Questions and answers
Send your questions to information@ghcs.ca and we will get back to you as soon as we can. We will post the answers to representative questions here.
The next 15 answers, "Information From the Gabriola Helath Care Foundation (GHCF)", were printed in the Gabriola Sounder newspaper on February 28, 2011
1. Why we are all members of the Gabriola Health Care Foundation?
All residents of Gabriola who support the purpose of the Foundation are members. This approach avoids possible misunderstanding that the Urgent Care Clinic would be available only to members, and reflects the universal nature of the Canada Health Act. Many not-for-profits are the same; e.g., the Community Hall Society. Anyone can withdraw his/her membership in the GHCF simply by sending a letter or an email message to the Foundation to that effect.
"2. Membership fees can be assessed to cover costs for the clinic."
In theory, this is true. GHCF bylaws state that membership fees can be set at a meeting requiring a vote of the membership. It has never done so. If membership fees were ever assessed, members that did not wish to pay them could withdraw from membership. They would still have access to all the clinic facilities.
3. Who owns the Urgent Care Clinic and are individual members liable?
The registered legal owner of the new Urgent Care Clinic will be the Gabriola Health Care Foundation (GHCF), which is an incorporated as a not-for-profit society under The Society Act of British Columbia. This Act clearly states that: "A member of a society is not, in the member's individual capacity, liable for a debt or liability of the society." Therefore, no member need fear being held financially liable or responsible for any problem that might arise.
4. Is there a business and financial plan?
Yes, the Foundation has a Business Plan. It is currently being updated. The Interim Clinic at Twin Beaches, operated by the Gabriola Health Care Society, has been running on the successful self-funding model used by other Island medical clinics, whereby rent from the doctors and other medical-support tenants cover the operating costs.
The Board is confident that the rental income will cover all the operating and maintenance costs, with a contingency fund to cover any shortfalls that might arise. The GHCF Board's Building Committee is currently updating the construction budget. It is possible that we will exceed our original $1 million construction budget by a small amount. The project remains doable because of the donated time and materials from the trades. The building is now designed to "post-disaster" standards.
5. Why own instead of renting?
The Board weighed all the options and we concluded that owning the facility would better serve the interests of the community. The Board, in its professional opinion, concluded that owning would give the Foundation better control over its operating costs, space allocation, etc. and would allow us to offer a rental structure that encourages doctor recruitment and retention.
6. Why we need a larger clinic and more than one urgent care room
We did not arbitrarily arrive at approx. 4,300 sq. ft. We did our research (see "Health Care Clinic Design Process" at http://www.ghcs.ca/2010_proposal.html), worked closely with our doctors and architects to design the facility.
7. "Is Gabriola likely to get a third physician ... ?"
We fervently hope so because our two doctors (one of whom is currently on maternity leave) cannot possibly continue to carry the burden of 24/7 on-call urgent care indefinitely. The competition for rural doctors is particularly intense so we are pulling out all the stops to recruit a third physician.
8. What guarantees that doctors will stay? "
We believe what truly retains physicians is the creation of a work environment that encourages a centre of medical excellence, with challenging medical practice components. Our vision for the new clinic should do just that. The GHCF intends to create a contingency fund to cover any shortfalls.
9. "Why an urgent care treatment room to handle multiple casualties?"
According to records from the Twin Beaches Interim Clinic, multiple urgent care events happen at least once a month, the last on Feb 17, 2011. We believe that our design for three urgent care bays is the responsible response to this documented need.
10. "Why an office for a nurse practitioner?"
The Interim Clinic employs a Registered Nurse (RN), and office space has been allocated to her nursing functions in the new clinic. This RN works with the medical team to manage patients with chronic and complex conditions.
11. How are the Community raised funds being used?
Except for a small (3.8%) percentage allocated to administrative costs, (legal, advertising, printing, postage, office supplies, etc), all of the money raised will go to construct the building and equip it in an integrated, multipurpose manner. No division has been made between the shared and common spaces, the urgent treatment room and the individual doctor's and staff offices.
12. What funding commitment has VIHA signed with the Gabriola Health Care Society?
In its letter of November 30, 2010 VIHA expressed its support for the new community clinic and reaffirmed its on-going support for the urgent treatment room. VIHA also expressed an interest in locating certain other programs in our new clinic but details have not yet been worked out.
13. What is the staffing and equipment plan for the urgent care treatment room?
VIHA has agreed to provide most of the equipment and materials. An urgent care room should not be confused with a hospital emergency room. Our facility does not provide walk-in emergency treatment. Patients in need of "emergency assistance" on Gabriola must call 911. The paramedics assess the patient and, if needed, page the physician on call, who then meets them at the urgent care clinic.
14. Why rezone a parcel of forestry land to create more commercial and institutional' land when Gabriola already has an excess of vacant commercial and institutionai properties?
The Foundation undertook an extensive four-year property search. Twelve sites were thoroughly evaluated. None were deemed affordable or suitable in terms of the site selection criteria. The Urgent Care Clinic will be built to be able to provide "post-disaster" services. Neither the Twin Beaches building nor the Gabriola Professional Centre is presently built to "postdisaster" standards.
The donated land on Church St. makes the project affordable and attainable in 2012. The land has already been logged by the previous owner; so no actual forest exists to preserve. In any case, land zoned forestry does not protect the trees on the property; in fact, it allows for logging on that property. The Foundation believes that securing the Church St. property benefits the community and provides for the possibility of growth in the future, if required.
