Healthcare · Infrastructure

The Real Cost of Our Infrastructure Deficit

It seems everyone likes to talk about how The Government of Alberta spends too much money. While this is a real concern, it is by no means a simple problem to solve. Many are quick to point to simple slogans, like “reducing waste” or “reducing wages of over paid public servants” these ideas on their face seem sensible. The problem is a great deal of our spending problems are symptoms of other, much larger, issues. If we do not solve some of the underlying issues, we will continue to see a rise in wasted spending, poorer outcomes, and longer wait times. Not to mention all of the departments who are chronically short staffed.

Not only does delaying infrastructure repair and construction cause the costs of the project to increase with inflation, which has historically been the highest in the country for most of the last 30 years. The costs increase as well due to further aging and deterioration of facilities. A plan may call for retrofit when initially proposed, but by the time we have ignored the problem for 20 years or more a retrofit will no longer address the issue. Resulting in more costs for design work, engineering etc and may require demolition and new construction.

A couple weeks ago  on Twitter Alberta Can’t Wait (@albertacantwaitattempted to compare AB’s higher spending to buying an old VW bug for the price of a Ferrari. This is a terrible analogy on many levels. The better analogy would be the VW we bought in the 80s is rusted out, leaks: gas, oil, break fluid, coolant, transmission fluid, and most days won’t even start. Rather than buying a new car, or even just properly repairing the one we have; we choose to attempt roadside repairs and/or take an Uber. The chief complaint from ACW, and other similar groups/political parties,  is that we already spend too much money on healthcare, and other programs. Ignoring the fact that we spend a lot of money dealing with the fallout of failing and/or inadequate infrastructure. The analogy I used on Twitter was a leaky pipe flooding the basement. You wouldn’t postpone repairs on a pipe that is flooding your basement simply because your water bill was too high, and you’ve already spent a fortune replacing wet drywall, carpet etc. Just as the leaky pipe flooding your basement adds to your water bill, so too does a leaky pipe flooding a surgical suite (or a dozen) add to the healthcare bill.

I have been working on this list for some time, but it is still wildly incomplete. I will post it here more fully later I hope some of you will contribute to the list. Many of the externalities listed are incomplete, but I hope you can begin to understand the true cost of neglect. When we delay infrastructure maintenance and investment there are a lot of costs beyond what we may ‘save’ by delaying the work. A lot of my most detailed information is for the healthcare system. This is in part because it is so badly neglected, but also because the less obvious human costs are easier to see.

Royal Alexander Hospital – Edmonton

  • Leaky pipes (fresh water and sanitary)
  • Leaky windows
  • Poor airflow and ventilation
  • poor infection control
  • Over capacity (5 beds in rooms designed for 4)
  • Mold
  • Electrical problems

Misericordia Community Hospital – Edmonton

  • Major capacity issues, hospital undersized.
  • Mold
  • Asbestos
  • Numerous plumbing and water issues
  • Fly and pest infestations
  • Electrical problems
  • Over Capacity

AHS Laundry – Rural AB

  • Failing facilities
  • Pest problems
  • Leaks
  • Serious plumbing issues
  • Roof and building envelop issues
  • Mold
  • Asbestos

Tom Baker Cancer Centre – Calgary

  • Operating above capacity since 2003
  • Inadequate room for patients, and families
  • Lack of Privacy
  • Asbestos
  • Mold
  • Project announced several times then scrapped just before breaking ground

I’ll pause the list here to review some of the impacts of the items listed above.

One common factor you’ll notice is asbestos and mold are both listed everywhere. Neither is unique to our medical facilities, in fact they are the norm across our public buildings, they pose unique problems to our healthcare system. While asbestos is generally considered to be very low risk if left undisturbed, it seldom is left undisturbed. Given the flooding, pest, and other issues presented throughout these facilities the risks of exposure become elevated. As asbestos containing Vinyl Composition Tile is common through out our hospitals, and eventually wears down over time asbestos is released into the air, exposing staff, patients, families and anyone else who is nearby. This of course isn’t the only place asbestos lives in the hospitals, many of the darker corners and mechanical rooms are littered with the stuff, which covers pipes, is in the drywall etc. Staff and the public are put at risk for exposure when an emergency repair is required in one of these areas.

We spend $2 billion a year nationally treating mesothelioma in Canada every year. That is just one of many illnesses related to asbestos exposure. Asbestos exposure does not cause an immediate problem, typically any illness takes 10 to 50 years to develop, depending on the nature of the exposure and other risk factors. So we have dozens of ticking time bombs in Alberta just on this one substance.

