Planned hospital merger could be big risk for Ross Memorial
On November 20, 1902, medical experts travelled by train to Lindsay to be part of the opening of the $80,000 Ross Memorial Hospital, named in honour of the benefactor James L. Ross’ parents. At the time it was one of the finest and best-equipped hospitals in Canada.
A local paper commented that the day was “a red letter day in the history of the County of Victoria.” Ross, a successful railway engineer and philanthropist, had lived briefly in Lindsay and covered the entire cost of the hospital’s construction on the condition that “the County maintain the facility as it would not only be a memorial to his parents, but also a gift to the community he had once called home.”
County of Victoria Warden John Austin, in his remarks at the opening proclaimed, “the spirit which dedicated this building as a memorial of the past, and a blessing for the future, will outlive even its solid walls.”
After generations of local citizens have been born and died in what is surely a cornerstone of our community the questions we must answer now are: “will the hospital outlive the proposed merger with the Peterborough Regional Health Centre (PRHC), and if it does, in what form will it survive?”
Those questions might seem alarmist or simply change-adverse — until one examines the overwhelming evidence of international, national and provincial data on hospital mergers that suggest this might not be a great idea.
The RMH and the PRHC announced their “integration discussions” by releasing a shared vision, a community engagement and communications plan and an overall integration work plan on April 24, 2018 after being mandated by the regional funding body — the Central East Local Health Integration Network (LHIN) — to ‘explore integration’ on March 28, 2018. But make no mistake — this is more than an exploration or the discussion of an idea: One of the strategic goals of the community engagement plan is to “build commitment to the new organization.” The very same document that plans for ‘town halls’ and surveys to get ‘stakeholder feedback’ also has the date for full integration: January 1, 2019. They are telling us, in advance of whatever “concerns” we might raise as a community, that this merger is a done deal.
Mergers Cost Money
Hospital mergers (or to use the more benign-sounding, consultant-speak of ‘integrations’) are not a new phenomenon in Ontario, in Canada or indeed much of the world. In fact, there have been so many hospital mergers that we can benefit from much research done on the topic. A study in the British Medical Journal states that the study of hospitals in many countries has shown that the best size for an acute care hospital is 200-400 beds and above that “management and administration costs tend to increase.” Another study in the same journal states that two years after mergers, the new institutions had not achieved the “predicted management cost savings.” But we needn’t go so far afield to look at the effects of hospital mergers.
Many of us are old enough to remember the rash of hospital mergers in Ontario in the 1990s, which were a response, we were told, to the challenging economic conditions of the time. Mergers were touted as a panacea to the woes of our health-care system. The end result was not so promising: A review by the auditor general of Ontario found that those mergers realized $800 million in savings and cost the healthcare system $3.9 billion. The Canadian Health Services Research Foundation (CHSRF) — now called the Canadian Foundation for Healthcare Improvement — has a stellar reputation for quality and impartiality. After reviewing the many academic studies regarding mergers, this is what they conclude: “The urge to merge is an astounding, run-away phenomenon given the weak research base to support it, and those who champion mergers should be called upon to prove their case.”
The Lindsay Advocate asked the CEOs of both the RMH (Dr. Bert Lauwers) and the PRHC (Dr. Peter McLaughlin) to ‘prove their case’ and the answers were long on generalities but rather short on specifics. To be clear, both hospitals are led by exceptional people with impressive records.
Dr. Bert Lauwers — who is highly regarded in our community — has had a distinguished career in medicine and hospital administration yet still provides clinical services at the Kawartha Family Health Team After-Hours Clinic. Not every community hospital has a CEO that can be involved in ground-level medicine.
As mentioned in the RMH-PRHC joint “Operational Plan” presented to the LHIN, and restated to the The Lindsay Advocate by Dr. McLaughlin, “it is important to note that under current legislation, all hospitals have a legal duty to explore opportunities for integration of the services they provide to patients.” So despite overwhelming research that mergers might actually cost money (thereby reducing the amount of money for actual healthcare) this is being proposed because it has to be proposed — and all rationalizations for it must be examined in that context.
The Ontario Health Coalition is a non-partisan network whose primary goal is ‘to protect and improve our public health care system.’ They have studied several hospital mergers and released detailed research reports on the results. As Executive Director Natalie Mehra told The Lindsay Advocate, “if there was any evidence that mergers were good for health care in Ontario we would support them because our mission is to be a watchdog for the Canadian Health Act. But even the most neutral sources say that mergers don’t save money.” Her analysis should give us some cause for concern, especially here in the City of Kawartha Lakes.
Smaller Hospitals Lose Services
Asked specifically about this merger, Mehra went on to explain how these hospital mergers tend to be implemented.
“…any services that are offered at both hospitals are considered duplication and something that is to be eliminated. Patients will have to travel, creating the opposite of a community hospital.” Asked specifically about services at the Ross, Mehra replied, “in our experience smaller hospitals lose services” in a merger. Mehra predicts that Lindsay “will lose surgeries, acute care and obstetrics, leaving only the services that are likely to be privatized in the future.
