Justice Vertes released the results of the Preferential Access (Queue Jumping) Inquiry this week. Health Minister Horne heaved a huge sigh of relief. Vertes found that allegations raised by Dr Duckett (former head of Alberta Health Services) and Dr Sherman (Liberal leader) were unfounded and there was no evidence that MLAs used their influence to get preferential treatment for themselves or their family and friends.* Whew!!
Fred Horne & Health Promise
Mr Horne was so busy gloating that he failed to tell the public that Vertes had indeed found numerous cases of queue jumping right up to the time of the Inquiry itself.
The queue jumping incidents fell into two categories:
- the gong show that passed for the government’s response to the H1N1 pandemic: Alberta Health Services (AHS) improperly inoculated the Calgary Flames hockey team and their friends and families, the friends and family of a group of Edmonton nurses and the non-essential administrative staff at the Red Deer Michener Centre, and
- an influential Calgary doctor (Dr Bridges) used byzantine booking and referral practices to fast track colonoscopy screening tests for his own patients and those from the Helios concierge clinic.
Mr Horne also failed to explain that Vertes found a system riddled with opportunities for queue jumping, including:
- AHS executives making “courtesy calls” to hospital staff to give them a “heads up” that a VIP was in the building
- expediting treatment for elite athletes
- allowing doctors and AHS executives to interfere with the emergency care and triage process for certain patients and
- allowing doctors to send patients to Emergency through the “private patient path”. Heads up, my patient is coming through.
Most importantly Mr Horne failed to mention that these queue jumping and near-queue jumping episodes occurred on his watch.
The Inquiry
Justice Vertes
Justice Vertes did a remarkable job given that he was hamstrung by the PC government from the outset—the Inquiry was restricted to queue jumping that “is occurring”.
Vertes did his level best to consider “background circumstances” despite strenuous objections from the government, the AHS and the Alberta Medical Association. He created a public uproar when Mr Horne tried to shut down the Inquiry prematurely.
Vertes’ Recommendations
Vertes identified serious systemic issues and issued 12 sensible recommendations to address them. They should have been adopted in a heartbeat without qualification; but Mr Horne balked on three, saying that he’d accept them “in principle”, but not as written because “they involve legal changes potentially and …some consultation.”**
“In principle” is legalese for wiggle room. Apparently there’s something about these three recommendations that troubles Minister Horne.
The “in principle” recommendations***
Recommendation #1 closes loopholes in the law that could otherwise allow improper queue jumping. It also requires people to report queue jumping violations and protects them from reprisal if they do so. Mr Horne balked.
Recommendation #2 provides whistleblower protection to all healthcare workers, including doctors who are contractors. Interestingly this change would provide whistleblower protection well beyond the queue jumping issue and would allow a contractor to sound the alarm over any improper behavior without fear of reprisal. Brilliant! Mr Horne balked again.
Recommendation #7 protects patients by creating an independent Health Advocate to advise them and help them resolve complaints. Hello accountability and transparency! Mr Horne balked a third time.
Whistleblowing and independence. Notice a trend here?
Mr Horne’s objections
Mr Horne says he accepted these recommendations “in principle” only because they may require legal changes and consultation. Let’s talk about consultation. He’s accepted, without qualification, five other recommendations that require consultation so the consultation excuse is a red herring.****
All that’s left in Mr Horne’s quiver is the excuse that these recommendations may require legal changes. This is rich coming from a majority government that slammed through the .05 drunk driving legislation and throttled the public’s right to be heard under the new Alberta energy regulations.
By requiring doctors to report abuses of the system and protecting them from reprisal, Recommendations 1 and 2 give our doctors “air cover”. They can speak out, notwithstanding their confidentiality agreements and are protected from bullying if they do so.
Recommendation 7 gives the public access to better healthcare by creating an independent advocate who will help them navigate through the healthcare system and resolve their complaints. This is a stark contrast to Mr Horne’s proposal for a puppet Health Advocate who is paid by and reports to the Health Minister.
Where’s the harm in that?
What’s next?
