A response to @WindsorCAMPP #YQG #megahospital

Phillippa from CAMPP posted some comment yesterday in response to my post and I tried to post this in the comments of my last post “What’s Wrong with these Graphs” but it wouldn’t work (to long). So I gave it its own post. I apologize for poor writing as I wanted to get this posted to continue the discussion.

Thanks for the comment to respond to some of your comments.

I don’t have an issue with additional consultation but my question to you is would be how much consultation is “far more”? What is the threshold for your approval? As you have said in a number of posts/comments elsewhere there will also be those who are unhappy with a site. In my opinion, there is a fine line between informed questioning and obstinate resistance regardless of facts. To my knowledge I have not seen a post that states if the Hospital Committee provides X, Y, Z that CAMPP will be satisfied or if they consult 3, 5 or 7 more time that will be enough. As I said in my post, I would have liked to have seen the hospital in the city core, but my opinion has changed based on information that I have seen and heard. Under what scenario would you accept the hospital at the location that it is currently proposed?

It comes from that lack of articulation of an “end game” that the perception of “anti-county bias” and rabble rousing emerges in my opinion. The majority of your posts and commentary are about Windsor, there is nothing wrong with that given your position, but given what is being established is a regional hospital system your failure to include county perspective is a fundamental flaw. You say that: “the best location for our new acute healthcare facility is one that balances aggregate city and county needs, access being the most important.” That’s great but your data hasn’t proven that this location is bad or another location is better because you haven’t fully included the county in your analysis. By not including parts of the county for whatever reason, you create the impression that they are not important to your view or that you are selectively not including information because it does not support your hypothesis. That plants seeds of doubt in the minds of those undecided on this issue. It gives the impression that you are just another one of these groups who are looking to rouse rabble over a non-issue – as per that letter in the Windsor Star and give the Hospital Committee an excuse to not directly to respond or disregard your commentary.

Taxi Cabs

I am not disputing the numbers that you presented, I completely expect that for some residents the cost to take a cab to the new hospital will go up and my numbers came within a relatively close margin of error to those that you posted. My issue is using Taxi cabs costs as justification of decision making when the facility is still 10 years away without quantifying it. CAMPP has offered 3 other “potential core sites” on their website what are the taxi costs to those sites in the city from the centre of the wards and county? Where is your threshold for acceptance of costs for low income individuals? An additional $10, $20, $30? If it costs $40 for someone in Ward 2 to get the Ford Test track site, is that too much for them to ask? Where is your line?

What I do completely dispute is your County claim. Lack of transportation is a massive barrier in the County and due the failure to establish some form of regional transit for many a cab is the only way into the City. There is a reason that St Clair College is running its own special shuttle bus to the Leamington and Lakeshore to provide students with transportation options or that Sutherland Global Services is looking to launch a “Job Bus” so it can hire people from the county and bring them into the City. South Essex Community Council, Life After 50 and ACCESS Community Services provide a senior shuttle to Windsor for $25 from Leamington and Kingsville from their own program expenses so County Seniors can access the city for socializing, shopping and other services. I have seen and heard the impacts of lack of transport options in the County as people with low income and no car can’t find work, have trouble accessing nutritional food or getting health care. As far as I am concerned any evaluation of Windsor-Essex County that doesn’t include the entire region is fundamentally flawed. For you to disregard a point of view without offering evidence does undermine your position in my opinion.

Aggregate Distance Traveled

I completely disagree that it is an under representation. The number of Emergency Department visits (from the entire region and beyond) being 128,000 per year do not justify your calculation of total people in each ward multiplied by distance traveled in a round trip than subtracting the nearest hospital from the mega hospital site. That isn’t a statistically controlled method as it doesn’t re-weight any jurisdiction all you have done is divide the population into their respective wards, multiply and add. A way it could be done is taking those 128,000 dividing that number by the population percentages of each jurisdiction and then using those numbers as the basis to calculate for the distance traveled.

