Loading...
The Goderich Signal-Star, 1979-01-25, Page 7McCaul. claims board has no recourse; now ... • from page I support in 1979-80 will be $3,718,786. "We can protest all we like and do what we want," said McCaul. "That's it." But things could be worse, McCaul pointed out. Thirteen active beds were closed at AM&G in 1978 when the hospital •was experiencing some financial difficulties, bringing the total number of approved active beds at AM&G to a8 beds at the present time. Only 53 active beds will be allowable after April 1, 1979 and so AM&G shows a surplus of five active beds. The hospital is penalized $12,000 per surplus. bed, meaning that $60,000 was lopped 'off .the top of, the 1978-79 funding which amounted to $3,615,392. Therefore the revised 1978-79 allocation was deemed to be only $3,555,392 and the allocation for the upcoming 1979-80 was figured on that base. "We frust fell into it," remarked McCaul. "We were lucky that we closed those 13 beds earlier or we'd have had no increase at all this year." To the base figure of $3,555,392 was added a 5.3 per cent increase to out-patient and chronic beds of $22,536 and a 4.5 per cent increase to in- patient active beds of $140,858, making the 1979- 80 allocation $3,718,786. SOME POSITIVE THINGS "There are .a few positive. things," M -Caul reported to the board Monday. >hs He said capital and interest charges will be an allowable expense where a hospital borrows money to undertake a cost-saving project. As well, an unanticipated operating budget deficit in one year may be recovered from savings le the ensuing year. Fifty percent of savings achieved in a year may be used for new or expanded programs. There have also been some changes in the authorized rates for such things' as newborn visits, emergency visits, therapy attendance, day care visits and preferred accommodation (semi -private and private active beds). "From an operating. standpoint, . though," said McCaul, "we'd better get down to the 3.5 beds per thousand. We've already lost $60,000 a year plus interest. We are being actively, penalized. It will affect our budget base forever. We must get organized and run this hospital with what we've got." Chairman of the board, Jo Berry agreed. "We've got to be practical," she warned. "We have to sit down and do some long range planning for three years at least." Mrs.. Berry suggested the board make two plans - one to meet current ministry demands and another to prepare for the eventuality that the decision of the ministry will be reversed. GODERICH SIGNAL -STAR, THURSDAY, JANUARY 25, 1979 -PAGE 7 "While we are working with one, we can fight for the other," the chairman said. ,.McCaul also recommended two committees he set up to work on the two plans. "They should be two active groups," McCaul added, "not just one to yell and another to push the paper." The board voted to have the management committee meet as soon as possible to make suggestions as to the makeup of these two committees and their different fun.ctions.. The management committee has plans to meet tomorrow (Tuesday) with doctors, nurses and other staff n} -embers invited to participate. 'No. financial rniracles' in irnrnediate mitment to a balanced hospital stay...and spend budget and reminded the that time at home with people of Ontario of "our their families. And of collective responsibility course, changes in to pay our way". medical and surgical "Our resources are procedures, such. as pre - strained," Timbrell told admittance testing, have the, hospital represen- helped reduce average tatives. "However, with length of stay in acute competent' management, beds from more than 10 a limit on our resources days in the 1960's to just does not have to mean a 'over eight days today. limit on our services. But it must mean a change in how we deliver them. And for the better." T-i.m.}r r.e4 l —said t h e BY • SHIRLEY J. KELLER Dennis Timbrell, Ontario Minister of Health, didn't pull any punches when he talked last Friday in Toronto to hospital representatives from across the province, including Jim McCaul, vice-chairman of the board of Alexandra Marine and General Hospital in Goderich; and the hospital's ad- ministrator Elmer Taylor_. Timbrell told the meeting there have been "no financial miracles" in Ontario since the Ontario Hospital Association annual conference last fall when he predicted general hospital bed cutbacks and other health care cost savings. In fact, Timbrell said, the provincial treasurer has since reiterated the govern'ment's com- hospitals of Ontario have shown a willingness to change and a flexibility in their planning that "augers well for their ability to meet the challenges of transition". "There has been a dramatic upswing in day - hospital programs and other out-patient ser- vices," the health minister