Letter to the Premier

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Doctors warned Williams
of crisis situation in 2008

The Williams Government says we have more doctors than ever in Newfoundland and Labrador.

Their radio and print campaign against the Newfoundland and Labrador Medical Association says theyve hired 161 doctors since 2003, and that government is spending more than ever on health care. The soothing tones of the radio ad would almost convince you that Together we are building a stronger healthcare system.

Almost.

When you read the following letter, you might conclude otherwise. You might fear for your life, the next time you check into your local hospital.

In November of 2008, three exasperated medical specialists at the Health Sciences Centre (HSC) wrote a letter directly to Premier Daniel Williams, to make him aware of the dire situation among salaried medical specialists in the province. The letter refers to a feeling of devaluation, frustration and anger felt by specialists province-wide.

I received a copy of the letter through an Access to Information request, routed through the Department of Health. The letter is signed by Dr. Bridget Fernandez, a medical geneticist; Dr. Mark Stefanelli, a neurologist; and Dr. Julia Trabey, a general internal medicine specialist. I will offer the most powerful excerpts here, and reproduce the letter in full at the bottom of this blog.

The Cameron Inquiry has shone a spotlight on the healthcare system in Newfoundland and Labrador. For all frontline physicians the message is clear: Patients expect that those to whom their health and well being is entrusted not be complicit in systems or circumstances which act against their best interests.

In the medical specialty areas we have raised our voices over many years to our clinical chiefs, our health authorities, and to our association warning of problems in these areas, and that patients are at risk, suffering and dying as a result. And now we bring these issues to our government.

The burden of disease is felt broadly across our population and not limited to a single disease process.

At an interview after your testimony at the Cameron Inquiry you were quoted as saying if it was me or my mother in that situation (and had been misdiagnosed) through this process and had found out later that she would have had better treatment I would be pretty annoyed over the whole situation.

Premier Williams, how would you feel if

you, or a family member, were advised 2 years after a referral was made to a Rheumatologist that the waiting list was closed and you would have to be referred to another specialist to face a similar wait time?

a referral was made to a neurologist and you were told the waiting list was infinity?

you were advised that NL Medical Geneticists are supervising the highest number of genetic counselors (per geneticist) in Canada, and still the wait time for genetic assessment if you have cancer and a history suggestive of hereditary cancer syndrome is over two years?

you, or a family member, were diagnosed with thyroid cancer and that the wait time to see an Endocrinologist was nine months?

you, or a family member, suffered from multiple chronic diseases and presented to the closest hospital so ill that you required immediate admission in Clarenville, Carbonear, Burin, and now Gander, only to find out that the closest General Internal Medicine Specialist coverage is in St. Johns, and that, even there, coverage is tenuous and fragmented?

These are not potential scenarios; rather, these are the realities of healthcare delivery in Newfoundland and Labrador today, and it is only getting worse.

Mark these words.

So, Premier Williams, we bring these issues to you to ensure that the people that need to be contacted are contacted.

Click here to read pages one, two, and three of the scanned document, which appeared under Eastern Health letterhead.

This letter was written several weeks before negotiations were supposed to have started with doctors. Those negotiations collapsed after 15 months, when Premier Williams said doctors expectations were, through the roof. Too high. Can't be dealt with. Can't be satisfied. Can't be answered.

The letter was written before Williams flew to Florida to take care of his own health care.

Since that letter was written, three more seasoned, experienced specialists have resigned from the HSC, citing work pressures as the chief reason. This makes the work situation even more difficult and can actually hasten the departure date for those left behind. The crisis has gotten worse, not better, since November of 2008.

Premier Williams was warned in 2008 that our health care system was already in crisis. But that didn't stop him from badmouthing doctors, when negotiations began. Way to go, Mr. Premier.

Government claims they have hired 161 new doctors since 2003. But most are quite likely family doctors, not specialists from what I am told, none are at the HSC. And that number does not factor in doctors who have left since 2003, for greener, quieter pastures. So, the terrible wait times presented in NLMA advertising are accurate and have not improved, despite the reassurances of government.

On 3 February 2010, during a media panel discussion on the CBC Radio Morning Show, Peter Jackson of the Telegram challenged the notion that the health care system is in crisis. He said complaints about the system have been a mantra for the last few years.

Frankly, I dont think theres a lot really statistically to back it up, Jackson said. Its very anecdotal.

This crisis is not anecdotal, as evidenced by the letter from the three doctors. In fact, if things deteriorate further at the HSC, the School of Medicine could lose its accreditation to teach.

I understand that governments latest offer has been presented to doctors, and its the same as the previous offer. It supposedly brings doctors in this province to 98 per cent Atlantic parity, in terms of what government spends in total on doctor salaries. However, doctors currently on a lower pay scale such as salaried specialists who are not oncologists and pathologists will not get Atlantic parity. Heck, they dont even get parity with their colleagues up the hall.

In other words, the situation will continue to worsen at the provinces largest, most important hospital.

Doctors will continue to leave.

