The life and death of a hospital

History of Queen E offers lessons for policy-makers

Saturday, May 17, 2008

More than a decade after the Quebec government abruptly closed the Queen Elizabeth Hospital in Notre Dame de Grâce, many doctors and nurses who worked there are still angry and bitter about the decision.

Affectionately known as the Queen E, the small community hospital was beloved by its patients, and news of its imminent closing drew thousands of protesters to the streets.

In Who Killed the Queen?, Holly Dressel revisits the scene of the crime, investigating the bureaucratic machinations that led to its closing, along with six other Montreal hospitals in 1995-96. In one of the last defiant acts of the Queen E's board of directors, Dressel was commissioned to write a history of the hospital. She has delivered much more than that.

The book is filled with fascinating historical tidbits, ranging from an account of the hospital's innovations in anesthesiology that revolutionized surgery after the Second World War to descriptions of nurses serving wine in crystal goblets to wealthy patients willing to pay in the early 1900s. (Originally known as the Montreal Homeopathic Hospital, the institution was founded in 1894.)

But Dressel, co-author of two books with David Suzuki, probes much deeper, revealing that the Queen E was one of dozens of community hospitals across Canada that were closed in the mid-1990s by provincial governments that seemed to be more concerned about satisfying bond-rating agencies in New York than ensuring the health of their citizens.

Dressel, an environmentalist who lives on an organic farm outside Montreal, confesses that she was new to the study of health policy when she undertook the project. Despite that lack of experience, she has written an astonishingly insightful book about the evolution of health care in Canada and its current crisis, alluding frequently to the Queen E's history to provide a case study.

She is right on the mark when she points out that Jean Rochon, Quebec's health minister at the time, never followed through on promises to fund more outpatient or so-called ambulatory care in the city's remaining hospitals, which had been a partial justification for shutting the Queen E. She writes that the impact was far-reaching, as family physicians who had been practising in the doomed hospitals were suddenly "thrown out," and have been working mostly in office clinics ever since.

"Today, family doctors have no contact with their patients once they enter a hospital, and hospitals have little information about the whole patient beyond their immediate acute symptoms," Dressel writes, adding that this rupture in the "continuity of care" is detrimental to people's health and ultimately costs the health system more money as patients grow sicker.

Compounding the problem was a cost-cutting decision by Quebec and the other provinces to slash enrollment in medical schools, exacerbating the shortage of general practitioners. Dressel also blames governments' fixations with large university teaching hospitals for their favouring medical specialists at the expense of GPs.

It's no surprise, then, that she's not a fan of superhospitals, including the $1.5-billion redevelopment planned by the McGill University Health Centre. She describes superhospitals as cold places "with interchangeable doctors and technicians" that are "inadequate substitutions for personalized care."

In the latter half of the book, Dressel turns her attention to what she calls the "medical-industrial complex" of big pharmaceutical firms, insurance companies, health maintenance organizations (HMOs) and international lending institutions. She accuses them of driving up hospital costs and of seeking to destroy Canada's cherished universal health-care system. She also warns that this country should be on guard against international trade agreements that could open the door to a U.S.-style system of mostly private health care.

She calls for a return to community hospitals like the Queen E and for GPs to play a greater role in the system.

Dressel makes a strong case for maintaining universal medicare, buttressing her arguments with hard data showing that public health care is not only more cost-efficient than private systems, but leads to better health outcomes for individuals. She's equally effective in her critique of public-private partnerships that European governments have relied on to finance the construction of new hospitals. Again, she takes a swipe at the MUHC project, which will be built under such a partnership.

However, Dressel is much less persuasive when she dismisses mixed public-private health systems in Germany and Sweden, offering no detailed analysis of their performance in those countries. And the book could clearly have benefited from a fact-checker. She writes that the Canadian ban on direct advertising to consumers by drug companies has been lifted; no, it hasn't. She erroneously refers to the Canadian Institute for Health Information as "a branch of the federal government"; in fact, it's an independent not-for-profit organization. And she gets major details wrong about the MUHC redevelopment project.

Despite these shortcomings, Who Killed the Queen? is an important addition to the health-care debate - a book that should be required reading by health bureaucrats who might be thinking of what hospital to close next.

Holly Dressel launches Who Killed the Queen? on Wednesday, May 28 from 5 to 7:30 p.m. at the McGill Faculty Club, 3450 McTavish St.

Aaron Derfel is a Gazette health reporter.


By Holly Dressel
University Press, 471 pages, $39.95

© The Gazette (Montreal) 2008

Reprinted without permission from The Gazette (Montreal) 2008.