Amanda Street wrote in "Urgent care plan will fail: local doc", (Niagara This Week, Nov.14, 2008):
"A plan to transform emergency departments in Fort Erie and Port Colborne into 24-hour urgent care centres is "destined to fail," says a local physician.
"Doctors are not going to want to work (in the urgent care centre)," said Dr. Jeffrey Remington, a Port Colborne physician and ER doctor. "It's not going to work."
On Oct. 28 Dr. Jack Kitts made his recommendations on a contentious restructuring plan released by the Niagara Health System in July. Kitts recommended emergency rooms in Fort Erie and Port Colborne keep around the clock service, but as urgent care centres, not emergency rooms.
Remington, a member of a family health organization at the Mapleview Medical Clinic, has worked in Port Colborne's ER for several of years, it's an essential part of his job, he said.
Emergency room doctors are prepared to handle all levels of patients. Remington explains physicians are drawn to emergency medicine as a specialty due to an interest in working under pressure and makine split-second, life-saving decisions. Acute care facilities, by design, do not include those elements.
It also creates satisfaction knowing a life was saved, said Remington, which makes emergency medicine worth practising.
"Trained ER physicians may not want to work in an urgent care centre," said Remington. "It's a whole different level of care."
Patients with minor injuries and illnesses will be treated in urgent care centres.
"The critically ill will go to the hospital most capable of handling them," which could be Niagara Falls, St. Catharines or Welland, said Dr. Bill Shragge, NHS chief of staff. "But 90 to 95 per cent of the people using those emergency rooms will use the urgent care centre."
Shragge said the NHS hopes the same doctors staffing the ER will staff the new urgent care centre. The job, he said, will essentially be the same, as 97 per cent of emergency room users in both communities don't have critical conditions.
Doctors working in emergency rooms in Fort Erie and Port Colborne are paid through an alternative funding agreement. The agreements were signed last year and took the responsibility of emergency room doctor wages off the Niagara Health System's hands. Doctors are now paid on an hourly basis directly by the province.
Shragge said the NHS is in talks with the province to continue using an alternative funding agreement for the urgent care centre.
Ministry spokesman Andrew Morrison said there is no universal definition of urgent care. He said it is a term used for a number of facilities across the province. In most facilities, Morrison said, physicians bill Ontario Health Insurance Plan for service.
Morrison said he is unaware of any urgent care centres under an alternative funding agreement.
If the NHS is unable to work out an agreement with the ministry, and billing goes back to a per-patient system, Remington said the NHS will have a hard time staffing the centre.
After midnight, when patient volumes are at a daily low, about one patient per hour, Remington said physicians will be unwilling to work in the unit.
"It's not worth a doctor's time," he said. "And (the NHS) going to have a hard time staffing it."
What worries Kim Scher, a Fort Erie physician and emergency room doctor at Douglas Memorial, is the loss of emergency nurses.
"A lot of our emergencies in Fort Erie are walk-ins," said Scher. "If we have a real emergency and nurses who aren't trained in emergency medicine, we have a real problem on our hands."
When commenting on the NHS plan, Kitts suggested patients were getting sub-standard care at the two south-end ERs when he said, due to a lack of equipment and specialists, residents were better off being treated in one of the larger sites.
Remington said those comments are an insult to small hospital emergency rooms across the province.
"We take good care of our patients in Port Colborne," he said. "If it's serious, we stabilize and we transfer - that's the job."
That's the case for many rural hospitals in Ontario, said Ray Dawes, chair of the Ontario Medical Association's section on rural practice.
"Most rural hospital emergency rooms are the same as Fort Erie and Port Colborne," said Dawes, who is also chief of staff at St. Francis Memorial Hospital in Barry's Bay, a community with a population of 4,300. "Of the nine small hospitals in (the area surrounding Barry's Bay), two have CT scans."
Dawes is concerned that the transformation from emergency department to urgent care centre will reduce quality of care, not improve it as the NHS indicates.
"These departments aren't going to operate in the same manner as an emergency department," he said.
Dawes said he sees the system failing in Niagara.
"Financially, this plan is just not going to work," he said. "There will be a price to pay for people having to take a longer trip for care."
Paramedics, said Dawes, will not be a replacement for doctors.
Shragge however, maintains the plan put forward by the NHS will improve health care for Niagarans. He said less than five per cent of current emergency room users in both communities are critical."
"The system is failing in Niagara" says Dawes: yet Liberal MPP Jim Bradley, the health-care monopolist, says nothing.
Jim Bradley has said nothing at all yet about the Kitts NHS HIP report - which was delivered to the LHIN over two weeks ago!
Of course "there will be a price to pay" for Liberal Healthcare Duplicity: This is the cost of Jim Bradley's arrogant Liberal ideology.