MAHC CEO Natalie Bubela responds to comments on hospital planning from retired nurse, Jean Bagshaw


On February 28, 2018, Doppler posted a letter to Muskoka Algonquin Healthcare (MAHC)’s Capital Plan Development Task Force from Jean Bagshaw, a retired registered nurse. In that letter (which you can read here), Bagshaw raised 13 points that she felt would allow the task force and MAHC’s board and administration to “have a productive relationship with the public.” We received the below reply from MAHC CEO Natalie Bubela today, March 21, 2018 — her answers are in bold text.

Dear Jean and readers,

Thank you for your insightful letter about the work to plan the best option for future acute care services in the region. The questions you raised and your suggestions have not been taken lightly. We appreciate the need for the public to have answers to the questions you raised.

1. Be perfectly honest with us and tell us the hard facts with as little health jargon as possible; this means explaining that there has not been sufficient funding to meet operating costs for many years, that small to medium-sized hospitals province-wide have been pleading their case to the Ministry of Health for years to no avail, that if the ministry was interested in adequately funding us, they would have changed the funding formula and they would have increased base funding, neither of which they have done, instead giving only one-time bailouts which do not meet our needs and have to be repeated every year.

There has not been sufficient provincial funding to cover the cost of MAHC’s operations and we expect this to continue into the foreseeable future. While the Ministry of Health and Long-Term Care has provided both recurring and one-time funding to MAHC over the years, MAHC is continually operating from a deficit position. MAHC is part of a group of hospitals advocating for changes to the provincial funding formula, but even with changes to the funding formula MAHC expects ongoing operating challenges that are compounded by duplicating services at two sites.

2. Explain that over the years many patient care beds were closed to try and meet budgetary constraints and live within the financial parameters set by the government, so it is not so much a question of space and rooms, as it is the wherewithal to operate them.

There is information on the MAHC website about funding reform and each budget year since 2013. Due to budget challenges, over the past five years MAHC has had to:

  • Single sited chemotherapy, ophthalmology and bone densitometry;
  • Introduced gynecological surgery as a new service and revenue opportunity;
  • Closed 10 acute care beds, then added 5 beds;
  • Removed eight Complex Continuing Care beds from the regional CCC program;
  • Moved 12 interim long-term care beds to the community as they do not belong in a hospital;
  • Reduced 37.3 full-time equivalent positions. Through the labour management process, there were No involuntary exits from MAHC;
  • Laid off seven PSWs. All seven were recalled into other positions at MAHC as work became available following their layoff. Not all chose to return.

3. Whenever a speaker or a writer adds an “s” to the word “hospital” and talks about keeping their town’s hospital, clarify that we have ONE hospital organization called Muskoka Algonquin Healthcare (MAHC), with two buildings; this happened several years ago when the two hospitals amalgamated; this is not just semantics as it makes a tremendous difference in how a person perceives the issue; to let people continue to believe that they still have their “own” hospital is to encourage them to live a fantasy that does not exist.

In 2005, the Board of Directors for both Algonquin Health Services and South Muskoka Memorial Hospital voluntarily initiated an amalgamation of the hospitals in Huntsville and Bracebridge, creating Muskoka Algonquin Healthcare. For nearly 13 years MAHC has operated as one hospital organization with two sites.

4. Do not be afraid to make it clear that no matter which option we pursue, we will end up with acute care services in one location; if we divide services between two sites, the site that has surgical services will be the acute care site; if we have one in-patient site and one outpatient site, the in-patient site will have acute care services; if we have one new build on a new site, it will be the acute care site.

There are three models being explored. Only one of the models proposes to locate all the inpatient (acute) services at one site and all outpatient (ambulatory) services at the other site. This model also includes emergency services at each site. The “Two Sites – Not Status Quo” model provides acute care services and emergency services in both sites’ space, although the specifics of what is contained at each site is still being finalized. The task force continues to refine the models based on feedback from stakeholders, including the public.  The “One Hospital” model proposes to combine all of the programs and services into a single location.

5. When people express the belief that a new build will be far more expensive than refurbishing two old buildings, answer that statement immediately with facts as you know them to date.

The 2015 costing of building the models as presented to the Ministry in the Pre-Capital Submission demonstrates:

  • Two Acute Care Sites would cost $475,479,414 through a combination of new build and renovation
  • Centres of Focus would cost $373,301,295 through a combination of new build and renovation
  • One Hospital would cost $348,985,661 as a complete new build

The base costs for renovations are less than new construction (in simple terms, you don’t have to build new walls or a roof), but the more complicated the project, the less this is true and costs of renovations quickly start to approach those of the new construction, and can sometimes be more. Hospital redevelopments are complicated projects. When renovating a hospital there are significant costs associated with phasing, project duration, temporary spaces, infection control management, decanting, unforeseen conditions (what’s behind the wall), replacing systems while still using them, etc. all of which drive the renovation costs. There are also the non-monetary costs that need to be factored such as staff impact, patient disruption, wayfinding, infection control issues, etc.

