Get on with it and build two hospitals


Editorial - Survey results in La Presse this week suggest 76 per cent of Montrealers would be happy to save money by having just one big bilingual new teaching hospital, instead of two. How discouraging it must be for all those who have worked so hard on this project to learn so few Montrealers understand what it's about.
To see all the faults of the "one big hospital" notion, it helps to understand the current plan, which has been debated and revised and refined over more than a decade. It calls for two new teaching hospitals, one for the McGill University Health Centre and one for the Centre hospitalier de l'Universite de Montreal. The U de M project is to be built at and near St. Luc Hospital in the eastern part of the city centre; the MUHC will be near the Vendome metro and commuter-train stations.
Each would provide state-of-the art facilities for patient care, as well as for teaching and medical research. Each will open its first phase in 2010. Each will cost more than $1.1 billion: at least $800 million from the Quebec government, the rest from a fundraising campaign, federal contributions and perhaps private entrepreneurs. Each will have other, existing, related hospitals to handle some primary care and certain other services.
Why two, at this price? Here's why:
First, Montreal has two medical schools, each excellent. Since they do things differently, in different languages, they need distinct teaching facilities. Nobody would seriously propose merging McGill and the U de M, or their medical schools. So how could the hospitals be merged?
Second, while all of Quebec's so-called "English" hospitals are in fact rigorously bilingual, francophone hospitals are not, and by law are not supposed to be. It's hard to imagine any government softening the language law in this regard; far more likely would be a plain and damaging loss of medical service in English.
Third, few hospitals anywhere have anything like 1,400 beds; experience shows 1,000 is the practical maximum. Opening the new hospitals would already entail a reduction in the city's total number of acute-care beds; nobody can want to cut out 400 more.
By coincidence, The Gazette's editorial board met Tuesday, the day before the poll numbers came out, with Dr. Denis Roy, executive director of the CHUM. He has just been through the process of working out the arrangements for transition to the CHUM's new functional organization, and speaks proudly of "CHUM 2010." We happened to ask about the one big hospital notion, and he dismissed it out of hand, explaining the complications and summing up by saying flatly "c'est pas vivable."
To their credit, Premier Jean Charest and Health Minister Philippe Couillard insist they are committed to the two projects. But they've been saying so for three years, and we don't seem to be much closer to construction. Quebec's budget for the fiscal year starting tomorrow, made public last week, contains not one penny for the hospitals. And while the cabinet might understand how their beloved "public private partnerships" fit into all this, nobody else does.

Nor have Charest and Couillard been clear about costs. The $800 million figure for Quebec's contribution to each project is getting shopworn, as inflation - which is substantial in the construction sector - works away. Until recently, the cabinet has clung to $800 million; now reality has taken hold and top officials are revising the numbers.
Meanwhile, time keeps ticking by. The Parti Quebecois might be divided on this issue but some elements of the party, at least, are hinting that Quebec can't afford two such projects. An election is now perhaps only a year away, and a Liberal leadership race could conceivably come sooner.
Even if the new hospitals open in 2010 as scheduled, it will have been 17 years since the idea was born. It has become urgent - the word is not too strong - that Quebec quit ragging the puck and get these projects under way. Roy expects to call for tenders this fall; so does his opposite number at the MUHC, Dr. Arthur Porter. There must be no more slippage. We can't afford further delay.

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