But the devil in a report’s details conjured up common concerns among medical circles as proposed changes to provincial health-care delivery would substantially impact services at facilities like the Sundre Hospital and Care Centre as well as clinics.
On Monday, Feb. 17 Moose and Squirrel Medical Clinic physicians and owners Michelle Warren and Rob Warren -- accompanied by Mark Diaz, Carly Crewe and Jena Smith -- hosted a live broadcast from their social media page to express their shared concerns as well as to encourage the community to reach out to elected officials.
Rob Warren -- who with wife, colleague and partner Michelle Warren opened the practice more than six years ago with a team of three physicians that has since grown to eight -- said the government released a report several weeks ago outlining a review of Alberta Health Services.
The document, said Warren, boasted some good news: rural hospital closures are not on the docket.
“We all breathed a sigh of relief,” he said.
“But there was some fine print in there. Anybody who works in a rural community in health care, looking at the fine print got very concerning.”
The Sundre hospital is among Alberta’s rural facilities under review to assess the viability and sustainability of services, with a report that was due this week. Of three areas identified for review, Sundre’s hospital will be looked into for each: obstetrics, emergency departments, and the consolidation of hospital beds, he said.
“Things are happening very quickly, they’re happening under the radar, and they’re happening that way because they don’t want you to realize that there’s a threat to your hospital. There is a threat, and we may lose the services that we have had at this hospital for 50 years."
Before outlining how services at the Sundre hospital could be impacted, Warren said recent history has been "a golden era for medical care in this community."
The hospital nearly lost obstetrical care a number of years ago following the loss of a physician. However a replacement was found, and as many as about 30 to 40 babies a year continue to be delivered in town. More recently, roughly four years ago, the facility nearly lost all of its 15 long-term care beds. But after the community rallied, a middle-ground solution was eventually achieved, retaining not only several long-term care beds but even obtaining new restorative care beds, he said, expressing pride in the community for the support.
“But the reason we’re talking to you today is we fear that’s about to change,” he said, adding that even though the hospital is not about to close, there remains a distinct possibility under the government’s proposed changes that the community could lose services that have been available for decades.
Obstetrics are among those services that could end up deemed unsustainable.
“If you’re in a hospital that doesn’t deliver 250 babies a year, that service isn’t really viable,” said Warren.
“Sundre delivers about 30 to 40. Even Olds struggles to get to 250.”
The government’s report has recommended a review of emergency rooms, suggesting low volume departments could, as a cost-saving measure, be closed between 11 p.m. and 7 a.m., he said.
“The three people who came in on Thursday morning (Feb. 13) would have come to a closed emergency department if that was the case,” he said, referring to incidents the week prior.
“And the Sundre hospital’s being reviewed for that,” he said, adding a report detailing the facility’s services was due for delivery to AHS last week.
And despite surviving the bed crisis just a few years ago, “that’s back on the table,” he said.
Crewe discussed primary care networks, and how proposed changes impact the way clinics operate their practices as well as physician compensation. These changes, she elaborated, will translate to shorter visits, longer wait times, and fewer health issues being addressed per session with a doctor.
Warren added the government’s 100-page report, available online, calls for cuts to services in rural hospitals and family practices while giving urban centres a free pass.
“I’ve read through it. There isn’t a single recommendation that talks about cutting services in hospitals in Calgary or Edmonton,” he said.
“There’s not a single recommendation that suggests that AHS administration should take a pay cut, even though they’re asking nurses and doctors to do the same.”
He said the proposal boils down to taking funding from rural facilities to pay for surgical services in the cities.
“That’s not fair to our patients, and it’s not fair to rural Alberta.”
Physicians understand the need to cut costs for a financially sustainable health-care system, but “it’s absolutely not fair to ask rural Albertans to take the majority of the cuts and services to provide more services in the city.”
Smith said since December physicians throughout Alberta have pursued efforts to express concerns to government officials about the proposed changes’ unintended consequences
“I don’t think they’re hearing us,” she said, urging everyone to “speak up and make yourself heard.”
