Part 2 : A cautionary tale from the Niagara Region

Will Windsor-Essex residents suffer the same consequences a decade from now?

Windsor-Essex is home to a population of 400k, spread over 199,730 hectares. The Niagara Region is home to a population of 450k, spread over 185,400 hectares. Their experience serves as a point of comparison for the future healthcare plan being foisted on our community.

In our last eblast we talked about human costs. This week we're examining financial impact.

Recap Of Part 1: Big shiny plans made over a decade ago for reconfigured healthcare services in the Niagara Region (anchored by a regional ex-urban mega-hospital) have now resulted in a dismal reality for many area residents. In 2009, the hospitals in Port Colborne and Fort Erie were replaced with urgent care centres. In September 2019, it was announced these UCCs will be closed when the new hospital opens in south Niagara Falls in 2026.

Years of public misrepresentations and broken promises in the Niagara Region have led to consolidated healthcare services, less hospital accessiblity for patients, and increased costs for taxpayers.

What resulted in the Niagara Region: Higher taxes for local residents and less accessible healthcare. One major result of the loss of accessible acute-care hospitals in Port Colborne and Fort Erie is that the costs for ambulance services have escalated throughout the region. The St Catharines Standard wrote on June 16, 2009 about a report that had gone to Regional Council, warning about the need for a $1.1M "temporary budget bump" to prevent longer ambulance response times and off-load delays at hospitals.

Officials with Niagara Emergency Medical Services estimated in 2009 the hospital closures could cost regional taxpayers more than $3M a year:

"That’s because ambulances will have to be on the road longer, travelling with patients from those south end communities to emergency departments at the hospitals in Welland, Niagara Falls and St. Catharines, meaning upwards of 19 full-time paramedics and more ambulances could have to be added to the service." -- Niagara This Week, June 23, 2009

Fast forward to 2019, let's see how those cost predictions worked out:

"[Niagara EMS Chief Kevin Smith] said he has been before regional council 12 times in the last four years, talking about the pressures Niagara EMS is facing. 'It has not gone away,' he said. However, the resources provided by Niagara Region council have consistently fallen short of requests — only increasing by about 25% since 2014, despite the 50% increase in call volume. But since it costs about $3-million to pay for a new ambulance as well as the staff to operate it, 'we recognize that it's an expensive proposition.' 'It's really unsustainable.'" -- St Catharines Standard, March 8, 2019

Learning from the Niagara Region's healthcare experience, what do Windsor-Essex residents need to know? AM800 reported on November 6, 2019 that a recently released Essex-Windsor EMS 10-year master plan outlines a need for 57 additional paramedics and 10 ambulances. The cost for these additional resources is estimated at between $10M-$18M. We're wondering how, on a per-ambulance basis, the Windsor-Essex master plan's costs are so much lower than the Niagara Region's $3M per ambulance estimate. In the absence of an explanation, we're forced to accept the costs at face value. The AM800 story also mentioned the region's busiest EMS station is located in downtown Windsor. Population density is much greater in the heart of Windsor than any other place in the entire region:

"Essex-Windsor EMS handles an average of 139 calls each day with about two thirds of those taking place within the city. The busiest station of the 12 across the region is located in downtown Windsor on Mercer St."  --  AM800, November 6, 2019

Earlier this month a local resident also raised this logistical issue in an online comment:

"The most calls come from the most densely populated area of the city. As if that is hard to determine. Moving the hospital to the bean field will reduce service without additional ambulances because of travel time from the core to the new hospital. Yet, no one wants to talk about that."

It's not clear in the AM800 story whether these additional resources took into account the reconfiguration of EMS routes if the new hospital is built on County Road 42. If these resources weren't taken into account, we can anticipate taxpayer-funded ambulance costs will rise over and above the additional $10M-$18M estimate. The maps below illustrate the exponentially increased distance from the region's busiest EMS station to the nearest hospital if the plan for the single site acute care hospital on County Road 42 goes forward as proposed:

There's very good reason to expect an even greater financial impact in Windsor-Essex than the one affecting Niagara residents today. Windsor's urban and suburban population (pop. 217k) is considerably larger than that of Port Colborne (pop. 18k) and Fort Erie (pop. 31k). The city's most densely populated neighbourhoods, Windsor's Wards 2,3,4 & 5 (pop. 86k), will be the most negatively affected by the proposed loss of Windsor Regional Hospital's Met and Ouellette campuses. These wards are home to the region's greatest numbers of seniors, people with impaired mobility and those living on fixed incomes. As noted in the AM800 story, these neighbourhoods (13-18 km from the proposed County Road 42 hospital site) use EMS the most.