Not that long ago 2 units at the Misericordia flooded. 50 patients and over 120 staff had to be relocated to The Royal Alexander. As the Royal Alex was over capacity some of the treatments were performed at the Mis, which required patients to be shuttled back and forth in ambulances. As you can imagine would be extremely stressful for everyone involved. Stress is terrible for patient outcomes, it delays healing and can contribute to a deterioration of the patient’s condition. Which of course is a cost to our healthcare system as well to families, their employers, businesses and the larger economy as a whole, especially when you look at the big picture.

Leaky windows are an opportunity for heat to escape, and for water and pests to enter the hospital. I’m sure I don’t need to explain how insets and other pests can spread disease, or how letting heat escape adds to heating costs. Or how poor ventilation makes maintaining a healthy  temperature extremely difficult, and expensive.

One of the biggest complaints made by Albertans, in addition to claiming a spending problem, is wait times. It seems like wait times never seem to improve. That shouldn’t be a surprise to anyone who is familiar with many of the problems listed above. How can you possibly clear a backlog when you regularly reschedule procedures because the OR is flooded, or the water has to be shut off to the equipment sterilization room after a pipe burst. These two scenarios are unfortunately extremely common in our hospitals. Just a few weeks ago two dozen surgeries were cancelled at the Royal Alex because a pipe burst on the 6th floor and water penetrated all the way down to the basement. You can imagine how extensive the cleanup for such a leak would be. How many patients, clinics, offices had to be moved to other locations while remediation took place. Rescheduling 24 surgeries also impacts other parts of the healthcare system as other procedures, tests, follow up appointments must also be rescheduled. Often when surgery is cancelled surgeons will cancel their office hours to catch up on surgical time. This office time is when surgeons do things like consultations, follow ups and other important work. Delaying consultation with a cancer patient can be extremely risky,  even a few day delay can make treatment harder, more expensive and put the patient’s life at risk.

Lets talk mold and infection control. Mold is a serous health risk, not only can it be infectious, the spores can be extremely toxic, and can weaken the immune and respiratory systems of otherwise healthy people. Mold exposure for someone who has a compromised immune system can be fatal. Imagine a patient developing severe pneumonia as the result of mold exposure in hospital. Now that person is spending even more time in the hospital, taking up a bed, using medicine etc. when they would have otherwise been discharged. Not only is this a needless expense, it is needless suffering. Poor ventilation, ongoing/frequent water leaks create opportunities for mold to grow, they also create a breeding ground for other pathogens to grow and spread. Which again is unnecessary, expensive and worst of all creates pain and misery.

Finally relating to laundry facilities. We have allowed our rural hospital laundry facilities to fall into such disrepair they require $200 million in repairs and retrofits. The solution to this problem according to AHS management, and the opposition is giving a no-bid monopoly on laundry to K-BRO. The first deal with K-BRO wasn’t exactly good for taxpayers. We own the facilities K-Bro took over, so the Alberta government paid to bring the facilities back up to code, and continue to provide maintenance to the building, as we own it.  K-BRO made out like a bandit in the deal. We are paying and will continue to pay for that mistake. When the health minister asked AHS to show their work they essentially said they didn’t do any work. No business case was created for the K-BRO takeover nor were any other business cases created for other options to deal with laundry. Assuming we sold off the laundry service, and didn’t repeat the stupid mistake of leasing the property out, we are still left with millions in remediation costs for the sites, and a recurring bill from whichever linen company takes over the service. The savings on this one are pretty slim. We only pay about $20 an hour to our laundry workers, which doesn’t leave much room for savings. Many of the other major costs will not change at all, natural gas, water, detergent etc are about the same regardless of who owns the facility. And that new company/companies would need to produce a profit, so potential savings are likely tiny. A year later and AHS has still not released any business case regarding laundry.

This post barely scratches the surface of the additional healthcare costs we pay every day in Alberta as the direct result of crumbling healthcare facilities. Those costs come in many forms from financial cost to taxpayers, businesses, insurance providers, and individuals to the costs paid in pain, suffering and death. The next time somebody tells you that Alberta was once debt free, remind them of the enormous liabilities inherent in not taking care of your public assets.

Since this post is already on the longer side I will write about some of the other categories of infrastructure and how they impact the lives and wallets of every Albertan later.

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