Clinton community shows out for hospital amid HPHA amalgamation proposal
BY SHAWN LOUGHLIN
Well over 100 people left a recent “Community Connections” meeting hosted by the Huron Perth Healthcare Alliance (HPHA) in Clinton frustrated with nearly four years of nightly emergency department closures and uncertain about the future of Clinton Public Hospital in the face of a proposed amalgamation.
The meeting was one of four held last week in every community in which the HPHA has a hospital - Stratford, St. Marys, Seaforth and Clinton - to update residents on the achievements made by and challenges facing the organization, as well as the amalgamation, which was first proposed in September and, if approved, would go into effect on April 1, 2024.
At the meeting, HPHA CEO Andrew Williams reiterated what has been the organization’s official position on the matter, which is that local foundations and auxiliaries will remain in place, local input will be paramount and that the organization has absolutely no plans to close hospitals, lose staff or reduce service levels in any way.
“On September 7, 2023 the Huron Perth Healthcare Alliance (HPHA) Board of Directors unanimously agreed to start the process to amalgamate the four corporations of the HPHA,” reads the amalgamation statement on the HPHA website. “Since its inception in 2003, the HPHA’s four hospitals, including the Clinton Public Hospital, St. Marys Memorial Hospital, Seaforth Community Hospital, and Stratford General Hospital, have effectively operated as an integrated organization, including a single Board, Administration and Professional Staff. The HPHA is also the single employer of the hospitals’ employees.
“‘This is an important and necessary step for the HPHA as we continue to provide the very best governance to our four hospital sites, and quality care to those we serve,’ said Board Chair Stephen Hearn. ‘The amalgamation will not affect our staff as they are already all employees of the HPHA, or the programs, services and staffing offered across our sites. It will also continue to ensure our four strong Foundations remain independent and raising funds vital for their own local hospital and healthcare priorities,’ he said.
“This decision is a result of a recent review of the 20-year old Alliance Agreement. Required updates were identified in order to align with the new Ontario Not-for-Profit Corporations Act that Ontario not-for-profit corporations must comply with by October 19, 2024, and other applicable laws, such as health privacy laws. These updates, combined with the HPHA’s current, integrated operating reality reinforced amalgamation as the most responsible step in today’s healthcare environment.
“As the HPHA moves forward with the amalgamation process, interested members of the public will be provided various opportunities to understand the process and provide feedback. The organization is targeting April 1, 2024 as the effective date of the amalgamation to align with its fiscal year.”
Williams told those in attendance that the organization and its board of directors remain as committed as ever to maintaining four strong, viable sites in Stratford, St. Marys, Seaforth and Clinton. However, many in attendance weren’t buying it, feeling that while the future may be questionable for the Clinton Public Hospital, the last four years haven’t been fantastic either, with nightly emergency department closures - implemented in late 2019 as a temporary measure - now stretching to nearly 48 months with no end in sight.
He said it’s foolish to think that the sites won’t change and evolve as needs evolve, but that the organization plans to work to keep all four sites viable and working within a larger healthcare framework, fitting it with other local hospitals and helping residents in a way that ensures a bright future for all four of the HPHA’s hospitals.
The amalgamation proposal, he said, would codify how the HPHA has been operating for the last 20 years, so, many of the things the organization is doing right now and the sites and assets it has under its auspices, he said, will not change as a result of the proposed amalgamation.
The amalgamation will result in one hospital service accountability agreement with Ontario Health (as opposed to the current number of four), one set of audited financial statements (currently HPHA has five - one for each hospital and one for the HPHA itself) and one funding letter and reporting requirement (currently HPHA has four).
In addition to that streamlining, Williams says other efficiencies will be realized as a result of the proposed amalgamation, though there will not be any traditional cost savings or jobs lost as a result of the move.
Williams also detailed the ongoing recruitment and retention challenges facing not just HPHA, but the healthcare field throughout the region and the country, and, really, most employers in the country. He said that several qualified positions remain vacant at the Clinton hospital, but that some promising trends are pointing in the right direction. However, he said, the fact remains that Canada is a country in which the number of jobs is greater than the number of people.
