Category Archives: Hospitals

Stung by recent criticism over a dysfunctional labour relations environment and cuts to hospital services, South Bruce Grey Health Centre has finally decided to consult the community – on uniforms. The four-site hospital corporation placed a notice in the Walkerton Times inviting the public to fill out a survey on what type of uniforms new multi-purpose workers should wear at the hospital. The notice asks if the public thinks it’s important for the patients and visitors to be able to identify the different roles of the staff at SBGHC, (ie. nursing, dietary, housekeeping, maintenance) by their uniforms. Given the hospital is merging dietary and housekeeping, one has to wonder whether the staff will be required to change between the various roles they perform at the hospital. SBGHC thought less of community input in recent years when it decided to end a number of clinical services at the hospital, including outpatient physiotherapy, without prior consultation. For the record, we are partial to OPSEU blue.

Almost three months into the fiscal year, hospitals still do not know exactly how much funding they will receive from the province via the Local Health Integration Networks (LHINs).

Funding letters are expected by June 30.

During the spring budget hospitals were told that their base funding would be 1.5 per cent. That is not turning out to be exactly true.

For starters, the amount is a little bit less – 1.467 per cent.

Secondly, the LHINs are splitting how that money will be distributed. In the Central East LHIN, 0.744 per cent will be given to all hospitals – 10 hospitals would share $8.95 million. The remaining 0.723 per cent will be allocated according to a set of performance criteria set by the LHIN. This amounts to $8.71 million of discretionary funding by the LHIN.

While the Central East LHIN reported that all 10 hospitals in that region will qualify for the full amount – including Peterborough which is facing a significant deficit – the criteria will be more stringent next year.

The criteria set by the LHIN have raised more than a few eyebrows, including LHIN board members who didn’t have input into the weighting of this criteria. The majority of this discretionary funding – sixty per cent — will be dependent on a hospital’s financial performance – whether or not they can balance their budget or follow their financial plan if in deficit. Thirty per cent is dependent on clinical performance, including how they deal with “alternate level of care patients” and wait times issues. Only 10 per cent is assigned based on quality and safety.

Given the rhetoric on quality, the LHINs are clearly not walking the talk.

Next year the hospitals have been warned they will have one additional criteria – the hospital must involve itself in at least three integrations, and be prepared to implement those integrations by the beginning of April 2011.

An “integration” under a LHIN can include partnering with another health care provider, amalgamate services from several providers, transferring services to another entity, coordinating services between providers, or to ceasing to provide a service. Northumberland Hills Hospital, for example, would have completed an “integration” by ending all outpatient rehab services. The public would likely not see that as a desired outcome, but one more likely under this scenario.

Despite the difficulties encountered by trying to establish accountability agreements with private for-profit entities such as nursing homes and agencies, there is no question the government intends to take as much as possible out of the hospitals, divesting what they can from the public coverage (ie. outpatient physiotherapy) and providing the rest in cheaper settings that unfortunately may also be of lesser quality.

Last month the same LHIN suggested they were not getting good reporting from many of these same agencies, and that there was no certainty of the quality of services they were delivering. (See: https://opseudiablogue.wordpress.com/2010/05/18/lhin-discovers-community-agencies-have-quality-and-financial-management-issues/) This month they discovered the perils of a largely for-profit nursing home sector which is telling the government to back off on its efforts to get accountability for public funding. Is this really how we want health care to be delivered?

If this is the early track record, should the government not take a pause and evaluate the situation first? To mandate integratons in this environment is potentially a prescription for disaster.

At the Central East LHIN the board members asked staff about the reaction of hospitals. Paul Barker, a senior director with the LHIN, said hospitals were surprised – “there was not 100 per cent happiness with the direction,” he said with considerable understatement. He explained the hospitals in the region were struggling to meet true inflation costs. The incentive was so small – less than one per cent for all three performance categories – that it may not be material. The hospital administrators said it would have made more sense to offer these incentives over and above their inflation costs.

The penalty for not involving a hospital in three integrations is so small, many may choose to simply ignore the directive. The work and cost of involving the hospital in an integration decision would likely exceed the financial penalty for not doing so.

Video of yesterday’s press conferences in Durham and Kincardine:

DURHAM/KINCARDINE—South Bruce Grey Health Centre is alienating both staff and community as it implements cuts to the four-site hospital in Grey and Bruce counties.

Community and labour groups are calling on the hospital board to listen to community concerns around a plan to dismantle the hospital’s kitchens and truck frozen pre-prepared meals into Ontario’s agricultural heartland.

