Even as a budget exercise, opponents say, converting the emergency rooms has failed. Niagara Health will save more than $1-million, but area municipalities and the province will spend an additional $3.1-million on ambulance service.
As well, documents obtained by The Globe and Mail show that keeping the emergency department at Niagara General staffed has required bringing in doctors from temp agencies - something usually done only as a stop-gap measure.
In this case, the part-timers are taking one-third of all shifts. They earn the same wages as staff doctors and are paid through medicare. But hospitals who use AIM Health, a private company formerly known as Med-Emerg, must pay a service fee and pick up any travel costs.
AIM has contracts with 29 hospitals in Ontario, often bringing in doctors from other provinces, and its services do not come cheap. According to an agreement with Niagara Health dated April 1, 2008 (well before the doctors resigned), it charges $500 for providing someone on less than 24 hours' notice as well as $30 an hour when it bills more than 150 hours in a month.
Ms. Sevenpifer calls the hiring of temporary staff "a normal cost of doing business," but she says AIM fills only a "few shifts." Most of the fill-in doctors, she says, are supplied by HealthForceOntario, a publicly financed agency whose overhead, travel costs and even incentive fees for remote assignments are covered by the province. According to its website, however, the agency's doctors are "an interim measure of last resort."
The resignations of Dr. Dobrovolskis and his colleagues came after Niagara Health announced that it was releasing a consultant's report saying the medical staff faced a risk of "burnout" because they were seeing too many patients. "It would be impossible," it states, "for the physician to deliver appropriate care, given the time constraints."
Niagara Health had commissioned the report from Hay Group Health Care Consulting because it anticipated that patient traffic in Niagara Falls would increase after the emergency rooms in Fort Erie and Port Colborne closed. But the doctors, who were putting in four long days followed by six days off, liked the status quo and fought Hay's findings.
A critique written by Kevin Speight, one of the doctors who resigned, says the report contains "glaring flaws in logic," adding that doctors were seeing an average of 4.75 patients an hour, which falls within the acceptable range of 1.8 to 5 patients an hour.
The doctors also sought input from the Ontario Medical Association's emergency medicine section, whose investigator, Myron Haluk, reported that they had run a stable, fully staffed operation for years. They acknowledged that changes were needed to deal with the influx of new patients, but insisted that a shortage of beds was the real issue. Patients waiting to be admitted were taking up space in emergency and forcing others to wait for treatment.
As well, the doctors bridled at the news that they would no longer be allowed to arrange their own hours - that duty was to be handled by Niagara Health, which has centralized its scheduling and now moves staff from one hospital to another.
Officials say the system is designed to be collegial, but that is not how it felt to Dr. Dobrovolskis when he was asked to fall into line last summer.
Tensions escalated after he led the OMA's Dr. Haluk on a tour of the ward. In a letter dated Sept. 28, Niagara Health's interim chief of staff, Joanna Hope, criticized him for disrupting the department.
"It is with great sadness," she concluded, "that I find myself obliged to write this letter and to accept your resignation from the medical staff."
But by then Dr. Dobrovolskis was already gone. His last shift had ended nine days earlier.