Ontario's courts have once again ruled in favor of Scarborough residents who are concerned about the direction the Board of Director is taking regarding the quality of health care at the Scarborough Hospital.  Given the continuing and broad based opposition from doctors, nurses, residents and now Ontario's highest court, there should be no doubt that the Board of Directors at the Scarborough Hospital must resign.

The question is no longer whether the Board should resign, or be forced to resign, but how will the Ontario government intervene in this affair, and how should residents respond given the Board of Directors were only implementing the government's policies to regionalize health care away from Scarborough.

In its decision dated July 7, 2007 the Ontario Court of Appeal (CoA) supported a lower court decision arguing the Board of Directors of the Scarborough Hospital acted in a "unreasonable" manner by disallowing community members the right to vote on Board matters.

The Court of Appeal noted that the courts would not normally interfere in a hospital's affairs provided that the Board of Directors "does not demonstrate bad faith or act contrary to the rules of natural justice".  However, for all the reasons reiterated in its decision, it is clear the Board was acting in a unilateral and unjust manner that limited community input.  This is contrary to not only the Hospital's own bylaws, but even the most basic tenets of law regarding democratic fairness.  

Over the past three years not only have the Hospital Board of Directors managed to raised the ire of local doctors, the Ontario Nurses Association and local residents over their lack of responsiveness to community concerns about the quality of health care, but now the Ontario's highest court has challenged the Board's "unreasonable" approach to dealing with its community members.    For a copy of CoA decision click here...

On December 22, 2006, the ongoing debate ended up in Ontario's Superior Court where Justice Brown ruled in favor of residents, doctors and community members of the Hospital Corporation.   This decision was subsequently appealed to the Ontario Court of Appeal on March 26, 2007.

The original court challenge resulted from the Hospital's refusal last September to allow community members the right to vote on two critical issues - the appointment of new Board of Directors and a new governance bylaw that would effectively strip community members of their voting privileges.  Supported by local community associations, Ms. Lai Chu brought forward the court challenge on behalf of 70+ community members including many physicians and nurses at the hospital.

Ms. Chu states that,

“It’s sad that we had to go to court, but we had no choice.  It’s hypocritical of the hospital to say they value community involvement and then strip community members of the right to vote”. 

In his decision, Justice David Brown highlights not only the Board’s indifference to the laws governing the hospital corporation, but their hypocritical treatment of community members.   Justice Brown quotes Dr. Scott’s comments in his September 22nd letter highlighting the need to “foster further dialogue”. 

Justice Brown then concludes, 

“The evidence paints the picture of a Board interpreting the Hospital’s by-laws in an unreasonable way that places complete control of governance matters in the hands of directors and negates any meaningful role for Approved Annual Members.” 
                                        Court Decision Judge David Brown
                                        Scarborough Hospital appeal of decision
                                        Dr. Scott's & ONA comments

Judge Brown’s decision mandated a special meeting of the Hospital’s Board be convened last winter.  On that agenda was to be a proposal to revoke the directorships of existing Directors (see below for list of the Board of Directors).

Unfortunately, this isn’t the first time the Hospital’s Board of Directors have put them at the center of controversy.  Last spring, Dr. Scott stated,

“If we were to save $1 million in maternal and child health, I don’t know where that would go, but I’m not short on requests... Our commitment is to the TSH and not a building. We don’t have any loyalty to any building.  A building is a building is a building.” 

With this pronouncement Dr. Scott set off a storm of controversy that has seen local residents, community organizations and doctors at the Grace Hospital challenge the Board’s commitment to the Grace as a full-service community hospital.   Two years ago, a Hospital committee put forward a proposal to close the emergency ward of the Grace Hospital.  Last year it was the Board’s closure of the Family Wellness Clinic as well as a proposal to cut and consolidate pediatric, obstetrical and palliative services between the Grace and General Hospitals.  More recently, the doctors at the Hospital’s sexual assault centre have resigned due to funding cuts to on-call doctors.

It was only through the efforts of local residents and doctors that forced the Hospital to backtrack on its consolidation proposals, at least partially and only temporarily.  Nevertheless, physicians remain concerned about the slow deterioration in the quality of patient care, especially in the area of maternal care.

Dr. Mary Cheng states, 

“Grace obstetrics used to be famous for family-centred maternity care - this program, like the palliative, is now being destroyed.   Nurses feel the space is too tight with noisy mothers in labor down the hall from post partum mothers.  And there's no space for a decent chair for the husband, let alone for the family to visit or stay a little longer”.

Doctors would like to see a solution that affords the highest standard of care to all members of our community, rather than one that simply addresses wait lists for elective surgeries. 

The ongoing debate has seen no shortage of recriminations from politicians and hospital administrators who have used "bullying" tactics on opposing doctors and residents.  One such incident saw the local politician intimidate an opposing doctor to the point of tears at a public forum.  On another occasion the same politician demanded that residents prove to him that the hospital needs more funding – a comment that drew loud criticism from his constituents.  Only under intense pressure from local residents, did the Ontario government recently highlight some new funding for the hospital.

At the center of the controversy are two very different visions for the future of a community hospital that is experiencing significant growth in its catchment population. 

• On one hand, community organizations, residents and doctors want to see the Grace Hospital grow as a broad spectrum community hospital providing a full range of health care services from “cradle to the grave”.  

• On the other hand, the Hospital's Board of Directors supported by provincial politicians want to see greater specialization and regionalization of services with the Scarborough Hospital becoming a regional “centre of excellence” for elective eye, hip and knee surgery. 

Unfortunately, as one elderly woman put it, “while creating centres of excellence sounds great, what about the Grace Hospital’s existing centers of excellence in maternal, new born care, palliative and pastoral care.”  Both have given the hospital a well-deserved reputation as an innovative and caring hospital.  

Under Dr. Scott’s direction, the Hospital’s Board of Directors has steadfastly pushed the consolidation model of health care as a means to improve the cost-effectiveness of health care services in Scarborough.   However, governance of a not-for-profit organization must go beyond addressing fiscal concerns, especially when they impact the most vulnerable of patients (i.e. newborns, mothers and palliative patients).   Effective stewardship requires not only ensuring its cost-effective mandate does no to harm the quality of patient care, but the hospital must also balance its fiscal mandate against the need to maintain stakeholder credibility with both hospital staff and the broader community it serves.

Regardless of where one’s opinion falls on this debate, there seems consensus on the badly managed community engagement process that has pitted local politicians against residents, hospital administrators against professional staff, and doctors against doctors at the Grace and General sites.  The fact that this discord has continued over a period of years suggests that there exists a more fundamental problem with the leadership offered by the Hospital’s Board of Directors.  The Court of Appeal further challenges the Board's competence and stewardship of our community hospital.

Change may be necessary, but as most organizations know, it can and must be managed.   The continuing acrimony among stakeholders suggests the Board has not done a good job consulting stakeholders on its proposed vision for Scarborough’s community hospital.  

For all the reasons stated above, the Scarborough Hospital’s Board of Directors must resign.  Scarborough residents deserve better!