LHIN -- further thoughts on this topic by Dr. McNamara Dr. McNamara is encouraging all of us to feel free to forward this to any/all persons that you think might find this of interest. as an fyi, this issue is gaining attention. local efforts have caught the attention of CTV news. they will be in town tomorrow to chat with Don Copping and Fran Moreau who have the recently organized and are representing a Committee of Concerned Citizens. Gerry Hello All; Firstly, thank you for all the hard work you’ve done to date in supporting us and our work at GBGH. It has been a difficult decade with many challenges and changes, not all for the better. I’ve spent considerable time reflecting on the issues and challenges facing us at GBGH and, in particular the responses we’ve received from the LHIN to our numerous requests for financial assistance. As you know, I ano longer the Chief of Staff at GBGH and have fulfilled my contractual obligations to the hospital. It is therefore as an ER physician working in this area that I now speak. While there are certain matters that I am unable to reveal publically, I do feel that our population deserves to know some of the history and events behind our current budget shortfall. The latest letter from the CEO of the LHIN to the mirror really says it all. She claims that we’ve received a 7% increase over the last three to four years. I can only say that this is a fascinating play on statistics on the part of the LHIN and the MOHLTC. Strangely, no mention of the fact that our BASIC costs have risen 10% during the same period without adding any enhancements to actually grow our services. A few more facts that you might find of interest, as taxpayers and health care users: Did you know that the MOHLTC has, in the past three years, negotiated wage settlements that they don’t contribute to? Somehow, we’re supposed to find these well deserved increases for nursing staff from within our current budget. If 85% of operating costs are wages, guess what gets cut when budgets are cut? Staffing, programs and services. Did you know that the LHIN and the MOHLTC publically state that their new system will be patient centric, yet there have been few improvements to make the system more user friendly. In places like Toronto, the LHIN designed system is so convoluted that private companies have sprung up, providing health “guides” who arrange all your appointments, tests and make sure you don’t fall between the cracks. Health care should b e as simple as going to your doctor or hospital. Especially for vulnerable elderly and those sick and weak. Did you know that our budget has actually been “frozen” for the past two years? Did you know that the MOHLTC ordered GBGH to open 1N and take over complex chronic care several years ago, all the while promising that the venture would be cost neutral for us? At the end of the contract, the MOHLTC reimbursed us for wages and costs at non unionized wages, all the while knowing that we are a “closed” shop and must hire and pay union wage rates. The total cost to us? 850,000 dollars that had to be found within current programs. NO reimbursement for actual costs of the service provided. Did you know that the MOHLTC did not provide one single dollar for the 4.1 million dollar ER renovation that we just completed? Our Er was last renovated in 1992 to accommodate 18,000 visits per year. We now see about 46,000 per year with 16 beds. The MOHLTC informed us that we could: A) Wait another 10 to 12 years for their contribution as we were very low on their list and wouldn’t be considered until that time, behind other renos such as Barrie, or B) We could pay the entire cost ourselves, out of money donated by you, the local taxpayers. We decided that we could not continue working in the current setting with only 16 beds and, faced with this choice, went ahead and built the addition. The MOHLTC and the LHIN have no promised to put in 90% of the next stage, but now they expect us to raise the other 10%. Fair? You decide. Did you know that we have a very unique population serviced from our hospitals? We have approximately 1,200 patients from CNCC (all high risk patients); we have a large population of patients with mental illness, whose last safety net is our ER on weekends and nights? That we see and commit more patients for mandatory psychiatric examinations than any other hospital our size? Do we receive special funding for this? Not at all. We regularly pay out more than 750,000 dollars per year for extra security when patients from these two sites are housed along with our community patients. The Ministry of Corrections met with us on several occasions before the jail was built and reassured us that if the CNCC population placed an disproportionate cost on our system, they would contribute to upgrade and bolster our security. To date, no new money forthcoming from this source or from the MOHLTC and the LHIN. Surprised? I’m not. Did you know that the MOHLTC and the LHIN, at the stroke of a pen, made it mandatory that all hospital equipment be purchased with funds donated locally. The Canada Health Act states that the provinces and the Federal government provide necessary health care to Canadians. How do we do this without basic equipment? Surely hospital beds, bandages, IV’s, splints are part of basic care? How do you treat someone without a hospital bed? Better yet, how were the MOHLTC and the LHIN able to divest themselves of this cost? Did you know that, in 1996, the MOHLTC and the LHIN, with the stroke of a pen, downloaded ambulance services to the Upper Tier Municipality but somehow neglected to download the responsibility for inter hospital transfers for