A group of County-based health care advocates are again urging Ontario’s auditor general to launch a full-scale investigation into Haliburton Highlands Health Services’ (HHHS) closure of the Minden ER.

Jeff Nicholls, Adria Scarano, Aurora McGinn, and Tracy Klompmaker have been leading the charge behind Minden Paper, a group of working professionals who have spent the past 12 months analyzing HHHS’ reasoning for the shuttering.

Last November, the group wrote to Shelley Spence, Ontario’s auditor general, and the office of the integrity commissioner, to request a thorough investigation. Nicholls said the team, which also includes an advisory group of 10 to 15 other people located across Canada, had spent more than 9,000 hours compiling data from HHHS and every hospital in Ontario from the 2022-23 fiscal years.

“We believe the closure of the Minden emergency department serves as a microcosm for what’s happening to hospitals, and health care services, across Ontario,” Nicholls said.

The decision to close the Minden site was made by the HHHS board last spring. It shuttered six weeks later. Board chair David O’Brien stated repeatedly over the following weeks that the decision had more to do with a local health care worker shortage than money, but Nicholls and the rest of the Minden Paper team disagree.

They have questioned how the organization’s deficit grew from $220,000 in June 2022 to approximately $4.1 million in March 2023.

Spence replied to Minden Paper March 19, stating much of the requested information was included in a 2023 report the auditor general’s office compiled looking at emergency department issues provincewide. Spence said several recommendations have been submitted to the Ministry of Health, Ontario Health, and dozens of hospitals, though she did not state whether HHHS was on that list.

The auditor general’s office will follow-up on the status of those recommendations this year, with a public report to be published in 2025.

Nicholls contends the Minden Paper team has uncovered a major oversight in the auditor general’s report, which claims HHHS extensively utilized the Health Force Ontario Locum program – to fill physician ER shifts – at its Haliburton and Minden sites between 2020 and 2023, logging more than 4,000 hours. Nicholls claims the program was rarely used in Minden, as corroborated by former Minden ER doctor Dennis Fiddler in a 2023 letter.

“Minden did not use the locum program for physicians until April 2023… the AG’s audit oversights regarding usage – incorrectly suggesting Haliburton and Minden used the locum program in equal amounts – raise serious concerns,” Nicholls said.

The team called on the auditor general’s office to re-evaluate data regarding Minden’s use of the locum program and amend its 2023 report.

Spokesperson Becky Fong said the auditor general’s office “carefully considers” all information when selecting and planning audits, including information submitted by the public, but noted, “we do not comment on specific details of information received by our office, or with respect to any planned or ongoing audit work.”

When audits are complete, they are tabled in the Legislature and then made public, she said.

Lauren Ernst, communications lead at HHHS, told The Highlander that HHHS did not distinguish separate numbers for locum program usage for Haliburton and Minden, instead grouping the two hospitals together in its reporting. She noted the sites utilized “almost” 4,000 physician hours between April 2022 and March 2023.

McGinn said she, and the community, are still waiting on answers.

“People still don’t really understand why this happened… we need to address the lack of accountability and transparency before we can move on,” she said.

Slippery slope

Klompmaker said she inspected year-end financial reports from hundreds of hospitals in Ontario, to see if the problems plaguing HHHS were happening elsewhere. The results, she said, were alarming.

Klompmaker found that 102 hospitals ended the 2023 fiscal year with a deficit – an increase from 33 at the end of the 2022 fiscal year. The average deficit rose by 992 per cent, from $545,000 to $5.9 million, with the total deficit climbing 3,300 per cent – from $17.9 million to $610 million.

Five hospitals have released projections for the 2024 fiscal year – Niagara Health System, Brant Community Healthcare in Brantford, Joseph Brant Hospital in Burlington, St. Joseph’s Healthcare in Hamilton, and Hamilton Health Sciences. Collectively they are anticipating their deficit to grow 280 per cent, to $145.8 million from $38.3 million in 2023.