I did select only discharges because the admission (and subsequent discharge) count many of the items that you list in your rebuttal. You must be admitted for almost any surgery, critical emergency cases or severe broken bones i.e. things that require acute care. Many of the minor fractures a broken arm or ankle; or going for an blood work, diagnostic tests or other basis treatments that don’t require admission could very well be provided by a visit that the downtown Urgent Care centre depending on its exact size or scope. Yes the regional cancer centre will be at the new acute care centre but I would point out that there is currently only one cancer centre in the city. If we are measuring the distance to cancer treatment you should recalculate all of ward distance calculations to the Metropolitan campus location rather than the nearest hospital. Also for cancer patents, there is a $100 dollar volunteer shuttle service that will pick you up at home, bring you to your treatment and then drive you back home for your entire cycle of treatment. The main issue is that because you are not specific enough about what service we are measuring you seemingly are listing statistics and services that people MAY need to access at some point in time at that site without taking into account other factors. As a result it does not justify the statistics that your graph presents.

Frankly I think the best statistic that comes from the Windsor Regional Hospital stats is the length of stay after Acute Treatment/Surgery – 5.9 days.

Distance from City Hall

First if you had population density information that is properly cited and presented than it doesn’t matter if it appears biased it is potentially powerful piece of information, assuming your methods are sound.

From a planning standpoint I understand why you did it, City Hall is a “central point” in most cities but not in Windsor. As our local politicians and WEEDC like to say Windsor has a unique geography, and if you are going to use planning principles to justify your measure than you should be taking that geography into account. Either compare us to other border/water side community so you are comparing apples to apples or use another measure.

Yes some of the 4,000 jobs will move out to the airport site but again there will still be 3 other sites that will be staffed by hospital staff in the city. The Tayfour campus footprint will be expanded for the dialysis unit (with new hiring) and the Urgent Care Centre and Mental Health facility on Ouellete will keep a presence (in fact an enhanced presence in the downtown. Beyond that the Land swap (Grace for Met.) will likely see commercial/residential infill on Tecumseh road in South Walkerville. Overall to estimate the impact of those changes are impossible at this stage in the game, we are 10+ years out from all of the facilities being open, probably another 5 before all of the ripple effects move through the region, if you can predict what the region will look like afterwards, I think you should by a lottery ticket.

EMS

It cost $45 to be moved by land ambulance for medically necessary services for an Ontario resident with OHIP, with low income individual being able to have that fee waived. Sickeningly in some cases it may actually be cheaper to wait and get sick to the point that an ambulance is needed rather than take preventative steps of going to the hospital (assuming they had to take a cab). Whether people actually do this I can’t and won’t assume but to make the claim that for profit Taxi cab cost bare any relation to the cost of a publicly funded service that saves lives is not a valid claim in my opinion.

If you want to figure out what ambulance services cost you can, but you will need to do some leg work to do it. Most of the data is freely available it is just a question of tracking it down. If you aren’t willing to, than don’t make associations that you do not have facts for.

Conclusion
This biggest issue in my opinion with everything that has been discussed here and beyond is that your use of data has been flawed, lacking proper clarity and vague assumptions. Even here your arguments have been contrary: you state that the Cab Costs calculation is justified by the fact that low income individuals may not have cars to drive to the new hospital. Then in the next section you calculating the mileage assumes that every person in the city will drive to new hospital site. These flaws undermine your overall argument and position.

The problem is, that the hospital issue will not be settled on Facebook with a graph and two paragraphs, it will be settled in a formalized manner. The hospital committee has sent its plan and recommendation to the province for approval. Now yes as private citizens we don’t have all of the information that the committee had access too, unfortunately they aren’t under any obligation to share it. We will never get patent data as medical records are some of the most tightly controlled data in Canada. But there is a wide range of freely available data from Statistics Canada, Health Agencies and Research organizations to engage on vital issues and force responses.

If CAMPP wants to truly change minds it needs to formalize its process. What is needed is an alternative plan. Social media is a tool to rally action but not a tool to carry out change in the face of institutional barriers. What this means is some sort of plan that outlines CAMPP alternative to the Mega-hospital site. What site do you suggest as an alternative? How does it stack up to the Mega-hospital site? What about to potential obstacles (NYBISM, helicopter landing needed, infrastructure improvements required) does the alternative location need to overcome? Can you estimate possible socio-economic spinoff benefits from your choice of alternative locations? In other words can you take the majority of arguments that can be made about the existing plan and in a single cogent document and provide a viable alternative there might be something to stand on.

