Doctor giving up medical licence because of frustration with health authority

A Cape Breton palliative care doctor is giving up his medical licence next month because he says the way palliative care is provided in Richmond County is forcing more and more people to die in hospitals, rather than at home.

Dr. Bob Martel says palliative-care system forces Richmond County residents to seek care in ERs

Dr. Bob Martel says the Nova Scotia Health Authority does not provide a home-based palliative care program that is safe and supportive for patients and their families. (Submitted)

A Cape Breton palliative care doctor is giving up his medical licence next month because he says the way palliative care is provided in Richmond County is forcing more and more people to die in hospitals, rather than at home.

Dr. Bob Martel lives in West Arichat and has practised medicine for almost 35 years in Nova Scotia, the last four of which have been providing palliative care in Richmond County.

Martel, 67, said the way the system is structured by the Nova Scotia Health Authority, it forces people to visit emergency rooms rather than be seen by a doctor or nurse at home.

He said this is because the health authority's palliative care physician only visits patients in their homes in Richmond County every two weeks and home care nurses are only available weekdays between 9 a.m. and 4 p.m., and by appointment on weekends.

"If you're going to manage end of life, there's nothing predictable about end of life, so it's rather disingenuous for the health authority to say, 'Sure, we can provide nursing if you give us notice,'" said Martel.

He said that while people could also call paramedics or a registered nurse for help, they won't know about the patient's history, so they're limited in the support in they can provide.

Martel didn't receive any referrals

For the past four years, Martel has been on his own to find patients. He said that because he's not part of the Nova Scotia Health Authority's palliative care program.

As a result, any patient in Richmond County needing the services of a palliative care doctor is referred to the physician who visits the area every two weeks.

The Nova Scotia Health Authority says it's working to deliver better palliative-care service in Richmond County. (Getty images/Cultura RF)

Martel said a full-time physician is needed, along with a larger support team, because one doctor can't possibly meet the demand for services with bi-weekly visits.

Using his own practice as an example, Martel said that in a given day, he would usually only be able to see a maximum of three patients because he'd spend about one to two hours with each patient and their families, as well as the travel time that was needed to get from patient to patient in the county. According to Statistics Canada, the county is about 1,250 square kilometres in size.

Nova Scotia Health Authority response

In a statement, the health authority said it's working with local leaders in the Strait Richmond area to implement the provincial palliative care strategy, with the goal of delivering improved palliative care service.

Besides the physician visiting the area every two weeks, there is a full-time palliative care nurse co-ordinator and a second palliative care nurse consultant, said spokesperson Kristen Lipscombe.

"Our NSHA palliative care teams include dedicated physicians, nurse consultants and in some areas social workers," she said in a statement.

"They work in partnership with many other providers including continuing care, family physicians, nurse practitioners, EHS, home support agencies as well as our hospice societies to provide individualized palliative care in the patient's location of choice."

With files from CBC's Information Morning Cape Breton