“For cash-starved hospitals, maternity wards are low-hanging fruit”, and Georgian Bay General Hospital is no different. In a similar move, echoed around the Province, “The Leamington District Memorial’s hospital board voted last fall to close, but a fierce backlash from residents led the region’s local health network to give the proposed closure a second look.” says Kelly Grant, Health Reporter for the Globe and Mail.
Midland’s Huronia District Hospital faces the same recommendations and will likely follow suit closing our OBGYN unit in the months to come if nothing is done. But what can be done? Are local residents willing to rally together to save our maternity ward? If so, how, when and at whom do we voice is displeasure? The local Board, the local LHIN or at the Provincial Government or some combination of the three?
In an article (cited below) Kelly Grant, in a story called “A ward worth saving” details how “More than 40 hospitals across the country have closed their obstetrics units in the last decade, most in rural and small-town Canada. While tight budgets make maternity wards easy targets, rural communities are fighting to keep theirs open.”
Leamington’s hospital’s board voted last fall to close the maternity ward to save money, but a fierce backlash from residents of the town of about 30,000 – a place best known as the tomato capital of Canada, though Heinz pulled up stakes in 2014 – led the region’s Local Health Integration Network to set up an expert panel to give the proposed closure a second look. That panel submitted a first draft this week, but the LHIN is keeping the recommendations confidential for now.
If the closure goes ahead, Leamington District Memorial will become at least the 43rd hospital across the country to lose its obstetrics ward in the last decade, most in rural and small-town Canada.
Some parts of the country have seen significantly more maternity wards shut down than others in the past 10 years, according to a survey The Globe and Mail conducted of provincial health ministries. In Alberta, for example, 14 have closed. At least 10 have closed in Ontario, six in British Columbia and five in Manitoba. Quebec, meanwhile, said it has not shut a single maternity ward in the last decade.
In some cases, these shuttered birthing units struggled to attract and keep specially trained doctors and nurses, a perpetual problem for rural medicine in all disciplines; in other instances, the units delivered so few babies that officials argued patient safety could be at risk and that care should be consolidated in a larger hospital. And in virtually every case, the maternity wards faced serious budgetary challenges that forced the hands of hospital boards or regional health authorities.
Delivering babies is expensive, especially for hospitals that don’t deliver many of them. Administrators can’t schedule births back to back like elective surgeries. They can either pay obstetrical nurses to sit there on days the ward is empty, or call them in on overtime when labouring women turn up, neither of which is cheap.
For cash-starved hospitals, maternity wards are low-hanging fruit.
To cite one example, researchers at the Centre for Rural Health Research at the University of British Columbia found newborns in that province spent more days on average in the level three neonatal intensive care unit, which cares for the sickest babies, if their mothers had to travel more than an hour to give birth. The figures were even higher for expectant mothers who lived between two and four hours from the nearest obstetrical unit. (Women who live more than four hours from a maternity ward generally leave their communities three or four weeks before their due dates, creating a host of financial and emotional complications.)
Stefan Grzybowski, the co-director of the Centre for Rural Health Research and a co-author of the 2011 study, said he and his colleagues found a much higher rate of unplanned births at the side of the road or at clinics en route to out-of-town hospitals for women who had to travel an hour or more to deliver.
“It was a six or seven times higher rate than for women who lived within an hour of services,” he said. “So quite a dramatic increase in unplanned, out-of-hospital deliveries, which are by any stretch of the imagination a dangerous situation.”
George Carson, a member of the board of the Society of Obstetricians and Gynecologists of Canada and the director of maternal-fetal medicine for the Regina Qu’Appelle Health Region in Saskatchewan, said health officials across Canada need to work harder to keep small obstetrical wards open by making them part of perinatal networks with regular training provided by large referral hospitals.
“But you’ve got to be reasonable about it,” he conceded.
Wildly Unpopular Decisions By Hospital Boards
Like all Ontario hospitals, Leamington District Memorial is grappling with the Liberal government’s decision to essentially freeze hospital budgets for the past three years. This approach has left hospital boards and LHINs to make often unpopular cuts at the local level, while insulating the government from the blowback.
“The decision to close OB was for one reason and one reason only and that was because of money,” said Jim Gaffan, chair of the Leamington hospital’s board. “Why would I or any of the other 12 board members want to make a decision to close OB and become, basically, a pariah in our community? My friends and my family think I’m a terrible person for doing this.”
But the numbers, provided by a consulting company that reviewed the hospital’s operations and plotted a course for its overall future, seemed to leave the board little choice: In 2012-2013, the $1.4-million birthing unit was “losing” nearly $740,000 a year under the province’s Byzantine, volume-driven funding formula.
The hospital was not delivering enough babies to cover the $1.4-million ward’s costs, meaning it was “losing” about $740,000 a year under the Ontario government’s hospital funding formula.
An outside consulting firm recommended closing the unit and shifting resources elsewhere, which the hospital’s board reluctantly endorsed last fall.
But a fierce backlash from the community prompted the Local Health Integration Network – the regional health authority that approves significant changes to health services – to stop the closing temporarily and appoint a group of experts to give it a second look. They opted for a “turn-on-the-lights” option for now…
This part-time approach – operating the maternity ward on a “turn-on-the-lights” basis – is the chief recommendation of an expert panel’s report on the fate of the obstetrical unit at the only hospital in Leamington, a southern Ontario town that was in danger of becoming at least the 43rd community across the country to lose its maternity ward in the past 10 years.
The panel’s report, released this week (May 2015), recommends that the “turn-on-the-lights” unit be supplemented by a “navigation centre” that would bring together doctors, midwives, doulas and the town’s sole obstetrician in one place to co-ordinate pre- and post-natal care for women outside the hospital.
The navigation centre would be funded with “existing resources,” while the hospital would save money by no longer paying obstetrical nurses to wait on standby in the maternity ward when it is empty.
If this matter is important to you, then you should attend one of the three remaining public information sessions hosted by GBGH’s Board, planned over the next week. Tonight’s session is at 7PM in Penetanguishene’s Memorial Community Centre.
For our part, we have several other follow-up stories planned that, we hope, will help clarify the issues at play and help us, as a community, navigate this report’s recommendations and plan a strategy to support our hospital and help them to continue helping us.
To read the update about the closure: http://www.theglobeandmail.com/life/health-and-fitness/health/panel-rules-leamingtons-maternity-unit-should-be-closed—until-needed/article24199817/