said. "As a result, many more people avoid an overnight MINISTRY LEADS THE WAY According to Timbrell, the Health -Ministry -itself is showing leadership in the area of restraint. He said- between 1973 and 1978, total complement has dropped by some 2,400, representing positions eliminated through better management and more efficient operation. "For example," the minister said, "from April 1974 to April 1978, OHIP staff decreased by 21.5 percent while the One out of every two will be left out ofAM& G beds soon BY SHIRLEY J. KELLER Dr. Bruce Thomson on Monday evening brought to the attention of th.e board .of •Alexandra Marine and General Hospital a report from the . admissionand discharge committee concerning 'occupancy rates at the hospital during 1977 and 19,78. It showed that in the active and medical - surgical beds, the average occupancy in 1979 (based on `1978 figures and taking into consideration "the proposed reduction in beds) would be more than 100 percent. In the whole hospital, for instance, an attached chart estimated the occupancy rate would be 106 percent. In the active beds alone, occupancy would be 126.8 percent; in the medical and surgical beds, 156.3 percent. "Half the people presently . in hospital would not be able to be here when the bed cuts are affected," warned • Dr. Thomson. He explained that when 13 beds were cut from the hospital's active segment in July because of a board decision, the reduction was made in tlie-medica]- surgical area. According to Dr. Thomson, it will he in this area where the cutbacks will he most keenly felt by the people of Goderich and area; Dr. Thomson went on to explain. that the Ontario ' Hospital Association and the Ontario Medical Association are in. agreement that a hospital is operating at -maximum efficiency with an average monthly oc- cupancy rate of about 85 percent. While such figures really apply to large hospitals, an even lower figure would be °ap- propriate . to smaller hospitals for a variety of reasons. According to Dr. Thomson, smaller hospitals deal,. with a higher proportion of acute illnesses as 'op- posed to the elective investigations done in the larger centres. Larger hospitals, he said, have a large amount of elective surgery andelective medical admissions„_both of which can be delayed. That gives the larger hospital then, a higher degree of flexibility. Larger hospitals, Dr. Thomson went on, can hold hack admissions from referral centres like Goderich. At the same time,4arger hospitals can discharge patients back to smaller hospitals for recuperation. "As we are dealing with a higher percentage of acute illnesses, we must have the ability to respond to •a varying census throughout the month,” pointed out Dr. Thomson. ' Figures presented by Dr. Thomson indicate an average census. "There are weeks that are considerably higher and that we must be able to deal with," claimed D r. Thomson. In actual fact, the Briefs BY SHIRLEY J.KELLER A director of `finance, a new position at Alexandra Marine and General Hospital, will begin duties Monday morning here. Craig Cass will assist administrator Elmer Taylor in the area of hospital finance. Bill Alcock has been named treasurer of the board at AM&G, replacing. Bill Wardley who has resigned from the board effective immediately. This leaves a spot on the finance committee that still has not been filled. The board is anxious to fill that opening with someone representing the doctors of the community, and time has been given to that group to think over the ap- pointment. Bruce Potter has been named the board's contact person when dealing with the local members of parliament. Bob Dempsey of Goderich joined the board Monday evening as one of two newprovincial representatives. The other is Gerry Ginn,former Huron County warden who lives in Goderich Township. Ginn was not present at Monday's meeting. -F- -I- Gordon Crabb presented his first financial report to the board of AM&G Monday evening showing the hospital is still well within budget. In his report, Crabb also mentioned that the Dr. John Wallace trust fund now stands at $2,800. The fund is still open and gifts in memory of the beloved family physician arestill being ac- cepted. doctor continued, the cuts are felt only in the active bed area. "We cannot effectively control pediatric or ob- stetrical illness so the true effect is actually felt on the medical -surgical beds," said Dr..Thomson. What's more, Goderich has had only four family physicians in , active, practice since last June. Two new doctors are expected in the spring and ,.,one physical medicine specialist has expressed interest in coming to the com- munity. Visiting con- sulting specialists are 'also corning to Goderich on a regular basis. "These factors imply more local physicians- and hysiciansand this implies more