I unfortunately can’t and won’t speak to my employers’ position or their willingness to share data on my personal blog. You are more than welcome to submit a request and I am sure a discussion can be had.

7 thoughts on “A response to @WindsorCAMPP #YQG #megahospital

  1. CAMPP originally organized itself around concerns about the “process” though our overarching goal was always to argue for our new hospital on brownfield land, within Windsor’s urban core. Some assumed incorrectly that we meant downtown, but we did in fact take care to define what we meant. You can see it best in the map on our site at the bottom of the page on http://windsormegahospital.weebly.com/site-considerations.html. It shows quite a bit of leeway in our stance, with both a first and a second choice for the preferred location. I think I can also publicly admit that some of us felt we could probably compromise on a greenfield site within the urban core. We very specifically are not promoting any one site. We haven’t been provided with insight into RFPs submitted and have been waiting for this information via an extremely slow FOI request.

    We consciously didn’t want to get bogged down with endless arguments about the limitations of the consultation process. This can get ugly really fast, and detract from the outcome. I think you, as somebody who conducts consultations as part of your work, should have a first-rate understanding of what was missing in transparency and completeness, but at this stage in the process, CAMPP is not calling for a start-over. Right now, it would be appropriate for the LHIN, as the public’s conduit to the MOHLTC, to conduct consultations on the proposed site, and to use the input received to answer the public’s questions.

    Some assumed we are engaging in an “us vs. them” debate. Not so! Shane Mitchell has often stated publicly that he is from the county himself, and is a strong proponent of balancing accessibility with maintaining the very qualities that residents are looking for in choosing to live in a less urban environment. We are consistently critical of the damaging effects of unchecked urban sprawl. This has been within our guiding philosophy all along. I can’t comment on the WS letter you refer to because I don’t know which one you mean. We strongly believe a healthy city is essential for a healthy region. Our position is echoed by many who themselves live in the county. Point taken for a need to articulate this more – we’d be happy to.

    I do want to add that my disappointment is that WRH simply keeps repeating the same mantra that the hospital needs to “serve both the city and the county” without presenting any data whatsoever that shows how this particular site improves regional acute healthcare delivery over what we have currently. It’s hard to imagine that it does since our calculations consistently show the proposed hospital is some 20% less accessible than what we have currently. Surely we should be holding the site selectors accountable, rather than allowing them to get away with unsubstantiated comments of “lacks integrity and credibility”? Frankly, I find this offensive, especially in conjunction with other public comments designed to quash open discussion and examination of the facts.

    Our concerns are organized under 4 broad themes, so to answer your question regarding what would make us change our view, these issues would have to be reasonably satisfied. They are not listed in order of importance, but because the Windsor Hospitals Study organized its questions under delivery of acute healthcare first, followed by cost-effectiveness and lastly other considerations, let’s briefly examine them in the same order:

    Access: I’m pretty certain it’s physically impossible to merge our 2 hospitals into 1 without increasing the overall distance. However the amount of that increase must be minimized. Crucially, delivery of acute healthcare should never be allowed to come at the expense of large numbers of low income residents as the current proposal shows. I am well aware of the other proposed elements of the plan including the UCC on the Grace site, but they will NEVER be a substitute for healthcare offered only at the mega hospital. (Many people don’t fully understand what this entails and it speaks to a need for further discussion on the topic)

    Cost: The cost to the community of additional construction, travel and municipal services must be comprehensively analyzed. This is over and above the 10% local construction component, but we have yet to see how much we should expect to pay and how the region intends to apportion these costs. How is the community going to pay for it, and what existing priorities will be given up? What incremental costs are attributable to this site vs. other shortlisted options?

    Urban vitality: Windsor has established goals for reducing the underutilized brownfield land blighting our landscape. We know we have stagnant population growth – you’ve blogged about it yourself. We’re exactly where we were in 1970. Long term projections no longer offer expectations of growth. In surrounding municipalities, while there is construction going on, population growth lags the national average – we are hollowing out our developed areas. We have a large baby boomer group starting to reach the age of greater medical need and young people increasingly deciding to move to cities with a more engaging urban feel. Moving an anchor institution to the outskirts of the city can only be a response to the hollowing, not a solution to the problem. We have an urban structure plan that identifies the area around the airport for aviation activities. It is nothing short of reckless to use it for acute health care without careful (public) consideration of existing urban planning goals and how this will impact other elements of our priorities.

