In the eyes of countless thousands of Niagara residents, it appears the word could just as well apply to an organization whose "mission" it is to provide "equitable and timely access" to hospital services across the region.

That organization is the Niagara Health System, created by the province in March 2000 to amalgamate all but the West Lincoln Memorial Hospital in Grimsby and Catholic-based Hotel Dieu Hospital in St. Catharines (now moved from the city's downtown area off Ontario Street to the former Shaver Hospital site near Brock University) under a single hospital board and administration for the Niagara region.

The NHS was borne with an eye to joining hospital boards in St. Catharines, Niagara-on-the-Lake, Niagara Falls, Welland, Fort Erie and Port Colborne in a single system capable of more effectively pooling Niagara's health-care resources and saving more than $25 million annually in costs for the region's hospitals and taxpayers.

Eight years later, Niagara has an NHS board and administration with an annual operating budget of $370 million, compared to $200 million eight years ago, and is now facing annual operating deficits that exceeded $17 million last year alone. The six hospital sites still under the NHS umbrella, including smaller sites like Douglas Memorial Hospital in Fort Erie, Port Colborne General Hospital and Niagara-on-the-Lake Hospital -- hospital sites operating in the black before NHS came along -- have since found themselves being towed under in a sea of red ink.

Eight years later, Niagara also has a hospital system which, as much as it was created around a "vision" of (in its words) "improving the hospital care of every resident in Niagara," appears to have lost the trust of many of those same residents, including more than a few of Niagara's municipal leaders and the doctors and nurses who work for it.

Last week, the Town of Fort Erie released the results of a random phone survey of 400 residents from across Niagara (considered accurate to within five per cent by the independent pollsters who conducted it), showing 62 per cent of the region's residents do not believe hospital services are "well-managed or credible" under NHS leadership and a similar percentage of residents fear they will become worse.

At a public meeting this October in Port Colborne where 900 Niagara area residents gathered to protest the Hospital Improvement Plan (HIP) which the NHS released July 2008 to address its deficit crisis, the city's mayor, Vance Badawey, made the following comment to Dr. Jack Kitts and his team from Ottawa's hospital system, invited to Niagara to review the NHS plan; "I deeply regret having to say that you can count on the fingers of one hand the number of citizens of Port Colborne who now trust the words of any official of the NHS."

Similar observations were shared when Kitts presided over town hall-style meetings in St. Catharines, Niagara Falls and one in Fort Erie attended by an estimated 5,000 residents. On Monday of last week, the day before Kitts tabled his recommendations on the plan, more than 200 physicians working for the NHS, by a margin of 2-1, voted in favour of a motion of non-confidence in NHS's administration at an "emergency meeting" their medical staff association scheduled in Niagara-on-the-Lake.

By a much slighter margin (possibly one or two votes), the physicians approved a motion calling on the NHS and province to locate the only new hospital complex now planned for Niagara in a more central site in the region rather than a far west corner of St. Catharines - a site the NHS chose five years ago for a new hospital, complete with first-of-its-kind cancer and cardiac treatment centres for the region.

Earlier this fall, more than 100 of Niagara's doctors, working in and outside the NHS, in Fort Erie, Port Colborne, Wainfleet, Welland and Niagara Falls, did something rare for a group of professionals that, historically, don't have a record of getting political. They took out an ad in local newspapers, including this one, signing their name to a petition for the new hospital - identified on NHS's website as one of the most costly infrastructure projects of its kind now on the books for the province - to be re-located to a more central site in the region.

None of this appears to have led to any reconsideration of the west St. Catharines site for a hospital which will cost the residents of this region and province hundreds-of-millions of dollars and may be the only new hospital the province approves for Niagara for decades to come.

Kitts and his team tabled their recommendations on the NHS's plan a week ago last Tuesday, before a provincially appointed board of the Local Health Integration Network (LHIN) - a board that has, as part of its mandate, to make sure hospital systems like the NHS are operating in the black.

As if to feed into a view held by at least some of those attending the public meetings that NHS's plan was a "done deal," the Kitts team gave its blessing to much of the plan, except for a few of the most controversial items like cutting back 24 hour/seven-day-a-week emergency in Fort Erie and Port Colborne. Instead, Kitts recommended a 24-hour urgent care centre for the two south-end hospitals. The Kitts team said yes to most of the organizaton's other proposals, including those for downsizing or eliminating maternity, mental health and other services across the system and "consolidating" or "centralizing" them at the hospital the NHS remains determined to construct in west St. Catharines, at a cost to the taxpayers of this region and province that is still unknown, even though the NHS is hoping for a groundbreaking before the end of this year.

