What do you do with a bunch of old, rundown hospitals?
That is the politically volatile question the Quebec government faces as it plans to shift care from 19th-century institutions to a pair of 21st-century super-hospitals in Montreal.
On the surface, the next steps seem simple. Old hospitals are unsafe and inefficient. You should tear them down and build new ones. (Not to mention that you should also aim to reduce the absurd amount of care given in hospitals in the first place.)
But Canadian health care suffers from hospital fetishism. Old hospitals never get torn down. Communities – with a lot of egging on from health professionals and their unions – rally to "save the hospital," and they invariably get expanded or repurposed. The one exception was the Calgary General Hospital, which then-premier Ralph Klein famously ordered demolished, and which was blown up in a gaudy public spectacle.
In Montreal, where new super-hospitals are being built and old ones renovated to the tune of about $5-billion (and counting), there are tentative plans to sell a handful of old facilities that are no longer needed. But don't count on that actually happening.
The complication is that Montreal's hospitals are not only old, they are architectural gems and located on prime real estate.
Take the Royal Victoria Hospital. It was built in 1893 on the flank of Mont-Royal. It looks like a medieval castle. Tearing it down would be a crime. But continuing to operate it as a hospital would be a bigger crime. The inside needs to be gutted. Condo developers would be happy to oblige, but building on Mont-Royal would spark public outrage and is likely a legal non-starter given the terms of the donation of the land. The latest rumour – or, more accurately, trial balloon – is that the Royal Vic could be converted into the faculty of health sciences of nearby McGill University.
A similar conundrum exists just a few hundred metres down the hill from Mont-Royal, at the site of Hôtel-Dieu de Montréal. That hospital, which dates back to 1645, was built in its current incarnation in 1861. It too is stunning from the outside, but is well past its best-before date inside. It is ideally located for condos, but, because of its heritage designation, there is political pressure to keep Hôtel-Dieu in public hands and convert it to long-term care.
Less problematic are the Montreal Children's Hospital, Notre-Dame Hospital and Saint-Luc Hospital, which are in the downtown core and will be incorporated into the new facilities.
In fact, it's worth recalling the staggering scope of new hospital construction, and a bit of the history.
The idea to create two networks – the "English" McGill University Health Centre and the "French" Centre hospitalier de l'Université de Montréal – each with a super-hospital at its core dates back to 1991.
The new facilities have taken longer to build than the Taj Mahal – the MUHC main site will be completed in 2015, and the CHUM main site should be done in 2018 – and cost considerably more.
Construction of the "French" facilities (in Quebec, everything is classified along linguistic lines) has been marked by some really nasty political bickering, mostly about the location of the new super-hospital, and delays in getting the construction going.
The "English" facilities got built a lot more quickly and painlessly, at least on the surface. But now the MUHC's former CEO is languishing in a Panamanian jail, awaiting extradition on fraud and money-laundering charges. Arthur Porter is accused, along with five others, of plotting with executives of SNC-Lavalin Group Inc. to use $22.5-million in company funds for an international kickback scheme in connection with the company's construction of the $1.3-billion hospital.
All told, the new MUHC facilities will cost in the neighbourhood of $2.2-billion and the CHUM is being buffed up to the tune of $2.1-billion. But that does not capture the full cost because, along the way, plans to close other facilities and streamline services were slowly but surely watered down.
Now, it looks like the Royal Victoria and Hôtel-Dieu, whose sale was expected to bring in a couple of hundred million dollars, will likely remain in the public domain, and a cost to the public treasury.
That is, sadly, one of the traditions of the dysfunctional Canadian health-care system: Every time we get close to leaping into the 21st century, we hesitate and keep our feet firmly mired in the 19th.