“Food is such an important component of good health and can assist in the recovery process,” says Natalie Mehra, Director of the Ontario Health Coalition. “There is a growing movement in Canadian and U.S. hospitals towards fresh, local and sustainable foods. To bypass local farmers to bring in the cheapest processed food stripped of many of its nutrients creates waste and diminishes patient comfort and satisfaction.”

“If Paul Davies is expecting to leave a legacy behind, it will be one of chaos and confusion,” says Mary Ellen Pollard, Co-Chair of the Friends of the Kincardine Hospital. “The hospital board cannot ignore the fact that nearly three of every four Kincardine residents polled want to see their hospital taken out of the amalgamated South Bruce Grey Health Centre.”

The Friends group was recently rebuffed by the SBGHC board that ignored their request to a follow-up meeting over a $10,000 consultant’s report on governance commissioned by the community group. The report raises concerns about SBGHC’s board secrecy and the lack of two-way communications with staff and the community.

There is also growing discontent with labour management at the hospital over a botched process to offer exit packages and heavy-handed management tactics aimed at reducing sick days.

Staff morale at SBGHC is failing as the hospital stumbles through a plan to convert support staff into multi-site, multi-purpose workers. Initially expecting to eliminate the equivalent of 15 full-time equivalent jobs, the Centre offered voluntary exits and early retirements to 12 individuals. It has since asked individuals to take back the exit package and is hiring to replace many of the eleven individuals who are being severed at public expense. One employees has agreed to rescind the package.

There are also ethical concerns given the hospital is offering exit packages without an exit date, leaving the eleven workers dangling indefinitely for their severance.

“From a labour-relations standpoint, this is one of the worst hospital employers in Ontario,” says Warren (Smokey) Thomas,President of the Ontario Public Service Employees Union. OPSEU represents administrative and support staff at the hospital. “There have been more than 40 grievances in the last two years, and we expect that figure could double in 2010.”

The union is upset that the hospital is overruling the advice of licensed physicians in making return to work decisions. A staff member who recently underwent surgery was told by her doctor that she shouldn’t return to work for 30 days. The hospital told her she must be back in 10 days.

Dave Trumble, President of the Grey Bruce Labour Council, has pledged support for a coalition campaign to pressure the hospital to listen to the communities it serves and to make peace with its workforce.

OPSEU wrote a letter to the CEO and Board Chair May 3rd offering to sit down and resolve the labour relations difficulties at the hospital. More than a month later the union has received no reply.

The Peterborough Health Coalition hosted a town hall meeting June 3rd to invite members of the public to address the first draft of the regional hospital’s fiscal restraint plan. Given the Orwellian title of a “Hospital Improvement Plan,” the “HIP” calls for closure of 20 beds, the elimination of 171 jobs, and consolidation of services at the new site. Featured speakers included Roy Brady (Peterborough Health Coalition), Natalie Mehra (Ontario Health Coalition) and Michael Hurley (OCHU). Marion Burton from OPSEU also spoke.

To view a short video of the meeting, see below:

Part of the Peterborough Regional Health Centre includes consolidating the rest of its operations at its new suburban facility. For the Women’s Health Centre, leaving the existing downtown location may make the facility less accessible to many clients. The Centre has taken many cuts — there has been a reduction of social work service for sexual abuse, for eating disorders, the resource librarian has been cut as has the “Well Women” programming. Staff cuts means there is also no capacity to nurture and strengthen community partnerships. The lactation (breast feeding) consultant has already been moved out to the main hospital site. Friends of the Centre say the move will make it particularly difficult for young women, young mothers, women without transportation and women with limited financial resources to access women’s health programming.

The Peterborough Regional Health Centre promised its own version of fiscal restraint after this spring’s peer review left the community reeling over the prospect of 71 bed cuts and the loss of more than 150 full-time equivalent (FTE) jobs.

Described as a working draft, the hospital released the new plan this week, limiting bed closures to 20 but looking for additional savings in such clinical areas pharmacy, rehabilitation, mental health, emergency room, sub-acute care, diagnostic imaging, laboratory, women and children’s, and other clinical support.

The new plan calls for fewer cuts to clinical areas such as critical care and medicine. The plan also calls for the equivalent of 20 fewer non-union and management full-time jobs. That would bring job loss to 170 FTE jobs. While it claims it is throwing these managers and non-union staff on the fire, the hospital indicates these jobs have already been eliminated. It is one of the few areas in the hospital’s presentation that they appear to regret, stating the change “may negatively impact managers (sic) ability to be effective.”

The hospital says that the plan is based on 2,400 cost saving ideas generated from front line staff and physicians. The fact that some of these initiatives are underway, or complete, suggests this may not be entirely a “working draft” as indicated in PRHC’s press release. Eight of 26 strategies are listed as either underway or complete.

