The mayor of Caraquet is promoting a radical change to health care in northern New Brunswick to deal with chronic staff shortages: fewer hospitals offering specialized services.
Bernard Thériault says pediatric and obstetric services in Miramichi, Bathurst and Campbellton should be centralized in a single location at the Chaleur Regional Hospital in Bathurst.
Thériault, a former provincial cabinet minister and former chief of staff to a Liberal premier, says it's unworkable to have three specialist teams in three hospitals serving an ever-shrinking population.
"We've seen in the last few years that it's a constant battle to keep some staff there," he said. "But by only keeping one, you don't have to have three obstetricians standing by at the same time"
Bathurst would be 'super-regional' centre
In his model, Campbellton and Miramichi would continue to offer other services, but those most often affected by shortages would exist only in a "super-regional" hospital in Bathurst.
"It's a matter of volume, and the population is not there anymore. Those three regions combined together hardly pass the 100,000 mark, which is not even considered the number for a regional hospital. And we're dealing with three here."
The summer of 2022 has seen a wave of temporary service shutdowns at various hospitals around the province.
In Bathurst, what was supposed to be a four-and-a-half day closure of pediatric services starting in late July has now stretched into its third week.
"The shortage of nursing resources is currently exacerbated by the summer period, the pandemic and staff burnout," the Vitalité Health Network said in news releases announcing the initial closure and the extension.
Thériault compared the sporadic shutdowns to a game of musical chairs.
"Right now you have three systems that don't work. Every single day one of them is shut down. .... Let's make sure we're dancing on chairs that are solidly installed, in one regional service."
Vitalité's vice-president of medical affairs, Dr. Natalie Banville, told CBC's Shift New Brunswick that the challenge with pediatrics is that it requires specialized nurses who can't be easily replaced from elsewhere on the staff if someone is sick or on vacation.
She said a decision to merge services from several hospitals would not be made by the health authorities alone.
"It's not under us. It has to come from the government, through consultation with the public, with everybody. … It's out of my field."
Thériault said he pitched his idea a few months ago to the then-health minister Dorothy Shephard and to Gérald Richard, who was co-chairing a provincial task force on the province's health plan.
Richard was appointed trustee of the Vitalité last month, replacing its board of directors.
Thériault said Richard was "very positive to that approach of centralizing."
The Department of Health did not respond to a request for comments on the mayor's suggestion.
In July, Premier Blaine Higgs suggested a "bureaucratic stalemate" and management procedures, not staff shortages, were to blame for long emergency wait times and service interruptions.
He said he wanted to see hospitals work together more closely to co-ordinate services.
"I don't believe this has anything to do with — and I'm just stating an opinion here — anything to do with the nurses on shift or the people on shift," Higgs said July 15. "I believe it is a management issue. I believe there is no co-ordination of activity."
Hospitals are sacred cows, mayor says
Thériault said he expects a negative reaction to his idea because hospitals are sacred cows in their communities.
He pointed out the Higgs government was almost toppled in a no-confidence in early 2020 over its plan to close the emergency departments at night in six small hospitals around the province, including Caraquet's.
"'Don't touch my hospital' is still very, very highly pronounced," he said.
But he added: "Even if people from my area may not be happy about that, I'm saying it's not only the best way to do it, it's the only way to make it work."
Campbellton Mayor Ian Comeau said Thériault's suggestion is unacceptable and is based on a subjective look at health care in northern New Brunswick.
Bathurst may be the centre of an area that covers Campbellton to Miramichi, but Comeau said people in Saint-Quentin and Kedgwick also use his city's hospital. Leave out Miramichi, and the "central" location is Campbellton, he said.
Campbellton's hospital serves 25,000 people in health zone 5 and another 15,000 across the river in Quebec, with that province's government paying New Brunswick for the service.
Comeau said rotating some services throughout the north may work but he'd resist anything more.
"Even if we have to look at having services one week here, one week there, that would be good, but I'm certainly not in favour of totally centralizing things to the Bathurst area."
Comeau added that Thériault was part of two Liberal governments that either cut health services or didn't do enough to head off predictable staff shortages.
"He should look himself in the mirror and say, 'What went wrong?' and 'Why did we do such things?' I think it's coming to haunt him now."