Peterborough Regional Health Centre officials are putting together their next balanced-budget plan behind closed doors.

The Ministry of Health-mandated process, now called the Hospital Annual Planning Submission, will not be released to the public until mid-November; after it's already approved by the hospital board and the ministry.

"We are going to keep the plans out of the media in the short-term, until they are approved,' said Paul Darby, hospital CEO, during last night's board meeting.

Last year the hospital released its balanced-budget plan before it was approval.

Part of the plan called for 125 layoffs and the closure of 14 inter-mediate care beds, which raised concern among physicians, hospital staff and the community.

In the end, the number of layoffs was about 75 full-time equivalent positions and the intermediate care beds did net close.

"Much of what all of us worried about didn't come to fruition," Darby said.

He said not telling the public the plans before they're finalized will eliminate unnecessary worry.

The ministry has made it mandatory for hospitals to balance budgets.

This year, the hospital will follow the same seven steps to eliminating a deficit.

The first step is generating revenues through things such as higher parking fees. The next two steps involve reducing costs in administration and support and diagnostic imaging, pharmacy and labs ancillary.

The next step is finding program efficiencies followed by making more efficient use of beds.

The sixth step is moving programs into the community.

The final step would be to cut programs

"I assure you will not be in that position at all," Darby told the beard.

The hospital bard and administration have a tight timeline to have the plan put together and approved.

A series of meetings are scheduled in the neat two weeks.

Yesterday, the board will meet behind closed doors to review and approve the budget in principle.

Hospital officials and ministry staff will review the plan in late October. The board will have to sign an accountability agreement after the plan is approved.

"It's a very tight timeline for everybody," said Wendy Fucile, hospital vice-president.

A date has not been set for the plan to be released to the public, but Fucile said it will be sometime mid-November.

Darby said the budget process has changed over the last 18 months against the backdrop of Bill 8, which spelled out the obligations of hospital boards to balance the books.

"It's quite a different paradigm," Darby said,

He said the ministry is more focused on performance-based budgets, where funding will continue as long as targets are met.

The hospital is also looking at multi-year funding for the first time, which lets hospitals know how much money they'll have over the next two years.

Fucile said this will help with future planning.

Fucile said hospital officials are hoping the ministry will soon address the need to ramp up for the new hospital.

She said the hospital had hoped to have 24 acute care beds and four intensive care beds added to the facility this year:

Fucile said the hospital is also calling for an addition 16 acute care beds in the near future.

Local hospital officials miss the point when they say that keeping budget negotiations secret until all the details have been approved is less stressful for everyone involved.

But before making that argument, we should go on the record regarding the "less stress" theory. We don't accept it, and we don't think taxpayers who fund the hospital and count on it for service accept it either.

If Peterborough Regional Health Centre (PRHC) has to make up a budget shortfall of $2 million or more, its options are to generate more revenue or cut costs. The people who are going to either pay more or lose services should know what is being proposed and have the opportunity to make their feelings known before it is too late to make changes.

PRHC doesn't see it that way. On Wednesday night, the hospital board agreed that discussion of its plan to eliminate an operating deficit would be done behind closed doors.

Not until a plan had been developed locally, sent to the Ministry of Health and approved would it be made public.

Hospital CEO Paul Darby believes that taking the negotiation stage out of the public eye eliminates unnecessary worry. As proof, he referred to last year's balanced budget exercise. To meet a Ministry of Health order for elimination of a $10 million operating deficit by the end of 2005-06, the hospital submitted a plan which included cutting the equivalent of 125 full-time jobs and closing 14 beds where particularly sick patients got a higher level of care.

Back then, Darby initially made the same "stress" argument: people should not get details of the plan until the ministry made its final decision. But after the medical staff president, Dr. Alan Thompson, refused to take part in closed-door discussions and warned of coming service cuts, the hospital reversed its position and announced those details.

The result was, as Darby says, a public outcry. In the end, the ministry backed off on its demand for a balanced budget. The number of job cuts was reduced to 75 full- and part-time. Fewer beds were closed. Some other services that were to be cut were kept instead. However, the hospital was still running $2.3 million in the red.

There are two interpretations of that result. Darby and the hospital board, which has agreed to closed-door talks this year, apparently believe last year's cuts would have been rolled back even if they had not been made public. In that scenario, public pressure on the ministry and the board had no effect and people got worked up for no good reason.

We doubt that is true. Admittedly hospital officials are on the inside and know more detail of what went on, but it is hard to believe that several weeks of protests from doctors, patients and their families, municipal politicians and the community at large had no effect on the outcome.

