Questions unanswered about attempts to reduce rural hospital services

Everyone in rural New Brunswick knows that our access to health care is likely to require some travel, even for routine appointments with a family doctor. We are not so naive as to think the full range of medical care will be available in every community of any size. We’re nothing if not realistic. Living here has made us that way.

But there are limits to what we are prepared to accept. Before cancelling the proposed changes to rural hospital services, the premier urged us to examine the details. We would have, and would still like to do that: however, at this point, we have more questions than answers, especially given Horizon Health CEO Karen McGrath’s preference for avoiding a main-door exit from the Sackville hospital where she would have faced an anxious public last week.

We were told that acute-care beds would be converted to beds for the long-term care patients now accommodated in the larger hospitals. Can anyone at Horizon Health explain the logic of moving these patients to Sackville or Sussex, further away from family and friends, while moving acute-care patients to Moncton, and thus also further away from familial and social “safety nets”?

Will the shuffle of patients meet the needs of those in long-term care? Will it release enough beds to accommodate all acute-care patients in the regional hospitals? We know that currently at least the three largest hospitals are operating at or well beyond capacity much of the time. We need many more details now, in advance of the premier’s proposed “healthcare summit” in June, so we will be prepared to respond appropriately during the consultations.

A primary concern that will need to be discussed at the consultations is added travel time, especially in emergencies. Ms. McGrath cited St. Joe’s (Saint John) and Oromocto hospitals as evidence that the proposed changes work. She neglected to add that each of these facilities is within little more than 10- or 15-minutes’ drive from full-service hospitals – the Regional in Saint John and the Chalmers in Fredericton. How do these distances compare with travel from Cape Tormentine to Moncton?

Both the NB Medical Society and the paramedics expressed concerns about the fragility of existing ambulance services and the risk of adding new demands to an already stretched system. When and how would ambulance services be adjusted to ensure adequate service delivery? Would rural patients be forced to shoulder the additional financial burden of ambulance or taxi costs to receive ER service?

Ms. McGrath claimed that with the proposed cuts, doctors would have been able to see many more patients during the day, since ER services would be closed at night. Can she explain just how they would accomplish this in the face of already full-to-bursting patient loads? How exactly would nurse practitioners be integrated into the system?

Sackville Memorial Hospital was one of the six rural hospitals affected by the proposed cuts. Did Ms. McGrath consider the potential impact of the proposed changes on the Amherst hospital, which provides service to many residents of the Sackville area? That facility was blindsided by the initial announcement of the cuts, just as were our own municipal councils and medical community. How would Amherst accommodate any increase in demand for services in its already overcrowded hospital?

What of the more than 2,000 university students in Sackville who rely on hospital access as much as our full-time citizens, and who, moreover, are unlikely to have spare funds to pay for ambulance or taxi travel to Moncton or Amherst? Were they considered in the initial plans for cuts? Will they continue to have timely access to needed services? After all, as one student commented last week, “we die too.”

What about recruitment and retention of medical professionals? The medical programs training doctors in New Brunswick were created with two objectives in mind: to offset the likely rate of retirements among doctors, and to ensure better access to physician care in rural areas. How likely would new doctors be to come to communities where, among other potential limitations, they believe that if future cuts go ahead, they will not even be able to admit their own patients to a local hospital and oversee their ongoing care? How easily will nurses be able to move to positions elsewhere, especially if a move means uprooting a whole family?

Did anyone consider potential “downstream” effects before proposing the changes? Sackville has welcomed a number of newcomers from more urban areas of the country; one factor in their decision to move here has been the presence of a hospital providing a good range of basic services and care. The attractiveness of this community and many others in New Brunswick risks being seriously undermined if access to health care is perceived as insufficient.

The communications fiasco that accompanied the roll-out of these changes provides an excellent case study in how not to develop and announce challenging new directions. The word was out informally by Monday, Feb. 10, and Sackville town council discussed it that evening; the formal announcement was made on Tuesday; a full-page ad appeared in local papers only on Wednesday; and not until Thursday was Ms. McGrath available to meet our local hospital administration and staff, the medical community and our municipal and university representatives — though remaining invisible otherwise. Her defense of the changes, published only Feb. 16 in the Telegraph-Journal, is as detail-free as the ads featured earlier in the week.

Rural New Brunswickers understand that our fiscal ship has been listing badly for some time, and that changes to high-cost services may well be inevitable to ensure continued access to quality health care. We know finding effective long-term solutions is a challenge.

What we learned last week is that the government was prepared to present a done deal, out of public view, with less than a month to prepare for and implement what clearly would be a major shift in service provision. Were no alternatives considered?

If the proposed cuts had gone ahead, there would have been so little time to put the required supports in place that patient care and public certainty would both likely have been the victims of a poorly-communicated, top-down, unconvincingly presented fait accompli, developed and announced without consultation and seemingly without consideration of alternatives or unintended consequences.

By backing off from the proposed cuts, Ms. McGrath, Minister Flemming, and Premier Higgs, clearly experienced significant blowback from skeptical voters. They have another chance now to show good faith to rural communities and come prepared in June to answer the many questions that this fiasco has raised.

Kathy Hamer (Edwards) came to New Brunswick in 1971 and worked as a Professor of French at Mount Allison University. She held various administrative posts at Mt. A before spending five years as Vice-President at the University of New Brunswick in Saint John. With the exception of those five years, she has called Sackville home. She and her husband Peter Edwards are now retired here. She is a member of the boards of the NB Youth Orchestra, Symphony NB, the NB Museum, and Sackville’s Festival of Early Music, and is a past president of ArtsLink NB.

This article is an updated version of a commentary originally published in the New Wark Times before the hospital cuts were cancelled.