The head of cardiology at the only hospital in North Scarborough is “extremely concerned” that a plan to close some of its key wards could undermine patient care.
Dr. Raymond Chan is one of hundreds of residents and medical professionals who attended a packed town hall in Scarborough on Feb. 25, 2019, to launch a “Save the Grace” campaign.
City councillor Jim Karygiannis organized the community meeting after the Scarborough Health Network announced a plan in January to close the obstetrics and children’s wards in one of its three hospitals. Maintaining the wards in all three hospitals “is not sustainable,” the network says, in a December 2018 report that calls for their consolidation.
But Chan says closing the wards at the Grace (now called the Birchmount) — and redirecting patients to the health network’s other two hospitals located a 15 to 30-minute drive away depending on traffic — is not safe for patients.
The plan would “completely shut down the women’s program — no more babies being delivered, no obstetricians on call” at the Birchmount, he says.
Same goes for pediatrics, he warns.
So “if a child were to roll into emergency that needs a pediatrician’s attention — there would be no pediatrician here,” he contends. “They would have to be stabilized or dealt with in the ER by an emergency physician, and then transferred elsewhere.”
“You can’t just shut down emergency services to pregnant women and children,” he says. “That’s thousands and thousands of people coming here, and you’re asking them to travel to South Scarborough. That’s simply not fair, and it will probably lead to downstream effects for the emergency room.”
Chan is not the only one concerned. More than 150 doctors and other medical staff have signed a petition to oppose “any plan for closing Obstetrics and Inpatient Pediatrics at the Birchmount site.”
But the chief of staff at the Scarborough Health Network says there will be no closures at any of the three sites — Birchmount, General or Centenary. Each hospital will continue functioning as a community hospital, Dr. Dick Zoutman says.
The ultimate goal is to provide the best quality of health care to all Scarborough residents, regardless of where they live, he continues.
“We want to develop centres of excellence so we deliver the very best care. You don’t do that by spreading the care over multiple sites,” he says.
“You got to consolidate it so that you have that concentrated expertise that can manage all of the eventualities that can come up — and offer absolutely world-class care, which is, you know, what our goal is.”
‘This is the third attempt’
It’s not the first time the hospital has floated similar consolidation plans, says Denis Lanoue, who presented at the February town hall.
A retired chemical engineer, Lanoue sat on The Scarborough Hospital’s community advisory council from 2009 to 2015.
Prior to merging in 2016, The Scarborough Hospital operated both the Birchmount and General sites, while Centenary fell under the separate Rouge Valley Health System. All three sites amalgamated in 2016 and were renamed the Scarborough Health Network two years later.
Under its previous administration in 2006, The Scarborough Hospital proposed closing the emergency ward at the Birchmount. Seven years later, it proposed shutting the obstetrics and pediatrics wards at the General and moving them to the Birchmount. Both plans were abandoned after locals objected and, in 2013, after the Local Health Integration Network intervened, Lanoue says.
Given the previous public outcry, Lanoue says he was shocked to suddenly hear the hospital’s new administration wants to try again.
“This is the third attempt. It’s ridiculous. It’s crazy,” he says. “They haven’t consulted us at all.”
Health care has to evolve, says Scarborough Health Network
Zoutman is aware “of many different attempts to consolidate over the years,” but says he doesn’t know the details around the decisions to rescind those earlier proposals.
Health care is constantly changing, he says, and service providers need to evolve otherwise they become out of date.
Back in 2013, there was no long-term vision for the delivery of health care, he continues, but the Scarborough Health Network is entrusted with developing that vision now for the entire community.
“Quite honestly we have to look to the future. What we’re doing now is a very different world than 2006,” he says. “The fact that we’re Scarborough Health Network — we’re serving all of Scarborough. We want to be Canada’s leading teaching community hospital.”
The health network’s spokesperson, David Belous, says the new plan emerged after a consultation process that involved online surveys with community members, talking to primary care and other physicians and midwives at all three sites in Scarborough, as well as in-person interviews with expectant mothers at the three sites.