More and more people will die unnecessarily.

Who is at fault here is not entirely clear. Does Premier Williams not think salaried specialists are worth it? Or is Bob Ritter of the NLMA not advancing their cause?

I do know this much: Neither Williams nor Ritter can say they werent warned of the situation.

The complete text of the November 20, 2008 letter follows:

November 20, 2008

Honourable Danny Williams

Premier of Newfoundland and Labrador

Confederation Building, East Block

P.O. Box 8700

St. Johns, NL

A1B 4J6

Dear Premier Williams,

We have been assured by your health minister, the Honourable Ralph Wiseman, that you have been fully appraised of issues facing salaried medical specialists in Newfoundland and Labrador but that action could not be taken on (your) issue at this time. Minister Wiseman, in his letter of October 10, 2008 followed with the assurance that you have a keen awareness and interest in physician issues and for that reason invited the NLMA to come to the negotiation table early.

The Cameron Inquiry has shone a spotlight on the healthcare system in Newfoundland and Labrador. For all frontline physicians the message is clear: Patients expect that those to whom their health and well being is entrusted not be complicit in systems or circumstances which act against their best interests.

In the medical specialty areas we have raised our voices over many years to our clinical chiefs, our health authorities, and to our association warning of problems in these areas, and that patients are at risk, suffering and dying as a result. And now we bring these issues to our government.

The burden of disease is felt broadly across our population and not limited to a single disease process.

At an interview after your testimony at the Cameron Inquiry you were quoted as saying if it was me or my mother in that situation (and had been misdiagnosed) through this process and had found out later that she would have had better treatment I would be pretty annoyed over the whole situation.

Premier Williams, how would you feel if

you, or a family member, were advised 2 years after a referral was made to a Rheumatologist that the waiting list was closed and you would have to be referred to another specialist to face a similar wait time?

a referral was made to a neurologist and you were told the waiting list was infinity?

you were advised that NL Medical Geneticists are supervising the highest number of genetic counselors (per geneticist) in Canada, and still the wait time for genetic assessment if you have cancer and a history suggestive of hereditary cancer syndrome is over two years?

you, or a family member, were diagnosed with thyroid cancer and that the wait time to see an Endocrinologist was nine months?

you, or a family member, suffered from multiple chronic diseases and presented to the closest hospital so ill that you required immediate admission in Clarenville, Carbonear, Burin, and now Gander, only to find out that the closest General Internal Medicine Specialist coverage is in St. Johns, and that, even there, coverage is tenuous and fragmented?

These are not potential scenarios; rather, these are the realities of healthcare delivery in Newfoundland and Labrador today, and it is only getting worse.

Mark these words.

So, Premier Williams, we bring these issues to you to ensure that the people that need to be contacted are contacted.

Compensation for physicians is an act of investment on the part of government in the health of its citizens and nothing else. It as, as evidenced by agreements completed over the past several years for other specialist groups, handled outside the framework of formal negotiations. Does the assertion that action could not be taken at this time simply mean that government wishes to barter and bargain over the health of its citizens? Specialist care is specialist care. Salaried specialist care is salaried specialist care.

There are issues for negotiations, but parity of remuneration of salaried specialists is not one of them.

So, what are the choices for physicians? Our first course is to advocate for the care and well being of our patients to those who have the authority and duty to respond. But patients have also made it clear that we have an obligation to not be complicit in unsafe practices and to communicate our concerns about their care directly and publicly.

We represent one salaried specialist group, but the feeling of devaluation, frustration and anger has been expressed by specialists province-wide. Some have already started the process of leaving. We have individually written reference letters for several of our colleagues who have already made, but not publicly announced, their decision to leave rather than continue in a system that jeopardizes patient safety.

Others are quietly exploring their many opportunities outside the province.

Minister Wiseman was gracious and attentive during our meeting of October 2, 2008. However, despite assurances that a more comprehensive response was forthcoming, we have received nothing that tangibly addresses these issues. Continued insistence that the negotiations are only a short time away does not allay but rather compounds and deepens our concerns.

We do not take this step lightly.

We ask for your direct attention to our concerns and request for parity with our specialist colleagues in pathology, oncology and laboratory medicine. We do not feel that health care policy should be decided on the front pages of the newspaper, but rather through fair and reasoned discourse.

As the government prepares a celebration to mark Newfoundland becoming a have province, we ask you to remember that for many Newfoundlanders and Labradorians requiring treatment for health problems, it remains a case of have not.

Your timely response is very important and we look forward to it.

Sincerely,

Bridget A. Fernandez, M.D., Medical Geneticist

Mark Stefanelli, M.D., Neurologist

Julia C.Trahey, M.D., General Internal Medicine Specialist

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  • Robin
    July 27, 2010 - 14:54

    Why didn't Danny pull this letter up in the House of Assembly like he did with the Doctor who played hockey with him (Dr. Jewer)? Once again Danny is trying to fool the masses. Will it work? It has for 7 years. When will we smarten up? Who knows?