$4 million in arrears claimed
Doctors Nova Scotia (DNS) filed notices with the Nova Scotia courts that it intends to proceed with three lawsuits against the government for breach of its rights to represent physicians and breach of the "master agreement" between DNS and the government. DNS alleges that the government is arrears for more than $4 million owed to the organization for payment of health and other benefit programs.
At an impasse
In a news release, the association, which represents 2400 physicians in Nova Scotia, says it has been working to resolve these issues for 12 months and that all doctors in the province could be impacted if the contract issues are not addressed. “We’re at an impasse on two contract issues and despite having worked over the past year to find solutions, we’re now at the stage when we require a third party to resolve them,” said Dr. André Bernard, Doctors Nova Scotia’s Board Chair. “The association’s Board of Directors, which is made up of 21 physicians from across the province, agreed that all possible avenues have been exhausted and, therefore, legal resolution is necessary.”
In a hastily called news conference Wednesday, Health and Wellness minister Randy Delorey disputed some of the assertions made by DNS in their notices about the impending lawsuits. Delorey said that the dispute is not with the doctors, but with "an organization." Nancy MacCready-Williams, CEO of Doctors Nova Scotia says that, becuase they are the negotiating agent fr the master agreement, a dispute with them IS a dispute with physicians.
Under dispute are the government’s use of unapproved contracts for Alternative Payment Plan (APP) physicians and monies owed to Doctors Nova Scotia for the physicians’ health and dental plan and other benefits.
“Ultimately, we believe this government is in breach of contract with physicians,” said Dr. Bernard.
In June 2016, after protracted negotiations costing more than a combined $700,000 in lawyers fees, agreement was reached and physicians ratified both the Master Agreement contract and the Clinical/Academic Funding Plan (C/AFP) contract. The Master Agreement contract serves as the basis for APP contracts.
Unnecessary risk
In the past 12 months, says DNS, government has unilaterally deviated from the previously negotiated APP contract templates. In some cases, government has removed important clauses, including references to the Master Agreement. In other cases, government has asked physicians to sign just a “deliverables” document, with no accompanying contract. These changes, says DNS, create uncertainty and could put physicians at unnecessary risk of losing protections negotiated through the Master Agreement.
DNS asserts that the government is $4 million in arrears for payments due for physicians’ health and other benefits as agreed to in the Master Agreement contract. These funds are used to support the physicians’ health and dental plan, parental leave and professional support program.
Depletion of contingency fund
“Without these payments from the government, Doctors Nova Scotia has had to deplete the contingency fund that enables us to maintain these important health programs for doctors,” said MacCready-Williams, at a news conference in Halifax. “We find ourselves in this situation because the government has taken exception to the association legally retaining a contingency fund for the benefits programs we administer under our contracts with government.”
Hardball
A physician familiar with the protracted negotiations and the issues behind them told SCT Wednesday that he interprets the government forcing DNS to deplete the contingency fund as a form of "hardball" politics. "It looks to me," he said, "that the government may be trying to squeeze DNS out of existence."
The government refusing to honour the master agreement, says DNS, could make it difficult in the future to attract and retain physicians, resulting in a further erosion of medical care in the province. In a recent DNS report based on consultation with physicians, the doctors identified threats to the medical system, including; fragility of the physician workforce, loss of professional autonomy and satisfaction, erosion of comprehensive family medicine, unsustainability of rural specialty services and lost opportunities to leverage technology.
One of the primary issues in the dispute is the creation by DNS of a contingency fund to "ensure that physicians’ benefits are protected from changes in the political and health-care environments." They describe the fund as part of what they describe as good governance and a prudent fiscal management strategy. Minister Delorey says that the fund is comprised of a surplus resulting from previous "overestimation of benefit costs".
No overpayments
When asked about the "overestimation" issue, MacReady-Williams said via email, "The contingency was built up over years. There were no overpayments by government. Government made only the payments required to be made by contract. Those payments were for benefits AND for other recruitment and retention initiatives (at DNS' discretion). DNS' Board, exercising good fiscal management, has built up a contingency to protect physician's interests."
“Ultimately, we are working to protect the rights of physicians so that they can focus on what they do best: delivering the best possible care to the people of Nova Scotia,” said MacCready-Williams. “By resolving these issues, we will help make the environment more welcoming, an important step in resolving the province’s current physician recruitment and retention shortages.”
Doctors Nova Scotia says it aims to resolve the contract issues in order to clear the air with the provincial government. Then, all parties will be able to move on to solve some of the health-care system’s more significant challenges, as outlined in Doctors Nova Scotia’s recent report “Healing Nova Scotia: Recommendations for a Thriving Physician Workforce.”
Contract spat a distraction
“These contract issues are a distraction from the real work we all need to do to strengthen Nova Scotia’s health-care system,” said Dr. Bernard. “Putting these issues in the hands of the courts allow us to focus on what’s really important: our patients.”
