This op ed originally appeared on healthydebate.ca
The reckless and rapid closure of the Minden emergency department with barely six-weeks’ notice and no stakeholder consultation is a microcosm of what’s happening across our province and nation.
In an interview with CTV National News correspondent Heather Butts, Alan Drummond, co-chair of the Canadian Association of Emergency Physicians, stated: “We can’t be doing this on an ad-hoc basis nationally; this is a national problem with common root causes that needs national discussion, a national dialogue, a national approach.”
The abrupt closure of Minden ED, a pillar of our community for nearly three decades, meets the very definition of an ad hoc decision. It occurred despite the population being set to at least triple from summer residents, guests and passersby. It also occurred despite intense opposition from former Haliburton Highlands Health Services (HHHS) board chairs, Minden ED physicians (who were staffed through September), local elected officials, most of the legislative assembly, most of the province and more than 25,000 signed petitions gathered over the course of 8 weeks of advocacy.
This is to all to say that the closure of the Minden ED was made with blatant disregard for best practices in board governance. It’s incredibly alarming – terrifying, even – that a CEO and a volunteer board can unilaterally (according to Minister of Health Sylvia Jones) close a public institution without consulting stakeholders.
Such a decision-making process (and the decision itself) blatantly defies best practices of transparency, accountability and stakeholder engagement. In fact, the reason for the closure by the board and CEO has proven to be unfounded.
According to the Ontario Hospital Association’s Physician Leadership Resource Manual: “Great boards are not measured by their rules and regulations, but by their culture and the way people work together.”
The Haliburton Highlands Health Services (HHHS) board’s disregard for its stakeholders was reflected again through its outright refusal to allow questions related to the Minden ED closure at its Annual General Meeting (AGM) June 22, a forum traditionally seen as an opportunity for open dialogue and accountability. In fact, the board failed to inform attendees (who had spent significant time preparing) ahead of time that these questions were not permitted– despite obviously knowing they would not be allowing them at the actual AGM.
By doing so, the board has most likely contravened the Ontario Not-for-Profit Corporations Act (ONCA), which explicitly mandates accountability to members and stakeholders. Given that the Act came into effect in October 2021, one would expect an institution as crucial as HHHS to be fully compliant, particularly in such a critical matter.
The Minden ED closure represents a complete failure in governance because hospital board governance must be held to the highest standard.
Moreover, the Zoom-based nature of the AGM made it impossible to determine which questions went unanswered, and the chat functions were disabled. It was also impossible to determine if questions about Minden ER had come from “members” rather than AGM attendees. If HHHS refused to allow “member” discussion, it is clearly in violation of its own bylaws and ONCA.
On June 29, HHHS held a town hall to discuss the closure of the Minden ED and the path forward. Unfortunately, Board Chair David O’Brien was not in attendance, thereby making many questions that depend on a historical understanding difficult if not impossible to ask.
The Minden ED closure represents a complete failure in governance because hospital board governance must be held to the highest standard. It underscores the necessity for entities like HHHS to surpass the bare minimum in governance.
The HHHS experience indicates it is time to review and overhaul how hospitals are governed in Ontario. Will we continue to allow unequal and inconsistent treatment of communities in their health-care needs by a board of directors?
As afforded in the Excellent Care for All Act, perhaps it is time for Ontario’s Patient Ombudsman to commence an investigation into the HHHS board before it is too late.
The people of Minden and surrounding areas deserve a health-care system that is responsive to their needs. The closure of our Minden ED without adequate consultation is not only a local tragedy; it is indicative of a nationwide emergency that calls for collective resolve and action.
The Minden ED closure serves as a timely wake-up call on how our hospitals are governed. As citizens and stakeholders, it is our responsibility to demand better because our lives, and those of our fellow Canadians, depend on it.
We must demand and ensure more than the bare minimum in board governance, insisting on transparent, accountable and engaged leadership. Only then can we hope for a health-care system that truly reflects the needs and concerns of the patients, residents and communities it serves.