It's no surprise that Hamilton Health Sciences' proposal to locate its new urgent care centre in the west end of the lower city has kicked up a hornet's nest.

First of all, the plan involves siting the centre at the hospital's existing property on Main West and closing down its own fertility centre that's already located there.

Positioned as a money-saving move, the closure casts uncertainty over the future treatment of the clinic's 1,800 patients, many of whom will be left scrambling to find a private-sector provider.

Fertility, or more correctly, infertility is a very emotional subject for some and HHS is sure to find itself dealing with an increasingly angry fallout.

Meanwhile, choosing the lower city instead of the Mountain for the urgent care centre may have appeased west end politicians, but Mountain councillors are doing a slow burn.

The centre, which would serve patients who need immediate treatment for non-life-threatening injuries and illnesses, is intended to take pressure off busy emergency departments and compensate for HHS's plan to turn the ER at McMaster University Medical Centre into a kids-only service.

It's clear that Mountain councillors Scott Duvall and Terry Whitehead are not about to roll over and play dead.

Arguing that the Mountain is drastically underserviced by health-care facilities -- it lost its ER at Chedoke in 1992 and the replacement urgent care centre in 1998 -- Whitehead caustically compares the situation with below the brow.

The lower city not only has three acute care hospitals with emergency rooms -- McMaster, General and St. Joseph's -- it also has an urgent care centre in the east end run by St. Joe's. And now there's another in the works to be run by HHS.

By contrast, the Mountain has one ER at Henderson Hospital and no urgent care centre at all.

"I'm not against the west end having an urgent care centre but I want to address the long-term need on the Mountain," says Whitehead.

Naturally, Murray Martin, president and CEO of HHS, counters with some nuts and bolts of his own.

He notes that when HHS had urgent care at Chedoke, it proved financially impractical because it only drew a maximum of 14,000 visits a year.

"In an urgent care centre, you have to have a volume of at least 30,000 to make it viable," says Martin.

He says the Chedoke centre was ultimately closed because of modest usage and easy access from the west Mountain to the emergency department at St. Joe's Charlton Avenue site.

Martin makes no bones that the proposed new urgent care centre is primarily intended to serve the west end, including the outlying suburban communities.

But he also argues distance from health-care facilities is not a crucial factor in Hamilton. For example, he notes that since the Red Hill Valley Parkway opened, more east end residents are bringing their kids to the children's hospital at Mac in the west end.

"In this community, the drive there is the small part of it."

Martin maintains that time spent waiting for treatment is the more important consideration. For example, he says, today people from west Hamilton will drive to the east end urgent care centre because they know they can likely get in and out in about an hour, whereas on a busy night in ER they might have to wait for three or four hours.

"That doesn't happen at urgent care centres because they are not destinations for ambulances or acutely ill people."

While the debate over location shows no signs of ending, certainly the benefits of more urgent care are irrefutable.

Last year, the ER at Mac cared for 38,595 patients, of whom 24,126 were adults.

According to HHS, nearly 60 per cent of those adults could have been cared for properly and more quickly at an urgent care centre.

Andrew Dreschel's commentary appears Monday, Wednesday and Friday. adreschel@thespec.com 905-526-3495