For the eight years NHS has been in existence, and for several years before, at least some doctors, municipal leaders and others in Niagara have been lobbying the province for a centrally located regional hospital or "super hospital" in the region - a state-of-the-art, acute-care hospital that would offer a "critical mass" of the best specialists available for responding to those of us suffering life-threatening injuries and illnesses, while more aging hospital sites across the region continue offering a mix of primary, emergency and longer-term care to Niagara's residents.

Among one of the earliest advocates for such a central facility was John Carter, a retired CEO for the Greater Niagara General Hospital, who continues to believe such a plan is the best way to go. In 2002, a year before NHS announced its plans to build a new facility, Carter made a presentation to Niagara Falls council for a central site for an acute-care hospital for all the region's residents.

Wayne Thomson, who was then Niagara Falls' mayor and is still representing the city on its council, embraced Carter's views, even though it meant the facility might be located outside his municipality - in Thorold, Pelham or Welland, or possibly close to Brock University in St. Catharines, where it could also serve as a teaching hospital for attracting young doctors and nurses to a region now chronically short of both.

In a letter Thomson wrote to the province and NHS in 2002, he questioned why the NHS was, at that time, proposing to spend more than $300 million upgrading some of the aging hospitals across the region, when at least some of that funding could go to a more central site for all Niagara's residents.

"The current proposal ... may satisfy the parochial wishes of area municipalities, who want to be seen as protecting their local hospitals," wrote Thomson. "However, I agree with Mr. Carter's view that the future health of Niagara residents is better served by a centrally-located, state-of-the-art hospital."

Nothing came of the call by Carter, Thomson and others for a more central site.

In October 2003, NHS announced plans to build a new hospital complex, at an estimated cost at the time of at least $285 million, on 40 acres of abandoned farmland in west St. Catharines. The following year, a majority of Niagara's regional councillors - following a lengthy debate over a planning report that raised concerns over the site chosen -- joined St. Catharines councillors in rezoning the land to accommodate the hospital.

Peter Partington, regional councils' chairman, declared a conflict of interest during the May 2004 debate. He was still serving as a lawyer, at the time, for the owners of the land who sold it to NHS for $4.54 million, according to land registry records reviewed by Niagara This Week.

Meanwhile, NHS was insisting, in information it circulated to the public that same year, that "hospitals need to be located where they are readily accessible to the people they serve. This will be a community hospital for the people of St. Catharines, Thorold and immediate area."

At the same time, Niagara This Week has learned, NHS was hiring consultants to look at consolidating key services, including obstetrical and gynecology services.

"All obstetric, gynecologic, midwifery and pediatric care should eventually be located at one site," said one report NHS commissioned at the time.

NHS continued to publicly avow its commitment to community hospitals across Niagara. In an open letter written by then NHS board chair Paul Leon in 2006, he stressed that the NHS remains "committed to our facilities in both Port Colborne and Fort Erie" and to the goal of bringing "much-needed services closer to home so people of Niagara can receive as much care in Niagara as possible."

Then in the restructuring plan which the NHS released this past July, it proposed consolidating obstetrics and other vital services at the new hospital site in west St. Catharines, at a cost to taxpayers yet to be determined.

Dr. William Shragge, NHS's medical chief of staff, told Niagara This Week during an editorial board meeting that the plan's vision is "driven around sustainability and quality (and) the resource constraints we are struggling with. ... (The year) 2008 is not 2002 and not 1997. It is another dimension of health care today. It is a totally different reality. And the challenge we face is not even to catch up to that, but to think about 2010 and 2015 and the changes that are going to come."

Others thinking about the changes to come, including Carter and many of Niagara's doctors, continue to believe that the only plan which makes sense includes a centrally located acute care hospital for the region.

"I really think this (locating the new hospital complex in west St. Catharines) is a huge mistake that is going to set us back 50 years," said Thomson in a recent interview. "How do you change your mind on something that you honestly and sincerely believe is right?"

Thomson says he'll continue fighting for a more central hospital site, and he will probably not be alone.

NHS board chair Betty-Lou Souter told Niagara This Week last week her board and NHS's administration is "taking all of the input it is receiving (from members of the public, doctors and others) very seriously" as it finalizes the HIP. "Regardless of what some may think, we are listening," she said.

The LHIN is planning to make its final ruling on the HIP before the end of this year.