Since 2015, when the County Road 42 hospital location was announced, Windsor-Essex residents have never been provided with any analysis of ambulance response times or financial impact on EMS services. Tax-paying residents deserve insight into these impacts. Without comprehensive and accurate budget projections, including data for additional costs such as new ambulances, EMS staff and other operating costs for transporting patients, the process is neither transparent nor accountable. Paying with our taxes and our lives Without additional taxpayer-funded financial infusions, ambulance response times will undoubtedly deteriorate. Add to that Windsor Airport, which is a permanent barrier to the chosen hospital location. One can't simply build new roads across the 813 hectare Windsor Airport lands. And that's just distance. Remember the 2017 flooding of access roads to EC Row Expressway, the city's major East-West route? This event literally cut off Windsor's largest population centre from areas to its south, including County Road 42. It's not unrealistic to predict that future patient outcomes will be grim if the region's only acute-care hospital is located there.

You're invited   Come join us for our annual holiday gathering for a beverage (alcoholic or not). Maybe order some food or split a pizza with us. If you have a gift item to donate to CAMPP's prize draw, please email us ASAP. Where: Marco's Pizzeria & Valente's Pasta House, 4141 Tecumseh Rd. E. When: Friday, November 29, 2019 at 8.00 p.m. – 11.30 p.m. Please join us. Bring a friend. No purchase is necessary and all are welcome.

In their own words: Members of our community continue to comment on the issues

"Hopefully, the tribunal will make a good decision with regard to the appeal of CAMPP that the site on Hwy. 42 is not the right location for this building. This hospital is being built not just for the elite and healthy people in Windsor and the region, but for all our citizens — the elderly, handicapped, unhealthy and low-income who will all have a problem travelling to this site."

"Hospitals are not just the emergency ward. Hospitals have sick people admitted whose family needs to visut or be there to make decisions. Hospitals have ongoung outpatient services such as cancer clinics, dialysis, diagnostic imaging and fracture clinics. The vast majority of people who must travel to a hospital are not going to the emergency department. I drive dialysis and other outpatients for a living. I see the hardships and difficulties people have in accessing care every day."

"The tragedy of Niagara health care impacted friends. A man who had stents put in for cardiovascular problems in December, died in February because he could not access care. He had no car. His partner took him to two emergency rooms, and one was closed. The other was open and wouldn't take him. He had been in the Niagara Falls hospital in December (admitted, sent to St. Catherines, then discharged from Cardiac surgery in St. Catherines back to Niagara Falls hospital) and didn't want to go back there. (He had been discharged from St. Catherines after cardiac surgery,  into the emergency room at Niagara, due to no beds.)  He thought he had an upper respiratory infection, and had pneumonia. He developed septicemia, and his organs shut down, within a day. So Friday night he was looking for an urgent care, and within a few days they had called the family about taking him off life support. His partner, not actually married to him, was sent out of the room as they sedated him (he was thrashing around etc due to hypoxia imo), and never got to say goodbye.  Is this what we have to look forward to? Niagara Falls has had a terrible reputation for years, and now the new hospital is out by Marineland."

"I'm really curious to know what is the added cost for the [public transit] route extensions to the proposed hospital site are. If we didn't need to make these connections... how much could be saved? (if the hospital were to be located in a more urban area)."

"Adequate healthcare is a backbone of a healthy population, it must  be protected from fraudulent claims, illogical plans."

A cautionary tale from the Niagara Region

A decade from now -- Will Windsor-Essex residents suffer the same consequences? Big shiny plans made over a decade ago for improved healthcare services in the Niagara Region (anchored by a regional ex-urban mega-hospital) have now resulted in a grim reality for many area residents. The region's multi-decade project has produced a much less attractive local healthcare system than the one it replaced. Ten years of public misrepresentations and broken promises have led to consolidated healthcare services, less hospital accessiblity and increased costs for local taxpayers. Is this what we can expect in Windsor-Essex a few years from now?

