Doctor’s concerned about new direction for Muskoka hospitals

This weekend a public post was made on the Muskoka Bulletin Board Facebook group by Dr. Rohit Gupta.

The post is an open letter signed by several physicians that illustrates concerns they have about the new direction that is being proposed for the two Muskoka hospitals.

Rather than give you my interpretation or slant about the letter, I will post it here and you can make your own assertions about it.

LETTER AS POSTED

Re: Muskoka Algonquin Healthcare Hospital Redevelopment Model

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.

Endorsed by:

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