15. When will the donated land be transferred to the Foundation?
The terms of the transfer of ownership have been clearly spelled out in writing. (http://www.ghcs.ca/images/2011 pledgeagreement.pdf). On Feb 24, 2011, Dr. Bob Rooks concluded that there was no longer any reasonable doubt that the clinic would be constructed so removed the "five year non-completion" clause formerly in the agreement. In short, this means that the gift of land to the GHCF is unconditional and that title will be transferred once the land has been sub-divided.
Why do we need a Medical Treatment Clinic?
We are fortunate to have attracted two doctors who have surgical experience and have been highly effective in stabilizing patients before moving them to Nanaimo General Hospital. An urgent care treatment room provides an ideal location for stabilization and may allow patients to avoid the trip to Nanaimo General Hospital entirely.
Why not rent instead of building?
The Health Care Foundation believes that a community built, owned and controlled clinic allows better control over costs and operation over the long term than if the clinic were privately owned. A private operator would have difficulty recovering the cost of building the urgent care treatment rooms in the Clinic since these are not significant generators of revenue.
Who will own the clinic?
In effect, the community, through its membership in GHCF. However, legally the clinic will be owned by the GHCF, an incorporated not-for-profit society. The incorporated society, not the members, will therefore bear the risks of ownership of the clinic.
Return to the top of the pageWill the Clinic be privatized?
The Gabriola Health Care Society has successfully operated the interim Clinic at Twin Beaches for close to four years and similar Clinics on other Gulf Islands have operated for many years. There is no reason to expect a change from community control.
The new Clinic will be owned by the Gabriola Health Care Foundation, a registered non-profit society with membership open to all Gabriolans who subscribe to the objectives of the Foundation. This will truly be a community owned Clinic. The Board of the Foundation has resolved to present a resolution at the next General Meeting of the Foundation requiring that any transfer of ownership of the Clinic must be approved by a majority of Foundation members at a special general meeting. Therefore the only way that the ownership of the Clinic could change is by a democratic decision of Gabriolans. The Board does not feel that a covenant or other restriction on transfer of the property at this time is appropriate since future decisions about the property should be made democratically by the Gabriolans who will be affected at that time.
Who is a member of the Foundation?
The Foundation by-laws provide that:
- "4. Members
- (1) All residents of Gabriola Island, B.C. who assent to the purposes of the society and who are at the time at least 19 years of age will be members of the society unless such person has ceased to be a member as provided herein.
- (2) In addition, any person may apply to the directors for membership in the society and on acceptance by the directors is a member.
- "7. A person ceases to be a member of the society
- (1) by delivering his or her resignation in writing to the secretary of the society or by mailing (by electronic or regular mail) or delivering it to the address of the society,
- (2) unless they became members under the provisions of section 4(2), by ceasing to be a resident of Gabriola Island, B.C,
- (3) on his or her death or, in the case of a corporation, on dissolution,
- (4) on being expelled, or
- (5) on having been a member not in good standing for 12 consecutive months."
These by-laws were based on those of the Community Hall, which also has all Gabriolans as members without actually having "signed up." This was done to ensure that the all members of the community would be entitled to influence Foundation policies by being eligible to attend annual and special meetings and be entitled to vote on any matters brought before those meetings. In addition, Gabriolans would be able participate in the election of directors or, indeed, be eligible to be elected to be a director.
There is no requirement that a person be a member of GHCS or GHCF, or even be a resident of Gabriola, for them to have access to the urgent care facility.
Why was the Church Street site chosen? Aren’t there other alternatives?
The Health Care Foundation’s Building Committee evaluated many sites on Gabriola Island. The Church Street site scored very high for central location, accessibility, ease of building, and proximity to First Responders. In addition, since the property is being very generously donated, the community can devote all of its funds to building and equipping the Clinic. Over the summer, Gabriolans were invited to comment on the Church Street site and two other alternatives. Respondents overwhelmingly supported the Church Street site as the best choice for the Clinic.
Several other alternative locations would also require rezoning and have similar or greater impact on existing forest land. Purchasing a property at market price with the appropriate zoning already in place would divert a significant amount of community funds away from building the Clinic.
Will the 4.1 clinic acres have paths, gardens and trees?
Yes. The gardeners of Gabriola are excited about creating paths and peaceful sitting areas using local indigenous plants and trees. We want to build a beautiful building and surroundings - something Gabriola folks can enjoy with pride. Gabriolans must be aware that Forestry zoned lands are designated for timber harvesting.. The trees are cut in rotation as they become big enough for economic harvesting.. The properties are privately owned, they are not parks, and continued public access is not guaranteed.
Why do we need a larger clinic?
First: The Interim Twin Beaches Medical Clinic is 1600 sq. ft. and the new Clinic will be approximately 4,000 sq ft. We need to accommodate a third doctor, as the interim Medical clinic currently handles more than 3000 residents, which overloads the current staff Since the interim clinic was built in 2007 the majority of Gabriolan’s now use island doctors.
Second: We need an treatment room that is large enough to handle more than one patient.. If a multi-patient situation, such as a serious automobile accident, does occur, patients can be stabilized before being routed to Nanaimo.
Third: We need an office for the nurse practitioner.
Fourth: It will have space dedicated for VIHA to be able to run programs vital for Gabriolans well-being and mental health.
Why is this so urgent now?
Every person on Gabriola can be served in the urgent care unit by calling 911. In May 2010, there were 46 emergencies and the treatment room of the interim Gabriola Community Clinic stabilized 39 patients. Only 7 had to be sent on to Nanaimo General Hospital.
