The Health Care Town Hall Meeting–How Come It’s Never Anybody’s Fault?

I went to the Health Care Town Hall meeting in Calgary last week.  After two hours I had a headache.  How come it’s never anybody’s fault?

“Fault” is defined as being responsible for an unpleasant situation.  I learned all about fault when as a child I was cavorting through the house and knocked a lamp off an end table.  The wire bit that held the light bulb snapped clean off the base.  Oh oh What to do?  With an unerring sense of self preservation I reassembled the lamp and placed it gingerly on the table.  It was fine—as long as no one touched it.  That evening my mother turned it on…and it fell to bits.  Who did this she asked.  Silence.  Well, the lamp didn’t just break by itself she said.  She had a point.  Given that I couldn’t pin the blame on my sister I confessed and lost my allowance for a week.

That’s how accountability works when you’re a child and that’s how accountability is supposed to work when you’re an adult—unless of course you’re the Minister of Health and Wellness.  In that case you’re free to deny accountability and, if you’re feeling particularly spunky, deny there’s any problem at all.

Minister Horne demonstrated this in spades at the health care town hall meeting.  In response to the question, do you think the healthcare system is in crisis, Mr Horne replied, “I do not believe our healthcare system as a whole is in crisis in Alberta, there are some relationships in our healthcare system that need attention”.*

Some relationships that need attention…?   The 420 page Health Quality Council (HQC) report on healthcare mismanagement had just landed with a thud on Mr Horne’s desk.  Part A described a critical lack of long term care beds which results in a misuse of acute care beds which in turn creates excessive wait times in ER and for surgeries.  Part B contained heart breaking stories of bullying (known in polite society as physician intimidation) at the hands of the departments of Health & Wellness (Mr Horne’s ministry), Alberta Health Services (the administrative arm of Mr Horne’s ministry), the College of Physicians and Surgeons and certain unnamed politicians.

So who’s accountable for this sorry state of affairs?  Apparently not the health minister.  Mr Horne acknowledged that the HQC report findings on physician intimidation were “very disturbing” but concluded that the problem arose because the centralization of 9 health regions into Alberta Health Services (also known as the Superboard) was carried out too quickly.

Ahh, I get it, like the lamp that broke itself, it’s the process’s fault.  Consequently it would be pointless to hold a public inquiry into physician intimidation to figure out what went wrong in order to prevent it from happening again.  Instead we should adopt Ms Redford’s mantra and simply “move on”.

Mr Horne has supreme confidence in the ability of his ministry (Health & Wellness), the administrative arm of his ministry (Alberta Health Services), the College of Physicians and Surgeons, and the Alberta Medical Association (AMA) to develop more processes to train physicians how to advocate effectively and create a “just culture” to prevent bullying.

Others are less optimistic.  Dr Swann put it best when he said Mr Horne’s plan was simply to ask the same health professionals who’d been intimidated to go back to work for the same people who’d intimidated them and rest easy because everyone’s learned their lesson and it won’t happen again.

To paraphrase my mother, the lamp didn’t break itself and the lamp won’t fix itself.  The bullying problem won’t go away without a thoughtful investigation that identifies the intimidators and why they stooped to intimidation and holds them accountable so that they and others like them will never be tempted to bully a physician again.

The Alberta Medical Association (one of the parties in the relationship that “needs attention”) is not prepared to accept this milque-toast solution.  While Mr Horne and his government are busy shuffling Alberta’s healthcare problems off the political stage, the AMA took pre-emptive action.  It launched a new public advocacy program called  “Just How Sick is Alberta’s Health Care System?” to demonstrate its commitment to a higher level of public advocacy “before, during and after” the provincial election.**

Wise move on the AMA’s part.  The Health Minister can cling to the “lamp broke itself” excuse, but the AMA and the public will drag these examples of intimidation into the light.  The bullying will stop when the bullies have nowhere to hide.

This is an extremely courageous move on the part of the AMA, particularly in this political environment.  They need our support.  Please click on the link and send your comments and concerns to whatithink@albertadoctors.org.  Let’s work with the AMA to end bullying and get on with creating the best publicly funded, publicly delivered healthcare system possible.

*Calgary Herald Online, March 7, 2012

** AMA President’s Letter Mar 6, 2012 

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24 Responses to The Health Care Town Hall Meeting–How Come It’s Never Anybody’s Fault?

  1. pining for change says:

    Well said, Susan. Maybe the PC government’s lamp will collapse when someone touches it. This election promises to be interesting, as Tory mistake after Tory mistake piles up.

