Pro-BanthTne for more than peptic ulcer INDICATIONS Pro-Banthine is indicated in peptic ulcer, functional gastrointestinal disturbances, ulcerative colitis, biliary dyskinesia, chronic hypertrophic gastritis, pylorospasm, acute and chronic pancreatitis, hypermotility of the small intestine not associated with organic change, ileostomies, irritable colon syndrome, diverticulitis, ureteral and urinary bladder spasm, hyperhidrosis. CONTRAINDICATIONS Glaucoma Obstructive disease of the gastrointestinal tract Obstructive uropathy due to prostatism Intestinal atony of elderly or debilitated patients Toxic megacolon complicating ulcerative colitis Hiatal hernia associated with reflux esophagitis Unstable cardiovascular adjustment in acute hemorrhage PRECAUTIONS Patients with severe cardiac disease should be given this medication with caution if even a slight increase in heart rate is undesirable. Fever and heat stroke may occur due to anhidrosis. Varying degrees of urinary hesitancy may occur in elderly patients with prostatic hypertrophy. In such patients urinary retention may be avoided if they are advised to micturate at the time of taking the medication. A decrease in bronchial secretion may lead to inspissation by these secretions and formation of mucus plugs especially in the elderly or debilitated with chronic pulmonary disease. ADVERSE EFFECTS Varying degrees of drying of salivary secretions may occur as well as mydriasis and blurred vision. In addition the following adverse reactions have been reported: nervousness, drowsiness, dizziness, insomnia, headache, loss of the sense of taste, nausea, vomiting, constipation, impotence and allergic dermatitis. Some of these effects are dose related. DOSAGE AND ADMINISTRATION Oral: Dosage should be individualized Pro-Banthine tablets (7.5 mg and 15 mg): the usual adult dosage is 7.5 mg to 15 mg of propantheline bromide with meals and 15 mg to 30 mg at bedtime. Patients with severe manifestations may require increased dosage up to 30 mg four times a day. Pro-Banthine PA. (30 mg): the usual adult dosage is one tablet in the morning and one at night. Occasionally patients may require one tablet every 8 hours. Parenteral: initial parenteral dose may be 30 mg or more every 6 hours intramuscularly or intravenously, depending on the condition for which it is administered and the requirements for prompt action. IM. solution - prepared by sterilizing the rubber cap with alcohol and injecting 1 ml of U.S.P. sterile water for injection into the ampoule. IV. solution - recommended that the contents of the 30 mg ampoule be dissolved in 10 ml of U.S.P. sodium chloride injection. COMPOSITION AND AVAILABILITY Pro-Banthlne 7.5 mg: each white, round, convex, sugar-coated tablet imprinted "Searle' on one side and "611' on the other contains 7.5 mg of propantheline bromide. In bottles of 100 tablets. Pro-Banthlne 15 mg: each peach-coloured, sugarcoated tablet imprinted "Searle' on one side and "601 on the other contains 15 mg of propantheline bromide. In bottles of 100, 1000 and 2500 tablets. Pro-Banthlne P.A. (Prolonged ActIng): the core of each capsule-shaped, compression-coated, peach-coloured tablet, impressed "Searle' on one side and "651' on the other contains 30 mg of propantheline bromide in the form of sustainedrelease beads, about half being released within one hour of ingestion and the remainder released slowly as earlier increments are metabolized. In bottles of 50 and 500 tablets. Pro-Banthlne VIALS: each vial contains 30 mg of propantheline bromide as a dry sterile powder for parenteral therapy following reconstitution. In boxes of 10 vials. Full prescribing information available on request or in OPS.
Searle Pharmaceuticals Oakville, Ontario
PEI's best buy hospital registers no sale By Milan Korcok There used to be something quasireligious about health care. Like Motherhood, God and Country, the quest for good health was inviolate to criticism. Whatever you had to spend, you spent. A politician with a hospital to his credit was walking tall. How times have changed! Can anyone imagine a political chieftain receiving public kudos for yanking the bulldozers off a hospital site, while at the same time admitting that the existing hospitals aren't what they should be? An unlikely scenario 10 years ago. But today... Premier Alex Campbell of Prince Edward Island is an astute politician. He knows where his support lies, and, in a jurisdiction as small as his, it's perfectly practicable to pick up the pulse of the community with just a few phone calls. Consequently, when he pulled the rug out from under his own hospital planners, who after 2 decades of health care briefs and studies saw their dreams about to take shape in a new building, he could be confident he wasn't rushing to any premature, political death. The 352-bed New General Hospital, which was intended to replace the 163bed Charlottetown and the 174-bed Prince Edward Island hospitals as well as the 28-bed Rehabilitation Centre, was an expensive proposition, at $29 million, for a province whose total population is just under 120 000. But as hospitals go, its aspirations were not extravagant. In fact it would cut back 15 beds from the existing inventory in town and usually, new hospitals add to the bed count. The NGH (only a provisional title; the permanent one would be selected by province-wide competition) was to be modelled after Britain's experimental "best buy" hospitals - a no-frills concept of building reputed to have re-
