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A Hospital at the Crossroads

author: Paul Dalby

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Picton's hospital rides a roller coaster of cutbacks and closures while the community is asked to raise even more money.

LEO FINNEGAN AND BARB PROCTOR MAKE A PERFECT TAG TEAM, albeit one with a few extra miles on the clock. Now the folks in Prince Edward County are counting on the ex-mayor and the retired nurse to win the
toughest contest of their lives.

In a nutshell, Finnegan and Proctor must breathe new life and financial support into the 50-year-old Prince Edward County Memorial Hospital (PECMH) in Picton. This is no small task because the existing hospital has been devastated by bed closures and budget cuts. Its future is clouded by uncertainty. If that wasn’t enough, Finnegan and Proctor will also ask county residents to dig even deeper to bankroll a brand new replacement hospital – likely 10 years away from construction.

It’s a high-wire balancing act for the formidable duo and one that places them squarely in the middle of a Titanic battle between bureaucrats championing austere healthcare economics, and passionate community flag-wavers fighting for their onceproud hospital.

Tempers are short, newspaper letters’ pages are aflame and libel suits are flying. Throw in a fourbus convoy of angry protestors walking into the Ontario health minister’s office, and you start to get the picture: people in the County are not happy campers.

That doesn’t deter Leo Finnegan, who finished his term in the mayor’s office, only to find himself a patient of the Prince Edward County Memorial Hospital after complications from heart surgery. Last Christmas he turned 80 years-old and, instead of stopping to smell the roses, he celebrated by accepting the top job at the Picton hospital foundation. “I have lived here in the County since the Picton hospital opened and I can tell you that people here are passionate about that hospital,” said Finnegan, who has spent the best part of two decades fighting cutbacks at PECMH.

For her part, Barb Proctor, 69, was a career nurse who spent five years in the Picton hospital operating rooms before moving into retirement, only to take on a new full-time job as a county councillor. She knows that boosting her beloved hospital will not be an easy sell. “The hospital foundation will tell you that donations are down,” she said. “And that’s one reason why we have to boost the community and reignite the enthusiasm that in the past has always surrounded the hospital.”

For as long as anyone can remember, the hospital in Picton has really been the heartbeat of Prince Edward County. It has saved thousands of lives, eased others to a graceful exit and heralded many more newcomers into the world. In a county that has no public transit and endures harsh winters that often overwhelm its rural roads, the Picton hospital has always served as an accessible oasis for full medical care. Not surprisingly, the 25,000 people who live in these parts have supported PECMH with towering civic pride and seemingly bottomless pockets. In the past 30 years the hospital foundation has raised $10 million for the hospital.

DEATH BY A THOUSAND CUTS?

But the fortunes of the Picton hospital changed dramatically back in 1998 when, like many other rural and small town hospitals, it was forced into an “arranged marriage” with a large hospital corporation. In the years since then, those smaller hospitals have lost most of their facilities and services to big city “silo”medical  centres.

The Picton hospital was amalgamated with the Belleville, Bancroft and Trenton hospitals to form the Quinte Healthcare Corporation (QHC) – a forced merger opposed by everyone in the County and one that still rankles. Ever since Quinte Healthcare has been officially classified as “a single hospital with four sites”, albeit as far apart as 160 kilometres, the transition has never been quite that smooth.

After a decade of QHC floating in deficits and red ink budgets, the Ontario Health Ministry finally lost patience and sent in its own troubleshooter, Graham Scott, the same man who helped shepherd in the amalgamation of QHC. He doled out strong medicine for the troubled hospital and promptly fired the board of directors.

“That was interesting,” recalled Finnegan, who sat on the first QHC board as County Mayor.“He fired the whole damn bunch of us. I’ve only been fired from two jobs in my life; the other was when I was 15 and worked in a service station washing cars. The owner said he couldn’t keep me on because I took too long and did too good a job on the cars.”

By 2010, Scott’s team had made a $4.7 million budget cut, tightened up QHC’s management team, ushered in a new president and welcomed a new board of directors. The reorganization should have ended Picton’s woes. Clearly it didn’t.

QHC is currently battling a reported $10 million deficit and last summer’s round of budget cuts hit the Picton hospital hardest. First came the closure of six out of 21 beds, with three more sure to follow soon; then the highly regarded maternity department was closed and moved to Belleville General Hospital, sparking the abrupt departure of two doctors. Finally, notice was served that the hospital’s yearly 3000 colonoscopy procedures will almost certainly go to Belleville.

