Grant LeFleche wrote in “Tumultuous year in health care,” (St. Catharines Standard, Jan.3, 2009):
“In many ways, 2008 was the year of the Niagara Health System. A new hospital, sweeping restructuring plans, and intense political fights over both issues dominated the local headlines. For that reason, the NHS is the 2008 newsmaker of the year.
The face of health care in Niagara is going to change.
In west St. Catharines, a soon-to-be-built 375-bed hospital will become home to a cancer centre and all of Niagara’s maternity services.
The emergency room in Port Colborne, and very likely in Fort Erie, will be repurposed to handle only less-than-serious medical cases.
Hospitals in Niagara Falls and Welland, like St. Catharines, will host specialized services for regional residents, becoming “centres of excellence.”
And all of it will be done under the shadow of a mounting multimillion-dollar Niagara Health System deficit that, at present, shows no signs of shrinking.
“It’s certainly been a tremendous year for us,” said Niagara Health System chief operating officer Bala Kathiresan. “It is really unprecedented.”
Year 2008 saw the approval of both the design of the new hospital and, more recently, the restructuring plan, setting the stage for the beginning of a complete overhaul of Niagara’s medical system over the next year.
Kathiresan said the new hospital is desperately needed.
“For anyone who has been to the St. Catharines hospital, the age of the building is very apparent,” he said. “Replacing it is something that is long overdue.”
NHS chairwoman Betty-Lou Souter said St. Catharines General Hospital on Queenston Street is not able to grow and adapt to meet the needs of the community or the demands of modern health care.
“The advantage of the new hospital is that it will provide room for growth for the next 50 years,” she said.
As with any major change of a community institution, the decision to build the new hospital in west St. Catharines irked some Niagara citizens.
Local proponents of smart growth wanted the facility to remain in an already developed area. Some politicians wanted it moved to a more regionally central location.
Souter said the new facility is not a regional “super hospital,” but is intended to replace the aging St. Catharines General. And like all major hospitals in the region, it will provide services for all of Niagara, such as the cancer centre.
Plenary Health, a division of the Plenary Group, was chosen to build and maintain the hospital. A ceremonial groundbreaking had been anticipated for the fall or winter of 2008.
However, Plenary has yet to close its financing for the deal. According to a British trade magazine, Plenary’s original backer, Deutsche Bank, pulled out of the reported $600-million project in the face of recent market turbulence.
Plenary has been in talks with TD Bank and German bank WestLB to acquire money needed to build the hospital, the report said. No closing date has been set, a spokeswoman for Infrastructure Ontario said.
The groundbreaking has been moved to spring.
The new hospital, which is expected to open in 2012, was one of two critical health-care developments in Niagara in 2008. The other was the restructuring program, known as the hospital improvement plan.
In June, the Local Health Integration Network (LHIN) ordered the NHS to come up with an improvement plan to address its inability to balance its budget.
The result was a sweeping program to revamp how area hospitals deliver health-care services.
The plan called for moving maternity services to St. Catharines, downgrading the ERs in Port Colborne and Fort Erie and creating clinical “centres of excellence” at the St. Catharines, Niagara Falls and Welland hospitals.
Kathiresan said that in drafting the plan, the NHS was sailing into uncharted waters. There is simply no other hospital system that is enough like Niagara’s to use as a model.
“We have six sites and 12 municipalities. There was really nothing the same,” he said. “The closest was Lakeridge (Health Network in Durham), which has four sites. So a lot of this was new.”
Kathiresan said the NHS knew its decisions would not be popular in all quarters and braced for political backlash.
It came in spades.
From the mayors of Port Colborne and Fort Erie in particular, the NHS came under fire for its plans to change those cities’ hospital emergency rooms to 12-hour prompt-care centres.
Port Colborne Mayor Vance Badawey sees the decisions as a poke in the eye for his community, which had worked hard a decade a go to build the hospital.
He said in the late 1990s and into 2000, the community pulled together to created an “integrated approach to health care at the hospital,” that included a full ER, operating rooms and a long term care facility.
“We built it. We earned it. The community worked so hard for that,” Badawey said. “But what happened is after 2002-2003, they (the NHS) have been taking things away from us, leaving us with a long term care facility and a walk-in clinic.
“We came up with our own plan that mirrored in a lot of ways the NHS plan. But our last recommendation to have a full ER was the major disagreement,” he said. “Our plan was simply ignored by the NHS and by the LHIN.”
When Dr. Jack Kitts of the Ottawa Hospital reviewed the NHS plan, he recommended a middle ground between the NHS plans and the mayors’ desire to see fully functioning and equipped emergency rooms.
Kitts said the ERs should be turned into “urgent-care” centres that would still be open 24 hours, but would not treat the most serious emergency cases.
The NHS embraced Kitts’ recommendations, but it was not enough for Fort Erie. The Fort Erie standing committee at the NHS voted against the restructuring plan. As a result, the NHS had to strip all references to the town from the plan it presented to the LHIN for approval.
The fate of the Fort Erie hospital is up to the LHIN, not the Niagara Health System.
On Dec. 16, the LHIN green-lighted the NHS plan and approved, in principle, turning the Fort Erie ER into an urgent-care facility. A final decision will come in January.
Badawey and his Fort Erie counterpart, Doug Martin, were not pleased with Kitts’ compromise and vowed to appeal the decision to Ontario’s minister of health.
Port Colborne is also planning to approach Ontario Premier Dalton McGuinty directly, and has recently finished a DVD presentation about the hospital for the premier, Badawey said.
“He came down to visit us long before this all happened and recognized and lauded the hospital for what it was,” Badawey said. “So our question to him is, ‘What’s changed?’ ”
The mayor says he wants to also work with the NHS to find a way to meld the health system restructuring plan with Port Colborne’s plans.
“We agree with a lot of what is in the (NHS) plan, but our aim is to keep that H on our hospital,” he said. “This is done through communication with the government and with the NHS.”
Even as the NHS moves from planning to action, it does so under the weight of a crushing, accumulated deficit of more than $100 million.
Debbie Sevenpifer, NHS president, has said the capital deficit could reach as much as $160 million by 2013. Even if the NHS achieves a balanced operating budget, that will not stop the deficit from growing.
The NHS doesn’t have the resources to combat its deficit, and often gets cash advances from the provincial government to manage it. Those advances are paid back via bridge financing from a bank, which in turn is repaid using a cash advance from the province.
In his review, Kitts said there was little room for the NHS to cut costs and that the system needed a sustainable cash infusion from the provincial government.
The systemic deficit is not unique to Niagara, Souter said.
“This is something that is happening at hospitals all around the province,” she said. “This is definitely going to be the big issue for us in 2009.”
The NHS is creating a plan to implement its restructuring program. Once presented to the LHIN, the oversight body may then lobby Queen’s Park for more NHS funding.”
Astounding – here's a St.Catharines Standard article recapping the year of events in the Niagara Health System, calling the NHS the top newsmaker of 2008 - and yet: NOT ONE MENTION whatsoever of bait-and-switch health-care monopolist Liberal MPP Jim Bradley’s role.
Bradley has yet to respond to the Kitts report, as he said he would.
Why expect the local press to bother asking the St. Catharines MPP any difficult questions, or, for that matter, any questions at all??