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Reviewed by Dr. T. Meagher

Associate Executive Director, Medical Affairs

McGill University Health Centre

Closing hospitals is unpopular business. Yet many countries, including Canada, have invested to various degrees; most are still dealing with the fallout.

'Who Killed The Queen?' is the story of a highly-respected Montreal community hospital that was unexpectedly closed in 1995, provoking vigorous protests from its staff and its local community. It is chronicled in this thoroughly readable account of the execution.

The Queen Elizabeth Hospital or 'Queen E', as it was affectionately known, was by all measures a successful institution. It had an illustrious past, had contributed a number of medical 'firsts', was affiliated with McGill University and enjoyed generous community support. It seemed to have a winning combination. The decision, then, to close it down came out of the blue and no one could fathom it.

As Holly Dressel points out in this probing, investigative narrative, the Government's reasons for closure seemed tenuous. The cited performance shortfalls seemed minor and quite remediable. A little patience and clever restructuring would have fixed them.

Dressel points out that the Queen E closure was all about money. Quebec's finances in 1995 were in a precarious state and a downgrading of its credit rating was on the horizon. As health consumed the largest share of the provinces's budget, trimming was in order. The prevailing wisdom at the time was that there was hospital 'overcapacity'. Fewer hospitals meant fewer beds. The Queen had to be killed.

The Queen E was not the only hospital brought to the guillotine. Six other Montreal hospitals suffered a similar fate around the same time. And Quebec was not alone in this hospital-closing movement. Other provinces joined the party; community hospitals disappeared across the country, although the gallows was favored outside Quebec.

As Dressel points out, a promise of major investment in ambulatory clinics to make up for the loss of hospital beds never materialized. Health care planners, who as a rule are more accurate when dealing with the past than the future, have argued that this wave of closures seriously wounded the entire Canadian health care system and ten years later the healing is incomplete.

But this book is more than a history of the Queen Elizabeth hospital. Dressel uses the Queen E's ups and downs, its successes and failures as a metaphor for the history of public health care in Canada.

As medical care in North America became more expensive, eventually outstripping the ability of most to pay, Canada introduced universal health coverage. The United States took a very different route. Dressel provides her own insights to explain the contrasting paths of neighbors who had every reason to chart the same course. This is highly topical given the current resurgence of interest in universal health care in the United States.

This is an extensively researched work; information about the Queen Elizabeth hospital is drawn from hospital archives, media clippings and many interviews with hospital staff and friends. Dressel has delved into the history of Canadian health care and provides a scholarly account of its evolution form the early 1900's up to the present. She is a stout supporter of universal health coverage and argues well that many of its present ills are fixable. Not surprisingly, government does poorly in this account. The pharmaceutical industry also takes a few knocks, guilty of promoting treatments for all the wrong reasons.

At times I found the criticisms lacked balance; true, government is often misguided, but on occasion it does get things right. Similarly, Big Pharma is not rotten through and through, although that is conventional wisdom. Other villains might also have surprised had they had the chance. Throughout this book inadequate exploration of alternative ideas and opinions detracted from the quality of the work and made the arguments, most of which I agreed with, weaker.

But this is a minor criticism. In all, this is a laudable work. It is recommended not only to those who lived the glory years of the Queen Elizabeth Hospital but also to scholars of Canadian Health care. Hopefully the errors it chronicles will enlighten the future.

Tim Meagher

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Reprinted without permission from the Continuing Medical Education department of McGill University web site.