Some recent and proposed changes to the governance model of the Ross Memorial Hospital (RMH) and the provincial act that legally establishes it, has Kawartha Lakes Health Coalition (KLHC) concerned about the future of the hospital and the direction it’s going with its governance model.
KLHC is a local chapter of the provincial health advocacy group known as the Ontario Health Coalition. In a press release issued earlier in the month, the KLHC outlined several concerns, notably the RMH board’s decision to eliminate community memberships and having the board elect itself. The KLHC is also worried about the language in the proposed special act that is to go before the provincial legislature that seems to some to open the door to a future merger or reduction of services.
The RMH responded with its own press release, inferring that the KLHC press release was “misinformation” and stating that the board is not planning to merge with any hospital.
To investigate, The Lindsay Advocate reached out to the hospital, the KLHC the City of Kawartha Lakes, and other related parties to get a sense of the issues.
To really understand the issues a little history is needed. Just over 117 years ago (Nov 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.”
To cement the creation, the hospital was legally established by an act of the provincial legislature (An Act Respecting the Ross Memorial Hospital) which received royal assent on May 22, 1903. Establishing the hospital by an act of the legislature would require the provincial parliament to amend (or repeal previous versions of the act) throughout the years in 1953,1964 and most recently in 2000.
Right from its inception, the hospital included community membership on the Board. The 1903 act spells it out: “and whereas the said trustees have, by their petition, prayed that the County of Victoria and the local municipalities of that county, including the Town of Lindsay, may be empowered to assist in the maintenance of the said hospital.” The actual composition of local representation on the Board would be amended over the years but there was always representation by local government and a form of community memberships.
The RMH board had previously tried to eliminate community memberships but as this was contrary to the 2000 act, that decision was reversed. The new proposed act eliminates community memberships and moves to a model whereby the board elects itself.
According to Veronica Nelson, interim president and CEO of the RMH, the decision to change the governance model was threefold.
“In 2012, the hospital membership voted in favour of adopting the directors-only model, designed to reflect the current operating environment for hospitals and are: (1) consistent with good governance practices, (2) aligned with recommendations made by Ontario’s auditor general regarding skills-based boards and conflicts of interest, and (3) reflect recent changes to relevant legislation such as the Excellent Care for All Act.”
KLHC’s co-chair, Zac Miller, says this is part of a province-wide trend of stripping boards of community input, describing this decision as “totally undemocratic.”
“The Corporations Act and Public Hospitals Act expects elections of the board to occur. Current day hospital leaders around the province are circumventing this by limiting the membership to the board and have the board elect itself. The interim CEO of Ross Memorial Hospital has chosen this route.”
Supporters of the ‘professionalization’ of boards of directors and skills-based membership claim that this is best-practice. Critics of this model claim that this keeps boards from being truly representative of the communities they serve, and they argue that boards that promote diversity and inclusivity at the highest level end up being a more dynamic and truly representative board.
According to Nelson, the hospital is including community members in other ways without community-elected members, stating, “community involvement in our governance has increased. For example, the hospital includes patients and families in decision-making with regard to their care plan. The board and board committees are comprised of community representatives and patient experience partners (PEPs). There are also many PEPs that serve on hospital committees and perform independent audits on patient care which are reported back to the board’s quality committee. We value the independent skills, knowledge, expertise and experiences of our volunteer board, community reps and PEPs.”
Others who study hospital board governance aren’t so sure of this approach. In a healthydebate.ca April 2018 article — In health care, do the people in power reflect the people they serve? — authors D Izenberg and N. Taylor quote Ron Rosenes, a long-time community health activist in Toronto who has sat on multiple boards and advisory groups.
Rosenes is skeptical of how much patient voices can impact decision-making from outside the board. ‘I’m not sure for a moment that advice from advisory committees makes it to the board very often,” he says. “It seems to me that by not having patients on the board itself, you’re lacking some aspects of strategic vision which you may not necessarily get from board members who have come to you from other industries, other fields.’”
