Tough Issues Provoke Hard Choices

The frustration of trying to balance the budgets of the two hospitals in the Middlesex Hospital Alliance - without cutting health care services - provoked heated debate and passionate opinions at the regular monthly meeting of the Middlesex Hospital Alliance (MHA) Board of Directors held last night.

"To satisfy the legal requirement of hospitals to balance budgets, this board has considered two contentious cuts. One to the outpatient physiotherapy department at Four Counties Health Services and the other to close the fourth floor at Strathroy. Neither are choices we want to make," Yvonne Lambert, Chair of the Board of Directors, said. The Strathroy site of the MHA has a $2.2 million shortfall and the Four Counties Health Services (FCHS) site is projecting a deficit of $500,000.

In a meeting with the South West Local Health Integrated Networks (South West LHIN) earlier in the day, the LHIN approved a plan that would delay, if not avert, the planned dramatic reduction in outpatient physiotherapy services at FCHS. The proposal by the South West LHIN is to use FCHS's reserves to carry the budget for an additional year - basically allowing the hospital to balance over three years instead of two. "It really only defers a very serious issue for another year. It's not a solution, but it takes the pressure off for now," Ralph Coe, treasurer of the MHA Board of Directors, said.

And pressure is what everyone is feeling. "The decision of the South West LHIN to allow us to use reserves in this way must be attributed to the very successful political pressure of community concern that was brought to bear on the government decision makers. Our staff and community are to be congratulated for keeping this issue on the front burner by elevating awareness and understanding of the effects on front line services, and for promoting solutions that do not cut health care services to our community," Ineke Haan, vice chair of the MHA Board of Directors, says.

Unfortunately, no similar financial shuffle solution was found for the Strathroy site. And, the board is considering another contentious solution, that of closing the fourth floor, which currently accommodates 25 Continuing Complex Chronic Care beds. The patients in those beds fall into two broad categories - Long-Term Stay patients - some of whom could go to Nursing Home or their own homes with support and Low Level Rehabilitation - patients recovering from strokes or major surgery - such as orthopaedics. These patients came from the MHA hospitals and hospitals in London. The types of patients occupying the 25 beds on fourth floor are almost evenly split between the two categories. The Board heard that 5 of the 25 beds have already been closed, in keeping with plans discussed at meetings with the South West LHIN and local MPP Maria Van Bommel.

Dr. John Marcou, Board Member and President of the Medical Staff made a presentation to the Board stating that closing this floor would be disastrous for the patients there. "We all know that a hospital bed is not the appropriate care for these patients - but the right residential setting is not available. We know they shouldn't be here and if there was any other choice they wouldn't be. What am I to tell the medical staff when the hospital closes these beds? We have no place to admit the patients to," Dr Marcou, said.

There is a desperate shortage of Long Term Care (LTC) beds in Middlesex County. "Part of the fallout that would occur if the hospital actually did close the fourth floor beds is that the patients would have nowhere else to go. There needs to be an integrated strategy for LTC - where do these people go when there are no LTC bed s open in all of Middlesex and waiting lists at every facility?" Dr. Paul Ferner, Chief of Staff SMGH asked.

In their continuing financial discussions last evening, the Board appealed to the MHA's two foundations - at Strathroy and Four Counties - for increased financial assistance. "We are asking that the FCHS and SMGH Foundations increase their contributions for the purchase of new equipment," Lambert said.

Indeed, the Board reviewed a SMGH Foundation proposal to introduce paid parking at both sites. This revenue-generating plan is common at many hospitals in the province and was in fact, suggested to the MHA by the South West LHIN.

A motion to initiate this plan at FCHS was defeated. The motion to implement it at Strathroy Middlesex General Hospital narrowly passed. "Some people say that paid parking is an additional tax. The board recognizes this criticism but we also see that revenues are available from paid parking to support essential health-care services and that cannot be ignored," Lambert said.

The paid parking system, which includes employee parking, is expected to launch on July 1, 2008. A pay and display system will be installed and monitored by an external contractor, so there will be no gates on the lots. Vehicles will easily be able to enter the parking area to drop off patients or visitors at no charge. The Foundation is projecting to net about $205,000 a year from paid parking to be used directly to improve patient care at the Strathroy site.

The Board continues to appeal to the Ministry, through the South West LHIN, for additional strategies to balance the budget and meet the health care needs of the community.

The Board heard that the South West LHIN will be initiating a process that will cause a review of the operation of the SMGH site. The South West LHIN has this authority under the legislation passed that requires balanced budgets in Ontario's hospitals by 2010. "The Board of Directors of the MHA welcomes the opportunity to work even closer with the South West LHIN through a third party to more fully explore the opportunities and review the strengths of the SMGH site of the MHA" said Lambert. "Our FCHS site will not be directly reviewed in this process - but because of the high level of integration between our sites - FCHS will of course be part of the discussion" she reported.

"The community has been very supportive in the wake of continuing uncertainty about our hospital health care services," Lambert said, "And this board wants to continue to keep our community informed about the pressures health care - and especially our communities' health care - is facing."

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Tough Issues Provoke Hard Choices