Square Peg/Round Hole — Redford’s Proposal to Beef Up the Health Quality Council Review

UPDATE — Premier Redford promised changes to the HQC which would allow it to conduct a public inquiry.  She delivered Bill 24 which allows the  HQC  to take the “public inquiry” behind closed doors under a number of circumstances.  So much for transparency.  I will post an analysis of Bill 24 this weekend.  Stay tuned.  

Have you ever watched a child playing with a wooden hammer and peg set?  It’s all sweetness and light until he gets bored hammering the pegs and tries to hammer in a lego block instead.  That’s because the lego block is a square peg being forced into a round hole…and good luck trying to get it back out again.

Premier Redford is using this “square peg/round hole” approach to augment the powers of the Health Quality Council* (HQC) and buttress her claim that the HQC can properly review (for a second time) allegations that physicians who dared to advocate on behalf of their patients were subjected to intimidation.

Physicians and the public have been calling for a public inquiry into these allegations since 2010.  But the PCs under Stelmach refused to budge, arguing that the HQC review was as good as a public inquiry.  However during the PC leadership race Ms Redford broke from the pack.  She promised a public inquiry into the culture of intimidation if she were elected—and now she’s trying to wiggle out of her campaign promise by arguing that a beefed up HQC review will be sufficient.

For the record, there’s been some discussion about whether Ms Redford promised a “public” inquiry or a “judicial” inquiry.  This is simply semantics.  The terms are used interchangeably in the media and mean the same thing to the public—a transparent inquiry that is open to the public.

So what are these “beefed up” powers and how will they magically transform the HQC review to something akin to a public inquiry?  Stephen Carter, the Premier’s chief of staff, says 3 key elements are mandatory:  “…the inquiry must be truly independent, it must be able to compel evidence and it must be led by a judge”.**

Let’s break down each element to understand why it falls short of the mark.

True Independence:  Mr Carter says the HQC should report to the Legislature instead of the Health Minister.  This would be a good move.  But as Don Braid astutely points out, this also means the HQC cannot file its report unless the House is sitting.  Given the fact that in 2011 the Legislature was in session for less than 2 months and 2012 is an election year this will cause an inordinate (or opportunistic) delay in completing the HQC review.

Furthermore, in order to be truly independent, Reg 130/2006, the regulation that created the HQC, must be completely gutted.  Today the Health Minister holds the HQC in the palm of his hand.  He appoints the Health Quality Council and has the power to “prohibit, restrict or place conditions” on the HQC’s already limited rights and powers.  In other words, the HQC will never be independent of the Health Minister unless Reg 130/2006 is repealed.

The power to “compel evidence”:   Mr Carter’s second key element sounds promising until you realize that the power to compel evidence is not the same as the power to compel witnesses to attend the inquiry.  A tribunal must be expressly given this power by legislation.***

Ms Redford, her health minister, Mr Horne and her chief of staff, Mr Carter have carefully avoided saying anything about the power to compel witnesses.  And we all know why.  It’s one thing to be able to see the emails written by Mr Liepert, Mr Zwozdesky, Mr Horne, and officials at AHS and the College of Physicians and Surgeons.  It’s quite another to force these individuals to attend the hearing and submit to cross-examination on their emails and anything else the tribunal deems relevant.

Judge led:  Mr Carter makes much of the fact that the HQC review must be led by a judge.  But this is simply a feeble attempt to plant the idea in the public’s mind that a judge-led inquiry is the same thing as a judicial inquiry and consequently Premier Redford has not back-tracked on her promise.  But it’s not.

The critical distinction is not who’s leading the panel; he can be a judge, a doctor or a businessmen, but rather, the nature of the inquiry process.  Will the tribunal have the power to summon witnesses and compel their attendance?  Will the tribunal have the power to compel witnesses to produce documentation?  Will the tribunal be able to protect the witnesses, particularly doctors who’ve suffered from intimidation, by giving them immunity from AHS lawsuits alleging breach of confidentiality.  By the way the need for immunity applies to all doctors and employees of AHS, not just the doctors who’ve settled lawsuits with the AHS and its predecessors, because all doctors and AHS employees are under an obligation of confidentiality as part of their employment relationship with the AHS.