People who are so inclined are encouraged to reach out to Rimbey-Rocky Mountain House-Sundre MLA Jason Nixon, Health Minister Tyler Shandro, and AHS CEO Dr. Verna Yiu, she said.
“We know that the government has to find ways to save money, but we believe there are better ways for them to do this without targeting rural health care.”
Concluding the presentation, Warren said, “I want to be perfectly clear about something. We’ve been fighting this for two months. We’re not going away.”
While the impending cuts to the way family doctors are compensated leave little room for private practices to adapt, he said there is no intention to throw in the towel yet.
“We’ve invested too much in this clinic and in this community to start leaving the province at this point,” he said.
“If we are unfortunate enough to lose doctors, we’re going to give you as much notice as we can, so that you can be prepared to go without a physician for a while. The reality is we may not be able to make it work. But we’re not going to close up shop in the middle of the night, and have you walk up to the clinic door with a closed sign on it.”
MLA Jason Nixon responds
The day following the broadcast, on Tuesday, Feb. 18, Nixon, who was in Edmonton at the time, responded to some of the concerns raised with a video posted on social media.
“There appears to be a lot of fear going around,” he said, expressing a desire to alleviate worries shared by residents.
The MLA assured the community that he had been assured by Shandro that no plans are in place to change services at the Sundre hospital.
He confirmed the government’s report does make reference to low volume emergency departments, recommending in some cases that such departments be reconfigured based on prescribed standards for patient safety.
“The report does not say which sites are low volume, and in no way indicated that Sundre is considered low volume,” said Nixon, adding that throughout the course of several conversations with Shandro, he has stressed the high volume handled by the hospital’s emergency department.
“And I will continue to have those discussions with him to make sure that the health department is aware of that.”
Any changes that would occur at the hospital would not be approved without prior consultation, he said.
“The (health) minister has reassured me that staff and doctors, the community and myself as your MLA would be involved in any discussions going forward in regards to the Sundre hospital, should they be warranted,” he said.
“Though at this point, I want to reiterate they are not, because the minister has assured me there is no planning underway for changes to the Sundre hospital.”
Furthermore, Nixon said Shandro was committed to arranging a meeting with the physicians who expressed concerns, the department of health, AHS, and himself within the coming days.
His statement did not mention anything about concerns expressed regarding changes to primary care networks, nor the consolidation of beds.
In a phone interview with the Round Up last Thursday, Nixon reiterated that "there is no planning underway for specific changes to the Sundre hospital" when asked about doctors' concerns regarding the consolidation of beds
AHS is reviewing hospitals throughout the province to come up with recommendations, but that does not mean the government will accept those recommendations. Furthermore, he said there would not be any significant changes approved without prior community consultation.
In terms of physician compensation, he said work to find "efficiencies" remains ongoing and that doctors remain in negotiations with AHS and the government.
"That’s a process that has to play out."
Responding to Nixon’s statement in a comment on his social media post, the Moose and Squirrel Medical Clinic expressed gratitude for the MLA’s advocacy on behalf of the hospital, but pointed out the facility meets all of the criteria outlined in the report, which does not specifically identify any hospitals.
“All that has been released by the health minister is that AHS is reviewing 36 rural hospitals for labour and delivery (if less than 250 deliveries per year), acute care inpatients (no parameters shared), and reduced emergency department hours (if 'low volume' overnight). Sundre hospital meets all of those criteria.”
Furthermore, the clinic’s physicians cautioned against “secretive planning by AHS” that has in the past had a negative impact on the hospital.
Up until Nixon’s video response, no one had “approached the community about participating in this plan and it has been happening very quickly without any information being shared.”
Although reassured by the health minister’s expressed commitment that no changes at the Sundre hospital are impending, the physicians sought similar assurances about the way clinics are operated.
They also hailed the community for the outpouring of support.
“We would not have gotten this assurance from Minister Nixon without your efforts.”
A town hall is planned for Sunday, Feb. 23 at the Sundre Community Centre.
