Host: Right now, many Ontario hospitals are relying on bank loans to make ends meet. As of March 2025, they owed more than $66 million. And that's just one snapshot of a much bigger financial picture laid out in a recent investigation. Stacy Kuznetsova is a Toronto based journalist with the Investigative Journalism Bureau. Doctor Blair Bingham is a critical care physician and a senior editor at the Investigative Journalism Bureau. Help us understand how did this investigation into hospital finances come about?

Blair Bingham: Sure. So I was working in a very busy, overwhelmed emergency department shortly after the pandemic, and I was hearing things like, oh, the hospital's in deficit. We really need to control our costs. At the same time, we were hearing that one hospital in Ontario, London Health Sciences, was in tremendous deficit, $100 million. And meanwhile, another hospital system north of where we live was shutting down an emergency department that was in Minden, Ontario. And I sort of asked myself like, how is this possible? Like, hospitals don't really have levers to bring in revenue, right? They get their money from the government and maybe what they're going to increase rent on Tim Hortons and charge you more for parking, but they don't have a lot of levers. And that's when we found out that some hospitals get this document called a balanced budget waiver, where they're allowed to have a deficit, but with no real plan to get out of it. And there's actually a law in Ontario, the Public Sector Accountability Act. It's been on the books since 2001, and it says 5.1 hospitals are not allowed to plan to be in deficit. Okay. And so we went after these documents. We asked hospitals for them, 44 across across the province, and most of them gave them to us. And we found out they were millions of dollars in deficit. And the ministry sort of was going to forgive them for it. Ontario health issues them, this piece of paper saying basically that they're allowed to circumvent the law and be in deficit now before 2022. This was very rare. Maybe 1 or 2 of these was issued a year. A hospital would have some particular need to spend a lot of money. But after the pandemic, it wasn't just a one off 40 hospitals, then 70 hospitals. And then in the most recent year, for which we have data ending in 2024, 85 hospitals.

Stacy Kuznetsova: For sure. This database that we've created is really a mix of publicly available documents, like audited financial statements that hospital corporations release at the end of their fiscal year. So we've looked at all of them in Ontario, 132, I believe, hospital corporations that we've reviewed for the past three fiscal years, looking at their operating deficit at the end of the year, things like bank borrowings, they had to declare. So think about this. Hospitals borrowing money from banks for short term borrowings just to stay afloat, not to build a new hospital wing, but just to cover their short term expenses. And then there was another important part of this database was documents from freedom of information legislation. So that's how we found out that the province can sometimes give hospitals money to address in-year operating pressures, none of which the public knew about.

Blair Bingham: You're going to make me choose. I think when we look at the money that was spent that we only found out about through a freedom of information request, which was about $200 million being given to some hospitals to kind of help cover the gap. Emergency funding, if you will. It was very unclear why one hospital would get $30 million to clear their debt, and another hospital got nothing. So we hit the pavement. We started to talk to senior leaders of hospitals, some of whom, I have to say, were outraged that their neighbour next door was getting floated when they weren't. We probably entered this investigation thinking that hospitals needed to tighten their belt. We found out that over the last 20 years, they've trimmed all the fat they can. For the most part, there's not a lot of opportunity for a hospital to increase its revenue. And so when your next door neighbour gets $30 million, after you've made hard decisions to close down some of your ultrasound, ours shut down some of your MRI machines, not repair elevators just so that you can get by it. Really, it really irks me because it's inequitable. And there are some hospitals that the ministry is favouring, and I think that is something that no Ontarian should stand for.

Stacy Kuznetsova: And just to add to what Blair is saying, right. We found I think it's about 23 hospitals that did get this this funding to address in year operating pressures. We don't know why these hospitals were chosen for this extra funding. We don't know how this process happened. And when we asked those questions of the province, we didn't get a response.

Blair Bingham: It's very odd. And Ontario hospitals actually have to plan a budget and go ahead with it and not find out what the amount of money they're going to get from the ministry is until many months into the fiscal year. I can't think of a single company that works that way. It's very backwards, and I think a lot of hospital CEOs are so used to this that they just assume the ministry at the end of the day is going to make sure everything's okay. So if the idea here from the ministry is to increase accountability and make sure that hospital management teams are spending every penny wisely, they're not really living up to their own standard. So I think what we have is this, this fake air of accountability where the ministry is saying, oh, we're going to watch you carefully and not give you a lot of money, but then they're not living up to their own deal and being transparent with hospitals and letting them know how much they're even going to get for funding. Meanwhile, as a hospital, you know, in the emergency department, we don't control who comes in through the front door. We have no way to control expenses in that regard. People are getting older, they're getting sicker, and medicine is just getting more complicated and more expensive. Just think of some of the new cancer treatments that have come out in the last two years. It requires more hospital beds. It requires more oncologists, it requires more nurses. None of that is being funded adequately.

