Category Archives: Hospitals

Algoma residents asked to drive 85 kilometres or more for a blood test

Not everyone may be aware of Thessalon.

The small retirement community is on the north shore of Lake Huron and bills itself as the “gem of Algoma.”

Last October the hospital closed the doors of its medical laboratory to outpatients. This affects a region of about 9,000 people who live to the east of Sault Ste. Marie.

This is not unusual. Thessalon was already an outlier given most hospitals have already closed their doors to outpatient medical laboratory testing. Nobody will say it’s a policy. It just… happened.

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Niagara and Peterborough hospitals struggle with “improvement” plans

The Niagara Health System and the Peterborough Regional Health Centre are frequently on the radar of the public, and presumably, the Minister of Health and Long Term Care.

While hundreds of kilometres apart, both have accumulated significant debt from years of running operational deficits and both are struggling with unrealistic hospital improvement plans (HIP).

This week both made the news.

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Musyj “very concerned” even though “nothing dramatic changing” – huh?

If you regularly read these pages, you’ll notice that we have been sounding the alarm for some time now about the surge capacity of hospitals.

If you have an average occupancy of 98 per cent, what happens when you have a bad flu season or there is a significant pandemic in the community? You can’t, as Spinal Tap’s Nigel Tufnel recommends, turn it up to 11.

One of our favourite targets here at the Diablogue is Windsor Regional Hospital CEO David Musyj, who has a habit of blaming everyone but himself for his hospital’s ongoing woes.

Musyj is back in the media this week telling Windsor residents to think about going elsewhere after the holidays given his already clogged emergency room at the Metropolitan Campus is going to get worse.

The fact that the ER is clogged during a traditionally quieter time is “making us very concerned about what we’re going to see after the holidays,” Musyj told the Windsor Star.

Less you worry about your ability to get treated after that somewhat uncooked turkey, Musyj also says “there is nothing dramatic changing one way or another.” Huh?

Musyj says he will have extra beds to fill with those emergency patients, but doesn’t say where they are coming from.

Maybe it’s a slow news day in Windsor. Then again, it could be yet another early warning that cutting all those hospital beds over the last decade may have gone a little too far.

Is McGuinty quietly adopting the Walker report?

August 31st the Ontario Ministry of Health did a curious thing. They posted on their website a report by Dr. David Walker, who had been appointed ALC lead back in January. There was no press release, no press conference, no op/eds were written supporting Walker’s 32 recommendations. Walker had submitted his report at the end of June, and for two months the government mulled it over before deciding to make it public on the eve of an election. During that election there was virtually no talk of Walker’s report.

ALC is the term for alternate level of care patients — those who have completed their acute care treatment in hospital but are not stable enough to return home.

Normally this kind of treatment of a report indicates a “thanks, but no thanks” attitude by government. However, at a meeting with public service reform commissioner Don Drummond, the Ontario Health Coalition was told that the government has actually accepted the recommendations of Walker.

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NDP promise to re-open Niagara ERs, raising questions about the role of smaller hospitals

NDP Leader Andrea Horwath promised to re-open the closed emergency rooms in Fort Erie and Port Colborne should voters put her in the Premier’s chair.

The NDP told reporters it would cost $10 million to reopen the two Niagara region facilities.

Confidence in the Niagara Health System has been flagging in recent years, resulting in the August appointment of Dr. Kevin Smith as supervisor. Smith is CEO of nearby Hamilton St. Joseph’s Health System. This year 33 people died at the hospital from complications resulting from the C. difficile outbreak at the Niagara Health System.

The issue raises the larger matter of the role of smaller community-based hospitals. In recent years, communities have been fighting to maintain their hospital services amid plans to close local hospital services, including emergency rooms.

Petrolia and Wallaceburg have both headed off potential closures of their emergency rooms. During one local area consultation, residents in Wellington-Waterloo Local Health Integration Network were told that they may have to choose between the Mount Forest and Palmerston hospitals. Both remain intact — for now.

In St. Mary’s Ontario, the local hospital faced overnight closure of its ER, which would have effectively made it an urgent care centre. So far the ER remains open 24/7.

Other communities have not fared so well. Shelburne lost the last of its hospital services. Residents now have to travel south to Orangeville. Burk’s Falls also lost its bedded facility attached to Muskoka Algonquin Health Care. Fort Erie and Port Colborne both lost their ERs.