in,- patients n;patients as we find more disease in the community that simply hasn't been found because of the lack of availability of physicians," said. Dr. Thomson. The doctors already in Goderich and , those coming to town are much more highly qualified than average, Dr. Thomson told the board. They will be ,capable of local care of more intense problems and that will increase the hospital census in the future, "Bed cuts in London will hold up transfers and return of patients im- plying higher local oc- cupancy rates," con- cluded Dr. Thomson. number of claims ac- throughout this area of tually increased by 25 the health care system. percent." "At this time, as you Timbrell called 'for are aware, some 35,000 "effective management extended care patients in of the health system" nursing homes and with the objective to homes for thetaged pay a ensure that everyone in per diem charge, while Ontario "receives the patients in chronic best value for money hospitals, which cost far expended". more, now pay no per "Specifically, this diem fee at all," Timbrell means a continuation in told the group. "This I the shift of some have -had to conclude, 'is resources from expensive no longer tenable. It is 24-hour acute care to less ._aimplx....__unfa.i-r__.and.,__._ j— costly alternate forms of continued, will in - care, within both the creasingly distort S the hospital and the com- best use of our facilities." munity," Timbrell said. Timbre]] said there is He warned this kind of currently no incentive to a transition cannot take move patients from place overnight. chronic beds to nursing "It is a slow and for hcl'me beds when nursing some, a difficult ad- home care could more justment we are going properly meet their through," said Timbrell. needs. "However, I believe it is He said that's why a necessary and in the per diem charge for those lasting interest of the occupying a chronic bed health care system of in a public or chronic Ontario." hospital for longer than 60 days has been instituted. USER FEES' As of April 1, 1979, the fee Timbrell told the will be $9.80 a day, equal meeting one change to the per diem nursing would be the institution of home fee. user fees - a principle that The 'same fee will also is not entirely new. apply to those occupying "In .fact, those who use a bed in a provincial ambulances and those in psychiatric hospital for nursing homes have paid longer than 60 days, user fees ever since these Timbrell predicted. services became insured Exemptions will be benefits," Timbrell made for those on family - pointed out. -. benefit allowance and on The Taylor Committee, general welfare one group studying health assistance, as. .well-. as. costs in oOntario, has veterans, in Sunnybrook suggested that when a and Westminster stay in a chronic bed' Hospitals for whose tare becomes a long-tetwm the Ontario government sta3„a daily fee should he has agreements with the levied' equivalent, to the federal government. 3u lementar pp y cttisirge As of`April 1 as well, the paid' by nursing home government is increasing residents. the 'ambulance user fees As well, the Select for the first time in 11 Committee representing years. all parties in the Ontario'. "I want to stress that a Legislature, noted that user fee is not a pre - chronic care patients in condition of receiving a hospitals escape a user health service," said fee that, is imposed on Timbrell. "The am- patients in other, 'lower bulance fee, for example, cost institutions. That is only levied after the committee recommended service has been that a per diem fee be provided." introduced for chronic OPERATING care in hospitals in order BUDGETS to.establish equity As of, April, 1, 1979, Wants campaign BY SHIRLEY J. KELLER Dr. J.L. Hollingworth wants the board of Alexandra Marine and General Hospital to urge local people to write to the Ontario Ministry of Health, the Premier of Ontario, the leaders' of the opposition parties and, the local m.ember of. parliament stating their objections to. the hospital bed reductions -throughout the area. Inevitably, according to Dr. Hollingworth, patients in Goderich and district will be denied the hospital care to which they are entitled. He, said cases of pneumonia, heart attacks, strokes , may have to be cared for at home because hospital beds will not he available for them in the future. The full text of Dr. Hollingworth•'s letter to AM&G hoard chairman Jo Berry is published in this week's letters to the Editor column. Doctors want the public well informed... • from page 1 we have in hospital now, only one will remain." He said the hospital board and the people could be considered "spineless" if they did not resist the current "unilateral, dictatorial, totalitarian attitude in Toronto". Dr. Thomson also referred to the govern- ment's bedding