Scarborough-Rouge: No merger decision, but hospital still selling benefits

If this were the private sector, you wouldn’t have the board of a $352 million organization sitting in such uncomfortable chairs.

Despite signs of modest economic recovery, it’s still hard times for many of Ontario’s hospitals, including The Scarborough Hospital. October 1st the TSH board met at the Birchmount Campus to conduct the hospital’s business.

Struggling financially – their line of credit recently increased to $30 million – the hospital is now facing an all-consuming discussion of merger with the somewhat healthier $326 million Rouge Valley Health System.

Maybe once they are a $678 million joint entity the chairs destined for board meetings will at least get better.

While engaged in an open and transparent process around the merger, there are clear signs that public engagement is not so much about gathering input to make a decision, but finding pockets of community opposition and trying to win them over to what appears to be a done deal. TSH CEO Robert Biron insists no decision has been made but continues to promote the benefits of merger.

Most of what the public has heard from the hospital amounts to little more than wishful thinking and high level assumptions. Nobody has heard the other side of the coin, such as what adjustments need to be made to executive compensation to reflect what would become the seventh largest public hospital in the province, or what costs are involved in physically aligning services at four hospital sites linked over two municipalities? At a time when Scarborough cannot afford basic medical equipment, how happy are they going to be about paying for a corporate identity program and new signage associated with a merged hospital?

Remarkably after Denis Lanoue spent considerable time presenting to the board what the TSH’s Community Council perceived as “risks,” the hospital turned around and asked if they could respond back to the Council. The hospital said it could present information that may “mitigate” some of those risks.

From the start the hospital set three basic minimums – no site would close, no ER would close and that existing patient services at Rouge would remain in place.

That can’t be a very comfortable feeling if you are on the board of TSH, non-ergonomic chairs notwithstanding. It also directly suggests that services would likely transfer from TSH to Rouge, to a third entity, or to nowhere at all. It’s that aspect that is making people worried.

Lanoue said the Community Council didn’t feel the assurances around the ERs were enough. They recognized that an ER is only as good as its supporting infrastructure, including access to on-site diagnostics. He expressed alarm that this consultation process was already costing in the vicinity of $1 million – a lot of money when you consider the foundation provides $2 million a year for acquisition of that badly needed equipment. TSH officials told the board that they have among the oldest equipment among peer hospitals.

As we reported yesterday, Lanoue said merger posed the risk of being a big distraction when the hospital was trying to transform itself – a situation already borne out by commentary at that board meeting. He also wondered about the impact of such uncertainty on the hospital’s ability to fundraise?

Lanoue questioned the wisdom of bringing the Ajax-Pickering Hospital into the merge when West Durham residents appeared to prefer realignment with Lakeridge Health. The Scarborough resident said he had never been to the Ajax-Pickering hospital, but heard they had much better equipment. Ouch.

Given adequate resources needed for a merge, the Community Council was concerned about its impact on the financial stability of the hospital.

To be fair Lanoue did also answer the question around perceived benefits, but appeared far less personally convinced by them. Many read like a PR exercise by the two hospitals – making assumptions about the ability to recruit professionals, attract funding, achieve efficiencies of scale and standardization of care.

If there was one benefit Lanoue appeared convinced by, it was the potential to achieve efficiencies by combining administrative or “back office” functions. Perhaps somebody should have pointed out that many Ontario hospitals have already done so without having to go through formal merger. TSH is already a member of Plexxus, a joint purchasing company owned by a group of public hospitals.

Reacting to news of the proposed merger, Lanoue told the board “I almost fell of my chair when I heard this come in.”

Rather than support or oppose merger, Lanoue said that there was not enough comprehensive detail to make a decision. Not that it mattered. He said the momentum was so big that it was unlikely it would be stopped.

Time is beginning to run out for the process. A recommendation has to be made before the end of this month, not that there is much doubt about what will be brought forward.

Biron recently wrote that he sees “a hospital that defines itself not by its limitations, but rather by the strengths of its community relationships and its diversity.”

The question is, if that community is not on-side with the plan, will Biron and the Central East LHIN none-the-less recommend merger to the Minister of Health, or will the pause button be pressed? In a minority government, those Liberal Scarborough seats could be very important to the Wynne government. They are not nearly as safe as they used to be.