"It doesn't matter if you have an 'H' on your hospital if they have gutted your services. They are moving ahead with closing emergency departments ... urgent care centres are not emergency rooms." -- Natalie Mehra, Executive Director, Ontario Health Coalition, 2009

What happened in the Niagara Region? A decade ago, the Niagara Peninsula cities of Port Colborne and Fort Erie lost their general hospitals. People in these communities had loudly voiced very real concerns. The Ontario Health Coalition shared and amplified these issues. Yet this public outcry was ultimately of no use. The decisions had already been made. In June 2009, both cities' emergency rooms (ER) were converted to urgent care centres (UCC).

The Niagara Region is home to a population of 450k, spread over 185,400 hectares. Windsor-Essex is comparable: it's home to a population of 400k, spread over 199,730 hectares. Ten years ago, local Niagara officials offered residents soothing promises about their future healthcare system. Their statements seem very similar to those being made today by Windsor-Essex officials. Rather than addressing the concerns of local residents, Niagara Region healthcare decision makers responded with vague reassurances that sound remarkably similar to what we've been hearing locally in Windsor-Essex: “The fact is, over 90% of the services received by patients at both the Port Colborne and Fort Erie sites will continue to be available to them.” "There will be the capacity to treat anything that comes through those doors.” We've pointed out many times that while the majority of ER patients don't need to be admitted, many are referred to specialist clinics located in or near hospitals - - not at urgent care centres  - - in order to complete their treatment. Is that the case in Port Colborne and Fort Erie too?

A local tragedy. A wider public reckoning Just six months after closing the hospitals, on December 26,2009, a car spun out on an icy patch of roadway almost exactly halfway between Port Colborne and Fort Erie. It was struck by an oncoming vehicle on its front passenger side. A teenager, Reilly Anzovino, was seriously injured. Because both towns' ERs had been converted to UCCs, it wasn't possible to treat her in Port Colborne or Fort Erie. She was taken instead to the nearby Welland County Hospital, where she died several hours later. Ms. Anzovino's family and community members believed the closure of the ERs had played a role in Ms. Anzovino's death. According to The Hamilton Spectator, her death, and the circumstances surrounding it, became an election issue in the 2011 provincial campaign, with both the NDP and the Progressive Conservatives pledging to reopen the shuttered ERs. To date, this has not happened. Almost exactly a decade later, the two communities were both shocked and infuriated by a new revelation: In September 2019, The St. Catharines Standard ran a story about plans to close the UCCs (that replaced the two local community hospitals) when a long-planned new hospital opens in south Niagara Falls in 2026.

What can Windsor-Essex residents learn from the first ten years of the new healthcare system in the Niagara Region? Windsor residents are being promised "emergency services" downtown. County residents are being assured that Leamington's hospital, Erie Shores Healthcare, will remain unchanged. How can residents be sure the politicians' and hospital representatives' promises today won't be changed tomorrow, after they have moved on? Calling out blatant misrepresentations The promises made in 2009 to maintain adequate and accessible (acute-care hospital - ER - and UCC-based) healthcare services to Niagara Region residents are not being kept. Today, - in 2019 -  if these decision makers have their way, 90% of healthcare services will NOT continue to be available to Port Colborne and Fort Erie residents. Capacity to treat anything at all will be eliminated. About conducting community consultation: Where have Windsor-Essex residents heard this before?  Niagara Health's Interim President Angela Zangari stated that there had been a "widespread, thorough consultation process" ahead of the decision to close both UCC sites in a few years. It seems that in the eyes of Ontario's healthcare planners, "consultation process" has little to do with responding to public opinion. Niagara residents have every right to be outraged. Windsor-Essex residents would do well to pay close attention to this story. We still have time to create a better healthcare future for our region than the current plan.

Stay tuned for Part 2: There's a lot more to be learned from what happened in the Niagara Region. In our next eblast, we'll examine the additional costs to taxpayers, very few of which have ever been revealed to Windsor-Essex residents.

In their own words: Members of our community continue to comment on the issues

"I wonder if there is a plan for when people with emergencies go to the Ouellette UCC because they can get there easily; like with chest pain or sudden injuries but who don't think it is worth calling an ambulance. How much contingency is planned for transfers to the mega?"