When OPSEU first met with Health Minister Deb Matthews, she was adamant that better quality care was dependent on Ontarians migrating to larger facilities where the volume of procedures were higher.

The Liberals themselves argued against this when in opposition, successfully challenging the Harris government’s plan to close the cardiac unit at the Children’s Hospital of Eastern Ontario, forcing Ottawa-area children and parents to Toronto. At the time the Tories argued there was an insufficient volume of work on the unit to maintain clinical proficiency at the Children’s Hospital unit.

The province formed a panel in 2008 to look at the question of rural and northern health care.

The panel recognized that people in rural settings were more likely to live shorter lives, have poor to fair health, and much more likely to be overweight.

They found that hospitals tended to be default health care providers in the absence of other services.

The real battle over the future of Ontario hospitals is not as likely to be fought along Toronto’s University Avenue as it is in the dozens of rural and northern communities across the province.

Clearly these hospitals need to fit into a larger plan that will look at improving health outcomes in these communities, not just in sending the sick to the bigger cities to find treatment.

OHA clarify estimates from curbing CEO salaries

Recently a Canadian Press story claimed the NDP planned on saving $80 million by capping the salaries of hospital CEOs at $418,000.

Clearly CP got it wrong.

The math appeared to way off given there are only 152 hospital CEOs in Ontario. That means the average salary would have to be in excess of $944,000 each to produce a savings of that magnitude.

There are some big earners out there, such as Dr. Robert Bell, chief executive of the University Health Network, whose salary was $753,992 in 2010. But nearly a million bucks each? No way.

The Ontario Hospital Association was evidently miffed by the CP report and issued their own press release clarifying the situation.

According to the OHA, if implemented, the NDP policy would save approximately $3.7 million annually at the hospitals. After requesting a correction, subsequent versions of the CP story stated that the NDP “plans to find the money by capping the salaries of public sector executives – including hospital CEOs at $418,000” – which they say will free up about $20 million a year, or $80 million over four years.

According to the OHA, 33 of Ontario’s 152 hospital CEOs make more than the proposed cap (including benefits). Based on the 2010 Sunshine List, 77 of the 207,000 people employed in hospitals, including CEOs, senior management, physician employees and other clinical staff reported a remuneration level (including benefits) higher than the proposed NDP cap of $418,000.00 for CEOs.

Royal Ottawa: Is the private operator trying to push costs onto the public payroll?

Approaching its five-year anniversary, a new wrinkle has developed between the private developer and the public tenant over the cost of dieticians at the Royal Ottawa Health Centre.

The hospital has twice tried to advertise a position that should, under its contract, belong to Carillion, the P3 operator.

The blurring between public and private has been a continual problem at the mental health hospital.

Now the private consortium is trying to offload one of its costs – for an administrative dietician – on to the hospital payroll. The question is, if Carillion is supposed to be providing this service, why is the hospital being asked to essentially pay twice for the same service?

Having originally listed the position as an administrative dietician, the hospital corrected the situation by re-advertising for a charge dietician — a position that works directly with patients to recommend appropriate diets. However, the job description is still mostly that of an administrative dietician, which is responsible for working with food services in preparing the diets.

It appears the hospital and Carillion have simply changed the title to duck responsibility for the costs.

The Royal Ottawa has had continual food services problems since moving into the privatized facility in 2006. Part of the problem has been the lack of appropriately credentialed staff in food services, which is the responsibility of Carillion.

It is not the first time there has been a dispute over costs at the hospital, managers claiming after the first year that the lack of access to the services contract means they are continually asked to pay for costs our of their clinical budgets.

The Royal Ottawa Mental Health Centre opened October 27, 2006 claiming to be on time and on budget. However, staff quickly complained to the Ministry of Labour that they had been moved into the building prematurely and faced significant safety risks as construction continued around them.

After delays with the other P3 – Brampton’s William Osler Hospital – there was a significant push to validate the privatized option by showcasing the Royal Ottawa. There was also one other incentive to move in early – the private consortium would not be paid until the premises were occupied.

The ROMHC was originally designed to hold 284 beds at a cost of $95 million. It opened as a 188 bed hospital costing $146 million under the P3 arrangement.

In 2010 Carillion’s international operations posted almost $300 million Canadian in reported profit, an increase of 24 per cent over the previous year.

Musyj calls for hospital mergers despite lack of supporting evidence

Windsor Regional Hospital CEO David Musyj is suggesting the best way to bend the health care cost curve is to amalgamate his hospital with Windsor Hotel Dieu Hospital.

