Health Minister Gatan Barrette not budging on MUHC's seasonal bed cuts

Quebec Health Minister Gatan Barrette isdismissingconcerns about the impact of dramatic bed cuts on patient care at the McGill University Health Centre.

"The plan was the plan, and they have to abide by the plan," said Barrette, referring to a 2007 clinical plan signed bythe MUHC and the province.

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Barrette'scomments come a day after it was revealed that the MUHC would have to cut dozens of beds in the summer and holiday periods more than a quarter of the year in orderto meet thebudget imposed on it by the Health Ministry.

Some surgeons predict the 14 weeks of "seasonal bed closures" could double wait times for cancer surgery and cause even longerdelays for non-urgent surgeries.

"It will put more stress on me to make sure my patients get done in time," one oncology surgeon said, under the condition of remaining anonymous.

'The way it will be,' says Barrette

When the planning was done for the superhospitalat the Glen sitein 2007, a clinical plan was signed by the MUHC and the province. It predicted everything from the number of beds it would need to staffing levels.

It was based on a projection of an average bed occupancy rate of 85 per cent.

The plan does not make clear that the MUHC's budget would be based on that "average occupancy," however,that's how the government has interpreted it.

The MUHC had hoped for some wiggle room and sought $50 million intransitional funding. The Health Ministry granted just $18 million of that request. Beyond that, the ministerisn't budging.

"It was planned that way. It was agreed upon, and that's the way it will be.OK?" said Barrette, when pressed by reporters.

Systematic planning

The MUHC is now scrambling to live with the reality of those numbers.

Dr. Ewa Sidorowicz, the MUHC'sassociate director general of medical affairs and head of professional services, admitsthe seasonal closures, which will see cuts made to beds in general medicine, surgery, pediatrics and at the Montreal Neurological Institute, are challenging.

There is a concern we may not have enough beds to cope with the access demands.- MUHC head of professional services, Dr. Ewa Sidorowicz

But they weren't done randomly.

"We looked back historically over the last three years to see what fluctuations in bed usage havebeen, and during the summer months, we do have beds that are not occupied in surgery," said Sidorowicz.

She points out that the MUHC has had bed closures in the past, but nothing quite as systematic as what it must put in place this summer.

MUHC administrators aretrying to reduce the amount of time patients stay in the hospital after surgery, and they're closely monitoringto make sure wait times don't creep up.

"Above and beyond that, there is a concern we may not have enough beds to cope with the access demands," said Sidorowicz.

More complex, acute cases

With the recent reorganization in the health care system, the MUHC is expected to take on more complex cases.

The MUHC was designated a centre of excellence in thoracic surgery, and with that designation, itwas asked to take on patients from the Jewish General, Verdun andGatineau, as well as other hospitals in the McGill University teaching network.

"This was not part of the initial(2007)clinical plan," said Sidorowicz.

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The Montreal General and Montreal Neurological Institute were also asked to take on acute stroke patients, which means manymore patients are being brought to those two sites of the MUHC than had been foreseen.

Despite the fact that, too, was not in the 2007 discussions, the Health Ministry has not provided extra financing to cover that increase in acutely ill patients.

"If we are admitting patients who are sicker and sickerand who are clearly going to be more expensivehow is that funding going to follow?" asksSidorowicz.

'Huge load on partner hospitals'

The MUHC says it needs community hospitals and regional health bodies to step up andtake on more patients.

Sidorowicz saidthere are somepatients that need to be moved out of the MUHC into long-term care facilities.

There are other patients that once operated on or stabilizedneed to be transferred to their localcommunity hospital and followed by medical staff there.

Sidorowicz saidstaff are spending an inordinate amount of time explaining to patients that there are resources in the community that are more appropriate for them to draw on.

"The ability of the network to take up some of our patients has been slow to come into place," said Sidorowicz.

"There's a huge load on our partner hospitals that are also very, very busy. It's really hard to slip into everybody's priorities and be one of the main issues that needs to be dealt with on the island of Montreal."

A spokeswoman for the Health Ministerysaid some short-term beds have been opened at Verdun and Lakeshore Hospital as well as a hemodialysis unit at Anna-Laberge Hospital in Chteauguay.