care? Patient have to pay for poorly equipped, poorly trained, private, non regulated patient transfer services to ferry them for necessary and sometimes critical tests. The cost is downloaded to the patient. In our case, our hospital has stepped up to the plate and covered the cost for patients who can’t afford the 600 dollars to transfer them (for instance) to the Southlake cardiac centre in Newmarket and other places. We’ve been paying the bill without any extra funding from the MOHLTC who has told us that this is not their responsibility. The only advantage to being old like me is that you remember previous political promises. For those of you interested in Ontario history, back in the 1970’s Premier Bill Davis’ government decided that they couldn’t staff all specialties at all hospitals so they decided to cover the costs of inter hospital transfers for patients so they could be treated in centres of excellence where all the specialists were. Now, 30 years later, we expect 80 year old patients to somehow drive themselves to appointments for cancer treatments when they can’t get out of bed. The Ambulance Act states that, if the patient is too sick to go by other means, the Physician can order an ambulance to take them and the cost is covered. Guess what? There are only two ambulances scheduled and available DAILY to service interhospital transfers for the five hospitals in our LHIN. We, as physicians can take a chance on getting one of these two, having you miss your appointment or sending you by a private carrier. Every physician I know has at least one story of a patient who has died in transit with private transfer services. Did you know that the LHIN cut our funding again this year because we didn’t meet their key metrics such as “time from ER to floor for admitted patients”. We are competing against hospitals such as Lindsay (200 beds). Level playing field? We calculated our expected budget based on our performance and the LHIN’s contribution from the previous year. Our LHIN CEO now informs us that we were “optimistic” in our predictions by using last year’s funding model. Another 1.1 million or so cut from our budget. Did you know that we would have to add 35 hours of nursing time to each floor to reach the same staffing ratios as the next lowest funded hospital in the LHIN, Alliston? We would have to add more than 60 hours of nursing time to our ER to equal RVH? Yet, our staff are supposed to somehow, meet metrics designed by the LHIN and the MOHLTC. Strangely, none of the metrics measure quality of care in any meaningful way. Did you know that the MOHLTC recently lost a “wage parity” lawsuit that dates back more than 20 years? We have had more than 6 CEO’s in the past ten years, including one supervisor appointed by the MOHLTC who left the new board with a “balanced” budget yet did not account for this in his review. This wage settlement cost GBGH more than 1.2 million. Neither the MOHLTC nor the LHIN contributed to this shortfall. Did you know that, when I began as a paramedic in this area in 1976, that GBGH had 160 active care beds, a pediatric floor, a surgical floor and 3 OR’s? Today, with more than double the population, we have 68 active care beds. The Penetang site once had 80 active care beds, an ER, an obstetrical floor and a radiology department. Now they are closing. Did you know that we are the last hospital in Ontario to provide outpatient lab services. The MOHLTC and the LHIN have refused to provide a license to any outside providers to service the local population. Due to budget and financial restraints, we’ve had to close satellite labs in Elmvale and Penetang. In fact, our lab services are so strapped for time that we can only process 6 blood draws from Christian Island weekly. The LHIN has been aware of this for at least 5 years but has failed to address this inequity. Now, we are forced with rationing lab services even further by using an “appointment” schedule. Does this seem to be the same level of care received elsewhere? Did you know that the LHIN is currently in discussion regarding our ICU? The current ICU is considered a “level 3”. This means that we can care for patients on ventilators and other critically ill patients. WE currently have two internists with a third joining us in November. There is a concerted effort to find a fourth. Should we be downgraded to a level 2 facility, we would only be allowed to care for vented patients for 24 hours, then be forced to transfer them out. If you combine this with the LHIN’s current attempts at centralizing services such as scopes and cataracts, the writing is on the wall. Ms. Jill Tettman was recently asked if it was the LHIN’s plan to eventually relegate us to an “urgent care centre status” with no local admissions. She denied that this was being planned, however, the current actions of the LHIN seem to contradict this. Do you , as citizens and taxpayers feel that you are being treated as well or the same as patients in other areas of the LHIN? If not, I encourage you to become advocates for yourselves and your families as well as for your hospital. Our staff are working long hours, with fewer resources than other hospitals, yet we continue to outperform in areas such as patient satisfaction, ER wait times and patient care. Our nurses, managers, physicians and numerous allied health workers at our two sites are to be congratulated and supported , not subject to further cuts by the LHIN for not meeting meaningless “metrics” that don’t truly measure health care quality or results. Some food for thought. Dr. M. McNamara.
Posted on: Wed, 22 Oct 2014 14:00:08 +0000
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