duced capital costs by 30 to 40%. (The two-storey, 122 x 122-rn structure uses ramps instead of elevators, and both floors are serviced by a type of ring corridor which allows quick, easy access to any part of the building. It uses the principle of greater flexibility to allow for future physical changes as the need arises, movable dividers, sharing of floor space between various units to avoid duplication, etc.) From a straight dollars-and-cents point of view the "best buy" hospital was a good deal for the money, comparing favourably with other options such as renovating and adding to the Charlottetown and the PEI hospitals, or building a new highrise on the existing PEL site. But the planning and building of hospitals, at a time when the health care system itself is in such a state of flux, has become an uncertain business, the vocation of masochists. The NGH failure was precipitated by a range of conflicts and fears that are not unique to PEI but are battering health care planners across the country: * Uncertainty about Ottawa's future commitment to health care funding. * The dismal economic outlook of the country generally. * The erosion of professional influence in local health planning. * The growing political orientation of health services. * The changing concepts of health care delivery itself, with a de-emphasis on institutional care and a rationalization of less costly "alternatives". * And, perhaps most important, the public's growing feeling that it might just not be able to afford everything it wants in the way of health care. The bombshell By the time Premier Campbell, Sept. 19, announced his government's with-
CMA JOURNAL/FEBRUARY 7, 1976/VOL. 114 269
pital, is not that charitable. "The gov¬ ernment's job is to govern, not to re¬ spond to a lot of crap in the media. This was the chance for government to do something of really epic propor¬ tions as far as this little province is concerned. They could have done some¬ thing that would have influenced health care here for generations. This was worth more than the government." The fact remains, however, that the hospital was poorly promoted among the public sector as well as among pro¬ fessionals. Few deny that. Information was being handed out piecemeal. Costs were projected at various times at $18 million, $21 mil¬ lion, then $25 million and finally $29 million. Actually, costs did not fluctuate wildly, but with the lack of any structured information program, they were subject to a lot of misinterpretation. Some es¬ timates referred to bare construction costs (only $18.4 million), others to construction plus site development and some equipment and furniture ($21.8 million). Still others referred tp building and furnishing budgets plus escalation costs public apathy. "It is remarkable that we have so and professional consulting fees ($25 little public debate about public ex¬ million) and still another included all aforementioned costs plus startup, postpenditures and financial policies." contract contingencies and financing Public priorities ($29 million). The is that time costs How is it, said the premier, that the were point there wasevery a different fig¬ quoted, public and the media would become ure to boggie the mind, and suspicions "almost hysterical" about a proposed that the planners didn't really $2 national park fee, a $3 derelict car grew know how much the hospital would tax (to dispose of ears when they be¬ cost. came junk), yet remain virtually mute To make matters worse, there was when it came to such large investments no organized public relations program as a share in the nuclear power plant to sell the facts about the hospital it¬ in New Brunswick, an underwater self, no attempt to point out the shortpower cable to the mainland and a comings of the existing plants or to new hospital costing about $29 million? show that the new hospital would signi¬ The bait worked. ficantly improve health care in the en¬ Letters to the editor questioning the tire province. value of the hospital started to appear. There was not even a sign at the Radio talk show hosts were asking emsite to explain why the bull¬ barrassing questions about the escalat¬ hospital dozers were tearing up earth and trees. ing costs of the new project. People Considering that the public was going were asking "who says we need this to be asked to dig into its pocket for hospital?" $4 million in direct pledges (over and If ever Campbell wanted a way out above the tax load necessary to finance of the hospital project and certainly the the failure to beat the building), it must have crossed his mind in the drums was a omission. glaring wake of Ottawa's restrictions on federal participation in health care funding Physicians ambivalent he didn't have to look far. At the same time, the attitude of One month after his Rotary speech, the axe fell. physicians toward the new hospital was In retrospect, many of the strongest ambivalent, at best. True, physicians at proponents of the hospital agreed that the existing hospitals had for years been the groundswell Campbell would have on record as supporting the principle liked in support of the building hadn't of a consolidated hospital. As far back materialized and that the premier's ac¬ as 1967, a brief presented to govern¬ ment by a joint committee of the tion was not politically reprehensible. Dr. Kenneth C. Grant, one of the boards of trustees and the medical staffs most avid supporters of the new hos¬ pressed for a "single hospital in the drawal of financial support from the project, the bulldozers had al¬ ready moved to the hospital site, a magnificent stand of white birch had been ripped out and the red earth lay exposed to the autumn skies. The decision was a bombshell. The key hospital proponents, Dr. Lemuel E. Prowse, chairman of the Hospital Services Commission and pro¬ ject coordinator of NGH, Frank MacDonald, interim chairman of NGH (also chairman of the Charlottetown hospital), and William S. Hunt, chair¬ man of the PEI hospital, are still in a state of shock. To them it didn't seem possible that government would reverse itself this far down the road, especially after a lastminute cabinet review in July gave them the final green light. But Premier Campbell did not act in a vacuum. His political instincts had been aroused. Something was wrong. Where was the discussion, debate and criticism that would usually have ac¬ companied so massive a venture? In a speech to the Charlottetown Rotary in August, Campbell decried
NGH
.
