So maybe I was grumpy

So last night as I was watching Star Wars Episode 2 (my wife and I decided to work through all seven + Rogue One).

 

See Rino I have a hobby! Then I noticed:

I have striven to not comment on the CAMPP posts, I feel I stated my position, it really hasn’t changed. In cased you missed it I do believe that a better location could exist than County Rd 42 and the hospital hasn’t been as open as it should have been but that was the site that was selected and efforts should now be put towards mitigating any negative impacts and enhancing the existing system rather than complaining about what is a done deal.

After tweeting on what seemed to be a slow news Saturday night and getting a response from interested individuals I have decided to outline the things about the post that bugged me:

  1. Misinterpretation and a Factual Error

Our map shows the exact locations of the offices of more than 350 doctors in private practice in Windsor. Only 8% are located south of E.C. Row.

This is hardly surprising, because at least two-thirds of Windsor CMA (Windsor, LaSalle, Tecumseh and Lakeshore) residents live north of the expressway.

Based on the quote above and the map that is presented there is a clear factual error there are some issue. First they state that “Our map” shows more 350 doctors in private practices in Windsor; but the maps shows Windsor, Tecumseh and bits of Northern LaSalle. They actually map some of the offices in Tecumseh, are they included in the 350 in Windsor?

Second, in the next paragraph they make a statement on the Windsor CMA. The Windsor CMA includes Amherstburg (see the Statistics Canada map) that was not included in their listing of CMA members. Was it included in their population calculation?

Their mapping doesn’t show these other communities (except for Tecumseh). If we are talking about a regional hospital system shouldn’t their doctors offices potentially be concerned? From my Googling Amherstburg is home to an additional 14 doctors offices which would be located South of EC Row. Their map also fails to show Lakeshore proper (Belle River) which is home to an additional 3 doctors offices (2 South and 1 North of EC ROW/County Rd 22). Although I imagine they wanted to exclude these elements due to their “rural county” location and the bias (which CAMPP transparently shows) if they are going to use standardized measure then they must include all elements of that measure.

I would also point out that EC Row is not near the geographic centre of the region nor the population density centre of the region. As a result, if doctors place their offices to be “Designed for Convenient Access” (more on that in minute) it shouldn’t be surprising that more offices are located north of EC Row. If you shift the North-South cut off line north to its actual point I would imagine dozens of doctors offices would move to the “South side” By cherry picking how they calculate their underlying statistics it can make the issue appear potentially much worse than it is.

 2. Time, Type and Location of Doctors Matter

Although CAMPP states:

Designed for convenient access
The office sites were designed to be convenient for patients with multiple medical conditions and for those who may need to see several medical experts, as well as for the doctors who need to be literally minutes away from the hospitals they serve.

We also identified numerous solo practices and office spaces shared by two or three physicians, most located with patient ease of access in mind.

To be clear this map only shows the offices, it does not show how many doctors work at said office or what specialty they provide or that patient catchment that they serve. This is important as certain doctor don’t have hospital privileges or they run family practices, or do procedures out of their own offices and the eventual hospital location will have no impact on the location of their services.

They also choose to ignore existing clusters that operate in West Windsor near the Prince Rd Campus and those facilities that directly service U Windsor or St Clair College which are anchored in other institutions (they also map a number of Family Health teams/Centres, Maryvale, Nurse Practitioners Clinics, the Health Unit) and would not be at risk of moving when the hospital does and include them in their count. Nor do they choose to inquire about how the development of a mental health and chronic disease hub on Ouellette or the UCC on University will impact doctor office locations. You might actually find certain specialized services opening near these future locations or doctors sharing space and services in new and innovative ways because of a change infrastructure.

This leads to a second key element, the spacial/time nexus of the Home to Office to ER relationship. Research out of McGill University in Montreal when they consolidated their 2 hospitals to 1 “Mega facility” was that the hospital location had little impact on housing locations for attending doctors. They found that although doctors choose to live closer to the hospital than other staff types (average of 6.4 km vs 11.2 km) this location choice was also driven by relative neighbourhood affluence. Although I wouldn’t want to directly compare Windsor to Montreal, 6.4 kms is in Montreal likely takes a significantly longer time than in Windsor. As a result a doctor might be able to live 8km away or maybe 10km in our region. In my brief search this morning on existing doctors offices moving as a result of hospital location change there is no literature I could find beyond “new cluster development” that is often associated with “Meds and Eds”. Undoubtedly the megahospital  will attract some doctor offices and support facilities but the extent isn’t know and it doesn’t mean that there aren’t alternative delivery models that would keep existing offices open.

Whether or not a doctor office relocates will be decided by individual doctors based on their person, profession and patients needs, as well as the cost associated with the moves, distances needing to be traveled and the size and type of new facilities that are available. A simple map and open ended questions fail to address the complexities of the issues at hand.

3. Causation does not equal Correlation 

A basic tenant of any research is that Causation does not equal Correlation but that is exactly what CAMPP is implying. A simple counting of doctors and their offices and mapping it as the basis of an argument without effective analysis is assuming causation without proving or providing correlation. What their mapping and narrative implies is that every doctors office that is near an existing hospital (Met or Ouellette) will close and move to the megahospital site. No where do they moderate their analysis, instead they take the easy way of asking opening ended questions after providing incomplete information and allowing their followers to jump to conclusion.