    • “Pining for change”…what a great nom de plume! I know that you, like so many of us, are doing more than “pining”, you’re working in the system to provide guidance to those who are looking for a viable alternative. I urge people to go to the changealberta.ca website over the coming weeks to check out the non-PC candidates in each riding and assess their relative “winability” quotients. Thanks for all your work on this Pining…it’s more important now than it’s ever been.

  2. Jeremy Dutton says:

    Well said Susan.

    Voters have a choice. They can choose to believe the fox who after 40 years of raiding the chicken coop swears, he’s different and won’t do it again. OR, you can choose people who will build a new stronger, bigger chicken coop for everyone, to protect them from the fox. Very simple really.

    • Great analogy Jeremy. Today’s Herald reported that Dr. Lloyd Maybaum, (bless his brave heart) said that the doctors need an inquiry and “some form of truth and reconciliation, an acknowledgment of what happened in the past, an apology and a steadfast desire that we are gong to change.” Horne’s response? “I’m not sure exactly what he’s looking for.”

      Really? Sounds pretty obvious to me, but let’s not forget, Horne was instrumental in forcing Raj Sherman to get a mental assessment when Raj (as the junior PC health minister) wouldn’t let the issue of ER wait times drop. A negative assessment could have cost Raj his medical license. That’s what intimidation looks like! Raj and all others like him deserve an apology; not a behind-closed-doors expression of “regret” by Mr Horne.
      Here’s a link to the Horne article.
      /Health+inquiry+include+intimidation+allegations/6319997/story.html#ixzz1pU5hJ0yy

      Jeremy, thanks again for all your hard work to present a better alternative for Calgary voters.

  3. Rose Marie MacKenzie-Kirkwood says:

    Accepting responsibility for what you have done never seems to be something people, companies or government want to do. Why is that so hard? Right and wrong are simple that right and wrong, just as black and white have no grey area until they are mixed together in an attempt to blend the colours or make the right/wrong situation a not so bad situation. Instead to bullying doctors to break them (which is wrong), fix the problem (which is right).

    Government likes to use the term “as a whole” when referring to issues because nothing “as a whole” is ever totally broken, so the statement stands true, sort of. Even a tree hit by lightning, that has split in two, is still partially alive and the only reason to chop is down is the “possibility” that it may come down on its own and cause damage to people or property.

    So Susan, the lamp “as a whole” was fine as long as you left it alone. Hopefully the government sees that fine is not good enough, “as a whole”.

    • Rose Marie, you make a good point when you refer to the slippery use of language on the part of this government. The Health Quality Council report found 20% of the doctors expected “active, hateful obstruction” if they tried to advocate on behalf of patients. Health Minister Horne’s reaction? He’s developing a yet another behind-closed-doors process to better understand the doctors’ experiences!

      All of this slippery talk is an effort to keep the horrible treatment of doctors out of the public eye on the eve of an election. Horne and the PC’s are extremely annoyed that the opposition parties (who represent the views of the doctors and the majority of the public on this issue) dared to make this an election issue. He said “It’s a serious matter, and I don’t think you address it through politicizing it.” My question to Horne and Redford is this: are we “politicizing” the issue or are we, like Dr Maybaum said simply asking for the truth? How sad that Horne and the PCs don’t know the difference.

      Thanks for your comments Rose Marie…now about the lamp…I wouldn’t really have tried to blame it on you…really …

  4. Carlos Beca says:

    Very well said Susan. Unfortunately the way governement works, no one is or will ever be responsible for anything. When Ralph Klein started this process of slow squeeze of the system until one day it had to be replaced, we this day would be coming. Well it is here now and as you explained, no one broke the lamp. Mr. Klein is now very sick and he will still take advantage of a system that will allow him and his family to go to the painful process. Some of us will not have that luck in the near future. The same old story, socialist systems for me and darwinistic for those that have no choice. This makes me very upset because it is an on going process in many different fronts. The reducing corporate taxes is now almost an obsession followed by more cuts to the public services. As if that was not enough we have spent more than 30 billion in Afghanistan and we all know where that one is going to end. Billions thrown out the window for nothing while we have no beds for old people and others in Canada. This kind of posture and this idea that poverty is only somewhere out there is nothing else but arrogance.
    I personally think our system is in need of a lot of care and I am not sure it will be fixed. If Danielle Smith takes over the government we can all forget about a system at all. It will be like the US.
    I read this morning about the AMA asking for the public help and I am 100% behind them. I do not think it will be very difficult to push the government against a wall if the doctors are for real. Most people do want a full investigation on the bullying.