If a judge led HQC review cannot wield these powers or deliver blanket immunity then it is not a judicial inquiry but simply a repeat of the watered down HQC review presently underway.

The vacuous “key elements” proposed by Mr Carter do serve one important purpose.    They confuse the public and deflect attention from the fact that not once has Ms Redford assured Albertans that the HQC review would be open to the public.       

A public inquiry by definition is an open process.  Testimony is given in public and documents are made available to the public (often by posting them on the public inquiry’s official web site).  This openness is something Ms Redford is working very hard to avoid.

The HQC review, even with the addition of Carter’s 3 key elements, will not be open to the public.  It will not serve the public or even the doctors who’ve been caught in the web of intimidation.  Not only is this a disservice to the physicians and the public, it’s a disservice to the HQC which simply was not designed to carry out an inquiry of such magnitude.

Which brings us back to the square peg and the round hole.  The only way to get a square peg into a round hole is to hammer the life out of it.  The end result is a square peg firmly wedged in a round hole—surely a frustrating and useless exercise.  But take heart, the Public Inquiries Act is sitting right there on Ms Redford’s desk.  All she needs to do is remember her promise and use it.

*The HQC was created by Regulation 130/2006 under the Regional Health Authorities Act, RSA 2000, c R-10.  Its focus is patient safety and health service quality.  It has no mandate to address the culture of intimidation.  It was given permission to conduct this review by former Health Minister Zwozdesky.      

** Calgary Herald, Nov 18, 2011

***See the Public Inquiries Act which sets out the power to produce documentation in Section 4 and the power to force the attendance of witnesses in Section 5

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10 Responses to Square Peg/Round Hole — Redford’s Proposal to Beef Up the Health Quality Council Review

  1. Rose Marie MacKenzie-Kirkwood says:

    I think I saw this on a movie of the week. A politician making promises, the money people applying pressure, the politician swaying on her/his promises, a witness coming forward but afraid to testify until they were promised witness protection and a new identity. So, that is what life boils down to these days.

    I watch my parents squirrel away every extra penny they have because they think they will die if they get sick and have to wait, on a waiting list, for tests. They feel if they have money they can pay for private tests. So what does my father do but make sure he has every test possible to try to “catch it early” and what does this do to the health care system but plug up the testing process with unnecessary tests. Politicians did this, they scared the pubic now they have to undo it.

    But what do I know of politics, I am still waiting for the government to explain what happened with the “temperarily” introduction of GST (7%), to help pay down the deficit, and how that led to the (12%) HST. The government mandated the increase within 6 months so why is it taking 18 months to undo it and restore the original 7% GST. The people voted, despite the backwards confusing ballots. We stood up and said no, so please explain why it will take 18 months. It is the public that has to change all the computer programs, invoices and their way of processing and paying the government the required tax. If it was being applied to the deficit there should be no need for the 18 month wait.

    Somone once told me that money talks I just wish I had enough to answer. I miss the days when doctors made the decisions, made house calls and payment was a chicken. Doctors and the public don’t seem to have much of a say about their health and treatment these days.

    So once again, I may not completely understand all the topics being covered in the political arenas but why not just let the individual departments govern themselves and report their findings to a central group.

  2. The Alberta Medical Association and the Canadian Medical Association identified exactly the same problem that you identified when you said “Doctors and the public don’t seem to have much of a say about their health and treatment these days.” The AMA and the CMA said that when the government centralized all of the health regions into the superboard the doctors lost their ability to make decisions at the local level (or any level for that matter) and the superboard viewed the doctors who spoke out as a disruptive force that needed to be controlled.

    Things will continue to go downhill until the government agrees to call a public inquiry. The only way to fix the culture of intimidation is to expose it to public scrutiny.

