The head of Muskoka Algonquin Healthcare’s emergency department is not renewing his contract because he says the proposed job and service cuts could be putting patients at risk.
“I informed the hospital (MAHC) I have no interested in renewing,” said Dr. Pierre Mikhail. “You’re getting paid by the hospital, and I find it increasingly difficult to receive money when I don’t agree with the decisions being made…. We take a Hippocratic Oath to do no harm and some of the things we’re doing are harmful.”
Instead, Mikhail will stay on as a full-time emergency physician at Huntsville District Memorial Hospital when his two-year contract as emergency department director ends in late April.
He says the possibility of cuts to services such as outpatient rehabilitation has him concerned for patients.
“If you’re poor in Huntsville and have limited resources, you can’t get physio,” he said. “We used to be the safety net for those people.”
Cancelling outpatient rehabilitation is one of the ideas MAHC is pursuing as part of its deficit recovery plan.
By the end of the fiscal year the multi-site health-care provider will have accumulated a $5.8-million debt load.
Already MAHC has closed seven beds and the urgent care centre in Burk’s Falls, among other changes. Some of the others avenues it is pursuing to reduce its debt load are the closure of 23 more beds and the loss of the equivalent of 56 full-time positions by 2012.
While MAHC executives have said these won’t necessarily translate into job losses if people retire or leave the organization — but Mikhail says the point is the positions are not being replaced.
“What about the patients who were going to be cared for by those people?” he asked. “We’re expected to be leaner and do more with less.”
That’s already being felt by the staff in his emergency room, he says. Part of the deficit recovery plan is not to replace the first emergency room nurse who calls in sick during a day shift.
In a recent shift, for example, instead of four nurses, there were two. They’ll often skip breaks to help their patients. “It’s hard for me to operate in that system when I feel so strongly that we’re burning out our nurses,” said Mikhail.
The proof is in the numbers, he believes.
According to Mikhail, for whatever reason, four ER full-time nurses have left their jobs or are about to leave. Since May four emergency doctors have left. Morale is low. People are worried about what will happen next.
“Stress is high for everyone, and people have their own reasons for what they need to do. What the reasons for these moves are, I’m not privy to,” said MAHC chief of staff Dr. David Mathies.
During a telephone interview on Friday afternoon, Mikhail says he wants to make it clear he’s not faulting Muskoka Algonquin Healthcare.
MAHC is struggling with an “impossible” situation, he says, which is rippling across the province. Hospitals are funded for the most part by provincial dollars, which are doled out through Local Health Integration Networks (LHINs). In Muskoka, that’s the North Simcoe Muskoka LHIN.
By law, Ontario hospitals can no longer run deficits. That means the LHIN has provided a $3-million cash advance to MAHC, which is paying $400,000 in interest a year.
No increase in funding could be a reality in 2010. Grappling with a $24.7-billion provincial deficit, the province has asked health-service providers to prepare budgets based on zero, one and two per cent increases.
Mikhail, who hails from Toronto originally but has lived in Huntsville for six years, said he’d continue to do the best as an emergency doctor. “I’m going to be a worker and I’m going to work hard for my patients and my colleagues and the nurses I work with because that’s my job,” he said.
“We’ll miss Dr. Mikhail in his role. He’s been very effective,” said Mathies. “We all have our own opinion and he’s welcome to his. But we have to do what we have to do and make the best of it.”