Telemetry is still left unresolved, although the original peer review called for $800,000 in savings despite the Central East Local Health Integration Network plan to designate Peterborough as a cardiac care centre. Telemetry devices are used for patients who are at risk of abnormal heart activity.

While many hospitals are increasing housekeeping staff as a way to reduce hospital-borne infections, the revised plan reduces housekeeping staff at PRHC by 11.3 FTE jobs. Despite saving 50 beds, the hospital’s plan makes few adjustments to the peer review’s recommendation to cut 131 FTE positions delivering clinical services. Under the hospital’s plan, 124.6 FTE jobs will still be lost in clinical services, leaving many to question who is going to be staffing those 50 saved beds.

With so many fewer staff, the impact on workload may challenge the hospital’s plan to reduce absenteeism costs by $1.4 million, overtime by $1 million, and health and safety by another $500,000. (See Linda Duxbury’s study on Role Overload:  https://opseudiablogue.wordpress.com/2010/02/02/health-care-workers-face-anxiety-fatigue-burnout-as-a-result-of-“role-overload”-study/)

The hospital plan includes raising parking rates, which it has already completed. The report admits this will impact public satisfaction, which they intend to overcome by explaining the need to do so.

The hospital picks up on the peer review’s insistence of reducing length of stay, including reducing the number of days palliative care patients can be cared for in hospital. It is unclear how the hospital will deal with palliative care patients who refuse to die within timeframes established as Ontario benchmarks.

While the hospital is now engaging the public, physicians will be specifically engaged over reductions in their remuneration. Nearly one in five local physicians are expected to retire by 2016. Without the means to attract new physicians, Peterborough could struggle to find replacements.

Reducing clinical staff could backfire in the near future given the region is expecting substantial numbers of health professionals to retire within the next five years. In a report from Employment Ontario, it is estimated about one in five regional health professionals would retire from 2006 to 2016. That includes 19.1 per cent of general practitioners and family physicians, 38.1 per cent of medical laboratory technologists and pathologists’ assistants, 29.1 per cent of registered practical nurses and 22.8 per cent of registered nurses.

While these retirements may allow for a greater opportunity to reduce overall staffing levels, it will leave remaining staff with heavier workloads and patients less access to the care they deliver.

After the peer review castigated the board for assuming funding would some day come, the new plan does assume $2.6 million would arrive in the form of a funding increase for 2010/11. This may be realistic given the provincial budget did state it was passing on a 1.5 per cent increase in core funding for this year.

Neither the peer review nor the hospital’s plan will make it possible for Peterborough to balance its budget in this fiscal year, although the hospital says a balanced budget will happen March 31, 2012.

In March the Central East LHIN approved an extension to the hospital’s accountability agreement under the assumption that $26 million in “efficiencies” would be found this year. However, for Peterborough to default on its accountability agreement with the LHIN is hardly news anymore.

The total budget is estimated to be $246 million by 2012. While 170 FTEs are being eliminated, the hospital clearly plans to hire some back, given it is estimating 141 fewer staff by 2012. The PRHC presently has 2,141 staff.

Given the Orwellian name of “Hospital Improvement Plan,” (HIP) the new restraint plan is expected to go to the PRHC board June 28th and to the CE LHIN for final approval July 20.

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The Peterborough Health Coalition is hosting its own forum on the new hospital plan:

Public Meeting – Health Care Cuts at the Peterborough Regional Hospital
Thursday, June 3rd / 7 pm
Evinrude Centre – 911 Monaghan Rd., Peterborough
For more information, call 742-4826 / 745-2446 / 742-5326

Beds on the chopping block at Cobourg’s Northumberland Hills Hospital may receive a reprieve after the Central East Local Health Integration Network agreed today to enter into negotiations to fund 11 interim long term care beds and open up to eight more restorative beds.

This winter the community learned the hospital planned to balance its budget by eliminating 26 beds, closing its diabetes clinic and cutting all outpatient rehab services.

The CE LHIN board made it clear the funding was one-time only. The LHIN had looked for community proposals to take the patients who would likely be orphaned with the closing of these beds. There were no immediate facilities willing to take this on, however, a former Port Hope retirement home has expressed interest in renovating towards becoming a 20-bed convalescent care home.

While the LHIN is treating the two events separately, there is little doubt that the hospital beds may again be at risk once the Port Hope facility opens.

Funding to keep open the hospital’s existing interim long term care beds will come from the LHIN’s Aging at Home fund, although these funds will be incorporated into the hospital’s budget.

