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.

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.