J. David Wake, K.C.
Office of the Integrity Commissioner of Ontario
2 Bloor Street West, Suite 2100
Toronto, ON M4W 3E2

Dear Integrity Commissioner Wake:

Subject: Request for Integrity Review: Role of Provincial Officials in the Permanent Closure of Minden’s Emergency Department

We are requesting a formal investigation into the conduct of Deputy Premier and Minister of Health Sylvia Jones, MPP, Laurie Scott, MPP and other provincial officials concerning the permanent closure of Minden’s Emergency Department (ED) by Haliburton Highlands Health Services (HHHS).

Our research has uncovered discrepancies in the statements made by Jones and Scott compared to official HHHS documentation, such as board meeting minutes and financial records. Both officials described the closure as a consolidation unrelated to financial issues and in the community’s best interest, despite their close involvement with HHHS. This contradiction suggests potential neglect of oversight responsibilities, failing to represent interests beyond those of HHHS and the Conservative government.

Minden Hills Mayor Bob Carter publicly stated that the closure was decided with no stakeholder consultation, six weeks notice, and hope in place of a plan. Doctors, nurses, EMS, volunteer firefighters, patients, residents, nonprofits, and businesses were not consulted or informed about the closure in advance. Both ED physicians working at Minden ED and HHHS’ former board chairs opposed the decision with written letters. All stakeholders wanted a moratorium. The community responded with over 25,000 signed petitions.

We urge your office to investigate this matter as a potential failure of public health governance at the levels of the CEO, the Board, and especially the Ministry. The circumstances surrounding the closure may be indicative of larger systemic problems.

Board Governance: Evidence suggests that HHHS’s board did not adhere to its responsibilities of leadership, fiscal responsibility, and community representation. There is also an indication of possible conflicts of interest regarding David O’Brien and Kelly Mitchell, who both performed in “ad hoc government relations” beginning in 2018. Mitchell was expressed as regrets for three board meetings ahead of Minden ER’s closure while simultaneously working on the Eastern Ontario Warden’s Caucus (EOWC) Seven by Seven Regional Housing Plan (a 28,000-unit regional housing plan).

Financial Management: Our analysis has revealed significant financial mismanagement within HHHS, including a $4.1 million deficit amidst excessive spending on agency nurses (calculated at 2.5x the cost of public nurses). We have detailed these findings to Ontario’s Acting Auditor General, and believe they warrant a forensic audit for the fiscal period 2017 to 2023.

Community Engagement: The failure to consult stakeholders before, during, and after the closure contravenes the principles of the Ontario Nonprofit Corporation’s Act (ONCA), the Public Hospital Act and the Members Integrity Act. It has also destroyed the publics trust, torn apart the social fabric of our County and planted a seed of doubt regarding public institutions and those who administer them.

Sociopolitical Landscape: Public statements provided by MPPs Scott and Jones conflict with documented internal discussions about financial pressures. This discrepancy is concerning, given their professed intimate involvement in the process.

Of note:

• Less than one month before the closure, HHHS board minutes capture Finance Chair Irene Odell’s assertion that “the deficit pressures have added a tremendous amount of stress. Staffing pressures and financial pressures were at top of mind and have a significant impact on every decision made”
• NDP Health Critic France Gélinas and MPP Chris Glover: Joined by the Ontario Health Coalition, criticized Premier Doug Ford and Health Minister Sylvia Jones for their inaction on this issue. Gélinas argued that Minister Jones has the responsibility and authority to intervene in the closure, which she believes is financially driven. She called for a minimum one-year moratorium on the closure.
• Criticism of MPP Laurie Scott: Gélinas criticized Scott for not being the “voice of the community” and for not fighting the closure. Scott had previously stated that the decision is a matter for the health board.
• Ministry of Health’s Stance: A spokesperson for the Ministry of Health, Hannah Jensen, stated that MPP Scott has been a strong advocate for her riding and remains in contact with the health board. Jensen emphasized that the decision is not a closure but a consolidation, aimed at providing better emergency care at the location best equipped for urgent acute care. She also noted that the Minden site would remain open for some services.
• Natalie Mehra’s Remarks: Natalie Mehra, executive director of the Ontario Health Coalition, expressed concern that the closure might signal future closures of other small, rural emergency departments. She criticized the Health Minister for a lack of action in addressing the staffing crisis affecting emergency departments.
• Official Party Visits: The NDP’s Marit Stiles and Chris Glover visited Minden to hear residents’ concerns, expressing support for the local community in their fight to keep the ER open. Dr. Adil Shamji, MPP and Stephanie Bowman, MPP also visited Minden.
• Conservative government rebuffs: Despite numerous constituent visits to the Legislative Assembly and calls for an audience, no Conservative government official would meet with patients, residents or the community.

An individual submitted a Freedom of Information (FOI) request seeking HHHS’ business case. The FOI response inadequately addressed the request, omitting the business case and heavily redacting pertinent information. We still do not know when the decision was made, who voted for it, nor the rationale behind it.

Why is HHHS keeping stakeholders from understanding its rationale for closing an ED that had served for nearly 30 years, despite protests from countless people and organizations?

Given the depth of the issues and concerns we’ve discovered and the potential deviations from core mandates by HHHS, we believe that accountability must be upheld. It is our hope that through your office’s oversight, we can reaffirm the principles of integrity, transparency, and accountability within Ontario’s public service.

We are prepared to present our comprehensive report and discuss our methodology for your review.

Thank you for your time and consideration,

Jeff Nicholls, Adria Scarano, Aurora McGinn, Tracy Klompmaker

On behalf of Minden Paper