The funding became available when a retirement home in the region had decided it was not going to upgrade its facility to accommodate the new requirements of the Ministry of Health to accept Lakeridge Health’s alternate level of care (ALC) patients.

Some of those beds have also been reallocated to a Bowmanville retirement home with close ties to a nearby nursing home.

According to the LHIN, ALC patients who are in these beds will no longer be considered ALC for statistical purposes, as they will be receiving care in an appropriate setting. Why they were previously counted while in the same beds is an open mystery.

Last week the community held a rally in front of MPP Lou Rinaldi’s constituency office. Rinaldi came out to address the group, stating he was working on a plan to save the outpatient rehab services.

OPSEU had used the Freedom of Information process to secure any correspondence between the Ministry and NHH regarding the closure of the diabetes clinic.

Closed at the end of April, the clinic had served 2800 residents. While a Port Hope clinic said it was able to take 500 of these patients, it left 2300 Northumberland County residents without any diabetes support. Since then the Ministry has told doctors that patients can be referred to the Peterborough, Campbellford and Quinte hospitals. Quinte has also recently closed its diabetes outreach from its Picton site.

Suprisingly, OPSEU was told by the Minstry’s Access and Privacy office that no such correspondence existed on the diabetes clinic between the Ministry and NHH. How could the Ministry lose access to a program in an entire county and have no written correspondence with the hospital?

When OPSEU met with the Minister of Health’s policy advisor on this issue, she suggested that these patients could return to their doctors. However, the region’s doctors had been asking the hospital where they should be referring these patients.

During the meeting one of the board members expressed the hope that the community would view the Local Health Integration Network has having responded to their concerns. Clearly, with regards to Northumberland County, the LHIN still has a long way to go.

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May 19th the Northumberland Hills Hospital issued a press release stating that all 110 of its beds would remain open due to the current lack of community alternatives for the hospital’s alternate level of care patients. The announcement will not alter the hospital’s original plan to cut its diabetes clinic and outpatient rehab services.

April’s release of the peer review into the Peterborough Regional Health Centre has unleashed a storm of criticism after recommending the closure of 71 beds and reduction of 151.5 full-time equivalent jobs at the hospital. After years of planning and building the new hospital, the cuts would take it to below the bed count it originally had at the Civic Hospital and St. Joseph’s Health Centre.

Having raised funds and paid dearly for the local share of the new hospital’s costs, Peterborough’s residents are understandably upset about this turn of events.

If the bed cuts take place, it will mean about a third of the new hospital beds will remain empty and unstaffed.

Worst still, the Peer Review indicated that at the “leap of faith” the LHIN took in approving its accountability agreement in March may be in vain – as drastic as these proposed cuts are, the Peer Review indicates that there will not be sufficient savings this year to balance the budget.

Did the Peer Review get it right?

What is remarkable in the final report is how little reference there is to anything learned on site by the peer review. Most of the recommendations are based on provincial benchmarking, not on local conditions. Surprisingly, given the Peer Review questions the quality of much of Peterborough’s data, it is not hesitant to make major decisions based on what it feels the data should be.

There is little reference to the high percentage of seniors Peterborough serves. Nor is there any reference to seasonal fluctuations resulting from an influx of summer cottagers. Nor is there any reference to what some patients say are high cancer rates in the city. All of these are considerable factors that draw on services from the hospital.

Further, in most of the performance metrics the Peer Review considered, most are actually middle of the pack or better, suggesting the Peer Review isn’t looking at Peterborough because its badly operated, but because of its burgeoning deficit.

Some examples: Four of its six safety indicators are better than the provincial average.  It indicates its ER is already efficient, boasting the third lowest rate of admission from emergency department visits among 21 peer hospitals.  The average length of stay in the intensive care unit for medical patients is among the lowest in the peer group, 15^th of 21 hospitals.  Average length of stay for surgical patients in the ICU is 11^th of 21 hospitals.  It states the surgical program operates very efficiently, usually putting it in the top 25 per cent provincially. Average length of stay for in the newborn and neonatal unit is 5.12 days, placing Peterborough 13^th of 21 peer hospitals. The report lauds the mental health program as “one that is effectively managed.” It says the hospital’s end-stage renal disease program is generally efficient.  While larger than it needs to be, the peer review said it was impressed with the equipment and physical plant of diagnostic imaging. While complaining about the wait for non-urgent CT scans, it does acknowledge the hospital is providing many more scans than they are getting paid for. It says the lab is “very efficient in its utilization of laboratory procedures” – the fourth lowest. It said the management of medical and surgical supply costs was among the best.

Further, the execution and redevelopment of the hospital is described by the Peer Review as “excellent,” the construction on budget and with very few change orders compared to other such projects.

