Our hellish history of hospital construction

As Nova Scotia struggles to service a $13-billion public debt, we should worry that the Finance and Health Ministers will find money to fund a new expansion of the Victoria General Hospital in Halifax. It sounds heretical to suggest new hospitals are not in the public interest, but given Nova Scotia’s hellish history with hospital construction we have to be wary of the calls for more and new buildings.

Capital Health wants to demolish the Centennial Building. This is part of a plan to build “better designed and more efficient facilities” according to a statement by Capital Health’s president, Chris Powers. It sounds good, but do we have to do a complete demolition? Wouldn’t a gut and restoration be faster, cheaper and less disruptive to patients?

I fail to understand the urgency given that this health authority has sat on an empty floor at the Dartmouth General Hospital for over 20 years! That’s 20 years that patients have waited for a bed. Obviously, somewhere along the line, the health authority overbuilt. How do we know that the new wish list isn’t a repeat of the past?

A new building is nice, but can we afford it? Facilities are part of health care, but so is staff. There always seems to be funding for capital projects, but less cash for on-going operations (like keeping ERs open) and front-line staff.

Ontario, whose impending status as a have-not province may negatively impact Nova Scotia’s revenue picture, is backing away from new hospital construction. While Ontario’s Premier campaigned on new hospitals just months ago, the new economic reality has changed his plans. Plus the federal government is not sending comforting signals about stable health care funding, or at least not the kind of stability which can support new capital projects.

As a province, we have to worry about health care’s wish list. A new building for Capital Health will cost over $100 million. The IWK, on their website, are talking about the sad state of their facilities and suggest its time to replace them. If multiple facilities in one city are in such sad repair, why not coordinate one building schedule? That would be the more efficient option, but to best coordinate our system we would need a level of unity that having 10 health authorities seems to hinder.

Let’s look at our hospital history. Thirty years ago we built a hospital in South West Nova where the doors were too narrow to accommodate hospital beds and other equipment. That was a $400,000 error.

In Halifax we built a sick hospital at Camp Hill. This negatively impacted both patients and staff, many of whom had their health ruined and were forced on long-term disability. This prompted the building of the Nova Scotia Environmental Clinic, which for a while put us in the forefront of environmental illness.

Before the QEII Health Sciences Building opened they had to spend $1 million redoing their new labs.

Valley Regional Hospital, which is only 20 years old, isn’t particularly patient-friendly. Nurses complain about how cramped rooms are to work in and windows are so high that anyone in a wheelchair can’t see out. And insulation has failed in some places, so patients can feel the wind blow across their beds. In 2010 when a strange dirt suddenly covered a patient room, staff thought it was mold but were told not to say that because the hospital didn’t have the funds to deal with a mold situation. Two years later no one has proven it wasn’t mold. (See the photo on the Health Care Waste page.) Most recently, the local health authority went 50 percent over budget renovating the kitchens in the EKM Clinic in Wolfville.

Truro’s new hospital had a $104-million budget. The cost of this building, which is a year behind schedule, has grown to $184 million. That’s not just a cost situation, it’s about delayed treatment of those who are sick and in need. The Auditor General concluded the original budget was insufficient and the local health authority had no experience in large construction projects.

Who are responsible for these mistakes and what penalty does anyone other than the taxpayer suffer?

It’s not enough to prove the need for new facilities, given our history and experience we need a new way of overseeing capital projects. Someone may be a brilliant surgeon or doctor or nurse or clinician or perfectly adequate administrator, but that doesn’t mean they’re qualified to supervise $100 million + construction project. If we build anything, let’s get some people with real dirt under their nails to do the job.

In the month where we mark the sinking of the Titanic, let’s be mindful not repeat the errors of our past.

Having his say:

A version of this piece appeared in The Chronicle Herald on April 7, 2012. This is the link: http://thechronicleherald.ca/opinion/81874-building-hospitals-let-s-not-repeat-mistakes-past

One of the readers (ggwhfx) who commented on the piece accused me of being fast and loose with facts.

His comments are in italics:

“It would not be cheaper, faster and less disruptive to patients to gut and restore the Centennial Building. The last engineering study showed that it would be highly disruptive to patient care, cost just as much as a new building (if not more) and take much longer. It would also produce a facility inadequate for the future needs of patient care.”

In a press release dated December 14, 2011, Capital Health President & CEO Chris Power said, “the province today announced that it will be funding a planning and design study for the future of Capital Health’s infrastructure, which will include vacating and eventually demolishing the Centennial Building at the Victoria General site and concentrating inpatient specialty services at one Queen Elizabeth II Health Sciences Centre site.”

Note the verb tense: “will be funding…” The Province agreed to provide Capital Health with $1 million for the engineering study. The way Powers’ announcement read (and it’s on Capital Health’s website) is that the study is to take place. She promised in the new year to inform staff about the progress. I haven’t found any reference that the study had been carried out or completed. It’s a public project so if the results are in, why the secrecy, why not share with the people who are paying for it?

“One of the most laughable statements in this column is “There always seems to be funding for capital projects…” It is clear to me that the author didn’t bother to actually test his opinion against the facts. A quick glance at Capital Health’s annual reports shows, year after year, compensation costs run at 10 times the funding for Utilities and Plant Maintenance (which is where capital project funding is located).”