As usual, Musyj lacks any evidence to support his suggestion, made before an audience of Rotarians in that city.

He may instead want to look at the independent Canadian Health Services Research Foundation web site, which says there is no evidence that such mergers save money.

“While the intuitive appeal of ‘bigger is better’ in hospital mergers is powerful, it’s clear the empirical evidence is weak and the potential for negative outcomes significant,” the Research Foundation states.

The Foundation warns that mergers are particularly difficult on staff morale, which has a direct impact on the quality of patient care.

They also note that mergers can disrupt services and absorb more management attention during a transition period, also affecting patient care.

The Windsor Star notes that the merger may be a tough sell given the last such merger cost the region two hospital sites and beds.

When mergers do occur, senior management usually go cap in hand to their boards, asking for more compensation to deal with the greater responsibility they now face.

Other money saving ideas Musyj gave the Rotarians include cuts to outpatient services and charging patients a fee for emergency room visits – the latter a clear violation of the Canada Health Act.

Musyj said Ontario needed a Royal Commission to look at the way the province delivers health services.

He also defended the LHINs, suggesting moving administrative offices to London or Toronto would not be in the best interests of his community.

Video: Peterborough’s “improvement plan” not working — staff

Only in Ontario can you eliminate between 250-300 positions caring for people and call it a “hospital improvement plan.”

Professional and support staff at Peterborough Regional Health Centre were joined by members of the local health coalition to speak out September 6 about the state of their hospital after implementation of the plan.

The workers — represented by OPSEU, ONA and CUPE — held a short rally outside of MPP Jeff Leal’s constituency office on the day before the Ontario election. Despite advance warning, Leal was not present.

To watch a short video of the event, click on the box below:

Peterborough Regional Health Centre and the elephant in the room

Peterborough Regional Health Centre CEO Ken Tremblay certainly tries hard to fit in with his community. The reality is he was sent in to do a job – downsize an active regional hospital in order to tame a budget deficit. That doesn’t always make you the most popular guy in town.

Ken Tremblay also writes a BLOG which is posted on the hospital’s web site. The BLOG contains entries about health care, restructuring and the importance of hand washing. It also features some folksy bits and pieces about Ken, including a picture of his dog Charlie.

Recently Ken posted about his “staycation” this summer in which he spoke about doing some odd jobs around the house, playing a little golf, and doing some recreational reading. Last year he even included pictures of himself atop an elephant as he described his vacation in Thailand.

Nobody begrudges Ken his vacation. As for the little personal anecdotes, it’s nice to know who your boss is.

However, the situation for workers back at the hospital has not exactly been rosy under Tremblay. While the CEO tells us about his splendid vacations, back at PRHC workers are being denied their summer vacations due to staff shortages.

With 250 to 300 fewer staff at PRHC, the hospital is having difficulty filling shifts and maintaining service. The performance dashboard the hospital posts on its web site is full of red and yellow boxes indicating the hospital is not meeting quality targets. Under Tremblay’s watch, for example, the PRHC went from having a better than average standardized hospital mortality ratio to a much worse one. While earlier this year Tremblay boasted to the Local Health Integration Network that the hospital was ahead of its target to reduce overtime, the reality is there is much anticipation that the overtime numbers will be more than just “creeping up” over the summer.

Further, workers tell us that the hospital is also doing more contracting out to replace the work of the people they let go, calling into question whether these layoffs will really lead to permanent savings.

Hospitals use something called the “NRC Picker” to survey staff satisfaction. While staff tell us they were surveyed over the winter/spring, the posted numbers are much older — from September 2010. We have to wonder why.

A year ago Peterborough scored 29.9 per cent on staff engagement and satisfaction. The average in Ontario for the standardized survey is 55.1 per cent. That means less than one in three staff at the hospital expressed satisfaction with their work.

How PRHC expects to improve quality and efficiency when staff morale is so poor is an open question.

Denying front line workers their vacation while writing about yours is not what we would call good leadership. That’s the elephant in the room, and we saw the pictures of who was riding it.

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Workers at Peterborough Regional Centre are picketing MPP Jeff Leal’s constituency office on September 6th at 4 pm. It’s the last chance to put pressure on the MPP to address quality issues at the hospital that have resulted from staff cuts and underfunding. On September 7 the provincial election officially begins. Please join us!