Alarmed by these predictions, The Lindsay Advocate presented them to both hospital CEOs. Dr. Lauwers (in an answer similar to his colleague) — responding to OHC’s experience that a smaller hospital always loses services in a merger — writes, “The discussion of clinical services is out of scope for these integration discussions. That means no movement of services is being considered as part of this process.”
Part of this process? What processes are to follow? For the residents of the City of Kawartha Lakes, the devil may be in the lack of details. So ignoring international, national and even provincial data, what has happened to hospitals closer to us that have underwent forced mergers?
The merger of Ajax/Pickering with Lakeridge saw Ajax’s non-acute care being moved to Bowmanville, meaning a long drive for affected family members. And that is an area that actually has some viable public transportation options unlike the City of Kawartha Lakes. After much community activism Ajax was able to maintain five major types of services — in a hospital with a catchment population twice the size of the RMH’s. Some figures demonstrate that it will take 62 years to pay off the cost of this merger.
The hospital mergers of the Durham West and Scarborough hospital systems should also raise red flags for citizens in Kawartha Lakes. The merger costs, according to the hospitals’ own figures, include $1.9 million for integrating the management team and $13 million to merge telecommunications, email and information technology, $1.1 million in legal and public relations costs and $2.5 million in costs to lay off staff and harmonize wages. Although mandated by the provincial funding authorities, the cost of these mergers are not covered by the province and must be absorbed by the hospitals themselves out of their operating budgets. The Scarborough Health Coalition and the OHC in their report on this merger noted that hospitals themselves, in a submission to the LHIN, stated, “there are minimal operating efficiencies that will result from integration.”
Both Doctors’ McLaughlin and Lauwers echoed the direction plan by stating that a merger would increase their ability to recruit staff and give the amalgamated hospital a bigger voice ‘at the table.’ On the recruitment issue, the OHC’s Mehra “questions what they were doing before.”
Beyond that there is a certain lack of logic to this process. The argument seems to be: “The LHIN and the law has mandated a merger; by merging we will be listened to more.” These arguments are also right from the merger playbook. A recent merger between two Muskoka hospitals was explained by MuskokaRegion.com this way: “The purpose of the merger was to gain a greater voice with the Ministry of Health and Long Term Care, the Ontario Hospital Association and the Ontario Association of Community Care Access Centres. Board members also hope the new association will be able to attract more physicians and personnel to the region, since this task was becoming a challenge.” This sounds very familiar.
Who Really Benefits in a Merger?
Given the sheer volume of negative or neutral data on hospital mergers, one might ask why our health care system is seemingly so addicted to them. A skeptic might point to the fact that research has shown that executive compensation after mergers increases far above the rate of inflation, while the current hospital funding formula funds increases below the rate of inflation. Or, that these mergers often require the services of consulting firms, themselves either staffed or owned by former hospital executives for this type of work.
Take the Durham merger for example: The OHC explains that those exorbitant merger costs “do not include the costs of the Minister’s appointed “facilitator,” a consultant with KPMG appointed in April to ease the passage of the merger, nor do the projected costs listed here include additional “transaction” (legal and PR costs) for the Central East L.H.I.N.”
Lost in all the false economies of hospital mergers and feel-good, unsubstantiated promises of “improved sustainability” and “an ability to expand programs and services for patients” is the elephant in the waiting room: hospital funding. In a comparison of hospital funding with national averages of 36 O.E.C.D. countries, only Mexico and Chile fund their hospitals at a lower rate per capita than Ontario.
Furthermore, a change in the hospital funding formula by the Wynne government further tips the scales towards the economic madness of mergers. In 2011, hospitals such as the RMH used to receive 98.5 per cent of their funding from the province. A new funding formula sees 70 per cent of the hospital being funded by a system that favours larger hospitals, with 40 per cent of funding coming from a health-based metric (which rewards hospitals for shorter hospital stays by patients, for example) and 30 per cent of the funding coming from a fee-for-service model, which rewards larger hospitals and punishes smaller community hospitals.
It would seem that people who want the City of Kawartha Lakes to have a full-service hospital now have their work cut out for them, but as Mehra reminds us “don’t accept this as a fait accompli. These are decisions that can be reversed or changed but to change them we [the citizens of Kawartha Lakes] must build a clear and vocal opposition.”
She continues, “a community hospital serving almost 100,000 people as does Ross Memorial, needs to have an emergency department, palliative care so people can die close to home, chronic care close to home for those with longer-term hospital care needs, acute care including surgeries and other procedures, diagnostics. In amalgamated hospitals these services are considered “duplications” and they are cut.
This causes hardship for people, particularly the elderly, who are forced to travel from town to town to access care. In any case, there is not the capacity in Peterborough to cut services in Kawartha Lakes and shunt patients to Peterborough. That hospital is already full. Both communities need more services not less. The amalgamation and the rationing of services that would inevitably follow would be harmful both for patients in Kawartha Lakes and for patients in Peterborough.”
Is this the change we want?
