A group of local physicians are expressing their concern over a plan to change service levels at Muskoka’s two hospitals.
On Monday January 27, Muskoka Algonquin Healthcare (MAHC) is expected to reveal changes to the service levels at the South Muskoka Memorial Hospital in Bracebridge and the Huntsville District Memorial Hospital Site. In December, Cheryl Harrison, the president and CEO of MAHC, confirmed that several confidential meetings had taken place to discuss service changes at the hospitals. Harrison declined to discuss the specifics of those changes at that time but a comprehensive breakdown is expected ahead of a series of open house meetings being hosted by MAHC beginning January 29 at 7:00 p.m. at the Dwight Community Centre.
Nonetheless, more than 40 local physicians and healthcare professionals released an open letter on January 26 outlining their concerns with the impending changes.
Here is that letter in its entirety:
“January 26, 2024
As physicians and surgeons who practice in South Muskoka, we have significant concerns with the proposed hospital redevelopment model and its implications for healthcare delivery in our community. South Muskoka Memorial Hospital often operates at over 100% occupancy of inpatients, with our volumes being especially heavy over the past several months.
This means that many sick patients have had to wait in the Emergency Department for multiple days before a room on the inpatient unit is available. As our population ages over the coming years, it is only natural to expect that the demand for hospital services in our community will grow with time.
We had expected that our hospital redevelopment plan would respond by expanding our ability to
provide care to those who need medical attention.
Instead, the new model proposed for Muskoka Algonquin Healthcare has reduced inpatient capacity at South Muskoka by almost 70%. Rather than expanding, our hospital is contracting.
This plan transitions the vast majority of inpatient and obstetrical care to the Huntsville site, leaving South Muskoka unable to provide adequate care for our population. This is especially perplexing given both the greater population and population growth1 in South Muskoka over Huntsville.
Furthermore, when we analysed admission data at Muskoka Algonquin Healthcare since 2017, we found that there is a 12% higher admission volume at South Muskoka over Huntsville. It is not rational, evidenced based, nor in the interest of patient care to allocate most of the inpatient services to Huntsville. Both sites deserve a hospital that can serve the needs of their community.
With this significant reduction of inpatient services, sick patients will need to be frequently transferred out of South Muskoka as there will be minimal capacity to care for patients locally. This will lead to poor patient outcomes and significantly worsens the quality of medical care for the citizens of South Muskoka.
There are numerous scientific articles that describe in detail the negative patient outcomes associated with hospital transfer including increased mortality2 3, longer hospital length of stay4, and delays in surgical intervention5 6.
If this redevelopment model proceeds, South Muskoka will not only be losing inpatient services, but we will be losing local physicians as well. Our obstetrical services are being closed, meaning that our family doctors who focus on obstetrics and women’s health will leave. Pregnant mothers will then need to travel for their routine prenatal care and appropriate help will be far away should they experience any urgent complication of pregnancy.
Additionally, this model makes it nearly impossible to recruit or retain specialists. Specialists such as cardiologists, internists, surgeons, or gastroenterologists will choose to leave for communities where they can work their typical practice in both inpatient and outpatient settings.
This has further implications for family doctors, who come to this community expecting to have the support of a fully functioning local hospital and its associated specialist care. In this new model, family doctors will leave and recruiting new doctors to the area will be harder than ever.
This will only worsen the current crisis of primary care availability as both family doctors and specialists will choose to work in communities that have a fully functioning acute care hospital with appropriate inpatient services.
1 Simcoe Muskoka District Health Unit, Population Data found at: https://www.simcoemuskokahealth.org/Health- Stats/HealthStatsHome/PopulationDemographics/Population
2 Schnipper et all. Interhospital Transfer: Transfer Processes and Patient Outcomes. Journal of Hospital Medicine, 2019.
3 Torner et al. Inter-hospital transfer is associated with increased mortality and costs in severe sepsis and septic shock: an instrumental variables approach. Journal of Critical Care, 2016.
4 Wen et al. Impact of interhospital transfer on emergency department timeliness of care and in-hospital outcomes of adult non-trauma patients. Heliyon, 2023.
5 Edye et al. Interhospital transfer delays emergency abdominal surgery and prolongs stay. Royal Australian College of Surgeons, 2016.
6 Reinke et al. Interhospital transfer for emergency general surgery: an independent predictor of mortality. The American Journal of Surgery, 2018.
This model drastically worsens access to healthcare for our population. This plan will significantly change the landscape of healthcare in South Muskoka for decades as it negatively affects the capability of our hospital and creates an undesirable environment for both specialists and family doctors.
We want to be clear that this model is not acceptable for South Muskoka. Any hospital redevelopment model that significantly reduces inpatient services should not be supported by our community.
Scott Whynot, MD, M.Sc (PT), CCFP
Luke Wu, MD, M.Sc., FRCPC (IM)
William Hemens, MD, M.Sc., CCFP
Timea Maxim, MD, CCFP, AAFP Christopher LaJeunesse, MD, DABFM, CCFP Courtney Potts, MD, CCFP
Bharti Mittal, MBBS, CCFP
Steve Rix, MB.BS, MRCS(Ed), PgDip-SEM, CCFP Adam MacLennan, MD, CCFP
Kimberley Forester, MD, CCFP
Lisa Tsugios, MD, CCFP
Cole Krensky, MD, CCFP
Jennifer Hammell, MD, CCFP
Jonathan Rhee, MD, FRCSC
Jessica Nairn, MD, CCFP
Kristen Jones, MD, CCFP
Chris Richardson, MD, CCFP (FPA)
Jessica Reid, MD, M.Sc., FRCSC
Vicki Dechert, MD, COE
Graeme Gair, MD, Past COS SMMH
Ken Hotson, MD, FCFP, BSc(Med), BA, BSc Kersti Kents, MD, CCFP (EM), PgDip (Derm) Michael Mason, MD, CCFP (EM)
Sandi Adamson, MD, MBA, CFPC
Joseph T. Gleeson, MD, CCFP, FCFP
Martin O’Shaughnessy, MD
Shannon Lees, MD, B.Sc, M.Sc., CCFP
Karen Martin, MD
Anton Deketele, MD, B.Sc., FRCPC
David Kent, MD, CCFP
Tina Kappos, MD, B.Sc(Hons), CCFP
Paulette Burns, MD, B.Sc(Hons)
Richard Daniel, MD, B.Sc, MB, CCFP
William Caughey, MD, FRCP(C)
Kent Phillips, MD, FCFP
Faizal Bawa, MD, CCFP
Ardyn Todd, MD, CCFP
Dave Hillyard, MD, CCFP
Keith Moran, MD, RCPSC, DABIM, RCS
Rohit Gupta, MD, DNB, FRCSC
Peter Maier, MD, CCFP, FCFP, AAFP”
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