6. When people say that you are trying to build a Taj Mahal that we don’t need … answer them with an explanation of what you have in mind.

 There is no talk by MAHC to create a “mega hospital”. We are planning for the same number of programs, services and beds in all of the approaches. The square footage that would be planned for a one hospital model would be less than the combined total for a two site model due to less duplication. Regardless of the model, future planning will provide more services in Muskoka through the proposed addition of stroke rehabilitation beds and an MRI machine.

7. When others say that there is no need for private patient accommodation with ensuite bathrooms because this is not a five-star hotel, give reasons for why this would be included in a new build.

The Ministry’s capital planning requirements require that 80 per cent of new hospital construction for Medical/Surgical beds is single patient rooms with their own washroom. This is not to create a hotel environment, but is to protect patients from infection. It is hospital safety best practice that patients do not share bathrooms and can be isolated from others when necessary.

8. When some say that it is impossible to build a new hospital in the boonies where there are no municipal services, address the topic openly and thoughtfully.

There are significant challenges and costs to building outside of designated urban centres where municipal services are not available. The Task Force is exploring the impact this would have on local economies and on land-use planning for all of the models.

9. When a writer talks about towns that are not within the Simcoe-Muskoka Local Health Integration Network (LHIN), tell them about the LHINs and their regions and how the distribution of funds affects decision-making at the LHIN level, and why our LHIN might not be concerned about health care in locations for which they are not responsible.

MAHC is planning for the acute health care needs of the MAHC catchment area, which includes the District of Muskoka and portions of East Parry Sound. While Georgian Bay is part of the District of Muskoka, the majority of their population accesses other hospitals. MAHC belongs to the North Simcoe Muskoka LHIN. The LHINs are responsible for planning, integrating, providing and funding health services not only for hospitals, but for home and community care, community health centres, long-term care homes, mental health & addiction programs, and community support services agencies within their boundaries. This map shows that the East Parry Sound communities that access MAHC services are not within the NSM LHIN boundary, but they are very much considered in MAHC future planning.

10. When someone who has been classified as a “senior” voices an opinion or asks a question, show them respect and understand that even though they themselves may not be here to benefit from future health services, they nevertheless care deeply about their town and the health care services available to those who live in that town or visit it.

MAHC values all opinions and is receptive to all voices.

11. The task force needs to reveal where any new build would be located if they expect people to be able to get onside with that option; it is impossible for anyone to even consider that choice without having a clue where it will be built (i.e. within a 20-minute drive from both or a certain number of kilometres south of Huntsville and north of Bracebridge).

The planning work to develop the models includes discussions on siting. Detailed information about the programs and services in each of the models, where the models could be located and how they could be built will be shared once it is completed. 

12. If talking about a site A or a site B, or an outpatient site and an in-patient site, they need to declare which site will be where.

Workshops with stakeholders are occurring to develop the models and include discussions on siting. Detailed information about the programs and services in each of the models, where the models could be located and how they could be built will be shared once it is completed. 

13. And finally, if the decision has already been made, then they need to have the courage to tell us that, with the reasons for it.

No final decisions have been made. The Task Force is overseeing a new chapter of MAHC’s future planning work. MAHC has asked the LHIN and the Ministry if they have a preferred model, or if any models can be taken off the table. MAHC has been directed to further explore and evaluate all three models to ensure all options have been researched. MAHC has deliberately focused on developing the two two-site models before developing the One Hospital model.

Natalie Bubela, CEO
Muskoka Algonquin Healthcare

MAHC also shared a media release today regarding a list of Q&As on its website. You can read it here.

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  1. No where have you discussed the method of how people with no vehicle will be able to get to a hospital out of Huntsville. Not only that but i see no answers how the people who live north or east can solve there time problem. Perhaps look at the amount of office staff etc and the space they take up and the money.

  2. Stephen Woodcox on

    It’s my opinion that Jean Bagshaw is correct on all accounts. What both towns need is their own hospital as MAHC or individually run, it doesn’t matter. No one seems to be addressing the fact that both communities double or more in population in the summer months. The government needs to provide a large increase in funding to reflect this. Also the upper management needs to be reduced and the taxpayers need to look at each team member’s value to the team as a whole. Is it right in your minds that the CEO makes 5-8 times what a front line staff member is paid? Also many other employees make large amounts and they have assistants. As far as the clerical staff, it is likely just by quick observation that there are more clerical staff then there are actually beds available at each hospital site. The front line staff are who take care of our community people. Each hospital should be supported by their communities. I don’t live in a fairy tale, it should never have been one organization, and we were all warned that this would happen. The entire organization is TOP heavy, and mismanaged, with loads of financial waste.