Accidents can happen at any time. With only two on-call doctors, 911 emergencies during the Gabriola Community Clinic hours mean that appointments have to be rescheduled. If a third on-call doctor is in the rotation, this will enable 24/7 on-call coverage.
Who will pay for the clinic’s ongoing upkeep?
The doctors will pay rent for use of the building. The rent will pay for projected maintenance and other building operating costs and provide a reserve for contingencies and major repairs. VIHA will pay for the drugs and medical supplies for the urgent care treatment room and for a significant portion of the equipment used therein.
How much will it cost?
The estimated costs to build are $220 a square foot. For a 4,000 sq/ft building, this equates to approximately one million dollars. To date Gabriolan’s have raised more than $714,000 in cash and volunteered labour. We still need to raise $300,000 dollars.
What about equipment?
Equipment that was obtained through fundraising for the Twin Beaches Medical Clinic will come to the new clinic. That is a substantial start. Because the Community Medical Clinic is a part of VIHA, VIHA supplies day-to-day medical supplies and materials as well as a significant portion of the equipment for the emergency room. The Lions Club, the Critical Care Fund the Ambulance Society and certain other private Gabriolans have also been very generous with their donations and bought several pieces of equipment. Dr. Verne Smith’s retirement event raised $6,000 for equipment which will go to the new clinic.
The next 20 questions were printed in the Gabriola Sounder newspaper in early 2010. The questions and answers are reprinted here.
1. Why do we need a new medical emergency clinic.
There is strong support within the community and sincere questions about how to raise such a large sum of money to build our new 4500 sq. foot Medical building. Remember Gabriolans have built their own Community Hall,the Agi hall, the Gabriola Museum, the Hope Center for kids, the Commons for everyone and the Rollo Center for seniors. Have we missed anyone?Oh yes, we fundraised to build the interim Emergency Medical Clinic at Twin Beaches in 2007 all with donations,donated labour, plus equipment donations by the Lions for the Emergency Room these last 3 years. Expanding our Interim Medical Clinic for 3 doctors and with a larger Emergency room is a big project and totally doable for Gabriolans because, we are industrious and hard working and most of all, a community.
2. Why do we need an emergency clinic?
We are fortunate to have attracted two doctors who have surgical experience and have been highly effective in stabilizing patients before moving them to Nanaimo General Hospital. An emergency clinic would provide an ideal location for stabilization. Vancouver Island Health Authority (VIHA) also prohibits storage of certain medication, such as clot buster drugs, anywhere other than an emergency clinic. Ambulance paramedics are not allowed to administer these life saving drugs, but our doctors do have authority to do so.
3. We already have four doctors. Why do we need another one?
It’s not as good as it sounds. We do have Dr. MacKenzie at the Professional Medical Center on North Rd. who has a general practice and sees patients during his office hours. "On Call" duty is a request of commitment asked of the doctors hired for the Gabriola Medical Clinic. On Call means one of our two doctors go out when the ambulance suggests that they can stabilize the patient, prior to the Nanaimo Emergency Hospital journey. The two doctors, Dr. Bosman and Dr. Thorne who work at the interim Community Medical Clinic at Twin Beaches, work a full and typically long day. They get booked up for non-urgent appointments as much as a week or more in advance. Those non-urgent appointments get bumped, understandably, for emergencies. After finishing work at the clinic, they take turns staying on call for the rest of the night. Unless a third doctor takes on a share of this burden as soon as possible, those two doctors face enormous challenges—and we risk losing them to burn out. Dr Smith, while doing a wonderful job by providing the Saturday walk-in clinic plus Friday in the office does not do on-call, and Dr Henderson, who does locums and does provide on-call when working, does not represent the much-needed third on-call doctor.
4. Why do we need a larger clinic?
There are four main reasons. First, we need to accommodate a third doctor as the interim Medical clinic currently handles more than 3000 residents. Since the interim clinic was built in 2007 the majority of Gabriolans now use island doctors. Second, we need an emergency room that is large enough to handle more than one emergency, a situation which does occur, and to stabilize patients en route to Nanaimo Hospital. Third we need an office for the nurse practitioner. Fourth, with a room for VIHA Wellness programs this will assist the well-being of our community and they will also pay rent.
5. Why don't the doctors set up their own practice?
We want doctors willing to utilize the emergency room in our medical clinic. The doctors want to focus on their work at the clinic rather than have to operate a business. We want 24/7 on call service, and need a 3rd doctor who is willing to do this in our clinic. As the Doctors say, you build the Community Medical Clinic and we will pay the rent.
6. Who will pay for the clinic’s ongoing upkeep?
The doctors will pay rent for use of the building. The rent will pay for projected maintenance costs and a reserve for contingencies and major repairs. VIHA pays for the drugs and medical supplies for the emergency treatment room and for a significant portion of the equipment used therein. The Gabriola Health Care Society (GHCS) board will administer the property.
7. Why not rent instead of building?
It is always better to own instead of renting. With renting you are never in control of costs and have no security of tenure. We want to build a seismically engineered building, so it is still available if a natural disaster occurs. The building committee has had many discussions on what to build for a community of our size, with projected population figures. The doctors and structural experts have been part of those discussions.
