Dear Health Minister

A very sad day  March 25th. Loss of community Hospital. Loss of essential services. Vulnerable families all alone. Where is our

government when we need them?

Here is a reply back from the Federal Health Minister regarding our concerns. A reply is going back to him stating that we have tried this route and we have had no communication.

A potential meeting is being arranged with AHS/Covenant heath and the HATCH PATCH AND DISPATCH GROUP. Keep up the pressure on Ron Casey.

Please keep writing as many letters as possible to the Provincial Health Minister.

  • Minister Horne,

    I am writing to express my extreme concern and displeasure over the closure of the Banff Hospital Obstetric Service.

    In these days of diminishing supply of obstetrical services, especially in rural areas, it seems anathema that the government would unilaterally reduce availability of such services. I recognize that many centers have had the misfortune to lose obstetrical services because they have been unable to attract and maintain professionals with the necessary skillset; but for Government to close a center where both physician and nursing staff are available, interested, and eminently competent flies in the face of responsible management!

    Centers such as Banff that are in fact able to maintain a safe, viable obstetric service with such limited resources should be lauded for their commitment, and held up as a model. They are an example to the many other small centers who’s expecting patients might also wish for local care. While it may be economically practical to centralize some of Alberta’s health services, others (and especially Obstetrics) are best provided close to home.

    I would urge you to reconsider this decision and allow the expecting mothers of Banff to continue to receive safe and excellent care from the dedicated professionals at Mineral Springs Hospital.

    Sincerely,
    Dr. G. D. Prince
    Director
    Family Medicine Maternity Clinic

Dear Minister,

We are writing this in response to your request outlining our concerns for the proposed closure of maternity in Banff. This is a matter of Province –wide importance especially since maternity hospitals in Calgary are often full and rural hospitals are expected to help with the burden.  Canmore is no exception as it has a large native population and operates daily on a bed shortage.

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. The majority of this population is in the work industry and a large percent have few resources. We must not forget the huge number of tourists that frequent our national Park and require the expertise in this area of medicine.

Currently we have excellent Doctors with expertise in maternity, caesarian sections and Pediatrics who actually live in the Community of Banff.  The concern of sustainability of the program is completely unfounded, as the Alpine Medical Clinic has just accepted another doctor who brings with her years of Obstetrical experience. She is also very used to working in rural areas.

The news is full of rural towns loosing Doctors, so why are we not going out of our way to encourage these doctors to stay rather than forcing them to move as the services are not available for them and their patients.

Numbers have been stated as a reason for this proposed closure and the difficulty in keeping staff trained. Firstly rural hospitals fluctuate immensely year to year whereas urban hospitals keep steady numbers. 52 deliveries in 2012 is actually a high number compared to a lot of rural hospitals. If you closed us down because of this number then you would be closing down a lot of maternity hospitals across Canada. The number of deliveries planned for 2013  in Banff is 70. This is a large number and is expected to increase with the impending arrival of our new OB Doctor. In the UK fulltime Midwives only deliver between 30-40 babies a year so the Doctor in Banff actually has a large volume.

The nurses In  Banff are extremely well trained and skilled in this area, with one of the nurses being an instructor in neonatal resuscitations. They are not concerned about their skills as we have continuous in house training with MoreOB and regular workshops. Doctors deliver babies and the nurses provide the care. AHS/Covenant  health care need to focus on the skills of the doctors and if the doctors are competent than it is the administrations job to keep the staff well trained. Nursing is not a problem at the MSH but undermining their ability will make a problem.

Safety is cited as the main concern.  No real reason has been given apart from low numbers and administrations perceived concerns about staffing. We know the numbers are not low and indeed are growing and we know the staff are skilled and competent.

Patient satisfaction in Banff is extremely high with our OB Doctor producing excellent results. Her caesarian section rate for 2012 was 8%. Canmore`s in 2011 was 38%. We believe that there numbers are still high for 2012 but the latest stats are not available. Not only does she keep her CSection rate down she also has a very low high degree tear rate. As you are fully aware WHO has been very critical of the extremely high CSection rates in North America. They state that the rate should be between 10-15% . The provincial rate is 27%

Why close down a facility that costs the health care very little money and is obviously working well and force women to go to a centre with poor results and a huge drain on the health care system. Are we not meant to be looking at Fiscal restraint and improving health care.?

Pregnant women have no voice and need to be protected from the system especially when they have no choice. You are giving them no choice, no accessibility and poor quality service.  An unnecessarily caesarian section  often forces them to have repeat Caesarian sections and sets them up for increased morbidity both for mother and child. This pending decision is going to force many families to have unattended births which unfortunately is growing in Alberta.

