When a group of New Brunswick doctors and hospital executives met at the Amsterdam Inn in Sussex in January, they had before them detailed proposals for hospital-based abortion clinics in the Maritime province's three major cities.
But rather than significantly expand geographic access to surgical abortions, the chief executive officer of New Brunswick's English-language hospital network decided two days later to limit the new service to Moncton, one of only two cities that already offered publicly funded pregnancy terminations.
In a Jan. 21 e-mail entitled "Confidential – Family planning," John McGarry listed his reasons, including the cost savings of a single site and the challenges of installing an expensive abortion clinic in an old emergency room at Saint John Regional Hospital, a space that was also being considered as a new site for the intensive care unit. (Read the e-mails here)
"I will even add an eighth reason that is only sitting in the back of my head," Mr. McGarry, the CEO of Horizon Health Network, wrote. "SJ [Saint John] is a very significant Irish Catholic community and it was quite a surprise to me that the hospital physicians would even entertain the matter. Times have changed of course. But it was a thought that lingered in my head."
Mr. McGarry's Jan. 21 e-mail is one of nearly 200 documents obtained by The Globe and Mail through the province's Right to Information and Protection of Privacy Act that reveal for the first time how close New Brunswick came to dramatically expanding abortion services earlier this year.
Instead, pro-choice women say, the province's Liberal government has fallen short of its commitment to increase options on the ground, despite dramatically loosening the regulations that once made New Brunswick one of the hardest places in Canada to end a pregnancy.
"It's frustrating that they threw away so much work that would have gone a long way to making services more accessible in New Brunswick," said Jessi Taylor, a spokeswoman for Reproductive Justice NB. "It perpetuates a health care system that is based on luck and privilege. And luck and privilege is not the same as access."
When newly elected Premier Brian Gallant announced in November that his government would scrap some of the province's old abortion rules – including one that said a woman needed two doctors to declare the procedure "medically necessary," before medicare would pay for it – Ms. Taylor and her allies warned the government had left a substantial barrier intact by limiting publicly-funded abortions to hospitals, which could simply opt out of providing the controversial service.
The documents show, however, that Horizon Health Network, the English-language health authority that includes a dozen hospitals across New Brunswick, initially made a concerted effort to expand abortion access. (Before this year, the only places that offered abortions were two hospitals in the French network and a Morgentaler clinic in Fredericton that shut down last summer, prompting a national uproar about abortion access in the Maritimes and elsewhere in rural Canada.)
On Nov. 27, 2014, the day after the Premier announced his new approach to abortion, Mr. McGarry sent a letter asking which sites in the Horizon network would be willing to host an abortion clinic.
Miramichi's chiefs of family practice and of obstetrics and gynecology declined immediately, with no explanation. "My colleagues and I in the Department of Obstetrics and Gynaecology at Miramichi have discussed this issue and have decided that we are not able to offer this service in Miramichi. Please be so kind as to forward this information to Mr. McGarry," wrote one sender in a Nov. 28 e-mail. The sender's name has been redacted.
The response from Saint John was warmer, but still circumspect. In a Dec. 1 letter, the chief of staff and the executive director for the Saint John area expressed a willingness to host a clinic as long as their worries could be assuaged.
"The primary concern of all involved was patient and staff safety … indeed, when staff have been identified as providing abortions in our province, significant adverse events have occurred, including threats to doctors and closure of practices," they wrote.
The next day, Dec. 2, Mr. McGarry e-mailed a Horizon official in Moncton: "Looks like we may go with two clinics, on[e] in SJ and one in Moncton. Gov estimates about 600 [abortions per year] and apparently PEI wants to use NB service as well. So maybe about 650-700. SJ really wants to play a role and there are a good number of clinicians who reportedly are interested in this, so there seems to be sustainability. I think Gov wants to demonstrate some geographic expansion as well. Can we count on Moncton Hospital to be part of a two site program?"
The Saint John officials plowed ahead, producing cost estimates, drawing up floor plans and drafting a job posting for a co-ordinator of the clinic, which it intended to call the "Complications of Early Pregnancy Clinic."
In a Jan. 8 e-mail, an official whose name is redacted wrote to say some Fredericton doctors were willing to perform abortions, too. "This is great news," Mr. McGarry replied in an e-mail the next day. "We will now be able to offer service in our three major facilities … please do all that is required to get this operational ASAP. Let's be sure to hire up at the same time as other sites, as required (and roughly equivalent to what we are doing in SJ and Moncton)."
In this and several other e-mails, Mr. McGarry alludes to pressure from the government to get more abortion services running quickly.
Ten days later, Mr. McGarry met with the doctors and Horizon executives from the Moncton, Fredericton and Saint John areas at the Amsterdam Inn in Sussex, a town in Kings County northeast of Saint John.
Officials from each "zone" made a presentation. Cost was clearly a hurdle. Setting up abortion clinics secure enough to protect patients and staff would cost "in excess of $800,000" at each site and Mr. McGarry was worried there would not be enough demand to justify clinics in all three cities.
Complicating matters further, news had broken three days earlier that a doctor had bought the old Fredericton Morgentaler clinic building with money raised through a crowdfunding campaign.
Adrian Edgar planned to open a full-service family health clinic that offered abortions, although the province's hospital-only edict meant women who used the service would not qualify for public funding.
Two days later, Mr. McGarry wrote his confidential e-mail to Brenda Kinney, Horizon's executive director for the Saint John area – where he mused about the reaction of Saint John's Irish Catholic community.
He listed several more important reasons for choosing a single site in Moncton, including the fact that Moncton had the "most solid" commitment from clinicians, had already been designated a provincial centre in perinatal health and the "cost to go to three sites, and the volume being so minimal if there [is] more than one substantial site."
Later that day, Mr. McGarry wrote an e-mail to all the participants at the Sussex meeting announcing his choice. The Moncton Hospital would be the only hospital in the Horizon network to offer abortions, beginning in the spring.
One unnamed person pushed back by e-mail Jan. 22: "John; I discussed with [redacted] who was at the meeting, we have 2 issues with the decision. Having 2 centers [sic] in the same city doesn't give access to all women in the province … It is a compromise, but not a good one."
Mr. McGarry declined an interview request for this story.
New Brunswick's Health Minister, Victor Boudreau, was unavailable for an interview, but he said in e-mailed statement that questions about "service delivery" should be directed to Horizon Health. The government has no plans to fund abortions outside hospitals. "As a province, we have a responsibility to respect women's rights and our legal obligations by providing this procedure in a safe environment like any other insured service under Medicare," the statement said.