8. How much will it cost?
Architrave Architects have given a large amount of time to drawing up plans, with input from the doctors for the floor plan. Currently, the interim Twin Beaches Community Medical Clinic occupies 1600 square feet. The estimated space required for three doctors and one nurse practitioner, is 4300 square feet. The estimated costs to build are $220 a square foot. This works out to approximately one million dollars. To date Gabriolans have raised more than $170,000 in cash and more than $100,000 in volunteered labour. Our $100,000 in donated labour will take us to lock up. We still need electricians, plumbers, drywallers and painters to step in and volunteer their time. We received a donation of $10,000 from the Lions Club and $25,000 from the Gabriola Ambulance Society in addition to the substantial amounts previously received from them. We have had over $20,000 from an anonymous donor. There is $700,000 more to raise in order to build our Community Medical Clinic. This is achievable.
9. But buildings never stay on budget...
We have a highly experienced project planner that has volunteered to run the project on a very professional basis. We believe that this and the vested community interest are so strong that there will be accountability for everyone to stay on budget.
10. Who is in charge of this?
Good question! There is such a solid core of committed volunteers for this community project that you will be proud they live in your neighborhood.
Margot Kemble of Architrave Design Build is assisting with the design. The accounting is handled by Harvey Graham who was a partner with Price Waterhouse. The books are open and the financial statements for 2009 are currently being placed on our WEB site. Chuck Connor has volunteered to be the project manager. John Campbell has a solid core of workers who will be involved with the construction, all of them volunteers. Brenda Fowler is the head of the Foundation and the Auxiliary and your spokesperson. Brenda works long hours and has a solid leadership style based on respect of all involved.
Nancy Nevison as Chair of the Auxiliary and the Volunteers’ Office coordinator, has committed to a year of keeping the clinic in the forefront of our minds through public awareness and local fundraising events. We project the Auxiliary to raise $80,000 dollars. Amongst the hardest workers of all have been the Auxiliary team. Since January the Volunteer Office has been open five days a week, with two to four persons each two hour shift. There have been 13 events so far this year raising $30,123.83 to date and it should be recognized that if it were not for the Auxiliary volunteers reminding us weekly this is important we would have not realized the urgency for our new Clinic. To date all the volunteers have put in 2,500 hours. There are 11 more events planned for 2010. Thank you, Gabriolans.
Dave Innell is chair of the Data and Services committee which has brought the Integrated Health Network Wellness program to the island and is leading the community Wellness survey during the month of June. The Grant writing team has 6 volunteers who have submitted a number of requests for grant money. The Property team will hopefully have a resolution soon for the land the Gabriola Medical Clinic will be situated on. They are working daily on this. The land situation involves space, suitability, zoning, and then measurements and re-thinking building design for each situation. It is important, complicated and they are working very hard.
11. How much goes to Administration Costs?
This is a very good question. Last year 1.5% of the money raised went to administration. Administration is printing, stamps, insurance, rent and so forth. All the positions are volunteer and unpaid. Our 2009 financial statements are on our WEB site: www.GHCF.ca.
12. What about equipment?
Equipment that was obtained through fundraising for the Twin Beaches Medical Clinic will come to the new clinic. That is a substantial start. Because the Community Medical Clinic is a part of VIHA, VIHA supplies day today medical supplies and materials as well as a significant portion of the equipment for the emergency room. The Lions Club, the Critical Care Fund and the Ambulance Society have also been very generous with their donations and bought several pieces of equipment.
13. How can I donate through my will?
Hello! We want you to live forever!This is the point of our larger clinic with a larger emergency stabilizing area. Already we have had a donation made to us for a tax benefit and a gift of cash for us. Once the clinic is built, ongoing fundraising efforts will go towards specialized equipment as time goes on. If you are thinking of leaving a bequest in your will this money would be invested to allow a steady income to provide new equipment or whatever else you wished. On the Website www.GHCF.ca there is a tab for "Tax Smart" Planned Giving under the "Click to Contribute button. Thank you.
14. Can't the government help?
The government hasn’t helped so far and isn’t giving any sign of helping. We do agree that the government should be paying for accessible medical care for all British Columbians. Accordingly, we still keep applying for any eligible government grants. We have a Foundation grant writing team who has just put in a number of proposals for grant money. They are researching and writing more proposals all the time. You can help by writing to your MLA and to the Minister of Health to urge them to support this initiative.
15. I don't have much money, what can I do?
There are lots of ways to help without severely depleting your wallet. You can buy all your gas at the Co-op using the GHCS member number - 611459. The Co-op staff knows the number, which saves you having to remember it. The percentage is really adding up. Volunteer time is gratefully accepted. We will need workers, painters, even site cleaning as we build. We also need stamps for mail outs, so next time you are at the Post Office think of us and our mail outs and buy a packet.
16. What about people who don't live here year-round, and visitors?
There is a writing team sending out letters asking them for as much as they can donate in pledges and cash. We believe they have as much interest as anyone in building this clinic. If you know anyone that should be contacted please let us know at ghcf@ghcs.ca. They may need it too!
17. If I give a big cash donation, will a room be named after me?
If you win the lottery and you give us the $700,000 then we will consider naming the building after you!That aside, there are plans to have an acknowledgement wall as you enter the clinic building to ensure everyone is aware of who has contributed. And yes, a significant donation could result in a room being named after you.
18. I'm a struggling artist, what can I do?
This is going to be a beautiful building. There has been discussion that gardeners might donate landscaping and create a serenity garden. We would also love to have a carving or entrance piece of art that was gifted to the clinic. Artists have already offered large paintings to decorate the doctors’ offices, clinic rooms and the lobby. Already we have received several pieces which we have raffled or auctioned in fundraising.
19. When will it be built?
With sufficient financial and other support this year, we could have the clinic open and operating in 2011, but realistically it will probably be 2012.
