Whose Domain Is It Anyway?

Minister Zwozdesky responded to my email last week—5 months after I’d written to him complaining about my daughter’s 22 hour wait in ER before being admitted to the geriatric ward for gallbladder surgery.  I expressed my support for Dr Parks’ recommendations to improve ER wait times.  Mr Zwozdesky thanked me for my suggestions (I made none) and told me to go away.  Well, not in so many words.  First he apologized for  “the inadvertent delay in responding” (I guess he mislaid my email).  Then he assured me that the Tories were working to improve access to emergency departments “regardless of the events surrounding the former President and CEO of Alberta Health Services (AHS) or any other individual”.  He added that “The AHS Board made the difficult decision in regard to the former CEO based on their judgment of his continued ability to lead the organization.”  Apparently Dr Duckett played a significant role in crippling access to ERs…either that or he’s become a convenient scapegoat.

The letter is curiously silent about the most critical issue facing Alberta healthcare and the Tory Government—the call for a public inquiry into the culture of intimidation which silences doctors who advocate on behalf of their patients.  It would have made political sense (an oxymoron if ever there was one) to include a passing reference to the issue and perhaps a few words describing why the Health Minister believes that the Health Quality Council (HQC) review is indeed the right way to proceed.

So let’s turn to that debate for a minute.  On Thursday, Apr 14,  the Board of Directors of the Alberta Medical Association (AMA) endorsed a two pronged process:  (1) the HQC review to investigate sub-optimal care of 330 patients in ER and 250 cancer deaths while on the surgical wait list and (2) a separate public inquiry into the culture of intimidation.  Dr White, the AMA president, said that the doctors feel that a public inquiry is the best way to change the culture and address physician disengagement from the AHS.  It should also be noted that a public inquiry is the only way compel politicians, senior bureaucrats and AHS representatives to testify under oath and to allow doctors to testify without breaching their nondisclosure agreements.

The Health Minister was not amused—but he should not have been surprised.

The Premier and the Health Minister have spend the last 3 months tripping over their shoelaces in their dealings with Dr White and the AMA.  For months the AMA, the AHS and the Government have been renegotiating the doctors’ contract for fees and services.  The Government insisted that doctors accept a 0% raise because that was (supposedly) the Government’s norm for all public sector settlements.  The AMA was prepared to accept a 0% deal until the Government announced that unless the AMA signed on the dotted line by Mar 31, 2011, nine key programs would be cancelled.  The AMA refused to succumb to bully tactics and did not sign.  Then everything went pear shaped.  Here’s the sequence of events:

  • Apr 1 (the day after the AMA was told it had to sign the 0% deal or lose 9 key programs) the Government and the Alberta Union of Public Employees (AUPE) announced an agreement which included a 4% salary hike plus two lump sum payments totalling $3000.  Dr White emailed AMA delegates to advise them that the agenda for the Apr 14-15 Board meeting would include a decision on whether to support a public inquiry.
  • Apr 2, Premier Stelmach called Dr White asking for “an urgent meeting” to address the shaky relationship between Alberta doctors and the Government.  Minister Zwozdesky applauded the “urgent meeting” but noted that the AMA had misunderstood the AUPE deal.  “Once  the AMA hears all of the facts of the deal, they will understand it better”.  Hmmm, 0% versus 4% seems crystal clear to me but perhaps politicians have a different way of doing the math.  The AMA also learned that the Government’s threat to cut the 9 programs was simply a negotiating tactic.  Others might characterize it as shoddy behaviour and a breach of trust.
  • Apr 8, the Premier, Minister Zwozdesky and Dr White met.  They agreed to cooperate, collaborate and introduce “innovations in delivery to ensure a health care system that is patient-centred and sustainable”.  They also agreed that Dr White and Minister Zwozdesky should meet regularly to “assess ways of building physician engagement and trust”.
  • Apr 14-15, the AMA Board of Directors formally endorsed the two pronged review/inquiry process whereby the HQC review would the 330 ER cases and 250 cancer deaths and a public inquiry would investigate the culture of intimidation.

Minister Zwozdesky reacted badly.  He categorically rejected the prospect of a public inquiry.  “I am not going to advocate for tying up $20 million, $30 million, or $40 million of taxpayer’s money to do a public inquiry that would take two, three or four years to get accomplished when we need some answers right now”.**  One wonders how the HQC, which lacks the legislative mandate to conduct this review, is going to investigate the ER cases, the cancer deaths and the culture of intimidation in just 9 months when, according to the Health Minister, a full blown public inquiry with the power to conduct a proper investigation into intimidation won’t be able to finish the job in 2 to 4 years.

But the Health Minister wasn’t finished.  He implied that the AMA decision was a negotiation tactic, noting that Dr White represents the “physicians union which is currently negotiating with the province.”  He also said something very telling:  “This is a bit of a strange way to go about putting into effect the arrangement that was agreed to in the Premier’s office last week, but that’s what people do and we have to respond accordingly” and added that Dr White had told him that the doctors planned “to stay out of the political domain”.** 

So there’s the nub of the problem.  In the Minister’s view, unless Dr White and the AMA support the Government’s position that a public inquiry is unnecessary they are meddling in “the political domain”.  No doubt this was a surprise to Dr White who described his meeting with the Government as a commitment to work together to introduce innovations in healthcare delivery and building trust;  not a sleazy backroom deal whereby the AMA agreed to stay silent in return for a 4% pay hike.

The problem isn’t that the AMA is meddling in the political domain;  it’s that the politicians are meddling in the doctors’ domain.  And that is precisely why the doctors are calling for a public inquiry into the culture of intimidation and precisely why the Government is fighting it tooth and nail.

So I’m going to heed Dr Maybaum’s suggestion that Albertans need to lift up their heads and speak loud and clear. ”** I will respond to the Health Minister’s letter by telling him that the Government’s position with respect to the public inquiry is unacceptable.  Here’s the link to the MLA’s contact information.  Tell your MLA, the Premier, the Health Minister and all of the heads of the opposition parties that the Government better get cracking on the public inquiry because we’re all meddling in the political domain and, guess what, we’re not going away.

*President’s Letter, Apr 13, 2011

**Calgary Herald, Apr 16, p A4

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