Much like what is proposed at Port Colborne General Hospital and Douglas Memorial Hospital in Fort Erie -- where the two facilities could lose their emergency wards to focus on complex continuing care -- the NOTL hospital had many of its services close throughout the years of its existence.

The possible change is a result of the Niagara Health System's five-year plan, called the Hospital Improvement Plan, that would improve health care through efficient services while eliminating the organization's $18 million deficit by 2012, said NHS chief of staff Dr. William Schragge.

Besides the changes in Fort Erie and Port Colborne, other changes to the region's hospitals include the possible elimination of a maternity and pediatrics units while adding a stroke centre at Greater Niagara General Hospital, and the addition of cancer centre, cardiac catheterization unit and women's health services at St. Catharines General.

Fort Erie and Port Colborne need only to look at NOTL hospital's history to see its evolution to become the complex continuing care facility it is now.

The first hospital in Niagara-on-the-Lake came in the form of a military hospital in then Newark in the mid 1800s. In 1919, the Niagara Cottage Hospital was opened as a private hospital on Gage Street.

In 1920, the hospital was moved to 175 Queen Street and was incorporated in 1921. By the late 1940s, the hospital was in need of expansion and in 1950 a new hospital was opened at its current address at 175 Wellington Street with 27 beds and 11 bassinets.

The site, then known as the NOTL General Hospital was a fully functioning facility with emergency ward, chronic care wing, obstetrics department, and emergency ward among other services. However as the years went on, the services the hospital offered changed.

"The hospital first lost its surgical services in 1969," said Christine Clark, the NHS' chief communications officer. "There was a lack of general surgeons at the time and with that went the anesthetists. You couldn't have one without the other."

By 1973, the obstetric department closed and between the 1970s and the late 1980s, the number of patients occupying hospital beds averaged about 50 per cent, Clark said. The hospital's emergency ward closed in December 1992.

"If you wanted emergency services, most people traveled to St. Catharines," said resident Harold Clement. "There was a lack of update equipment. Service was also lacking because of a shortage of staff. I once went in for a bad back and stayed there for three weeks and don't know why."

Pat Balasiuk, a member of the NOTL Hospital standing committee, said at that time patients requiring emergency care were transferred to St. Catharines General or Greater Niagara General in Niagara Falls. By 1995, the daily operational services of the NOTL hospital was merged with St. Catharines general in an effort to maximize staff and patient care services, Balasiuk said.

At the same time, the number of available beds was reduced from 38 to 20, Balasiuk said. With the closing of the emergency ward and the decline in hospital beds, the community felt the NOTL hospital was threatened to close itself.

To rally support to save the hospital, resident Gerald Wooll formed Serve Our Sick, a group of concerned residents that fought to keep the facility thriving.

Bill Allingham, then a member of Serve Our Sick, said there was talk of shutting down active care and turning the hospital into a walk-in clinic. Allingham said the group created an intense campaign to prevent that.

"We created buttons and posters and got a lot of people to join the hospital board to make a change," Allingham said. "It was heated and controversial. There were strong feelings on both sides (Serve Our Sick and the hospital board). The fight lasted for years until the hospital became part of the Niagara Health System in 2000."

Clark, who served on the hospital board at the time, said it was tough to work with the community because of the emotion, but what resulted is the type of care one can expect at the NOTL hospital today: outpatient services by a team of a nurse practitioner and physicians and 22 inpatient beds for complex continuing care, rehabilitative services to help patients transition to home or other care settings.

Resident Judy MacLachlan, who was also part of Serve Our Sick, said the level of health care provided at the hospital currently serves the community well. MacLachlan said at the time the emergency ward closed, many of the patients had ailments that could be tended to by services currently offered.

"Nobody likes change but this was change for the better," MacLachlan said. "Things are going well at our hospital and it was a result of change."