20. Has the passage of time made this request urgent?
The answer is yes. Please donate at the Gabriola Credit Union: to the Gabriola Health Care Foundation or go on the website www.ghcs.ca and donate (Tax Receipt). Come to the GHCS office, currently open at the Women's Institute or email us through www.ghcs.ca or phone 250-247-9045. These questions will be posted the website and at the Village Food store.
The next 16 questions were received from the Flying Shingle newspaper May 4, 2008. The questions and answers are reprinted here with the permission of that publication.
1. Why, considering the fact that both Gabriolan medical clinics have weekend drop-in clinics, are Gabriolans being asked to pay for the clinic at Twin Beaches and not for the Professional Centre?
- The doctors at the Professional Centre are not on-call after office hours for emergencies and have not signed up for the on-call system. Also, there isn’t an emergency treatment room at the Professional Centre.
- The Vancouver Island Health Authority (the "VIHA") pays for the supplies and all necessary drugs and equipment for the Emergency Treatment Room. The list of requirements for an authorized Emergency Treatment Room ran 13 pages and ranged from the size and required equipment to the proximity and availability of on-call physicians for monitoring patients.
- The Emergency Treatment Room is used for all people on Gabriola (residents, Visitors etc. ) whether they have a physician on the island or not. This is separate from the Medical Clinic. Gabriolans will always be able to choose who their general practitioner is, whether on island or off. The Emergency Treatment Room will be there for all emergencies. Being on-call is different from a drop-in clinic. The MD must carry a pager linked to the Ambulance Services, must be available at any time during the day and night to respond and can’t leave the island.
2. Are the doctors at Twin Beaches paying rent for their facilities like the ones at the Professional Centre, or is GHCS covering their rent? If they are paying a percentage of their rent, what percentage is it?
- Yes the doctors are paying rent. No they are not being subsidized. They are also paying down the leasehold improvements costs so that the money can be reused for the permanent clinic.
3. If you wish to build a clinic elsewhere is it possible that you would then expect the public to be involved through taxation?
- We expect to raise some money through donations from Gabriolans, but the bulk of the funding will come from grant proposals to philanthropic organizations and foundations and possibly "government" agencies such as the Regional District of Nanaimo. There will be no specific tax or special Gabriola "levy" that people will be asked to pay for building the clinic. Our policy is that no money will come from property tax or other taxes imposed specifically on Gabriolans. Money from the Ministry of Health and VIHA is obviously from the broader Provincial tax base.
4. Do you have any stats on the number of visits to the Emergency Clinic/lives/limbs and/or dollars saved by folks having access to the clinic or an on-call doctor?
- That data is being collected. The early numbers are significant but we need input from VIHA and others to get proper data. There are also some privacy constraints in discussing individuals. There have been a number of stories published by individuals who provided this information directly. We did collect data for the first two months of clinic operation. While there are many variables at play and changes have occurred over the course of the year – these statistics for the first two months do represent a rough estimate of the work carried out by the on-call physicians.
- 74 emergencies seen (either ambulance or came in with an emergency)
- 38 emergencies seen during office hours
- 36 emergencies seen out of office hours (note that these have been extended since the new clinic opened)
- 2 patients accompanied to NRGH
- 2 critical cases (lives saved due to immediate intervention)
- 48 (65%) of these emergencies were not patients of the clinic physicians.
5. Why does GHCS think a permanent clinic is the best idea?
- We plan to co-locate as many VIHA services (Mental Health, Public Health, Home Care), as possible as with the physicians. This requires more space than we currently have access to. At the last public meeting it was also clear that a majority of people felt that owning the clinic was preferable to leasing. There would be tax advantages as well as not having to respond to a landlord’s commercial needs. No decision has been made though on lease vs. own. There will be lots of opportunities for public input on these issues.
- The Interim clinic was created because the conditions in the old clinic were unacceptable to patients and physicians alike. The space was insufficient for an Emergency Treatment Room or the additional full-time physician needed to provide on-call services. At the time we were looking the Professional Centre only had 1000 sq ft free (currently G&S Meats) and we needed a minimum of 2000 sq ft. The former liquor store at Twin Beaches was the only immediately available space with appropriate space and zoning.
6. When you are talking about looking for a central location for the clinic, what area are you thinking of?
- No decision has been made. We are currently considering a number of sites. All except one are roughly within the Village Triangle area. [Updated Apr. 8, 2009]
7. Re: the whole Ladysmith Clinic/coercion issue, how is the way that Ladysmith folks are registered at their clinic different from how Gabriolans are members of the GHCS? Are you certain that VIHA sees it the way you do, and how do you know for sure?
- In Ladysmith they have rostering. This means that the clinic is given a per capita amount based on the number of residents in the area. If a patient chooses to go to another physician (outside of Ladysmith since ALL of the 6-7 physicians in Ladysmith are part of their primary health centre) then the budget is reduced proportionally. The rostering occurred after the physicians threatened to withdraw their services. There is no health care society in Ladysmith and it was the physicians who accepted rostering.
- I have the assurance of the Chief Medical Officer that this will not happen on Gabriola since the situation is very different here. The GHCS board would not agree to it and none of the MD’s on the Island would agree to it either.
- The GHCS by-laws were based on those of the Community Hall, which also has all Gabriolans as members without actually having "signed up." This was done to ensure that the Emergency Facility was "owned" by all Gabriolans. There is no requirement that a person be a member of GHCS or, indeed, even be a resident of Gabriola for them to have access to the ETR or the drop- in clinics. By making all Gabriolans that share our goals members (unless they choose not to be) we ensured that all Gabriolans would have a vote in determining the GHCS Board of Directors, and thus a role in determining GHCS operating policies.