270 CMA JOURNAL/FEBRUARY 7, 1976/VOL. 114
city that
would provide for better health care to the island community". The brief said, "The two-hospital sys¬ tem in this community had its origin in religious differences and bigotry. The prize of the future, leaving behind a tradition which has become stagnant, can only be realized with the help of good neighbourliness and clear think¬
ing."
The report urged the community "not to perpetuate the present system with two mediocre hospitals and only adequate care." Another equally strong report was issued in 1972. But there appeared to be a difference between supporting the principle of a unified hospital and facing the reality of building it. To many physicians there was some¬ thing disconcerting about tearing down two separate medical hierarchies and constructing one in their place espe¬ cially when the new hospital would result in 15 fewer beds than already existed. Physicians who now practise across the street (the Charlottetown clinic and hospital are neighbours), or who could walk to the hospital from their homes, would have to drive a couple of miles out of town. A rearrangement of pecking orders and new personal and pro¬ fessional relationships sometimes cause hard feelings, and in a community the size of Charlottetown hard feelings were pretty hard to disregard. It was also troubling to hear per¬ sistent rumours that physicians would be asked to contribute several thousand dollars of their own money to get the hospital built. Cocktail parties served as fertile medium for passing on gossip as to how much would be expected from each physician. The range ran from $6000 to $25 000. The pros and cons Dr. Lewis Newman, a young family physician on the PEI hospital staff, has been most articulate in opposing the spending of $29 million on the new
hospital. Newman's opposition is not directed at the principle of a single hospital so much as it is against the "bulldozing" tactics of project coordinator Prowse and his "entourage of hospital plan¬ ners". "I might still change my mind if someone came to me and tried to dis¬ cuss plans with me like a human being
and did not treat me like a child," declares Newman. "The hospital boards have never tried to show us, with cold, hard facts, why this new hospital is better over a 25-year period. I just have not re¬ ceived the information to convince me
that it would be cheaper to build a hospital than to repair the existing
new ones.
"We physicians were brought into the picture after the architects had drawn up their plans. That's pretty far down the road; that's rubber stamping, and I am surprised, shocked and amazed that the rest of the medical population has not felt insulted." Physicians have always been reluctant to get into politics, says Newman. But the rules have changed. "If we don't decide on important matters, someone will decide for us. This is
living proof." Dr. Lloyd Cox, surgeon and pres¬ ident of the medical society, originally also opposed the idea of the new hos¬ pital. He has changed his mind. "I will admit that at first I wasn't for the idea of the NGH, but I gradu¬ ally came around. I was opposed for selfish reasons. We had built a new wing, a lot of us were feeling we had a nice hospital. But one by one, we With population of less than 20 000, Charlottetown nevertheless must serve an island succumbed. in existing acute care facilities, few of its population we all came to "Eventually support community. Despite inadequacies cancellation of the NGH. protested it, but we had a lot of misgivings. We worried about the reduction of hospital "We're moving our patients, parti¬ Ironically, just as the premier was beds, about the lack of backup facil¬ his axe, the lack of support faster than ever," ones, surgical sharpening cularly ities; we worried about statements by the premier that there would be no ad¬ says Cox. But in spite of that turnover to which he made so many references ditional backup chronic care facilities there is still a 3-month waiting list for was changing. Dr. Thomas A. Laidlaw, chief of until at least 1980. We already have most elective surgery. "There comes a extended medical where without sufficient staff at the PEI, swung con¬ point no backup facilities, and we just can't siderable care facilities you can't even get your support to the NGH when, moved now. get people in a to the editor, he expressed acute Dr. Cox. letter in," patient says "There was that fear." "And we are now down to a tight displeasure with the government's ac¬ tions. situation." Chronic and acute beds Dr. Lem Prowse, a former navy man Unfortunately, his comments weren't The province's indecision about the who sports an impressive Colonel published until a week after the premier future of chronic and extended care Whitehead beard (and does, incident¬ announced the government's withdraw¬ facilities has been a critical factor in ally, drink gin and tonic) delights in al of financial support. the selling of NGH to the profession. "I am quite sure that until a week "telling it like it is." And some physi¬ It is estimated that between 80 and cians don't like the way he tells it. or two ago, I would have been one of 100 beds in the existing hospitals are The Prowse reputation is not built on those in agreement with cancellation taken up by patients requiring not diplomacy. on second thought, however, I now acute but chronic care. That is almost "We're piling all our money into the feel much less sure that the right de¬ 30% of the total hospital population. wrong spot," says Prowse. "Our em¬ cision has been made. Board chairmen MacDonald and phasis has been on illness care and this "If hospital services are to be pro¬ Hunt say that construction of the NGH is goddamned nonsense. We wanted to vided to the people of this area of a would have allowed them to retain one get our acute care beds down from 6.9 quality comparable to those in pro¬ segment of the PEI hospital for chronic per thousand. We're right on top in this gressive communities elsewhere in Can¬ care, and another segment could have respect so far as Canada is concerned. ada, making use of modern concepts been alloted to the Alcohol Addic¬ We'd like to get it down to 4.5. and technologies, we must not only tion Foundation. That would have freed "But doctors would use any given provide a given number of beds, but all 352 beds at the NGH for acute number of beds. If you gave them adequate backup facilities outpatient care. 3000 they'd fill them up, because the and day-care facilities, operating room "A lot of physicians thought that more beds they fill the more dollars services, x-ray and cobalt, isotopes, would be ideal," said Cox. "But we had they can put in their pockets." dietary, convalescent and extended no assurance this was going to happen." How does he feel about the premier's care, respiratory, intensive, coronary They were right. The premier later thesis that physicians dropped the ball and diabetic units, among others. said: "We will have to meet the prob¬ in not showing support? "This cannot be done effectively and lem of providing more extended care "He was absolutely right," grumbles economically, in my opinion, by patchProwse. "The physicians who did sup¬ ing up one or the other of the existing facilities, but not until about 1980." PEI has one of the highest ratios of port it said nothing. The ones who hospitals. "Since it is inevitable that we must hospital beds to population in the coun¬ were on the fence didn't show any entry, and disproportionate use of these thusiasm. And the few who were build a new single facility in the near, beds for chronic care has heated up the against it, their wives were vocal. It foreseeable future, and since construc¬ was the cocktail circuit that beat us." tion is unlikely to become cheaper as system. ...
