Out of the loop

County physicians remain in the dark about proposed cuts to PECMH

Quinte Health Care needs to cut between $10 and $15 million from its $190 million a year budget. To do this senior management appointed six committees last fall to recommend where it might find these savings. But who are the folks who concluded in their proposal in January that Prince Edward County Memorial Hospital should lose nearly half of its ever dwindling complement of inpatient beds, maternity care and endoscopy services? Who decided that Picton should bear such a disproportionate share of the cuts? And how did they arrive at this conclusion? Where is their analysis? Where is their report?

Lost amid the furor over looming bed closures and yet further service cuts to PECMH has been a persistent call by local physicians asking for more information about how this proposal was arrived at, and by whom. So far to no avail.

“There are no [County] physicians sitting on any of the committees,” explained Dr. Elizabeth Christie. “I have not yet obtained a list of the names of the members of the six committees that produced the proposals.”

She says that despite QHC’s stated desire to work closely with stakeholders— including County physicians— little information has been forthcoming.

“There is no physician engagement beyond responding to proposals,” said Christie. “I’ve seen no comparison of alternatives—no financial or patient health analysis—nor have I obtained reports I assume they provided to the senior leadership team.”

QHC said last week it would continue to consider suggestions until February 19.

But County doctors are growing increasingly frustrated by what they see as a lack of answers— particularly since the data they do have access to suggests PECMH is a more cost efficient place to treat most diagnosed illnesses than is BGH.

FULL TO OVERFLOWING
Dr. Christie worked overnight in the emergency room at PECMH last Thursday. When she arrived for the beginning of her shift, all 21 beds were full. One admitted patient was waiting in emergency for a bed to become available. During her shift two more patients had to be admitted.

“We can open extra beds under some circumstances but we don’t call in extra nurses,” explained Christie. “The load grows for the existing nurses. Once we use up these beds— we have no choice but keep them in the emergency department.”

It isn’t a rare occurrence, according to Christie.

“Over the Christmas period there were times where we had 26 admitted patients in Picton— five more patients than we have allotted beds to accommodate. The consequence of this is a significant risk to the quality of patient care.”

A far more rare occurrence is when just 12 inpatient beds are occupied. Yet this is the number of beds PECMH will be left with if QHC makes the cuts contained in the proposal.

“Just two years ago we were cut from 26 beds to 21. Since then I would say that we have been full to overflowing very often.”

ADDING WHILE SUBTRACTING
So what does QHC propose to do with the patients barely being accommodated in Picton now?

In its statement last week QHC assured that “for almost all of the proposed solutions, current health care services will remain in the local communities, but may not be delivered in a hospital setting anymore.”

Susan Rowe, director of communications for QHC, says the hospital won’t cut beds until the capacity in the community is in place to look after them.

“The onus is on the hospital to ensure these supports are in place,” said Rowe. “We need to ensure that our physicians are comfortable that this capacity is in place so they can discharge their patients. It will take time to build that.”

But Dr. Christie questions how QHC can offer such assurances.

“QHC has no means to ensure this capacity will be in place in the community,” said Dr. Christie. “To say that there are going to be real community-based changes consistently and effectively in place, a year from now, is simply naïve.”

Dr. Christie expects this shift to happen, indeed she is contributing to initiatives to move care out of the hospital and into a community or home care setting, but she knows this kind of change happens over a much longer time frame than is contemplated by the QHC.

“By the time this capacity is in place, we will need more beds in the hospital simply because our community is getting older.”

EMERG SERVICE TO REMAIN 24 HOURS
Rowe issued the statement in part to address rumours the emergency department at PECMH might soon be coming under the knife—that hours might be reduced.

“The emergency room is not closing nor are its hours being impacted,” assured Rowe. “We will continue to have a 24-hour emergency room—when people need emergency services it will continue to be there in the future.”