With two Cape Breton hospitals closing, others wonder what could be next
'Without a transparent process ... we really don't know what the logic is'
At least some of the medical professionals in Cape Breton say they weren't surprised the province has decided to close hospital emergency rooms in New Waterford and North Sydney.
After all, the Northside General Hospital is only 29 kilometres away from the Cape Breton Regional Hospital in Sydney, and the New Waterford Consolidated Hospital is even closer at 20 kilometres away.
The Nova Scotia Health Authority, the provincial Health Department and the provincial government have also said the New Waterford and North Sydney buildings were out of date.
The Glace Bay hospital is only 23 kilometres away from the regional hospital, officials said, but the building is newer and suitable for expansion. That's why it's not closing.
Other hospitals near each other
The move has people in other parts of the province wondering if their local hospital could face the chopping block:
- All Saints Springhill to Cumberland Regional in Amherst - 23 km.
- Cobequid Community Health Centre in Lower Sackville to Dartmouth General - 20 km.
- Musquodoboit Valley Memorial to Dartmouth - 72 km.
- Twin Oaks in Musquodoboit Harbour to Dartmouth - 40 km.
- Hants Shore Community Health Centre in Newport to Valley Regional in Kentville - 43 km.
- Soldiers' Memorial in Middleton to Valley Regional in Kentville - 52 km.
- Roseway Hospital in Shelburne to South Shore Regional in Bridgewater - 111 km.
- Roseway to Yarmouth Regional - 100 km.
- Queens General in Liverpool to South Shore Regional - 48 km.
- Fishermen's Memorial in Lunenburg to South Shore - 19 km.
Emergency departments in New Waterford, North Sydney and Glace Bay have all experienced temporary closures in the last year due to a lack of doctors, nurses or paramedics.
In addition to those hospitals, 11 others were hit with temporary closures.
The eastern zone, which includes Cape Breton, had the highest number by far. The total hours closed were nearly double that of the Eastern Shore zone.
And two years ago, New Waterford was among the top three hospitals in the province with the largest number of ER visits for non-emergency reasons.
But All Saints in Springhill had the most temporary closures, by a wide margin, and Roseway in Shelburne was also shut temporarily.
Facilities in Musquodoboit Valley and Lower Sackville did not record any temporary closures last year, but both were scheduled for closures in the thousands of hours.
No 'transparent process'
Chris Parsons, provincial co-ordinator for the Nova Scotia Health Coalition, said no one is saying if the permanent closures in New Waterford and North Sydney are warning shots aimed at facilities elsewhere in the province.
But he said people are asking the question, and it's disconcerting that there is no immediate answer.
The problem, Parsons said, is no one is being consulted and the decision to close two hospitals is following the pattern the Liberals set for school closures. He said the process lacks transparency and the decisions are being made behind closed doors.
That means the criteria for closures, if there are any, are not easy to discern.
"Without a transparent process to talk about these closures in advance, we really don't know what the logic is," Parsons said.
Communities live or die by their schools and hospitals, he said, and Monday's decision in Cape Breton has "really ramped up that fear" of hospital closures in other communities.
It's made worse by repeated assurances in the past that there were no plans to close community hospitals in New Waterford and North Sydney.
Parsons said it will now be more difficult for communities to attract economic development if they can't guarantee their hospital will remain open and if they can't trust the government to honestly say whether their hospital is at risk.
Janet Knox, CEO of the Nova Scotia Health Authority, said there isn't one set of criteria that will be used to assess all facilities in the province.
Distance from a regional hospital is important, she said, but so are age of the building and the mix of services available in nearby communities.
"At this point in time, our focus is on the Cape Breton Regional Municipality and we'll learn a lot here, as well," Knox said. "But I would want to say that we're always looking at how best to deliver our programs and services."
New facilities coming elsewhere
For example, she said, South Shore Regional Hospital is currently being renovated to better accommodate dialysis and emergency services, and the government is investing in facilities in other parts of the province.
A collaborative care centre is under construction in Shelburne to complement the hospital there, said Knox, and there's no plan to close that hospital because it's an hour or more to drive to the closest regional hospital.
The CEO acknowledged that people in Cape Breton were told there was no plan to close their community hospitals, but Knox said that only changed in the last few months when detailed building assessments became available.
The way health care is delivered across the province has to change, she said, but the government hasn't yet got detailed financial and physical building assessments like the ones used to justify closing hospitals in New Waterford and North Sydney.
Ultimately, the government needs to be flexible, Knox said.
The process is not new though, she said. It's already been launched for the redevelopment of the Queen Elizabeth II Health Sciences Centre in Halifax.
Upgrading the old
Kevin McNamara, a retired deputy minister of health and former hospital administrator on the South Shore, said distance from another facility might be a concern, and age of a facility could be another.
However, he said, the "extremely old" Queens hospital in Liverpool has been modernized and made useful for local residents.
The same could be done in Sheet Harbour and Middle Musquodoboit, said McNamara.
There are locations where it might make sense to downsize or change services, he said, but the key is to get local input, if not complete agreement.
People worried about their local hospital might not be able to stop changes or closures, McNamara said.
But he had some advice nonetheless: "Get involved early enough so that you can influence the outcome."