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However, according to Jain, it was SteriPro who initiated the proceedings to bring the contract to a close. "It was SteriPro that took Trillium to task," says Jain. "We filed a change inquiry notice, and according to our agreement, the next step would have been arbitration, and we would have won a very, very large compensation from Trillium if we had gone to arbitration." Rather than going through arbitration, SteriPro opted to begin negotiations to terminate the contract. "We got compensated a significant amount of money by Trillium to enter into this termination agreement. So, it's not that they terminated the contract. We terminated it."

Jain explains that rather than being dissatisfied with SteriPro's service, the hospital instead had carried on along a trajectory of increasing demand for those services, but neglected to honour the contract elements that mandated further talks about increasing compensation along the same lines. "There were some issue in the contract that enabled us to increase our compensation with increased volume," says Jain. "When a hospital's surgical case volume goes up by 70 per cent, you would expect that our compensation would increase by 70 per cent, but it went up by zero per cent over the last four years, and that's because Trillium did not engage in the discussions that were dictated in the agreement to enable us to increase our compensation for the extra work and the extra labour force that we needed to employ the work that needed to be done."

For Jain, the notion that it was the hospital who terminated the SteriPro contract is factually incorrect, but the added idea that that decision would have been made because of lapses in quality runs counter to the high mark that he sets for his company, and which is attested by the level of accreditation they've received.

"We are the first private facility accredited by Accreditation Canada, which looks at all your work. We've been accredited strictly for reprocessing, Which is a very stringent and highly controlled and monitored service that meets all the standards set by the CSA." With regards to the company's contract with Pembroke Regional Hospital, two main concerns were raised by CUPE representatives during their March media event: that prolonged turnaround time on instruments needing cleaning could lead to shortages at critical times, and that the 400-plus kilometre one-way trip to Pembroke from the SteriPro facility could result in compromises to the sterilization of the equipment. On the topic of instrument inventory, Jain points out that the issue was raised during the preliminary portion of contract talks with the hospital, and to mitigate that concern, SteriPro agreed to cover the cost of an augmentation to the hospital's existing inventory with brand new equipment so that they would always be sufficiently well-stocked to deal with routine and unforeseen situations.

When it comes to the notion that distance presents an insurmountable hurdle to assuring the sterilization of treated instruments, Jain points to his company's provision of service to a trauma centre in Newfoundland, and their various other contracts, as his main response. "If we can service a major trauma centre on the East Coast, we can service anyone from coast to coast. We consider ourselves the experts in sterile transport, because we have developed the methodologies and the techniques, and we've tested them out, to ensure that instruments can be transported safely by road or by air. We currently transport instruments to major hospitals throughout the GTA, and we transport them safely."

In addition, Jain says that SteriPro has a number of detailed tracking and data systems to ensure that every step in the process is wellsupervised and documented. "We have temperature and humidity-controlled and monitored trucks, which have GPS monitoring on them as well. If there was a particular case that had an infection, we can pull out all the records on that particular tray of instruments and provide the data to show when it was sterilized, by whom, and under what conditions that sterilized set was kept. So the chain of sterility from the time that it comes out of the sterilizer to the time when it goes on the shelf in the storage room in Pembroke is completely documented, and we are practically the only ones in Canada who can do that, and we maintain all that data in our database forever. If there was a case that was done 10 years ago where, say, an orthopaedic implant which became infected 10 years ago, we can provide the hospital all the records they need to prove that sterility was not the issue." Over the past few months, SteriPro officials have been working to get the necessary underpinnings of their service to PRH in place, and they are expecting to be fully operational for surgical equipment reprocessing by the end of April. rpaulsen@postmedia.com Twitter.com/PRyanPaulsen

Questions were also raised by Ricci and other union officials present about how much the cancellation of the agreement ended up costing Trillium Health Partners, and especially whether Pembroke Regional Hospital officials

had contacted them to discuss potential issues with entering into their own agreement with SteriPro. Questions about the cost of their deal's termination, communications personnel with Trillium Health Partners were vague. "In response to your questions regarding Trillium Health Partners' contract with SteriPro," reads an emailed statement from THP interim communications manager Catherine Pringle, "the

hospital reached a mutual agreement with our service provider to end our services agreement. Trillium Health Partners is in the process of assuming sole responsibility for its medical device reprocessing operations." "I am unable to share any specific information regarding the terms of the mutual agreement due to confidentiality obligations," it continues, "however I can tell you that fiscal responsibility was an important factor at the heart of our decision-making process."

