At the risk of driving away everybody but the six other people in Niagara with internet access (oldest CMA in the province!), some more local bloggery follows. (Does it strike anyone else as pathetically lame to respond to a local letter to the editor in an even less-read medium? If this blogging thing doesn’t work out, I can always scratch these rantings in the paint of toilet stalls.)
I used to joke that as you grow older you move closer to the hospital which my wife and I did a number of years ago, minutes away from Douglas Memorial Hospital. Ironically, four years ago, my wife had a mild heart attack while we were watching my grandson’s lacrosse game in Brampton, but we were minutes away from the first class Osler Centre Hospital and had excellent fire department and paramedic service, and my wife came through just fine. Now, our brilliant health authorities are working towards closing the Douglas on us, step-by-sneaky-step.
What am I to do now, be reassured by the NHS and its transparently insincere and infantile arguments that they will provide a better solution? Fast ambulances with snowplow escorts! Heaven help us!
Without getting bogged down in the details of the planned hospital shuffling, let’s consider a hypothetical question: What is the smallest community that can support a hospital emergency department?
It takes a certain number of people to make an emergency department worthwhile. I don’t know what the smallest possible emergency department would be, but for the sake of argument let’s say it’s one doctor and one nurse. In a town like Fort Erie, would this doctor-nurse duo have much to do during the day? I doubt there are a lot of births and heart attacks every day in a small community. In addition to the medical personnel, an emergency department consumes other resources – support staff, utilities, physical space – that might be used better.
We could build hospitals with fully equipped emergency rooms at the corner of every concession road, ensuring that no resident of Niagara lives more than a kilometre or two away, but is that a reasonable way to spend our money?
Why are Ontario’s best hospitals in Toronto? Because Toronto is home to millions of potential patients and the best medical personnel. As with most things (think of shopping malls and sports teams), it takes a critical mass of people to support these massive hospitals. The same principle holds for middle-weight hospitals; even they need a moderate number of people to sustain them. Fort Erie just doesn’t have enough people, from both the patients and staff sides, to support a modern hospital.
As it turns out, the people of Fort Erie and Port Colborne, who stand to lose their hospitals and emergency departments are not actually losing much. From the Kitts Review of the NHS Health Improvement Plan:
The Douglas Memorial site and the Port Colborne General site do not function as full service hospitals today. Residents of Fort Erie and Port Colborne incorrectly believe they have access to full service Emergency Departments, a wide range of surgical services and comprehensive acute care inpatient beds. The sites do not have the necessary diagnostic equipment or specialist support to offer a full scope of services. The Douglas Memorial site and the Port Colborne General site do not provide inpatient surgical perioperative services. The current surgical program consists of minor surgical procedures that can be provided in minor procedure rooms and clinics. Patient volumes are low and the buildings require significant renovation to meet modern care delivery standards.
So for all the fuss over these hospitals, they aren’t even full-service.
I think if you’re really concerned about access to emergency medical care, you should live close to the ambulances. No matter how close you live to the hospital, an ambulance takes you there, and it provides medical care on the way.