CMA JOURNAL/FEBRUARY 7, 1976/VOL. 114 271
the years go by, I now believe should get on with the job."
we
The agony of decision Pulling back from the hospital pro¬ ject was politically a difficult move. Government had embraced the hospital idea, had supported it; now it would, in a sense, have to eat crow. Michael Lane, special adviser to the premier, describes the pathway to the decision. "Executive council of the cabinet ap¬ proved construction of the hospital Sept. 12, 1974 at a total cost of $21.9 million there was little more heard about the project until April '75 when they approved financing in the amount of $25.9 million. "In the meantime," says Lane, "there were very few articulate, literate mem¬ bers of the community writing or speaking in favour of the hospital.. and the medical profession itself didn't seem to be particularly anxious to speak ...
.
out.
"When the time for decision did come, cabinet had to consider the pos¬ sibility that this might be a political albatross. "The profession wasn't supporting it, the federal government's attitude on medical care ceilings and its withdrawat from hospital services insurance after 5 years made the future somewhat un¬ certain, and the general financial situa¬ tion suggested that we direct our re¬ sources to a higher priority. Add to this the point that we really ought to be looking for more new and innovative ways of handling the whole health care system in this province. "Given those considerations, we de¬ cided we would withdraw our fi¬
One of the major principals in this process has been Ronald J. McQueen, executive vice president of Agnew Peckham, who has accompanied the hospital planners down their tortuous
path. During the summer, when there were hints in the air that all was not well, McQueen wrote a memo to Health Minister Catherine Callbeck and advisor Michael Lane, summarizing the hospital care situation in Charlottetown and charting the course of develop¬ ments to date.
In
effect, the
memo was an
indict¬
existing hospital system, as well as of the way government had assessed its priorities. As McQueen noted: "The existing hospitals cannot continue to serve, par¬ ticularly the Charlottetown hospital, for more than another 5 years without serious damage to the entire health care system in the island. The costs of building a new hospital in 5 to 10 years will obviously be double again the cur¬ ment of the
rent costs,.
"Current
government," McQueen
when applied to hospitals." What next? This is the big question for health planners and physicians in
PEI. The boards of trustees of both hos¬ pitals have been directed to go back to the drawing board and redevelop their options. Chairmen MacDonald and Hunt really don't know what new information might be added that hasn't already been searched out in the pre¬ vious studies and projections. "When I consider the number of studies we've already been through," says MacDonald, "I'm teed off." But since they have already been offered provincial money to hire even more consultants to come back with updated and precise projections, that is obviously the next step. Says project coordinator Prowse: "It's not a dead issue. I hope the profession will keep it alive. I hope other public organizations will bring it up at their meetings, and send resolutions on to the premier. "But clearly, a revival has to come by combined effort: the profession, the hospital administrators, the patients and the man in the street." It seems unlikely that the project will be revived in its original state. PEI, like other provinces across Canada, is in the midst of redefining the parameters and expectations of health care. There is a basic rethinking going on about how to devise a health, not a sickness, system, and to do it at a price the public can afford. Consequently the emphasis is away from institutional care. At present there are various studies running their course in PEI that should shed light on where the province has to go. The Health Care Systems Study group, looking at hospital and home care needs, is expected to report reason¬
pointedly continued, "may not have a concrete responsibility to provide for 5 to 10 years in the future, but surely it is a major consideration." McQueen's memo was dated Sept. 15. The premier's announcement was made Sept. 19. The effect the memo might have had on public and professional opinion had it been released before the decision was made is speculative. But once the press got hold of it the headlines were pre¬ dictable: "Safety hazard at Charlotte¬ town." McQueen pulled no punches in charting the deficiencies: "The Charlottetown hospital poses a nancing." major safety threat... from the point The fallout of view of fire hazard and inadequate Cancellation of the NGH is bound air handling systems and infection con¬ to have immense repercussions on the trol systems. ably soon. health system of PEI. "Every day the Charlottetown hospi¬ New means of treating mental illness Planning for new, expanded hospital total continues to operate poses a hazard are also being studied, the emphasis the patients' safety. These concerns being on taking patients out of institu¬ facilities in Charlottetown goes back 2 decades. Survey after survey has have been documented throughout by tions and putting them back into the been done, each recommending various the federal government and in accred¬ community. The relationship of hos¬ itation reports. options to the existing system. pitals to mental health care is still to "A major loss of life or injury would be determined. The original best buy Agnew Peckham & Associates, hos¬ pital consultants, have done a series of have ample supportive evidence to jus¬ proposal called for 40 psychiatric beds, but these were pruned out in the cost surveys; so have federal government tify a major lawsuit in the courts." Over and above the difficulties in¬ cutting. personnel, particularly G.B. Rosenfeld. It was DNH&W money that provided