March 23, 2009
Mr. Gary Switzer, CEO
Dear Mr. Switzer,
I am writing you today in advance of your public consultation meeting this Friday in Wallaceburg regarding the Small Community Hospital Emergency Department Study. While you have not extended an invitation for me to attend, or provided me with any information relative to these matters which are of grave concern to my constituents in Lambton-Kent-Middlesex, I nevertheless I want to advise you I have been asked by my constituents to attend this meeting and I plan to do so.
I do have a number of comments and questions I would like to pose to you prior to the meeting in the hope that you will address them, so that I in turn can provide accurate and helpful information to the scores of questions and concerns I have received from my constituents by phone, fax, email and personal contacts.
This past Friday a delegation of several hundred concerned citizens presented themselves at my Wallaceburg office with a request that I assume a larger role in assisting them as they seek to have their concerns addressed. I am pleased to honour their request. I am cognizant of the fact that the Federal Government has no role that is apparent to me in the delivery of health care services in the Province of Ontario. Nevertheless, what is of concern to my constituents is a concern to me. I can assure you my constituents are very concerned.
However, as you will know the Government of Canada does by way of transfers to the Province of Ontario under the Canada Health Act provide approximately 20 percent of Ontario's health care spending. In addition the Government of Canada provides funding for specific national priorities including funding to Aboriginal peoples and to reduce waiting times among others. And it is in this regard, constituents of my riding have asked me to address some of their concerns.
In order to do this I have reviewed a number of documents including the following:
1. The Small Community Hospital Emergency Department Study by the Hay Group dated January 23, 2009
2. The Operational Review of the Chatham Kent Health Alliance by Deloitte dated January 28, 2009
3. The web sites of the Erie St. Clair LHIN and the Chatham-Kent Health Alliance
4. Various media reports detailing public statements made by yourself and the CEO of the CKHA
5. Emails and letters from concerned citizens
6. Strategic Planning Retreat by the CKHA dated May 28, 2004
7. News Release from the LHIN and the CKHA dated March 11, 2009
Following my review I would now like to offer you the following comments, concerns, questions and suggestions.
1. Comments regarding consultants reports by the Hay Group & Deloitte
Throughout my public life I have had the opportunity to review numerous reports prepared by consultants. Some are good and some are not so good. I will limit my comments to what are simply my impressions of the two noted above, which in my view would fall into the latter category, or the "Not so good."
Reports from people with particular expertise in a given field are quite often informative and necessary in the process of sound decision-making. Good reports detail the following:
1. A terms of reference detailing the rationale for engaging a consultant, who is engaging the consultant, a scientific methodology for those matters for which outside expertise is being sought and the particular expertise and experience of the consultants.
2. A clear identification of the primary issues
3. A clear presentation and detailed analysis of data and reference material
4. Recommendations based on the analysis and which detail how the recommendations which if accepted and acted on materially and positively address the objectives for which the consultant was engaged.
5. Written in a manner that is clear, concise and understandable.
In my personal opinion, both of the reports noted above fail on virtually all counts. With respect to point five in particular I am of the view the amount of bafflegab is unsurpassed in any reports I have ever read.
Beyond that it is unclear to me, particularly with respect to the consultants who conducted the Emergency Department study their qualifications and expertise to carry out such a study. With respect to the Sydenham Study the consultants noted as primary in their Summary and Directions for Change the following:
1. Low visit volumes
2. Difficulties with recruiting staff
3. A physical plant which does not meet standards
In my review of the biographies of the consultants detailed in the report I find no relevant work experience which would satisfy me that have the expertise to provide relevant information related to their recommendations. Perhaps they do but one would think that such information would be important enough to include in their biographies, if for no other reason than to firmly establish their credentials as experts.
It is not my intention to be too harsh in my critique, so let me acknowledge that the scope of their work would be limited to those areas for which they were engaged to do. If in fact, the terms of reference they were given by those who contracted them, were either unclear or limited then the failure must fall to those whose responsibility it was to provide a clear and complete direction. In this case, these failures would belong to the LHIN and the CKHA.
As important as the matters detailed in these reports may or may not be, what I find surprising and quite frankly unacceptable, are those matters which are not addressed and which may have led to the current circumstances which required these reviews. This again constitutes a failure by the LHIN and the CKHA. I draw attention to the marked contrasts between these reviews to put forward a financial recovery plan and those conducted in 2004 to increase market share and be the hospital of choice. Based on the information detailed in the reports it would appear efforts to increase market share and to make the CKHA a facility of choice have failed given the fact that patient volumes have declined at both hospitals in the CKHA.