Recruitment for smaller hospitals is especially challenging, he said, where on-call shifts are more frequent and there are fewer people to do more work. Competing with larger urban centres, from which many of the potential candidates hail, given the differences between working in a rural setting versus and urban setting, makes bringing professionals to the area very challenging.
It’s with that being said, Williams added, that the community, the culture and its amenities are the best selling points when recruiting not just healthcare professionals, but their families as well, with promises of a great community, full of great people and with plenty to offer. Furthermore, he said that the Clinton emergency department - notwithstanding its nightly closures - has a lot to be proud of, including its short wait times for patients and its success in admitting or moving patients in a timely fashion, far quicker than many urban centre hospitals.
Following Williams’ presentation, which included presenting several staff members with awards, lauding the work of the Clinton Public Hospital Foundation and the hospital’s auxiliary, and the potential expansion of the pediatric surgery program at the hospital (to alleviate wait times in London) those in attendance asked questions for nearly two hours, expressing concern for the future of the hospital and openly questioning the motives of the HPHA and its board of directors, with many feeling the Clinton site has been underserved by the HPHA.
QUESTION AND ANSWER
Several people asked about the future ownership of the Clinton Public Hospital, the land it sits on and its assets if the amalgamation were to be approved and Williams said there would, effectively, be no change, other than in name. The HPHA has ownership of the site now, through the nature of the organization, and that would continue under amalgamation.
However, some felt that the paperwork associated would be very important to the community. Long-time Central Huron Councillor Alison Lobb and former Clinton Public Hospital Foundation President Michael Falconer both felt the land should continue to be owned by the local community, harkening back to former Minister of Health Frank Miller and his plan in the 1970s to close many smaller hospitals throughout the province. What saved Clinton Public Hospital from the chop in those days, Lobb said, was its local ownership and the fact that it had been established without the use of provincial funds.
Falconer agreed, saying that Premier Doug Ford and his majority Conservative government could make a similar decision - “in his wisdom” - and the local hospital would be well served to be ready for a decision like that being made on such a whim.
In regards to local representation, a number of people criticized what they perceived to be a lack of local input on the board of directors. Furthermore, the amalgamation would mean the end of Local Advisory Committees (LACs), but Williams said the organization intended to create a Community Council that would allow for local representation from all four of the hospitals’ catchment areas.
Clinton Public Hospital Foundation Chair Darren Stevenson addressed the composition of the local LAC, saying there are only a handful of members on it. The board of directors would need a two-thirds majority to vote in the proposed amalgamation, with votes coming from the LAC.
However, he alleged that the board of directors had been blocking the addition of new LAC members, essentially as a “waste of time” to add members to the council that, if amalgamation is approved, would be disbanded anyway. However, Stevenson said, if the LAC carried a full, 10-member complement of members, there would be a more robust local voice to potentially vote against amalgamation, if that was the wish of the members.
Board Chair Stephen Hearn, however, rebutted, saying he said he didn’t want to waste people’s time, not that it was a waste of time.
Williams reiterated that the board of directors has no intention of closing hospitals or reducing services and they would be misguided to think that the board would be motivated by anything other than providing residents with the best possible healthcare. Furthermore, he said, unravelling the fabric of the HPHA and sending each hospital to be on its own would be time-consuming, costly and ill-advised after all the work that’s been done by the four hospitals together.
Gord Lavis, who had served on the LAC as well, was also critical of the lack of Clinton representation on the board of directors and said he had been muzzled and intimidated by the board of directors in his fight for the hospital, which he said was near and dear to his heart. He said that while he felt HPHA had done a good job for three of the four hospitals, the Clinton site was being left behind, specifically citing a decline within the last 15 years or so.
Lavis and Williams would banter back and forth throughout the night, with Williams eventually asking Lavis to agree to disagree with him, adding that he didn’t intend to assassinate Lavis’s character publicly and asked that Lavis give him the same courtesy.
