For the second time in a decade, there’s a proposal to close one of Scarborough’s maternity wards. Currently, the area’s population of about 632,000 is served by three of them, each in a former standalone hospital that over the years have become the Birchmount, General and Centenary campuses of the consolidated Scarborough Health Network (SHN).
In January, SHN administrators decided to close maternity and pediatrics at its Birchmount campus. That would mean no maternity ward above Highway 401 in north Scarborough, where the population of about 200,000 is higher than in smaller cities that do have maternity wards, such as Cambridge and St. Catharines.
“People will get whatever service they need, no matter where they come from in the Scarborough Health Network,” said Dr. Dick Zoutman, SHN’s chief of staff. Even if that’s true, the reasons for making often racialized, low-income patients travel farther for that service isn’t quite clear. Especially since not much seems to have changed since 2013, when a proposal to close obstetrics at the General campus was declared unsafe.
Obstetrics is the number one service patients use at SHN – there are 6,424 births there a year, the fourth highest volume in the province. Birchmount has the lowest number of births of the three campuses: 1,720 a year at last count, versus 2,581 at the General and 2,118 at Centenary.
In early January, SHN released a review of its women’s and children’s services, citing those numbers as the reason that Birchmount’s obstetrics program isn’t needed. Low birth rates were blamed for high turnover among staff, and for making it hard to attract medical students. The reasons behind ending pediatric services were less clear.
The review was informed by consultations with doctors, midwives, nurses and residents last fall, Dr. Zoutman said. “We wanted to hear from our clientele, our patients,” he said. “What was important to them, what matters." All in all, 300 people participated, including 64 “community members” who completed a survey.
The survey didn’t specifically mention a potential closing, Dr. Zoutman said, but was made up of “open-ended questions." Some were sent out in the area’s two most common non-English languages, Tamil and Traditional Chinese (a dialect less common on the mainland, where the majority of Toronto’s most recent immigrants come from).
That’s important, because demographic differences between north and south Scarborough are significant. In 2017, 84 per cent of those north of the 401 fit into the census category of “visible minority,” compared with 66 per cent of those to the south. Scarborough’s higher-income neighbourhoods are also in the south, which makes transportation an issue.
SHN says the majority of obstetric patients arrive by car, but that doesn’t mean they own one. This isn’t about twice-yearly dental checkups: late pregnancy can mean multiple medical appointments a week. An extra 10 kilometres means a big fare hike for those taking taxis. And my deepest sympathies to those in their third trimester relying on the lurching buses of Scarborough to get them anywhere.
Neighbourhood associations are dead set against the closing, including the Chinese Outreach Committee. Founded by May Ye Lee, it has raised more than $2-million for Scarborough hospitals, and had much to say about how they’re run. That includes helping to mount a successful opposition to the 2013 proposal to end maternity services at the General campus.
Pushback then led the health network to put together a panel of medical experts and one resident to review its proposal. The panel rejected every single recommendation. Noting a number of “clear clinical risks" over all, it emphasized that reducing obstetric services had the “potential to significantly, and negatively, impact timely access to care for a large proportion of the population.”
This time around, 130 doctors have signed a petition against the closing of obstetrics and pediatrics, which they say will reduce the standard of care in an emergency department that treated 8,625 children last year.
Dr. Zoutman said no such review is planned this time. To him, the closing is a done deal. “We are now in the implementation phase,” he said, which will involve about six months of planning, then about another six actually making the changes.
The SHN head didn’t answer whether he anticipated any job cuts, but emphasized that money isn’t the issue. “This decision is part of our broad, very exciting and bold plan for delivering premium, high-quality health-care services for all of Scarborough,” he said. “It’s not a funding decision at all.”
It’s hard to understand exactly why this is happening, if there’s no financial pressure and widespread community concern. The end result is that the people of north Scarborough are losing a space to welcome their babies, and nearby doctors to care for their children.