Nova Scotia Health orders workplace assessment of cardiac surgery unit amid complaints

Dr. Mohammed Al-Mansob arrived in Halifax in 2018 for a two-year cardiac surgery fellowship with a sense of optimism. After years of working in Saudi Arabia while his family was based in Montreal, he wanted to be in Canada full time.

Al-Mansob, who is originally from Yemen and has permanent residency in Canada, hoped the fellowship in Halifax would lead to a permanent job.

Instead, he got what he describes in a written complaint as a "very painful experience with racism, discrimination, double standards, disrespect and division" from some doctors, trainees and staff connected to the cardiac surgery division of Nova Scotia Health and, in some cases, Dalhousie University's medical school.

Al-Mansob, 43, is one of three doctors with international training who talked to CBC about the problems they experienced during their time in Halifax, concerns that have contributed to the health authority recently launching an independent workplace assessment of the cardiac surgery division.

• Senior officials identify problems of racism in N.S. health-care system

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Over the course of multiple interviews via video chat, phone and email in the last two months, the doctors described getting fewer opportunities in the operating room than white colleagues, being held to different standards than white colleagues, facing accusations of bad behaviour without evidence, and a lack of action from leadership to address their complaints. CBC reviewed the complaints, which went to some of the most senior medical officials in the province.

"I end up [saying], 'Mohammed, just finish your training and get out of here as soon as possible," Al-Mansob said in a phone interview from Toronto, where he has been a cardiac surgery fellow with the University of Toronto since 2020 at Toronto General Hospital and now Sunnybrook Health Sciences Centre.

Dr. Mohamed Othman also arrived in Halifax thinking it could lead to permanent work.

In 2021, Othman moved his family from Toronto, where he completed fellowships at Toronto General and Sunnybrook over four years. Previously, he had trained and worked for years in universities and hospitals in his native Egypt and Saudi Arabia. If he did a one-year fellowship in Halifax and if things went well, he was told, there could be work.

But Othman, 49, said the workplace he found at the Halifax Infirmary upon arrival was so toxic, "It was like a circus."

"Everyone was complaining against each other," he said, describing the cardiac surgery division as fractured between a group of surgeons looking to promote diversity and a group more interested in Canadian born, Canadian-educated doctors who look like they do.

"[The public] should know that there is — I'm sorry — some racist people in that department," Othman, who has Canadian citizenship, said during several video interviews from Egypt where he works as a heart surgeon and professor at Benha University.

"They are abusing the overseas or internationally graduated medical doctors by giving them hard times."

Othman said he had to fight against a sentiment among some doctors that, as someone with international training, he was there to provide service to the unit rather than spend time in the operating room.

Nova Scotia Health interim CEO Karen Oldfield said during an interview that she is aware of these complaints and first started hearing concerns about the cardiac surgery division in February. After gathering information, Oldfield said she decided to order the external assessment.

'There is no place for racism'

There have been at least three previous reviews of the division since 2010. The health authority would not provide CBC with those reviews. CBC has requested them through the access to information process. Oldfield, who was appointed interim CEO last September, said she couldn't speak for what work happened before she arrived.

"What I can tell you is that, you know, there is no place for racism, intimidation, harassment [or] bullying at Nova Scotia Health. I don't condone it and we as an organization do not condone that."

The assessment is being led by Dr. Jack Kitts, past president and CEO of The Ottawa Hospital, and Joy Noonan, a lawyer whose practice is focused on mediation, arbitration, workplace assessments and conflict coaching.

In an internal memo sent to members of the division, obtained by CBC, chief of surgery Dr. Gail Darling notes "[t]here continues to be ongoing concerns identified both with respect to interpersonal conflict and to the overall organization and staffing of the division and the Heart Health Program."

A health authority spokesperson said that in the last five years, there have been 10 respectful workplace complaints filed. Of those, six were determined to be unsubstantiated and four were found to have breached the policy. The spokesperson said those cases were addressed "in accordance with best practices."

Oldfield said she expects the assessment to be complete by the fall and said appropriate action would be taken based on any recommendations.

The latest assessment comes as the College of Physicians and Surgeons of Nova Scotia recently accepted an external review that found a lack of understanding and action to address anti-Black racism.

Even before that review was released, college registrar Dr. Gus Grant, who requested the work, said racism exists within the regulatory body and the field of medicine.

