LETTER: Carp doctor concerned about ‘mega-hospitals’

By Dr. Barry Bruce

To the Editor,
Health Care expenditures support a system that Canadians and Ontarians greatly treasure. For Ontarians that’s about $61.2 billion, up sharply from $55.9 billion in 2016-17.

Hospital mega-projects seriously threaten this system. At least five mega-hospital projects totalling $9 billion dollars in capital are being planned and built in Ontario as we speak. And once the ribbon is cut, the costs really go up – that $9 billion is then spent every year to operate. Once built, if a hospital is over-sized, we’re stuck with it for decades. If these hospitals mirror the hospitals in Ottawa, they are expanding inappropriately, at tremendous cost, inefficiencies and all.

Oh, the inefficiencies! We always seem to need more hospital beds, hospitals and emergency wards that are being chronically overburdened with patients and always in crisis. However, several of the causes for overcrowding lie outside of the hospital. For example, many patients don’t belong in a hospital, but have nowhere else to go. Ten per cent of health costs occur in the last year of life because palliative care and patients end up in hospital inappropriately. Stroke commonly causes admission, yet 50 per cent of hypertensive patients (hypertension = the leading cause of stroke) neglect their medication. Community care home services (formerly CCAC) have underperformed for years. The LHINs are ineffective and costly, according to the auditor general. Effective programs like community paramedicine have not been expanded in a meaningful way. Emergency wards have long wait times, yet many patients are not emergencies. Too many family physicians don’t see patients in a timely fashion.

The Ottawa Civic Hospital, plagued by the sort of systemic inefficiencies mentioned above, proposes doubling in size, at a cost of $2 billion to build, and then, to operate annually. To provide perspective, the entire Champlain LHIN annual budget, which includes hospitals, is “only” about $2.5 billion.

If the bathtub is overflowing, do you get a bigger tub, or do you shut off the tap?

I propose the Ministry of Health and Long-Term Care provide leadership and not allow hospitals to essentially plan themselves. Hospitals are a health destination of last resort. Hospital mega-projects drain resources for a hundred kilometers around and decades in the future. The Ottawa Civic Hospital expansion planning is taking place in relative isolation and is based on brute force – getting the bigger bath tub – rather than including the rest of the health care system that could “shut off the tap.”

Hospitals like the Ottawa Civic, with important research and advanced-care mandates, should give up their emergency wards and secondary level care – they don’t manage them well. The Ottawa Heart Institute is a world-class example of this concept, focussing on its advanced mandates from non-invasive coronary to heart transplant surgery without exposing its vulnerable population to infections and capacity demands from an emergency ward. Funds would then be available for the development of more basic, community-tuned hospitals in areas of need.

The Ottawa Civic Hospital expansion as planned, represents a financially, clinically and politically risky blunder. It’s an irresponsible, unaffordable, and ineffective substitute for thoughtful, whole-system reform.

Let’s shut off the tap, open the drain and clean up the whole system before even thinking of expanding a hospital.

Dr. Barry Bruce

Dr. Bruce is a family physician in Eastern Ontario, part of an award-winning Family Health Team. He has served as Chief of Staff in a secondary level urban hospital, was the Primary Care Lead for a sub-LHIN from 2013 to 2017 and has received the OMA Physicians Care Award, Family Physician of the Year for Ontario, and the Order of Ottawa.

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3 thoughts on “LETTER: Carp doctor concerned about ‘mega-hospitals’

  • July 19, 2018 at 2:53 am

    Dear editor,

    I am pleased to see such a well-argued letter from a local physician who has put some thought and research into what we need to do to make not only health care services better but actually help people get healthier! I think offering care and services as close to home as possible is the responsible and fiscally prudent thing to do. We are blessed in West Carleton with an excellent Family Health Team and it would be good to see their offerings increased, reducing the need for residents to have to drive to hospitals for basic services better offered locally. I look forward to reading more about such important issues in the West Carleton Online. Thank you for providing us with a venue to share not only our opinions but also to read the news and current affairs in our community.


    Judi Varga-Toth

  • July 24, 2018 at 3:02 pm

    Thank you Dr. Bruce. As a retired administrator in LTC, I have seen a ‘health system in distress’ as well. I strongly believe that our current system, which was built as an acute care (hospital-based) system needs to be revamped around chronic care which is where the aging of the population is driving Ontario’s health care needs. In addition, the Local Health Integration networks (LHIN) are not managing waste and duplication between neighbouring communities. For example, how many hospital boards want (and get) their own CT scanner even though there is one 20 minutes away and not being used to capacity? How many hospitals, including those with a LTCH on site, do not share food services, maintenance services or resident transportation services with the local LTCH? My concern is that the our current model is not sustainable because each LHIN does not have the authority to identify health service needs and gaps across their region, plan and fund accordingly and no one is looking into the waste and duplication that occurs every day in every sector. Our system has a series of disjointed services working in many different silos. Currently, there are more that 2,500 funded health organizations/agencies in Ontario, many with their own leadership team and board of directors. Is this not waste and inefficiency? Should there not be consolidation of these agencies with the merging of leadership teams and/or boards to achieve efficiency and to provide for the local LHIN to best plan, integrate, and fund health and social services within their geographic area. Every three years each LHIN prepares an Integrated Health Services Plan for their region. The problem is that the plan is not adequately communicated to the many stakeholders despite the insistence that each LHIN is transparent and accountable to their public. I believe our system must be patient-centric not provider-driven. The focus should be on primary care with the family health teams as the gate-keepers and home care supported by the required resources. There needs to be coordination across the continuum of care if we are to achieve quality outcomes and efficiency. Our generation has the huge responsibility to provide a more equitable, more cost-efficient and higher quality system for future generations..a reformed system which responds to the health care needs of the day.

  • August 18, 2018 at 2:44 am

    Experience tells me how sane are Dr Bruces’ words. The baby boom generation is ready to swamp our hospitals with ailments that need early intervention and education for prevention to be able to stay ‘at home ‘ for as long as possible before extended care in home, or care facility. I have seen the civic emergency beds filled with the elderly. No room for emergencies and no beds for the elderly folks who need care in emerg. because there was nothing in place to prevent the emergency situation long before it occurred. I have also experienced the community paramedic service out of the Carp family medicine clinic while caregiving. Not only was this a service beneficial to the elderly gentleman but a source of stress relief for the care givers, Two for one. So, how do we lobby to have the right people hear and understand this logic? The previous government started to talk about a better model. NOW where do we go to keep the ideas rolling? Just how loud do we need to be, to be heard AND listened to? It is never too late but it is if we find ourselves spending 48 hours on a gurney in emergency wishing we had politically advocated for something different.