Undoubtedly some doctors offices will move, but will it be 10%, 20% or 80% we don’t know. What level of realignment is acceptable to the community, again we don’t know. What is the capacity for the community to reach the new office locations, again we don’t know. They didn’t ask these questions or see out answers to them.

If they have compiled a full list of all 350+ private practices they have the capability to reach out to them and ask for answers in a confidential manner. A simple tool would have been to send a 1 question survey to each of these doctors offices to ask them if they intend to move their offices in a decades time when the new hospital it hopefully built.

Instead they jumped to a hypothetical:

The office sites were designed to be convenient for patients with multiple medical conditions and for those who may need to see several medical experts, as well as for the doctors who need to be literally minutes away from the hospitals they serve.

We also identified numerous solo practices and office spaces shared by two or three physicians, most located with patient ease of access in mind.

What will become of the pharmacies, therapists, laboratories, and other ancillary medical services currently located in or near these established doctor hubs?

If the mega-hospital plan goes forward at its proposed site, what will happen to all of these medical offices and services, current employees (and the many nearby businesses they support)?

They do not offer an answer, they don’t provide context, they don’t offer an alternative solution. Does it need to be that way, no it doesn’t but they choose to have it that way because it fits their narrative. By distributing this incomplete and inaccurate information via email and a post on their website it creates a veneer factual and correct information when in my opinion it is not.

 

It is actions like these, that prevents a process of mitigating negative impacts from developing and any actual discussion of solutions from taking place; it polarizes the politics in our community and it makes people on social media very grumpy.

Through this process both the Hospital and CAMPP has effectively destroyed what little middle ground existed in this community. The opportunity for some form of grand bargain has come and gone. Instead we are left with a zero sum situation where their the hospital or CAMPP will “win” and the community will lose not matter what. The result is the ability to actually organize and advocate for effective mitigation of negative impacts of the hospital plan has become that much harder because the well of good will and public interest have been tainted by information released last night.

1i7h1x

2 thoughts on “So maybe I was grumpy

  1. Only two comment question I would ask
    You to consider.
    1. The selection committee itself said that the Lauzon location Scored higher using their own criteria
    It was rejected because it cost more
    On what authority did they make that decision? Why would they not go
    Back to the community to ask what value it placed on a location with a higher score?

    Does that not seem suspect to you
    By their own logic their process would reject A higher scorer location even if it only costed a penny more?

    2. The scoring itself had one section regarding meeting Windsor’s official plan but it didn’t ask if it met the plan as a whole. Only specific sections of the official plan were considered and it omitted major sections that referred to residential intensification in the core and sprawl
    Does that not seem suspect to You

    I do think campp should consider your criticisms . But shouldn’t you also consider and acknowledge the validity of some of these arguments

    Does the optics Not make it appear that
    They were trying to rush this through or were

    • Mark thanks for the reply and your points.

      1) Does it seem suspect ya, but they had the power to do it. Take a step back and look at this process or other processes in other communities. The hospital had the power to just pick a spot with 0 consultation. They could have quietly RFPed for a location and just picked or they could have spent hospital/foundation dollars and bought a parcel. When Woodstock announced its “megahospital” back in the 1990s (my dad was apart of this process as head pharmacist in Oxford County) they just bought a plot of land on Woodstock fringe right near the 401 and then told the community that is where the hospital will be going. Ironically there is a subdivision around it now.

      They had no obligation to go back to the community and although I wouldn’t call the hospital process the greatest thing in transparency since sliced bread they certainly could have done less. Regarding the specifics of the cost between the Lauzon and 42 locations they are well within their rights to weight or considering scoring criteria as they deem. That is a power that is bestowed upon them by the province and has been reinforced several times in this process where provincial officials have said that “site selection is up to local authorities”. They got/are getting sued over it unless the suit was dropped and I didn’t see.

      2) Again the hospital was well within its power to pick and choose its criteria. Is that the best thing, probably not, but not illegal or irregular. Should have the Windsor Planner on the committee spoken out? Ya probably but you would need to ask him about why he didn’t. Should the mayor or council done more, absolutely. Are those failures the fault of the hospital? Not in my opinion that is a bigger Windsor issue.

      I have accepted many of CAMPP arguments and positions the fundamental problem with them is that they aren’t nearly effective enough to change positions and move the debate. They have missed key opportunities where the could have had leverage based on date to press a line of attack. Instead they went the route of ideological purity and absolutism In fact all they have managed to do is fragment the situation worse and increase polarization in the community.

      Shady optics about the process doesn’t change the outcomes, the only way you change it is if you get a rapid sustained groundswell of support from the community (see the petition for the xmas lights vs CAMPPs latest petition) or you successful sway those in leadership positions to oppose the process (Mayor, Councillors, County Pols, MPPs) all of who are on record supporting the process. The arguments that have been put forward by CAMPP to date have failed to achieve both outcomes and there is no sign that they have a plan or a willingness to change course.

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