"Everyone deserves access to good quality health care. However, its impossible to have a single location that is going to be accessible and “convenient” for everyone. And while Windsor is not paying for the hospital alone, on a greenfield site in an undeveloped area, it IS paying for all of that additional infrastructure - construction, and maintenance forever, at a time that that growth is far from justifiable. Certainly, by far, the greatest density of population in the entire county is in the core of Windsor and Windsor has a large infrastructure deficit to deal with already. Many people who live in the core, by necessity, or by choice, do not drive. They live in the core because of accessibility by foot, bike, or public transit. It really does not make sense to be making vital health care services (like a real emergency room) less accessible to the highest density of population, and truly inaccessible for many, while making it only marginally more “convenient” for the county. By doing this, we only create a situation where more people NEED to drive, putting a much bigger strain on roads, traffic congestion, the environment, and family budgets. Such services are traditionally located in city centres for a reason. What we really should be asking is, if the county population is expanding, its no longer so rural, and warrants better access to healthcare, why on earth should we be downgrading our hospital system to ONE emergency room and the same or lower number of beds and putting it in a location that is much worse for the city (for access and many other reasons), and only very minimally closer for some county residents. Lets not sell ourselves short by bickering over who deserves a hospital a few minutes closer....This is an investment of a lifetime, not a “its not perfect but just get’er done.” We all deserve a much more thought out plan that will better benefit both the city and county."

"When IODE er was closed about twenty yrs ago an UCC was promised with the same drs and a blood lab and xrays. In the beginning it did have all the same er drs working in it with a blood lab an on site xray dept. It originally operated from 8-8 7 days/week. Over the years the hours started dwindling to 6 pm then 5 now it's 2 or 3 pm but you have to get there by noon to get your name on the list to be seen. Pretty sure it is not open on Sundays now. There MAY still be an er dr there but i doubt it. The blood lab and exray dept are long since gone. They MADE the SAME promise back then and they will BREAK the SAME promises NOW!!. I have absolutely NO TRUST in their system."

"Mayor Drew Dilkens You accused Jennifer Keesmaat of being a hired gun. Name one planner that supports this hospital that isn't paid by the city or hospital to say so. You also insinuate that all doctors are on board with this plan by saying they all agree we need improved hospital infrastructure. Almost everyone says that, including CAMPP. Doctors with hospital privileges by contract are not allowed to speak against the hospital or its plans. There are so many alternatives to this plan"

"Mega Sprawl gobbling up valuable farmland is NOT sustainable development!"

"Growth pays for growth has repeatedly proven false."

"All farmland is valuable. Basing this rating on whether it can be cash cropped with the holy trinity of corn, soybeans, and wheat should not be our benchmark. Even the most marginal land as far as cropping goes is valuable to our ecology."

"The most calls come from the most densely populated area of the city. As if that is hard to determine. Moving the hospital to the bean field will reduce service without additional ambulances because of travel time from the core to the new hospital. Yet, no one wants to talk about that."

Social media firestorm erupts after lawn sign vandalism

Just this week: A social media firestorm erupted in response to a Facebook post by Windsor's mayor - - who used Facebook to "explain" an act of private property vandalism against a CAMPP supporter. A handful of Facebook posts on the topic have now generated 800+ comments. The social media platform has become the de facto forum for the mega-hospital debate. CAMPP does not oppose the construction of a new hospital. We are challenging Windsor Regional Hospital's (WRH) chosen location 15 km from the region's largest population centre. It's the #1 reason CAMPP filed for an LPAT review of the City's planning decision. Among the mayor's Facebook comments, he promised that an "emergency room" would remain in downtown Windsor.  According to Ontario.ca, an Emergency Room (ER) provides treatment of "severe illnesses and life-threatening injuries 24 hours a day, 365 days a year." This type of facility has never been proposed as a replacement for WRH's Ouellette Campus.

On October 31, 2019, The Windsor Star reported a motorist had driven onto and across the property of an East Windsor resident and removed a lawn sign.  Responding to the story, Windsor's mayor chose to use his official Facebook account to share some controversial thoughts on this apparent act of vandalism. This led to a deluge of online comments that quickly took on a life of their own. Ironically, in the six years since WRH proposed its single site acute care hospital, the local community has never been provided with an appropriate public forum to discuss the $2 billion plan for its future healthcare. Is it any wonder that residents took to social media to vent? There has never been an opportunity for residents to provide feedback that wasn't supportive of the plan - - - WRH's contractually silencing doctors opposed to the plan has not helped the public's understanding of it. Nor - - since the 2015 County Road 42 site announcement - -  has the proposed location for the new hospital ever been debated at a Windsor City Council meeting. No public referendum was ever held. Yet, the Mayor trumpeted an extremely wishful "~90%+ of Windsorites" wish to see "this project move forward" as fact on his official Facebook page. Where is the data proving that Windsor residents overwhelmingly support the County Road 42 site? Social media is not the right platform to be arguing about this serious matter. It's a decision that will affect the health and wellness of our community for decades to come. This discussion certainly shouldn't be led in a reckless manner. It's careless at best and a flagrant misuse of the Mayor's elected position at worst. And it comes at a very inappropriate time while we await the LPAT ruling on CAMPP's historic appeal.

