We need to understand what we are voting for in Hospital survey ~ Opinion

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Greg Stewart
Huntsville Family Doctor

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
ventilated patients.

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.

Here is the link to the survey.

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24 Comments

  1. Andrea Rahmel on

    Part of the problem is the “silent majority” that hope someone else will take care of it and hope for the best.

    With all the “busyness” people don’t bother – even when they know they should.

    A direct link to who to voice your opinion to is the best way to have more people give that opinion.

    I am also a part of this problem. I am not happy with the options, I would like to say so. But, I don’t even know what to do about it.

    • Thanks Dr. Greg for the explanation. One wonders if there is something “steering the ship” in the background forcing the Board to limit our options. Politics is not a clean sport.
      And yes, we need to be involved with what’s going on in our community or we will get what we ask for… nothing.

  2. Hugh Mackenzie on

    I think it is important to complete the survey or the takeaway will be that the community doesn’t care. There is a space to comment on each of the options. In the space provided to comment on the 2 site (not status quo) option, one can say that the very best option is to get the funding model changed to reflect the reality of a two hospital campus and the need for fully acute care services at each site. That is what I did. The top priority of the Hospital Board should be to get the Funding Model changed. It is a shame that they didn’t even mention it in their options.

  3. Many of us made our feelings known before the Burk’s Falls Hospital was closed – we had a very ‘vocal majority’ defending our wishes.
    We were told that Huntsville Hospital needed the money which was being spent here.
    First they removed the inpatient beds, leaving limited emergency services.
    None of that remains…

  4. Jenny Kirkpatrick on

    Thank you Greg, once again for standing up and clearly defining some of the extraordinarily frustrating issues regarding our future hospital care choices…..I feel SO angry about this. Why are the folks who have volunteered / been chosen to do what is best for our community unable to come up with a transparent survey?? Where is the respect for the clearly voiced community wishes: We want a fully acute care hospital in our community….I just don’t get it….

    • I agree with Jenny K. The Board knows what the People want. Meantime to the Board It is just a matter of going through the motions until the Board gets what they want. Just one more thing: ” The Hospital Foundation can kiss all the generous donations good-bye if they tick too many people off. “

    • Well the town did same thing happened with the ‘pipe man’ survey. It would seem that we have a particularly difficult time designing effective surveys in this area.

  5. Sharon Stock Feren on

    I remember when we had the Mayor rallies a few years ago. When I looked around at the crowd I couldn’t help but notice the attendees and made a guess that the average age would have been 65 or so. We were all eager to voice are concerns and opinions. It struck me that whatever came to be would not benefit a good number of us. We don’t have young family here but I realize that the community is growing and widespread. It did not seem logical to either remove or downsize a necessary service such as a fully functioning hospital. I did complete the survey but still feel that the issue is going in circles. It does seem like a tug of war between Bracebridge and Huntsville.

  6. Your comments as always provide importance information and guidance. You raise important points that need to be understood by the broader community and hopefully ignite broader interest and discussion by the community at large. Publicly funded healthcare & acute care services shareholders are the users of h.c services and every tax payer in Ontario. Hopefully community leaders will ensure & recognize that a local voice is the most important element with any delivery changes within Muskoka.

  7. Very accurate assessment of our community health requirements. Since moving here 4 years ago from the York/ Durham region, this discussion continues unresolved to this day. Shameful! Our area requires, simply put a full functioning Acute Care Hospital with all the allied services, end of story! No compromises! Bracebridge can proceed how they want! That’s a whole other story from ours.. different demographics, separate resources etc. Two entirely separate Hospitals that’s my choice….

  8. Frances Botham on

    Greg Stewart’s opinion makes total sense. It is obvious that we need the basic core services retained at Huntsville Hospital. I think we need additional services as well. The magnitude of the continual dialogue added to the ambiguous survey has grown out of hand. People have talked the issue to death with no solution in sight. It has become a quagmire. Present a time staged plan of the requirements to upgrade the present site. Don’t entirely preclude that option with today’s mindset that it costs more to renovate than build. Analyze using wasted space. Is it logical to take up space and resources for long term care patients who could be cared for in a specialized assisted living space at a much lower cost? Is the administration as cost effective as it could be? Do we need a new impartial analysis? Make a logical overall plan with firm resolution that Huntsville Hospital not be designated as plan A or plan B. We should be staying in the “as is” status quo. The medical professionals, the hospital board, the citizenry and the politicians must present an impenetrable united front.

  9. Katharine HIll on

    Thank you, Dr. Stewart, for stating so succinctly exactly what I feel about the survey and the recommendations, but am not able to state so very clearly. To offer options that will benefit no one and that will actually remove many care options is ludicrous and is driven only by the desire to save money. Patient care doesn’t enter in to the picture at all. As you mention, the funding formula doesn’t fit the situation in our area where there are two hospitals and one MAHC. It is my hope that the time around realistic solutions will be explored. Again, thanks Dr. Stewart.

