Ontario Health Coalition

15 Gervais Drive, Suite 305, Toronto ON M3C 1Y8 416-441-2502, ohc@sympatico.ca , www.ontariohealthcoalition.ca Ben Lefebvre c/o Northeastern Ontario Health Coalition P.O. Box 99 Porquis Junction, Ontario P0N 1E0 March 5, 2013 Dear Ben, Thank you for your inquiry about the consequences of amalgamation of local hospitals. Briefly, Ill share with you what Ive learned over the last 15 years about this issue during my tenure as a board member and director of the Ontario Health Coalition. There had been rationalization of services between local hospitals and significant bed cuts earlier, but the systematic and formal amalgamation of local non-profit hospital corporations really started in the 1990s. We now have 15-plus years of experience with amalgamation and we can see what it has done to local hospitals and their services. The rationale was that the hospitals would enjoy administrative savings from reducing administrative duplication. Amalgamation, in itself, was not supposed to be a carte blanche to close down local hospitals and centralize services. But this is what happened. The Ontario Health Coalition conducted a province-wide consultation in small, rural and northern communities with hospitals in the spring of 2010. We travelled with a very experienced non-partisan panel of experts including retired nurses, physicians and health professionals, who are members of all three major political parties in Ontario. The full report is available on our website at
http://web.net/~ohc/hospitalhearingsreport2010.pdf

In summary, this is what Ive seen and experienced: 1. Amalgamation of local hospitals has been accompanied by a re-writing of the by-laws in the new amalgamated hospital corporation to eliminate local elected boards and replace them with appointees. Local advisory committees are hand-picked to support whatever the hospital CEO wants and no one else is allowed onto them. Processes for meetings and selection of board members is shockingly undemocratic and unaccountable. 2. Amalgamation has resulted in the continual erosion and closure of local hospital services in the smaller hospitals within the amalgamated hospital corporation. Usually one hospital dominates. As budgets are constrained, the dominant hospital cuts off its appendages in order to save itself. Empirebuilders within the larger hospital gain more and more power to centralize services onto one site. In the extreme cases (see attachment) smaller hospitals are entirely closed; or their ERs are closed down; or their acute care beds, surgeries and other services are cut. 3. Amalgamated hospitals have fewer protections under the LHINs legislation from cuts or even total closure. Because an amalgamated hospital is no longer

its own separate corporation (it is a site like a department-- of the larger hospital corporation) local hospital CEOs have made plans to close down entire hospitals (see Shelburne Ontario) or massive service cuts (all over Ontario) without any oversight whatsoever. Under the LHIN legislation a service transfer that requires a

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LHIN board motion (called an Integration Decision) and thus presumably discussion and debate -- only relates to movement of services between separate corporations. Under the Act the closure or dissolution of an entire corporation requires the Ministers approval. But the closure of a site or department is not recognized at all and therefore can happen without any checks or balances. Thus, there is no required process that requires any oversight for the movement of a service within a corporation, which is the case in an amalgamated hospital, even if it means a whole community loses vital care. There are no protections against the ongoing movement out-of-town of equipment that has been fundraised-for and bought by the local community. It is outrageous. And it is a complete departure from all health planning under previous governments. But it is a fact. Amalgamation will leave your local hospital much more vulnerable to service cuts without even the paltry checks and balances that exist if you stay as a formally separate entity. There are alliances that are not formal amalgamations. But these deals have also resulted in the loss of services and democracy. (See St. Marys Ontario where they tried to close the ER at night or Seaforth where they did.) Amalgamation has led to less transparency. Local community members are not able to get separate financial information about the different sites of the hospital once amalgamated. (See Kincardine.) Most communities have not been able to enforce what they believe are their legal rights (to protect services or governance) under amalgamation and alliance deals made in the 1990s. Either it is too expensive to hire lawyers, or the records are incomplete, or the process is too lengthy and the chances of winning too slim to take it on. The folks in Petrolia are discussing a legal case to try to win back their hospital and this may be a test case. In most of the communities where there are small hospitals that have been amalgamated that I am involved with, the local community desperately wants out of the amalgamation in order to preserve their hospitals. Virtually all of them have been fighting for their lives routinely since amalgamation.

I strongly believe that whatever the rationale for this move, smaller hospitals are poorly served by amalgamation. In my experience services are continually eroded, democratic input is dismantled, and many entire hospitals or vital acute and emergency care services are at risk simply as a result of the amalgamation of the governance of the hospital and the way that amalgamated hospital boards deal with tight budgets. Conversely, those small and rural hospitals that are stand-alone hospitals (like in Napanee or Winchester) are doing very well and have a much more robust range of services (and less financial trouble). I hope this helps. Warm Regards,

Natalie Mehra Director