For Fort Erie, its emergency department and inpatient beds are out of the hands of the NHS and in complete control of the LHIN.

The LHIN asked the NHS to re-submit its controversial hospital restructuring plan, without mention of the emergency department at Douglas Memorial Hospital because Fort Erie's standing committee didn't approve the proposed plan to replace emergency with a 24/7 urgent care centre. The move means any changes to emergency and inpatient beds in Fort Erie have to come from the LHIN instead of the NHS, after what NHS board chair Betty-Lou Souter called a "legal technicality."

The LHIN board discussed the plan for more than two hours Tuesday, deliberating the NHS's financial situation, quality of care and relations with the community.

Despite recognizing the NHS as an efficient organization, LHIN board member Bill McLean said he doesn't believe the NHS's plan can be implemented without additional government money.

"I don't think that the NHS has any chance whatsoever of balancing its budget," he said. "Do we have any assurances of any kind, that money will be coming from the province?"

Board Chair Juanita Gledhill said most of Ontario's hospitals run working capital deficits and there are no immediate and apparent solutions to the chronic budget shortages.

The NHS has a budget of $360 million and is forecasting a deficit of $17.8 million in 2008-08 and $14.9 million for 2009-10.

LHIN board member Bill Millar questioned the financial savings as a result of converting the 24-hour emergency departments at Douglas Memorial and Port Colborne into 24-hour urgent care centres.

"I'm puzzled by what will be the difference? In terms of resources and money, I don't see where the savings will come."

LHIN CEO Pat Mandy said since the plan calls for an increase of inpatient beds and no acute care, that's where the savings will come from. The cost for 24-hour emergency care is the same as urgent care, she said.

"If the savings aren't obvious, we put two communities through Hell. When does a hospital not become a hospital? I'm not sure urgent care centres are going to bring better care to the communities," said LHIN board member Douglas Archibald.

With still plenty of questions and the clock past the scheduled end of the meeting, the LHIN board opted to receive the report and reconvene for an extended meeting Dec. 16 in Lincoln town hall.

After Tuesday's meeting, NHS CEO and president Debbie Sevenpifer told reporters there while there isn't a savings affiliated with operating an emergency department versus urgent care, urgent care centres don't require inpatient beds, which is where the savings will be.