These are hardly examples of a hospital that is being badly run.

Some of the comparisons are flawed, given not all of the peer hospitals offer the same level of service. For example, it states PRHC has the 3^rd highest costs in interventional cardiology and angiography when compared to its peer group. Many of these peer hospitals do not even offer angiography.

Many of the recommendations are contradictory.

While the peer review acknowledges the difficulties in retaining hospitalists, it actually proposes decreasing their annual income to save money. How will paying hospitalists less actually improve retention?

It complains of the number of alternate level of care (ALC) patients, but then the report suggests that the hospital may have been designating more patients as ALC than the definition warranted.

While it proposes cutting 71 beds, it expects Peterborough to make available 20 to 30 beds every day at midnight in order to accommodate the following day’s admissions. It also states that patients are left in intensive care longer due to a present lack of available medical beds. How will fewer beds change this situation? Surprisingly, it complains of a lack of revenue from premium accommodations, yet acknowledges they won’t even have these beds if their plan is implemented.

Up until the time it moved into the new amalgamated facility, Peterborough’s expenses and revenues ran a roughly parallel path, expenses slightly higher than revenues. However, while the expenses continued on a rather predictable path, revenues started to flatten after the move to the new hospital.

Had funding for Peterborough been modestly better over the last six years, the financial situation would have never gotten this out of control.  Today Peterborough has a working capital deficit of almost $90 million.

What is remarkable is the number of recommendations that involve more funding, not less. Nowhere are these new expenditures totaled.

The report is most scathing when it describes the assumption made by the hospital’s leadership that additional funding would be coming.  Had funding come years earlier, Peterborough today would be a reasonably well-functioning hospital by any standards.

The report also ignores the 11 other hospitals the province chose to rescue from dire financial straits. Was it reasonable to expect the same would happen for Peterborough? Yes.  So why didn’t it?

The bottom line is Peterborough is a large regional health care provider that needs to be funded appropriately to get the job done. Too many of the assumptions and recommendations in the peer review are pie in the sky, reliant on external conditions that simply don’t exist. It is compared to peer hospitals that often operate in large urban centers where multiple hospitals are present.

The Peterborough area has too few long term care beds. The Central East CCAC is struggling financially – this winter it was only accepting the most acute patients. The LHIN has some money for interim ALC beds, but it’s not nearly enough for the region, and there is no indication that enough retirement homes will be willing to step up their facilities to take on these patients.

This winter’s peer review is a deeply flawed document. The province needs to first provide all the post-construction funding Peterborough was promised, and next look at how it can help the hospital get on firm footing without gutting the needed regional services the hospital was initially built to provide.

On these pages we have run numerous reports of US private hospital bankruptcies. In today’s Toronto Star Gillian Steward reports on a private Alberta hospital that declared bankruptcy last week. Like its counterparts in the US, the public will end up picking up the pieces from the Health Resource Centre, which was under contract to Alberta Health Services to perform surgeries the other Calgary hospitals couldn’t handle. Calgary faced a shortage of operating rooms after former Premier Ralph Klein closed three public hospitals in the city. The HRC had been paid 10 per cent more than the cost of providing surgeries at the public hospitals. Obviously it wasn’t enough. Now Alberta has gone to court to pay the receivership fees in order to keep the place operating. Meanwhile, New York city is trying to rescue another hospital from bankruptcy after the legendary St. Vincent hospital was forced to permanently close its doors this spring. Westchester Square Hospital, a 205-bed facility in the Bronx, has come up with a five year survival plan. The hospital had last declared bankruptcy in 1997. Meanwhile the city’s public hospital system is planning on laying off another 500 workers. … After a 28 day strike, nurses at Philadelphia’s Temple University Hospital defeated management’s plan to break their union and impose a gag rule to prevent the nurses from criticizing the hospital. Temple spent an estimated $5 million a week hiring scab labour, providing transportation, housing, food and security. The nurses made the strike about quality patient care. To view a video of the strike, see below:

Faced with significant cuts to their hospital, Cobourg residents are planning a protest in front of their Liberal MPP’s office this Thursday at 4 pm.

Northumberland Hills Hospital has lost a diabetes clinic, all outpatient rehab, and 26 inpatient beds in the latest round of belt-tightening. Whereas other Liberal MPPs have secured additional funding to save or enhance services at their hospitals, the local community sees Lou Rinaldi, their local MPP, as doing little beyond offering excuses.

The demonstration will take place in front of the Fleming Building, 1005 Elgin St. W. in Cobourg at 4 pm on May 13th.

For more information, contact either Linda (416-809-2601) or Peggy (905-885-4005).