    • I agree with you. Since Jean Bagshaw worked as front line staff for decades, perhaps we should listen to her. We do not need to spend loads and loads of money on administration when we are desperately in need of the people who actually do the work of caring for the citizens of the communities served. Just as army officers are told that you always take care of your non-commissioned officers, so the administration of the hospitals should be very concerned about the overwork and poor morale of the front line hospital staff. We don’t even have PSWs at our hospitals to help relieve the burden on the nurses. The primary reason for that is that PSW’s are so poorly paid that they figure that they might as well work at Tim Horton’s than to put up with the frequently messy, exhausting work of being a PSW. The shortage of PSW’s is even worse than the shortage of nurses in the Province. Maybe if we weren’t top-heavy with highly-paid administrators at the local level, and bureaucrats in the Health Ministry, we might be able to increase the wages of these valuable employees and spare our nurses from their crushing loads.

  3. I think the government also needs to consider that a lot of our seniors don’t drive or have the means to afford transportation, unlike the cities we don’t have buses, or subway transportation that will reach our outer limits to all our small communities. This is already a huge expense to add on a extra 20 minutes to a taxi fair that may not be in reach for those on a fixed income. The elderly may not be able to actually get to a test, appointments etc. which could result in high demands on our community care assistance programs, that are already stretched to the max. It will become a never ending revolving door.

  4. From the article .. my money is on a one hospital solution . WHY .. it’s based on money from the government, cost to maintain 2 hospitals and all the other cost that have been documented, the current problems with the 2 hospital solution DO NOT go away as have been happening since 2005, the future is important and I believe the government has this in mind and WILL make the correct decision and move this FWD!

    • Why do we have to settle for the one-hospital solution? If the administrative and bureaucratic fat was cut out of the system and put into front line workers, we could have a two-hospital solution with likely money to spare to help repair, expand and refurbish our ailing hospital structures–there’s PEELING PAINT on some of the walls in our hospitals! Surely, if we can pay the hospital CEO over $240,000, we could spare a few dollars for a new paint job?

      Listen to old front line workers of the past–they KNOW that things got increasingly more difficult for front line staff when a highly-paid, administrative structure was imposed on local hospitals. There are huge salaries being paid–and for what? So that our front line staff is increasingly overworked, making them vulnerable to burn-out and disability? Poor morale is a severe problem in at least one of the hospitals in Muskoka and it will only get worse.

    • Yes, Bob I agree. Having spent over 30 years working in and consulting with Ontario Hospitals, the one hospital solution is the best economical solution. We need specialists along with the new technology here and one hospital solution gives us the best chance to achieve this.

  5. Craig Nakamoto on

    I thought Jean Bagshaw’s questions were relevant and well articulated but I also thought that Natalie’s responses were very good. If you knew nothing else about this entire situation, you would be hard pressed to understand why there is so much contention in this process.

    It sounds like the MAHC is pursuing three options and will reveal all of the details in due time. The real question – which has not been discussed at all in this letter – is how will the final decision be made?

    It seems clear to me that there is only one forward-thinking solution: two acute-care sites. Nobody could argue that sometime in the near future (much less than 7 generations) we will have an acute-care site in each town. Why shouldn’t we keep that trajectory now?

    As usual, the real decision will come down to money and politics. In other words, you might as well flip a coin.

  6. Celia Finley on

    With all due respect to Natalie Bubela, MAHC does NOT value all opinions, or even consider them. MAHC must be dismantled, as it is an illegally constituted body whose authority is highly doubtful and possibly completely irrelevant. I challenged MAHC weeks ago to provide proof of the legal foundation of the mandate they claim to have, and no such proof has been produced, BECAUSE IT DOES NOT EXIST! It is up to the municipalities who use the hospitals to determine their future, not a group of illegitimate elitists, who have tried to create their own little fiefdom.

  7. The answer is right there in the response to number 5. The MOH will choose to save over $100 million and will build one new facility centrally located. Now check a map…. Port Sydney. Now before people freak out, keep in mind this is not going to happen for a decade or more. It was a 15 year process when it all began a few years ago.

    • Considering the enormous cost of running services to Port Sydney, it is almost guaranteed that will not be chosen. While our close-to-the surface bedrock may be picturesque, its presence makes running services extremely expensive. The Ministry of Health might elect to save that $100 million but the Province as a whole, would not consider it a good alternative, because the Province would be on the hook to kick over their portion of the cost of running services.

