Downward spiral

Dr. Christie outside her Picton offices.

Head of Family Health Team predicts effective closure of Picton hospital

Elizabeth Christie thinks health care works pretty well in Prince Edward County. In fact she believes that if the planners and policymakers guiding Ontario’s health care system copied aspects of the model that has evolved here and applied it elsewhere across the province, it would serve people better and cost taxpayers less.

Dr. Christie isn’t naïve. She knows that health care costs can’t continue to rise at six or seven per cent per year. Nor does she suggest that successes achieved in this community can be overlayed on every community. But she understands that the key to better care and greater efficiency is through deeper collaboration and seamless integration among the folks who operate within the system. This is what County health care professionals are good at. They’ve had to learn to get along—to work together—and share resources. They have had to do this to improve the care they provide to their neighbours.

She says the proposal QHC to cut nine beds, maternity care and endoscopy at the Picton hospital risks destroying one of the most highly integrated and collaborative health care communities in the province.

Worse, she contends the assumptions underlying the proposal are flawed, that recommendations aren’t supported by evidence, and that the community supports that are supposed to catch patients once these beds and services are removed, simply aren’t in place.

KNOWING THE SYSTEM
Dr. Christie is well placed to make these observations.

She was born at Prince Edward County Memorial Hospital. She became a lawyer. Then a physician. Currently Dr. Christie is a family physician as well as an emergency and inpatient physician in Picton. She is also the president of the Prince Edward Family Health Team.

She knows the system from the inside out.

Either by training or inclination, Dr. Christie poses questions rather than concluding inevitable outcomes. She is conciliatory rather than confrontational. She strives to observe the positives while urging re-evaluation of opposing viewpoints.

But inside this concensus-seeker is a steel backbone that insists upon answers and won’t accept decisions that run diametrically opposite her own experience and that of her colleagues.

Christie spoke to a committee of council last week, a meeting at which QHC administrators came to deflect the growing sense that the Picton hospital is once again being cut to salvage services and jobs in Belleville.

LOOKING FORWARD
QHC chief Mary Clare Egberts told the committee that she understands this is an emotional issue in this community but that “going backward is not an option.”

“You may fear you are losing some services from your hospital,” said Egberts. “But you are not losing services in your region.”

Katherine Stansfield, director of patient services at QHC, spelled out the proposed cuts to PECMH that include eliminating nine beds, maternity care, outpatient physiotherapy and endoscopy. As well QHC proposes to divert ambulances bearing patients with fractures or mental health issues from Picton to Belleville.

“The status quo is not an option,” said Stansfield to a group of folks who have heard this many times before. “Change is hard. We must balance our budget.”

MORE DETAIL NEEDED
Dr. Christie agreed.

“We all recognize the status quo is not acceptable,” said Dr. Christie.

She says the County Family Health Team formed and evolved amid near constant turmoil in the health care system—particularly acute in this community. She said it wasn’t change that she and her colleagues were recoiling from, but rather a lack of details about how the funding formula works; why the recommendations target the Picton hospital disproportionately, and why no Picton physician or health care professional sat on one of the six committees created to advise senior management on the proposed cuts.

She also worries that the community services that are meant to take up the slack from the shrinking Picton hospital aren’t in place and may not be sufficient to do the job.

“There is no extra CCAC capacity,” said Christie. “It is unclear if additional funding [to the Community Care Access Centres] will be enough to maintain adequate services.”

She agrees that more hospital services might well migrate successfully from the hospital to community or home settings but says these concepts are still in their infancy.

More problematic for Christie is that she believes the method and data used to calculate bed cuts is fundamentally flawed—that the theoretical notion of conservable days fails to take into account the variables present when humans treat other humans.

Others suggest the calculation also fails to consider the comparative cost of providing services at various hospitals.

Christie challenges the very notion that bed cuts create real savings, suggesting they do little more than fill up emergency wards and eliminate the people most directly responsible for patient care.

She sees this community getting older and the demand for care rising.

“PECMH should be 45 beds,” said Christie. “Twelve beds is untenable.

“PECMH is a highly efficient, highly effective hospital with excellent camaraderie, excellent morale, highly motivated professionals who cooperate in quality of care and cost savings efforts enthusiastically.”

But Christie fears the proposed cuts become merely the first step toward its closure.

She predicts a downward spiral in which PECMH is doomed to fail as a viable hospital if the proposed cuts are implemented. She suggests that with just 12 beds, basic services will be rationed. This in turn will result in increasing lengths of stay and decreasing quality of care. Then hospital administrators will have their ammunition to close the hospital.

She predicts an array of bad things will follow. Overloaded nurses will lead to more sick days. Cuts to physiotherapy mean greater frailty in the population, meaning longer hospital stays and re-admission.

She foresees the loss of nurses, more difficulty recruiting and retaining physicians, and a significant deterioration of the quality of care.

Christie says there is a better way forward—that some of the remedies to the system’s woes are here in Prince Edward County. They should be emulated rather than crushed, according to Dr. Christie.

“Prince Edward County residents would never have imagined marking the 100th anniversary of this community- built hospital with its effective closure,” concluded Dr.Christie.