Letter to VIHA by President James Schmidt:
As many of you who attended the recent public meeting with VIHA representatives will recall, a major problem we face is how to provide medical coverage until such time as we recruit a full-time physician. At that meeting VIHA proposed to put a full-time nurse practitioner on Galiano until a full-time doctor could be found. The “bad news” part of the story was that this would mean that we would no longer have locum physicians. Following the presentation of this proposal, there were a number of discussions, both within the board and with islanders more generally, about this plan. The board recognized that a strong advantage of this proposal was that it would provide regular and consistent care from a single provider over time at the clinic. However, after considerable discussion, the board decided to reject this proposal. The concerns leading to this decision are as follows:
(1) The nurse practitioner cannot provide many services that can be provided by a physician. At the meeting concern was voiced about this around such issues as prescribing narcotics. However, as time has gone on we have seen the same problem arise around other issues, including such things as getting medical certificates for insurance purposes, drivers license clearances etc. More and more islanders are having to make special trips for even minor issues such as these.
(2) Although there are of course far more nurse practitioners available than there are physicians, we nevertheless believe that it would take a significant time to recruit such a person, agree on a start date and get them “settled in” on Galiano, etc.; hence it would do little to meet our immediate care needs.
(3) Even after such a person is recruited, we are concerned that such a person would not be willing or able to work without medical support over an extended time frame. Although she has not, so far as I know, complained herself, we have received feedback from patients, etc. expressing concern about the hours Leanne Hale is having to put in and the volume of work that is falling on her shoulders. I know our administrative staff are very concerned about how much they have to ask her to assume. As an example, I received the following report on Friday: “(An island resident) had the first appointment of the day on Wednesday last, got there at five to nine and found Leanne already seeing another patient, and then in the early evening of the same day her son cut his leg and I guess they went down to the clinic and Leanne was still there catching up on paperwork..this was about seven…so she looked at the leg…and then the next day (the island resident) took her some flowers to thank her, and I gather in the course of conversation she learned that Leanne still had more paperwork and ended up staying over at Colette’s and working on that till late Thursday night, and then presumably caught the early ferry for another day of the same on Mayne.” It is simply not fair or reasonable to expect the NPs to work at this level over the long term. We have similar concerns about the demands on our on-call nurses. Our emergency on-call nurse last weekend, for example, had already seen six patients by noon on Saturday!
(4) Our greatest concern is that getting the NP would mean giving up our locums and hence losing the on-call coverage we have when locums are here. Nurse Practitioners are not allowed to do after-hours emergency coverage. Locums do provide such coverage during the weeknights when they are on-island. That coverage is by no means consistent but is still considerably better than having no coverage at all. As we have frequently pointed out to VIHA, lack of locum coverage means minor medical problems require excessive personal and financial costs when people who could be treated here by a physician are evacuated because there is no physician. This can be something as simple as a cut needing a stitch or two. Likewise, more serious medical problems run the risk of becoming much more critical when medical intervention is delayed.
Taken together, then, although this idea has some merit, it is the opinion of the board and those we have consulted that, at the end of the day, the problems with this plan, especially with respect to loss of much of the already-limited emergency coverage we have, outweigh its advantages.
The board is also continuing to push VIHA and the Ministry of Health to assure that adequate locum coverage is provided in the coming months. Two problems we are currently being dealt with. First, at the present time, the locum program requires a locum to be on-island for five days. We have had candidates who wanted to be on-island for only three or four days but they are not allowed to do this. While this is not ideal it is nevertheless better than having no locum at all and we are pushing the locum program to revise this policy. We are also seeking to have locums work on weekends so we have emergency coverage during that critical time. Second, the locum position on Galiano is often listed only a short time before it is needed. This means that a lot of potential candidates have already accepted positions in other places that were listed earlier. We are working on this as well in order to try to assure that candidates for the locum positions as sought as soon as possible.