volved in maintaining the existing What these various studies and rePEI with a grant to study the "best plants "the hospitals would continue definitions hold in store for health plan¬ buy" concept. The intent was to evalu¬ to operate duplicate programs, each of ners in PEI is hard to guess. There is ate its applicability to Canada. them naturally fighting for new devel¬ still a state of shock pervading parts of Now that the best buy has been opment and equipment and neither of the medical community, following the them being able to fully justify the September bombshell. aborted, planners are wondering what next? Is it really back to square development of a new advanced feature But whatever the options, standing one? If so, then Prince Edward Island or service." still is not one of them. has been thrown back to an earlier As chairman Hunt of the PEI de¬ Says McQueen: "Competition in age, with a lot of catching up to do business is perhaps healthy. But it is clared: "We've just got to get revved and a lot less time to do it. a serious problem for cost and quality up again." ¦ .
.
.
272 CMA JOURNAL/FEBRUARY 7, 1976/VOL. 114
Searle Pharmaceuticals Oakville, Ontario
PEI's best buy hospital registers no sale By Milan Korcok There used to be something quasireligious about health care. Like Motherhood, God and Country, the quest for good health was inviolate to criticism. Whatever you had to spend, you spent. A politician with a hospital to his credit was walking tall. How times have changed! Can anyone imagine a political chieftain receiving public kudos for yanking the bulldozers off a hospital site, while at the same time admitting that the existing hospitals aren't what they should be? An unlikely scenario 10 years ago. But today... Premier Alex Campbell of Prince Edward Island is an astute politician. He knows where his support lies, and, in a jurisdiction as small as his, it's perfectly practicable to pick up the pulse of the community with just a few phone calls. Consequently, when he pulled the rug out from under his own hospital planners, who after 2 decades of health care briefs and studies saw their dreams about to take shape in a new building, he could be confident he wasn't rushing to any premature, political death. The 352-bed New General Hospital, which was intended to replace the 163bed Charlottetown and the 174-bed Prince Edward Island hospitals as well as the 28-bed Rehabilitation Centre, was an expensive proposition, at $29 million, for a province whose total population is just under 120 000. But as hospitals go, its aspirations were not extravagant. In fact it would cut back 15 beds from the existing inventory in town and usually, new hospitals add to the bed count. The NGH (only a provisional title; the permanent one would be selected by province-wide competition) was to be modelled after Britain's experimental "best buy" hospitals - a no-frills concept of building reputed to have re-
duced capital costs by 30 to 40%. (The two-storey, 122 x 122-rn structure uses ramps instead of elevators, and both floors are serviced by a type of ring corridor which allows quick, easy access to any part of the building. It uses the principle of greater flexibility to allow for future physical changes as the need arises, movable dividers, sharing of floor space between various units to avoid duplication, etc.) From a straight dollars-and-cents point of view the "best buy" hospital was a good deal for the money, comparing favourably with other options such as renovating and adding to the Charlottetown and the PEI hospitals, or building a new highrise on the existing PEL site. But the planning and building of hospitals, at a time when the health care system itself is in such a state of flux, has become an uncertain business, the vocation of masochists. The NGH failure was precipitated by a range of conflicts and fears that are not unique to PEI but are battering health care planners across the country: * Uncertainty about Ottawa's future commitment to health care funding. * The dismal economic outlook of the country generally. * The erosion of professional influence in local health planning. * The growing political orientation of health services. * The changing concepts of health care delivery itself, with a de-emphasis on institutional care and a rationalization of less costly "alternatives". * And, perhaps most important, the public's growing feeling that it might just not be able to afford everything it wants in the way of health care. The bombshell By the time Premier Campbell, Sept. 19, announced his government's with-
CMA JOURNAL/FEBRUARY 7, 1976/VOL. 114 269
pital, is not that charitable. "The gov¬ ernment's job is to govern, not to re¬ spond to a lot of crap in the media. This was the chance for government to do something of really epic propor¬ tions as far as this little province is concerned. They could have done some¬ thing that would have influenced health care here for generations. This was worth more than the government." The fact remains, however, that the hospital was poorly promoted among the public sector as well as among pro¬ fessionals. Few deny that. Information was being handed out piecemeal. Costs were projected at various times at $18 million, $21 mil¬ lion, then $25 million and finally $29 million. Actually, costs did not fluctuate wildly, but with the lack of any structured information program, they were subject to a lot of misinterpretation. Some es¬ timates referred to bare construction costs (only $18.4 million), others to construction plus site development and some equipment and furniture ($21.8 million). Still others referred tp building and furnishing budgets plus escalation costs public apathy. "It is remarkable that we have so and professional consulting fees ($25 little public debate about public ex¬ million) and still another included all aforementioned costs plus startup, postpenditures and financial policies." contract