Why a centrally located, single-site hospital is not the answer – Sven Miglin


By Sven Miglin

The next chapter in Muskoka’s ongoing hospital saga is about to unfold. In July the Ontario Government provided Muskoka Algonquin Health Care (MAHC) with $1 million to proceed with the development of its Capital Redevelopment Plan. In May 2015, MAHC had proposed redevelopment based on a single-site hospital located between Huntsville and Bracebridge. A MAHC-lead committee has been struck to oversee this most recent process, a process which requires the committee to revisit this single-site model.

I believe that MAHC’s current single-site model is seriously flawed and that we need to revisit the two-site hospital model.

A new single-site hospital would not open its doors for another 15 to 20 years. It’s absurd to believe we can forecast our healthcare requirements 20 years into the future. Equally, Muskoka shouldn’t have to wait 20 years to see meaningful change in the delivery of its acute care services. The two-site model calls for the redevelopment of the current two sites. This redevelopment can commence much sooner and be done incrementally and continuously over the next 20 years. This will allow re-development to adapt and change as it proceeds.

The current MAHC model calls for the new single hospital to be built in a field somewhere between Huntsville and Bracebridge. That would be a terrible location. The only supporting argument provided in the 2015 report, is that this location provides the most equal distribution of travel times for Muskoka and area residents. It fails to mention that compared to the two-site model, the single-site model increases the time required to get to an emergency department for close to 90 per cent of Muskoka and area residents. How is that better healthcare?

The catchment area for our Hospital isn’t just Muskoka. What about the residents to the north in East Parry Sound? What about the hundreds of thousands of people visiting Algonquin Park each year? Closing the Huntsville site would present these people with serious travel issues.

What about the huge cost of building new infrastructure (water & sewer, roads, hydro, gas, etc.)? What about the lack of supporting services (other healthcare providers, restaurants, hotels, etc.) close by? Besides being smack dab in the middle of Muskoka, what else does it offer?

Locating the single hospital in either of the two towns will eliminate these issues. The stark reality is that a single hospital will only be built in either Huntsville or Bracebridge. This would pit North Muskoka against South Muskoka. Without broad community support throughout Muskoka, the Ontario Government will back away and our redevelopment application will stall.

I appreciate that certain hospital services are best provided at one site. Our current two-site hospital already does this with numerous services singled sited. When appropriate, I’m sure others will follow suit. However single-siting acute care will mean that there is only one emergency department. I believe that would be a deadly mistake.

The argument has been made that a single-site would be more efficient and cost effective. This point of view looks only at hospital operating costs. What about the huge economic costs for the Town that loses its hospital?

Just as importantly, these hospital operational savings would not be realized for another 20 years. Muskoka can’t wait that long. Our hospital is experiencing major financial challenges right now. It is a mistake to base our redevelopment on a flawed funding formula that penalizes our two-site hospital. The more appropriate course of action is to modify the provincial funding formula to support the model that best serves Muskoka and area residents, which is a two-site hospital model.

I appreciate that there are numerous medical healthcare issues that need to be considered when weighting a single site hospital versus a two-site model. I leave those issues to be addressed by someone more qualified to do so.

A hospital is arguably the most important facility in any town. The health of our town depends on having a strong, viable hospital. It can be one of the largest employers in the town. It helps attract new businesses and is critical in retaining those already here. Individuals considering relocating to a town look at what healthcare services exist there, usually asking “Does it have a hospital?” A world-class tourist destination is expected to have the appropriate healthcare services available, one of which is a hospital.

However the most important reason for a town to have a hospital is that hospitals save lives. Hospitals make people healthier. Hospitals improve the overall health of the community they are located in.

I believe that the Committee needs to reconsider the previous decision to redevelop as a single site hospital. For all the reasons above and more it’s simply the wrong model. I believe they need to thoroughly evaluate the redevelopment of our two hospitals and adopt that as the model for Muskoka’s future. I intend to tell them this. What about you?

Sven Miglin was on the Board of Directors of MAHC for 6 years (2007 – 2013), two of which he was the Chair. In 2015 he was appointed to the Huntsville Hospital Retention Committee. In 2016 the NSM LHIN appointed him to the Executive Committee of MAHST (Muskoka and Area Health System Transformation) project.

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  1. Russell Nicholls on

    Muskoka Algonquin Health Care (MAHC) would do well to listen to the good sound advice that Sven Miglin has given them. The single site hospital makes absolutely no sense.

  2. I have to agree that a single-site hospital that is neither in BB or H’ville would not work – what about families who need to visit and have come from away? To me that is but one consideration but an important one, as we all know that family support is crucial.

  3. We need two hospitals, one in Huntsville and one in Bracebridge, the same as we have. It’s too far for people from the north and other places to go. Please leave them as is.

    • Well said everyone, we need the two hospitals, I totally agree with Mr. Miglin. I’m sure a lot of the citizens in Huntsville and Bracebridge would suffer without the two site plan. As Verna said Please leave it as is.

  4. My wife and I recently travelled from BC to be with my Mom in the Huntsville hospital as she nears the end of her life. My Dad travels from his condo in Huntsville to the hospital 3 times daily to assist in her feeding. He is 85, she is 83. They have resided in Huntsville since the mid 1980’s.

    What would it look like for this scenario to play out with a hospital located in Bracebridge, or a single site located halfway between North and South Muskoka? An elderly spouse/caregiver is expected to travel a fair distance several times a day down Hwy 11 in all manner of weather? Or perhaps they would visit less often? Or perhaps not all? What would be the effect of this on the spouse in the hospital bed?

    It seems crazy to consolidate services in one location. As stated above, there might be a level of economic efficiency achieved, but the social cost seems high. I don’t believe the health authorities will obtain or should obtain the “Social License” to do this.