A Hospital`s sole duty is to treat sick patients without discrimination. Neglecting any particular area or procedure for which expertise exist can never be excused by the mere statement that it is not a ‘core programme’. The question is as to whether patients can be denied treatment in their own hospital and if so how can it be done and on what grounds? It is of such importance that it can only be decided by you.

Does the community really need vascular and plastic services?  I ask you with a heavy heart?  It is so sad that the plastic surgeon was on the small committee which decided to remove the Obstetrical services as it was in his vested interest to gain more OR time. No one directly involved in the OB program in Banff was consulted not even our local OB Doctor.

More information is being made available about the refusal of the plastic surgeons to bill AHS for AHS related surgeries. They are requesting that all these patients go privately with the MSH still getting  funded from AHS. Something is not right and the last thing that the government need is another inquiry.

The vascular surgeons will be coming up from Calgary with their own patients mainly from Calgary. This is not a community hospital.

The community has risen up in support with a petition that has now got over 1300 signatures.

You have chosen to ignore a community concern that relates to health care, which is your responsibility and mandate. You have been elected in a democratic and political process and should welcome opportunities to be in contact with well-educated not emotional members of the Banff community. To disregard this important matter shows irresponsibility, insensibility and a total lack of respect for the community of Banff.

You have indicated that this request is not valid because it has become political disallows for the political process that is part of the effective management of situations or conflicts. Democratic systems like Canada require political involvement of all its citizens beyond casting a vote to be able to be called democracy.

In conclusion AHS/Covenant health feel that they have succeeded with their plan in that the administration are planning to close down the program on safety grounds. This is a very old tactic that has been tried before when they tried to close down the endoscopy program. Interestingly this is the next service to be forced out again . The pattern repeats itself. When will it stop? The huge implications for patient care will be obvious to you.

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4 thoughts on “Dear Health Minister

  1. Dear friends: I have just had the opportunity to again read the letter from family doctors from “the other group.” It is a sad commentary indeed when this group of opportunistic physicians uses this issue as a chance to “toot their own horn” and ingratiate themselves with administration.

    What we know from our published national study of family physicians who used to do maternity care but have stopped or never did, is that they are afraid of birth. They acquired that fear in medical school (so never started) or stopped when they could, as they never felt comfortable in the area (Klein MC, Baradaran N, Kaczorowski J, Hearps S, Tomkinson J, Brandt R. Family physicians who provide intrapartum care and those who do not: very different ways of viewing childbirth. Canadian Family Physician. 2011; 57 April: e139-e147)

    Our study showed that those in these two non-delivering groups were more attached to technology than most obstetricians. Compared to family physicians currently doing deliveries, they believed that caesarean sections were safer for mother and baby (which they are not), that episiotomy should be routinely used, that epidural analgesia should be routinely used and had no downsides, that a mother’s role in her own birth was minimal, that vaginal birth had seriously negative effects on the pelvic floor (including causing urinary incontinence and sexual problems.) Again all this negativity and incorrect information is passed on to women under their care BEFORE they transfer care to another family physician (in this case in Canmore) or to an obstetrician. Again perhaps explaining in part Canmore’s high cesarean section rate. In fact family physicians who provide only prenatal care provide more than 50% of the prenatal care in Canada, which may again explain part of our high national cesarean section rate, a national disgrace.

    While we cannot say if the signers of the letter follow this belief or practice pattern, but they certainly have the general characteristics of those who participated in this Canadian national survey of 2391 maternity providers.

    The signers of that letter ought to be embarrassed for writing such a self-serving letter, but I guess when self-interest is at play one can engage in enough self-deception to actually believe what you are saying.

    Sad
    Michael

    • Dear friends: I have just had the opportunity to again read the letter from family doctors from “the other group.” It is a sad commentary indeed when this group of opportunistic physicians uses this issue as a chance to “toot their own horn” and ingratiate themselves with administration.

      What we know from our published national study of family physicians who used to do maternity care but have stopped or never did, is that they are afraid of birth. They acquired that fear in medical school (so never started) or stopped when they could, as they never felt comfortable in the area (Klein MC, Baradaran N, Kaczorowski J, Hearps S, Tomkinson J, Brandt R. Family physicians who provide intrapartum care and those who do not: very different ways of viewing childbirth. Canadian Family Physician. 2011; 57 April: e139-e147)

      Our study showed that those in these two non-delivering groups were more attached to technology than most obstetricians. Compared to family physicians currently doing deliveries, they believed that caesarean sections were safer for mother and baby (which they are not), that episiotomy should be routinely used, that epidural analgesia should be routinely used and had no downsides, that a mother’s role in her own birth was minimal, that vaginal birth had seriously negative effects on the pelvic floor (including causing urinary incontinence and sexual problems.) Again all this negativity and incorrect information is passed on to women under their care BEFORE they transfer care to another family physician (in this case in Canmore) or to an obstetrician. Again perhaps explaining in part Canmore’s high cesarean section rate. In fact family physicians who provide only prenatal care provide more than 50% of the prenatal care in Canada, which may again explain part of our high national cesarean section rate, a national disgrace.