Neither report deals in any substantive way with the circumstances and the decisions made since 2003 by senior management at the CKHA and which may well have led to the current dilemma. In this regard, I would make the following comments as they relate to the Summary and Directions for Change.
Low Patient Volumes
If in fact patient volumes at the Sydenham Hospital ED are low, then why? The report seems to indicate as the primary factor the declining economic situation in the region. While this is no doubt true, I fail to see the relationship considering the population and community needs have not materially changed since the hospital was first constructed in 1957. Indeed the situation now would seem to indicate the opposite, in that the current needs are even greater now than they were in 1957.
In my view it would have been useful for the LHIN to review the decisions made by the CKHA over this period in order to measure their impact and how they may relate to the current situation. Some of those decisions include a drastic reduction of services at the Sydenham Hospital. Business people will tell you that you cannot sell from an empty shelf. The following facts are in evidence:
1. The CKHA has run multiple deficits since 2003. This constitutes a failure by the CKHA to properly manage resources.
2. As a result, at least in part, the CKHA closed the Intensive Care Unit, the Obstetrics Department and the Mammography departments and greatly reduced a number of other services in laboratory, rehabilitation, digital-imaging and operating room services.
I claim no more than common sense but it would seem no one should be surprised that patient volumes go down when you reduce and eliminate services. That patient volumes have declined at the Sydenham Campus constitutes a failure by the CKHA, particularly when their stated objectives in 2004 were to increase market share and to be the hospital of choice.
Difficulties with Recruiting Staff
1. To the best of my knowledge the last physician or specialist recruited for Wallaceburg and the Sydenham Hospital was in 2002, almost seven years ago. That the local complement of family physicians and specialists was both ageing and declining was apparent and noted in 2004. The report seems to lay blame for this unfortunate situation at the feet of the community. However the CKHA has had a physician recruitment process in place for at least five years and while excuses may be plentiful, the fact of the matter is only results matter. The CKHA has failed to recruit adequate staffing for the Sydenham Hospital and the Community of Wallaceburg. And again, in my view the elimination of the Emergency Department and the medical beds at Sydenham Hospital will further complicate medical staff recruitment and retention, especially if family physicians have to spend 1-2 hours per day travelling to Chatham to care for their patients.
Physical Plant does not meet standards
1. Other than the visibility of the ED waiting room and doors that close in the department's cubicles, which would seem to be relatively minor renovation projects, the report fails to disclose major structural projects which would require significant capital investments. If there are, such information would support the conclusion. I understand there was a report prepared in 2005 that the CKHA is refusing to release. I do not understand their reluctance to disclose this information if in fact, it supports the recommendations detailed in the ED Study.
2. To the extent there may be a need for major structural projects, they should have been identified and appropriate steps should have been taken at the time they were apparent to address them. To the extent they were not, this again constitutes a failure by the CKHA.
3. I have also received information from staff and patients regarding the inadequacy of routine maintenance, i.e. painting, cleaning, repairs etc. To the extent these may be true; this again would constitute a failure by the CKHA to allocate sufficient resources to do those things which Canadians do every day in their own homes.
Claims detailed in the reports and in public statements from the CKHA of inadequate funding and increasing expenses I find to be dubious at best considering the fact that the CKHA has continually added new programs and services. It seems to me a more prudent approach and again, that practiced by most Canadians is to take care of the necessities before spending on luxuries. I doubt there are many people who when faced with a situation where they cannot pay their mortgage would go out and buy a new car or an MRI machine. Similarly it baffles me when the CKHA claims poverty and yet continues to expand programs and services that are available in larger centres. And in this regard I would note the Federal Government has increased transfers to the Government of Ontario under the Canada Health Act by six percent last year and six percent this year in addition to funding to reduce wait times.
1. My constituents believe that decisions made by the CKHA over the past number of years were motivated at least in part to diminish services at Sydenham for the purpose closing the hospital. Based on the information currently available there may be some merit to this view. If you fail to recruit staff, if you fail to properly allocate resources, if you ignore the physical needs of the structure and then use those failures as a rationale to further reduce or eliminate services you have effectively taken the steps which have resulted in the current crisis. These are factors which should be considered by the LHIN prior to making any decisions with respect to services at Sydenham Hospital.