contingencies and financing Public priorities ($29 million). The is that time costs How is it, said the premier, that the were point there wasevery a different fig¬ quoted, public and the media would become ure to boggie the mind, and suspicions "almost hysterical" about a proposed that the planners didn't really $2 national park fee, a $3 derelict car grew know how much the hospital would tax (to dispose of ears when they be¬ cost. came junk), yet remain virtually mute To make matters worse, there was when it came to such large investments no organized public relations program as a share in the nuclear power plant to sell the facts about the hospital it¬ in New Brunswick, an underwater self, no attempt to point out the shortpower cable to the mainland and a comings of the existing plants or to new hospital costing about $29 million? show that the new hospital would signi¬ The bait worked. ficantly improve health care in the en¬ Letters to the editor questioning the tire province. value of the hospital started to appear. There was not even a sign at the Radio talk show hosts were asking emsite to explain why the bull¬ barrassing questions about the escalat¬ hospital dozers were tearing up earth and trees. ing costs of the new project. People Considering that the public was going were asking "who says we need this to be asked to dig into its pocket for hospital?" $4 million in direct pledges (over and If ever Campbell wanted a way out above the tax load necessary to finance of the hospital project and certainly the the failure to beat the building), it must have crossed his mind in the drums was a omission. glaring wake of Ottawa's restrictions on federal participation in health care funding Physicians ambivalent he didn't have to look far. At the same time, the attitude of One month after his Rotary speech, the axe fell. physicians toward the new hospital was In retrospect, many of the strongest ambivalent, at best. True, physicians at proponents of the hospital agreed that the existing hospitals had for years been the groundswell Campbell would have on record as supporting the principle liked in support of the building hadn't of a consolidated hospital. As far back materialized and that the premier's ac¬ as 1967, a brief presented to govern¬ ment by a joint committee of the tion was not politically reprehensible. Dr. Kenneth C. Grant, one of the boards of trustees and the medical staffs most avid supporters of the new hos¬ pressed for a "single hospital in the drawal of financial support from the project, the bulldozers had al¬ ready moved to the hospital site, a magnificent stand of white birch had been ripped out and the red earth lay exposed to the autumn skies. The decision was a bombshell. The key hospital proponents, Dr. Lemuel E. Prowse, chairman of the Hospital Services Commission and pro¬ ject coordinator of NGH, Frank MacDonald, interim chairman of NGH (also chairman of the Charlottetown hospital), and William S. Hunt, chair¬ man of the PEI hospital, are still in a state of shock. To them it didn't seem possible that government would reverse itself this far down the road, especially after a lastminute cabinet review in July gave them the final green light. But Premier Campbell did not act in a vacuum. His political instincts had been aroused. Something was wrong. Where was the discussion, debate and criticism that would usually have ac¬ companied so massive a venture? In a speech to the Charlottetown Rotary in August, Campbell decried
NGH
.
270 CMA JOURNAL/FEBRUARY 7, 1976/VOL. 114
city that
would provide for better health care to the island community". The brief said, "The two-hospital sys¬ tem in this community had its origin in religious differences and bigotry. The prize of the future, leaving behind a tradition which has become stagnant, can only be realized with the help of good neighbourliness and clear think¬
ing."
The report urged the community "not to perpetuate the present system with two mediocre hospitals and only adequate care." Another equally strong report was issued in 1972. But there appeared to be a difference between supporting the principle of a unified hospital and facing the reality of building it. To many physicians there was some¬ thing disconcerting about tearing down two separate medical hierarchies and constructing one in their place espe¬ cially when the new hospital would result in 15 fewer beds than already existed. Physicians who now practise across the street (the Charlottetown clinic and hospital are neighbours), or who could walk to the hospital from their homes, would have to drive a couple of miles out of town. A rearrangement of pecking orders and new personal and pro¬ fessional relationships sometimes cause hard feelings, and in a community the size of Charlottetown hard feelings were pretty hard to disregard. It was also troubling to hear per¬ sistent rumours that physicians would be asked to contribute several thousand dollars of their own money to get the hospital built. Cocktail parties served as fertile medium for passing on gossip as to how much would be expected from each physician. The range ran from $6000 to $25 000. The pros and cons Dr. Lewis Newman, a young family physician on the PEI hospital staff, has been most articulate in opposing the spending of $29 million on the new
hospital. Newman's opposition is not directed at the principle of a single hospital so much as it is against the "bulldozing" tactics of project coordinator Prowse and his "entourage of hospital plan¬ ners". "I might still change my mind if someone came to me and tried to dis¬ cuss plans with me like a human being
and did not treat me like a child," declares Newman. "The hospital boards have never tried to show us, with cold, hard facts, why this new hospital is better over a 25-year period. I just have not re¬ ceived the information to convince me
that it would be cheaper to build a hospital than to repair the existing
new ones.
