Some of the recent questions and concerns related to the establishment of a municipally controlled corporation for Onoway Regional Medical Clinic, accompanied by Lac Ste. Anne County's responses, are listed below..
On May 1, 2019, a Public Hearing was held in Council Chambers concerning the establishment of a Municipally Controlled Corporation for Onoway Regional Medical Clinic; a move that would begin the process to develop a new facility for Onoway Regional Medical Clinic, and that would provide for ongoing administrative oversight for the clinic.
At the start of the Public Hearing, Lac Ste. Anne County Assistant County Manager Robert Osmond presented a synopsis of the initiative, followed by a set of responses to public questions that had arisen leading up to the hearing date.
Following Mr. Osmond’s presentations, members of the public were given roughly five minutes each before Council to speak both in favour of and against this contemplated initiative. Public comments, questions and concerns were also voiced across various channels prior to and following the May 1 Public Hearings.
One of the most resonant pubic critiques has been that there are too many unanswered questions to make an informed decision regarding this important initiative before Council. Accordingly, the County has curated the questions and concerns raised to date, and has written a response to each item below. This information will also be cross-posted to the Onoway Regional Medical Clinic website, and will be amended as any substantive developments warrant.
Why wasn’t clarification about the Onoway Regional Medical Clinic provided before the public hearing?
Clarifications and in-depth analysis, prepared by County Administration on all issues, are presented to County Council prior to public communication. The business plan for the Onoway Regional Medical Clinic Municipally Controlled Corporation was published to the Lac Ste. Anne County (www.LSAC.ca) and Onoway Regional Medical Clinic (www.onowaymedical.ca) websites on April 1, 2019, following its presentation to Council on March 28, 2019. Advertisements in the Lac Ste. Anne Bulletin and posts on social media and the websites attempted to draw as much attention as possible to this business plan. The business plan is a nine-page document which included information about the purpose, governance, financial strategy, risk analysis and the process being observed in the formation of the Onoway Regional Medical Clinic Municipally Controlled Corporation.
Why is Lac Ste. Anne County responsible for keeping physicians and a medical clinic in Onoway?
Although Lac Ste. Anne County, and its municipal partners (the Town of Onoway and the Summer Villages of Ross Haven, West Cove, Silver Sands and Val Quentin), wouldn’t choose to be in the medical clinic business, they are not prepared to lose this important service in the community. Alberta Health Services, while supportive of local access to medical care, does not provide medical clinic (physician) services. The local physicians are not prepared to assume the business of operating the clinic business as they are focused on practicing medicine and the care of their patients. The only private entity that was interested in running the clinic required financial subsidy from the municipal partners of more than $70,000 annually. The place we find our community in is choosing between taking responsibility for ensure the service continues or allowing this important community service to close.
What is the economic value of maintaining a medical clinic in Onoway?
There are a number of reasons why Lac Ste. Anne County, and its municipal partners (the Town of Onoway and the Summer Villages of Ross Haven, West Cove, Silver Sands and Val Quentin), are working to preserve physician services and a medical clinic in Onoway. Some of these reasons are based in economics, including that new and existing business benefit from these types of services in the communities when they are looking to attract employees, that residents booking medical appointments in Onoway are more likely to conduct other business there including filling prescriptions at the pharmacy, filling vehicles with fuel, and dozens of other commercial transactions possible in the community. Residents who book medical appointments in other communities are more likely to conduct these business transactions in those communities.
The most significant benefits to maintaining a medical clinic in Onoway are not economic; but rather, community. The County has heard the comment that people can just go to other clinics in Mayerthorpe, Barrhead, or Stony Plain for physician services. While that may be true for many with the financial means and mobility to use facilities in other communities, there remain those for whom the financial and mobility demands of going to another community would greatly impact their ability to seek care. Although many in the region benefit from the convenience of local services, those that facing socio-economic challenges rely on having these services locally, and would require additional social assistance to access facilities in other communities.
Why did Community Peace Officers restrict access to transfer station sites by those gathering signatures on petitions?