8. Re: on- call emergency doctors, are they available to all Gabriolans even if they have a different GP, when are they available, and how does one reach them?
- The on-call physicians will deal with an emergency for any individual on Gabriola, regardless of whether they live here (full time or part time) or not, regardless of who their GP is (or if they even have a GP). The on-call doctors are generally available 24 hours a day, 7 days a week. You reach them by calling 911. When you call 911 there is a protocol that determines what is best for the patient. Some will go straight to Nanaimo, others will be stabilized at the Emergency Treatment Room then transported to wherever is necessary (Nanaimo, Victoria or Vancouver), the vast majority are treated at the Emergency Treatment Room and sent home.
9. Is it correct that what you are looking for funding for from VIHA is: start up costs for a third doctor, funding to cover on call work, and money for a new clinic? Is there anything else you are requesting funding for?
- We have been granted a Family Physician for BC position. This comes with up to $100,000 for startup cost for the third physician. This money comes from the Province (not VIHA) and is already committed. The ad is already posted.
- We are looking to VIHA for funding for the MD’s under the MOCAP program to compensate them for being on-call and lost opportunities to see their own patients.
- We are also looking to VIHA to pay rent with respect to the space in Twin Beaches occupied by the Emergency Treatment Room.
- In the future we will be working with VIHA to ensure that we have long term commitments to pay rent from the various VIHA entities that will reside in the new facility (long term leases for example); that VIHA will provide funding to equip any new Emergency Treatment Room or other emergency related facility; and that VIHA will pay rent for the space occupied by the new Emergency Treatment Room.
- VIHA is currently providing supplies and equipment for the Emergency Treatment Room and the Gabriola Emergency Treatment Room is in the VIHA capital budget.
10. What will VIHA be looking for from Gabriolans when they hold their forum?
- The Ministry of Health is facilitating the public consultation. Both the Ministry of Health and VIHA hope to get ideas on what service Gabriolans would like to see, what Gabriolans priorities might be and to answer questions. The report of the facilitator will be used to create a plan for the future with time lines etc. as well as further opportunities for public input. All of the MD’s signed the Memorandum of Understanding as well as GHCS, VIHA and the Ministry of Health. It will be an opportunity for all issues relating to health care to be discussed. It is likely that there will be semi-private opportunities to talk with the facilitator’s team as well as an open public meeting in the evening.
11. If the VIHA funding goes ahead, what will it pay for and what will the foundation pay for?
- VIHA funding is already coming to Gabriola, including funds for supplies and equipment for the Emergency Treatment Room as well as some funds for planning. We are hoping to hear soon whether or not Gabriola will receive MOCAP (Medical On-Call Availability Program) funding from VIHA – this funding will be provided to all physicians that are providing on-call emergency response. There is currently a provincial moratorium on new MOCAP funds while the government reviews its processes, but it is expected that the moratorium will be lifted shortly. We have been guaranteed equity with the other Gulf Island via the Memorandum of Understanding. All of the Gulf Islands have community health clinics and societies and all of the Gulf Island physicians other than on Gabriola either receive MOCAP or are on salary.
- The foundation will pay for the capital costs of the permanent clinic. The space will be rented to the professional and other users.
12. You have talked about the vision you have of making the clinic an interdisciplinary team with access to many services. Could you tell me what other services you are thinking of bringing on board? Have you talked to these folks, and do they seem interested in the idea?
- The main VIHA services have been contacted - Mental Health, Public Health, and Home Care. They are all interested and definitely would like to increase their presence on Gabriola. They are particularly interested in better co-ordination of services to better serve their clients. The Memorandum of Understanding does commit VIHA and the Ministry of Health to this model of integrated service. BC Ambulance may also be interested in sharing space.
- We are also interested in talking with any health professional who may have an interest in an integrated approach to patient care and health promotion.
13. Could you tell me what the money that Gabriolans have donated to date has been used for? Was it for the renovations on the Twin Beaches Clinic?
- Prior to the opening of the interim clinic funds raised were used to renovate the old liquor store at Twin Beaches. VIHA has repaid part of the cost of the Emergency Treatment Room; the rest was from the funds raised on Gabriola. Therefore Gabriola has helped to create the Emergency Treatment Room which is independent of the space rented by the physicians and the physiotherapist. The individual renters of the remaining space are paying back their share of the leasehold improvement costs as part of their rent. At the end of three years, all Gabriola raised funds used for renovations to the space occupied by the renters (that is, for items that can not be moved to the new clinic) will have been recovered from the renters and will be put into the fund for the permanent facility.
- All equipment such as the heating/cooling system, cupboards etc were designed to be moved from one location to another so that all of the moveable assets in the interim clinic will become part of the permanent facility.
14. Are the funds you are campaigning for now to go to pay for building the permanent clinic?
- Substantially all of the funds collected since approximately August 2007 will be put towards the new permanent clinic. All potential occupants of that clinic will pay rent so that the clinic will be self sustaining. It is possible that some of the funds now being raised will (at the request of the donor) be used for specialized equipment for the Emergency Treatment Room that VIHA is not prepared to fund. In that event the equipment will also become part of the permanent clinic.
15. If the answer to these questions is yes, I am back to my first question which is why are Gabriolans being asked to donate towards renovating and/or building one set of doctors’ offices and not the other? I am guessing it has to do with the new interdisciplinary model you are working towards, but I would prefer not to guess on that.
