Conditioning

It has been only six years since Quinte Health Care’s administration and governance underwent life-altering surgery. It was a traumatic time. Though in the brief history of the hospital corporation, there have been few days that weren’t coloured with drama, intrigue and disappointment.

Since 1998, QHC has also had its share of ‘new beginnings’ and resets—exclamatory moments when an consultant, advisor or manager has triumphantly declared the answer was at hand. Then, when the real world resumed and these answers proved wrong or inadequate, there was always an intractable community or doctors and nurses to blame.

But 2009 was different. The architect of Quinte Health Care, Graham Scott, was forced to come back to save his creation. The province had given up on QHC’s management and its board had fallen in with a bad crowd—the community it served. Board and management both had to go. Scott would not make the same mistake again.

He chose an up-and-coming accountant from North York General to run QHC. The community- elected board was replaced by a hand-picked group, selected for their fidelity to the corporation. Then he erected a ring wall around them, ensuring this hand-picked lot would appoint their own successors.

He had one last trick left before he handed the reins to Mary Clare Egberts. The $15 million deficit—the catalyst for this bout of upheaval— was wiped out with a stroke of his pen. Scott had managed to persuade his counterparts in Toronto, where Bruce Laughton and the previous QHC board had failed, to expand QHC’s permanent funding.

Scott walked away from QHC a second time. He fervently hoped he had fixed the structural errors in his original design of the hospital corporation. QHC would work better this time.

It wasn’t long, however, before familiar cracks began to reappear. Just a year into the job, Egberts, citing financial pressures, began cutting services, beds and resources at Prince Edward County Memorial Hospital (PECMH). Simultaneously, Katherine Stansfield QHC’s director of patient care, was sent to the County to talk about building a new hospital.

A couple of years later, QHC had to find $8.5 million to balance its budget. More resources were cut in Picton and Trenton. More talk about a new hospital.

Today, Egberts says the hospital corporation is $12 million in the hole, and calculates that hole could get $30 million deeper within five years.

It’s a lot of money. QHC’s total revenue is roughly $195 million. A $12 million deficit represents six per cent of the hospital corporation’s top line—$30 million is over 15 per cent. Making these numbers work will fundamentally alter the function, operation and viability of QHC’s component parts.

QHC’s financial hole is bigger than PECMH. This should concern every resident in the County, and indeed in Quinte West. In 2005, QHC’s total cost to operate the Picton hospital was $10.3 million dollars. Sadly, segmented operating data for each hospital is no longer available. In any event these 10-year-old numbers demonstrate rather starkly the severity of choices facing the current QHC administration.

Barring another magical wave of Graham Scott’s pen, balancing QHC’s books will require deep structural cuts to services and resources. This hole will not be filled by an increase in parking rates or a more judicious use of tongue depressors. Nor can this patient tolerate much more trimming of flesh on its extremities.

The folks at QHC are surely considering amputation— PECMH, Trenton Memorial or both. Provincial officials are likely trying to talk QHC down from this extreme decision, preferring the optics of a thousand cuts to one fatal stab. But there is a reason we know the size of QHC’s projected five-year deficit. This regime is careful about what and how much information it dispenses. I suspect we are being conditioned for the terrible and brutal proposals they will soon make public.

In this context, everything must be on the table, including the role of Belleville General Hospital. In 2005, BGH accounted for 70 per cent of QHC’s costs. That share has likely grown as QHC has cut services disproportionately in Picton and Trenton.

BGH is where the dollars are. That is where the cuts must be made.

rick@wellingtontimes.ca