Rhys Trenhaile, the property owner, described the incident on his Facebook page on October 30, 2019. He added:

"There’s been a lot of talk lately in Windsor-Essex about the issues with virtually all hospital officials now using misleading language that tends to nastily divide the citizenry in regard to the location of the future mega hospital. By far the greatest fallacy in this whole argument, pushed by these very same hospital officials, is this continued narrative that people that don’t want a hospital in the middle of nowhere - don’t want a hospital at all; that is the great lie. Everyone wants a shiny new hospital. Everyone."

Windsor residents don't oppose a new hospital. They just want a responsible location. Mayor Drew Dilkens responded to the story on his official Facebook page. Rather than acknowledging the important distinction between choosing a responsible location and wanting a new hospital, he used the social media platform to diminish and belittle CAMPP's arguments. He also wrote that he appreciated "the frustration that many feel every time they see a sign that shows opposition to a plan that would significantly enhance our local health care system." UCC vs. ER: Understanding the difference is a matter of life and death Windsor's mayor was elected to represent his constituents. Yet, rather than addressing the significant concerns thousands of engaged residents have publicly expressed during the last six years, he chooses to perpetuate a false narrative. Particularly disappointing is how he keeps publicly emphazing that under the plan, WRH Ouellette Campus is going to keep its ER.

In fact, there has never been an announcement that anything other than urgent care services will remain in downtown Windsor. At the LPAT hearing just last month, we don't recall the lawyers representing WRH stating that the original plans for a downtown UCC (to replace both existing acute care hospital campuses) had been shelved. We wrote about the fundamental distinctions between urgent and emergency care in our eblast on August 18, 2019. For the benefit of our newest subscribers, here is the instruction provided to patients in Brampton:

#JustTheFacts: Residents deserve honest and accurate information from elected officials We are calling for a straight answer: Has the plan for an Urgent Care Centre in Downtown Windsor been replaced by a plan for an Emergency Department?  In other words, will WRH Ouellette Campus remain open as an acute care hospital? Because you can't have an ER without a hospital on the same premises.

In their own words: Members of our community continue to comment on the issues

"The hospital needs to be central to the people. If for no other reason than for their own safety. One mega-hospital constructed on the edge of the built environment, away from the core, and the centre of the overall population, is a risk to the public good, safety and welfare"

"Keep up the good work CAMPP! Yes we need a hospital that is accessible .I really cant beleive Windsor has to fight to keep hospitsls here or from them putting a hospital way out of reach.No windsorite should be forced to fight for something that is needed to stay close by where it can be accessed by some of Windsors most vulnerable citizens"

"I agree that it is very sad indeed that it has come to this sort of nonsense, perpetrated by these supposed pillars of our community! So disheartening, and frustrating!!!"

"Windsor deserves a state-of-the art medical system. Properly planned to save lives."

"Nobody is against a new hospital, they are against the location."

"Yes, a new “state of the art” hospital is everyone’s desire. There are a few choice properties within the City of Windsor to accommodate such a mega hospital. We cannot give up the fight!"

"We got our sign vandalized, then a few days later stolen."

"The hospital leaders should be more inclusive and they should be looking to work with community partners on a plan that is best for all of us not just the wealthy!!"

"Windsor could be a really world-class city if it embraced things like density and innovation as opposed to just outward sprawl"

"Emergency care and urgent care are two very different scenarios. It is my understanding you cannot support an Emergency room downtown without an attached Hospital. "

"it's a false narrative that is being pushed on the people of Windsor and Essex county. No one is going to lose a hospital if there is more thought and reasoning put into its location. The province is not going to strand over 300 thousand people without acceptable hospital facilities. Wake up. There are a few people who stand to gain a tremendous amount financially by putting a mega hospital 10 km outside the core of the city."

"Windsor needs at least two acute care hospitals and if only one true severe trauma emergency hospital it should be in the population center. Detroit burned, deteriorated lost well over half it’s population but they kept their hospitals open in the city core which the new development rose from around them. This is the glue that any major metro area needs."

"I do not accept that bullying and shaming should ever be a part of policy making."