- The interdisciplinary model for Primary Health Care is a big part of the answer. Co-location is an important element of our goal toward providing better service to Gabriolans, of course. The Emergency Treatment Room is also an important facet of a new permanent clinic. In early discussions with the Province and VIHA, it soon became apparent that neither them were prepared to finance the construction of a new Emergency Treatment Room or the space for co-location (i.e. they had no budget for infrastructure expense). If the community wanted these facilities, it would have to fund the initial cost. Operating, maintenance and similar costs, and a portion of the original cost, will be recovered from the tenants of the building. VIHA/MOH and GHCS are looking at health care needs for Gabriola and it is important to note that physicians at both clinics are involved in the process. Gabriolans are being asked to support health care on the island not a specific physician.
16. Another question has just arrived asking how a person removes themselves from the GHCS membership
- They should contact the GHCS at either PO Box 295, Gabriola Island, BC V0R 1X0 or by Email to information@ghcs.ca and indicate their desire to not be members.
- Please note that this does not change the provision of emergency medical help via 911, they will still receive treatment at the Emergency Treatment Room if that is what is deemed appropriate. They would also still have access to walk-in clinics at either physician location.
The remaining questions and answers were initially published in 2006 or 2007, prior to the opening of the Twin Beaches Interim Clinic and prior to the formation of the Gabriola Health Care Foundation.
What is the Gabriola Health Care Society?
- The Gabriola Health Care Society ("GHCS") is a non-profit society incorporated in BC.
- All residents of Gabriola Island, B.C. who assent to the purposes of the society and who are at the time at least 19 years of age will be members of the society unless such person has opted to not be a member. In addition, any person may apply to the directors for membership in the society and on acceptance by the directors is a member. There are no fees and all members will be able to vote at meetings.
Who will own the clinic?
In effect, the community, through its membership in GHCS. However, legally it will be owned by the GHCS, an incorporated not-for-profit society. [Note that because of the requirements of the Income Tax Act, Canada, it will now be GHCF that will own the structure.]
Return to the top of the pageWhat are we doing?
- Creating a Health Care Clinic which will include an Emergency Treatment Room to stabilize patients and provide doctors with a facility to treat minor emergencies.
- Providing a clinic to support the recruitment and retention of health care professionals.
- Obtaining Vancouver Island Health Authority (VIHA) funding and ongoing involvement on Gabriola.
- Reducing the number of trips to Nanaimo - by ambulance and other means – for Gabriolans requiring urgent treatment.
Why do we need a health care clinic?
- To maintain “on call” urgent and integrated medical services here on the island.
- To provide a facility for emergency patients; government funding will be applied for to pay doctors for providing this service.
- We have the opportunity to recruit another full time doctor to Gabriola, but must provide a place for him to practice.
- An Emergency Treatment Room will reduce the number of trips to Nanaimo by Ambulance or otherwise to obtain urgent treatment.
When and where will it happen?
- There are two stages, an Interim clinic which is now open at Twin Beaches, to be followed by a larger permanent facility in due course.
- The decision to create an Interim clinic allowed us to take advantage of the opportunity to obtain another doctor now, as well as immediately improve and integrate health care services.
- It will take some time to raise the funds required for a permanent clinic and to obtain the land. Many options for a permanent location are being explored and studied; most are within ½ km of the village.
Who pays the rent?
The tenants. The Health Care Professionals and VIHA will all pay rent for the space that they utilize.
Return to the top of the pageWhy Twin Beaches and not the Professional Centre?
Twin Beaches was the only place currently available on Gabriola with more than 1500 sq ft available. A minimum of 2000 sq ft was required to house the professionals working there as well as provide for the Emergency Treatment Room.
Return to the top of the pageDetails of Interim Clinic
- The Interim Clinic at Twin Beaches includes an equipped Emergency Treatment Room, offices for at least 2 doctors, and office for VIHA and space for a Physiotherapist. This will enable us to recruit and retain health care professionals, stabilize and treat patients on an emergency basis, as well as cut the number of patients making unnecessary trips to Nanaimo.
- The Emergency Treatment Room is a facility where patients can be stabilized, a frequent medical necessity to avoid a worsening of their condition while en route to Nanaimo. It could also be very useful when the ambulance is off island, when weather precludes travel to Nanaimo, or in the case of multiple casualties. In many cases, splints, casts or a few stitches could be provided in the Trauma Room and the patient can return home without having to go to Nanaimo.
How many beds will it have?
None, just examination tables.
Return to the top of the pageWhen did it open?
July 3, 2007.
Return to the top of the pageDetails of Permanent Clinic
- The permanent clinic will cost $500,000, or more, and will comprise of 3500 sq ft or more.
- A planning committee including an Architect and medical experts is already at work planning the facility.
- The vision is to build on donated land, and there are several possibilities within ½ km of the Village.
- There will be room for at least 3 doctors, other health care professionals, and offices for mental health, home care providers, and additional related government services.
- The overall goal is to integrate health care services on the Island.
How will we sustain a clinic in the long term?
By renting the space to tenants who provide health care.
Return to the top of the pageRecruitment/retention of Health Care Professionals
Rural doctors are scarce. It is simpler to practice in a large centre, because:
- there is easier access to large hospitals
- doctors can pool costs for a good private practice facility.
- there is greater access to peers and specialists.
- there is no 24 hour on-call for emergencies and other factors.
The challenge for a small community such as ours is to find a doctor interested in a rural lifestyle and then provide them with an attractive working environment.
Return to the top of the pageWhy are we building a clinic for the doctors?
We aren’t. It is being built for the community. The doctors and others that work there will pay rent for the use of the facility.