guidelines, and said the board of AM&G should not use the term "over - bedded". "Overbedded is only used in connection with the Ministry's figures," argued Dr. Thomson. "There is no proof anywhere in the world those figures constitute quality health care." HEALTH PROTECTION? The doctors at Monday" evening's meeting were quoting from an article taken from the recent Ontario Medical. Review written by br. -Charles M. Godfrey entitled "How Doctors and Patients Can Help Save Hospitals"., In that article, Dr. Godfrey called the government's decision a "ferocious attack" on. the health care industry in Ontario. "If a similar attack were mounted on a major industry in Ontario with as much ferocity," Dr. Godfrey said, "that industry would appeal -to the government for help. Unfortunately our present executioner is. also our judge, and appeals are buried in the "pending" basket." Dr. Godfrey said he agreed with some of his associates who believe that ministers of health "have concentrated their thinking on the curative aspects of health, the most expensive element of the system, while paying scant attention to health prdtection, health promotion and health maintenance". Dr. Godfrey charged that the Ontario Medical Association had not been able to convince the public that the health industry is not taking an inordinate amount of money but is actually "a bargain for the dollar spent". In July 1978, Dr. Godfrey said, Peter L. Wood, the assistant e)recutive director of the Ontario Hospital Association, had reported that the Ministry of Health's estimated. share of public hospital costs at $2.04 billion was very close to the low point of 2.13 per cent of thegross provincial product which had been set in 1973. "More importantly, he indicated that these figures showed a downward trend which had been consistent, since the cost surges of 1974," , wrote Dr. Godfrey. "Certainly figures which were readily available have consistently shown that the percentage taken by the Ministry of Health for the provincial budget has actually been lower," argued Dr. Godfrey in his article. "From 30.6 per cent in 1970, it was reduced to 26,3 per cent by 1975." "Yet We have been unable to get these facts over to our elected officials, our civil service or the people of Ontario," he charged. NO MODEL The English system of health care doesn't make a good model, Dr. Godfrey pointed out in his article. Hesaidadministration costs have risen in England and they are rising in Ontario. In Dr. Godfrey's view the administration costs had gone up "because of government .bureaucracy, which was demanding so many reports and so much more information back from the hospital, and then unloading the cost of doing that adrninistrative work onto the hospital, so that budgets were being skewed to provide the information." More doctors are getting involved in the financial matters of their lbcal hospitals, Dr. Godfrey said. He said many physicians have a "growing awarene, Us that their future is tied up with budgetary considerations" and unless they are in on the financial process, "when the axe falls, they have no way of knowing why they have been picked as the chosen race to be sacrificed". "Orffr industry is saddled with old equipment and old realities," Dr. Godfrey went on. ''Where are the day centre which we know will cut hospital costs? Where are 'the up -patient dining rooms which replace the Tabor -intensive Penalty for sick BY SHIRLEY J. KELLER Dr. Michael Conlon, president of the medical staff at Alexandra Marine and General Hospital doesn't like the idea of user fees for the chronically ill or those patients requiring long- term psychiatric care. "Extended or long term illness is something we all dread," said Dr. Conlon. "However, unfortunately it is a _..r.eality_._Lt.-..Gan--•eq•ua-lly- - afflict young or old - more particularly the old, and now the authorities are in effect imposing a penalty or what is tantamount to a fine on the sick, or physically or mentally, disadvantaged, =after a period of 60 days." Dr. Conlon said he found the concept of user fees in whatever form, "totally contrary and alien to the very basic philosophies and sen- sitivities of the physician, and for that matter, I hope, the general population of the province." He warned it will inflict hardship on people whose lives are already afflicted by extended illness p.nd._suffering. "It is unnecessary and uncalled •for in this relatively affluent society of ours," said Dr. Conlon. "These are the very people to whom we should be dedicating more of our financial resources and assistance. Surely this is our Christian and moral obligation, regardless of the duration of the illness"; Dr. Conlon doesn't even like the term . "chronic care "I have always felt that such a term as ap- plied to illness should be abolished," said