The results of that consultation suggest that consolidating will better serve residents by maximizing resources most efficiently across the sites of its network, Belous and Zoutman both say.
“There are 1,000 less births occurring at Birchmount now than there were 10 years ago. So that’s very significant,” Zoutman says.
And it’s difficult to maintain highly trained staff at all three sites, he reiterates. “If you consolidate, you can have a centre of excellence.”
Consolidating could also help address the aging infrastructure of the Centenary and Birchmount sites, he notes. And it could help anticipate the needs of an aging community, and how best to meet them.
“Scarborough has a very high proportion of elderly folks, larger than the average in GTA,” he says. “For example, elderly people break a hip. So what’s the best way for us to organize our services, so that if [there’s a] fracture, surgery gets done very efficiently? Because we know the outcome of that elderly person is far better the faster they get that surgeon.”
A community hospital should serve its community, says advocate
To May Ye Lee, the Scarborough Health Network’s explanations for consolidating its obstetrics and pediatrics departments sound like “spin-master speak more than anything.”
“It’s like pulling wool over our eyes,” she says.
A semi-retired barrister and solicitor, Lee sat on the board of The Scarborough Hospital from 1999 to 2006. She also founded the Scarborough Chinese Outreach Committee in 1996 to engage the Chinese community in health care issues. The committee raised more than $2 million to benefit The Scarborough Hospital, she says.
“Right now the hospitals have certain duties and obligations — and they think it’s better to put money in seniors and mental health? Those programs, yes, there needs to be a focus. But those can be outside the hospital environment,” she says. “A hospital is a special place for acute care and surgery.”
The Scarborough Health Network is “just vying for funding because the [health] ministry is saying we should focus on these issues,” she alleges. “This is not the right way.”
A community hospital should serve its community, and “offer core services to support a full-fledged ER,” she says, including obstetrics and pediatrics departments at every site.
Clinical studies and data analysis will not tell you how consolidation will impact a certain geographic area, especially one that is racialized, and with a high percentage of lower-income families, she continues.
“Can you imagine a mother of a newborn — and these days it’s the sandwich generation, having to look after the elderly and the young — having to trek all the way to Centenary just to visit the baby, if you have to hospitalize them?” she asks.
“Travel time is important,” she says. “When it affects women and children, you have to make sure you fulfill the basic duty of serving them.”
‘How can you not consult emergency department doctors here?’
This consolidation will leave a community with a high percentage of immigrants, low-income families, visible minorities and non-English speaking people stranded, says Dr. Lisa Salamon.
An emergency room doctor at the Birchmount, Salamon says she’s concerned about the safety of her patients. The Scarborough Health Network’s plans to have on-call pediatricians available is only a transitional measure, she suggests.
Moreover, she’s frustrated that she and her colleagues were not even informed about the board’s decision, let alone consulted.
“Christmas Eve I was working in Emergency and two of the physicians who work in my hospital came up to me and said, ‘Hey Lisa, have you heard about this?” she says.
“‘There’s a whole secretive thing going on in the hospital, like the hospital is shutting down pediatrics, obstetrics at Birchmount,’” she says they told her.
Over the next few weeks, Salamon says she started to gather and distribute information to her colleagues. “How can you not consult emergency department doctors here? It will affect us.”
Zoutman says there are no plans to close the emergency department, and patients will be taken care of — no matter which Scarborough Health Network hospital they show up at.
“We know we need to keep all three of our vibrant hospitals going full tilt,” he says. “We have a very busy Emerg at the Birchmount, and likewise at the General and the Centenary.”
For Lee, the next steps include trying to spread the word about the Scarborough Health Network’s plan to consolidate. It will require a lot of work, translating the information into all of the languages spoken by people living in this community, she notes.
“We just keep trying and trying, and hopefully we can reach the ears of the minister,” she says. “Once we reach that stage, we can sit down with the hospital. I don’t even mind raising funds to help redevelop obstetrics and pediatrics. But they cannot just ram it down our throats.”
This story is part of our ongoing coverage of Scarborough. Sign up here to subscribe to our weekly newsletter.