      While we cannot say if the signers of the letter follow this belief or practice pattern, but they certainly have the general characteristics of those who participated in this Canadian national survey of 2391 maternity providers.

      The signers of that letter ought to be embarrassed for writing such a self-serving letter, but I guess when self-interest is at play one can engage in enough self-deception to actually believe what you are saying.

      Sad
      Michael

      Michael C. Klein, MD,CCFP,FAAP (Neonatal-Perinatal), FCFP,ABFP,FCPS
      Emeritus Professor Family Practice & Pediatrics
      Director Clinician Scholars Program
      Department Family Practice, University British Columbia
      Sr. Scientist Emeritus
      Ctr Developmental Neurosciences & Child Hlth
      Child and Family Research Institute
      Listmaster: Maternity Care Discussion Group (MCDG)
      Clinical Services Building Room V3-327
      948 West 28th Avenue
      Vancouver, BC Canada V6H 3N1
      mklein@interchange.ubc.ca 604-875-2000 ext 5078.
      mklein@mail.ubc.ca
      http://www.michaelcklein.ca

  2. Please find enclosed a letter from the people of the Town of Banff to you asking to reconsider the proposed closure of obstetrical services in our town on March 25, 2013. The letter is signed by over 1200people (a very significant proportion of the adult population in this town of 7584 residents). I urge you to intervene urgently and decisively in this matter that is of concern to so many citizens of Banff. Several of these people have voted for you and your government and they expect that their pressing concerns be addressed by the government.

    Sadly, Alberta Health Services and Covenant Health did not undertake a proper consultation process with the townspeople prior to making this vital decision. This was amply evident at the information session they had for the community on February 13, 2013 The session was attended by far more people than expected with standing room only in the facility. There was disappointment and frustration expressed by the townspeople regarding the planned withdrawal of obstetrical services and the lack of consultation with the community. The response from the administration was quite simply that the decision had been made and that they were not open to hearing community concerns

    The administration cited patient safety as the main reason for removal of obstetrics services, but provided no statistics or instances of poor outcomes to babies or mothers to back up their statement. In fact Patrick Dumelie, President and CEO of Covenant Health, who was the main speaker at the event said repeatedly that babies are currently being delivered safely in Banff and they always have been. He was not able to give good reasons for why safety will be compromised after March 25, 2013. Compared to the Canmore General Hospital, where obstetrical services are being moved, the Mineral Springs Hospital in Banff has far lower cesarian section rates and rates of serious perineal tears in mothers during delivery. These numbers suggest that, at least by the statistics that are available, deliveries in Banff are safer and more cost-efficient than those being done in Canmore.

    The Society for Obstetricians and Gynecologists of Canada released a joint position paper in October 2012 making recommendations for obstetrics in rural settings. They recommend that “women in rural and remote communities in Canada should receive high-quality maternity care as close to home as possible”. They also state that “maternity nursing skills should be recognized as a fundamental part of generalist rural nursing care.” The administration of the hospital is responsible for recruiting, training and retaining staff to provide services that their community needs. It is not acceptable for them to close a service such as maternity care simply because they are not willing to continue to put in the effort required in hiring the appropriate nursing staff.

    .
    Furthermore, studies by Dr. Michael Klein (Maternity Care Researcher and Professor Emeritus of Family Practice and Pediatrics at the University of British Columbia) have indicated that average birth weight babies (by far the largest group of babies born in Banff) actually suffer worse health outcomes when mothers have to travel away from their home communities for delivery. His research also shows that low volumes centres (and the number of deliveries in Banff cannot be considered low volume for a rural hospital by any means) provide as good outcomes for mom and baby as high volume centres.

    The sustainability of the community depends also in the growth of its members by the natural process of giving birth.

    Lastly, the Banff Mineral Springs Hospital is replacing the obstetrical services (that every single person in the community will use at some time in their lives) with Plastic and Vascular Surgery that has far less importance to the town’s people. There is no other town the size of Banff that has these services available in Canada and with good reason. Very few people in Banff will ever need these highly specialized services in their lifetimes and their community hospital will be providing these services to people from Calgary and other communities at the expense of providing essential maternity care services to the people of Banff.

    Once again, I ask that you consider the very reasonable request of the citizens of Banff, and reconsider the decision to close obstetrics services on March 25, 2013 at the Banff Mineral Springs Hospital.

  3. Banff hospital closes down obstetrics service
    Editorials

    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.In return, Canmore General Hospital will relocate most of its plastic and vascular services to Banff. That is, 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 OR 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.”“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,” says the SaveBanffMaternity website.
    “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.
    View all posts by Penney Kome.

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