The state of Alberta healthcare is the most important issue facing Alberta voters—and it’s resting in the hands of squints and politicians. Lord help us!
A “squint”, like his compatriots the geek and the quant, is a highly trained technical person specializing in data collection and analysis. They’re lovely people but have been known to miss the forest for the trees. A quick read of the Health Quality Council (HQC) report on the problems of our healthcare system makes it clear that the 20 odd (and I mean that in the nicest possible way) people who compiled the report are predominately in the squint camp.
The story of the squints and the politicians starts on June 7, 2011 when Ms Redford broke from the pack of PC leadership hopefuls and staked her political career on a promise to call for a public inquiry into “charges of political interference in the provincial health-care system”*. Remember that on June 7, 2011 the only way to call a public inquiry into healthcare was under the Public Inquiries Act.
Like so many Two Minute Tories, I made the mistake of voting for Ms Redford and helped her capture the premiership by a very slim margin. It simply hadn’t dawned on me that once elected Ms Redford would slip the noose of her political promise by enacting a new piece of legislation**to give the Health Quality Council (the squints referred to above) the power to hold a watered down “public inquiry”.
It took 3 months for the new HQC Act to be proclaimed. Meanwhile Ms Redford ordered the HQC to investigate the issues. When asked if this was a needless duplication of effort given that the HQC would soon be conducting a public inquiry, Ms Redford replied that the HQC report would set the terms of reference for the inquiry. This is a very important point that I’ll return to later.
The mandate of the HQC is to measure, monitor and report—this is what squints do best—and the HQC performed its duties well.
It found that emergency department wait times exceeded the Canadian guidelines by 10 to 20 times in a significant number of cases. No surprise there to anyone who’s spent 22 hours in the ED waiting for someone, anyone, to treat them. It found no evidence of needless cancer deaths, but noted there were legitimate concerns with managing the lists and that these concerns had been addressed.
Most importantly, it found substantial evidence of physicians being threatened, censured, bullied, ridiculed, punished and at risk of losing their hospital privileges or positions.
This is where being a squint has its limitations. Much to Ms Redford’s surprise, the HQC recommended against a public inquiry. Instead, it suggested two task forces be set up to sort out the roles of the government, Alberta Health Services (the doctors’ employer) and the College of Physicians and Surgeons (the doctors’ disciplinary body) versus the doctors. Rather like taking your kids on a long car trip and drawing a line down the middle of the back seat so that they can make it to your destination without killing each other.
The HQC’s mind is made up. It will not come to a different conclusion in the public inquiry. Lawyers call this fettering the jurisdiction of an administrative/quasi judicial panel. It would normally be grounds for appeal…but for the fact that the HQC Act prohibits appeals.
So where does that leave Ms Redford? Should she order the public inquiry anyway? If so how will she force the HQC to set terms of reference for an inquiry it says is unnecessary?
The only way out of this mess is to ensure that the HQC inquiry hears fresh evidence that might lead to a different outcome. Past and present health ministers, their top bureaucrats and the administrators must be called to testify. Did Mr Liepert roll up the 9 health regions into the mega AHS so the government would have more control over the doctors? Mr Zwozdesky and Mr Horne, please explain why, after 4 years of operation, the lumbering AHS bureaucracy has finally managed to bring the state of healthcare back to where it was in 2006. (No that’s not a typo.)
And most importantly, doctors who’ve been bullied must be called to identify who bullied them, how they were bullied and how this impacted patient safety. Once all the facts are made public, the bullying will stop because the bullies can’t hide.
The squints cannot set the terms of reference for the inquiry because they’ve already neutered themselves. It’s now up to Ms Redford. She must set broad terms of reference to capture this fresh evidence. If she does, her ministers and former ministers will testify. If she doesn’t, she’ll continue to tap dance, hoping that we’ll be dazzled by the coming election rhetoric and lose sight of what’s really going on here.
Over to you Ms Redford.
*Calgary Herald, Feb 25, 2012, A4
**Health Quality Council of Alberta Act, SA 2011, c H-7.2
Susan on the Soapbox 
I am always nervous when someone states “I am from the government and I am here to help.” by calling for a public inquiry, especially when an election is right around the corner. I am not sure if the effort will be made to sweep things under the rug, or promise lollipops and cotton candy (at no extra cost to the taxpayer) or whatever.
I stumbled across a new word, at least for myself, that I think might capture what our provincial government has been doing with our health care system for the past six years. It is a German word and of course there is no exact English equivilant’. I am still struggling to figure out how to pronounce it. The term is Schlimmbesserung which loosely translates into “to make things worse through an effort to improve”.
So now I see Allison wanting to schlimmbesserung our health care system under the guise of an Inquiry (not a public enquiry as she originally promised) where the government can continue to meddle (after the election is held). Well, I am tired of being schlimmbesserunged (I am starting to love this word!) and if the past record of this government is any indication of where our health system is going with increased tinkering we will be really schimmbesserunged.
There is good news and bad news with regard to all these recent pronouncements. We know an election is imminent, which is the good news part of the story. The bad news could be that people won’t vote or continue to vote for the PC’s and then we will all be schimmbesserunged.