Mr Horne had a choice. He could have accepted Recommendations 1, 2 and 7 without qualification, in accordance with Justice Vertes’ belief that they give healthcare professionals “added safety” and “increase transparency and public confidence in our healthcare system.*****
Instead he reverted to form and is working feverishly to maintain iron-fisted control over the healthcare system. No doubt a smoke and mirrors “consultation” process and legislative tweaks purporting to implement these recommendations will be announced soon.
Then Mr Horne can bury the Vertes’ Inquiry Report in the same place that the PCs stashed the AHS Governance Report and the Groeneveld Flood Mitigation Report…and call it a day.
The Inquiry cost $7 million. Countless brave witnesses came forward to tell their stories. We deserve better.
*Government News Release, August 21, 2013
** Calgary Herald, Aug 22, 2013, A3
***Recommendation 1 would amend section 3 of the Health Care Protection Act; Recommendation 2 would amend the Public Interest Disclosure (Whistleblower Protection) Act
****Recommendations 3, 5, 8, 10, and 12 all require consultations among one or more of the government, Alberta Health Services, other sectors of the health care system and the public.
*****Inquiry Report, pp 116, 153, 154
Susan on the Soapbox 
A well parsed and analyzed observation of Horne’s response to the Vertes report , Susan. Being near Horne puts all in danger of falling. That’s how slippery manipulative Horne is in an effort to maintain absolute control over this whole issue. Certainly Judge Vertes’ narrow scope limited the inquiry in order to protect this government. It’s up to all concerned to keep pushing this government to be acountable to the people it purports to serve.
Bang on Ted. The media failed us here. Not one reporter asked himself what’s the difference between accepting nine recommendations “in full” and three “in principle”. In fact it took the media just ONE day to blur that line completely–the Calgary Herald is now reporting that Horne accepted all of the recommendations which is not exactly true. No doubt this was exactly what Horne and his spin doctors were counting on. So if the media won’t ask the right questions it up to us and all of the opposition parties to keep the pressure on.
Although the inquiry devoted a few days to evidence showing that private “concierge” clinics scooted their patients more quickly through the public facilities, Justice Vertes seemed to think it was “accidental”. I think, however, it was just a hint of the extent to which this kind of “special access” is becoming endemic in our system.
In a recent edition of the Calgary Herald, there was a pull-out titled, “Options: Your Guide to Private Medicine” advertising several “concierge” G.P. clinics, surgical facilities and MRI clinics- most operating in Calgary and a couple in the U.S. The concierge clinics promise 24/7 access to physicians for an annual fee, as well as “timely and expedient referrals to outside specialists”. They are very forthright in advertising this kind of queue- jumping for people who want to, or are able to pay. How our provincial government, and the College of Physicians let them get away with this is a puzzle. Federal legislation in the form of the Canada Health Act also forbids this.
There is a lengthy article written by the Fraser Institute’s health “scholar” deriding Canada’s public system of health care, claiming that a family of four pays $11,400/year for public health care that doesn’t deliver. The problem is, the author doesn’t account for how much of what he is quoting is going to “private” operators such as the clinics advertising in the “Options” publication. I’m pretty sure all these operators are billing Alberta Health Care for as much as possible, i.e. they aren’t “opting out” of Alberta’s Health Plan. Therefore, they are charging the public system (that they denigrate) and charge extra fees for access to physician care. I believe this is known as “double-dipping” and is clearly addressed in our provincial legislation.
See p. 7- 10 of the Alberta Health Insurance Act, that seems to speak clearly to the issues of doctors opting in/out of the Plan and what constitutes extra-billing and what the penalties are.
Click to access A20.pdf
If our government chooses not to enforce our legislation, it encourages the proliferation of these types of practices, reducing health resources for the rest of us, and further entrenches a two-tier health system. And they are not doing their job.
Elaine I am sorry but they are doing their job. With all due respect you seem to fail to see that this government does not want to enforce the law. They have always wanted the two-tiered health Care system and they are winning the game. They will never enforce the current Health Care legislation. They do not believe in it. A change of this magnitude should be debated but just like they have done so far they prefer the stealth process.
Not only does neither the federal or provincial government want to enforce current health legislation, but health minister Fred Horne is on stand-by to flick the switch on ours, and with the new “Alberta Health Act” (Bill 17) eliminate : the Alberta Health Care Insurance Act, Nursing Homes Act, Hospitals Act, Health Care Protection Act and the Health Insurance Premium Act. The plan for this was revealed in the leaked government document from 2010, following Raj Sherman’s excommunication from government.
