Health minister insists on no hospital closures, but cuts to rural services still on table

When a major review of Alberta Health Services dropped earlier this week, Health Minister Tyler Shandro made it clear some of the report’s recommendations would not proceed, including: “no hospital closures.”  But the report offers other recommendations for cuts that have some rural doctors wondering exactly what they’ll be left with.

Some rural doctors ask what services will be left if consolidation, bed closures happen

The AHS review suggests some rural hospitals should be closed but Health Minister Tyler Shandro has said that option is not being considered. (CBC News)

When a major review of Alberta Health Services was released this week, Health Minister Tyler Shandro made it clear some of the recommendations would not proceed, including hospitals closures.

But the report recommends other cuts that have some rural doctors wondering exactly what they'll be left with.

"If you reduce the level of services to the point where we can't offer reasonably safe, comprehensive and continuous after-hours care to our patients, it can be a potentially dangerous situation if patients walk in ... expecting a service that we can't provide," said Dr. Noel Dacunha, speaking on CBC's Edmonton AM on Wednesday.

Dacunha is based in Westlock, a town of about 5,000 about 90 kilometres north of Edmonton. But the hospitals in question also operate in much smaller towns, meaning few patients in facilities that are relatively expensive to run and maintain.

The AHS review shows some small hospitals operate less than an average of five acute care beds, and some get less than 10 people visiting the emergency department in the overnight hours

The review found 77 of the province's 83 rural hospitals have underused emergency departments. The report recommends they either be consolidated with other regional ERs or "re-classified," meaning they might operate under an urgent care model that doesn't run 24 hours per day.

Cuts in some towns could mean growth in others

That could be a boon for towns like Whitecourt where Mayor Maryann Chichak says the local hospital has one of the busiest emergency departments in the region.

It could grow further if other nearby ERs close down and patients are diverted to her community.

For smaller communities that don't meet service thresholds, losing services has real life consequences, say community leaders. 

Our community has story after story of moms delivering on Highway 16 on their way to the city.- Kara Westerlund, Brazeau County


"We have had a number of 'on the way' deliveries, people delivering on the side of the highways and phoning for an ambulance because they can't make it to the city," said Kara Westerlund, a councillor for Brazeau County, which includes Drayton Valley, a town with no maternity care in its local hospital.

"Our community has story after story of moms delivering on Highway 16 on their way into the city."

The ability to provide obstetrical care is a major measurement of hospital viability in the review of AHS services.

The 28 small- or medium-sized hospitals have specialist obstetrical services available around the clock, but average only about 200 births per year.

That's not always good for the patients, even if they don't have to drive as far to see a doctor, according to the report.

"Physicians and other care providers require ongoing exposure and experience with certain types of procedures, such as complex births, to maintain proficiency," the report states.

"Clinical evidence indicated that less than 250 births annually would be deemed sub-optimal and may result in clinical quality concerns for the facility."

AHS says it has an implementation team looking at all recommendations in the report and will develop a detailed plan for implementing some of the measures within 100 days.

The report, compiled by Ernst & Young, contains a total of 57 recommendations and 72 "opportunities" to improve the quality and sustainability of health service, with the total potential to save $1.9 billion per year.

- with files from Ariel Fournier