Return to the top of the pageWhy isn’t the Government paying for the clinic?
VIHA will not invest in capital structures except for hospitals. Also, a portion of the clinic is private doctor and physiotherapy space. VIHA is going to pay rent for their share of the space and which will help cover the operating costs.
Return to the top of the pageWhat about the sign on Don Powell’s property? Why not just let him build it.
We believe that the community's view is that the permanent clinic should be a community owned building. This will be less expensive in the long run and the community will have better control.
Return to the top of the pageWill fund raising have to go on forever?
Once in place the Clinic should be self sustaining. However, some fund raising may take place in the future, for example, to buy new or more equipment.
Return to the top of the pageWhat happens if there is a change in VIHA or Government and no longer want to participate?
No one can predict what Government policy might be in the future. If there is a change the community will have to decide what to do in light of circumstances at the time.
Return to the top of the pageWho is going to work there?
See “details of Interim clinic” and “details of permanent clinic.”
Return to the top of the pageWill it be open 24 hours a day?
No, but the Emergency Treatment Room will be available for the use of doctors and ambulance paramedics at all times.
Return to the top of the pageWhy do we need a hospital?
This is not a hospital. Please see “details of Interim clinic and permanent clinic.”
Return to the top of the pageWill this add time to the trip to Nanaimo in an emergency?
No, because the paramedics (or the paramedics and the doctor, if a doctor is at the scene) will immediately decide if a situation can or should be dealt with at the Emergency Treatment Room or if the patient should be transported to Nanaimo, or elsewhere directly.
Return to the top of the pageMy doctor is in Nanaimo. What will this do for me?
It may save you a trip to Nanaimo in an emergency. It may be a life saver if you can’t get to Nanaimo right away. This will provide Gabriolans with a much greater chance of being treated within the “golden hour”.
Return to the top of the pageWhat will this add to my tax bill?
Nothing, the clinic will be self-sustaining.
Return to the top of the pageWill I be able to go to the clinic even if I don’t have a doctor on the Island?
The Emergency Treatment Room is for the use of everyone in an urgent care situation.
Return to the top of the pageWhy not just improve the transportation to Nanaimo?
Weather plays a large role. Our main form of transport (the ferry) was eliminated for after hours’ service and the decision makers are unlikely to change their minds.
Return to the top of the pageHow long is the interim clinic planned for?
Until the permanent facility can be put in place. Probably three or more years. See above “details of interim clinic and permanent clinic.”
Return to the top of the pageWhat is the fund raising goal?
$500,000 or more for the permanent clinic.
Return to the top of the pageDo Gabriolans have to raise all the money?
Probably not. We are investigating government and private grants.
Return to the top of the pageWill there be a system for recognizing donors?
Absolutely, but it is too early to say what form it will take. In the meantime, we are keeping careful records of donors.
Return to the top of the pageWhy do I make my cheque payable to the Gabriola Health Care Foundation, not the Society?
We have two entities. The Society will be engaged with the operation of the clinic. The Foundation is a charity for income tax purposes and will be able to issue tax receipts with respect to the donations that it receives.
Return to the top of the pageHas a location for the proposed health centre been selected?
No. Society Directors are conducting a preliminary review of a number of possible locations with appropriate zoning. The intention is to prepare a list of requirements, and invite the owners of these properties, and possibly others, to submit a proposal to the Society. No decision regarding location will be made until that process has been completed, and all resulting proposals have been carefully evaluated.
Return to the top of the pageWhy a Society?
A society provides an independent entity to:
- Assess and respond to community health care needs
- Work with the health professionals and VIHA to develop programs that address those needs
- Provide facilities to licensed health care practitioners in a way that fosters integrated team care and accessibility wherever possible
- Work in partnership with other community agencies to improve conditions affecting health
All profits of the Society are to be exclusively used for advancing its purposes. There will be no distributions or benefits to its members. Should the Society be disbanded, any remaining assets will be refunded to the donors or transferred to an organization having objectives similar to those of the Society, as may be directed by the members. These provisions are unalterable.
Return to the top of the pageWhat are the Society's long term goals?
To develop and maintain a fully equipped health care facility to deliver integrated Primary Health Care services to people on Gabriola. The work will be carried out in three phases:
Phase 1
- Hold informal consultations with and provide information to Gabriolans regarding the Society’s goals & objectives;
- Facilitate a Town Hall meeting to provide a project overview, gather feedback and plan next steps;
- Legally formalize Gabriola Health Care Society;
- Investigate other Primary Health Care models currently in practice provincially and beyond;
- Investigate various funding opportunities;
- Investigate possible building sites (consider zoning, water, septic); and
- Meet with Vancouver Island Health Authority to identify options/opportunities for partnerships/funding.
Phase 2
- Establish Society Board of Directors and Officers;
- Secure necessary funding;
- Formalize building requirements. This could possibly include:
- -- Trauma room - Examination rooms X 6
- -- Physiotherapy facility
- -- Reception and administration office
- -- Staff facilities - Meeting room
- -- Lab equipment & X-ray
- -- Public Health/Mental Health/Home Care & Community nurses offices
- -- Wheelchair accessible, ambulance accessible, and single level
- Acquire, construct, and/or lease real estate, and manage such real estate; and
- Acquire medical and other equipment for use in the facility.
Phase 3
- Lease or otherwise provide the facility and related equipment to physicians, government health agencies and other appropriate users;
- Provide administrative and other services that may be required in connection with the administration and use of the facility; and
- Establish the Society’s next goals.
Return to the top of the page