What’s Next…Unmarked Bills in a Plain Brown Envelope?

Queue jumping? “ Go-to- guys” who adjust waiting lists for prominent Albertans?  Are you kidding me?

Just when Mr Zwozdesky thought he’d stared down the Alberta Medical Association, the opposition parties and Albertans who were demanding a public inquiry into healthcare, Dr Duckett tossed out another grenade.  This time Dr Duckett wasn’t complaining about Alberta’s “edifice complex” (its love for shiny new understaffed hospitals) but a potentially illegal activity – the allegation that certain Albertans received preferential treatment as a result of their personal relationships with prominent MLAs or healthcare executives.

Dr Duckett says he’d heard that some of his predecessors had designated “go-to-guys” who would, upon request, push prominent patients to the front of the line.  In June 2009 he issued a directive to the AHS Board and all AHS vice presidents condemning the practice.  “By its very nature, such a scenario represents “queue-jumping”, a practice that a public health care organization cannot defend or support”.  He directed that any such requests be referred directly to him.  Amen to that.

The Duckett directive had a very long fuse and ignited 2 years later when Dr Duckett referred to queue jumping at a medical conference in Toronto.  Mr Zwozdesky emphatically denied the allegation.  He had never “…seen anyone ask for or exert any pressure to alter a wait list”.  He said the accusation was unfounded, unhelpful and disrespectful.  Having gotten that off his chest, Mr Zwozdesky allowed that perhaps Dr Duckett was trying to “establish some control over the system” but this action wasn’t in response to actual instances of queue-jumping.*

So the big question is did it happen?  And more importantly, is it still happening?

Not surprisingly, Minister Zwozdesky refuses to call a public inquiry to find out.  So the NDP leader, Brian Mason, turned the matter over to the RCMP.  While we’re waiting for the RCMP to report back, let’s look at the evidence which is circumstantial thus far.  Dr Duckett may be headstrong and somewhat quirky but he’s honest.  In issuing the directive he acted properly based on what he had been told.  His belief that queue jumping existed has been reinforced by Dr Paul Parks and Dr Raj Sherman, both dedicated physicians who have put their careers on the line to advocate on behalf of patients.

Furthermore, if queue jumping was a figment of Dr Duckett’s imagination one wonders why the Conservatives focused on it in their review of the existing healthcare legislation.  A power point presentation entitled Alberta’s Health Legislation, Moving Forward** devotes an entire page to queue jumping, noting that queue jumping is prohibited by the Health Care Protection Act only in the case of “non-hospital surgical facilities”** It’s unclear what “non-hospital surgical facilities” are because the Act doesn’t use that term, instead it bans queue jumping in the case of insured surgical service ie. surgery funded by public healthcare.   The government had an opportunity to clarify and strengthen the prohibition against queue jumping but chose not to do so.

What’s really troubling is how Mr Zwozdesky responded to questions about this presentation.  He was vague.  He says he wasn’t there.  He doesn’t know who presented it and he’s not “intimately familiar” with the document.****A curious state of affairs given that Mr Zwozdesky is the Minister for Health and Wellness and the purpose of the presentation was to inform the Conservative caucus of the proposed changes to Alberta’s health legislation—which is the cornerstone of Alberta’s 5 year healthcare strategy.

Even more curious is Mr Zwozdesky’s statement that the queue jumping comments in the presentation are just the “opinions and ideas of Albertans not the policy of the government”* This statement is contradicted by Fred Horne, the Conservative MLA and Parliamentary Assistant to Health and Wellness (aka Mr Zwozdesky’s assistant).  Mr Horne co-chaired the Minister’s Advisory Committee on Health (MACH) which toured the province in 2009 gathering feedback from Albertans on what they wanted to see in the new health act.  Mr Horne reports that while Albertans expressed fears about privatization they said nothing about queue jumping (perhaps because they didn’t know it was going on).  As a result, the presentation contained no comments from Albertans on queue jumping.  In legal terms, Mr Zwozdesky’s allegation that these comments were the “opinions and ideas” of Albertans is not corroborated by Mr Horne.

The RCMP may not be able to find evidence of queue jumping.  After all they are trying to get evidence of an illegal or questionable activity from the fortunate few who were bumped to the front of the line and the physicians and politicians who put them there.  It is unlikely that these people will step forward voluntarily.  Other healthcare providers who witnessed this abuse of process are bound by obligations of confidentiality and can’t come forward unless they are subpoenaed in a public inquiry or a criminal prosecution.

With that we’re back to why Mr Zwozdesky won’t call a public inquiry.  The concern is no longer the cost of an inquiry or that it will expose the government’s general mismanagement of the healthcare portfolio.  This time the failure to deliver healthcare services may involve illegal activity or an abuse of process which resulted in some well connected patients moving to the front of the line while sicker patients were bumped back.  What’s next…unmarked bills in a plain brown envelope?

* Calgary Herald June 10, 2011, A6; Calgary Sun June 10, p5

**Presentation dated July 12, 2010, leaked to the media in Dec 2010

***The Health Care Protection Act

****Calgary Sun, June 10, p 5

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3 Responses to What’s Next…Unmarked Bills in a Plain Brown Envelope?

  1. Rose Marie MacKenzie says:

    The queue jump possibility is a scary thought. Where does this entire concept land when it comes to transplant patients? I have always thought that transplate patients are ranked by “critical need” along with “survival rate based on current health.” I don’t consider those criteria queue jumping but factor in expendable incomes and all of a sudden the queue changes. As a middle income family, where does that leave me?

    • I think you’re right Rose Marie. The factors you’ve listed are clearly health related, however when a person gets what Dr Duckett called “preferrential or expedited care” he’s getting care more quickly than medically required or than is the norm for the organization and the big question is why? Did he help pay for a new wing to the clinic? Is he a politician or a government official? Maybe the reason why some politicians (Stelmach and Zwozdesky come to mind) don’t think we have a problem with healthcare delivery is because they’re in the fast track queue, not the usual queue like the rest of us!

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