One hundred and sixteen years ago, members of our community articulated a vision. Change is clearly being planned for our community hospital. The question that remains is, as active and engaged citizens, do we want the change being thrust upon us? Or do we speak up, clearly and strongly, to refocus that vision back towards a true community hospital.
Have your say at a Public Meeting at the Ross Memorial’s cafeteria on Wed. Aug. 29 from 7-8 pm.
Bravo Trevor! Beautifully written and informative article!
Good article to read unfortunately we did not read it until after we went to the meeting held in Fenelon Falls. We are however now considering going to the meeting being held at the Ross Memorial Hospital Cafeteria on Wed August 29th at 7pm with free parking.
This article gives us more information and questions to take to the meeting. We need to try and get more people out as this does not sound like the best deal for The Ross however reaching the residents of The City of Kawartha Lakes is always a challenge.
Would it be possible to get the Lindsay This Week to also interview Trevor with all these important issues/questions that need to be answered. It would be good to have it in next weeks paper.
Hi Ron and Carol,
We are happy you found the article informative. Trevor is our Contributing Editor here at the Advocate — we are not in the business of giving the Metroland weekly our stories. However, I would hope they are doing their own outreach to remind people of the meeting. In the meantime, the Advocate is working to get the word out about the meeting, from our online news site to our social media channels, and in our print magazine. There is much at stake and we intend to follow and report on this closely.
I put a message out about my feelings. Having worked for many years at a hospital that went through a merger and having also seen what the merger did in Toronto hospitals; I wish only to remind people to really think about the changes that will happen and some are not good changes. One only has to question the staff (not the managers) to hear how they feel about the changes to the people they care for; for themselves and their families and how a small happy comfortable working environment changed drastically. Toronto hospitals THE UNIVERSITY NETWORK are all close to each other and are on transit routes—subways,streetcars,buses,taxis,Go train. What kind of service will be offered when hospitals are so far apart?? How much money will be saved really when more management is in place and yet no front-line workers like nurses and doctors? My experience saw 2 beautiful and amazing parents sell their home to move to an apartment across from a hospital to look after their daughter; only to have their daughter moved to another hospital within the corporation but in another town. How is this providing better care for the patient and their families??
We can jump up and down all we want about this issue, but as we have seen numerous times in the past – amalgamation for instance, our voices will fall on deft ears. It’s a done deal.
This isn’t about providing better services. This is about multiple layers of bureaucracy being harder if not impossible to control. It is being created, as it has already in multiple markets to game government distorted health care markets that are dominated by huge wealthy insurers, corporate medical, pharmaceutical companies, nursing homes and benefit managers – all playing against each other to increase executive and shareholder profits – all at the expense of ‘the patient’. Hospital mergers are rarely about creating better care; they’re about mergers an acquisitions.
Yes, the system needs an overhaul. You only have to go through it once to realize how ridiculously ineffective it has become. The coordination and communication among multiple doctors, staff and referring doctors is a joke. I had one Dr. tell me recently that my file showed that I’d had major surgery; a major procedure when in fact I had a completely unrelated simple procedure. I once went in for surgery on my right wrist and last minute before going under found them prepping my left. Recently I’d been referred to a specialist in Whitby that spoke very little English. I explained that my feet felt swollen; my shoes felt tight. The file came back to my Dr. saying that I felt swollen when wearing a tight dress. That had both the Doctor and I laughing, but it’s not funny – not funny at all. The recording and reading of medical charts from Dr. to Dr. is not working. Someone is not paying attention.
There’s also the issue of the Ross being overwhelmed with the elderly; not having enough beds resulting in canceled surgeries for others etc. This is an enormous problem and extremely costly on the system. Guess what? The Boomers are coming next. We need more facilities and/or stay-at-home services to accommodate this situation alone, but…health care expenditures are being cut by government.
And why does it take 12 Doctors to screw in one light bulb. Why multiple expensive procedures like x-rays by every doctor you are referred to for the same issue. Why three letters by mail and 2 phone calls from the hospital to remind you that it’s time for a mamogram. Every time I went to see a referred Dr. on my wrist they wanted another x-ray, when I already had several in the span of a couple weeks. I ended up with 7 X-rays and when questioning this, response was all the same “we like to take our own”.
Sharing and privacy of medical files is another issue. I was contacted last year by a local clinic and informed that my medical files had been copied and breached, along with several other patients by an employee that had been fired. Why aren’t we carrying our own medical files on a Thumb Drive that WE are in control of? It’s that easy.
YES – there are problems and the system needs to be streamlined. The old-school foundation of intimate Dr. / Patient relationship seems to be eroding, but it was and is the best way to provide an individualized perspective. It should be up to our doctor and ourselves to reduce error and co-ordinate care. Instead it is being infiltrated by incentives for investors.
Bottom Line. It’s already been proven by numerous past hospital mergers that this move will not provide better care for our communities. It’s not anything remotely about that.
when will the voters of kawarath lakes wise up, keep voting for scott i didn’t see her response.” we are here for you[ dub ford]