Karen McGrath, president and CEO Horizon Health Network in the atrium at Sackville Memorial Hospital
“I’ve always wanted to be a CEO of a hospital,” Karen McGrath told the Advertiser, the newspaper in the small town of Grand Falls-Windsor as she reminisced in January 2013 about her six years as Chief Executive Officer at Newfoundland and Labrador’s central health authority.
“The position as CEO of Central Health was my dream,” said McGrath, who now serves as President and CEO of the Horizon Health Network in New Brunswick.
“I had many hospitals. I had two referral centres and many other smaller hospitals,” she told the Advertiser. “I can generally say by and large that I was living a dream. Every day I came to work I enjoyed the challenges that were presented to me.”
When she spoke those words seven years ago, McGrath was leaving one of those challenges behind as she prepared to take up her new post as President and CEO of the Georgian Bay General Hospital (GBGH) in Midland, Ontario.
A week after the Advertiser published its story about her departure, the newspaper covered one in a series of protest rallies held in several communities.
“Armed with brightly coloured signs, supporters braved the cold Thursday morning to gather in front of the Carmelite House long-term facility in Grand Falls-Windsor,” the paper reported.
It explained that registered nurses and their supporters were protesting against a plan, announced several months earlier and backed by McGrath, to cut the number of RNs on the overnight shift from two to one at nearly all rural clinics, health centres and long-term care facilities in central Newfoundland.
The Advertiser quoted Debbie Forward, president of the provincial nurses’ union, saying she had been assured that the number of nurses would not change because RNs would be moved around, but she worried that reducing overnight staffing levels would affect patient safety.
“That’s fine for the nurse, they’ll still have a job, but it’s the impact on healthcare in these communities,” she said.
“As you decrease the number of registered nurses within a facility, you increase the incidence of infections, of falls, of urinary tract infections, respiratory infections,” Forward said on the day a 4,500 signature petition against the nursing cuts was presented to the provincial House of Assembly.
But in spite of continued protests, the nurses lost their fight and today, the RN staffing reduction is still in effect, one of many instances in which frontline healthcare workers and their supporters were overruled by cost-conscious administrators and the politicians they serve.
However, as the next stage of Karen McGrath’s career illustrates, it doesn’t always work out that way.
When McGrath took over as President and CEO at Georgian Bay General Hospital in 2013, GBGH was facing serious financial problems. The consulting firm, Geyer and Associates, was hired in 2015 to conduct an operational review.
Its report noted that the hospital had a long-term debt of $10 million and it called for reductions in expenses of $5.2 million.
Among other things, the consultants recommended closing the hospital’s maternity ward, cutting surgery times, removing beds in the intensive-care unit and shutting down the cafeteria.
According to the Midland Mirror, McGrath said that the measures would ensure the hospital stayed open. “This is not death by a thousand cuts,” the newspaper quoted her as saying. “We are planning that this will make us stronger and position us to grow in the future.”
A storm of opposition followed from members of the public who were especially upset over the plan to end childbirths at the hospital.
Doctors warned that GBGH might not survive the proposed cuts and that First Nation and francophone communities had not been consulted about them.
The nurses’ union wrote to the local paper saying the cuts could lead to increased suffering and even death while the local member of the legislature, who also happened to be the leader of the opposition, tabled a petition with almost 16,000 signatures calling on the provincial government to stop the cuts.
About 10 months after the recommendations were made public, the hospital board voted against implementing most of them which meant that GBGH would need to find other ways to trim its deficit of about $1.2 million.
“We have not identified other areas in terms of savings. This is the challenge ahead,” the local paper quoted McGrath as saying in October 2016. “Since we’re not really doing any of the cost-savings things the report recommended, it will still leave us with the shortfall we had before the report was released.”
About two weeks later, McGrath announced her departure to become President and CEO of the Horizon Health Network in New Brunswick, a job with increased responsibility and substantially higher pay.
Public documents show that in her last full year at GBGH, McGrath was paid $208,565.44 while the latest figures from the New Brunswick government show her earnings in 2018 at Horizon Health fell within the range of $275,000 to $299,999.
Now, McGrath finds herself embroiled once again in an outcry over cuts that according to CBC, were actually much milder than ones proposed in 2014 before she joined Horizon.
The minority Conservative government has postponed the latest cuts for now, but both Premier Higgs and McGrath say that something will have to be done to make health care here “sustainable,” especially in light of looming shortages of healthcare workers.
During a news conference in Sackville last week, McGrath was asked how she would compare New Brunswick healthcare with the services delivered in the two other provinces where she has worked.
“I think we have a superior system in New Brunswick,” she answered. “It is a system that is focussed on quality and safety. It is a system, though, that is starting to show cracks,” she added. “That is forcing us I think to make some hard decisions that are not popular.”
It remains to be seen, of course, how the healthcare system’s “cracks” get repaired and whose “hard decisions” are finally implemented.
As an online essay by Dr. Chris Goodyear, president of the New Brunswick Medical Society shows, there are sharp divisions, once again, between frontline caregivers and the senior administrators and politicians who oversee the healthcare system.
Commentary: Community hospitals have ‘a duty to the living’
by Alexander (Sandy) Burnett
Alexander (Sandy) Burnett
Horizon Health CEO Karen McGrath seemed perplexed last week.
Faced with questions from the public and the press about planned reductions in service at six small-town hospitals across New Brunswick, her standard answer suggested a serious lack of understanding of the sense of community ownership that has fostered the development of healthcare in this province for over a century.
“This is not a consultative process,” she declared. “This is me… coming up with a plan.”
