Why is this ER in cottage country closing? Doctors, health officials say they’re baffled

It’s a good-sized letter in a small-sized newspaper — about eight paragraphs in all, long enough to catch your eye as you turn the page, but easy enough to miss if you’re in a hurry.

It’s a farewell lament, of sorts, to a community that’s about to lose its emergency department.

Beginning “To the Minden Community,” it’s written by a doctor representing a group of physicians who will no longer be providing their services there to the people they believe are being failed.

The letter, which appeared in this week’s The Highlander, which serves the Haliburton Highlands, is also a snapshot of the kind of debate that’s roiling communities across this country, as cash- and resource-strapped health-care systems struggle to provide adequate levels of care to local patients.

“As physicians of the Minden emergency department, we would like to express our sincere appreciation and support to the wonderful community we have had the privilege of serving for the past 28 years. It has been an honour to provide emergency medical care to you, our adopted neighbours, friends and community members during some of your most vulnerable moments,” writes Dr. Dennis Fiddler on behalf of the Minden Physician Group.

“It is with a heavy heart that we must inform you that the decision to close the Minden ED was not ours to make. Despite our best efforts and unwavering commitment to the community, circumstances beyond our control have led to this challenging decision by Haliburton Highlands Health Services (HHHS).”

The closure, announced last month by the HHHS board, is just one example of the ongoing strains Ontario’s health-care system is facing. In a news release, the board said Minden emergency services would be “brought together” with those at the Haliburton Hospital, about 25 kilometres away, on June 1.

The decision has been widely condemned by community residents, elected officials and health-care workers, and has prompted questions in the legislature, petitions, protests and a human rights complaint.

HHHS CEO Carolyn Plummer previously told the Star that the decision to close was made due to “significant and persistent physician and nursing staff shortages experienced by HHHS, as a result of the global healthcare staffing crisis.”

In an emailed statement on Tuesday, Plummer said the “consolidation” of emergency services at the Haliburton site “has nothing to do with the exemplary care provided by the physicians and staff of the Minden emergency department.”

Notably, the Minden site was not one of the 24 Ontario hospitals that were forced to temporarily close their EDs over the last year, as found by a recent Star analysis.

The sadness expressed by the Minden ED doctors joins that of five former HHHS board chairs, who slam the decision as “unconscionable” and one that flies in the face of reason and community support.

That message, conveyed in another letter published in local media, notes that the decision was made “with a complete lack of transparency,” without consultation with the communities most affected by the move, and note that the announcement — just six weeks before the June 1 closure — provides “little or no time for careful planning or reasoned community input.”

“As past chairs, who have helped guide the development of Haliburton Highlands Health Services (HHHS) since its inception, we strongly disagree with the announcement by the corporation regarding the closure of the Minden Emergency Department,” write the former board chairs in a letter published in The Minden Times this past week.

“The action is unconscionable in so many ways and flies in the face of more than two decades of responsible health care developed by the corporation.”

Jack Brezina, one of the signatories to the letter who served as board chair of HHHS 20 years ago, says neither the current board nor CEO have offered much concrete reasoning for the closure.

“This facility was always open and staffed to the point that it was operational,” Brezina told the Star, adding that the decision to close seemed to “come out of the blue.”

Indeed, in his letter on behalf of the Minden ED doctors, Fiddler says his group was informed of the decision to close just a few hours before the public media release on April 20.

He notes that before the closure was announced, the Minden ED had coverage until September 2023, with a small amount of support coming from Health Force Ontario, a government job board that connects Ontario doctors with shifts that need filling.

“In the fall, there were physicians who were expected to fill these gaps, bringing us back to full coverage,” Fiddler writes, adding that the ED is staffed by doctors who are based at other hospitals in the surrounding areas.

Fiddler says in his letter that the Minden physician group became involved in service-reduction discussions over the past two years and offered to support “various reduction options that involved partial ED closure scenarios, but we were clear that we could not support a full closure scenario for one of the EDs.”

“We told the HHHS Executive and Board in February 2022 we could not provide physician coverage if one of the EDs were going to close, and it is still the case today,” he writes.

Plummer told the Star that when it comes to staffing at the Minden site, “as we know from 18 months of on-going shortages, having a full roster doesn’t stop a physician from needing to call in sick on relatively short notice and HHHS having to scramble to fill that shift.”

“As well, it does not address the on-going and persistent shortages of nursing staff,” she said. “Our EDs cannot operate without adequate nursing coverage, which has been the cause of numerous ‘close calls’ for temporary closures at both the Minden and Haliburton EDs over the past 18 months.”

Brezina wonders why the rush to close the ED, noting that the coming May long weekend marks the beginning of the busiest season in the Haliburton Highlands as camps begin to fill up with kids, resorts start accepting guests and cottagers arrive.

“I would say it’s four or five times the population and even more because everybody brings family and friends up to the cottage for the holiday weekend,” he says. “That’s when the two emergency departments are the busiest.”

Kenyon Wallace is a Toronto-based investigative reporter for the Star. Follow him on Twitter: @KenyonWallace or reach him via email: kwallace@thestar.ca