Allegations by Al-Mansob, Othman and another doctor who talked with CBC, are supported by several other people connected to the medical school and health authority. CBC is not identifying these people because they are concerned about professional retaliation for speaking publicly.

'This is modern colonialism'

One source said racism is insidious within the cardiac surgery division and there is a mentality among some doctors and staff that "we should be teaching our own." That attitude is perpetuated by examples some supervising doctors set for their white trainees, they said.

"The way that the residents see how the surgeons are treating everyone, they are learning this and they're also picking up on this and say, 'Oh, this is permissible, they're not getting in trouble. They can treat people like shit. I can act like this, too, toward visa trainees."

Another source said Canadian-born and educated trainees are more likely to get quality time in the operating room, while their counterparts from other countries are often left to observe or run the ICU and manage patients on the floor. That means they have fewer opportunities to practise their surgical skills, said the source.

"This is modern colonialism," they said.

The sources confirmed to CBC that senior officials within the cardiac surgery division and Dalhousie's medical school are aware of the problems, that the issues have been raised multiple times by multiple people and yet they persist.

Othman and Al-Mansob were considered hospital-based fellows and, as such, were paid for their work. Othman was paid $65,000 for his year working in Halifax, while Al-Mansob was paid $60,000 per year during his two-year fellowship.

Dalhousie University, meanwhile, brings in fellows and residents through visa training agreements with Saudi Arabia, Kuwait, Oman, the UAE and Qatar. The sponsoring country or health-care institution pays the university $100,000 a year for people from those countries to do residencies or fellowships and must sign a contract saying they'll support the trainee with a return-of-service contract.

In 2019, Dr. Ahmed Al Lawati was a visa trainee headed to Halifax from Oman to do a cardiac surgery residency at Dalhousie following a successful application and short-term trial.

Like Al-Mansob and Othman, Al Lawati says he experienced discrimination while in Halifax. He said he felt unsupported in trying to address the problem with officials at the medical school.

Now 30, Al Lawati said he soon realized the great pressure he was under to perform after arriving at Dalhousie as a representative funded by his country.

'These are smart people'

Looking back, however, Al Lawati said it was more than just being pushed by instructors and doctors charged with helping him become a heart surgeon.

"At the beginning, it was a lot of passive-aggressiveness and a lot of microaggressions," he said.

"These are smart people. They would never abuse you in front of other people."

During several video interviews from Oman, Al Lawati said that early in his training, his seriousness was questioned because when he would leave the hospital to attend afternoon lectures back on Dalhousie's campus as part of his program, he didn't inform people that he would not be returning to the hospital. It was an expectation Al Lawati didn't see placed on other residents who were simply following their program outline.

He found some staff standoffish and difficult to interact with, despite needing to deal with them on a near daily basis to secure evaluations as part of his program. At one point, he said, he was told his communication problems were because he was "from far away" and that he should do several years of medical school in Canada so he could learn like a Canadian.

"I cried. It was the only thing I could do," said Al Lawati.

'I have to leave this place'

Eventually, the feeling of being unsupported, along with the death of his brother, pushed Al Lawati into a downward psychological spiral. He documented what he was going through, took time off, but when he returned, he said the work environment in the cardiac surgery division continued to cause him anxiety and it affected his performance.

Al Lawati was placed on an informal type of academic probation and later a formal version. Reviews related to that time, which he shared with CBC, are harshly critical of his performance and paint a picture of someone with little chance of succeeding. Some people evaluating him were the same people he was having problems with, said Al Lawati.

The harder he worked, the more it seemed like he was falling short, said Al Lawati. He was given indications there was no way he'd be able to salvage his time at Dal, regardless of how he performed.

"That's when I was like, 'OK, that's it. I have to leave this place.' "

Midway through his second year at Dal, Al Lawati started looking for alternative options in Canada where he could continue training in what he hoped would be a more supportive environment.

Al Lawati applied to and was accepted in the vascular surgery residency program at McMaster University in Hamilton last August. But he could not accept that offer because officials in Oman have so far denied his request to transfer his program funding. They told him he would not be considered for any other training opportunities abroad until he pays $200,000 to cover his time at Dalhousie.

"To the people from my country, for them they just couldn't believe that I was leaving my training because people were racist against me at Dalhousie," he said.

Complaints determined to have no evidence

Al Lawati said officials in his country believe he ended his training at Dal for no reason. He cannot afford to pay the money his government spent on his training and an appeal he filed was recently denied.

