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Friends and family of Reilly Anzovino stand behind photos and drawings of Reilly in her family's kitchen on Jan. 16, 2009.

JENNIFER ROBERTS

Panic raced through Denise Kennedy's mind when she answered her bedside phone at 1:17 a.m. A police officer said her daughter had been in a terrible car accident.

Reilly Anzovino died that same morning of internal injuries, two days after Christmas, after the Chevy Cavalier she was riding in skidded into an oncoming car on an icy stretch of Garrison Road.

Now, Ms. Kennedy lies awake at night wondering whether her 18-year-old daughter might still be alive if the emergency room at the local hospital had been open.

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Ms. Anzovino has become the human face of what many residents in the Southern Ontario border town of Fort Erie feared would happen when the only emergency department permanently closed its doors as part of a budget-cutting measure - one that, paradoxically, has actually cost the province and municipalities more. Politicians of all stripes have joined her family in calling for a public inquest to determine whether the teen's life was cut short because of decisions made by bureaucrats.

"What makes us cry ourselves to sleep is, you saw this coming, you just didn't know who was going to be first," Ms. Kennedy said in an interview. "We feel she could have been saved if we had our hospital."

Ms. Anzovino was home for the holidays from Ottawa, where she was studying fine arts at Algonquin College. On the night of Dec. 26, she and a childhood friend were returning to the house when the car was broadsided just 16 kilometres from Douglas Memorial Hospital in Fort Erie. But its emergency department closed last September, forcing the ambulance to take nearly twice as long to transport Ms. Anzovino to the next nearest hospital, in Welland. She died shortly before arriving.

Kim Craitor, Liberal MPP for Niagara Falls, is among those calling for an inquest, though it leaves him opposing his own government's policies. "I represent the community and they come first, no matter which party I belong to," he said. Ontario's Chief Coroner is investigating "the sudden and unexpected nature" of Ms. Anzovino's death, but has not yet decided whether to hold an inquest, a spokeswoman said.

The teen's death has ignited a heated debate over the fate of small and rural hospital emergency rooms. Community activists in the Niagara region say it serves as a cautionary tale for other cash-starved hospitals considering closing their emergency departments.

In an era when every provincial government is mired in deficit and trying to rein in rising health-care costs, many hospitals across Canada are cutting services that directly affect patients - and redefining their traditional role as providers of one-stop health care.

Hospitals do not all offer the same services, Ontario Health Minister Deb Matthews said in an interview. "It's important that the public understands that if you want to take advantage of the best health care, we can't provide that in every single community."

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Alberta Health Services is projecting a $1.3-billion budget shortfall for this year. In B.C., the Fraser Health Authority must find $160-million in budget cuts by the end of March for its 12 hospitals. In response to community opposition, Fraser Health abandoned plans to cut back emergency-room hours at a small Mission hospital and instead is closing its operating room, which a spokeswoman said is used only two days a week.

In Fort Erie, Douglas Memorial is on the vanguard of a trend to close emergency rooms in rural and small-town Ontario. Emergency departments in Petrolia, Wallaceburg, Trenton and Wellington County are all at risk, says the Ontario Health Coalition.

Niagara Health Services, which operates six other hospitals in the region, also closed the emergency department at the hospital in Port Colborne last July as part of a plan approved by Ontario's Health Ministry to find $28-million in cost savings. That decision is now under review following Ms. Anzovino's death.

Activists in Fort Erie said Ms. Anzovino's death is all the more senseless because closing the two emergency rooms will actually drive up health-care costs, not save money.

Niagara Health Services will save over $1-million a year with the conversion of the two emergency departments into around-the-clock urgent care centres, said Joanna Hope, Niagara Health's interim chief of staff. But the cost of providing ambulance service in the region - one shared equally by the province and municipalities - will jump $3.1-million a year, according to Niagara Emergency Medical Services.

Ms. Matthews, however, maintained that closing the emergency departments was about providing better quality health care, not saving money. She said Douglas Memorial is not equipped to handle serious emergencies and often had to divert patients to other hospitals in the Niagara region or, in some cases, across the border to Buffalo.

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"I am absolutely convinced that the people in Niagara have better quality health care now than they did before," Ms. Matthews said.

That view is not shared by William Hogg, the retired chief of pediatrics at Douglas Memorial. He warned Niagara Health officials that lives would be at risk if they closed the emergency rooms. He said in an interview that it might have been possible to save Ms. Anzovino if she got to a hospital sooner.

Ms. Anzovino was in urgent need of a blood transfusion. But ambulances do not carry blood and paramedics can only try to staunch the bleeding until they get to a hospital.

For her mother, it's the unanswered questions that haunt her. The deputy chief of Niagara Emergency Medical Services, contacted by The Globe and Mail, declined to say how long it took paramedics to arrive at the scene and transfer Ms. Anzovino to the ambulance, citing the coroner's investigation. He did say that the ambulance took 191/2 minutes to travel 23 kilometres to the hospital in Welland.

In their letter to the Chief Coroner, Ms. Kennedy and her husband, Tim Anzovino, say their hearts ache wondering whether their only daughter would still be alive if she had received a transfusion sooner. They said Reilly died shortly before the ambulance arrived at the hospital.

"There was so much time missed," she said in the interview. "If this was just an instant crash where someone died on the scene, it's a whole different feeling than picturing someone clinging on to life for that long. Right now, we have no peace and no rest."

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