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Who Killed the Queen?: The Story of a Community Hospital and How to Fix Public Health Care
Book by Dressel, Holly
502 pages, Hardcover
First published April 11, 2008
4 people want to read
About the author
Holly Dressel
6 books1 followerHolly Dressel has been a writer and researcher for television, radio and print for over a quarter of a century. She is a bestselling author of books on subjects such as environmentalism, the sustainability of healthcare, ethics, economics, and aboriginal culture among other topics.
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January 10, 2020
The Queen Elizabeth Hospital, located in the West end of Montreal and affectionately known as the “Queen E”, has long been acknowledged as an exemplary community hospital. It was respected as the home of several medical firsts and for its delivery of community based care but was suddenly closed by government edict in 1995. The end came quickly and unexpectedly following on the heels of a newly purchased CT scanner, laparoscopy equipment and a mammography unit. To the citizens it served and the staff who worked there it was a shock and many did not believe it would happen. It did not make sense, especially with the millions spent on a recently renovated Emergency Room. But the truth lies in the fact that the closure of the hospital was never about the Queen E. itself or its role in the delivery of health care in the city. And it was not alone. Several other community hospitals across Canada met the same fate between 1994 and 1998 when Canada lost 20% of its bed capacity.
One of the last defiant steps taken by the Board of Directors at the Queen E was to hire Holly Dressel to write the history of the hospital. She has done that but she has done something more, using the history of this hospital and its closure to explore why so many community hospitals were closed across Canada in the mid-1990s. Using the Queen E as the subject of a case study, Dressel takes readers through the international financial forces, language politics and provincial political machinations to answer the question she poses in the title of the book, showing how the closures of community hospitals across the country had a significant impact on the health care system, much of which still affects us today. The closures caused grief to patients and families who relied on these hospitals for community based care. It broke up efficient specialized medical and nursing teams, interrupted paths built up over decades to provide continuity of care, ended emerging innovative research projects and cut access to preventative care, long known to help prevent disease and save lives. In its wake it left behind a health care delivery system in chaos, and without the investment in ambulatory care capacity the government promised would deliver better, cheaper and more efficient care.
Dressel offers well documented evidence that explains the closures, information that will anger and shock patients, professionals and administrators. In this investigative narrative, Dressel accuses the government of manipulating information to meet their needs, including using old data, ignoring blatantly obvious statistical errors and information out of context, doing whatever was necessary to support their arguments. Frustrated administrators, user groups and health care professionals tried to turn the tide with rational arguments, current data and relevant questions about how the delivery of health care in the city and the teaching of heath care professionals would be affected. Citizens protested in the streets. But all to no avail. Because the closures had nothing to do with the Queen E itself or its ability to delivery efficient or effective healthcare.
The government based their argument for the closures on overcapacity. They insisted there were too many in-patient hospital beds and not enough ambulatory care services, which led them to conclude they must close hospitals. The Queen E and six other hospitals in Montreal were targeted for closure. All dialogue opposing the directive was ignored or quickly shut down, with officials insisting there was no turning back despite the fact they had no plans for how to measure the impact of the closures or how the system was to manage during the gap of time between the closure of in-patient beds and the creation of the promised increased ambulatory capacity.
As Dressel points out, the closures had nothing to do with the health care or improving the system that delivered it. It was all about money and the possibility Quebec’s credit rating would be downgraded as their debts rose. With the International Monetary Fund threatening to downgrade the country’s rating, affect their ability to get credit and threatening to call in loans, they forced government to take drastic action to right things. Since health care consumed the largest portion of provincial budgets, significant cuts were deemed the way to avoid financial disaster.
Dressel has completed extensive and meticulous research to detail the Queen E’s history, medical innovations and present care practices. She uses hospital archives, media clippings, board meeting minutes and interviews with hospital staff and patients to detail the long tradition of successful patient care at the Queen E. and share the tragic results of the closure. She details its innovative Anaesthesiology Department led by Harold Griffiths, who at the Queen E adapted the dosage and delivery of curare into operating room practice in 1942, increasing post-surgical survival rates and facilitating many subsequent innovations in surgery. She describes its part as a teaching hospital in McGill medical and nursing programs and its development of a home for the only family medicine training center in the city.