Lavis persisted, however, saying that, after he had left the LAC, he continued to do his own research, speaking with those involved in healthcare in Goderich, whose Alexandra Marine and General Hospital amalgamated with the South Huron Hospital Association in Exeter to form Huron Health Services (HHS) back in February. He said he found the culture was different with that hospital and that was how it found success. As a result, he said, the Clinton Public Hospital should consider joining those two hospitals as part of HHS, a proposal that was not only met with applause from those in attendance, but encouragement from representatives he spoke with from both Goderich and Exeter, he said.
Dr. Maarten Bokhout, who practised at the hospital for many years, was in attendance and preached pressing the pause button on amalgamation before a number of foundational issues had been squared away, such as returning the emergency department to its former glory. He said creating a realistic and achievable timetable for its return to full hours would earn HPHA some trust with members of the community and those in attendance. From there, perhaps, further steps could be taken.
In regards to staffing levels at the hospital, especially in its emergency department forcing its nightly closure, an emotional Jessica Vanderhaar, who said she had worked as a nurse at the hospital for a decade, addressed Williams and those in attendance. She told of her dismissal in 2022 after refusing to be vaccinated against COVID-19 while both pregnant and breastfeeding, noting that she was among a handful of nurses who were dismissed at that time for refusing the vaccine.
She also lamented the lack of alternatives to vaccination that had been rolled out in other professions, such as more frequent testing or increased personal protective equipment, saying she and others were not provided with any alternatives.
Williams did say that, yes, a small handful of people were terminated from HPHA for refusing to be vaccinated - he said those people numbered in the teens of the HPHA’s 1,300 employees - but that HPHA was the first hospital in Ontario to “draw a line in the sand” and mandate vaccination, which was then widely accepted by hospitals across the province. The policy had just been revisited the previous week, he said, and HPHA remains firm in its stance regarding COVID-19 vaccination.
The issue would resurface occasionally over the course of the night, despite the fact that low staffing levels forcing the nightly closure of the hospital’s emergency department date back to the fall of 2019, well before the declaration of the COVID-19 pandemic, with Williams reiterating HPHA’s stance.
Other residents focused on staffing and recruitment over the course of the night, but from the perspective of attracting younger professionals. One speaker said that Clinton is the educational hub of the county with thousands of students being educated in the town every day. Outreach and early recruitment in the schools of students already living in Huron County would be a step in the right direction, she said.
Williams agreed, but stated that HPHA is already very active in area schools, running several programs and workshops in the hopes of interesting Huron County students in a career in local healthcare.
Several people in attendance were also concerned about the future of the Clinton Public Hospital Foundation and Auxiliary, both of which have spent decades raising money for the local hospital. They wanted to ensure, first, that the bodies would remain intact and, second, that people could donate to them knowing that their money would be spent on equipment that will benefit the local hospital. Williams assured those in attendance that will be the case and that nothing will change on that front. In fact, he said, the plan is to include strengthened verbiage in the amalgamation documents to ensure that is enshrined within them.
Stevenson also said that would be part of the foundation’s continued mandate to ensure that any of the money raised by the foundation and donated to the hospital remained within the community, which he assured people is a top priority for the foundation.
As a somewhat ominous ending to the nearly-four-hour meeting, returning to the importance of keeping hospitals, as they are, open in Huron County, Williams said that an elephant in the room that had yet to be discussed is the future of the county’s five hospitals. All of the hospitals, he said, were built around the same time and are aging at the same rate. He called the cost of building a new hospital in today’s economic climate “daunting” and said there would be some challenging discussions ahead for healthcare in Huron County someday, so it’s wise for HPHA and others to maintain what they have for as long as they can.
As for the amalgamation itself, Williams said that it has been formally recommended by the board of directors, dating back to September. If it goes ahead, it will have to be approved by the provincial Ministry of Health with a goal of coming into effect on April 1, 2024 to coincide with the HPHA’s fiscal year.
For more information on the proposed amalgamation or to read up on the proposal or the HPHA’s frequently-asked questions regarding the proposal, visit its website at hpha.ca.