The Corporation of Delta COUNCil REPORT Regular Meeting

To: Mayor and Council

From: Office of the Chief Administrative Officer

Date: March 3, 2015

Delta Hospital Services

• RECOMMENDATIONS:

A. THAT Mayor lois E. Jackson and Council support the Delta Hospital Medical Staff Association's request for four surgical acute care beds and a cast clinic, as an immediate but interim solution to the current situation at Delta Hospital, through increased funding in the 2015-2016 operating budget.

B. THAT Fraser Health Authority work with the Delta Division of Family Practice and the Delta Hospital Medical Staff Association on the development of a long-term community­ based health care plan for Delta Hospital to guide future development and funding towards the establishment of a 20 bed surgical ward within a 150 bed hospital, in­ patient mental health services and comprehensive orthopaedic services, and this plan be developed within a relatively short 2-3 year timeframe. c. THAT the Honourable Terry lake, BC Minister of Health be requested to meet with Mayor lois E. Jackson and George V. Harvie, Chief Administrative Officer to discuss concerns regarding services at Delta Hospital, specifically:

• that it is unacceptable to continue to underfund critical services at Delta Hospital, including the acute care surgery program, mental health services, and orthopaedic services, as outlined in this report; and

• to request that a proportionate share of the $3 billion committed by the BC Government towards health care services over the next 3 years be targeted to fund service improvements at Delta Hospital that would bring it up to the same service levels as other hospitals in communities of comparable size in British Columbia.

D. THAT Michael Marchbank, President and Chief Executive Officer of Fraser Health Authority be requested to meet with Mayor lois E. Jackson, George V. Harvie, Chief Administrative Officer and Dr. Robert Shaw, Delta Division of Family Practice, to discuss the above-mentioned issues.

E. THAT Tsawwassen First Nation be requested to provide a letter of support for Delta's position.

F. THAT copies of this report be provided to Fraser Health Authority, Delta Hospital Executive Director, Delta Hospital Medical Staff Association, Delta Hospital Foundation, the Friends of Delta Hospital, Delta Auxiliary Society, and the Delta Division of Family Page 2 of 8 Delta Hospital Services March 3, 2015

Practice as well as to the Honourable Kerry-Lynne D. Findlay, PC, QC, MP Delta­ Richmond East, Jinny Sims, MP Newton-North Delta, Scott Hamilton, MLA Delta-North and Vicki Huntington, MLA Delta-South.

• PURPOSE:

The purpose of this report is to highlight some issues of concern regarding service levels at Delta Hospital and bring forward recommendations to address short and long-term service level short-falls at the hospital.

• BACKGROUND:

A brief chronology of the changing role and status of Delta Hospital is provided for context:

1980-2002: Operating as a full service hospital since 1980, Delta Hospital faced significant challenges in the early 2000s when the Fraser Health Authority implemented policy changes to centralize many hospital services in Richmond, Vancouver and Surrey. This resulted in the closure of Delta Hospital's acute surgical program and critical care unit, and in 2002, Delta Hospital was downgraded from an acute to sub-acute care facility.

2003 - 2008: The local community responded with an extremely well-organized and well-supported campaign to restore services at Delta Hospital. From this campaign came the 'Declaration of Dependence' of 2003, which was signed by numerous community and business groups as well as Delta Council of the time.

As a result of the community's efforts and fund-raising campaigns, many (but not all) of the hospital services were gradually restored. Between 2003 and 2008, the Emergency Department was expanded, surgical daycare was renovated and 12 additional acute-care beds were added. In 2008, Delta Hospital regained its status as an acute care facility, although the surgical program remained downgraded to a day surgery program.

In 2008, the Corporation of Delta donated $500,000 from municipal surplus funds towards the purchase of a CT scanner for Delta Hospital. The decision to donate municipal funds received overwhelming public support during the 2008 Local Government Election which included a public opinion question, for or against, on the ballot. In a tremendous fund-raising effort, the Delta Hospital Foundation and Delta Auxiliary Society donated more than $1.7 million to complete the purchase.

