has already been done by U.S. states on behalf of Exxon shareholders. They’re arguing in civil court that shareholders weren’t properly advised of the threat to the value of their holdings posed by climate change. 

Here, courtesy of the Pulitzer Prize-winning Inside Climate News is an overview of legal actions against Exxon in the U.S. 

I’m certain the plaintiffs would gladly share their evidence against Exxon with Canadian investigators and I would like to see similar lawsuits here, but I’m far more concerned about the well-crafted public deception that undermined the fight against climate change. 

Scientific American says “One thing is certain: in June 1988, when NASA scientist James Hansen told a congressional hearing that the planet was already warming, Exxon remained publicly convinced that the science was still controversial. Furthermore, experts agree that Exxon became a leader in campaigns of confusion. By 1989 the company had helped create the Global Climate Coalition (disbanded in 2002) to question the scientific basis for concern about climate change. It also helped to prevent the U.S. in 1998 from signing the international treaty, known as the Kyoto Protocol, to control greenhouse gases. Exxon’s tactic not only worked on the U.S. but also stopped other countries, such as China and India, from signing the treaty.” (Emphasis added.)

Remember, Exxon did this while possessing its own research validating climate change science.

So, I would like to see criminal charges under Section 219 and extradition requests to the U.S. for Tillerson and other Exxon executives.

But let’s not stop there. My guess is there are hundreds of equally guilty Canadians working for Exxon or other fossil fuel companies. As noted, the U.S. has done the groundwork, so let’s use it to hunt down our own climate criminals.

I understand that lawyers would probably shoot down this idea down because of some legal subtlety.

OK fine. Then we need a new law to instill palpable fear in Canada’s executive suites about degrading the environment. For example, executives inclined to secretly pollute so much as a trickling stream should be prepared for jail.

The environment is not an abstract concept: it’s our habitat. We are not trying to save the planet, which has survived climate change before; we are desperately trying to save ourselves.

People who get in the way belong behind bars. If our current laws can’t do the job, then let’s write new ones. 

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Doctor-less down, hospital up

(Updated post. Please see correction below.)

December is off to a good start for the Nova Scotia Health Authority.

This month it is able to report the first significant decline in the number of citizens who need a family doctor but cannot find one.

5,322 people reported they had found a family doctor and 3,738 registered with NSHA to get help in finding one.

That’s a net improvement of 1,584, the first decline since January. The final number is even better because, beginning this reporting period, NSHA can include results from the Patient Attachment Incentive Trust, which offers docs a one-time payment of $150 for each new patient they take on.

It began April 1 but the results were not counted until now, giving NSHA the benefit of eight months’ of incentives in a single entry.

That means there are 55,801 doctor-less citizens as of December 1, down from 59,225 on November 1 (3,424). Whatever number you settle on, it’s a little bit of good news.

Screen Shot 2018-12-10 at 2.53.25 PM
NSHA graph shows number of doctor-less Nova Scotians, based on its registry. The December 1 number shows an encouraging improvement. It’s accurate, but a little misleading.

DGH New Entrance2
Architect’s rendering of the new entrance to Dartmouth General, which opened today, December 10. The official opening is tomorrow, December 11.

And there is more good news at Dartmouth General. The official opening of its new entrance, which faces Acadia Street, happens tomorrow, Dec. 10.

In your correspondent’s view, the “official” opening of a door is a good idea when it’s part of a $140-million renovation because it’s a chance to remind the public this important project is well underway, which makes it harder for governments to stop it.

I say this with the lonely saga of DGH’s ghost floor in mind. It’s the building’s fifth floor, built circa 1988 but left empty until now. 

Citizens may recall that during the ghost floor’s big sleep, emergency departments on both sides of Halifax Harbour were practising hallway medicine because there were no beds for emergency patients once they had been stabilized.

This will continue until the construction, finally underway,  of the ghostly fifth floor is complete. But it’s galling to know that additional capacity has been available —on the ghost floor— for the last 30 years. It’s the kind of thing that makes voters cynical. Preventing hallway medicine is the responsibility of elected officials and all three political parties have dropped the ball at one time or another.

But enough negativity. The DGH project is itself a part of the much larger “QEII New Generation” project that will replace the VG, Centennial and Dickson buildings in Halifax.

NSHA’s Victoria van Hemert, who is overseeing the whole thing, says the changes at DGH will have a huge impact on the community.