It explained how the government first intended to get the trust of Albertans through “consultation” and PR, then dismantle our protective statutes and replace them with Bill 17 that would allow double-dipping by doctors (no need to opt in/opt out of the public Alberta Health Insurance Plan), and allow private insurance companies to provide health insurance to Albertans (like in the U.S.) The document that was presented to the PC caucus actually stated, “Prohibiting private insurance limits choice in accessing publicly-funded health services within Alberta (e.g. private diagnostic facilities) and outside of Alberta (e.g. Mayo Clinic)”. It also states that Bill 17 will not prohibit queue jumping or extra-billing for essential services. It says it is going to address health workers working to “their full-scope of practice”, which means hiring workers with fewer skills to replace the skilled ones- pretty much what is happening now with Mr. Horne’s “Workforce Transformation”. So, what is unfolding in Alberta is all according to plan. Except for one thing- the trust part isn’t going so well.
Click to access PowerPoint-AHA.pdf
Elaine and Carlos, you’re both right. As Elaine points out the government is not doing its job in accordance with the existing legislation and I believe Carlos is right–it doesn’t want to. The queue-jumping inquiry reminded me (again) that the PCs passed the “new” Alberta Health Act in 2010 but have not yet passed it into law. The really important question is why. The secret power point presentation provides some answers (thanks for the link Elaine, everyone should commit these slides to memory!)
The power point presentation says the new Alberta Health Act will be implemented in the fall of 2010 (missed that one by 3 years) and that there will be further “consultation” (I use the term loosely) on the 5 statutes that will be replaced by the new Act, on the creation of a new “independent” (oh please) evidence based entity (to do what?) and on the “phasing of key issues arising from a new Alberta Health Act.”
Deeper in the power point presentation you get hints of what these “key issues” might be. Drum roll please…they are:
(1) the continued shift towards “healthcare providers working together and to full scope of practice”. This is the Workplace Transformation process that has the United Nurses of Alberta up in arms (for good reason). Note: no consultation there.
(2) leveling the unlevel playing field so that doctors can work in both the public and private healthcare systems just like midwives and pharmacists. This is a ridiculous comparison. If you want to look at a “level playing field” you need to look at comparable players, ie. doctors should be compared to doctors, not midwives and pharmacists.
(3) the need to consider private insurance options and give greater flexibility (??) to out-of-province and out-of-country health services.
This power point presentation is a road map outlining exactly where the PCs are going with healthcare, however they don’t have the courage to lay it out for the public so we can have an adult conversation about the issues. Instead the PCs have resorted to sliding bits (like Workplace Transformation) by us in the hopes that we won’t notice, turning a blind eye when concierge doctors charge extra for what should be insured services and not enforcing the penalty provisions in the Alberta Health Insurance Act.
And to think that Redford campaigned on more openness and transparency. Hah!
It is really laughable to read these documents. These people are worse than the old communist regimes for spin. What is more worrisome is that these people really believe what they are saying. It is a mental distortion. If it is not pathological then they are great con artists. I believe in the latter.
The level playing field is just another joke. In freedom of information for example a study was done in five parliamentary democracies – Australia, New Zealand, Ireland, the United Kingdom and Canada. We were dead last. Well it did not bother anyone in the government of course, after all there is always Burkina Faso that is worse than us 🙂
What counts is perception and she was on the papers this week twice with a shovel in her hands. The spin has moved temporarily from children and seniors to a more ‘I work hard atittude’. In the meantime another 60 thousand dollars for another trip to China. She has to convince the Chinese to buy more of our resources because we have a 5 billion deficit. Hmmm I heard 700 million in the black – or is it in the red? Who knows, I do not believe the finance minister knows so how are we supposed to figure it out. I maybe wrong but it all sounds like the now familiar game of having a strong reason to make more cuts so that next year we are in the black and we can then give the corporations another tax cut. Or maybe even like Klein suggested in one of his alchool moments – The province is doing so well we may one day end income tax in the province. 🙂 Enough said.