Speaking with Niagara This Week following the recommendations Kitts made about the plan, McMullan said the fact the Ottawa doctor largely agreed with the direction the NHS is taking should serve to restore confidence in the hospital administration.

While the political leaders in St. Catharines didn't waiver in their belief in the ability of the NHS to make the recommendations, some did, he said, and in some cases even their motivations were questioned.

"With a handful of the mayors, it was almost bordering on questioning the integrity of the administration, the leadership of the NHS," he said.

McMullan said the NHS plan to centralize some patient services and procedures, both in the new St. Catharines hospital from other hospitals and the other way around, was supported by Kitts, who in a private meeting with the mayors said the experience in Ottawa has been shown to improve patient care and reduce mortality rates -- by as high as 50 per cent for some procedures.

"If we have that opportunity here in Niagara to save even one life, then we have an obligation, I believe, as elected officials to get behind the NHS plan and work co-operatively and collaboratively toward its implementation," he said.

Kitts, president and CEO of The Ottawa Hospital, was the expert advisor appointed by the Niagara Health System to review the proposed restructuring plan order by the Hamilton-Niagara-Haldimand-Brant Local Health Integration Network. The process also included a period of public consultation, which in the south of the region brought out thousands of people who passionately spoke out about the proposed relocation of services. These included the replacement of the emergency rooms in Port Colborne and Fort Erie with prompt care centres which would close at 10 p.m., and the centralization of obstetrics and inpatient mental health care at the new St. Catharines hospital.

Kitts threw his support behind the latter when he made his recommendations at the LHIN meeting Tuesday at Niagara Falls city hall, saying it would greatly improve patient care.

"We support the notion of consolidation of services," Kitts said. "We're bringing together masses of patients into what we call in the report centres of excellence."

On the matter of emergency rooms, Kitts said he's heard the community opposition loud and clear and recommended instead the ERs in Fort Erie and Port Colborne become 24-hour "urgent care centres."

He said about 20,000 patients annually receive treatment for serious to medium health problems at each emergency department. Kitts described the medical care as CTAS3, CTAS4 and CTAS5, ranging from complications to less-serious injuries and problems.

"We believe significant volumes of CTAS 3, 4 and 5 patients are getting excellent care in Port Colborne and Fort Erie," said Kitts.

"Provide this essential service. You cannot handle having 20,000 patients showing up at any other site."

He said the cost savings from closing the departments for 10 hours a day are unproven and recommended around-the-clock care remain at those sites, with a review later to determine if it's feasible to keep them open.

However, Kitts also stressed that the NHS's plan did not address the entirety of the deficit, projected as $15 million this fiscal year, a "significant finding," he said.

About $12 million in operational costs savings could be realized he said, but the plan would actually take a capital injection to implement, and Kitts said it would be impossible without community support.

NHS board chair Betty-Lou Souter said that she thought the recommendations "certainly reflected that Dr. Kitts listened to the community."

"That was our commitment all along, that this was a vision and wasn't set in stone," said Souter.

She also acknowledged Kitts' finding that the cost savings of the NHS's proposed plan won't be quickly realized, and that in fact implementation of the plan would cost money.

Souter said the amalgamation Community Care St. Catharines-Thorold, where she is executive director, took years before the savings became a reality.

"I know in any amalgamation you won't get the cost-savings right away," said Souter. "I think one of the drivers here has always been quality of care."

Kitts recommendation that the NHS mend fences with the community also sat fine with Souter, who pointed out Kitts repeatedly pointed toward misconceptions as the basis for the dark cloud hanging over the hospital board.

"In any relationship, there's always issues with trust," she said.