“Picton hospital is under threat,” said Michael McMahon, a retired high school science teacher and president of the Quinte Health Coalition, one of 400 grassroots community healthcare advocacy groups connected to the Ontario Health Coalition.

“It will always be there as an emergency facility, but there was a time when a woman could go there and have a child,”McMahon said. “That’s no longer the case. Maternity is a big loss. In peoples’ hearts that’s what the hospital means.”

Wellington Times editor Rick Conroy agrees: “For me personally and for a lot of other folks, our faith in this administration’s view towards this hospital evaporated in that fell swoop. There is a widespread disillusionment, when year after year you see your services being cut.”

But if you speak with hospital bureaucrats, they insist there is still a place for the Prince Edward County Memorial Hospital in the future.

Paul Huras, CEO of the South-East Local Health Integration Network (S.E.LHIN) that controls the purse strings of the Quinte Healthcare Corporation and seven other hospitals in the region, is adamant: “There is fear in the community that the Picton facility will close down. It’s not being discussed at LHIN. I totally believe the Picton hospital will be rebuilt. It probably will not look the way it does today.”

Those assurances aside, more belt-tightening seems likely at QHC. Huras himself believes a sluggish Ontario economy demands the present drastic makeover of hospital service. Often referred to as “integration and transformation”, it usually translates into deeper cuts for smaller hospitals.

Ironically the latest round of budget cuts came just as the Picton hospital won top honours among 136 rural hospitals in a survey by the Ontario Hospital Association. Picton’s inpatient unit was named “best performing hospital” and its emergency department treating 35,000 patients a year, scored an over 90 percent rating. Only seven years ago the Picton hospital was called “the jewel in the crown” by a government consultant. That seems a lifetime ago.

CRISIS OF CONFIDENCE

Understandably many local residents feel there’s a ‘crisis of confidence’ throughout the County over the future of their beloved hospital.

“We have obviously had some losses over the past year and we want to ensure that that is the end of it,” said Prince Edward County Mayor Peter Mertens. “I think we are pretty much down to a bare bones hospital with the delivery of services we have now.”

Local discontent peaked last fall after the latest hospital cuts when community leaders, including Finnegan, led four busloads of protestors in convoy to Queen’s Park. The 200 peaceful protestors made an extraordinary demand of Ontario health minister Deb Matthews – they wanted the Picton hospital released from its amalgamation with Belleville-based Quinte Healthcare. They demanded that the province “give them back their hospital”.

The Picton hospital supporters, led by POOCH (Patrons of Our County Hospital), argued the hospital should not be reduced to the level of a small medical outpost. But the meeting with Matthews, several months in planning, lasted just four minutes and the digruntled protestors were shown the door.

“We didn’t get very far at all,” said Finnegan. “I can tell you I’m a liberal and, if you’ll excuse my language, that really pissed me off.”

But it must be said the downsizing of Picton’s hospital is more than just a bubbling local controversy. Picton is viewed by many as a snapshot of the future awaiting many rural hospitals right across Ontario.

SHAPE OF THE FUTURE

The current catchphrase is “hospitals following the patient home”. And certainly at the new “one-stop shopping” hospital proposed for Picton, more patients would be treated at home by Community Care Access Centres (CCACs). Other patients will likely face a long road trip to the bigger hospitals in Belleville and Kingston.

It’s not hard to see what’s driving the Ontario health ministry’s growing preference for home care: ministry figures show that one day in a hospital costs $1,000 per patient; one day in long-term care costs $130; but a day of home care or community care costs only $55.

One way or another, the healthcare landscape is experiencing a seismic shift and the people of the County are uneasy about their hospital’s future.

“People worked so hard to keep this hospital going and many times we nearly lost it,” said Fran Renoy, who worked at the hospital for 30 years as an x-ray technician until her retirement.

“We’re all just sick about what’s happened. History calls the hospital the house of healing but we all call it the house of hurting. We’re not leaving a very good legacy for our children and grandchildren,” said Renoy, a tireless campaigner for saving the hospital.

But Barb Proctor, who as county councillor chairs the PEC Health Advisory Committee, is concerned that amid all the public protests, “the (healthcare) train is moving forward without us. “As a small rural community we are getting left behind,” she said. “I don’t agree with all the healthcare changes but instead of banging your head against the wall, let’s get out there and deal with it in a positive way.”

ONE-STOP SHOPPING

The proposed Picton hospital, estimated to cost at least $40 million, will certainly look nothing like the all-purpose general hospital it hopes to replace. The final blueprint will likely include an ER, an imaging department and some in-patient beds.