At the end of the day, CUPE representatives wanted assurances that PRH representatives have done their due diligence ahead of a making the decision to outsource the sterilization service. "I'm hoping the hospital up here would ask [THP] why they ended their contract," says Ricci, who also wondered if there were quality problems getting clean equipment from SteriPro to THP, at an average total distance of 20 kilometres of travel, how much more difficult would it be for the same equipment to have to travel the more than 450 kilometres from the GTA to the Ottawa Valley. rpaulsen@postmedia.com Twitter.com/PRyanPaulsen

Ryan Paulsen, Daily Observer / Michael Hurley, president of the Ontario Council of Hospital Unions of CUPE, left, Simone Burger, vice-president of CUPE Local 1502, and Joe Ricci, president of Trillium Health Partners CUPE Local 5180, hosted a media conference recently to discuss the issue of Pembroke Regional Hospital outsourcing the sterilization of surgical equipment to the GTA-based company SteriPro.

Regional Hospital did a thorough investigation of the performance of steriPro or a comprehensive risk assessment. Compounding the quality issues, the contract involves the transportation of very delicate surgical instruments over rural highways in all weather conditions, which is not recommended by their manufacturers, " said Hurley. "We urge the Pembroke Regional Hospital to reconsider the contracting out of sterilization. We are dismayed by the huge expenditure the hospital must now make on surgical trays and equipment to use this contractor, in order to have sufficient supply on hand," said Cindy shulz, president of CuPe local 1502, which represents staff at the hospital.

Renfrew and area residents are among the patients seeking services at PRH. At Renfrew Victoria Hospital, sterilization is done on-site.

the hospital reached a turning point five years ago, explained president and CeO Randy Penney. "We made the decision to make the investment," said Penney. "We have invested in both the equipment and staff and have all staff certified."

"There is a widespread feeling in the community that we already don't have enough beds and that the closure of these beds and these services is something they are deeply concerned about," said Hurley. The union also revealed that the introduction of voice recognition software will mean the layoffs of seven stenographers at the Pembroke Regional Hospital. They noted that none of the county's four other hospitals sends out their surgical instruments for sterilization. sean.chase@sunmedia.ca

"We are a regional hospital with new state-of-the-art operating rooms and we are sending our surgical trays to Mississauga for sterilization," said CUPE Local 1502 vice-president Simone Burger. "This is not acceptable to us." Ontario has frozen hospital funding for four years. Estimates cited by the Auditor General calculate that hospitals need a 5.8 per cent increase annually to meet their basic costs, however, the union contends the contracting out of an essential service is not the answer. In soliciting public support, the union has received back 6,000 cards signed by concerned citizens.

"Skilled workers are no longer going to be utilized to their full ability," said CUPE 1502 president Cynthia Schulz. The union restated that under this arrangement there are no guarantees surgical instruments will be able to be delivered to Pembroke in time if the road is closed due to bad weather or accidents, and there is a matter of quality control on the work. The union charged that at least one hospital in Toronto's west end is looking to pull out of its sterilization contract after instruments came back with blood and bone marrow stuck on them.

CUPE 1502 vice-president Simone Burger (right) makes a point during a press conference Wednesday that focused on cuts at the Pembroke Regional Hospital. Looking on is Michael Hurley, president of the Ontario Council of Hospital Unions, and CUPE 1502 president Cynthia Schulz.

CUPE 1502 (Canadian Union of Public Employees), which represents Registered Practical Nurses, technical staff including x-rays and diagnostics and support staff at the hospital, is seeking to reverse the cutting of five medical beds and two paediatric beds and the contracting out of services once provided by the Central Service and Reprocessing (CSR) department. CSR provides patient-care areas with clean and sterile supplies and include all reusable patient care equipment such as bowls and basins, anaesthetic supplies and surgical instrument sets. While the 10 people who worked there didn't lose their employment, they were reassigned to housekeeping, and the job they once did will now be handled by a Toronto-based company.

The budget plan involved a large number of stakeholders, including union reps, to vet the issues and evaluate alternative solutions. According to Wren, the April 1 bed reduction was known about since the February 2015 and the physicians have been actively engaged in working towards this eventuality. Outside the hospital, Cindy Schulz, president of CUPE local 1502 representing Registered Practical Nurses, technical staff including x-rays and diagnostics and support staff, begged the question, "What will be next?" Michael Hurly, president of the Ontario Council of Hospital Unions, also addressed the crowd during the rally.

"There are deep cuts to services," Hurly started. "We are here today to say that we are not accepting these cutbacks or the privatization of surgical, clinical and support services." The second issue revolves around the discussion indicating changes to Central Service and Reprocessing department (CSR) at the hospital. CSR provides patient-care areas with clean and sterile supplies and include all reusable patient care equipment such as bowls and basins, anaesthetic supplies and surgical instrument sets. After these supplies are used, they are returned to CSR to be processed before being used by another patient. Processing involves cleaning and may also include disinfecting and sterilizing the item, dependent on its use.