2009 - 2014: In recent years, ongoing funding cuts have led to an erosion of services offered at Delta Hospital, particularly the acute surgical program, which suffered a budget cut of $1.2 million in 2009. The repercussions were, and continue to be, felt throughou~ the hospital, for example, it is becoming more difficult to recruit specialists such as anesthetists. Page 3 of 8 Delta Hospital Services March 3, 2015

In October 2014, the Delta Hospital Medical Staff Association wrote to the Honourable Terry Lake, BC Minister of Health, advising him of an "impending medical crisis impacting the citizens of Delta" and requesting that acute care surgery be restored at Delta Hospital. A copy of this letter is provided in Attachment 'A'.

In response to this letter, a joint meeting of staff from the Fraser Health Authority and Delta Hospital took place in November 2014. Four recommendations were brought forward by hospital staff:

1. Funding of a pre-operative clinic. 2. Funding of a cast clinic staffed by Delta orthopaedic surgeons. 3. Funding of 3 operating rooms. 4. Establishment of four surgical acute care beds.

These recommendations were presented as an immediate solution to the current crisis and were not considered to be a long-term solution. Fraser Health Authority agreed to implement the first three recommendations within 12 months; however, shortly thereafter, Fraser Health indicated the cast clinic would have to be funded within the existing hospital budget.

Delta Council: In January 2015, Fraser Health Authority officials attended a Delta Council workshop and outlined the planning and development priorities for Delta Hospital for the next 20 years. Proposed changes include an expansion of laboratory services; a potential residential care complex expansion; the creation of a community health centre; and the possibility of a mental health unit in the longer term. There was no indication, however, that the status of the acute care surgical program would be revisited.

Council supported a motion to ask Fraser Health Authority to hold community meetings regarding their plans for Delta Hospital and for staff to bring back a report on hospital service levels in DeJta.

• DISCUSSION:

Like many community hospitals, Delta Hospital faces ongoing challenges to provide more and better services with fewer financial and staff resources. Following the budget cuts in 2002 and again in 2009, Delta Hospital has struggled to regain its position as a full-service facility - any gains that have been made have largely been as a result of community-led fund-raising efforts.

With its team of extremely dedicated hospital staff and a high level of community interest and support, Delta Hospital consistently provides high quality medical services to more than 33,000 patients a year and it has an excellent reputation for patient care and patient satisfaction (as evidenced by BC Ministry of Health statistics).

In 2011, a collaborative of Delta family physicians established the Delta Division of Family Practice, with the goals of improving patient access to local primary care, increasing local Page 4 of 8 Delta Hospital Services March 3, 2015

doctors' influence on health care delivery, and providing professional help for physicians. From this group, two sub-committees were formed:

• Collaborative Services Committee - to bring Delta doctors and senior level staff from Fraser Health Authority to a collaborative planning table.

• GP for Me Steering Committee - aimed at helping people find a family doctor; increasing capacity of the primary health care system; and strengthening the GP­ patient relationship.

Delta's Chief Administrative Officer, George V. Harvie, has participated and assisted with these committees since early 2014. A variety of issues have been identified with respect to Delta Hospital, including:

Orthopaedic Care - the need for a comprehensive orthopaedic care program, including a cast clinic. Although Fraser Health Authority recently agreed to restore the cast clinic, Delta Hospital doctors are now reporting that funding (approximately $30,000 a year) must now come from within the existing budget. Delta has an historical relationship with specialty resources in Richmond and Vancouver which should be recognized and formalized by the Ministry of Health to ensure seamless access to health care in both jurisdictions.

This report is recommending that funding for the cast clinic be restored in the 2015-16 operating budget for Delta Hospital as an interim measure until a full program of orthopaedic services can be implemented.