Linked on the same campus to a new clinic for the Picton Family Health Team and its 20 doctors, the new hospital would serve essentially as a platform for primary care delivered in the patients’ homes.

It all harkens back to an earlier generation when family doctors and visiting nurses made routine house calls to look after their patients, according to Katherine Stansfield, QHC vice-president and chief nursing officer. “In some ways we are coming full circle back to the level of care that people used to get in their homes,” she said. “It used to be part of a family doc’s scope of practice to drop in on patients at home and see how they were doing. I hear this from many family physicians that they really want to provide that level of care.”

On the drawing board for over a year and undergoing major revision, the Picton hospital plan will be presented to the Ontario Ministry of Health for approval later this year. But Stansfield points out that the ultimate success of the proposed hospital rests heavily on gaining “concrete support” from the community. “It’s required as part of the QHC submission that the community will show their support with fundraising,” she said. “Under the funding model, the ministry funds 90 per cent of construction, and the community funds 10 per cent as well as all of the hospital’s equipment.”

Stansfield believes the people of Prince Edward County are “absolutely committed” to their hospital.
“That passion for their local hospital is definitely there. What we need to do is work on educating them on what the vision for the hospital is.”

FENCE MENDING

But talk in the local coffee shops, on Twitter and in the columns of local newspapers indicates that QHC may also have some fence mending to do. When health ministry supervisor Graham Scott handed QHC back into public hands in 2010, he commented: “I was surprised by many of the negative attitudes and lack of support for the QHC that continued to exist across the region.”

He also said that the community at large viewed any changes that were made as “an attempt to erode services”, rather than recognizing it was the reality of the new world of healthcare in Ontario.

If present community unrest about the fate of the Picton hospital is any guide, public perceptions haven’t really changed much, if at all.

“We have to assure people that every penny we raise will stay in Picton, none of it is going to Belleville,” says Fran Renoy. “People have lost faith. The fundraising has dropped dramatically.”

Indeed donations to the hospital foundation are reportedly down by 50 per cent. But Leo Finnegan and Barb Proctor hope and believe the very geneous people of the County will eventually rallyaround their hospital once again, maintaining the present scaled-down operation until a new replacement can be built.

To understand the extent of emotions in the County, one must understand just how deep the civic pride has always run for the Picton hospital. By sheer determination and heroic fundraising, the County opened its first hospital overlooking Picton Bay just months after the end of the First World War. The Picton Gazette reported: “The first impression on entering this house of healing is surely the air of hopeful cheerfulness which seems to emphasize the spotless purity of everything in sight.”

Within 40 years the old hospital was bursting at the seams, its 58 beds running at full capacity. Once again the people of the County dug deep into their pockets and raised most of the $1.5 million for the brand new facility and equipment that still serves the County today.

Then hospital president J.M. Hartwick proclaimed proudly: “No human endeavour is perfect but this hospital is about as perfect as it can be.” Picton quickly expanded to become a 95-bed facility offering a full range of services to Prince Edward County.

Barb Proctor was born in the original hospital on the hill and during a long nursing career, loved the Picton hospital. “When I worked there, they had 50 beds and we had two operating theatres and they were busy. There is a lot of deep connection to that hospital,” said Proctor.

The County’s Health Advisory Committee that she now chairs is in fact the same umbrella group first formed by Leo Finnegan back in 2005 after he was elected mayor of Prince Edward County on a platform of “saving the hospital”.

IMPROVING LIAISON

Although Proctor’s committee has no legislative power, Proctor believes it can do a good job of improving communication between the healthcare system and the public through new website links and regular round-table meetings with all the key players in healthcare.

“It is quite true we are losing services in the hospital but hopefully we can reassure people that these services haven’t gone away,” she said. “We’d like to tell the story of healthcare in Prince Edward County and what’s available.”

So while Proctor promotes optimism, Leo Finnegan must again rouse his volunteer “army” to shake the collection boxes ever more vigorously.

“If the decision is made to build a new hospital, we’ll work hard to raise the funds and people will support it,” Finnegan promises.

Only time will tell if this amounts to high hopes or a tall order. One thing is certain – in five years’ time Prince Edward County will mark an important milestone, the centenary of hospital care based in Picton. With today’s hospital now reduced almost to the size of that original start-up facility back in 1919, nobody’s quite sure if this will be a time for celebration…or wistful reflection.

 

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