'I may have to close': N.L.'s only abortion clinic faced bankruptcy, gave government ultimatum

Documents obtained by CBC/Radio-Canada detail how Newfoundland and Labrador's only abortion clinic faced bankruptcy earlier this year and pleaded with the provincial government for more stable funding.

The Department of Health and Community Services eventually took action, but only after Athena Health Centre which performs more than 90 per cent of the province's abortions threatened to close.

"I have come to the realization that I may have to close the clinic if something doesn't change in the very near future," wrote clinic co-owner Rolanda Ryan in an ultimatum sent to the premier and health minister on Feb. 3, more than 14 months after first requesting a new funding model.

Fifty-three pages of emails and letters between Ryan and the government show how the clinic's previous fee-for-service funding model crumbled during the COVID-19 pandemic, as people self-isolated and spontaneous sexual activity dropped.

Revenue down, costs up

For each abortion, the clinic received $875. The doctor performing the procedure also billed the provincial Medical Care Plan an additional $195. During the first year of the pandemic, the clinic performed about 100fewer abortionsthan the year before. That 11 per cent drop equated to$84,000 less revenue.

At the same time, medical equipment costs skyrocketed as demand soared. Staffing costs remained the same despite the drop in revenue, as staff were paid for eight-hour shifts at the clinic which operates once a week in St. John's and once a month in Corner Brook or Grand Falls-Windsor regardless of the number of abortions performed.

"Most operating costs are fixed costs which cannot be reduced when the number of procedures declines," Ryan wrote in her first letter, sent Nov. 27, 2020.

"A fixed-revenue stream would secure our clinic's existence," wrote Ryan, who requested $1 million in yearly fixed funding. "Such a funding model will ensure stability for our clinic operations while also reducing hospital-based abortion care."

Under the fee-for-service model, which had increased the fee since 2010, the clinicreceived about $809,000 for performing 924 abortions in 2019. Abortions at Athena Centre cost less than half as much as abortions performed at hospitals, according to Ryan.

Emails show the Health Department was open to the revised funding model, but also preoccupied with the government's pandemic response. An initial meeting with then health minister John Haggie was also delayed in January 2021 because of the provincial election.

Ryan repeatedly requested updates after hearing nothing from officials for months on end.

"It has now been five months since I initially reached out, and I am hopeful the meeting can be rescheduled in a timely manner," wrote Ryan on April 20, 2021.

A meeting with officials took place in May 2021 and by July, emails show the department had begun reviewing the clinic's funding model.

'We really need a bulk funding model'

However, half a year later, there was still no decision and Ryan who had maxed out a line of credit and received thousands in federal subsidies and loans while waiting for the province to act worried about making payroll.

"It has now been three months since I last reached out for an update on our review for a financial reimbursements/facility fee. As indicated from our 2020 letter, and our 2021 letter (attached again for your reference) our financial situation is becoming quite dire," Ryan wrote on Feb. 3, 2022, in the same email in which she threatened to close.

"To keep our doors open, we really need a bulk funding modelor a significant increase in our facility fee."

Emails show block funding quarterly payments equalling $1 million a year was finally approved in the spring. Ryan says the first payment arrived in her bank account in July.

"The idea of actually shutting this clinic down was devastating because I realize that people who want an abortion will have an abortion, whether it's self-inflicted or whether it's done with care and compassion and safety," Ryan told Radio-Canada on Friday. "I did not want to shut the clinic down and it was truly a last resort.

"I do the work because I truly, in my soul, feel this is such good work, people need this service and we know that ifabortion isn't safe and legal it still happens," she added.

Minister says delay 'unfortunate'

On Monday, Health Minister Tom Osborne said there needsto be "an evaluation and an approval process"when making decisions on public funds and that health officials faced a barrage of challenges because of the pandemic.

"It was an extraordinary length of time and that is very unfortunate," he said.

"I think it's fair to say that it would have been more appropriate to have it dealt with in a shorter time frame but the circumstances around COVID and the approval process are there as well."

Athena Health Centre requested a facility fee increase in February 2018, but was denied. The government did, however, agree to pay the clinic a fee for patients prescribed the abortion pill Mifegymiso.

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