Mental illness and addictions - have also been identified as Significant issues in Delta and the Delta Division of Family Practice (GP For Me Steering Committee) has identified people with mental health issues as being the number one priority population needing enhanced primary care capacity. This is an issue that has been increasingly problematic for Delta Police Department since the number of incidents involving people with mental health and addiction issues is growing yet there is no facility in Delta equipped to deal with such patients, meaning that they are often taken into police custody, or more usually, taken to the Surrey Memorial Hospital emergency department, or released back into the community. This represents a significant drain on police resources as officers are required to stay with patients through the often lengthy wait in the emergency department. There is an urgent need to establish a facility for the assessment, care and treatment of people with mental health and addiction issues and it is recommended that this issue be addressed in the long-term health care plan to be developed for Delta Hospital.

Acute care surgery - although Delta Hospital is classified as an acute care hospital, it does not have the same surgical capabilities as the eleven other acute care hospitals in the Fraser Health Authority region - the operating rooms at Delta Hospital close at 3pm which means that patients needing emergency surgery after that time must be transferred to another hospital to receive treatment. On weekends, Delta Hospital has no dedicated emergency surgery time. Page 5 of 8 Delta Hospital Services March 3, 2015

As a result, approximately 300 patients a year are treated at other hospitals in the region and, of this number, some 150 are transferred from Delta Hospital to other hospitals, many for relatively routine emergency surgeries such as appendectomies. Geographically, Delta Hospital is not well positioned for patient transfers - there is often heavy traffic congestion at key exit routes from Ladner (especially the tunnel) and the nearest tertiary care facility, Surrey Memorial Hospital, is more than 28 km away.

For comparison, both Eagle Ridge and Ridge Meadows secondary care hospitals have quicker access and shorter distances to the closest tertiary care hospital:

• Delta Hospital to Surrey Memorial: 28.2 km, 28 minutes travel time without delays. • Eagle Ridge Hospital to Royal Columbia: 10.6 km, 20 minutes. • Ridge Meadows to Royal Columbia: 22.4 km, 23 minutes.

Not only do patient transfers increase the cost of patient care (average $700 per patient) but it delays treatment and increases patient stress and the risk of a negative outcome for the patient.

In addition, Delta does not have a good public transit system which makes getting to hospitals outside of Delta for follow-up treatment particularly challenging for seniors, people with disabilities or people without cars. There are other compelling reasons to take action now:

Demographic Changes:

• Delta's population is ageing and the number of 60+ patients is expected to double in the next 20 years. This is expected to significantly increase the pressure on medical facilities at all levels, but particularly on emergency care, as the number of complex care patients rises with age.

• Delta's population is growing - although growth in the existing population is stable, there is a considerable amount of development activity taking place and proposed for Delta and Tsawwassen First Nation, which will result in a significant net inflow of people to the area over the next decade. Currently, there are more than 1,000 residential units under construction in Delta and an additional 1,160 units pending approval. The . Tsawwassen First Nation residential development includes 2,780 units with an estimated population of 7,000 as well as an estimated 10,000 new jobs created over the next decade.

Emergency Response/Community Self-Sufficiency:

• Delta has a significant industrial base with numerous industrial facilities and manufacturing plants, including an LNG facility, coal terminal, and the largest container terminal in Canada. It is also a provincially and nationally significant transportation hub for road, rail and marine goods movement involving a wide variety of products, Page 6 of 8 Delta Hospital Services March 3, 2015

including hazardous and dangerous goods. It is critical for Delta Hospital to have 24/7 emergency surgical capability in order to respond effectively to a major incident.

• As recent mock disaster exercises have ably demonstrated, Delta is extremely vulnerable to being isolated in the event of a natural disaster such as an earthquake. This means that Delta is very likely to be cut-off from the mainland and would be unable to receive immediate outside emergency assistance. For this reason, Delta needs to be self-sufficient in as many ways as possible, especially in terms of its medical emergency response capability.

