Response from Minister of Health

Response from Minister of Health

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3 thoughts on “Response from Minister of Health

  1. Dear Editor,

    I believe that small communities deserve to keep primary health services at their publicly funded community hospitals. This belief actually aligns with the current mission of the Mineral Springs Hospital as stated on their website: “…the Banff Mineral Springs Hospital provides a high standard of emergency, surgical and primary health care…” Primary health care is described at the bottom of the webpage as including acute care, continuing care, maternal/childcare, outpatient clinics and palliative care. I believe that the loss of the maternity ward signifies the first step in the death of our community hospital.

    No public consultation was sought during the decision making process. As well no professional external facilitation was used. This does not seem like true community engagement to me. It would appear that another important voice that was missing was those who will be directly affected- pregnant women.

    To state it simply it would seem that closing the maternity ward is a “solution” to a “problem” that does not exist. Currently all staff are in place to continue to deliver babies in Banff. The first claim from Alberta Health Services and Covenant Health was that it would be safer for moms and babies at the Canmore Hospital. However they do not provide any evidence of why this would be the case. In fact through my own research I discovered that the C-section rate and 3rd and 4th degree vaginal tear rate is low at the Mineral Springs Hospital indicating that it is indeed very safe. I ask Covenant Health where is the evidence?

    The second reason that Alberta Health Services and Covenant Health gave for the closure was that due to a reduced number of births at the Mineral Springs Hospital they feared that nurses would lose their skills. Again, as admitted by Alberta Health Services themselves, there is no evidence indicating a critical number of births that nurses need to participate in in order to maintain their skills. As well the nurses at the Mineral Springs Hospital participate in ongoing training (MOREob) which has proven quite effective. Could management at the Mineral Springs Hospital not be run similar to the Canmore Hospital. There are other small communities that have maternity wards that deliver fewer than 50 babies a year. How do these hospitals keep up the competency of nurses? Next year there are 70 births planned for the Mineral Springs Hospital and this is with only one doctor. There is currently another Doctor that has come to Banff and is ready, willing and able to deliver babies in Banff.

    My biggest concern is that this will be the first in a long line of important basic health care services that Banff will lose. Perhaps it will be endoscopy and general surgery next. My biggest concern is that the next 3 year plan will include the removal of long-term care from the Mineral Springs Hospital. These fears are not baseless. All you have to do is read their vision: “a centre of excellence for specialty surgical and emergency care.” This vision doesn’t say community hospital to me and research shows that this is the opposite direction which rural hospitals should go to serve communities effectively. So the question comes down to this: do you think that a publicly funded hospital should provide basic/primary health services to the members of the community in which it is situated? If your answer is “no” then this new vision of surgical tourism is fine. However if your answer is “yes” then you should be concerned about the loss of the maternity ward in Banff.

    Sincerely,
    Kristen Wiggins

  2. Here Lies Maternity Care in Banff—too good to last
    A victim of unrestrained self-interest and greed
    • While few speak for pregnant women and their families, many speak for themselves.
    • Who gains:
    o Family physicians in the second group in Banff and NOT attending births, support moving birth to Canmore (they are in competition for patients and can easily denigrate a practice group providing services that they do not provide).
    o Plastic surgeons stand to benefit financially from the demise of maternity care so that they can do more surgeries privately. They support moving birth to Canmore
    o Family physicians in Canmore who will receive more maternity patients, support moving birth to Canmore (even though their birth outcomes are far inferior to those in Banff).
    o Administration in Banff and Covenent and Alberta Health, who can more easily staff plastic and vascular surgery (compared with maternity nursing, which is more unpredictable), and who will gain financially through collection of private fees for use of the Banff Hospital facility.
    o Administration and physicians who are afraid of birth and who would prefer to pass their problems or potential problems on to those further down the line in Canmore and Calgary. They would gain by avoiding birth, which makes them uncomfortable and fearful, while rationalizing their action by claiming low birth numbers are unsafe—despite no evidence for safety problems nor even that 100 births per year are unsafe. If all units with fewer than 100 births closed, Canadian women would be poorly served by being forced to travel to distant locations to be cared for by well-meaning strangers, who despite their best efforts, would get results that are inferior to better outcomes that would have occurred if the women stayed in their own communities.
    Who looses:
    • Banff women who have to be cared for by strangers, resulting in more adverse outcomes for woman, the fetus and newborn.
    • Banff women who have to travel to Canmore after hours when public transport is unavailable (especially those least able to have personal transportation, the poor and those on public assistance.
    • Banff women who must appear at the Banff Mineral Springs Hospital because they are too far advanced in their labour for transport. They will be attended by physicians who have lost the needed skill set, and who therefore may cause damage to women, the fetus and newborn.
    • Banff women who are in labour with a fetus less than 36 weeks. They will be transferred to Calgary as Canmore physicians are afraid of a very slightly early baby.
    o And this way of thinking about birth demonstrates “birth fear” and explains in part the high cesarean rates in Canmore.
    o Moreover if you can’t or won’t care for a 36 week baby then you will not know what to do when one arrives anyhow.
    • Banff women who have had a previous cesarean and want to try for a vaginal birth. They will be transferred to Canmore or Calgary where routine cesarean section is done in this circumstance—and her next pregnancy again will be by cesareans section, resulting in adverse outcomes for mother and baby.
    • Women in the communities surrounding Banff, Lake Louise etc., who will have to go additional distances to Canmore, where less than optimal results occur.
    • Women who need reconstructive surgery and other plastic procedures covered by the public purse, whose plastic surgeons will only operate if the woman “goes private.”
    • The community, who will have lost a genuine, needed service covered by Medicare, a service replaced by destination plastic surgery not needed by Banff citizens and available in larger centers like Calgary.
    o And the community will loose related services that tend to follow birth as a package, including pediatric services, child health services, child developmental services and school health.
    o The kind of physicians who support birth tend to be engaged in all these services, while those who do not attend birth tend also to be lacking in involvement in these as well.
    o And the community will tend to recruit physicians who stay a short time and to remain disengaged with the life of the community.
    o It turns out that maternity care is a window thorough which one can view an entire system, a system that is a risk of collapse.
    o Maternity care loss is one step along the path to a complete change in the character of physician and nursing services in small communities like Banff.

    Maternity Care RIP

  3. Dear Banff Community: Having just learned
    that Canmore ships to Calgary any woman labouring before 37 weeks, attitudinal issues are becoming even clearer. I can understand under 34 or 35 weeks but if you transfer before 37 weeks you will not know what to do with babies who inevitable arrive earlier than expected. Everyone knows that very small premature infants ought to be delivered in Calgary but not what we call early-term or late-preterm.

    This together with Canmore’s refusal to attend women with a uterine scar (a VBAC), is part of the same picture. Canmore is afraid of birth. Lack of trust in birth, as these two issues illustrate, accounts for their high cesarean section rate. In fact they care for such an exceedingly low risk population that their cesarean section rate ought to be at least as low as Banff.

    In childbirth anxiety drives everything. Providers who are afraid of birth have high intervention rates of all types (as in Canmore). Administrators who are afraid of birth try to pass on their “problems” to somebody else down the line. They can then be free to undertake care for a population that requires minimal nursing and OR staff time and is largely ambulatory. Not only will you balance your budget but you can even make money. So much for concern for the community.
    Michael C. Klein

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

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