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Canada's largest city is about to undergo the largest medical restructuring in North America, as 11 of 44 hospitals have been ordered closed by the province's Health Services Restructuring Commission.

The closures and amalgamations of Toronto's hospitals will be implemented over the next five years, the commission said. By the end of the exercise, nearly 3,000 hospital beds will be eliminated, for a savings of $343 million a year.

The hospitals slated for shutdown include world-renowned facilities such as Women's College Hospital and Wellesley Hospital's AIDS Center.

This "vision represents the most comprehensive redesign of health services ever contemplated in Ontario and will set the stage for building an improved and better-coordinated health services system" for the residents of Toronto, said the commission chairman, Dr. Duncan Sinclair.

Over the past six years, Ontario has opted to eliminate 11,000 hospital beds -- the equivalent of 35 medium-sized hospitals -- rather than shut down an entire hospital, the commission said. The result has been massive duplication and inefficiencies, it said.

Sinclair vowed there "will be no reduction of services." To ensure this, the commission said, the government must spend $136 million to expand, renovate and upgrade the new facilities along with a new annual budget of about $150 million for long-term, community and home care to replace the current in-hospital care.

Provincial Health Minister Jim Wilson has promised that the government will abide by all the commission's recommendations.

While the commission's mandate was aimed at streamlining Ontario's 210-hospital system and cutting the nearly $2 billion the government spends on hospitals as part of its $13 billion annual health-care budget, the commission's earlier orders to shut down 25 hospitals have already sparked lawsuits.

Pembroke Civic Hospital in Pembroke, a town about 250 miles northwest of Toronto, has challenged the commission's closure order on the grounds of religious discrimination.

Mary Eberts, lawyer for the hospital, told a Divisional Court in Toronto that by transferring the services of the Civic to the Pembroke General Hospital, operated by the Grey Sisters of the Immaculate Conception, the religious rights of the district's 45,000 residents are violated by forcing them to use a facility governed by Catholic tenets.

Bryan Finlay, lawyer for the General, told Justice Archie Campbell that "there is nothing coercive" about the hospital's policies that couldn't be respected by non-Catholics.

But when Campbell asked whether a director of the General could advocate allowing abortions at the hospital, Finlay replied, "that would not be respect."

Then, Campbell added, "there is a restriction against people who happen to disagree or who do not respect the views" of the Catholic Church.

A decision on this case is expected Monday.

Board members of Toronto's Wellesley Hospital, whose patients include many gays with AIDS, are hoping a ruling against the commission will bolster their fight against moving the Wellesley's patients to St. Michael's Hospital, also run by the Catholic Church.

"I hope there's nobody in the public that believes you can lay off (an estimated) 10,000 hospital workers and still have the same quality of care remaining behind. That's a joke if you believe that," said Sid Ryan, president of the Canadian Union of Public Employees. "It's people who deliver health care, not machines."

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