Dr. Conlon. "In our System it appears it implies a concept of hopelessn°ess - that little more in the form -of active treatment will be°of any avail.." hospital budgets for in- patient acute care will "increase by -4.5 percent, but., the budget base will be reduced according to the number of beds in excess of the bed - population guidelines. ' Timbrell said the ministry of health believes that bed -to - population guidelines provide the fairest and most equitable way of lessening the emphasis on acute care "So we can continue to shift resources to alternate forms of, care and -to primary care". He added that to fur- ther encourage alternate forms of care, a larger budget increase - 5.3 percent - will be applied next fiscal year to out - 'patient services and chronic care units, as well as to chronic and rehabilitation hospitals. "The net ,effect of the 4.5 percent increase, plus the larger increase for out-patient, chronic care and small hospitals, plus the cost of annualization and new programs, will bean -overall increase in funds available for operation of hospitals and related facilities of about 6.7 percent for a total of $2.203 billion in fiscal 1979-80," Timbrell told the meeting. Asa result of limits on budget growth for the next fiscal year, Timbrell advised hospital representatives the tray systems? Where are the in -common laboratories which will utilize the down-time of hundreds of thousands of dollars of hospital equipment? Where are the 1.2 -hour, seven -days - per -week programs which will use the ex- pensive real estate which is now used for 35 hours out of a possible 84?" "How can anyone who has watched invasive techniques of the head or abdomen deny a sick person his premium -paid right of access to the most modern techniques - and because he lives in Barrie or some small town, he has to go south of Finch Avenue to enjoy that right?" Dr, Godfrey wrote. MUST INFORM PEOPLE Dr. Godfrey urged medical practi.oners to "let the powers -that -be know just how long the waiting lists for elective procedures and out- patient appointments have become". "Now we must counter by detailing in exact numbers how frecjuently it has been necessary to play Russian roulette with a patient because a bed was not available so that safe medicine could he practised rather than cheap medicine," said Dr. Godfrey. He also referred to,a.fight in recent years to keep soene,liospitals'open'When The government had recoml•nended th It they be closed. . Using a book by Voltaire Cousteau entitled ministry will be in a position tofund only a few new hospital construction or planning activities next year. "These will include those designed to correct safety hazards or con- serve energy; said Timbrell; Projects already under con- struction will not he af- fected. ATTITUDE Timbrell said the most effective long-term an- swer to the pressures facing hospital boards across theprovince is a lower demand for acute hospital care. "A change in attitude of health profess,ionals toward hospitalization will also help ease demand," Timbrell stated. "Many still feel an acute-care hospital bedis the only place for all their patients, no matter what level of care is actually needed." , Timbrell went"on to say . the ministry is planning several steps to stimulate the trend to alternate forms of care. Iris hoped, ,for instance, to expand Placement Co-ordination Services to assist doctors and hospitals to place patients in appropriate accommodation or programs, such as nursing homes, homes for the aged, day care centres for senior citizens, chronic hospital care and chronic home care. How to Swim With Sharks: A Primer, he quoted: "Get out (of the water) if someone is bleeding. No useful purpose is served in at- tempting to rescue the injured swimmer. He either will or will not survive the attack, and your intervention cannot protect him once , blood has been shed". "I think that last year we jumped into the • water and rescued injured hospitals when we should have stayed on dry land," said Dr. Godfrey. "Yes, we saved Doctors (Hospital) and a few others, but at a cost which is just beginning to be cdunted." Dr. Godfrey stressed the need to enlist the help of "one powerful ally" - "the patient over whose body this war is being fought, and who pays for the sheTls". He urged doctors to tell the story. "And I do not mean by this judging medical care in the yellow haze of front-page headlines," said Godfrey. "What I mean is simply telling the story of an industry which' is proud, which is one of the best, 'and which refuses to be kicked around by any political process." Dr. Godfrey is head 06 rehabilitation medicine at two Toronto hospitals, an associate professor at the University of Toronto and a former member of the Ontario Legislature. The paper was prepared in October, 1978.