    • Carlos, your point about reducing corporate taxes is a very good one especially when you couple it with the wasteful spending on both on the federal and provincial level. It’s a real mess and must be corrected fast.

      In the healthcare context, I think the AMA is “for real”. The AMA president Dr Linda Slocombe is an effective leader. She’s helped the 7000 AMA members speak with one voice. That one voice created an ad campaign telling the public that the doctors have been threatened and intimidated when they’ve tried to do their jobs. Mr Horne’s platitudes about setting up a process with the AMA, the College of Physicians and Alberta Health Services to “brainstorm” ways to reach out to doctors is too little too late. It’s also hypocritical. One of the reasons that the negotiations over the doctors contract broke down last March was because Minister Horne and Alberta Health Services refused to allow the doctors to have a joint role in decision making.
      The government’s refusal to accept the AMA’s message demonstrates that the government is not interested in acting in the public interest to rectify this difficult issue…it’s trying to kill the controversy so that it can get through the next election. We all need to support the AMA to ensure that that doesn’t happen.

      Thanks for your comments Carlos and your support for the AMA. I sincerely hope others will follow your lead.

  5. Jane Walker says:

    In my opinion we are all at fault for letting this valuable jewel deteriorate so dramatically over a relatively short period of time. I know that we ‘try’ and we ‘communicate’ and all those good intentions but we need a direct departure from the way we have been doing things. How many different approaches have we tried? How many citizens really understand what we stand to lose? Is there a preferential place where citizen action really makes a difference?

    I am not criticizing what has happened (I was there and I have participated and I appreciate the genuineness and the expertise) but I am challenging all of us to look at what possible alternatives might be out there that have not yet been engaged. I do not have the answers …. only questions!

    In ‘whatithink’ I have suggested that partisan politics have no place in human services organization, administration and delivery.

    In ‘my perfect world’, the Department of Heallth would ideally be the source of fiscal resources for allocation that fits for the current and anticipated needs of the population being served. The Alberta Health Services Board would be the liaison and advocate for the professional and support services and infrastructure within the government system. As soon as we could change the flavour of the relationship between staff and administration, we would look to a healthier system and a visionary approach that results in improved service circumstances ….. staffing levels that relate to optimal outcomes, infrastructure that supports the staff recommendations, administration that works wtih staff as colleagues, not adversaries. Outcome = healthy health care workplaces. Leadership from Within …. ultimate fulfillment for professionals leading themselves and advising their advocates in designing a system that mentors, delivers and reinforces human service delivery systems, performance and outcomes for the greater good!

    Those are my thoughts but …… I’m only one person and I’m pretty weary at times!

  6. Jane…for a “weary” person you’re doing an excellent job at challenging us to think differently. Your suggestion about a “direct departure” is intriguing to say the least. As you point out, there are so many of us out there (groups and individuals) who are trying to raise awareness of the issues and communicate concerns to the government, and yet, nothing changes. We all have our pet issues and consequently we don’t all speak with one voice. More importantly, we don’t all vote for the same non-PC party. If in this next election we fragment the left vote again, two things will happen. One group of voters will throw up their hands in disgust and never vote again because “it’s no use”. The other group will finally see the light and pressure the parties on the left to unite. It will take some time, but it will happen. Alberta will then have 3 parties, the Wildrose, the Conservatives and the new Liberal/NDP/Alberta Party group. Won’t that be a fun project to work on.

    I really liked your “whatithink” suggestions, they go a long long way toward “unpoliticizing” healthcare. Ironically this is one of Mr Horne’s stated goals, but of course absolutely impossible under the existing PC regime. The answer: implement your recommendations under the new political regime. I’m up for it and I know you are too or we wouldn’t be having these discussions, Thanks again Jane.

  7. Elaine Fleming, Whitemud Citizens for Public Health says:

    Hi Susan,
    You’ve got some good discussion happening here.
    Your topic about fault, or “accountabiltiy” is so interesting. Your analolgies are so right on! Who can’t relate to the little child in a wee “mishap” at home, not wanting to be caught out?
    However, these are not kiddie issues, or, “mishaps” in a random world of growing up, when we talk about health care that affects each of us at very vulnerable times in our lives.
    Aside from the denial of fault from every “new” PC government group for the difficulties Albertans face with access to sensible health care, we have to be watching our flanks as the Wildrose Party comes out with proposals like “Hybrid” (read Private\Provider and Insurance) “solutions” and long-time debunked ideas such as “Medical Health Savings Plans”. What they are really saying is, “Hello, American health care”, and “Hang onto your wallets!”.

