By Dr. Greg Stewart
I would like local people to re-start this hospital planning process with their eyes wide open. That being said, I would like to make a few points.
Yes, this is the second time around. The Ministry of Health (MOH) forced Muskoka Algonquin Health Care (MAHC), the administrators of our two hospitals, to start again because the first time resulted in a recommendation that the public did not support. The MOH is on the record as saying they want a solution that has both public and municipal support.
However, MAHC is presenting basically the same three options this time as last time. It seems like we are going down the same path. Some may not be aware that we have broader community representation at the table this time around. Despite this, I wonder if the community truly understands what they are really being asked, and what they are not being asked?
The survey that is being thrust at the public contains the same three options.
Option #1 – One central hospital. This was resoundingly rejected in round one with public outcry as well as a negative municipal response. The Province even commented negatively on the massive future costs of developing a new community.
One central hospital was the ‘selected’ option until public outcry caused MAHC to shift more towards option #2.
Option #2 – Two hospitals but with one more focused on acute care and the other on long term care. To save the necessary funds this would involve relocating surgical services to hospital ‘A’. As the public became aware that this would cause the eventual collapse of the other core services at hospital ‘B’, this option started to not look so good. The emergency department, internal medicine/ICU and obstetrics are all interlinked and inter-reliant. Without on-site surgical services there would be an eventual loss of all these core services. Neither town wanted to be site “B.” To this day, neither town wants to be site B. This option was not well received as well and the MOH knows that.
Option #3 – “Two hospitals (Not the Status Quo)” is how it is labelled in the present survey. What does that mean? What services are kept? What services are lost? We have no idea. How can we vote for something so undefined? With the two previous options already experiencing strong public and municipal rejection, is this really the only other option with which we are left?
In 2006, the Ministry of Health produced a document called “The Core Services of Small Hospitals in Ontario.” Huntsville and South Muskoka were both mentioned by name. Here are their recommendations. (At that time our hospitals were each between 2500 – 3000 weighted cases.)
4.2 Core Service Recommendations
For the province’s smallest hospitals, with up to 1,500 weighted cases of inpatient activity, core services include:
• Emergency services:
– Emergency departments must be prepared to provide care to, or stabilize and transfer, patients entering via the emergency department;
• Medicine program with inpatient medical beds;
• Physician specialty of General/Family Practice:
– supported by broadly-trained Nurses;
• Inpatient allied health services, such as:
– Physiotherapy, Clinical Nutrition, Occupational Therapy, Respiratory Therapy, Speech Pathology and Pharmacy; and,
– Tailored to meet the specific needs of the population being served; and
• Diagnostic services, such as:
– Laboratory, Ultrasound, General Radiography and Non-invasive Cardiology.
For our category they also recommend, as “core” services the following
For the group of relatively larger small hospitals, whose inpatient activity ranges from 1,500 to 4,000 weighted cases, core services include all of the basic core services identified for very small hospitals above, PLUS:
• General surgery and day surgery program;
• Obstetrics program;
• Physician specialties of General Surgery and Internal Medicine; and
• The provision of Special Care Units and the ability to accommodate temporarily
This is exactly what we “now” have as core services in Huntsville and Bracebridge. Exactly what the government concluded was appropriate. Why are we considering a step down?
I would like to close with a statement and a question.
Can we all agree that MAHC is ‘one’ organization but in reality is ‘two’ hospitals? This is one of the major reasons that the funding formula does not fit, as the MOH has openly admitted. Here lies the base of the problem.
Secondly, why are we not demanding that we keep the very basic core services we already have? Don’t we deserve them? The Ministry’s own research concluded that they were appropriate. Why can’t our hospital board not stand up and say, “Wait, we will not let you do this to us!” ? Is part of this our own fault as a general public? Have we have not been influential enough in making our priorities known to our local board members? They are good people. Do they need stronger support from us, the general public?
In the MAHC survey the public is not being asked what it ‘wants’. It is being asked to chose from three alternatives that do not come close to what we really want, or already have. Two alternatives have already received major rejection and the third is completely undefined. Be careful what you vote for. You may get it. And it may not be what you want. They never asked that.
Please vote with your eyes wide open.
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