    • Thanks Dr Greg,the survey was not clear and went around in circles. I now realize why I was so frustrated trying to answer the questions.
      Absolutely essential we secure our services in Huntsville. Let’s keep the pressure on our best interest for Huntsville and surrounding area to the East and North.

  10. J. R. Bruce Cassie on

    Dr. Greg Stewart hits a home run with this one. He’s absolutely correct in his presentation and explanation of the two-hospital model. How significant that someone so close to the delivery of medical services Muskoka would share so clearly what should be done to save us from the collateral damage of decisions made elsewhere!

    I also support Hugh MacKenzie’s insightful suggestion that we make our thoughts known in the survey by proposing the funding model be changed to reflect the reality of a two-hospital campus and the need for fully acute care services at each site.

    It’s all about getting the funding formula changed to reflect what is best for our area. Too much time is being spent deciding whether Huntsville or Bracebridge should lose its hospital when no sane person in Muskoka thinks either community would be better served by having the LONG drive elsewhere. It’s two hospitals and nothing less.

    Thank you, Dr. Steward and Hugh MacKenzie, for showing us how to make our voices heard.

  11. Does anyone know if we get a do-over; now that the survey has been clarified? Or is the survey monitored by one e-mail address/one survey response?

  12. Thank you Dr. Stewart. The waters are a little less muddy. I said a “little” less. Your explanation is the best one yet. I’m older than dirt and I appreciate the clearing up. Let’s just get on with it. Does our vote really matter?

  13. So if MAHC was no longer, and Bracebridge & Huntsville Hospitals each applied for their own funding as individual hospitals would the picture be different? I too filled out the survey but was unhappy with the options, and unclear statements (2 hospitals but not status quo- what does that mean?) In an attempt to save the province money by amalgamating our two hospitals they reward us with closing one of our hospitals? This is not north against south our geographic area is just too big to decide where a single site would be, someone will always be too far away. If you are having a heart attack in Algonquin Park would want to travel another 1/2 hour down the highway to Bracebridge, conversely if a medical emergency happened while watching stars at Torrance Barrens Huntsville is a very long drive. Both are vibrant towns that deserve a hospital, complete with ER and beds. Maybe specialties split between the two, ie cardiac at one, oncology at the other. Thank you Dr. Stewart & Hugh Mackenzie for spelling it out and taking leadership.

  14. Doctor Stewart has said most of what needs to be said and said it the best I’ve seen it said so far.

    We are all growing communities now, with aging populations and growing health needs to match. Why are we being asked to take a huge step downward in services from what we already have now? Is it just funding? I’m sure is not being done in the name of service to the public.

    The survey is, as Hugh has stated, clearly very important but it is flawed in my opinion. Like so many surveys these days the results can be more or less pre-determined by the questions asked and this needs to be kept in mind. A survey is an interesting starting point but it has many limiting factors and depending on the number or responses it should be viewed as just this… a starting point for more research.

    In a perfect world I’d like to see two well equipped and staffed hospitals for our area and maybe gradually a growth of the Huntsville site to be one day more like what is now in Barrie (far in the future granted, but we need to think that far ahead for capital projects like hospitals).

    I get the feeling that I am dissatisfied with this process somehow. As already pointed out the MAHC people are good and smart folks. I’m sure they are doing their best here but I wonder if they are being pushed into a situation from which there is really not any single satisfactory solution? Maybe as a Province, we need to look more closely and realistically at small town hospital services? Maybe the rules in place need to be adjusted somewhat?

    I know Jim Sinclair is correct in that the pool of donations may well dry up rather quickly if the final solution is disliked by the majority of current doners.

  15. I filled out the questionnaire, (remember it’s NOT a survey) and I spelled out a lot of what I was thinking in the comments section. I left question #7 (3choices) blank) but this negated the entire questionnaire, telling me I had to pick one. I picked 2 sites but NOT the status quo. It’s not what I WANTED – EXACTLY, I THINK, MAYBE? but in order to make my voice heard, or words read, I had to pick the closest choice. Somebody is messing with us!!

    • Karen Wehrstein on

      Yes, I noticed that too. I wrote in a comment box that my “vote” for “two sites (not status quo)” was NOT to be counted as favouring the option, but only there to ensure that my survey was received. This survey was *not* designed to test the true opinions of the public, but to force acceptance of the Board’s preferred outcome and create the appearance of favour for one of three options that are all roundly disliked. Thus it is deceptive and should be exposed as such. Comments that people have made should be considered, but counts or percentages of the option votes are not valid data and so should be ignored.

  16. Thanks to both Dr. Greg Stewart and Hugh Mackenzie for alleviating some of this constant fog surrounding this questionnaire. Valid suggestions and points stated need to be followed up by the Hospital Board on the funding formula and the vague options given, and a more defined and fair questionnaire issued.

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