They've been trying to recruit new doctors for years. Now a lab tech is leaving and NSHA says he won't be replaced. Many North of Smokey are left wondering if this is the beginning of the end for Buchanan Memorial Hospital.

~Carolyn Barber, The Victoria Standard

Dr. Bernard Buffett believes that Buchanan Memorial Community Health Centre (BMCHC) in Neil’s Harbour has reached a “tipping point” in not being able to recruit or retain physicians.

Buffett has been practicing medicine at BMCHC for 34 years. He says limited x-ray services, frustration with EHS dispatches and reluctance of doctors to work in a facility without a CT scanner together will make it hard to attract new physicians. Compounding matters, the NSHA told BMCHC on Jan. 31 that it will not replace the outgoing medical lab technologist (MLT) leaving at the end of March. While routine blood collection will not change, clinicians at BMCHC will now perform emergency department and patient bedside blood testing using handheld or portable Point of Care Testing (POCT) devices.

On Feb. 7, Senior Director of Pathology and Laboratory Medicine for the province Shauna Thompson explained the NSHA’S rationale for not replacing the MLT. She says POCT devices are widely used and that the NSHA has data proving that implementation at other rural sites has been successful.

“Feedback from physicians and nursing staff that are using the technology have validated they are getting quicker turnaround times, it's reliable, it's there when they need it.”

Thompson said that testing volumes and the average intensity of care required for patients presenting to the emergency at Buchanan also factored in the decision not to replace the MLT.

Buffett, however, is skeptical of the device’s effectiveness. He says doctors in Chéticamp, Canso and Sheet Harbour have reported that they are "very disappointed" with POCT.

In a CBC Nova Scotia report, BMCHC physician Nicola Smith stated she did not think POCT was as effective as an MLT, and that her MLT colleague provided extra insight and adeptly suggested additional tests.

To Smith’s concerns, Thompson replied that POCT is “not about replacing the MLT”. She says POCT is subject to the same quality rigour as testing that's performed in conventional laboratories, adding that the chemical reactions that occur in lab instruments and the chemical reactions that occur in POCT devices are the same. She said though MLTS may not be on site, physicians will still have 24/7 access to the MLTS in the NSHA system if they have questions.

Thompson said there will be an “enhanced transportation system” in place to ensure routine blood work is delivered in a timely manner including “on demand” service for transporting bloodwork outside scheduled runs.

The NSHA said it was the MLT’S “personal decision” to relocate to Halifax and that he was a valued employee.

It was known that the MLT planned to leave in two years’ time due to family commitments. Neither Buffett nor Ingonish resident Earle Tubrett dispute it was a personal decision. However, both feel circumstances created by the NSHA "forced" the MLT to leave prematurely.

Like other commuting clinicians and lab techs, the MLT stayed in one of three on-call rooms at no charge while working at BMH. Buffett says the NSHA suggested the MLT find paid accommodations outside the hospital. Off-hour calls then meant a 14km to the hospital rather than a walk down the hall. Then came reduction to his on-call pay.

The Standard reached out to the NSHA media spokesperson Annette Bourgeois-bent on Feb. 11 regarding changes to the MLT’S accommodations while working at BMH and any changes to his compensation that may have expedited his departure.

Bourgeois-bent did not reference accommodations or compensation in her response, and instead provided the following statement:

“The larger challenge is sustainability,” she wrote. “One MLT working full-time hours, plus 24/7 on call is not a healthy or sustainable work-life balance in any facility. This schedule means that when the MLT leaves the community, gets sick or takes a vacation, an MLT from another facility must be found to cover the work. Taking from one site to support another is not a sustainable solution when MLTS are already in short supply. The arrangement at BMCHC, while it may have worked for a period of time, is not sustainable in the long-term. Nor is it fair to the employee. Laboratory services are vital for patient care. The decision to use this opportunity to move to point-of-care testing means that laboratory services at BMCHC will be stable and sustainable – and that’s the focus of patient-centered care.”

Buffet says never has never heard a complaint from the MLT and says his colleague is a "very accommodating, very lovely man to work with". He questions why one MLT is not sustainable in Neil’s Harbour but is sustainable in locations like Baddeck and Chéticamp.

Buffett was ready to retire before news came that the MLT would not be replaced.

“Why am I here?” asks Buffett. “I'm trying to keep this legacy and care for people open.”

He is one of three physicians at BMH, the others being long-time physician Ken Murray and newest physician Nicola Smith. Murray has worked at BMH for 47 years and is close to retirement.

Buffett feels diminished resources will undermine physician recruitment and ultimately the future of BMH.

“If you don't have physicians at Buchanan Memorial, what do we have left? I'm not elevating our positions. It's just the way it is. I know Dr. Murray is not willing to work under this situation. And listen, I'm with him. I can see this place saying, ‘we can't do this anymore, it's not viable, it's not safe.”

Image: Buchanan Memorial Hospital. Courtesy of mdcareerinnortherncapebreton.com