      As another alternative, the new hospital could be sited on Mary Lake and use suitably-treated lake water and a package plant for wastewater treatment but the Ministry of the Environment does not like package plants in general, because poorly maintained systems become an environmental problem. There is also the problem of having to acquire a site on Mary Lake and having to use eminent domain to acquire it. It’s pretty safe to say that a single hospital in Port Sydney is the least likely alternative to be chosen.

      There are also political considerations. The current government in Queens Park is not interested in fostering growth in outlying areas like Muskoka. Liberals are preoccupied with large urban areas because their underlying philosophy is the globalist neoliberal notions of “world cities”. So, unless we get a Conservative government in the Province, it is pretty clear that what we want won’t matter very much to the Province. Our ancestors carved a way of life out of the wilderness but that is meaningless to those who are “forward thinking” and concerned not at all with individual rights or desires. Having said that, my guess is that the Province will likely overrule the Ministry of Health (especially if we get a Conservative government installed) and go with the improved two-hospital alternative. Any Conservative government would be likely to reason that the easier decision will be to avoid scrapping either of the two existing hospitals and to just fix the problems with each. The most pragmatic approach would be to use a wholistic plan for delivering health services to the populace. And Conservatives tend to be more pragmatic rather than being rigidly ideological. We need to take an honest look at the problems that are apparently not being effectively examined.

      A main problem that has been dumped on the hospitals is the number of disabled seniors who are taking up acute-care hospital beds because they are no longer capable of living in their homes. Because there is a drastic shortage of nursing home beds (the waiting lists are long) these seniors are kept in hospital beds, even though their needs could be met by an adequate nursing home structure. It is clear that what we are now doing is not working.

      But even if the nursing home beds were available, there is another problem that the nursing homes should be required to cover–that of the nursing home residents’ medical needs. The nursing homes see their mandate as just providing minimum medical care while looking after the physical needs of residents. If any new medical problem occurs in one of their residents, they automatically ship them back to the hospitals. This is a real waste of resources. The way the problem could be solved is to have another section of the nursing home where those with increased medical care could receive it. This could be easily attached to a nursing home. A resident who has need of becoming a patient for a few days–just until the problem is resolved (or not) will not become a burden to the already stretched acute care hospitals. It is ridiculous to be shipping the resident from the nursing home to the hospital and then back to the nursing home (and likely repeating the process several times per resident). Who do you think is paying for all of that expensive transportation to and from? That’s not even to mention the disruption of the dignity of the nursing home resident who just wants some peace at the end of his/her life–not to be shipped around like some troublesome package.

      So what if the MoH is hostile to the idea of maintaining and improving both sites? If we insist that is what we want, it is likely that any Provincial government (and particularly a Conservative government) will NOT ignore us if we speak up loud and clear on our desire for two hospitals. But that is why we need a referendum of sorts on the ballot for the municipal election this fall.

  8. I am relieved as I am not currently working and have to witness the spiral in healthcare which will become a full blown tornado . After 32 years I developed PTSD. It involves horrific nightmares and thats just a start. From the many years working in our local ER, I cannot even begin to relay the sick feeling I got in the pit of my stomache each time we were notified of a critically ill or hurt patient from Algonquin Park, Sprucedale, Burks Falls just to name a few areas in our catchment. The reality was that they may not make it by the time they reach us. My nightmares involve a sea of faces who did not get to the hospital on time, screams of anguished family who had to be told of the loss of someone who they loved and cherished. Could the patient have made it if he or she got to hospital a little sooner, if the hospital had just been a little closer? Without a doubt yes. Not always, but occasionally yes. However even one life saved out of 10 that could not be is priceless. Those communities north of Huntsville are the forgotten and categorically get marginalized. They are just as much entitled to good healthcare as those in Huntsville and Bracebridge parameters. An extra 20 minutes can make a significant difference. A 20 minute longer trip suddenly becomes an extra 30 minutes mid winter. Every minute of delay is one step closer to a tragic outcome. I have seen it as has every frontline healthcare worker. Did PTSD develop because of the tragedy I witnessed in my career? In part, however the devastating feeling of helplessness is most profound. The knowledge that no matter how hard you work and what innovative high tech equipment and life saving drugs you try… the patient could not be grasped from death or life altering injury, solely because too much time has evolved. When will lives matter? When will the reality set in that Huntsville’s catchment area does not end at Novar??? That extra 20 minutes in summer, 30 minutes in the winter translates to a higher likelihood of death or permanent injury. To intentionally consider a hospital location further south than Huntsville Hospital is currently located is nothing short of a death sentence for critically ill or injured patients in northern communities requiring emergent care when time is of the essence. How many lives will be lost because of such a decision? We currently have no numbers however historically we know there will be. A life can’t be treated as collateral damage. Involve your front line workers and they will tell you the reality of what happens in real world.

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