Responses to the LHIN Decision Sept. 29, 2008

Below are two letters of response to the decision made Sept. 29 by the Local Health Integration Network to accept Hamilton Health Sciences Access to Best Care proposal to make McMaster University Medical Centre a children’s only hospital.

The first is a letter from Dr. Kenneth Ockenden, which he wrote the day after the decision. The second is a letter written by Rob Payne on Oct. 2.

Each writer has given the AWWCA permission to send their letter to members and to post it on the AWWCA website.

Response from Dr. Kenneth Ockenden:
After sitting through the LHIN meeting, I feel a few comments are in order regarding this whole Hamilton Health Sciences process.

Firstly, I have never seen such a sloppy, uninformed, undemocratic process as that which unfolded yesterday. One Board member declared a conflict of interest while a former V-P of HHS said nothing (while it is true that [CEO of Hamilton Niagara Haldimand Brant LHIN] Pat Mandy did not vote, I have no doubt that she has expressed her opinion).

Next a presentation was made to a Board which appeared not to have read the submissions. Ms. Emo (who continually misnamed the proposal) carefully edited her speech to present the HHS in a good light while downplaying or dismissing concerns outlined in the 30 or so public comments received. For example, she commented that in the EMS submission, the best case scenario would decrease ambulance ED off-load times. She failed to mention that the EMS submission also stated that the opposite might occur and no one on the Board even questioned the assumption.

Likewise, when she acknowledged public concern re the lack of consultation by HHS, the Board accepted assurance that a list of consultations refuted that concern. Again no one asked what changes or discussions had resulted from the so-called consultations. These “consultations” were essentially presentations of foregone conclusions which we could accept or not but could not change.

Ms. Emo was asked a few questions some of which were clearly inappropriate for her to attempt to answer on behalf of the HHS but she tried to do so. These questions further reinforced my feeling that the Board had not done its homework.

My greatest shock came however when a Board member stated clearly that he was going to base his opinion and vote on the conversations he had with his golfing buddies! So much for sober consideration of issues, weighing of outcomes and making decisions based on what is best for the community!

I was also dismayed to see that at least one Board member seemed to resort to voting according to the “Trust me–I’m a doctor” attitude precluding any hard questioning of the plan.

Thus, using a double negative, the LHIN approved the Access to Best Care proposal.

Personally I feel fairly neutral about the closure of the adult ED. However I do feel very strongly that the whole process has been grossly flawed and unfair to the public.

If I do not like products in one store I can go to another. If I do not like the service from one company I can go to another. But the public has no choice in the provision of health care and yet must pay a great deal for it. Hospital administrators are making the choices but the public has no option but to accept. These decisions are too far-reaching to have such a limited hearing.

Still unanswered are how the city will afford the extra ambulance and paramedic services needed and what McMaster students will do. The recruitment of pediatric emergentologists is highly problematic despite claims by HHS. If current HHS emergency physicians are “stretched” what will it be like when they staff both MUMC and a new Urgent Care Center? Where is Family Medicine in all this?

I make no claim to have all the answers but I believe they should at least be addressed. Since HHS did not I had hopes the LHIN Board might do so. Like all physicians I have always tried to provide the best care for patients. I believe this plan falls far short of that.

Response from Rob Payne
The community engagement process used by Hamilton Health Sciences, and accepted by our LHIN’s appointed board of directors as sufficient for their decision to approve the HHS Access to Best Care Plan, needs a significant overhaul.

It is recognized that the LHIN structure is relatively new, and that LHIN boards will more fully understand their role to represent the community, much like corporate boards represent the stakeholders, as they gain experience.

However, the Ontario government’s decision to let them operate without training wheels has placed these boards in an overmatched and under-informed position when faced with the communications resources available to our larger hospital organizations. The result is the tail wagging the dog.

Community engagement in a normal public planning process, where the healthcare experts propose a plan and then leave sufficient time to engage the public in an effort to improve their proposal, was not followed. The process as structured by our provincial government does not allow for any recourse for the public to have their concerns taken seriously. Community presentations are not permitted to the LHIN board.

Cynically, one could interpret this structure as deliberate by our government, as it allows for no one to be responsible for decisions taken. The buck, in fact, stops nowhere. However, let’s take the high road.

The current public engagement process needs an external professional review immediately. Decisions made by the LHIN will have long term impacts on our communities, and it should be important to all of us that we take the time to get these decisions right. Leaving this to physicians, most of whom having no training in organization structural issues, needs to be re-examined. Ignoring any wisdom that can be gained from the public is a mistake.

To paraphrase HHS, it is not the time it takes to get to the decision that is important, but it is the shape of the decision once you get there that counts. The public does not want the fastest decision, just the best decision.

AuthorKen Ockenden