The County respects the public’s petition rights provided in the Municipal Government Act, and as such has allowed those collecting signatures on petition to use public gathering sites such as County transfer stations for this purpose. However, as a public facility, access to and from these sites by ratepayers cannot be restricted, and petition signature gatherers are expected to accept the decision of those who don’t wish to participate. During the weeks when petitioners were gathering signatures, they attended many transfer stations in the County; users were given space to access the facility; and decisions to sign or not were respected. There was, however, a single day when the County received a number of complaints from a single transfer station regarding petitioners impeding access to the transfer station bins, petitioners standing behind vehicles to prevent them from leaving, and petitioner(s) who would not respect the decisions of those visiting the facility. These complaints were forwarded to enforcement, and Community Peace Officers attended the site. The petitioners were asked to back up from the bins, and were reminded that they were not to impede access to the site or otherwise harass those declining to sign the petition. The petitioners followed the direction of the Community Peace Officers and there was no need for further enforcement. No further complaints were received.
How much will the Board Members and the Executive Director be paid?
The Lac Ste. Anne County Councillor who sits on the Onoway Regional Medical Clinic Board does not collect any additional compensation for fulfilling this role. Councillors receive compensation for the many commitments they attend as a Councillor. The Executive Director, who coordinates meetings and advises the Board, receives no additional compensation and completes these minimal tasks within their current role and compensation. Any additional administrative services, financial management, payroll, et cetera, are the responsibility of the Onoway Regional Medical Clinic, and the cost of these services is budgeted. Currently, these services are contracted from the County and the Clinic pays for those services. In the event that the County is unable to provide these additional administrative services due to staff availability, the Onoway Regional Medical Clinic could, once incorporated, purchase these services from a third party.
Why wasn’t expanding in the current location considered?
In reviewing options for a medical clinic expansion, the Onoway Regional Medical Clinic Board did consider expansion in the current location, and began negotiations with the Landlord in July of 2018 to review what options were available. Although the lease rate, management fees, and several other points of negotiation weren’t resolved, the issues that emerged central to the decision to consider other options had to do with lease rate predictability and renovation costs. Simply put, without a lease that would provide some certainty around future rate increases, the Clinic could face a situation where they would have to abandon the significant renovation costs of the new space should the landlord raise the rate significantly. Other lease and purchase options were also considered; however, in each case the significant renovation costs and lease rate uncertainty was a risk the Board was not prepared to take given the importance of maintaining physician services in the region.
Can Onoway even support a clinic this size?
The Onoway Regional Medical Clinic, in addition to the communities of Onoway, Alberta Beach, a number of Summer Villages, and the majority of the east end of Lac Ste. Anne County, also attracts patients from communities outside the County, including parts of Parkland and Sturgeon Counties. Service features such as the availability of same-day appointments, appointments after 5:00 pm, and physicians who are accepting new patients, make the Onoway Regional Medical Clinic a draw for a much greater area. The 2.5 Alberta Health Services approved physician positions have, since 2017, operated out of the clinic with the only real limitation being insufficient space for all three physicians to practice at the same time.
Isn’t is unfair that Lac Ste. Anne County is 82% of the Onoway Regional Medical Clinic initiative?
At the outset of the Onoway Regional Medical Clinic initiative, all the municipal partners including Lac Ste. Anne County and the Town of Onoway and the Summer Villages of Ross Haven, West Cove, Silver Sands and Val Quentin understood that ownership of the organization would be based upon financial contribution. The Country, given its larger population base, undertook 82% of the partnership and later provided 82% of the start-up funding required to begin the trial. It was included in the preliminary agreement that when the Onoway Regional Medical Clinic was incorporated, the shareholder percentages would reflect this same division. Lac Ste. Anne County recognizes that its proportionate benefit from the Clinic is greater than the other partners because of its population, and as such agrees with the current splits. The other municipal partners understood these calculations and agreed to the terms when they signed onto the partnership.
Why are the partners looking to incorporate the Onoway Regional Medical Clinic?
There are two important activities that incorporating the Onoway Regional Medical Clinic as a Municipal Controlled Corporation will allow. Incorporation creates a legal financial independence from the County, requiring the Board to maintain that independence and further proving the case for an unsubsidized medical clinic in Onoway. Most importantly, incorporation allows for the sale of the clinic to a physician or medical clinic operator if an offer is made, whereas an unincorporated municipal initiative would have to refuse such an offer if received.