Dressel then widens her lens to examine the closure of several community hospitals across Canada in the mid-1990s to show how these closures were so destructive to the delivery of patient care. She points out how governments became fixated on the concept of tertiary care super hospitals staffed by medical specialists and filled with high tech equipment but also how these mega hospitals have their own problems of over-specialization, dehumanization and increases in nosocomial infections. And as she points out, not all health care requires the level of expertise delivered in a tertiary care center. Much of the interaction between patients and the health care system is for common health problems that can be handled effectively and efficiently at small community based facilities. She also shows how these smaller hospitals provided environments that supported medical research and innovative care practices. Initiatives were not held back by the bureaucratic hoops practitioners and researchers had to go through in larger centers to get projects approved. And requests for donations and funding were more personalized and effective with a community ready to support a facility located in and supportive of their own community. As she lays out her explanations, Dressel shows how the two categories of hospitals complement each other rather than compete with each other. Both have an important role in the health care system. They provide different kinds of services which require different types of technology and differently trained staff.
In the second half of the book Dressel examines all cuts to health care. She points out issues most of the public are not aware of, pries out secrets from government documents and shows how healthcare, education and our social services are threatened by foreign influences unknown to many politicians or simply ignored. She turns her attention to the large pharmaceutical firms, insurance companies, health maintenance organizations and international lending institutions that drive up the cost of health care and put enormous pressure on universal health care. She warns against systems of mostly private care such as that in the United States and calls for a return to community hospitals and a larger role for General Practitioners in the system. Dressel makes a strong case for universal health care, presenting hard date to show how it is more efficient and leads to better health outcomes. She is equally wary of the private-public systems in Sweden and Germany but does not present a detailed analysis of their performance.
Dressel presents an excellent document to add to the health care debate, one that should be required reading for government bureaucrats, hospital administrators and health care professionals. It is a dense narrative filled with facts but moves surprisingly quickly. The amount of data Dressel was required to collect, review and analyze is incredible. She wisely uses excerpts from hundreds of interviews to break up the text, making it more readable and illustrating her points. She clearly articulates our most pressing problem: how to fund individual and public health care in an age of endless technological development when cultural, financial and political influences sidetrack our attention and steer us away from examining and analyzing hard economic data, health outcomes and clear health care policies.
Dressel has produced an interesting and informative book that deserves an important place is the health care debate. It is well worth everyone’s time and attention.
One of the last defiant steps taken by the Board of Directors at the Queen E was to hire Holly Dressel to write the history of the hospital. She has done that but she has done something more, using the history of this hospital and its closure to explore why so many community hospitals were closed across Canada in the mid-1990s. Using the Queen E as the subject of a case study, Dressel takes readers through the international financial forces, language politics and provincial political machinations to answer the question she poses in the title of the book, showing how the closures of community hospitals across the country had a significant impact on the health care system, much of which still affects us today. The closures caused grief to patients and families who relied on these hospitals for community based care. It broke up efficient specialized medical and nursing teams, interrupted paths built up over decades to provide continuity of care, ended emerging innovative research projects and cut access to preventative care, long known to help prevent disease and save lives. In its wake it left behind a health care delivery system in chaos, and without the investment in ambulatory care capacity the government promised would deliver better, cheaper and more efficient care.
Dressel offers well documented evidence that explains the closures, information that will anger and shock patients, professionals and administrators. In this investigative narrative, Dressel accuses the government of manipulating information to meet their needs, including using old data, ignoring blatantly obvious statistical errors and information out of context, doing whatever was necessary to support their arguments. Frustrated administrators, user groups and health care professionals tried to turn the tide with rational arguments, current data and relevant questions about how the delivery of health care in the city and the teaching of heath care professionals would be affected. Citizens protested in the streets. But all to no avail. Because the closures had nothing to do with the Queen E itself or its ability to delivery efficient or effective healthcare.