    Environment: We know our carbon footprint needs to be reigned in. It is foolish to develop a plan that totally ignores all consideration of this in its site selection criteria. A destination that results in more aggregate road miles, reduces the inventory of farm land, adds acres of surface parking and doesn’t reduce the inventory of brownfield land will never reduce our carbon footprint. I am well aware that the land in question is designated for future industrial use. That doesn’t mean we have to develop it now, as long as other options exist and our population isn’t expanding at a rate that necessitates outward development.

    I know the above is lengthy, but I believe it’s essential for a better understanding of this subject. It hopefully also clarifies questions that other readers may have. Let’s move on to more specific comments on your post:

    Taxi Cabs & Distance
    At least some of our differences on this subject are fewer than one might think. I’m so glad you mentioned the need for regional transit, though I want to make it clear that the proposed site does nothing to address any pre-existing needs – current suggestions that buses will be laid on are too vague. So few have spoken about it so far, least of all WRH, who specifically declined to look at anything other than the direct provision of healthcare. A more constructive approach would have been to incorporate transit planning in partnership with the municipalities, who have more expertise on the needs and resources.

    An urban site can be just the catalyst we’ve been waiting for to get a regional transit system off the ground, especially in view of the provincial funding for improving transit (as opposed to roads: Councillor Bortolin is just one of many who believes our chances of landing this funding are much greater if we focus on transit rather than roads).

    If it is true that county residents take cabs to the hospital in sufficiently significant numbers to be comparative to city residents, I’m all for looking at the data. What statistics show how people arrive at the hospital and from which wards/towns? In the absence of such data, I will maintain that it’s in Windsor that we have the much greater number of residents without cars who frequently use cabs to get to hospital today. It was in talking with several people in Ford City and the west end that I realized there is a need to quantify how the location will impact residents, especially those on ODSP. But I’m also aware that other neighbourhoods are similarly home to people who don’t drive. Did WRH or the LHIN examine access for mobility challenged low income residents? That this might be 10 years out makes it no less problematic.

    However that analysis came after the “aggregate km” analysis, which is the starting point. I totally disagree that 128k should be the focus of the calculation. The 28k discharges you refer to are inpatients. They exclude ambulatory care visits which are not counted as inpatients and are far in excess of 28k. Also, many of the ER visits will be reduced by the UCC. While it is true that the UCC will be able to deal with many of the medical issues you list, the announcement mentions only that there will be ER staff stationed there – not specialists. It is a fact that emergency physicians refer much larger volumes than they used to, even in the past 10 years. There is no reason to believe on call specialists will be servicing both sites, mainly because of the distance involved. Many UCC patients will be temporarily patched or stitched up, and given a follow-up appointment at a clinic at the hospital at a future date. That’s exactly how it works today, only the distances are shorter. As it is, on-call surgeons are busy to the point of complete burn-out, with several hospital trips A DAY beyond their normal work week. Why have we not heard from surgeons airing their concerns about the practicality of how both sites will be served?

    So perhaps there is a way to find common ground here. Let’s aim to find out the actual number of hospital visits – I’m hoping WRH can oblige because I know that they know this number within a reasonable margin of error. Even better would be statistics breaking down hospital visits by postal code – we could do a lot with that! Your suggested alternative mileage calculation is still going to come up with the same overall conclusion that Windsor residents will travel on average 107% further, county residents 16% less, and overall 20% more. But for the sake of common ground, I have added 2 new images to the graphs. You can see them on http://windsormegahospital.weebly.com/distance-by-ward–municipality.html. I have added a weighted average km calculation and a bar chart that depicts it. To avoid confusion with the original chart, I kept the default yellow.

    On the subject of Cancer Care – we must point out that the Windsor Hospitals Study suggested keeping it at Met Hospital. It was a recent and very costly $50 million addition. It would be a shame to tear it down but apparently it is justified.