Where do the profits go?
The future profits of the Onoway Regional Medical Clinic will be reinvested into the Clinic. Any profits would provide contingent operating funds to ensure the financial independence of the Clinic or provide funding for capital equipment to increase the variety or availability of medical services in the community. If the incorporated Clinic was to be sold, the proceeds from the sale would be distributed to Lac Ste. Anne County and its municipal partners (the Town of Onoway and the Summer Villages of Ross Haven, West Cove, Silver Sands and Val Quentin), according to the shareholder percentage of each partner.
What influence would the public have over an incorporated Onoway Regional Medical Clinic?
Remembering that until Lac Ste. Anne County and its municipal partners (the Town of Onoway and the Summer Villages of Ross Haven, West Cove, Silver Sands and Val Quentin) assumed operations of the Clinic in 2017, the only influence the public had over the Clinic was that of a customer. After incorporation, the public will continue to be able to influence the Clinic in that way. Additionally, as a municipally controlled corporation, the ratepayers will have influence; both the elected official on the Board and the Council that appointed them to the role are elected. As such, the public will have an electoral authority not previously available over those elected positions. Finally, as an incorporated entity the business decision of the Clinic will be their own; however, any request for assistance or support from the County would provide all the public oversight opportunities of other Council decisions.
What obligations would the ORMC MCC place on taxpayers?
Virtually none. Onoway Regional Medical Clinic is operating financially independently from the municipal partners that control it, having eliminated the need for the nearly $75,000 in annual subsidy paid by regional municipalities until 2017. The County and its partners have made a commitment to keeping this service in the community; however, its operations are financially independent.
Can We Get Enough Doctors in Onoway?
With a relationship going back more than ten years with Alberta Health Services, Onoway Regional Medical Clinic has been very successful in recruiting physicians. AHS has offered to recruit a physician to replace the one that left the Clinic earlier this year. Due to space limitations in the current facility, however, these plans have been delayed.
Why does Lac Ste. Anne County need the ORMC MCC?
Onoway Regional Medical Clinic (ORMC) is being organized to run the Onoway Clinic as an independent and self-supporting business. During the trial, the partners were able to eliminate the nearly $80,000 in annual subsidy paid by regional municipalities to the Clinic operator. The partners wish to continue the momentum of the Clinic’s significant success.
What costs are there to establish the ORMC MCC?
The costs to establish the ORMC MCC are limited as many of these costs were incurred at the outset of the trial in 2016/2017. There will, of course, be a cost for Advertising and Legal costs, both of which are included in the approved 2019 budget for the ORMC. These funds are included in Contracted Services and Advertising in the budget projections.
Why was a Market Impact Analysis not completed?
The purpose of the Market Impact Analysis is to review the impact of adding an additional competitor or additional services into a competitive market. In the case of the ORMC, there are no competitors. The lack of interest by private medical Clinic services providers and physicians is the reason that the County and its municipal partners acted to preserve the Clinic. Additionally, the two-year trial demonstrated a growing demand for in community physician services as access is improved with the reintroduction of walk-in availability, evening hours and the acceptance of new patients.
Why don’t the physicians purchase/operate the Clinic?
Over the last twenty years, physicians in general have become less interested in the management of offices and buildings and more focused on the delivery of medicine. Although there was a time in the past when most physicians sought to open and run their own Clinic, those types of situations are now rare. This situation leaves many communities like St. Paul, Kneehill County, and Peace River to find new and innovative solutions, like ours, to address this widespread problem.
What additional services are being considered?
The ORMC MCC is working with Alberta Health Services to ensure that both entities are working in concert, not competition. Services delivered by AHS in Onoway such as Laboratory Services are not being considered. However, Primary Care Network resources such as Nurses, Dietitians, Geriatric Support and Physiotherapy may be areas to investigate first. Additionally, specialized physician services may also be obtainable on an occasional basis. This position will remain open until a suitable candidate is found. The County thanks all applicants in advance for their interest in this position; however, only candidates selected for an interview will be contacted.