Doctors Nova Scotia is accusing the province of throwing uncertainty into an already fragile health care system by breaking its contract with physicians.
The association that represents all of the province’s doctors says it plans to take the government to court for two breaches of the master agreement signed last year.
It is suing the province for $4.6 million in unpaid bills for health benefits and for the use of what it considers “unsanctioned” contracts.
Doctors Nova Scotia filed the notices of intended action on Tuesday morning — starting the clock on a two-month waiting period before formal court action can start.
“We’re at an all time high level of fragility,” said board chair Dr. Andre Bernard.
Bernard said the disputes are adding to the “uncertainty” in the health care system and lowering trust with government.
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The court case is the latest in a string of cases against the government including the Nova Scotia Teachers Union charter challenge to its legislated contract, the NSGEU’s charter challenge to wage legislation and the federation of labour’s intervention in a reference question on the same wage legislation.
In a briefing with journalists, Doctors Nova Scotia CEO Nancy MacCready-Williams said the association is at a “fundamental impasse” with government after trying to resolve the issues for several months.
She said the organization is at a “loss” to understand the government’s actions.
“We were one of few organizations who actually ratified a contract with this government,” MacCready-Williams said. “And so just honour the contract.”
Bernard said the issues put the trust between government and physicians at “risk.”
“What we need is an atmosphere of trust that allows doctors to say, ‘You know what, Nova Scotia is a place where I can go and I’ll be respected,” he said.
At a Tuesday news conference Health Minister Randy Delorey disputed the group’s claims.
“I don’t see this as picking a fight with anybody,” he said. “I’ve been nothing but available and open with the president and the staff with Doctors Nova Scotia.”
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Doctors asked to sign ‘unsanctioned contracts’: Doctors Nova Scotia
The first breach of contract according to Doctors Nova Scotia, is the government’s use of “unsanctioned contracts” for physicians who are using the government’s preferred payment model.
Called an alternate payment plan, it gives doctors a set salary rather than billing on a per service basis.
Doctors Nova Scotia says since January, it has been made aware of 23 doctors being asked to sign contracts for alternative payment plans that are different from the template agreed to by Doctors Nova Scotia and the government.
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Notably, the association says the changed contracts remove references to the master agreement and also some references to Doctors Nova Scotia. MacCready-Williams said that means it is not clear whether these doctors have the same entitlement to benefits and protections in the master agreement.
“We’re really at a loss in terms of why government is taking the steps that they’re taking,” she said.
The association says doctors who were asked to sign the new contracts also weren’t told that they were out of step with Doctors Nova Scotia.
“There’s a question whether physicians can rely on the contracts they sign,” MacCready-Williams said.
Delorey said that he had met with the doctors’ group in August and “my takeaway from that meeting is both sides agreed to sit down and move forward … and I believe those concerns can be worked out.”
Government left benefits unpaid for one year: Doctors Nova Scotia
The second alleged breach of contract dates back to negotiations between the government and Doctors Nova Scotia for a new contract signed last year, according to MacCready-Williams.
The association says the Liberal government “unilaterally” decided to stop paying its share of physician benefits — leaving Doctors Nova Scotia holding the bag for more than $5 million in claims between November 2015 and September 2016. MacCready-Williams said a $4 million contingency fund was depleted and the association had to take out a line of credit to ensure doctors still had their health benefits covered while talks continued and the contract was brought into force.
The government paid Doctors Nova Scotia for outstanding costs from November to September in December 2016. Until Monday, it had again stopped paying for the health benefits and the contingency fund was again depleted, according to MacCready-Williams.
On Monday, she said a payment of more than $200,000 was made by the government as part of its monthly payment requirements, and not to replenish the reserve fund.
She said the contingency fund was built up over decades to allow for a buffer if the benefits were ever cut out of a new contract and doctors had to find alternate health plans. And she said the money is from obligations under previous master agreements for both doctors and the government.
“It’s physicians dollars that they have decided to put into a reserve,” she said.
Delorey said that the government viewed the money in the contingency fund as “taxpayers’ money” that built up due to an earlier deal with doctors.
The arrangement provided Doctors Nova Scotia with set payments which proved to be higher than the actual costs of the benefits plan, he said.
“I believe this is a dispute with the organization, but not directly with the province’s physicians,” he said. “This is a dispute around a surplus fund of taxpayer dollars being held by a third party organization.”
During contract negotiations, MacCready-Williams said the government made it clear it didn’t think the fund was needed. But MacCready-Williams said under the contract, they agreed to keep the contingency fund while auditors assessed its need.
She said the contingency fund was created years ago on the advice of external auditors.
Doctors Nova Scotia says this is the first time since the 1990s that it is taking court action against the government.
-With files from The Canadian Press.
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