“The big benefit is capacity,” she says. “It means services will be closer to people’s homes.”

Here are some of the other benefits:

  • 48 new beds, some of which will accommodate morbidly obese patients
  • Renovations are finished on the third and fourth floors.
  • Eight new operating rooms (replacing four existing ones), which will increase  surgical capacity by 3,500 operations per year.
  • Two of the new O.R.’S will be high-volume facilities dedicated to orthopaedic surgery, making DGH a key focus for those procedures.
  • Patient rooms will be spacious and offer a view of the outside wherever possible. They will be single-occupancy where feasible. Both features have been proven to speed recovery, reduce relapses and promote infection control.
  • Some rooms will have two patients, but that’s the maximum. There will be no four-bed wards.
  • Outpatient services capacity (procedures not requiring overnight stays) will double.
  • A three-storey addition is under construction and planned for completion next summer. It will house the new O.R.s, a new ambulatory care clinic (ongoing treatments not requiring an overnight stay, such as dialysis), and an endoscopy centre.

The entire project is expected to be finished by late 2021, which pretty much eliminates the possibility of progress being suspended by an election, as it did in 2009 and arguably 2013. This time Premier Stephen McNeil’s government seems to have the bit firmly in its teeth and technically has until 2022 to drop the writ.

Nonetheless, we should keep a sharp eye in the Halifax Infirmary redevelopment, which is ambitious, critical and expensive. Completion might come in 2024-25, which is a long way away in political terms.

NSHA has been refreshingly open about the doctor shortage and the hospital reconstruction. I hope they keep it up and even go further. Believe it or not, open government brings results.

CORRECTION: Earlier, I wrongly reported the fourth floor of Dartmouth  General Hospital would be used for administration. It will continue to be an inpatient floor.

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How to boost sales of illegal painkillers

Predictably, the number of Nova Scotians in need of a family doctor hit a new high as of Nov. 1.

On the bright side, it’s “only” 1,179 more than the month before, and it’s the fourth number in a row suggesting some kind of moderating trend. So, fingers crossed, eh?

On the dark side, our 59,225 doctor-less citizens may lose access to a much-needed painkiller next year.

Health Canada is proposing to make low-dose codeine products available by  prescription-only. This would include Tylenol No. 1, which is an alternative for people who cannot tolerate a class of common painkillers called NSAIDs. It includes Aspirin, Ibuprofen, Alleve and many others.

I’m not saying Tylenol No.1 is risk-free. Regular Tylenol (and its generic versions) contains acetaminophen, which by itself can have serious side-effects when misused, but is safe when guidelines are followed.

However,  Tylenol No. 1 also contains codeine and caffeine, which are intended to boost the pain relief. Codeine is an opioid which, given the current paranoia over anything with that name, explains what’s going on here.

Health Canada has a stout defence of its proposal and I lack the science to debate the issue with them.

But I will say that even retail drugs can have unwanted side effects. The misuse of Aspirin and its cousins, for example, can cause stomach ulcers. The question is whether the benefits of a drug outweigh the risks.

If you have chronic pain, you might be willing to risk a lot for relief. (On the flip side, I know someone whose death likely began with a refusal to request opioids for severe pain.)

And I note Canadians take about 600 million doses per year of Tylenol No. 1, which pro-rates to about 15 million doses in Nova Scotia, the equivalent of 300,000 bottles containing 50 tablets. I don’t know how many prescriptions that will require, but the calculation starts at 300,000.

Whatever the final number is, it’s bound to be a burden for family doctors, some of whom have already endured oppressive and unnecessary prying by authorities waging a war on opioids.  Nonetheless, a doctor I know supports the management of opioids even in small doses, but feels other types of painkillers should be made more accessible and less expensive. Interestingly, this doctor suggests including opioids among the drugs pharmacists are permitted to prescribe.

And that brings us to the biggest problem here: if Health Canada makes this change, how will you get Tylenol No. 1 if you don’t have a family doctor? 

How many of our 59,225 doctor-less citizens will have go the infamous “street” for their pain relief? These folks are about six per cent of the province which, using my seat-of-the-pants calculation, equates to a potential market of about 18,000 bottles.

So that could be new biz for “the street” and its dangerous, unregulated products. That’s a lot of risk. I wonder if the benefits are worth it.

But I’m no expert. To quote the Great Ignoramus, I’m just sayin’, that’s all.

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