But back to the main point: whether telling people what was planned helped, hurt or had no effect is not the issue. PRHC is a public body supplying a publicly-funded service. The board has an obligation to debate its spending plans and the effect those plans have on health care in public, not huddle with the ministry behind closed doors and then announce a prescription.

People can deal with news, good or bad, but they need all the information. In fact, they have a right to deal with it, and to decide for themselves whether their voices have an impact.

First it was the nurses, now hospital doctors have broken ranks to voice concern about dangers facing patients in what they call a chaotic and stressful emergency department.

As hospital workers decried staff shortages and a lack of beds, CEO Paul Darby said the next cost-cutting budget plan could be approved, signed and sealed before the public sees any details.

"Above all we are worried about our patients," states a letter from emergency department doctors. "We worry about the indignity that they suffer lying in our hallways. We worry about the risks they face sitting in our waiting room because there is no space in which to see them. And we worry about our ability to provide the top quality care our patients deserve in the face of such pressures."

The letter was addressed to Darby and also sent to Peterborough Regional Health Centre chief of staff Dr. Peter McLaughlin and hospital vice-president Wendy Fucile.

In it, emergency room doctors said they put their concerns to paper after a unanimous vote at a department meeting.

They also expressed worries about the people working in their department.

"We too are alarmed that conditions in our department have continued to deteriorate," the letter states.
"We are worried about the effects of this chaotic and stressful environment on our staff. We fear burnout and future staffing crises could result."

The letter comes on the heels of a similar one written a month ago and signed by 60 PRHC employees, most of whom were nurses.

Diane Crough, president of CUPE Local 1943 representing nurses, said it was important to see doctors support the unusual risk her co-workers took in publicizing their concerns.

"If the doctors stand behind us, then the administration needs to stand behind us," Crough said. "If the doctors are saying things are depreciating and they're taking a stand, I think it's time the higher up people really take a good look at what's happening in this hospital. We can't go on like this until we get a new hospital. We just can't."

Medical staff president Alan Thompson wasn't directly involved in creating the letter, but he shares some of the concerns.

He said the emergency department is facing two main problems.

The first is the lack of primary care in Peterborough, leaving thousands of patients without doctors.

The emergency department has to pick up the slack, he said.

"But the bigger problem is the lack of in-patient bed space," he said. "We're working on that and actually think we're getting somewhere and hoping we're going to be able to add to our bed compliment. From those two problems flow all the other problems."

Darby said he met with emergency doctors Sept. 15 to talk about the budget, strategic directions and the state of emergency department.

He said Fucile also met with nurses about the same issues.

Darby said the hospital's balanced-budget plan, now in the works, should help to relieve some of those woes.

Cuts a secret process

"I'm quite hopeful that our capacity issues around beds and the impact that has on our emergency department will be addressed through this budget process we're in right now," he said.

But the public likely won't know about the decisions being made, including cost cuts, until the final budget is approved.

"I don't think there's a legal obligation," Darby said. "We are a publicly funded organization and we're governed by a board of directors and they've been charged with a responsibility to act on behalf of the community."

During last year's budget cuts, the hospital laid off 75 full-time equivalent positions.

Darby said the hospital is keeping discussions secret this year to prevent the widespread concern from the community that occurred last time.

"You can't convince me that's a healthy process," he said.

Darby said he's still unsure if the board will even make its final budget approval in a public meeting.

"It's up to the board, we haven't had that conversation," he said. "I know the board recognizes the public interest. We still have to have that conversation."

Board chairwoman Bonnie Patterson couldn't be reached for comment last night.

But board members will be the public's eyes and ears, Darby said.

"These are your neighbours and your friends that are sitting around the table."

Thompson, a vocal opponent of last year's budget plans, said it's too early to say if keeping this year's plans secret from the public will be detrimental.

"To some extent it is a worry," he said. "It's a fine line between sensitivities of staff and the public's need to know and the public's need to be engaged in the debate. It is a fine line and I don't have an opinion right at this instant as to what side of the line we're falling on. But it's a razor's edge."

PRHC Board of Directors
(PRHC Website)

The following are the members of PRHC's Board of Directors as of June 23, 2005

Mr. Kevin Breese
Mrs. Doris Brick, Past Chair
Mr. K. Wayne Brownlee
Ms. Barbara Cameron, 2nd Vice Chair
Mr. Greg Connolley
Mr. Paul Darby, President & CEO
Mr. Ross Garland
Dr. Peter McLaughlin
Mr. Gord James
Dr. Srinu Kammila
Mr. Rick Krug
Mr. Ron Osborne
Prof. Bonnie Patterson, Chair
Elizabeth Powell
Mr. Ken Powell, 1st Vice Chair
Mr. Peter Roach
Mr. Neil Rogers
Dr. Alan Thompson
Mr. Jeff Wickware