Staffing Muskoka Algonquin Healthcare’s (MAHC) two obstetrical units with primary obstetrical (OB) nurses at all times has been an ongoing challenge for two years and doesn’t show any signs of getting easier, chief nursing officer Bev McFarlane reported to the MAHC board of directors at their last meeting on May 8.

“We have been, over the past two years, trying to increase our ranks. We’ve sent I think six with two (more) going from South Muskoka (Memorial Hospital [SMMH]) for extensive training but then people leave (or go) to other positions and as we get the cup filled up it seems to empty out the bottom again,” she said.

In order to properly cover both obstetrical wards, including circumstances such as maternity leaves, the equivalent of 14 full-time nurses is required.

McFarlane’s report states that currently SMMH has only the equivalent of six full-time nurses while Huntsville District Memorial Hospital (HDMH) has 10.5.

She said over the last two years there have been times when a patient has been diverted from one site to another due to a nursing shortage.

At the meeting MAHC chief of staff Dr. David Mathies told the board that there are about 400 to 420 births per year, which equals just over one a day for the entire organization.

He said that while both sites have experienced nursing shortages at one time or another, “my concern is if it happens on the same day and both sites have a shortage then I’m not sure what we’re going to do.”

Mike Provan, MAHC board chair, asked Mathies if it would be more efficient to have only one hospital in Muskoka with an obstetrical unit.

“No question. The budget and efficiency would like it. I don’t think the communities would.”

McFarlane stated in her report that to operate one unit for Muskoka instead of two, the equivalent of 20 to 21 full-time nurses would be required, as opposed to the 28 needed now.

Mathies added that there is no safety or medical reason to amalgamate the OB units, stating that research shows no increase in infant or mother mortality by operating low volume OB units, such as the ones in Bracebridge and Huntsville.

Both Mathies and McFarlane noted that, because the two OB units are low-volume, beds are filled with patients from other areas, which the nurses care for when there are no deliveries.

McFarlane said that may be a contributing factor to the shortage, since some nurses might not want to care for other patients, or may find balancing the two duties difficult.

“(The challenge is) how do you provide the obstetrical unit in a manner that allows you to have the staff there to provide it seamlessly and we’ve had some rips in the seams,” she said.

In the end an amalgamated obstetrical operation may not be MAHC’s decision to make.

Currently, MAHC is working with the North Simcoe Muskoka Local Health Integration Network (LHIN) to reduce a $1 million operating deficit for 2008/2009.

In the April 21 medical advisory committee meeting minutes, which were presented and passed at Thursday’s meeting, it was noted, “If a Ministry of Health supervisor is assigned to MAHC, one OR (operating room) and one obstetrical unit would likely be established.”

Barry Lockhart, CEO of MAHC, told this newspaper that his recollection of that discussion was that it was a “worst case scenario” and stressed that he believes MAHC is nowhere near a situation where a supervisor would be called in.

He said there are a variety of situations in which the ministry would appoint a supervisor, such as the hospital board as a whole resigning or a significant deficit situation. He cited one hospital in southern Ontario where a supervisor was called in because the hospital was operating at a $50 million deficit.

Lockhart says MAHC continues to meet with representatives from the LHIN each week and that progress continues to be made on reducing the deficit.