Unexpected move opens up OR time for elective surgeries.
by Penney Kome
Pots and pans have been banging and clanging in Banff lately, as residents marched to protest the sudden announcement that Minerals Springs Hospital (MSH) will be closing its maternity ward, and the Operating Room (OR) time used instead to expand local surgeons’ joint repair and plastic surgery services for visitors.
The change had been brewing for a couple of months – Covenant Health and Alberta Health Services posted an announcement on their website on December 11 2012 — but most Banff expectant parents were caught off guard on February 13, when Convenant Health really pushed their plan to the public. (Covenant Health is the Catholic charity that runs Mineral Springs and 17 other hospitals under contract with Alberta Health Services.)
Alberta health authorities announced through the media and a public information session that as part of “consolidating” MSH and nearby Canmore General Hospital, they will shut down MSH’s maternity ward as of March 25, 2013. After that date, a pregnant woman who goes into labour in Banff is supposed to jump in a car and race to Canmore.
Pregnant women who live in Banff will have to drive about half an hour on the highway in order to give birth in hospital, at the same time that the Banff hospital’s valuable Operating Room time is reserved mainly for elective surgeries.
Covenant Health president and CEO Patrick Dumelie told Larissa Barlow of the Banff Crag and Canyon that the administration is concerned the centre’s low birth rate may decrease maternity staff’s essential skills. “It’s a bit of a numbers game.” he told Barlow. “With a low number of births it’s hard to keep our staff clinically competent….Ultimately for us, we need to ensure we can provide safe, quality care to mums and babes.”
Covenant’s December announcement talks about needing “a critical mass of [obstetrics] patients to ensure safe quality care.” Passing right by doctors, the document focuses on nurses: “Obstetrics is a specialty area of nursing and requires advanced practice skills to ensure competency and confidence in the birthing process.”
Language like that enrages Dr Jane Fowke. She is, for the moment, the sole Banff doctor qualified to deliver babies. (A second doctor left last year, and Alpine Medical Centre has already hired a replacement with decades of rural maternity experience.) Fowke also has admitting privileges at nearby Canmore General Hospital. She points to the Mineral Springs’ sterling record and disputes the notion that safely delivering 50 to 100 babies every year somehow makes Banff “small,” as rural centres go.
Banff general practitioner Dr Jane Fowke’s own years of rural doctoring and delivering experience tell her Banff’s maternity service works exceptionally well.
Her own years of rural doctoring and delivering experience tell her Banff’s maternity service works exceptionally well. “Patient satisfaction in Banff is extremely high,” she wrote to the Minister of Health, pointing to a very low Caesarean section rate (only 8 percent in 2012, compared with 38 percent in Canmore in 2011.)
As for nurses, she said, MSH’s nurses are extremely well trained and skilled in this area, with one of the nurses being an instructor in neonatal resuscitation. Also, MSH has continuous in-house training with MoreOB and regular workshops. As for safety concerns, no actual instances of less-than-skillful nursing have come to light, she said. “No real reason has been given apart from low numbers [of births] and the administration’s perceived concerns about staffing.”
Conversely, “Maternity care is particularly vulnerable to the negative effects of centralization,” according to family physicians and internationally-known pediatrician/neonatologist Dr Michael Klein. As he wrote in an editorial for the July 2002 issue of Canadian Family Physician. “…the false economy of centralization is revealed when women have to travel long distances to seek services. It is much more than an inconvenience for them and their families – it can be dangerous.”
Centralizing maternity services can be hazardous for communities too. Rural hospitals help hold rural communities together. Removing local maternity services not only increases maternal and neonatal risks (statistically), it can hollow out hospital services, discourage potential medical personnel from applying, and eventually have adverse effects on the whole region’s economy.
Moreover, Fowke warned, the proposed “consolidation” of Convenant and Canmore facilities would change Mineral Springs’ relationship with the community. She told the Crag and Canyon that the loss of a basic service like obstetrics means structural changes for the hospital, which she said will become a “glorified day surgical unit….If we lose the [maternity] service then we’ve lost our community hospital,” she said.
Despite the uproar, despite the counterarguments, Convenant Health still insists that MSH maternity services will close on March 25. In response, Banff residents are signing a petition (more than 1300 signatures so far) and banging pots and pans in their own Casseroles marches. Although Covenant cites cost factors – and competency factors, which just raises the local medical community’s hackles – the protesters insist that a publicly-funded hospital must take social factors into account.
“Mineral Springs hospital is a community hospital funded by the government and thus is expected to serve the needs of the community. In the 2011 census the population of Banff was 8244, with more than half being in their child bearing years.”
“Friends of Medicare is quite incensed by this government’s lack of response to the needs of a community versus the need of a few interest groups,” said FOM Executive Director Sandra Azocar in an email interview. “Holding women hostage and forcing them to travel unnecessary distances to receive health services is a huge step away from all the government’s talk of community health.
“Maternity wards in Calgary are often full and rural hospitals are expected to help with the burden. Canmore is no exception and it serves a large population from surrounding areas and operates daily on a bed shortage.”
Canmore General Hospital is about the same size as MSH, said Jane Fowke – 22 beds, with only one Operating Room to MSH’s two – but it serves 59,000 people, including a large native population. Nearly 300 women give birth there annually, with nearly four in ten of them (38 percent) ending up with Caesarean sections. The C-section rate at MSH is eight percent.
MSH is gaining a reputation for other kinds of surgery, noted a recent letter to the editor of a Banff newspaper, “I personally know several people from all over Alberta who come all the way into Banff to have their knee or shoulder surgeries by the amazing surgeons here.” Not only do the surgeons have great reputations, but the Rocky Mountains’ grandeur and luxury lifestyle make recovery more pleasant.
Julie Vincent identified herself in a letter to the Rocky Mountain Outlook as potentially the last woman to give birth at MSH, according to her due date. She wrote wryly, “Wonderful that we have legitimately famous, obviously competent surgeons who have cornered a whole new market which I’m sure brings in plenty of revenue, and it’s great that Banff is so accommodating for all of Alberta; but at the expense of whom, your neighbours and their newborns?”
Friends of Medicare wants to know, “who is this new surgery service going to serve and are Alberta Health Services (AHS) and Covenant Health allowing a public facility to be used for private-for profit surgeries? Elective plastic surgeries are not covered by AHS and are the responsibility of patients,” writes Azocar. As a publicly-funded institution, FOM’s position is that “Covenant Health most definitely needs to run as a public steward of our taxes – it not only receives funding from its donors but primarily from AHS, from our taxes.”
Sports medicine – fixing knees and shoulders – seems right at home in a ski resort. Popular elective plastic surgery procedures these days include post-mastectomy reconstruction, and umbilical reconfiguration. FOM and Jane Fowke both noted that the committee that made the decision to close the maternity ward did not include anyone from the MSH obstetrical/gynecological service, but did include an MSH plastic surgeon, who will now gain valuable OR time as the plastic surgery service expands to fill the newly-available space.
At this stage, Covenant Health presents the decision as an irrevocable fait accompli. If the provincial government takes a stand against medical tourism, and ties public funding to providing full public services, that position may turn out to be as untenable as standing between a nine-months-pregnant woman and the bathroom.
About Penney Kome
Penney Kome is an award-winning author and journalist who has published six books with major publishers. She is also the Editor of Straight Goods.
She is co-editor with Patrick Crean of Peace: A Dream Unfolding (1986, Sierra Club Books). She started marching against the atomic bomb when the placards were taller than she was, and she emigrated from the US to Canada in protest against the war in Vietnam.
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