Providing quality health care is not about sacred packages of philosophy which must not be tainted! You need to listen to feedback from the public and community physicians.
By Ted Mitchell
Published September 11, 2008
I attended Monday's special meeting of the City's Board of Health purely as a spectator. Here are my impressions on the current state of Hamilton's hospital restructuring soap opera.
Council called this meeting to have the Hamilton Health Service (HHS) "Access to the Best Care" proposal further explained and answer some questions and concerns that councillors have been hearing from their constituents.
So far, this story has been about the content of the proposal. Content is no longer the problem. Transparency is absent, and dark opacity has started to infiltrate the hallowed halls of HHS administration. I felt like I was watching Lord of the Rings, and something really evil was about to happen.
Let's recap and shed some light on the events of that evening.
First order was a motion to allow two five-minute presentations from community speakers, both of them experienced older physicians: Dr. Ken Ockenden of the Ainslie Wood Westdale Community Association, ex emergency medicine, and Dr. Bob James, a family physician from Dundas.
Both of these gentlemen had prepared a script and clearly had warning of this meeting, yet council still needed to pass a motion to allow them to speak. But get this: two councillors actually registered as opposed to allowing their delegations. Pardon? Was I in China?
Then I took a deep breath and settled into the 65-minute-long Powerpoint presentation by about eight fancy-suited members of the HHS, who, of course, were allowed to speak first and without time limit.
It is truly astounding how many words these people can say without conveying any actual information. I thought that politicians were good at that, but HHS admin takes it to a whole new plane. There is even a medical diagnosis I will offer: Receptive aphasia: gobbledygook speech that superficially sounds normal but makes no sense.
Sorry, this rhetoric is rubbing off on me; I'll get back to the point.
In that long presentation, all HHS representatives spoke in generalities. Not once in an hour did anyone actually mention that McMaster would be closing to adult patients, although that was the elephant in the room that drew a capacity public audience.
The only new bit of information that had not been put forward before, and the only direct fact I could identify, was a decision to relocate the proposed Urgent Care Centre from the west Mountain to the family practice building on Main Street West by Hwy 403.
So, an hour was wasted in rhetoric that all the councillors had surely heard before.
Then our two community doctors were allowed to speak. They raised several important concerns, similar to points I've made on this site, and together conveyed more information than everyone in the entire previous hour had managed.
There was a brief attempt by an older gentleman from the audience to speak, and he was shut down promptly.
Councillors then questioned members of the HHS on the plan's specifics. Here I was pleasantly surprised by council's pointed questions. I was unimpressed by the answers, if you could call them that.
If I am asked a question, you will get a yes, no, maybe, it depends, or I don't know type of answer. Nobody from the HHS seems capable of giving answers in that form.
For example, a couple of councillors asked what impact the McMaster closure would have on ambulance services in the City, which is doubly important because the City foots the bill for this.
The best that CEO Murray Martin could come up with, I think (heavily interpreting rhetoric here), was that they didn't look at that specifically, but it should be about the same, and there are several ways it could decrease demand, and many patients already go directly to the most appropriate hospital, bypassing McMaster.
Nobody even acknowledged that patients west of the 403 will have to travel several extra kilometers to the General, St. Joes, and Henderson, which I think has a pretty clear effect on demand for ambulances. Reducing four adult ERs to three, without creating any extra medical beds, also has a pretty clear effect on ambulance offload delays.
Councillors also made clear that the concerns of their constituents have not been addressed by HHS. In answer to this (again, heavily interpreting) was that basically HHS has ignored them, because we have a fundamental difference in philosophy, and the opposition to it was just from people who can't deal with change.
What the hell! Providing quality health care is not about sacred packages of philosophy which must not be tainted! Whatever the details of the plan, if you do not ask for or listen to feedback from the public and the majority of community physicians, you are going to fuck up.
Something this complicated cannot be trusted to a bunch of powermonger administrators. They will get many of the details wrong, and having burned bridges, are going to have a hell of a time fixing it.
And don't even get me started on change. I thrive on change. But it helps if the change is positive, and HHS does not appear to have considered that their plan could be anything but uniformly positive.
So the night went: an obviously biased format in favour of HHS, shutting out the public and even preregistered delegates from asking any questions of HHS, and nothing resembling a debate on the plan's specifics.
I listened hard for even one thoughtful, objective remark, admission of negative consequences, or problems yet to be ironed out. There were none: complete positive endorsement from all members. HHS is steadfast in pushing forward this package as is, without amendment. Solidarity!
Now, the proposal goes to our Local Health Integration Network (LHIN) for approval or rejection. I have no idea what that entails.
The ballsiest councillor, Russ Powers of Dundas, stated that HHS had been given the opportunity but could not provide enough answers or reassurance to his constituents that this was a positive plan for Hamilton, and he would bring these concerns to the LHIN. Martin and his disciples were for once without a reply to that.
So the questions I have to ask HHS admin are these:
Good people can have bad ideas. But good people do not resort to these kinds of bullying tactics to get their way. Good people listen, and give honest, understandable answers. I think the fascist methods of HHS administrators need to be exposed, and so I am issuing a challenge:
Will the HHS accept a moderated, publicized debate, Cable 14 style, where the "Access to the Best Care" plan can be challenged by a panel of concerned physicians and members of the public?
Bring it on. Compared to these fancy administrators, I am nobody. But I am absolutely sure I can skewer the HHS's finest orators on this topic, because honesty and respect for the community still matters.
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