This report is recommending that funding for four acute surgical beds be restored to Delta Hospital in the 2015-16 operating budget as an interim measure until a long-term community­ based health care plan is developed for Delta Hospital.

Funding Disparity:

Delta has a population of more than 100,000 people, representing 6% of Fraser Health Authority's total population. By comparison, Delta Hospital receives only 1.8% of Fraser Health Authority's surgical program budget. Delta is the only jurisdiction in Be with a population greater than 60,000 that does not have full surgical care at its local hospital. Delta does not have a 24/7 emergency surgical program anywhere close to being comparable with its counterparts, as indicated by the following budget numbers:

• Eagle Ridge Hospital annual surgical budget - $15 million. • Ridge Meadows annual surgical budget - $13.1 million. • Delta Hospital annual surgical budget - $5.1 million.

In response to concerns raised about service levels at Delta Hospital during the November 27, 2014 Parliamentary debate, the Honourable Terry Lake, Minister of Health, responded as follows:

"The people that per/orm services at Delta, as the member well recognizes, are superb. But we can't have all services provided in every community. It makes sense from a regional perspective to have high level services concentrated in certain hospitals. In this case Delta has a great day­ surgery program and will continue to have a great day-surgery program, but they do not have a postoperative surgical unit or a critical care unit. It does not serve patients well to provide a higher level of surgery service when those ancillary services are not there. That is why it is best to take patients that require that level of service to Surrey Memorial, which has had a huge investment, part of the $12 billion that we have put into hospitals around this province. We need to ensure that patients are well looked after. Fraser Health is doing that. II

The recent 2015 provincial budget includes a $879 million budget surplus and a commitment of $3 billion on health care over the next 3 years. According to the Delta Hospital Medical Staff Association, the situation at Delta Hospital could be rectified at relatively low cost with the provision of four in-patient, 24 hour acute care beds at an annual cost of $2 million. This Page 7 of 8 Delta Hospital Services March 3, 2015 represents 0.74% of FHA's annual surgical budget of $270 million. The surgical budget for Delta Hospital is currently $5 million.

It is clear that further discussions with the Minister of Health, and the Fraser Health Authority, need to take place. Resolving this matter will require cooperation and commitment from all stakeholders, including the Fraser Health Authority and the hospital medical staff. Tsawwassen First Nation has been supportive of the Friends of Delta Hospital campaign and it is recommended that they be requested to send a letter in support of Delta's position.

Looking Ahead:

Looking ahead, a strong, community-based health plan is needed. Critical components of such a plan include comprehensive community care, long-term care, primary care and preventative health care programs. A community the size of Delta typically requires a 20 bed surgical ward within a 150 bed hospital - this has been shown to be an efficient model for community hospitals. The long-term plan must also include in-patient mental health services and orthopaedic services. The Fraser Health Authority shol;lld work together with the Delta Division of Family Practice and the Delta Hospital Medical Staff Association to develop this long-term community-based health plan to guide funding and development at Delta Hospital for the next 20 to 30 years. It is recommended that work on this plan begin immediately so that the plan can be finalized within a relatively short 2-3 year period.

Implications: Financial Implications - there are no financial implications associated with this report.

• CONCLUSION:

Delta has shown time and again that its community-based approach to service delivery works, whether it be policing or law enforcement or medical care. There are compelling reasons why Delta Hospital should be restored to a full service hospital:

• Delta is the only community in British Columbia with a population greater than 60,000 that does not have full surgical care at its lo~al hospital.

• The geography and demographics of Delta make patient transfers particularly challenging and undesirable in terms of cost, time and patient care. .

• We must plan for population growth in the community through new residential development and economic growth and ensure that Delta is self-sufficient in terms of medical services in the event of emergencies or disasters.