"We physicians were brought into the picture after the architects had drawn up their plans. That's pretty far down the road; that's rubber stamping, and I am surprised, shocked and amazed that the rest of the medical population has not felt insulted." Physicians have always been reluctant to get into politics, says Newman. But the rules have changed. "If we don't decide on important matters, someone will decide for us. This is
living proof." Dr. Lloyd Cox, surgeon and pres¬ ident of the medical society, originally also opposed the idea of the new hos¬ pital. He has changed his mind. "I will admit that at first I wasn't for the idea of the NGH, but I gradu¬ ally came around. I was opposed for selfish reasons. We had built a new wing, a lot of us were feeling we had a nice hospital. But one by one, we With population of less than 20 000, Charlottetown nevertheless must serve an island succumbed. in existing acute care facilities, few of its population we all came to "Eventually support community. Despite inadequacies cancellation of the NGH. protested it, but we had a lot of misgivings. We worried about the reduction of hospital "We're moving our patients, parti¬ Ironically, just as the premier was beds, about the lack of backup facil¬ his axe, the lack of support faster than ever," ones, surgical sharpening cularly ities; we worried about statements by the premier that there would be no ad¬ says Cox. But in spite of that turnover to which he made so many references ditional backup chronic care facilities there is still a 3-month waiting list for was changing. Dr. Thomas A. Laidlaw, chief of until at least 1980. We already have most elective surgery. "There comes a extended medical where without sufficient staff at the PEI, swung con¬ point no backup facilities, and we just can't siderable care facilities you can't even get your support to the NGH when, moved now. get people in a to the editor, he expressed acute Dr. Cox. letter in," patient says "There was that fear." "And we are now down to a tight displeasure with the government's ac¬ tions. situation." Chronic and acute beds Dr. Lem Prowse, a former navy man Unfortunately, his comments weren't The province's indecision about the who sports an impressive Colonel published until a week after the premier future of chronic and extended care Whitehead beard (and does, incident¬ announced the government's withdraw¬ facilities has been a critical factor in ally, drink gin and tonic) delights in al of financial support. the selling of NGH to the profession. "I am quite sure that until a week "telling it like it is." And some physi¬ It is estimated that between 80 and cians don't like the way he tells it. or two ago, I would have been one of 100 beds in the existing hospitals are The Prowse reputation is not built on those in agreement with cancellation taken up by patients requiring not diplomacy. on second thought, however, I now acute but chronic care. That is almost "We're piling all our money into the feel much less sure that the right de¬ 30% of the total hospital population. wrong spot," says Prowse. "Our em¬ cision has been made. Board chairmen MacDonald and phasis has been on illness care and this "If hospital services are to be pro¬ Hunt say that construction of the NGH is goddamned nonsense. We wanted to vided to the people of this area of a would have allowed them to retain one get our acute care beds down from 6.9 quality comparable to those in pro¬ segment of the PEI hospital for chronic per thousand. We're right on top in this gressive communities elsewhere in Can¬ care, and another segment could have respect so far as Canada is concerned. ada, making use of modern concepts been alloted to the Alcohol Addic¬ We'd like to get it down to 4.5. and technologies, we must not only tion Foundation. That would have freed "But doctors would use any given provide a given number of beds, but all 352 beds at the NGH for acute number of beds. If you gave them adequate backup facilities outpatient care. 3000 they'd fill them up, because the and day-care facilities, operating room "A lot of physicians thought that more beds they fill the more dollars services, x-ray and cobalt, isotopes, would be ideal," said Cox. "But we had they can put in their pockets." dietary, convalescent and extended no assurance this was going to happen." How does he feel about the premier's care, respiratory, intensive, coronary They were right. The premier later thesis that physicians dropped the ball and diabetic units, among others. said: "We will have to meet the prob¬ in not showing support? "This cannot be done effectively and lem of providing more extended care "He was absolutely right," grumbles economically, in my opinion, by patchProwse. "The physicians who did sup¬ ing up one or the other of the existing facilities, but not until about 1980." PEI has one of the highest ratios of port it said nothing. The ones who hospitals. "Since it is inevitable that we must hospital beds to population in the coun¬ were on the fence didn't show any entry, and disproportionate use of these thusiasm. And the few who were build a new single facility in the near, beds for chronic care has heated up the against it, their wives were vocal. It foreseeable future, and since construc¬ was the cocktail circuit that beat us." tion is unlikely to become cheaper as system. ...
CMA JOURNAL/FEBRUARY 7, 1976/VOL. 114 271
the years go by, I now believe should get on with the job."
we
The agony of decision Pulling back from the hospital pro¬ ject was politically a difficult move. Government had embraced the hospital idea, had supported it; now it would, in a sense, have to eat crow. Michael Lane, special adviser to the premier, describes the pathway to the decision. "Executive council of the cabinet ap¬ proved construction of the hospital Sept. 12, 1974 at a total cost of $21.9 million there was little more heard about the project until April '75 when they approved financing in the amount of $25.9 million. "In the meantime," says Lane, "there were very few articulate, literate mem¬ bers of the community writing or speaking in favour of the hospital.. and the medical profession itself didn't seem to be particularly anxious to speak ...