  5. What do people who don’t drive do when they are sick? I can’t afford a taxi, so then I call an ambulance. Now there is a strain on our ambulance services, or I just don’t go and something major happens, but at least we are saving money on our hospital.

  6. As a seasonal resident, I sense a real community pride, support and ownership in the Huntsville
    Hospital. The same is probably true in Bracebridge. What would happen to all of this with a single site hospital centrally located in possibly Port Sydney? Two hospitals, each with an ER, and beds makes the most sense to me. Yes, all the specialized services do not need to provided at each hospital. Residents now accept driving to Barrie, North Bay for specialized care. If $$$ drive the decision, it will be one hospital. There are many other important factors to consider. The residents can not allow this to happen.

  7. Christine Rivière-Anderson on

    I cannot but agree fully with Sven Miglin and all the other comments made previously. I don’t understand how we could even hesitate to maintain a hospital in Huntsville and another in Bracebridge. It seems so obvious that it is the right thing to do for so many reasons . I trust that money can be found when it is in everyone’s interest. It’s a matter of creativity and reallotment on the part of the decision makers.

  8. J. R. Bruce Cassie on

    Sven Miglin has captured the thinking of the majority of citizens in Muskoka. Sven’s comment on projecting 20 years ahead is absolutely correct. Give me one such projection made by our government that has been borne out. One hospital is and was a decision baked in South Ontario. One of the most significant attributes of both Huntsville and Bracebridge is its hospital…. centrally located in each community. What is wrong with common sense, backed by relevant history?

    What about having one mega high school for both Huntsville and Bracebridge? What about having one Police Station for both these communities? The thinking is the same and it is mindless.

  9. Well said Sven. But who is listening?
    The committee has its marching orders from Queen’s Park.
    Maybe we are being punished for always voting “Blue” instead of “Red”?
    Two emergency departments are essential if lives are to be saved.
    Then again does Wynne even care?
    Without Prejudice.

  10. I totally agree with the article as written and with all of the comments. I would not have relocated to
    Huntsville had there been no hospital or one located miles away.

  11. How about asking those residents in Stephenson Township, whether in the Communities of Utterson and area, whose population is one of the largest in the Town? Do you get the impression that some people don’t recognize this and other areas similiar to it in Muskoka, but only that of Huntsville proper? Wouldn’t this be a rather weak rationale vs that of well conducted consultations, best accessibility for all, optimized acute health care, strategically positioned ancillary services support as just a few positive reasons, oh maybe a bit more…the old buildings and perhaps those nasty bugs too!

  12. In addition to Svens valid comments, what would a single site in either town or in between do to volunteerism without which the hospital cannot function? What effect would a single site have on donations to the hospital foundations? Have these important factors been considered?

  13. Sven has this right!

    Also it is well to remember that a hospital is a place to go for “emergencies” and by their very nature an emergency or accident is not planned. To best be able to respond to these events the time to respond must be minimized and this is best done with two sites, not one (out in the bush away from either town)!
    Staff in an emergency department cannot be “managed” like a factory. They need to be available for work during any unplanned emergency and this too has a cost that can’t be “administrated away” completely. It is just a cost of being ready, like an empty ward bed or not in use X-ray machine. This is just the nature of emergency medical care.
    This service, provided in two sites, may cost slightly more than a theoretical “one site model” but I think this is a cost we must carry in order to have timely emergency care.

    As Sven points out, things change drastically over a 20 year period and his concept of a sort of organic, ongoing development of the existing sites, one that gradually becomes the best, most efficient service method over those years, may not only provide better service to more people but actually not cost any more than the concept of a “new” hospital located in some theoretically perfect spot.
    Remember that great big “new airport” (Mirabel) at Montreal…..? It did not work and has now been closed after millions and millions were spent. We don’t want to repeat a mistake like this with our hospitals here.

  14. I think one of the key points made, is that we are dealing with a flawed funding formula that penalizes not only our two site hospital, but all small hospitals. But do we have the power to modify the provincial funding formula to support the model that best serves Muskoka residents? I suspect that the Ministry of Health has devised their funding model as a mechanism to encourage smaller hospitals and communities to consolidate and centralize facilities and services. From the Ministry of Health’s perspective, two old buildings are more costly and less efficient to operate than one new building and that’s the end of the discussion. We are going to need some very persuasive arguments to convince them otherwise.

  15. I have been a frequent visitor to H.D.M.H. Emergency over the last quarter century and I doubt very much that I would still be alive to celebrate my 80 th Birthday on Saturday or our 60th wedding anniversary on Oct,5 if I had to travel to Bracebridge emerge. On two occasions I was put directly in I.C.U. on arrival. Thanks to the response of the Doctors and Nurses who saved me twice.

  16. Sven has the experience and knowledge, and should be listened to, by the Province. If you take the emotion out, and just look at the facts each town needs at the very least an emergency department. I think since Toronto is the capital of the Province and Provincial workers live there, they are forgetting about SNOW, and WINTER. Some one needs to remind them. They are also forgetting about the aging population and the fact that many elderly people who need the hospital are unable to drive. We don’t have buses and subways. Some one needs to bring the decision makers to Muskoka, on a dark winter night during a snow storm, before they decide.

  17. I had just filled out the survey before I went on to read Sven Miglin’s opinion. I totally agree with him and his comments are very similar to mine. I can’t see why there is such difficulty adopting his point of view.

  18. Very well said Mr. Miglin! I totally agree with your points and those of Dr. Greg Stewart and Hugh Mackenzie. We are all aware of the need to amend the funding formula and I am quite sure we have the experts here to fully address that important issue. It has been stated that the MOH is looking for acceptance of our hospitals futures by both the Board and the residents and the funding formula has to be first on the list.

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