Premier Stephen McNeil had to shout over heckling and a chorus of boos at an announcement Monday that the province will overhaul how it provides emergency health care in the Cape Breton Regional Municipality.
The government says both the Northside General Hospital in North Sydney and New Waterford Consolidated Hospital will close, while Glace Bay Hospital and Cape Breton Regional Hospital will be expanded.
But the announcement in Sydney was greeted by anger from some area residents attending the event. As he tried to speak, McNeil was called a "clown" and some yelled "shame."
"You're looking to use Cape Breton as a guinea pig," said one person.
McNeil defended his government's decision.
"That's what these announcements are about today is how do we best ensure that when an emergency happens in your community, that you have certainty on which emergency rooms are open and to ensure those emergency rooms are equipped and staffed with what they should be," said McNeil.
Northside and New Waterford Consolidated will be replaced by new community health centres, however, they will not be equipped with emergency rooms. The new centres will include spaces for collaborative family practice teams.
According to a government briefing document, the Cape Breton Regional Hospital emergency department will be about 40 per cent bigger after the expansion. The Glace Bay Hospital emergency department will be expanded by 30 per cent.
Dr. Paul MacDonald, a cardiologist who has worked in Cape Breton for more than 20 years, is department head for internal medicine at Cape Breton Regional Hospital.
"I know that Cape Breton is the most warm and welcoming place in the world — except when we are threatened," he said.
"And when we are threatened, as you can see by this gathering today, we will stand together and fight against that. But I don't see this as a threat, I see this as an opportunity, as a growth, as an investment in our future."
MacDonald said even the relatively new Cape Breton Regional Hospital — which opened in 1995 — is out of date.
"This a major improvement to help us take care of patients. I have a number of new specialists coming to our community who are going to practice critical care, pulmonary medicine and if I bring them into a facility that's out of date, that doesn't have the equipment and the resources that they need, they're not going to stay," said MacDonald.
He said he's "excited" for the changes and said he didn't think the day would come.
"I think this is a great day in Cape Breton."
In 2016-17, Northside General was closed more than any other emergency department in the province, according to provincial statistics. New Waterford's ER was the third-most closed on the list, just behind Musquodoboit Valley Memorial Hospital.
The province cited a number of reasons for the changes, including aging infrastructure and the difficulties in recruiting health professionals.
Tammy Martin, the NDP MLA for New Waterford, said she's shocked by the news.
"So what's New Waterford hospital going to become?" she said in an interview.
"What is happening with that — I would like to know. I'm sorry, I'm so furious right now it's unbelievable.
The province also said the cancer centre at Cape Breton Regional Hospital will more than double in size.
A new community paramedic service is also expected to be up and running in the next six months at an estimated cost of $900,000 annually.
Planning for the project is expected to take place over the next nine to 12 months at a projected cost of $500,000.
It's not clear yet about much all the changes will cost. The province said those costs will be made public after tenders are awarded.
According to the province, Northside opened in 1954. It currently has 45 acute care beds, 14 transitional long-term care beds and 22 beds on Taigh Solas, a licensed community long-term care unit.
New Waterford Consolidated opened in 1963, according to the province. It currently has 21 acute care beds and 24 nursing home beds on Waterford Heights, a licensed community long-term care unit. NWC has 123 staff.
The collaborative model that will replace New Waterford and Northside hospitals is meant to bring together a variety of health-care professionals — a family doctor, nurse, nurse practitioner, dietitian, psychologist and others — to provide better care and free up doctors to spend more time with patients who need to see them, the health authority has said.
In 2016, Nova Scotia Auditor General Michael Pickup questioned the number of hospitals in the province, suggesting hospitals within 30 minutes of each other should be reviewed for possible closure.
All four hospitals in CBRM are no more than about a 40-minute drive of one another.
"The department and the health authority must deliver health care more efficiently and more effectively as well," Pickup said in 2016. "The way things have been working are not the most efficient and effective ways to deliver health care.