"I don't have that kind of money. I've never had that kind of money, either."

Although he brought his concerns to his program director during his time at Dal, in September Al Lawati filed formal complaints with the school's postgraduate medical education office in the hopes that validation of his concerns would convince his government to fund him to go to McMaster.

Three months later, however, he received an email from the assistant dean of resident affairs saying the matters were investigated and it was determined there was no evidence of harassment or racism.

"I know this must be extremely disappointing for you and will have implications for your career," Dr. Carolyn Thompson writes in the email to Al Lawati, which he provided to CBC.

"Unfortunately I do not have access to the report so I cannot provide more details other than to say that the investigation was thorough and multiple interviews were conducted before the findings were released."

'Discrimination in any form is unacceptable"

Officials with Dalhousie University's medical school declined to be interviewed for this story.

In an emailed statement, a spokesperson said the medical school "takes all incidents of learner mistreatment very seriously."

"Discrimination, in any form, is unacceptable behaviour that is subject to a wide range of disciplinary measures," said Jason Bremner. "While we can't comment on specific allegations, we are committed to providing our trainees with a learning environment that is free of harassment and mistreatment."

Bremner said students and trainees at the medical school have a variety of ways to report incidents. If a complaint is received, the school "strives for diverse representation on the investigative panel to ensure an accurate and culturally competent investigation is conducted."

Bremner said the medical school tracks the number of complaints it receives, but said the number for the last five years is fewer than 10 and, thus, too small to publicly report.

Despite the differences in where they are from and where they trained before arriving in Halifax, Al Lawati, Al-Mansob and Othman describe similar experiences with the health authority and at Dal.

'Systematic racism'

All three say they felt targeted by allegations from colleagues, allegations that were not substantiated or fully shared with them.

"In my view, it is a systematic racism, discrimination against outside people, mainly the Middle East people," said Al-Mansob.

In each case, the three doctors say they were provided no concrete details about the allegations levied against them and, when the matters were concluded, received no explanation about the findings.

Division officials told Al Lawati a woman complained he was harassing her. He was never provided further information. He said he was told during a disciplinary meeting that just because he comes from "a different background where they treat women badly" does not mean he can behave that way at Dalhousie.

Al-Mansob said he was regularly told people filed complaints about him and was placed on probation at one point, yet he was never provided any documentation or evidence of the complaints despite repeated requests. Those complaints temporarily meant he was not allowed to cover the ICU, a decision eventually overturned upon further review.

"Nobody will tell you what you did or what you should have to do to make them happy," he said. "You just hear that someone filed a complaint against you."

Othman, meanwhile, said complaints against him increased as he raised concerns about the workplace environment. He was sent home from work for approximately six weeks at one point while a complaint against him was investigated.

He was provided no details of the allegations until engaging a lawyer. Eventually he received a letter from Nova Scotia Health saying a formal complaint of harassment was determined not to meet the required standard to warrant a formal investigation, as was the case with other allegations raised during that process.

"Every time I asked, 'What did I do,' they said, 'It's confidential,' " said Othman.

"Can you imagine sending a surgeon home … without telling him why?"

Even after his return to work, Othman said some doctors treated him as if he was guilty.

"This was very traumatizing to me," he said.

"I never believed this could happen in Canada. Never."

Al Lawati, Al-Mansob and Othman each filed complaints about people they worked with, including some supervising doctors, hospital staff and other trainees.

Doctors detail complaints

Most notably, all three filed complaints against cardiac surgeon Dr. Roger Baskett for the way he treated them and his general behaviour within the department.

"I had two years of painful experiences," said Al-Mansob, pausing to collect himself.

In a complaint he shared with his fellowship director and the division head at the time, Al-Mansob writes that Baskett made him feel discriminated against and humiliated, often treating him in a rude and dismissive way when he tried to discuss cases and patients.

"Again when I just started I thought it were the culture and the system differences and it is a matter of time to overcome it and break the ice," Al-Mansob writes in the complaint, which he shared with CBC.

"Unfortunately, such treatment is becoming more and more frequent and aggressive…."

Othman said Baskett criticized him for being left-handed and would not speak to him directly when the two were on call together, choosing instead to tell a nurse to tell him what he wanted.

"When you look at him, he never talk to you or mention your name," said Othman.

"He used the word, 'him.' "

Othman said he raised these issues when he was interviewed as part of a division review last summer and brought them to the attention of supervisors.