.
out.
"When the time for decision did come, cabinet had to consider the pos¬ sibility that this might be a political albatross. "The profession wasn't supporting it, the federal government's attitude on medical care ceilings and its withdrawat from hospital services insurance after 5 years made the future somewhat un¬ certain, and the general financial situa¬ tion suggested that we direct our re¬ sources to a higher priority. Add to this the point that we really ought to be looking for more new and innovative ways of handling the whole health care system in this province. "Given those considerations, we de¬ cided we would withdraw our fi¬
One of the major principals in this process has been Ronald J. McQueen, executive vice president of Agnew Peckham, who has accompanied the hospital planners down their tortuous
path. During the summer, when there were hints in the air that all was not well, McQueen wrote a memo to Health Minister Catherine Callbeck and advisor Michael Lane, summarizing the hospital care situation in Charlottetown and charting the course of develop¬ ments to date.
In
effect, the
memo was an
indict¬
existing hospital system, as well as of the way government had assessed its priorities. As McQueen noted: "The existing hospitals cannot continue to serve, par¬ ticularly the Charlottetown hospital, for more than another 5 years without serious damage to the entire health care system in the island. The costs of building a new hospital in 5 to 10 years will obviously be double again the cur¬ ment of the
rent costs,.
"Current
government," McQueen
when applied to hospitals." What next? This is the big question for health planners and physicians in
PEI. The boards of trustees of both hos¬ pitals have been directed to go back to the drawing board and redevelop their options. Chairmen MacDonald and Hunt really don't know what new information might be added that hasn't already been searched out in the pre¬ vious studies and projections. "When I consider the number of studies we've already been through," says MacDonald, "I'm teed off." But since they have already been offered provincial money to hire even more consultants to come back with updated and precise projections, that is obviously the next step. Says project coordinator Prowse: "It's not a dead issue. I hope the profession will keep it alive. I hope other public organizations will bring it up at their meetings, and send resolutions on to the premier. "But clearly, a revival has to come by combined effort: the profession, the hospital administrators, the patients and the man in the street." It seems unlikely that the project will be revived in its original state. PEI, like other provinces across Canada, is in the midst of redefining the parameters and expectations of health care. There is a basic rethinking going on about how to devise a health, not a sickness, system, and to do it at a price the public can afford. Consequently the emphasis is away from institutional care. At present there are various studies running their course in PEI that should shed light on where the province has to go. The Health Care Systems Study group, looking at hospital and home care needs, is expected to report reason¬
pointedly continued, "may not have a concrete responsibility to provide for 5 to 10 years in the future, but surely it is a major consideration." McQueen's memo was dated Sept. 15. The premier's announcement was made Sept. 19. The effect the memo might have had on public and professional opinion had it been released before the decision was made is speculative. But once the press got hold of it the headlines were pre¬ dictable: "Safety hazard at Charlotte¬ town." McQueen pulled no punches in charting the deficiencies: "The Charlottetown hospital poses a nancing." major safety threat... from the point The fallout of view of fire hazard and inadequate Cancellation of the NGH is bound air handling systems and infection con¬ to have immense repercussions on the trol systems. ably soon. health system of PEI. "Every day the Charlottetown hospi¬ New means of treating mental illness Planning for new, expanded hospital total continues to operate poses a hazard are also being studied, the emphasis the patients' safety. These concerns being on taking patients out of institu¬ facilities in Charlottetown goes back 2 decades. Survey after survey has have been documented throughout by tions and putting them back into the been done, each recommending various the federal government and in accred¬ community. The relationship of hos¬ itation reports. options to the existing system. pitals to mental health care is still to "A major loss of life or injury would be determined. The original best buy Agnew Peckham & Associates, hos¬ pital consultants, have done a series of have ample supportive evidence to jus¬ proposal called for 40 psychiatric beds, but these were pruned out in the cost surveys; so have federal government tify a major lawsuit in the courts." Over and above the difficulties in¬ cutting. personnel, particularly G.B. Rosenfeld. It was DNH&W money that provided volved in maintaining the existing What these various studies and rePEI with a grant to study the "best plants "the hospitals would continue definitions hold in store for health plan¬ buy" concept. The intent was to evalu¬ to operate duplicate programs, each of ners in PEI is hard to guess. There is ate its applicability to Canada. them naturally fighting for new devel¬ still a state of shock pervading parts of Now that the best buy has been opment and equipment and neither of the medical community, following the them being able to fully justify the September bombshell. aborted, planners are wondering what next? Is it really back to square development of a new advanced feature But whatever the options, standing one? If so, then Prince Edward Island or service." still is not one of them. has been thrown back to an earlier As chairman Hunt of the PEI de¬ Says McQueen: "Competition in age, with a lot of catching up to do business is perhaps healthy. But it is clared: "We've just got to get revved and a lot less time to do it. a serious problem for cost and quality up again." ¦ .
.
.
272 CMA JOURNAL/FEBRUARY 7, 1976/VOL. 114