    Thanks for your comments Rose Marie.

    • Carol says:

      Susan, the doctors’ professional associations have enormous influence, if not control, over our health care system. Go back as far as MSI in Alberta… and forward to the “TrilateralMaster Agreements”. More recently, of course, are the PCNs (Primary Care Networks), with hidden contracts where local boards of doctors – who evaluate themselves- decide what services we need and who will deliver them.
      Re: the PCNs – see Healthcare Quarterly, 14(4) 2011: 7-8 http://www.longwoods.com/publications/healthcare-quarterly/22591
      Primary Care Networks: Alberta’s Primary Care Experiment Is a Success – Now What?
      I had the opportunity to ask Mr. Ludwick to compare the PCN service delivery model with the northern European community clinic model; he said he knew nothing about that.

      • Carol, how nice to hear from you! The Healthcare Quarterly link was very informative. It indicates that a PCN is a business venture which is funded by the government (ie the taxpayer) and is free to spend the funds anyway it wants provided that the spending is in accordance with a 3 year business plan. Mr Ludwick is a very well qualified businessman with a PEng, MBA, PMP and PhD (I had to google PMP–turns out thats a Project Management Professional). He says PCNs perform well against benchmarks, but this doesn’t align with the Government’s decision to reject the Malatest study of PCNs and conduct its own review of the delivery of primary care. I can’t figure out whether the Government is truly concerned about how PCNs perform or it is simply using the review as leverage in the upcoming trilateral contract negotiations.
        Mr Ludwick’s article was clearly a pitch for even more government funding and a broader scope so that he can grow the PCN and integrate with other public and private health services. The desire to “integrate” with the private sector is a worry. We need only look across the border to see where this could end up. Thanks for your comments, very insightful as always.

  3. Neil Fleming says:

    It is really enlightening to hear the legal perspective you put on these issues Susan, thanks for doing this.
    I always tend to over simplify things. It seems to me that if the Conservatives and the College of Physicians and Surgeons have nothing to hide, why would they not simply call for the public inquiry and put the issue to rest. Premier Redford promised an inquiry during her campaign and that promise helped to get her elected. She can dress up the HQC anyway she wants, but it is not the public inquiry she promised.
    The longer she drags this out, the more apparent it becomes that she and the Conservative party are complicit in attempting to cover up the intimidation they are accused of.

    • Neil, you mentioned a tendency to oversimplify things, but I’ve found that the simple view is often the best. Premier Redford’s dance around this issue has left us all wondering whether, in the words of Shakespeare, “the lady doth protest too much”. Surely it would be wiser for the PCs to defuse the attention and speculation about her resistance to a public inquiry and simply call for one under the Public Inquiries Act instead of monkeying around with the regulations for the HQC. Anything less than that will leave us all feeling that something or somebody was swept under the carpet away from our prying eyes. Not a comforting feeling for voters heading into an election. Thank you for your comment.

  4. Carlos Beca says:

    I totally agree with Susan that sometimes the simple view is the one with the bigger message.
    Alison Redford just does not know what else to do to transform her promise in something that does not resolve anything but carries the same weight in terms of public acceptance. The same game just to get elected.

    It takes a long time for people to realize what is really going on and change strategies and in the meantime they get away with it. In the meantime it is becoming clearer that the Conservative Party is affraid of the results of a true inquiry. I for one know exactly what they have to hide.

    • Carlos, I agree. There is no other explanation for why the PCs have been so insistent that there will not be a public inquiry. I sincerely hope the public and the doctors don’t let them off the hook! Thanks for your comments.

  5. Carlos Beca says:

    We discussed a bit the Occupy Movement a couple of weeks ago and I found an article that I think it is right on about many things going on in the movement and in the world of politics. I am not sure this is ok to do but if not just let me know and I will not post again. I just think that it is something people should read

  6. That’s fine. The link is here for anyone who’d like to follow up. Thanks Carlos.

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