    City Hall
    Our geography isn’t as unique as some believe. Other similarly lopsided cities are: Burlington, Gatineau, Halifax, Longueuil, Quebec City, Saskatoon and Surrey. Their average distance from city hall to hospital is 3km.

    As for jobs moving out of the core vs. those staying behind, let’s be a little more realistic. The vast majority of nurses, physicians and medical office workers who live in the core will not be employed in the core. Medical offices for surgeons are almost all clustered around the hospital for quick access and they will definitely migrate over time. This will definitely have longer term urban vitality ramifications and it is naïve to minimize them.

    I have seen the argument floated that the UCC will lead to new medical business development in the area. There is little to suggest that anything meaningful will materialize from this assertion, just like we didn’t see the development of hotels around the WFCU. Of course we’re looking 10 years out, but I have watched too many erroneous assumptions being pushed over on us to justify construction projects (WFCU, Canderel Building, Aquatic Centre). This one is on a bigger $$$ scale and will have greater implications. Greater skepticism is definitely warranted.

    EMS
    It’s not for me to calculate what EMS will cost our system – whether it will be paid for by individual users or the public purse. The $45 you mention is paid by the patient, but we need to know the actual cost. An impact analysis needs to be performed by those who have the numbers, not the public. I have not ever pretended to know how much it costs, but it’s a perfectly reasonable assumption that if the new hospital is further away in aggregate than current facilities, more miles will be driven and that this can increase the total cost.

    Conclusion
    The aggregate mileage chart doesn’t negate the taxi chart. They still represent road miles. The latter has implications for those who use cabs to get around, the former affects everybody to pays taxes, is concerned about the environment and who gets around.

    I disagree that CAMPP needs to suggest an alternative site. Personally I would be very interested in knowing why the GM site was rejected early on in the process, and I’m constantly surprised how many members of the public mention this too. I always thought this particular site could transform Windsor’s urban fabric in ways that go beyond acute healthcare.

    You are correct that there is little obligation to share all the facts, but at the same time we have a right to transparency and analysis. We are paying for our new hospital as a community and there is no reason for a group without urban planning credentials to load a decision on us without supporting data showing that it does in fact improve the delivery of acute healthcare in a cost-effective manner.

    • I could go back and forth with you on these issues but it isn’t going to really get us anywhere in my opinion. I am familiar CAMPP’s position, I have read your website and I am not opposed to those positions personally but I have just as many questions about your positions as I do about the proposed Hospital site. From the beginning my issues come from the data that you are presenting and how it is being presenting. I think it would be great if they had picked one of the site that you outline but those sites also have drawbacks. You claim that they are less than the proposed site but there is no way to evaluate that claim as you have offered no evidence to support it. I assume that your response will be that the hospital committee should share that information, but the fact of the matter is they are under no obligation to do so and unless you provide a compelling and coherent argument as to why another site should be selected, why should anyone believe you? Because you said so, what expertise do you bring to the table to make your voice/opinions more valid than the Hospital committee? What measure of analysis or methods have you used beyond adding up km from google maps? Thus far I haven’t see it and that is why the hospital committee can and will continue to ignore you. Yes they will see your posts, but they don’t feel the need to respond because as you have pointed out on your Facebook page, they don’t take you serious..

      What you don’t know is that since I posted my original post I received several emails/messages from people thanking me for my analysis of your positions, so the entire community isn’t united behind you, there is a portion that thinks the hospital location is fine. General demographic trends have moved people out of Windsor to the rest of the county. I am willing to bet that the majority of hospital employees live in South Windsor or the surrounding communities (LaSalle or Tecumseh). The new hospital site actually makes it more convenient for them to get to work. I base this on general demographic trends for out community. You say that more consultation is needed, they had 700 people participated but we have no idea how many people had the opportunity to be involved and choose not to. For every person that is agree about it, how many ignored the issue?

      The fact of the matter is even if you were to get your own way and have the Ministry or Committee reconsider building at a brown/greenfield site in the city this comes with its own unique challenges and costs. Yes you might have few aggregate km to travel to get to the hospital but you also would face opposition. Would South Walkerville residents like a new hospital built across the road from them with an air ambulance helipad? What about the fact that Seminole, Central and Millory roads would need to be widened, potentially leading to trees being cut down (not to mention the loss of a giant green space) to accommodate new traffic patterns near the Ford Test track to connect those residential streets to true arterial roads? The Zehev site would require the acquisition of land from a profitable private business and cleanup of toxic waste off of the site before any construction could be considered. All of those items come at a cost and do not guarantee that in a year or two from now YOU aren’t the one writing against a person from some other group saying it should be back out by the airport.

