Documents obtained by CBC/Radio-Canada detail how Newfoundland and Labrador’s only abortion clinic faced bankruptcy earlier this year and pleaded with the provincial government for more stable funding.

The Department of Health and Community Services finally took action, but only after Athena Health Center, which performs more than 90% of abortions in the province, threatened to close.

“I have realized that I may have to close the clinic if something does not change in the very near future,” clinic co-owner Rolanda Ryan wrote in an ultimatum sent to the premier and minister of health. Health on February 3. more than 14 months after first applying for a new funding model.

Fifty-three pages of emails and letters between Ryan and the government show how the clinic’s old fee-for-service funding model crumbled during the COVID-19 pandemic, as people self- isolated and spontaneous sexual activity dropped.

Revenues down, costs up

For each abortion, the clinic received $875. The doctor who performed the procedure also billed the provincial health insurance plan for an additional $195. In the first year of the pandemic, the clinic performed about 100 fewer abortions than the year before. This 11% drop was equivalent to $84,000 less revenue.

At the same time, costs for medical equipment have skyrocketed as demand has increased. Staffing costs remained the same despite lower revenues, as staff were paid for eight-hour shifts at the clinic – which operates once a week in St. John’s and once a month in Corner Brook or Grand Falls-Windsor – regardless of the number of abortions performed.

“Most operating costs are fixed costs that cannot be reduced when the number of procedures decreases,” Ryan wrote in his first letter, sent on November 27, 2020.

“A fixed revenue stream would guarantee the existence of our clinic,” wrote Ryan, who requested $1 million in annual fixed funding. “Such a funding model will provide stability to our clinic’s operations while reducing inpatient abortion care.”

Under the fee-for-service model, which had increased fees since 2010, the clinic received approximately $809,000 for performing 924 abortions in 2019. Abortions at the Athena Center cost less than half of abortions performed in hospitals, according to Ryan.

The emails show the Department of Health was open to the revised funding model, but also concerned about the government’s response to the pandemic. An initial meeting with then-Health Minister John Haggie was also postponed to January 2021 due to the provincial election.

Ryan has repeatedly asked for updates after hearing nothing from officials for months.

“It has now been five months since I first made contact, and I hope the meeting can be rescheduled in due course,” Ryan wrote on April 20, 2021.

A meeting with officials was held in May 2021 and by July emails show the department had begun reviewing the clinic’s funding model.

“We really need a crowdfunding model”

However, six months later, there was still no decision and Ryan – who had maxed out a line of credit and received thousands in federal grants and loans while waiting for the province to act – worried about making the mass salary.

“It has now been three months since I last contacted our Financial Reimbursement/Installation Fee Review. As noted in our 2020 letter and 2021 letter (again attached for your reference), our financial situation gets pretty terrible,” Ryan wrote on Feb. 3, 2022, in the same email in which she threatened to shut down.

“To keep our doors open, we really need a block funding model or a significant increase in our setup fees.”

The emails show block funding — quarterly payments equivalent to $1 million a year — was finally approved in the spring. Ryan says the first payment arrived in his bank account in July.

“The idea of ​​closing this clinic was devastating because I realize that people who want abortions will have abortions, whether it’s self-inflicted or done with care, compassion and safety,” Ryan told Radio- Canada on Friday. “I didn’t want to close the clinic and it was really a last resort.

“I do the work because I really feel in my soul that it is such a good job, people need this service and we know abortion is not safe and legal, it still happens “, she added.

The minister considers the delay “unfortunate”

On Monday, Health Minister Tom Osborne said there must be “a process of review and approval” when making decisions on public funds and that health officials faced a deluge of challenges due to the pandemic.

“It was an extraordinary length of time and it’s very unfortunate,” he said.

“I think it’s fair to say it would have been more appropriate to deal with it in a shorter time frame, but the circumstances surrounding COVID and the approval process are there as well.”

Athena Health Center applied for a facility fee increase in February 2018, but was denied. The government has, however, agreed to pay the clinic a fee for patients prescribed the abortion pill Mifegymiso.

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