Juggling act as hospitals eye savings
February 15, 2010
Theresa Boyle
HEALTH REPORTER
Barb Pickering spent Thursday afternoon on the phone, calling pain clinics around the GTA in search of one that would take her on as a patient.
The 60-year-old former nurse was informed two weeks earlier that the pain clinic at St. Joseph's Health Centre, where she goes every five weeks for nerve-block injections, would be closing in March.
She was given a list of 15 other clinics and clinicians, but so far she's found no takers.
"They told us that the Ministry of Health is cutting funding," says Pickering, who suffers from severe arthritis and chronic pain from injuries sustained in an auto accident.
"There's nowhere to go. I tried. There are long waiting lists," she warns.
The pain clinic is one of four clinics that the west-end hospital is closing. Across Ontario, hospitals are looking for savings and attempting to balance the books by the end of their fiscal year, March 31. Some are cutting staff and others, like St. Joseph's, are cutting services.
In previous years, the province has come to the rescue of hospitals with big bailouts or increases to allow them to remain in the black. Last year, about a third of Ontario's 154 hospitals ran deficits, despite legislation forbidding it.
But this year they are under greater pressure to balance their books. As the province comes out of the recession, it is facing a deficit of $24.7 billion.
Tom Closson, president of the Ontario Hospital Association, notes the sector's inflation rate is close to 3 per cent. He is hoping the upcoming provincial budget will include a funding increase of 2 per cent, or $360 million, on base funding of about $18 billion. Anything less will result in "significant cuts," he warns, describing the cuts to date as "moderate."
There are other examples of how the sector is finding savings, including:
- York Central closed 18 beds and laid off 22 employees, including nurses, physiotherapists and occupational therapists, in December.
- Toronto East General is closing its physiotherapy clinic.
- Providence Healthcare laid off 14 managers, including two vice-presidents.
- Rouge Valley Health System has a list of 25 services, including its TB clinic, that is being eyed for possible cuts should it receive less than a 1 per cent funding boost.
- St. Michael's Hospital is postponing elective surgery until the start of the new fiscal year. Office cleaning is also being reduced.
- The University Health Network is capping its intake of patients in some areas even though demand for services is growing.
The Ontario Health Coalition says hospital cost-cutting measures in the Niagara area may have had deadly consequences. It's calling for an inquest into the death of 18-year-old Reilly Anzovino, who was injured in a car accident in Fort Erie in December. The accident happened about 16 kilometres away from Douglas Memorial Hospital, but because its ER closed last September, an ambulance had to travel to a hospital in a neighbouring community. She died on the way.
Ontario's 14 Local Health Integration Networks, agencies created by the province to coordinate health care within specific geographical boundaries, are working with hospitals to find savings. Janine Hopkins, spokesperson for the Toronto Central LHIN, says the only services being cut in the city are those deemed not to be "core" to acute care hospitals. Decisions to close outpatient clinics are made only after determining that the same services are available in the community, she says.
The Ontario Health Coalition argues that Ontarians are increasingly forced to pay out of pocket for services once available in hospitals.
"There are new user fees as physiotherapy, chiropody, speech pathology and other services are cut from local hospitals," Natalie Mehra, director of the coalition, recently told a prebudget consultation at Queen's Park. Issues of equity arise because many can't afford the services, she says.
"The measure for LHINs is not whether or not the services are accessible somewhere in the community, but whether they are available somewhere in the community. That means that if the only place to get physio is a private clinic where you have to pay $70 to $100 for the visit, that is deemed `available' and the service can be cut in your local hospital," she says.
Healthcare analyst Michael Rachlis agrees that community health services are best suited to provide care. But he notes that the transition to community care doesn't always transpire as planned and points to the deinstitutionalizing of psychiatric patients as an example.
In the case of the closure of the pain clinic at St. Joseph's, Dr. Roman Jovey, past president of the Canadian Pain Society, challenges decision-makers to show him where replacement services exist in the community.
"Pain management is already such a poorly serviced health care domain in Ontario, we can ill afford to lose any pain clinics," he argues. Hospital CEOs like Jo-Anne Marr at York Central say they are "really up against it" when it comes to balancing the books and serving their communities. She notes the number of people visiting the hospital's ER has jumped to 77,000 this year, up from 63,000 last year.
At the University Health Network, the same juggling act is underway.
"Our system is very stressed in that we will not know what our inflationary increase is until the spring budget," says CEO Bob Bell.
Toronto Star
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