2. The report by Deloitte specifically cautions that implementation of the recommendations do not address the current operating deficit. As the basis of a fiscal recovery plan this seems inconsistent with the objective.
3. I believe there needs to be a detailed analysis as to why the current fiscal crisis exists. What decisions by the CKHA have led to this situation? To use a medical analogy if the recommendations are treating the symptom and not the actual disease, it becomes an exercise in futility because you will find yourself back in the same situation in a year from now or two years from now. Has the LHINS analyzed management decisions and if so, what were the conclusions and will you make this information available?
4. Constituents in my riding are angered that money they have donated to Sydenham Hospital over the years to acquire assets specifically for Sydenham Hospital have been misallocated by the CKHA. If in fact this is true and if there wasn't clear consent from the donors at the time of their donations, then they have a legitimate point. Can you clarify as to whether or not, assets acquired at least in part with public donations have been removed from Sydenham and sold, disposed of or are in use by another hospital? If so, then at the very least the CKHA has a moral if not a legal obligation to reimburse or provide consideration to those donors.
5. With respect to the volumes at Sydenham Hospital it seems to me the CKHA and the LHIN have adopted a counter intuitive approach. In noting the five categories of the Canadian Triage and Acuity Scale it seems to me that category 1 and 2 would be a priority for the people who use Sydenham. Certainly, given a choice between receiving services locally for heart attack, stroke or trauma as opposed to categories 3, 4, and 5, people in my riding would opt for categories 1 & 2.
6. Certainly one of the things that have profoundly disappointed me this process has been your failure to study ways to keep Sydenham Hospital open and providing the excellent care it has to the community for the past 52 years with all its services intact. Again, if you have done this, I would like to see that consultant's report as I am sure would my constituents.
In section 3 under the Canada Health Act with respect to purpose it says this:
It is hereby declared that the primary objective of Canadian health care policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers. (Emphasis mine)
In my review of the information currently available, there is in my estimation a failure on behalf of the CKHA and the LHIN to look at the current issues from a purely business perspective and with that a failure to comply with at the very least the spirit of the CHA, particularly as it relates to section 3.
There is also in my view a failure in this approach to understand the tradition and history of this great country and a failure to recognize the role of individual Canadians over our 152 year history in forming the society we are - a society I might add that is the envy of the world.
From solely a business perspective, Canada does not make sense. It didn't make good business sense to build a national highway, railroad, broadcasting company or Medicare system. But we did those things because we are a caring and compassionate people in a way that distinguishes us as unique in the world. I am not unmindful of the principals of good stewardship, especially as they relate to the public purse. But I want to remind you it is neither the only thing, nor the most important thing. Canadians do the right thing because it is the right thing to do. So when you characterize the legitimate opposition by my constituents as their refusal to accept change or you patronize them as not being capable of understanding the importance of these issues you do them a great disservice and you should not be surprised at the outpouring of anger you are now hearing. Calling a group of concerned citizens an "advocacy group" and then refusing them the information that allow them to assist you fails the test of transparency and accountability. Rather, I do hope you will listen to them. Believe me, they know as much about healthcare as you do and they have a valuable and positive contribution to make in resolving this crisis in a way that is acceptable to you and to them.
So, the question is where do we go from here? You can continue on your present course which will never satisfy the community's interests. This would be wrong.
Or you could opt to take a step back and take a deep breath. You can do this by immediately placing an indefinite hold on implementing any recommendations with respect to Sydenham Hospital. During this time, you should take the opportunity to address the concerns and questions of my constituents. You need to measure twice and cut once. You have in my view, much more work to do before you carry out any of these recommendations and you will not be able to accomplish this in the timeframe you have identified. You need to have a serious look and do a thorough evaluation of the administration at the CKHA and you must deal appropriately with their shortcomings.
I realize this writing has been lengthy and I do appreciate your indulgence as you may consider what I have had to say on behalf of my constituents. Failure to do so would in my view constitute another failure on top of all the other failures I have detailed in this writing and which will only further compound these issues and others in the future.
Obviously I lack the authority to compel you to do anything with respect to the delivery of health care services in Ontario. However, I will be forwarding copies of this correspondence to those noted below in the hope that those who do have authority beyond mine will consider these issues to act accordingly and to further consider what are irrevocable decisions.
I thank you for your time and I look forward to your response.
Bev Shipley, M.P.
This was released by Bev Shipley's office. It's long, but salient, so we'll post the whole letter.