• Serving 6.25% of the Fraser Health Authority population, Delta Hospital's surgical program is underfunded, receiving only 1.8% of FHA's surgical budget ($273 million 2012-2013). This inequity must be addressed and Delta should receive its fair share of medical funding. Page 8 of 8 Delta Hospital Services March 3, 2015

It is understood that the restoration of services at Delta Hospital to pre-2002 levels cannot be done overnight; however, it is critical that the Ministry of Health, through the Fraser Health Authority, start implementing changes requested by the hospital physicians, including the provision of four acute surgical beds and a cast clinic, and provide the necessary funding in the 2015-16 operating budget.

The discussion needs to take place with the Minister of Health and, with his support, Fraser Health Authority will be able to plan for a new, more sustainable future at Delta Hospital. Delta is not asking for special treatment: simply to have the same level of hospital services as other communities of comparable size in British Columbia.

($o..t.l \I. ~ ...... George--- V. Harvie Chief Administrative Officer

Department submission prepared by: Bernita Iversen, Senior Policy Analyst F:\Bernita\Hospital\GP for Me\MarchCR.docx

ATTACHMENT:

A. Letter from the Delta Hospital Medical Staff Association to BC Minister of Health ( Date: October 20, 2014 r- enera\ Q9?ffi-qohios- From: Medical and Surgical Staff U flLE# I Delta Hospital 5800 Mountain View Blvd Delta, BC

To : Hon. Dr. Terry Lake TYPE: :' N FrO Minister of Health DEPT: rrt.rcil/) Government of British Columbia A. T. #: txOEAlo . Comments:

Dear Dr. Lake,

We are writing to you urgently as Delta Hospital's medical staff to alert you to an impending medical crisis impacting the citizens of Delta.

The surgical programme at Delta Hospital, after years of cutbacks, is in imminent danger of imploding, which could have a snowballing effect, reSUlting in the complete collapse of acute medical care for the Corporation of Delta and its 100,000 residents.

Earlier this year a seventeen year old girl came to Delta ER in the morning with acute abdominal pain. The ER physician and the general surgeon made the diagnosis ofacute appendicitis.

However, because OPERATING ROOMS AT DELTA HOSPITAL CLOSE AT 3PM, the girl had to be transferred by ambulance to Surrey Memorial Hospital, where she had to wait again to be re-evaluated by the emergency physician there, as well as the surgeon. Eventually her appendix was removed, but only after a FIVE HOUR DELAY.

She could have been operated 5 hours earlier at Delta Hospital if FHA had been willing to pay $150 for nursing overtime. Instead, tax payers paid an additional $1,150 for ambulance transfer and additional costs incurred at the other hospital.

As you may remember, in 2002 Delta Hospital was downgraded to a subacute facility, serving the 9th most populous municipality in B.C. The acute surgical programme,· along with the critical care unit, was shut down, forcing Delta general surgeons to operate and care-for their patients elsewhere, in Surrey, Vancouver, and Richmond.

INFORMATION TO COUNCIL

DATE 0& ' ?-3 I {y-- f Slowly the Delta general surgeons had no choice but to convert their practices into ( the Day Surgery model. However, out of their sense of obligation to Delta residents, they continued to take 24 hour calls at the ER, even though there were no longer surgical beds at Delta Hospital, and never stopped tirelessly advocating for Delta patients.

Together with Delta Hospital's anaesthetists and surgical nurses, these surgeons have made the Delta day surgery programme the most productive, and achieving the highest quality indices in Fraser Health, according to the recent Ministry Review of FHA.

However, the combination of over ten years of continuing cutbacks, (during which period medicine has become ever more complex), and an aging population, has taken its toll.

Dear Dr. Lake, as a fellow health professional, you must appreciate from your days at Coquitlam Animal Hospital, that surgical treatment is just as essential as medical treatment.

