Loss of funding means closure for maternity clinic that delivers half of Medicine Hat's babies

A maternity clinic that delivers about half the babies in Medicine Hat has announced it will no longer accept new patients by the end of January, and will be closed by the end of July unless new funding can be found.

While family physicians typically pay their own overhead, a gap in Medicine Hat's obstetric services in the mid-2000s led to the creation of the Family Medicine Maternity Clinic.

Funding was provided by the local Primary Care Network (PCN) and Palliser Health, which later merged with the other regional health authorities to form Alberta Health Services. 

Dr. Gerry Prince, a family doctor who helped establish the clinic in 2006, told the Calgary Eyeopener on Monday that the clinic will be closing because the PCN's funding is due to end in March, and AHS wants the clinic to cover the overhead that includes rent, utilities and all staffing costs.

Prince said this would be impossible, as the costs to run the maternity clinic are roughly double the amount of what it can bill for patient services — and the doctors are already paying overhead for their family practices. 

"[The clinic] is closing because AHS is backing out of our partnership, and says that they want to rent us the space that we've been able to occupy for the last 17 years with their support," Prince said.

"And the numbers they've given us are just impossible. So, they've given us an overhead number, which is about double the amount of billing that we would actually do through the clinic in a year.… Our guys, you know, as much as they love it, just — there's no way you can do that."

A 'flawless service'

The Family Medicine Maternity Clinic was established due to a crisis of accessibility, Prince said. At the time, obstetrics was a declining service in the area.

"There [were] fewer and fewer physicians doing it, and got down to the point where there were only two family docs delivering about half of the babies in town — as well as running the regular community clinic," Prince said.

"It was becoming quickly unmanageable."

Prince said that some of the local doctors turned to health authorities and asked for help. 

The regional health authority agreed, and later partnered with the Primary Care Network to meet the community need. The clinic was established, attached to the Medicine Hat Regional Hospital.

"We went with this idea of a maternity clinic, a dedicated care centre, and they helped support it. And ultimately, we built a specified, designated, custom-design clinic area in our new ambulatory care building," Prince said.

Eventually, Prince said, that clinic would deliver 500 to 600 babies a year.

"We've had a flawless service that's been providing great care for 17 years."

Soon, it's all coming to an end — and why is complicated.

"The docs want to provide the services, we just need to be able to manage it financially. So the real question is, whose job is it [to save the clinic]?" Prince said.

Difficult decision

Treena Klassen, the executive director of the Palliser Primary Care Network, told the CBC that the network — which has covered about 80 per cent of the maternity clinic's budget since 2006 — has not had an increase in its per capita budget since 2012.

It has also faced greater expectation from government to meet its four primary objectives, which are governance and accountability, partnerships and transitions of care, community and population needs, and implementing a patient's medical home.

Obstetrics, Klassen said, now falls outside the scope of these objectives, and led the PCN to re-evaluate where its funding is allocated.

It notified the maternity clinic in March that the funding would be discontinued.

"In efforts to meet our provincial objective, the board had to make the difficult decision of what it could fund through its 2020-2021 budget and forward," Klassen said.

With that, the vast majority of the clinic's funding fell through.

Prince said that though AHS notified him on Monday afternoon that it would extend the clinic's funding until the end of July 2021, instead of allowing it to run out in the spring, it has not seemed eager to help overall.

"Their perspective is, 'We never had anything to do with the clinic' … which is a little unfair, I think," Prince said. 

"They've been significant partners, even though they haven't had a lot of cash outlay … AHS seems to be kind of at the direction of Alberta Health, looking to say, 'We don't want to support any services that enable physician income … [and] we think they need to be more independent in some way.'"

When asked for comment, an AHS spokesperson said via email that the decision to reduce funding for the clinic was made by the PCN.

"The decision to end the Family Medicine Maternity Care Clinic service was not made by AHS. The FMMC clinic was funded by the Palliser Primary Care Network (PCN), which informed the clinic's physicians in 2018 that funding would be reduced," the statement read in part.

"In March 2020, the PCN informed the physicians that funding would be discontinued for the FMMC in both Medicine Hat and Brooks in 2021. AHS does not recover any overhead costs for these services, nor has funding for these services been shifted to AHS."

The fallout

Regardless of who could or should do something, Prince said that those who will unquestionably be impacted by the clinic's closure are the expectant mothers in Medicine Hat.

They are nervous, according to Prince, and drafting petitions to keep the clinic operational.

And when the funding runs out, the doctors can go back to their community clinics, where Prince said they will be quite busy. So, the conversation about the clinic's future is not solely about their compensation.

It is primarily about the women who will be left with fewer resources, he said.

"The expecting mothers … are going to be the ones left in the lurch. And we just want to make sure that we can get this fixed so that they have access to care," Prince said.

"It creates a pretty big gap in the care service in Medicine Hat. That's, you know, that's our biggest concern."

With files from Elissa Carpenter and the Calgary Eyeopener.