If there were adequate allocation of funds, Nova Scotia wouldn’t have so many ER closures. From April 1, 2010 to March 31, 2011 Emergency Rooms in Nova Scotia were closed for 788 days. Those are the Department of Health and Wellness statistics (they published it in hours, I converted them into days). If it’s not a cost staffing issue, why close ERs? In the Annapolis Valley clinic hours in Wolfville and Berwick were substantially cut back starting in September 2011. That was a money issue. This health authority which admits to daily carting food for 160 administrative workers across Kentville from the hospital to corporate offices, recently cut food services staff, expanded shifts and reduced kitchen hours in an attempt to save $100,000. In Cape Breton, the ER in Inverness had its hours reduced to save $53,000.  I’m sure if we went across the province we would find numerous instances where a lack of operating funds have been cited as the cause for reduced hours of operations, closures, staff shortages, elimination of positions, etc.

“Furthermore, he notes all of the instances where there have been construction cost overruns and delays, and he would have readers believe that these examples are the rule, but he has not offered any balance. There are plenty of examples when capital projects come in on budget and on time. One recent example was the recent QEII ER expansion.”

If the QEII ER expansion came in on budget and time, that’s great. Did Capital Health tell anyone? And is that the rule? That’s just one example. Look at Truro. How do you go 78 percent over budget and have no one held responsible? It was the Auditor General who said the local health authority had no experience overseeing capital projects.

“The author also makes a huge and highly insulting comment that we need “… people with real dirt under their nails…” to manage capital construction projects. His conjecture is that health authorities don’t have professional engineering and facilities management staff. Another example of how his opinions are presented as facts, and he is simply wrong.”

Having professional engineering and facilities management staff doesn’t mean that these people will be put in charge of projects or allowed to express an opinion or be listened to. Our history suggests it’s the boardroom crowd who take charge. Would a professional engineer have his or her name attached to a project that is 78 percent over budget?

“I am disappointed that the Chronicle Herald continually gives this writer a soapbox to influence public opinion when he clearly plays so fast and loose with the facts to support his own biased opinions.”

Nova Scotia’s health authorities have had over a decade of issuing comforting press releases and announcements about their accomplishments. They have gone virtually unchallenged for 12 years. Most recently, the IWK neglected to sterilize equipment. I know families who are impacted by this and terrorized by the implications. The IWK says trust us, we double wash, we’re confident that’s sufficient. If it were that simple, why bother to have a sterilization program? Health care consumes 40 percent of the public funds of this province. We deserve to know what they’re doing, how they’re doing and if we’re getting value for money. If you live on public funds, you have to be accountable.

Because we have so many health authorities in one tiny province all issues and problems within the system have traditionally been treated as a ‘one off’, something confined to that one authority or hospital or community. Until now no one has looked to see if the problems are merely ‘one offs’ or it they represent a larger, system-wide problem. And that, with good reason, is making the people in charge uncomfortable.

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4 Responses to Our hellish history of hospital construction

  1. Gary MacLeod says:

    The new plan for health care is to convalesce at home so why the rush to build anew one.

    I think it takes too long to get in (unless it’s a real emergency like vomiting and writhing on the floor) and they kick you out far too soon. I witnessed a man at the main entrance of the old Centennial building a couple of years ago collapse on the floor. I later learned he was a cardiac patient that had undergone open heart surgery and was discharged after only a few days in hospital. He was on his way out of the hospital when he collapsed, apparently suffering from complications. I heard the response team calling for paddles but none was in immediate range but some, after precious moments, were found and applied to the patient. I don’t know if the man survived but I assume he did since nothing was mentioned in the media. I have heard other stories from other people in similar instances.

    We do not have hospital facilities where patients are allowed to convalesce and are only geared toward emergency services. Anyone taking up a bed longer than a few days is looked upon as lost revenue. Our health tax dollars at work. Where is all the money coming from when the Dexter government continues to make the cuts they have been making?

  2. woof says:

    Maybe if the Irvings could run health care we’d have all kinds of magic money popping up from where no money existed before.

    • The Irvings do what they do well. As for getting government money for the ships – or any – project, I don’t blame them. They’re business people. Their goal is to reduce risk and increase potential profit as much as possible. There’s no hidden agenda. Just because they asked doesn’t mean the Premier or Cabinet had to say yes.

      At least we know about this. What don’t we know about how health care operates? Anyone seen where the health authorities have complied with the Public Sector Compensation Disclosure Act? The health authority CEOs seem to behave as if they are above the law. Or at least this law.

  3. Bob Brown says:

    At least with a hospital project we can relate to the tendering process and cost overruns. However, like the F-35 boondoggle, some projects are so abstract and secretive that the taxpayer has little chance of retaining control. And once the grand plan is put in motion, normally conscientious bureaucrats tend to deviate from ethical practice to cover up misjudgment.

    Consider our DHW multimillion dollar project to deliver an electronic health information system. In 2004, a federal government financed vendor group (Canada Health Infoway), enticed DHW bureaucrats to commit to a single vendor electronic health system. Like the F-35, logically it makes sense – a single system provides maximum efficiency and control. Nobody asks why taxpayers are expected to pay for office software for highly paid private physicians. Questionable ethical practices to stifle interference from local innovation prevail. And since the users are not making the investment decisions, nobody notices or cares that it misses more critical healthcare objectives.

    With the F-35 fiasco, taxpayers are fortunate that Canada’s auditor general had the authority, resources and initiative to expose the debacle. Nova Scotia’s electronic medical record implementation is proceeding without independent analysis or critical review.

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