How did the Alberta health care system melt down so dramatically in such a short space of time?* In 2008 Dr Parks and other ER doctors provided the government with hard evidence that there was a serious problem by documenting 322 cases of substandard ER care in just one hospital. Dr. Sherman, a practicing ER doctor and MLA worked diligently to get the government to acknowledge the problem and address it. Doctors inside and outside of the Legislature have been sounding the alarm continuously for over 2 years. In Dr Parks’ view “…they didn’t get it”. Dr Sherman’s says “[Health Minister Liepert] just didn’t get it or he didn’t want to hear”. So what’s going on? Do the Tories truly not get it or have they sacrificed health care in the interests of political expediency? The answer becomes clear when you look at the events that have unfolded since the last election.
In Feb 2008, Stelmach called an election and the ER doctors seized the opportunity to tell the Health Minister, Dave Hancock that they would go public with their concerns if the government refused to address them. Stelmach realized that the timing of such a revelation could negatively impact the election and directed his staff to meet with Dr Parks and the AMA Emergency Medicine Section. Stelmach ultimately promised to create 600 new long term beds to ease overcrowding and to create an expert committee—the Emergency Department Integration Team (EDIT)—to review the situation and develop a plan to ensure that the national benchmarks for timely emergency care were met. Most importantly, Stelmach put these promises in writing. This pacified the ER doctors who agreed to remain silent.
In March 2008, the Tories won the election with a 72 seat majority. Dr Sherman was delighted to learn that he’d been appointed the parliamentary assistant for health, but quickly realized that his new boss, Ron Liepert, was focused on controlling escalating health care costs and not remotely interested in reducing ER wait times. Sometime during this period Jack Davies, the CEO of the Calgary Health Region, popped up and sounded the alarm (again) by asking for $115 million to eliminate the deficit and add beds to address ER overcrowding.
In July 2008, the government responded by firing the 9 health board CEOs and rolling their organizations up into the AHS or Superboard. The Board brought in a Code of Conduct which was described by Dr Sherman as “draconian” and was interpreted by the medical profession as sending the following message: “Anybody who says anything, look out…We’re going to hammer you” (Hansard Nov 24, 2010, p 1552). This reaction was not pure paranoia. The government may have ignored Dr Parks’ letter outlining the fate of the 322 patients in ER, but the hospital administrators subjected him to an accusation of delivering poor care to a patient. Dr Sherman and others who voiced their concerns suffered the same fate. Even before the recent allegations about his mental health, Dr Sherman had been embroiled in a 10 month struggle with the administration to clear his name and regain his hospital privileges following unfounded claims of poor care (Hansard, Nov 24, 2010, p 1551).
In Jan 2009 AHS announced that it had hired Dr. Duckett, a health economist, to lead the effort to improve health care delivery in Alberta. Dr Duckett’s priority was to reduce the deficit and he was successful. However the quality of health care continued to deteriorate and by late 2009 the Health Quality Council of Alberta reported that ER wait times were now 30% longer than they had been in 2007.
In Sept 2010 at the annual meeting of the Emergency section of the AMA, the ER doctors’ frustration boiled over and once again they wanted to go public but were persuaded by Dr Sherman to Zwozdesky who had replaced Liepert, a chance to make improvements. In October 2010, Dr Parks wrote to Zwozdesky, Stelmach and the AHS stressing the need for immediate action. Zwozdesky and the Premier ignored the letter but it was leaked to the media and the situation exploded….
*See also the special report by Matt McClure (Dec 5, 2010 Herald)
As I continue to read your blog what comes to mind each time is “why is this so hard?” You either need staff, hospitals or both, figure out which and to what degree and get on with it. At this point I think I am going to hold out for Karma and maybe the whole problem will come to a head when either Zwozdesky or the Premier need to visit an ER.
Right, and to make sure that their visit was on the same footing as ours, we’d need to ensure that the ER staff did not know they were the health minister or the Premier. Then they’d be told to wait in line with the rest of us. Wouldn’t that be ultimate justice!