CEO says he wants to increase power base through Toronto hospital mergers

After all the talk about system integration it’s notable that the CEO of a Ontario public hospital should argue for a merger on the basis of enhancing the institution’s power base.

This hardly strikes us as being in sync with the present evidence-based narratives emerging from the Drummond Report or the Minister of Health’s new action plan. Isn’t health planning supposed to be about providing care in the right place at the right time by most appropriate provider? The “power” scenario suggests the province may be making decisions on a different basis.

It is even more surprising given one of the two potential dance partners in the merger is Rob Devitt, CEO of the Toronto East General Hospital.

Devitt is often a go-to guy for the Minister of Health. When e-Health imploded, it was Devitt who was sent in to clean up the mess. Devitt has also been called upon to act as supervisor when other Ontario hospitals have run into trouble, such as the William Osler Health Centre and The Scarborough Hospital. You might say Devitt epitomizes the kind of guy who buys into the idea of planning by evidence, not power.

To be fair, it wasn’t Devitt who said anything about power structures, but Dr. John Wright, CEO of The Scarborough Hospital.

Wright believes that if the two hospitals merge, the province will be hard pressed to ignore them, creating a power base to rival Mississauga’s Trillium Health Centre, which apparently became the western GTA juggernaut after swallowing up the former Credit Valley Hospital. Wright believes that united they can also compete with the University Health Network for big capital projects. You can almost feel the testosterone.

Capital projects? Did Devitt not include Wright in his recent announcement of a new patient centre for Toronto East General with a kick-start of $5 million from the Thomson family? It seems the Toronto East General is already doing a fine job attracting capital projects.

Regardless, Dr. Wright says he is tired of being ignored. No doubt he is also dreaming large.

The two CEOs have already commissioned a $90,000 study by consultants Corpus Sanchez to see if this is feasible. Their report is due in March. You know this is just the beginning of the cheque writing related to amalgamation.

But wait a minute, isn’t this the kind of merger the Drummond Commission proposed in the 105 health care recommendations?

Yes, but Don Drummond is also recommending cutting the rate of funding increase to health care in half, and further suggests that hospitals may have to do with even less given home care is rattling its tin cup.

So who is going to pay for all these mergers?

Last time we got seriously into this, it cost the province about $4 billion in restructuring costs. That was more than 10 years ago. With funding increases stunted at a little over a billion dollars per year until 2018, it is possible that a new round of significant hospital restructuring could pretty much eat up all the funding increases. Yes, all of it. In that context, maybe it’s time to look a little closer at this conundrum before Health Minister Deb Matthews bestows her blessing.

Talk of hospital mergers tend to make everyone just a little nervous. The doctors at the two hospitals are said to be overwhelmingly opposed to such a merger.

Phrases tripping from the CEO’s lips like “minimize program closures” do tend to make everyone perk up. The people in Scarborough are likely checking which bus routes will take them to East York, and the denizens of East York are wondering if they should instead just go downtown should services begin to migrate eastward.

Meanwhile, Wright has suggested among his motives is a new cancer centre for the Scarborough Hospital; something denied him by the Central East Local Health Integration Network. The LHIN, after much deliberation, decided Lakeridge Health is their regional centre of excellence for cancer care. It helps that Lakeridge happened to begin building their cancer centre before the LHIN existed. This proves the maxim that if you already built it, they will likely come.

Could the Central East LHIN have two cancer centres?

Not likely, unless, reasons Wright, you merge into this big powerful colossus to kick and scream and bully the LHIN to do so. Except which LHIN?

The Scarborough Hospital is in the Central East LHIN. The Toronto East General is in the Toronto Central LHIN.

This is starting to hurt our heads.

Hospitals have proven they can cooperate with each other without creating the chaos of a formal merger.

Devitt has already said as much.

“We share a microbiological lab with The Scarborough Hospital and North York General, together we founded Plexis, which buys supplies for hospitals, and started digitizing and sharing X-rays five years ago,” Devitt told the media.

Cooperation also means you don’t get a raft of managers expecting their pay to go up because mergers given them another site to sniff around in.

Wright suggests the motivation might also be the coming restraint, arguing the Scarborough Hospital cannot maintain the status quo with an aging population and declining real revenues. The Scarborough Hospital has recently announced it is eliminating 85 unionized positions, including about 4 per cent of its nursing staff.

So where would the savings come from? We know mergers are expensive and there is little evidence to suggest they end up saving money. While the CEOs say they would not close one of the hospitals, there is no question they would be looking to rationalize services between them. That would mean even more layoffs and less access to health care.

Obscurely, Devitt says “forced” mergers have a much lower success rate. Does this means if the partners are willing, they will have a better result? How so?

The Friends of the Toronto East General Hospital are hosting a public meeting at 7 pm next Wednesday, February 28th at the East York Civic Centre.

Those attending may want to ask about how much debt each hospital is bringing into the merger, which services are likely to be rationalized and where, and how much this is all likely to cost.

Integration is not about wielding power; it’s about working with your partners in the health system to ensure the best care for patients. You don’t need to change your signage and stationary to accomplish that.