Niagara This Week
Peter van Hiel
August 15, 2012
Niagara Health System supervisor Dr.
Kevin Smith says there will be no common ground in the debate over
centralized and decentralized maternity care in Niagara. A centralized
model would see all in-patient maternity care in single location, while
the decentralized model also provides care at hospital sites in Niagara
Falls and Welland. Smith, who has recommended moving all in-patient
obstetrics and pediatrics to St. Catharines until a proposed new
southern hospital is built, acknowledged that there were persuasive
arguments for retaining the current model of decentralized care.
“These are very different models. That means that a level of
disagreement exists. That’s not a surprise to us. It also demonstrates
that highly qualified professionals can disagree, collegially,” he said.
Nonetheless, a decision must be made soon for the good of the region,
“Opinion or preference isn’t going to land us where we need to land,” said Smith.
He made these remarks on Aug. 14 at the Casablanca Inn in Grimsby,
where Smith and a panel of experts listened to presentations from both
sides of the debate. The panel, which Smith described as unbiased, will
make a recommendation based on the information they received during the
evening. The panel consists of Brenda Flaherty, executive vice-president
of clinical care at Hamilton Health Sciences, Dr. Lennox Huang, chief
of pediatrics at McMaster hospital, Mary Jo Haddad, CEO of the Toronto
Hospital for Sick Children, and Dr. Nicholas Leyland, chief of
obstetrics and gynecology at Hamilton’s McMaster hospital. The panelists
assured the presenters that they would be looking at all aspects of the
“A portion of my practice was actually in a community hospital and I
have the utmost respect and an understanding of what the differences are
between practice in that setting and in a tertiary care setting. I hope
you are reassured that I will present that perspective,” said Dr.
Arguing in favour of decentralized maternity care was Dr. Ken Reddy,
president of the Greater Niagara Medical Society. Reddy said the
centralized model of care presents a risk to young mothers and babies.
He said the centralized model disrupts “the continuity of care” and adds
dangerous travel times for expectant mothers.
“It may risk the life of children, newborns and mothers while they’re
being transported to the St. Catharines hospital,” Reddy told the
panel. His concerns were echoed by Dr. Alison MacTavish. She told the
panel that decentralized care is the better option in 90 per cent of
Dr. Johan Viljoen, the regional head of obstetrics, spoke strongly in
favour of the centralized model. He said a central location would allow
services to build a “critical mass,” in which larger numbers of doctors
working together could provide a higher level of care over all. Viljoen
said most doctors in Niagara were willing to work with a centralized
“I’ve had discussions with all my obstetrics colleagues, and if we
can’t keep the services in the smaller communities, then that’s fine,”
he said. He quoted one doctor who said he was “ready to be a team
Viljoen also said the aging population of doctors in Niagara has
presented serious problems in smaller hospitals. He used the example of
Welland, where all three doctors working in obstetrics are over the age
“Our big enemy is the aging demographic,” he said. “If you have a
single unit with 13 or 14 people, there’s room for redundancy. You can
afford to have two people away… and still keep your unit well staffed.
If you have a unit with three, and one suddenly has an acute illness,
you find yourself running in panic mode. That has happened.”
The panel will consider the presentations and made a recommendation
to Smith, who intends to present their findings to the Minister of
Health before the end of the month.