Last week, a 57 year old patient who had undergone a hysterectomy 7 days prior, presented to Delta ER with severe abdominal pain due to an entero-vesicular fistula, which is not an uncommon surgical complicatiOn. ( However, because of the cutbacks to the Delta surgical programme, the patient had to be transferred to Surrey Memorial Hospital. Naturally the patient was very upset. She assumed that the surgeons at Delta Hospital would be able to repair her.

This patient is not alone. Every year over 300 surgical patients have to be transferred out of Delta Hospital for surgical care that could have easily been performed at De~ta Hospital.

As a result of decreasing capabilities in the surgical programme, Delta Hospital has not been able to recruit any new anaesthetists over the last 5 years, and is in danger oflosing the entire anaesthesia department.

Dear Dr. Lake, we, the medical staff at Delta Hospital, sincerely request that Acute Surgery be restored at Delta Hospital. We believe that when Delta patients come into the Emergency Department, which receives over 31,000 patients per year, they should expect to receive prompt acute surgical interventions for acute bowel obstruction, acute appendicitis and cholecystitis, just as they expect to receive urgent medical treatments for acute stroke, acute myocardial infarction, and acute infections. ( Currently the operating rooms at Delta are open only until 3pm. We believe the operating rooms should be available for emergency surgeries.

These changes do not need to be expensive. With 6.25% of Fraser Health's population, Delta hospital's annual surgical budget is $5 million, or 1% of FHA's annual regional surgical programme budget. In comparison, FHA's corporate budget this year is $197 million, and is scheduled to increase to $250 million in 2016-17.

We believe that a relatively small increase in the budget will revive the acute surgical programme at Delta hospital, and dramatically improve patient care for over 100,000 residents of Delta.

Yesterday a 65 year: old man underwent a routine screening colonoscopy. Unfortunately, he was found to have colon cancer by the surgeon. His Delta general surgeon was more than qualified to resect the cancer on the same day, but was forced to refer the patient to another surgeon at St Paul's Hospital, adding to the delays in his treatment.

The patient will likely need to WAIT FOR FOUR WEEKS to have his colon cancer removed.

Dear Minister Lake, we believe that Delta residents wlII appreciate the Ministry and FHA's working together to improve in their surgical care, to save taxpayers' contributions by avoiding unnecessary ambulance transfers, but most importantly, to avoid unnecessary delays in care.

We look forward to hearing from you, and to work together with you to improve acute surgical care for the 100,000 residents of Delta.

Sincerely,

Robert Shaw, MD, Head, Internal Medicine President, Medical Staff Association

Dan Robibo, MD Head, Surgery

Robin Woodhead, MD Surgery ( Greg Polyakov, MD Surgery

Jean Segal, MD Surgery

Saleem Nagra, MD Surgery

Jeff Hornstein, MD Head, Anaesthesia

Dean Jones, MD Anaesthesia

Ari Gilligson, MD Ophthalmologic surgery

John Bayne, MD Ophthalmologic surgery

Ken Poon, MD Urologic surgery

Lorne Brown, MD Plastic surgery

Andrew Bartlett, MD Head and neck surgery

Colleen Lee, MD Family Medicine

Christine Gemeinhardt, MD Family Medicine

Edward Lerner, MD Family Medicine

Jennifer Rogerson, MD Family Medicine

Ruth Turnbull, MD Hospital Medicine

Ljiljana Kordic, MD Hospital Medicine

Barbara MacFarlane, MD Hospital Medicine

Jacques Lafleur, MD Emergency Medicine

Dan Rubin, MD Emergency Medicine

Gordon Bird, MD Emergency Medicine

Melissa Tan, MD Emergency Medicine

Navdeep Grewal, MD Emergency Medicine

Trevor Newton, MD Emergency Medicine ., ~.

( Lawrence Lee, MD Emergency Medicine

Heather Enns, MD Emergency Medicine

Cathy Truong, MD Emergency Medicine

Cuong Pham, MD Internal Medicine

Peter Zetler, MD Pathology

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