      You are well within your right to disagree with my critic, just as I am within my rights to disagree with your analysis or the outcomes that you conclude from your data. Based on what you have presented you have not convinced me that the Hospital near the airport is a disaster that you make it out to be and your refusal to even consider evaluating your own alternative options makes you appear to be little more than a group of naysayers. The committee rejected other sites, and you are not going to convince them that their selection is wrong on facebook, you need to prove to them, city council, and the citizens of Windsor in general that another site is better.

      • Mr. Fathers how can you be so complacent with the continued scar that suburban sprawl has on our city? How can we be OK with the status-quo? This city is in peril. Our urban centre is littered with blight and poverty and we continue to fail to keep residents or attract new ones. Our city has grown in size substantially for the past 40 years with little increase in population. City administration admits this model of growth is both economically and environmentally unsustainable.

        The decision to locate the hospital on the proposed site will only exasperate this problem and I’ve yet to see any explanation why an urban location would not work. Urban planners know that more and more people these day want to live in vibrant urban centres, not low density suburbs. HOW does this decision help us build a city that will be attractive to potential residents or future generations? If we sit complacently while our city turns to a wasteland of blight and stripmalls we are failing our community. If we sit and watch as decisions are made that have a blatant disregard for the preservation of prime farmland, we are being environmentally irresponsible. Mr. Fathers you may argue for this location and for the convenience of motorists but you don’t have a good handle on the urban planning issues at hand here. This city is in crisis and we need to completely change our philosophy or we will forever be a struggling city.

      • I guess I do not take as stark or alarmist of a view as you do. You and I both can’t predict the future (if you can, do you mind passing on the lottomax numbers for Friday) and the development of the hospital system will be a decade long process, in that time a lot of things can happen. For example 2 municipal elections will occur between now and when the hospital is scheduled to open. As a result we could see a complete change over in council, completely different dynamics and politics in the city (for better or worse). You want to know what real threat to Windsor’s urban structure is, the Ford Engine Plant potentially closing next year as it has no product to make after Dec 31, 2016, that is a far more pressing concern for our community IMO than where a hospital will sit in 8 years. This hospital is in my opinion the impetuous for action on a number of issue in our region as it will force regional cooperation. One of the biggest causes of poverty in our region is a lack of transportation and in speaking to several councilors on this issue, if the hospital eventually goes to the lands by the airport, a REGIONAL transit system will follow.

        You are right I am not an urban planner, I’m a political economist, so I don’t know the some of the nuances of urban planning. But I see Windsor as one element in a larger whole for our region in my opinion, the greatest hardship that befell this community was the forced amalgamations of the 1990s that left Windsor isolated and surrounded. The broader issues of urban decay, flight, blight and poverty have long been present in our community this hospital would not be the magical solution to all those problems even if it was put into the City Centre. IMO it is no business of mine if a private farmer wishes to sell his land to allow a hospital to be built, or developer to build homes or oil driller to drill for oil he is well within his rights to do so. There are rules and regulations that must be followed and if they are followed than the market acts.

  2. I can’t resist adding another comment. The new chart on http://windsormegahospital.weebly.com/distance-by-ward–municipality.html that shows the relative distance impact to each municipality and ward is bound to be confusing.

    I understand your concern with the original version that essentially assumes an average of 1 trip to hospital per resident. However basing it on 128k ER visits is completely inaccurate. We need data on the annual number of hospital trips (i.e. inpatients stays + ER visits + ambulatory care + family visits to inpatients + staff + volunteers). This can be determined fairly accurately by WRH and I imagine they know it already.

  3. Frazier Fathers, you say you are not opposed “personally” to CAMPP’s position and that “I have just as many questions about your (ie: CAMMP) positions as I do about the proposed Hospital site”.
    Where might one find your questions or concerns about the proposed site since you mention them here?

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