In fairness, Ms. McGrath, who has degrees in Business Administration and Social Work, speaks from the perspective of a seasoned administrator. Before her arrival in New Brunswick three years ago, she had more than 10 years of experience as a CEO, at the Georgian Bay General Hospital in Midland, Ontario, the Central Health Authority in Newfoundland and Labrador, and the Ontario Division of the Canadian Mental Health Association. Sad to say, such employment does not seem to have prepared her very well for public engagement and accountability.
That is unfortunate, as she now finds herself face to face with the passionate belief of local citizens in Sackville, Sussex, Perth-Andover, Grand Falls, Caraquet, and Richibucto that they have the right to participate in decisions affecting the healthcare facilities of their communities. And as of the weekend, even Premier Higgs reluctantly conceded the point.
Before getting embroiled further in head-to-head debate with a significant percentage of the population, Ms. McGrath might do well to inform herself about the history of community engagement that underlies such fierce opposition to her seemingly inflexible position.
Six years ago, I was commissioned by the Tantramar Heritage Trust to write a history of local healthcare, later published under the title A Duty Toward the Living.
I drew that title from a letter to the editor of the Sackville Tribune, written by William B. Fawcett and published on March 10, 1919. In it, he applauded the idea of establishing a community hospital as a memorial to soldiers lost in the First World War, and backed it with a pledge of $10,000 (about $144,000 in today’s currency) to start the ball rolling.
Explaining his gift, he stated, “Outside of all the sentiment surrounding the idea of a monument to the dead…I believe Eastern Westmorland is in even greater need of such a Public Hospital as a duty toward the living.”
It would be another 25 years before the Sackville Memorial Hospital finally opened its doors, but the concept that the community at large had “a duty to the living,” has remained central to Sackville’s view of healthcare from that day to this.
Sackville Memorial Hospital officially opened in August 1946
Throughout that century, the people of Sackville and eastern Westmorland County have consistently embraced that sense of duty by way of selfless volunteer service on boards, committees, the Auxiliary, and the Hospital Foundation, and through generous support of fundraising. Their goal? To build, maintain, and enhance a place where the health and wellness needs of the community could be met or, if need be, effectively referred to other centres for more advanced care.
Some of those efforts were as down-to-earth as donating locally made jams and jellies to the hospital kitchen to sweeten the breakfast toast served to patients. Others were as complex as the raising of millions of dollars over the years to purchase life-saving equipment for local use. Small wonder that members of the Tantramar community, from Dorchester to Cape Tormentine and beyond, have a proprietary sense of “their” hospital.
The editor of the Tribune-Post summed up that attitude in an editorial published on September 29, 1960: “We must remember that the Sackville Memorial Hospital is our hospital, built by the community and controlled by a Board of Trustees made up of local people who give of their time and energy without any remuneration. It is an institution in which the people of the community take justifiable pride. We want to continue to control its administration and operation. Our only means of keeping it that way is to maintain and strengthen local interest.”
In the years that followed, with the introduction of Medicare and a steadily expanding role for federal and provincial governments in providing state-of-the-art healthcare across Canada, that dedicated local commitment was enhanced by massive support from the higher levels. But the sense of local ownership and accountability never diminished.
In May 1986, the Board of the Sackville hospital adopted a new mission statement in which that determination was clearly evident: “The hospital provides primary medical, emergency, obstetrical, surgical, and ambulatory care, supported by diagnostic and consultative services; enhances access to secondary and tertiary care through integration with the larger health system; and maintains contact with discharged patients to ensure continuity of care.”
A year later, hospital administrator Neil Ritchie put it this way: “Family medicine is still our focus. Your family doctor is still in the best position to decide what health service you need. We [the hospital] are here to support the community and to enhance the ability of the family doctor to deal with your problems.”
It came as a shock, then, in March 1992, when provincial health minister Russ King announced the dissolution of the hospital’s Board of Trustees and a reduction in local services, amalgamating all independent hospitals within new regional authorities.
Board chairman David Jones reported it this way to a sombre meeting in Sackville: “Effective April 1, this board has no more power and no more purpose. I attended a meeting in Fredericton today. I was there to represent not only this board but all previous boards that helped build Sackville Memorial Hospital and make it what it is. And there was not one word of acknowledgment of those volunteers.”
It is significant that, despite that takeover 28 years ago, despite the consolidation of eight regional authorities into two province-wide networks (Horizon and Vitalité) and despite the transfer or reduction of some services, community loyalty has remained strong. The people of Tantramar have sustained a healthy desire to influence, support, and enhance “their” system, raising millions of dollars to keep the Sackville Memorial Hospital at the forefront of community medical care.
In view of this vital record of involvement, it should have come as no surprise to Ms. McGrath, her associates, and her political masters in Fredericton, that this community and others expect and demand open and constructive consultation on how best to achieve needed adjustments to the healthcare system.
She herself, on taking up her duties as CEO of Horizon, stated: “Engagement is the key to success — with patients, staff, physicians, and our communities.”
At the time, that sounded like a commitment to a consultative process. The supporters of small community hospitals across New Brunswick expect no less.
Alexander (Sandy) Burnett has lived in Sackville since 1978. Formerly employed as a teacher and with the National Film Board of Canada, he has been a freelance writer and communications consultant since 1984, working for a wide range of clients, among them the Canadian Wildlife Service, the Nature Conservancy of Canada, Ducks Unlimited Canada, and the World Wildlife Fund. His articles have appeared in a variety of publications including Canadian Geographic, Equinox, Harrowsmith and Nature Canada. He is the author of a number of books, among them: On the Brink: Endangered Species in Canada; A Passion for Wildlife: The History of the Canadian Wildlife Service; and A Duty Toward the Living: A History of Healthcare in Tantramar.