Roy I love your new word but unfortunately I cannot even imagine how you pronounce it. German has always been a mystery to me.
I have a better word for what has happened and is happening to our Health Care System – sound a bit German as well but much more appropriate and easy to read – DeKleined.
After that we had Stelmacked and now the ‘in’ word is Redforded.
It is interesting to note how only now people are starting to realize the disaster of their so loved ‘Klein Era’. Electricity is shot, The Health care system is fatally wounded, education has diabetes and all the outsourcings are bleeding. They are more expensive then when run by the Government and now the profits go out of the province. I know we keep making sarcastic comments about this situation but the reality is that one more government of this disgusting mismangement and we will be past the point of return. I continue to say that trying to fix is not going to work. We have to get rid of them altogether to escape disaster.
On the second paragraph please replace the second ‘Happened’ with ‘Happening’
Thank you
These terms are delightful Carlos. I especially like “DeKleined”! Looks like the only upside to this government is that they’ve created a whole new vocabulary for the rest of us who continue to suffer at their hands. I agree with your conclusion–the PCs have got to go. We’re in desperate need of fresh ideas and a whole new approach.
I just got back from an organizational meeting for a rival candidate. I won’t go into the details because this blog is not about a particular party but rather about the need for change. I’ll say this much though, he is a great young candidate who is prepared to listen to his constituents and work hard to bring their views to the Legislature. Let’s all get out there to support these candidates. They’re the only ones who can change the face of Alberta politics and defeat the big blue machine.
Schimmbesserung…! A perfect description for how, after 4 years of hard work and angst, we’ve ended up with a healthcare system that 6 years behind. (Bless those squints for giving us this data!) As I said the squints did a good job, but they missed the mark because it was outside of their mandate. It’s up to Alison Redford to set up a public inquiry that will be truly effective. Unfortunately I don’t believe she has the courage to go there.
PS. I googled “how to pronounce schimmbesserung” and came up with a grand total of TWO entries. That’s never happened to me before. You’re way ahead of the curve!
Wow. Oh, wow. Just… wow. (I can’t come up with a great word like “schimmbesserung”, so “wow” is all I’ve got :))
You have done a masterful job of capturing exactly what has transpired with this critical issue and where it’s headed. It’s crushingly disappointing.
Danielle, your description of the process as being crushingly disappointing sums it up perfectly. That’s exactly how I felt when I read the HQC report. The HQC is not and never was the right body to do the investigation. It surprised me that Dr Cowell thought the HQC was up to the task in the first place. Perhaps it would have been political suicide for him to turn away the assignment, but I don’t think Dr Cowell did himself any favours when he concluded that no public inquiry was required. So we continue to muddle along. But there is a ray of hope. I just introduced Norm Kelly to our readers in the Larry Summers blog, now I’ll introduce you. Danielle meet the people. People meet Danielle Klooster. DANIELLE KLOOSTER IS THE ALBERTA PARTY CANDIDATE FOR INNISFAIL SYLVAN LAKE. Danielle, like Norm, has decided to get involved and work for change.
(Seems like this is meet the candidate night…)
PS. I like wow.
Hi Susan,
It was good to read “your take” on the report of the Health Quality Council of Alberta. A couple of us from the Whitemud Citizens for Public Health group attended the news conference when Dr. John Cowell introduced the HQCA’s report last week. There are so many differing opinions on this document, and whether or not it is going to lead to us to the real information Albertans need in terms of why there are dysfunctions in the system, who pulls the levers, and especially who is intimidating whom.
Like you said, we need names named. Really, just to say there is a problem with intimidation, and there are shortages of hospital beds, etc. is just re-stating what Albertans, and health-care workers have already been saying for years. The bed shortages, for instance are a direct result of the policies going back to the Klein government (nod to Carlos).
Dr. David Swann was sitting beside us, and he asked for our quick impression of the HQCA report. I mentioned that one of the things I was glad to see was that the role of Alberta College of Physicians and Surgeons was at least questioned. It came to me later on reflection, that he himself was a victim of intimidation. He actually lost his job in 2002 as the Medical Health Officer for Palliser Region, when he spoke out against Alberta’s stance on the Kyoto Protocol. I was working as a community health nurse at that time and I remember the shock we all felt when this happened to him. This was a powerful message sent to all health workers. And the thing was, he was speaking out, I believe, in the context of looking at environmental effects on the public’s health.
Intimidation of health care workers is still ongoing. I know of a doctor who was criticized for his opinions regarding care “issues” the day after the HQCA report was released. We attended the “Beyond Acute Care Conference” in Edmonton last weekend and talked with nursing home staff who said they are absolutely FORBIDDEN from speaking to patients’ families about their conditions or care. One of them defiantly stated that she does anyway. At the conference, it was notable that one of the speakers stated that ALL Albertans are intimidated by their government.
Sorry for going on … I’ve been saving it up.