But in addition to the elimination of community elected boards the changes eliminate official participation of the board by representatives of our local government, which have always been a part of the RMH board, since its inception. The City does not seem too worried about this, however.
Ron Talylor, chief administrative officer of the City of Kawartha Lakes, had this to say:
“Our City solicitor has reviewed the new Ross Memorial Hospital Act. Although the hospital was enacted by legislation that proposed a board of governors that would include the mayor of the municipality, the proposed legislation authorizes the hospital to be run by the board of directors of the hospital corporation; not necessarily including representation from the municipality. A letter of support has been submitted to the Ross Memorial Hospital.”
The RMH did not respond to the question of why eliminating this type of representation was a desirable course of action.
Another area of concern for the KLHC is the wording of the ‘objects’ or purpose of the hospital in the proposed special act. According to Miller, “Section 3 of this special act changes the objects of the hospital. RMH lawyers have chosen to insert the word “or” rather than “and” in this clause. This means that the Board can operate a hospital or a different type of health facility which effectively means they no longer have to run a hospital. The KLHC believes “or” should be removed and amended to require the Board to run a hospital. If the CEO wants to close the hospital, it is in the public interest that they have to go back to [the] community to allow them the chance to organize to save the hospital if they wish.”
When asked about this wording and if people should be concerned, Nelson replied, “The language in the proposed special act enables flexibility for the hospital to enhance or expand services without opening another corporation. If the hospital changed the word ‘or’ to ‘and’ it would be required to also operate ‘a different type of health facility’ in addition to the hospital; this is not practicable nor an effective use of public resources. In addition, decisions regarding mergers and changes to services are governed by the Ministry of Health and Ontario Health.”
Nelson is absolutely correct in that the Ministry has ultimate control over mergers and closures. However historically the RMH acts always had language that at least symbolically defended the local character of the institution. Section 11 of the original act, which was confirmed in later versions, always had language that protected the local control of the RMH in the event of any merger. KLHC had asked for an amendment of the act to offer at least a symbol that the hospital was committed to a local presence and control which the RMH board rejected. Asked specifically about this Nelson replied that, “When the hospital was founded under the special act in 1903, the health system was much simpler. In 2019, Ontarians receive care from many health service providers and hospitals are only one part of it. The 1903 language limits the hospital’s ability to adapt to new care models as our healthcare environment changes, including the introduction of Ontario Health Teams.”
Because our MPP is a member of cabinet, the new RMH special act has to be presented by Gila Martow, MPP (Thornhill) to the Standing Committee on Regulations and Private Bills. Martow’s office has yet to respond to questions of when this will be presented to the committee or if she was aware that some people in the community had reservations about the proposed act.
It is perhaps ironically fitting that an act that eliminates community representation will go to a committee for decision and not to parliament itself — where it could be debated.
Miller and the KLHC ultimately worry that these changes open the door for another proposed merger or closure. RMH has been emphatic in denying that there is any plan to merge with any other hospital. When asked if these changes hypothetically allowed for the hospital to merge with another entity and discontinue all day hospital service offering, Nelson replied, “No.”
“The Board does not have absolute power in mergers or changes to key services, as the hospital is governed by the Ministry of Health, Ontario Health, and several acts of legislation. The special act amendment is not tied in any way to a merger with another hospital, discontinuation or transfer of services. The hospital is committed to bringing more services to our community to better support local patients and families.”
Miller, for his part has found the entire process flawed, stating, “In terms of the process for the special act, it’s clearly undemocratic. The interim CEO and board made no effort to get community input on the special act other than their original obligatory notice in Kawartha Lakes This Week. It should be the hospital’s job to educate the public regarding their intentions with writing a new act. Unfortunately, after multiple attempts by the KLHC to amend the special act, the interim CEO and board plan to push ahead with their original language with the clear intention to leave the doors open to another merger. It is nothing short of undemocratic and a disservice to the community.”
The KLHC is planning on holding an initial protest in front of Ross Memorial on Saturday November 23 from 12-2 p.m.