Back on his home turf, Dr. Jack Kitts, the man commissioned by the Niagara Health System to provide an independent, third party review of its restructuring plan is recommending a flip-flop on changes implemented for Ottawa Hospital, where he is CEO, and recommended to be carried out in Niagara.

On Oct. 28, Kitts recommended the removal of most minor surgery from Douglas Memorial and Port Colborne General as part of his recommendations on the contentious plan released in July.

But back in Ottawa, where Kitts' health system is on the road to an estimated $10 million shortfall in next year's budget, health administration officials are looking to trim operating costs by redistributing some of the hospital's caseload back out to peripheral hospitals in the area, stated Richard Wilson, senior vice-president of finance, earlier this month.

Martin said what is being considered in Ottawa is a verification of what Fort Erie doctors proposed to the NHS: use the smaller hospitals to take some of the burden off the larger hospitals. By having caseloads that are ambulatory in nature go to the smaller hospitals, it will do exactly that, he said.

Rather than cut services to smaller hospitals, Port Colborne's mayor said his community's response addresses how the hospital can add to the services provided by the NHS.

"Port Colborne General can have a positive impact on wait times and handling critical mass. It's in black and white in our response," said Mayor Vance Badawey, noting the article exemplifies how smaller sites can enhance the system.

Kitts was not available for comment by press time, but spokesperson Natalie Hanson said The Ottawa Hospital is forecasting a balanced budget for 2008/09.