N.S. ophthalmologist says health officials won't give him suitable replacement for retiring colleague

A busy ophthalmologist in Nova Scotia says he's reached an impasse with the health authority over surgical safety, and as it stands, he'll have to drastically reduce the number of surgeries he does every year.

Dr. Robert Scott treats thousands of failing eyes every year and he says health officials won't give him a suitable replacement for a retiring colleague at Soldiers Memorial Hospital in Middleton.

“Dr. (David) MacKinnon has provided conscious sedation and support for the patients for 25 years," Scott told CTV News at his clinic in New Minas Wednesday. "He's now retiring, and we're unable to convince (NS) Health at this point to provide a suitable replacement for him."

Scott says the retiring GP and Family Physician has provided on-site support and emergency aid during eye surgeries, and he's not comfortable working without another doctor in the building.

"Their offer for us as the surgeons and the nurses to basically 'go it alone' in the hospital is just not acceptable or safe."

But the health authority begs to differ.

"The physician has performed cataract surgeries using a method called ‘conscious sedation,’ which allows patients to stay awake during a procedure without discomfort and without the stronger side effects and risks of general anesthesia," Dr. Cheryl Pugh, NS Health's Western Zone medical executive director, told CTV News in an emailed statement.

"Soldiers Memorial Hospital is the only remaining site in the province that provides intravenous ‘conscious sedation’ for the majority of their cataract surgeries.

"Cataract surgery has evolved considerably over the years and most surgeries are now provided through much-less invasive oral sedation," the statement said.

"A review of literature and evidence throughout North America shows just 10-20 per cent of cases require the more invasive ‘conscious sedation’ method of cataract surgery.

"There is no plan to continue this practice at Soldiers Memorial," said Pugh.

"While the large majority of patients do not require this type of care, those who require additional anesthesia services will be provided that support.

"We are working with physicians at Soldiers Memorial to align services there with how cataract surgeries are performed at every other facility in the province. It is our plan for the hospital to proceed with this unified approach in the coming months."

Scott says the comparison is unfair.

"Certainly does if you're in a larger hospital with Anesthesiologists and other physicians around the corner. We don't have that, and many times we're the only staff in the hospital, the Emergency is not always open, and it's unreasonable to do those comparisons."

He says it's also unreasonable - and somewhat dangerous - to remove that vital second professional in the OR.

"I have to concentrate of what I'm doing, providing the best eye care possible," said Dr. Scott.

"If I'm trying to listen to monitors that are beeping, going off, it's going to distract me, and at some point I'll have to make a decision to save the eye or save the patient," he said.

"It's inevitable."

Scott seems to have plenty of support from patients, who credit him with helping to save their vision.

Eighty-three-year-old June Corkum had a cataract removed Tuesday, and said the results were miraculous.

"I can read things now that - even since yesterday - that I couldn't read before," she said.

Bradlow Smith says Scott spotted and treated undiagnosed glaucoma in his eyes.

"He lasered me. He needled me. He did my cataracts. So, I mean, without somebody like that around, what are you going to do?" said Smith.

Scott says he's submitted a number of proposal to the health authority, but they've all been rejected, so he's already scaling back on booking future surgeries because of the uncertainty.

"As of Dr. Mackinnon's retirement in a few weeks, we've not been able to book surgeries into January, even though we have patients waiting, because we don't know the situation at Soldiers," he said.

The health authority insists there will be backlog.

"This family physician’s retirement should not affect future cataract patient care in the region and there will be no reduction in cataract surgery volume because of this retirement," said the statement from Dr. Pugh.

Current wait times for cataract surgery in Nova Scotia range from 52 days in Cape Breton to 264 days on the South Shore.

Scott says future surgeries in Middleton are up in the air.

"Very much so. We deal with a wide range of surgeries, unlike ambulatory surgical centres, we deal with complicated cases, we deal with patients with advance medical disease, and we want to continue providing the same level of care and the same competency of surgery going forward that we've done for 25 years," he said.

"There's 80,000 people in this area that we provide service to, and if this surgery stops, they're all going to be impacted directly or indirectly going forward," he said.

“Everybody gets cataracts eventually. This is a problem that's going to go into the future."

For more Nova Scotia news visit our dedicated provincial page.