Al Lawati also said Baskett ignored him in the operating room and would brush him off when Al Lawati would try to discuss cases or attempt to speak to Baskett while passing in the hallway.

"I would try to greet him, but he never answered back and acts as if I do not exist at all," Al Lawati writes in the complaint he submitted to Dal's postgraduate medical education office.

In that same complaint, Al Lawati alleges Baskett created a hostile work environment.

"I am bewildered that such treatment and behaviour is overlooked and allowed in the division."

All three men said their concerns about Baskett did not seem to be taken seriously. Most shocking to Othman was that Baskett was put in charge of the cardiac surgery fellows during Othman's year in Halifax.

Al Lawati also filed a complaint against Dr. Christine Herman, saying she repeatedly referred to him as Mohammed and regularly asked if he was from Saudi Arabia, despite the two working together for months. He also alleged she neglected him as a learner and was often late in filing paperwork vital to his evaluations.

Complaints dismissed following investigations

Baskett and Herman declined interview requests through their lawyer.

In a statement on their behalf, Michelle Awad said her clients are familiar with the allegations made against them.

"Some time ago, it was suggested that each of our clients … behaved inappropriately. They both denied all wrongdoing at the time and their positions have not changed.

"After full reviews and investigations of the allegations through the internal processes noted, which included interviews with our clients, the review of contemporaneous documentation, and interviews with the complainants, all complaints were dismissed. That was the end of the matter."

Awad writes that Baskett and Herman have been members of the cardiac surgery division "for many years and have not seen any evidence of racism, harassment or discimination at any time."

Information shared with CBC shows Othman and Al-Mansob pressed repeatedly for updates on their concerns and appealed to senior leaders within the cardiac surgery division and at Dalhousie for help.

Depressed, humiliated and discouraged

Al-Mansob's complaints also included people openly questioning his competency. His frustration is palpable in a document titled "My burnout story in the division of [cardiovascular] surgery," which he sent to his fellowship director and shared with others. In it, Al-Mansob outlines a series of false accusations he said were made about his standard of care and the way he was treated by some staff.

"I have worked in many different systems, starting from China, Saudi Arabia and ending here in Canada. I have never been as depressed, humiliated and discouraged as what have happened to me in this place."

While some people told him privately they were sorry for what he was experiencing and that they were trying to help him, Al-Mansob said nothing formal ever came from those efforts.

Othman and Al-Mansob also said they felt their performance was assessed differently than white colleagues. Othman presented reviews to CBC that show widely differing opinions on his work and abilities. He noted that the people he worked with most often were not asked for their opinions.

Both said some supervisors criticized them for non-life threatening difficulties encountered while caring for a patient. Yet white colleagues were treated with kid gloves when far more severe problems transpired.

"They do catastrophes. And when I say catastrophes, I mean catastrophes," said Othman.

"And [their supervisors] said, 'OK, yeah, don't worry. This is part of the game. You are here to learn and don't worry about that.'"

'I am lucky that I came to Toronto'

Despite calling for the workplace assessment, Nova Scotia Health's Oldfield said the public should not be concerned about patient safety or the delivery of care within the cardiac surgery unit.

"From all of the information I have in front of me, absolutely not," she said, adding that the unit consists of "highly qualified surgeons."

Back home in Oman, Al Lawati continues to try to find a way to deal with his debt to the government so he can consider other learning opportunities abroad. He's training at Oman's national heart centre, which he said is a more supportive and inclusive environment than the one he left behind in Nova Scotia.

"People respect you, regardless of where you're from or what you do or what you believe in."

Othman had to hire a lawyer before officials with the cardiac surgery division would provide him with the proper certificate stating that he completed his fellowship. He sent a detailed email outlining his concerns about the division to Oldfield. Oldfield told CBC she received the email and it was clear real concerns were being expressed.

"You don't just dash off that email."

A lawyer from the health authority responded to Othman, saying NSH takes allegations of harassment and unprofessional behaviour seriously and takes steps to address them. Although it does not address his concerns about the workplace, the lawyer's letter does refer to Othman having been placed on administrative leave.

As for Al-Mansob, he said he was thrilled at the prospect of training and working in Canada when he arrived in Halifax back in 2018, but that quickly faded. It's only since he moved to Toronto in 2020 that his positive feelings about this country returned.

"I am very lucky that I came to Toronto to live there. If I were to leave Canada from Halifax, I think that was to be a very miserable experience regarding my impression of Canada."