The government based their argument for the closures on overcapacity. They insisted there were too many in-patient hospital beds and not enough ambulatory care services, which led them to conclude they must close hospitals. The Queen E and six other hospitals in Montreal were targeted for closure. All dialogue opposing the directive was ignored or quickly shut down, with officials insisting there was no turning back despite the fact they had no plans for how to measure the impact of the closures or how the system was to manage during the gap of time between the closure of in-patient beds and the creation of the promised increased ambulatory capacity.
As Dressel points out, the closures had nothing to do with the health care or improving the system that delivered it. It was all about money and the possibility Quebec’s credit rating would be downgraded as their debts rose. With the International Monetary Fund threatening to downgrade the country’s rating, affect their ability to get credit and threatening to call in loans, they forced government to take drastic action to right things. Since health care consumed the largest portion of provincial budgets, significant cuts were deemed the way to avoid financial disaster.
Dressel has completed extensive and meticulous research to detail the Queen E’s history, medical innovations and present care practices. She uses hospital archives, media clippings, board meeting minutes and interviews with hospital staff and patients to detail the long tradition of successful patient care at the Queen E. and share the tragic results of the closure. She details its innovative Anaesthesiology Department led by Harold Griffiths, who at the Queen E adapted the dosage and delivery of curare into operating room practice in 1942, increasing post-surgical survival rates and facilitating many subsequent innovations in surgery. She describes its part as a teaching hospital in McGill medical and nursing programs and its development of a home for the only family medicine training center in the city.
Dressel then widens her lens to examine the closure of several community hospitals across Canada in the mid-1990s to show how these closures were so destructive to the delivery of patient care. She points out how governments became fixated on the concept of tertiary care super hospitals staffed by medical specialists and filled with high tech equipment but also how these mega hospitals have their own problems of over-specialization, dehumanization and increases in nosocomial infections. And as she points out, not all health care requires the level of expertise delivered in a tertiary care center. Much of the interaction between patients and the health care system is for common health problems that can be handled effectively and efficiently at small community based facilities. She also shows how these smaller hospitals provided environments that supported medical research and innovative care practices. Initiatives were not held back by the bureaucratic hoops practitioners and researchers had to go through in larger centers to get projects approved. And requests for donations and funding were more personalized and effective with a community ready to support a facility located in and supportive of their own community. As she lays out her explanations, Dressel shows how the two categories of hospitals complement each other rather than compete with each other. Both have an important role in the health care system. They provide different kinds of services which require different types of technology and differently trained staff.
In the second half of the book Dressel examines all cuts to health care. She points out issues most of the public are not aware of, pries out secrets from government documents and shows how healthcare, education and our social services are threatened by foreign influences unknown to many politicians or simply ignored. She turns her attention to the large pharmaceutical firms, insurance companies, health maintenance organizations and international lending institutions that drive up the cost of health care and put enormous pressure on universal health care. She warns against systems of mostly private care such as that in the United States and calls for a return to community hospitals and a larger role for General Practitioners in the system. Dressel makes a strong case for universal health care, presenting hard date to show how it is more efficient and leads to better health outcomes. She is equally wary of the private-public systems in Sweden and Germany but does not present a detailed analysis of their performance.
Dressel presents an excellent document to add to the health care debate, one that should be required reading for government bureaucrats, hospital administrators and health care professionals. It is a dense narrative filled with facts but moves surprisingly quickly. The amount of data Dressel was required to collect, review and analyze is incredible. She wisely uses excerpts from hundreds of interviews to break up the text, making it more readable and illustrating her points. She clearly articulates our most pressing problem: how to fund individual and public health care in an age of endless technological development when cultural, financial and political influences sidetrack our attention and steer us away from examining and analyzing hard economic data, health outcomes and clear health care policies.
Dressel has produced an interesting and informative book that deserves an important place is the health care debate. It is well worth everyone’s time and attention.
Displaying 1 of 1 review