Blair Bingham: The bottom line is that it changes the way doctors practice medicine when they're constantly being told that money is tight. We need to cut costs. I trained in the United States. I'll give you one example. So in some people who have critical brain injury, they need certain type of neurodiagnostics brain tests within hours in the states. I could get those tests done in an hour or two. Where I work now, it can take 3 or 4 days. That's for an emergency brain image. So why is this happening? It's because hospitals have very few levers to pull, but what they can pull is technician hours. They can try to save money, you know, Penny by Penny here and there. And what it means is that it changes the way we sort of tolerate the tests that we need and the timeliness with which we need them. And we see this when people need an MRI non urgently, they can wait three months, six months. That is a cost control measure. We hear about operations that get delayed because the hospital says we're not going to pay an hour of overtime to keep that operating room open just to finish the surgery. We're just going to cancel it. Hospitals are slashing wherever they can, and at the end of the day, it does affect patient care.

Stacy Kuznetsova: The one answer I heard from health economists that we've spoken with was the need for long term health care planning. So, as Blair described, not year in looking for a way to balance our books at the end of this fiscal year and not knowing what happens next, not knowing how much funding hospitals are going to get. But we need a way to plan for the long term. We know that the pressures on the health system are going to increase in the next two decades dramatically. Blair is seeing it firsthand. We have more and more people who are sick and have multiple chronic illnesses, people who will require time in hospital, and we need to prepare for that inevability. So that requires long term strategy that the government needs to be involved with.

Blair Bingham: I think to Stacy's point, all of this only matters if we're transparent about it. Throwing money at a problem without accountability is probably not going to fix the problem. Hospitals, yes, need to be held accountable. Clinicians need to be held accountable, but so does the government. You can't tell a hospital to plan a budget, a one year budget, which very few companies would ever plan for. They would always plan for three years, five years. But to do a one year budget without knowing how much money you're going to get is insane. The government needs to make sure that hospitals know what's coming to them, so that hospitals can at least plan what cuts need to be made. It needs to be done with advanced notice. Otherwise, we get this scrambling at the end of the fiscal year, some hospitals getting gifts from the government just to close out, other hospitals having to cut even further. It's not fair to anybody. It's not making sense. And I think at the end of the day, the responsibility lies with the provincial government to make sure hospitals know how much money they're going to get, so that hospitals can tell their communities, look, this is what I've got. This is what we're able to deliver with that money. We've already cut all that we can. Sure, there are bad apples, and we've seen that in a few hospitals in this province. But by and large, of 132 hospitals, about 129 of them are doing the right thing. I'm not saying cut a blank check to all the hospitals in the province, but this idea that we can just keep trimming the fat is a total fantasy, and the government needs to wake up to that.

Stacy Kuznetsova: Two things I think awareness. So, as you said, we all have been in an emergency department and waited and have seen what goes on, but people don't really connect the dots there. Connect that with the funding for their local hospital. And that's what we hope the Ontario Hospital Finance Explorer, the free public database that we've built, would do for Ontarians that they can go there, look up the name of their hospital and try and figure out, you know, how healthy is my hospital financially? How much have they borrowed from a bank, how much they paid in interest, money that could have gone to patient care, but instead might have gone to interests on a line of credit for a bank. Right. And so flowing from that, we would want Ontarians to ask informed questions of the provincial government based on the information that we've made publicly available to them.

Blair Bingham: And also to hold those hospitals and the government accountable. So when you go online, you can see my government just gave Royal Bank or TD millions of dollars to stay afloat and keep the lights on. You need to be angry about that. That is money that could have gone to your parent or your child's health care. And so get angry, go to your hospital and say, this is unacceptable. Go to your MPP and say, this is unacceptable. What we're trying to do here is shed a light on the real, the real challenges that hospitals are facing, the real numbers so that Ontarians can take matters into their own hands and say, that's not enough. I want better health care than that.