St. John's doctor resigns from Eastern Health, says he didn't have resources to do job

A medical specialist says he's resigning from Eastern Health because he can't get the support and space he needs to practise.

Dr. Andrew O'Keefe is an allergist and clinical immunologist who has been working part time for the health authority since 2014 while maintaining his own community clinic. But he says he can't do it anymore.

"I resigned from Eastern Health because I no longer had the resources to meet my patients' needs," O'Keefe said.

O'Keefe said he has access to clinic space at the Janeway children's hospital to see pediatric patients but other things he needs to work, like administrative support, have diminished. 

"Those bits and pieces of access that we had to the hospital became less and less and it became more and more challenging to provide appropriate patient care."

O'Keefe also said he was not able to secure dedicated space at the Health Sciences Centre to see adult patients and work to his full scope of practice as an allergist and immunologist.

"That became a real issue because some of the procedures that we do, like any medical specialty, again need to be done in the hospital for safety reasons," said O'Keefe.

"Someone could have an allergic reaction, an anaphylactic reaction, and it's just safer to do it in the hospital where there's more support if someone gets very sick."

O'Keefe also said to do certain hospital procedures he'd need access to nursing staff, pharmacists to mix drugs, the emergency department as a backup and administration.

Resignation letter 

O'Keefe said he and a colleague proposed to set up an allergy and clinical immunology division at the Health Sciences Centre, such as exists in other provinces, but their requests were never granted.

O'Keefe treats and manages patients with allergies to food and medication, as well as conditions like asthma, eczema and people with primary immunodeficiency. Before he set up his practice in the province, he says, there was no other board-certified allergist in the province who had completed two years of training in allergy and clinical immunology. 

"I know the care that people need and I have the skill set to be able to provide it, but whenever I've tried throughout the last eight years to advocate for my patients to be able to access that care, I met with barriers," O'Keefe said.

O'Keefe said he sent a resignation letter to Eastern Health on Aug. 18 but will continue to see patients there until mid-January. 

"I find myself no longer willing to participate in the morally injurious process whereby Eastern Health prevents me from providing the care required by patients in N.L." reads O'Keefe's resignation letter to Eastern Health.

In his letter, O'Keefe calls the situation a "systems failure" that "does not espouse the values that Eastern Health promotes as their own: accountability, caring, collaboration, excellence and respect."

"It's difficult to listen to the kind of corporate talk about accountability, caring, equity, things like that, and then to be treated this way. It feels a bit like gaslighting," he said.

He said he began to feel downtrodden after years of unsuccessfully trying to establish an allergy and immunology division at the hospital.

O'Keefe said some work he intended to do at the hospital would result in cost savings.

He said between 10 per cent of admitted patients believe they have an allergy to the antibiotic penicillin. O'Keefe says allergists can do testing to check if people do indeed have the allergy. 

"Probably 95 per cent of people who think they're allergic to penicillin are not," he said, adding that if they find someone can take the drug, rather than an alternative, it could save the health-care system $3,000 or more per person.

O'Keefe's resignation comes as the province's health-care system grapples with a shortage of doctors, leading to the closure of some rural emergency rooms this summer, and with some prospective recruits criticizing the physician recruitment efforts. 

"The more we lose health-care providers from the system, the worse it's going to be all over," he said.

"So we can't just always be in crisis mode, responding to crisis after crisis. We need to look at some preventative care for our system," said O'Keefe.

In a statement, Eastern Health says it can't comment on the status of an employee or doctor. 

"Eastern Health values its relationship with all of the health-care professionals who provide services to patients within our region," reads the statement. 

The health authority says it works with doctors to allocate finite clinic space and other resources as "equitably as possible."

Like Eastern Health, the provincial Health Department also said in an emailed statement that it can't speak to employment-related matters. 

But they say they've recently consulted with the Newfoundland and Labrador Medical Association and are making changes to the province's health insurance plan — known as MCP, or medical care plan — to approve some low-risk testing to private doctor's offices when the testing is completed by certified allergists and immunologists. 

"Work is currently underway to introduce fee code changes to appropriately compensate clinical allergists/immunologists performing this work in their private offices," read the statement.

O'Keefe says that change would allow him to do most drug allergy testing in his office and outside the hospital, but he said he applied to have the fee code changed in October 2019.

He said it could take years before the fee code changes are finally approved.

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