Little hospital has big price tag

Prognosis not good for facility in Carleton Place

The hospital in Carleton Place, built in the 1950s, has 22 beds, plus assorted other services.

The proposed new one, some seven to 10 years in the planning, might have 24 beds, plus assorted other services, and cost an estimated $96 million, or more, on 10 acres of empty land.

Two more beds, close to $100 million. The math is hard to get around, so too the optics: a skeptic might see an ambitious little town pitching the $50-million hospital bed, with state-of-the-art doodads attached, mostly provincially funded.

The plan, and what a shock, has yet to be approved. Some are wondering if it ever will.

The town of Carleton Place, pop. 10,000, finds itself in the middle of a perfect storm of cross-currents that have left its muchtalked-about new hospital hanging:

a) the provincial money taps, which have funded 23 major hospital projects since 2003, are drying up under the weight of deficits;

b) nobody, including the regional heath planner and the Ministry of Health, seems certain what a small hospital should look like in 2017 and beyond; and

c) the time horizon of 15 years to completion is so long that momentum and community engagement are difficult to sustain, giving rise to all manner of revision, if not suspicion.

“I think the community certainly feels the fatigue,” said hospital chief executive Toni Surko. “We tell them that 15 years from your first request is not unusual for a hospital. This is the life cycle.”

It also gives contrarians time to noodle around.

Local blogger Doug Snedden has created a buzz in some town circles with his scrutiny, done with a skeptical eye, of the so-called Carleton Place Health Village Integration Project, slated to be started in 2017.

Instead of a traditional all-in-abox concept, the hospital is proposing a 24-bed acute-care hospital — with room for expansion — connected by walkway to a hub of clinics that would serve day patients, house administration and provide space for “tenant” health-care partners in an effort at one-stop shopping.

In August, Snedden coaxed a letter out of Health Minister Deb Matthews that rattled a few teacups, even surprising area MPP Randy Hillier, who has been watching the project closely.

The ministry, she wrote, has “raised issues” about the “scope of services” to be provided in the proposal. Thus, the project is not in the Liberal government’s 10-year infrastructure plan, called Building Together.

“When we saw the letter, our eyebrows raised, too,” said Surko. But, upon further inquiry, the hospital is satisfied that Matthews was not saying anything new, merely restating that the plan needs fine-tuning before it is a candidate for capital funding.

The process for a new hospital is proof that, in deepest, darkest government land, there do exist seven circles of hell. First, there must be approval and co-ordination with the (Champlain) Local Health Integration Network, then submission to the Ministry of Health, then a variety of funding approvals, with a dose of political suasion mixed in.

Carleton Place first submitted its plan to the LHIN and ministry in 2008. Yes, five years ago. Then the Champlain LHIN had a big rethink about regional care delivery. So, long pause, quick retool.

One of the issues possibly gumming up the works is the fact that Lanark County, pop. 70,000, already has three hospitals (a joint PerthSmiths Falls, Almonte and Carleton Place), while the Queensway-Carleton is within fairly easy reach.

Is there an appetite, one has to wonder, to spend $100 million on a Cadillac health facility to serve a catchment area of 25,000, when big areas like Orléans (at 100,000 plus) are under-served and the Civic campus is creaking along in hodgepodge of buildings that date to 1924?

Hillier, meanwhile, has been trying to push the matter. Last week in the legislature, he introduced a petition with more than 1,000 signatures calling for funding for the redevelopment.

However, the opposition member admitted his appeals to the Ministry of Health are not met with much enthusiasm.

Surko indicated the original plans have had sizable alteration. They first went to the LHIN with a pitch for 35 beds, then reduced it to 24.

“The ministry,” she said, “is still questioning whether that should be lower.”

Lower? Is is not reasonable to ask whether a facility with fewer than two dozen beds is even a “hospital” anymore? The bias in health-care planning these days is away from hospitals because of expensive care delivery.

Not to be overlooked, too, is the emotional currency invested in local hospitals, where, after all, we are born and volunteer and often die. There would, too, be a massive effort needed to raise some $16 million of the local share.

So, it needs a lot of hands rowing in the same direction. And they aren’t there yet, nor is it clear where the port is, in this ocean of change.