The current discussion evaluates the option of outsourcing a portion of the CSR function to an off-site service provider. "By looking at out sourcing a portion of the work, it allows us to expand our patient services," Wren said. The move will create service capacity that is currently not available internally in the hospital in allowing PRH to expand its patient services through possibilities such as Orthopaedics and other specialized surgical procedures. These additional services will serve to create new jobs in the community. "We're not losing our jobs," said Elizabeth Labron, a CSR department staff member. "We're being repos i tioned within the hospital, but the biggest part of our job is going to be shipped to Southern Ontario."

Labron is concerned that their skills and knowledge will not be utilized by the hospital anymore. A memo from Wren's office confirmed that 'All CSR staff will be retained and will be doing comparable work. There will be no layoffs, and any minor reductions will be facilitated through attrition.' The CUPE campaign will conclude with a public meeting scheduled for 7 p.m. on July 30 at the Knights of Columbus Hall, 170 Ellis Ave., Pembroke.

Schultz said they were not happy with what they see is a lack of commitment to supporting their concerns, and so decided to stage a rally outside his office. Yakabuski was in Toronto Wednesday, so wasn't in his constituency office to hear or speak to those gathered outside. About 60 health care workers and their supporters took part in the rally, which included those from Kingston, Smiths Falls, Perth and other places within Eastern Ontario. Following the rally, the group marched from 84 Isabella and through the downtown core before looping back.

Cindy Schulz, president of CUPE Local 1502 which representing Registered Practical Nurses, technical staff including x-rays and diagnostics and support staff at the PRH, said they decided to bring their message to Yakabuski in person because they feel let down by the MPP. "We first met June 19 with Mr. Yakabuski regarding stopping the closure of the CSR department and the bed cuts," she said, "and his response was what can he do about it?" Schulz said the MPP promised he would attend a town hall meeting on the matter which was held July 30, and he never arrived.

Federal NDP candidate Dan McCarthy also attended the rally, and said this shows the need for a national approach to health care, where local, provincial and federal levels of government respond and cooperate together to the needs. He said changes to the funding formula from the federal level has led to cutbacks right down the line, which is affecting everyone. "The NDP is the pioneer of public health care," McCarthy said, pledging that an NDP government would step up to see to it this Canadian tradition continues.

The cutbacks at the PRH began April 1, when the medical beds were reduced by five. This reduction was implemented in accordance with the hospital's 2015/2016 budget. Back in July, John Wren, senior vice-president of corporate and support services at PRH, told The Daily Observer the decision to reduce the number of beds in the hospital came after examining hospital services and the needs of the patients that PRH serves. He stated becoming more efficient in patient length of stay has resulted in the beds no longer being needed. According to Wren, the April 1 bed reduction was known about since February 2015 and the physicians have been actively engaged in working towards this eventuality.

Another aspect of the protest is a postcard campaign directed at the Minister of Health Eric Hoskins, asking him to intervene in the hospital's decision to outsource sterilization services. Schulz said this has been going well, with 7,000 of them signed so far, reflecting the public's opposition to the changes. She said they will be hand delivering these to Queen's Park once the fall session starts in September. Stephen Uhler is a Daily Observer multimedia journalist

Members of the Pembroke Regional Hospital staff and their supporters march down Church Street following a rally held Wednesday in front of 84 Isabella Street. They were protesting the contracting out of services and the closure of medical beds.

The rise of throw-away medical supplies

Efforts to improve hospitals’ waste production

But isolated hospitals are making changes. The Children’s Hospital of Eastern Ontario is in the process of moving toward a green purchasing strategy, which it’s developing in partnership with Canadian Coalition for Green Healthcare. (The draft plan is currently available online for other hospitals to utilize.)

Ways to minimize the impact of disposables

She also thinks hospitals should be encouraged to buy more socially responsibly, given that many health supplies are produced around the globe by people working in dangerous conditions for poverty-level wages. “The health, environmental and social costs of the production of these consumables is something that doesn’t get costed,” she says.

The areas being looked at are: health records, registration and booking, laundry, payroll, central sterilization, food service, human resources, information technology and telecommunications, library services, general administration, finance and supply chain and material.

The consulting firm is being overseen by a steering committee made up of senior staff from the province’s district health authorities. However, no one representing the province’s front-line, health-care workers is on the steering committee.

The unions believe that cleaning staff may be the first to go and they fear that might lead to superbugs in hospitals.