Elaine, great point about the role of the College of Physicians and Surgeons in the intimidation of doctors. What I can’t get over is how the College continues to flat out deny it. In the Feb 25 Herald, Dr Trevor Theman, the College registrar, said “I will state categorically we have never threatened a physician in that sense”. Two thoughts sprang to mind: (1) the HQC didn’t just make it up and (2) if the College didn’t threaten doctors “in that sense” in what sense did they threaten doctors?
Your example of how you and your co-workers reacted when Dr Swann was so unjustly fired illustrates just how damaging the government’s course of intimidation really is. We simply can’t allow ourselves to be “governed” by a government that intimidates us.
Much of what the Alberta government says about health care is about language. As an example, they like to use the term ‘publicly funded’ health care and most people are likely to equate that with public health care. But is it? If Redford meant public health care, meaning health care that is funded, administered and delivered publicly, she’d say that. But she doesn’t. She repeatedly uses the term ‘publicly funded’. Truth is that public funding can and does fund ‘corporatized’ healthcare, or ‘investor driven’ healthcare. It’s much more costly and much less efficient. Another term she deploys is ‘continuing care’. It sounds good, comforting, and may evoke a smooth seamless transition from one level of care to another. Wrong again. Continuing care is meant to obfuscate, to mislead, to suggest something that it isn’t. Continuing care includes DAL, (designated assisted living) where seniors pay essentially for room and board, and any extra needs that they may have, they pay for through supplemental fees. Costs can be as high as $5000 per month, very expensive and unaffordable to low and many middle income seniors.Continuing care also includes LTC (long term care) also referred to as the traditional nursing homes. At a current regulated cap of $1700 for a private room, these health care facilities are for seniors medically assessed as needing 24/7 monitoring. As in hospitals, medical care is free in these long term facilities. And as Public Interest Alberta’s seniors’ researcher Noel Sommerville writes, ” …. one has to question why the government is talking about lifting ‘caps’ on these fees and abandoning the most vulnerable seniors to the tender mercies of the private-for-profit seniors’ care industry’. And this is where architects of these policies come in. They’re called squints as noted above. Another name ascribed to them by writer and thinker John Ralston Saul is ‘technocrats’. He defines the technocrat in the following manner: ” they are the committeemen, sometimes called the number crunchers, always detached from the practical context, inevitably assertive, manipulative; in fact, they are highly sophisticated grease jockeys, trained to make the engine of government or business run but unsuited by training or temperament to drive the car or to have any idea of where it would be steered if events somehow put them behind the wheel. They are addicts of power, quite simply divorced from the questions of morality which were the original justification for reason’s strength.” (p 22, Voltaire’s Bastards – The Dictatorship of Reason by John Ralston Saul.) It will be up to Albertans to move beyond the misleading language of these squints or technocrats and compel Ms Redford and her candidates to be forthright in explaining their agenda in a clear and unambiguous manner in the upcoming distant election period. Secondly, she will need to explain why the government is not providing the right kinds of beds that are needed for seniors requiring long term care. Currently there are 1500 seniors on wait lists for long term care beds. The governments’ response to this crisis in December of 2011 was to announce the addition of 30 long term care beds in the province (all in Strathmore), a pathetic 2% response of what is required.
Ted, thank you for this enlightening comment. Your clear description of what on the surface appears to be a “good” thing but in reality is anything but is very timely as we head into the election. As you point out this government is extremely adept at using weasel words to slide things past the unsuspecting public. We all need to ask more questions and challenge what we’re told.
On a related note, tonight’s Herald reported that Premier Redford has reneged on her promise of a public inquiry (even the watered down HQC version) into the intimidation of physicians, instead she’s going to look into queue jumping. Nice bit of “bait and switch” which leaves the doctors out in the cold but preserves the reputations of politicians and senior administrators who are suspected of participating in acts of intimidation. Here’s the link to the article. http://www.calgaryherald.com/news/alberta/Updated+Health+inquiry+cover+doctor+intimidation+despite+Redford+promise/6223905/story.html
I just read on the Edmonton Journal as well and the way the Conservative party deals with serious issues is outright arrogant and idiotic. It is an insult to the citizens of this province. These people will have a day in the court of common sense soon and I certainly hope they get pushed out of Albertan politics forever. It is disgusting. They mismanaged this province to the point of nausea and they continue to play the game as if nothing has happened. Furthermore, this premier, given the oppportunity to do something really different is behaving like she is in a Rave party on ecstacy. What a display of immaturity and irresponsibility.
Yes, the announcements over the last few days leave a lot to be desired. The latest one I’ve seen is Redford confirming that the HQC inquiry will focus only on queue jumping. She says that as far as the culture of intimidation goes it’s time to “move on”…then she says that the results of the queue jumping investigation may show links to intimidation or political interference. Sounds like she’s trying to leave the (vague) impression that the inquiry might address the issues. This is misleading. The terms of reference exclude that line of inquiry and the HQC has already demonstrated that it simply looks at the evidence to determine whether the “bad” behavior occurred but doesn’t have the guts or heart to pursue who caused it.
Squints don’t make judgment calls they simply present the numbers. Thanks Carlos.