    • Good point Elaine, it’s easy to jump on to a proposal that appears to be the silver bullet without really understanding what it entails. I just finished the CMA article you posted on the Whitemud facebook page, it speaks to the need to look at the pros and cons of all the alternatives out there and then tailor them to fit the Canadian model of universal healthcare. This is something that will require thoughtful reflection as opposed to a quick pre-election sound bite. Thanks for raising the “heads up”!

  8. Ted Woynillowicz says:

    While disenchantment with the current government is obvious and justified, a prudent and informed response to all that has transpired in health care is necessary. It would be easy to throw out the baby with the bath water and usher in a new government and believe that the problem has been solved. Unfortunately it is not as easy as that. Political parties can be crafty creatures and that creates the potential that may lead to unintended consequences. Especially in Alberta where the notion that governments, when they finally reach their end date, are usually replaced by a new political party on the scene. While this has been tradition in century old Alberta, it does not have to be so. But note that this scenario has been and continues to be crafted until it becomes a self fulfilling prophecy. Secondly, it should be noted that political party platforms are carefully designed and crafted with phrases such as “European model”, or “increasing choices” which really are about privatization of health care. A more recent example occurred at the AMA forum, mentioned above, that was was about introducing the contentious issue of MSAs or “Medical Savings Accounts”. It will be important for Albertans to inform themselves and understand in clear terms what their options are before proceeding to the ballot box. Their health may well depend on it.

    • Ted, we would all do well to heed your wise words of caution, particularly the reference to “increasing choices” by shifting healthcare delivery to the private sector. Today the New York Times reported that the governor of New York just axed the Medicaid auditor. In a 4 year period the auditor had recovered $1.5 billion in Medicaid overpayments due to fraud and “misspending” by healthcare providers. Apparently the healthcare providers felt his audits were “nitpicking and overzealous”. The auditor found himself caught in the crosshairs between the governor’s plans to cut Medicaid costs and the Legislature’s allegiances to campaign contributors from the health care industry. Funny how that dilemma always seems to resolve itself in favour of the campaign contributors.

  9. Carol Wodak says:

    A pox on both the government and the medical association houses! When will we learn that allowing vested interests (both ideological and financial) to make decisions for us does not serve us well? Surely it is for us – as citizens, taxpayers, consumers, and neighbours to define what services we need, when and where we need them, and what measures we will use to assess sucess (read: fundamental values) – and for government and other “stakeholders” to make that happen! Our challenge is to create the environment in which public discourse (not controlled forums or infomercials or either-or choices) can begin to define what we do want.
    Carol
    (PS: never forget – it was the doctors’ association who tried to scuttle Tommy Douglas’ medicare plan – I don’t think they have surrendered even now!)

    • Carol, I must admit I’m not familiar with the role of the medical associations in the development of universal healthcare. It seems to me that the AMA has finally realized that the government has thrown it under the bus. Now that they’re under the bus with the rest of us perhaps we can work together to turn this situation around.

      I agree with your suggestion that the place to start is true public discourse that focuses on what we need (not what someone tells us we need), metrics to measure success and I’d also add, what it will cost for us to get there. Interestingly, many people would be prepared to pay higher taxes, IF we could be assured that our tax dollars would be properly spent.

      Thanks for your comments Carol…they’re always enlightening!

  10. Carlos Beca says:

    I was just reading this article this morning and I thought important to let you all know about it. This is really amazing and one more reason to get these people out of there as soon as possible. Do not choose the Wildrose though because then there will be no royalties period. They do not believe in that kind of interference in the Saint Market.

    http://rabble.ca/blogs/bloggers/parklandinstitute/2012/03/alberta-government-set-forego-55-billion-royalties-over-nex

    Thank you

    Carlos Beca

    • Carlos, what a timely article. The $55 billion in lost royalty revenues would have gone a long way in funding much needed improvements in healthcare delivery, seniors care, education, you name it. I’m continually surprised to learn that Peter Lougheed, the father of the Conservative Party, managed to succeed in government with a revenue target of 35% while his successors can’t make ends meet with a target that’s dropped to the 10 to 13% range. Says a lot about the quality of Mr Lougheed and not much about the quality of his successors. Thanks for this Carlos.

  11. Mark Barker says:

    It is very obvious that privatization of any Public system does not work. The public health care in Alberta is just a prime example of what happens when you take too much money out of the system, it does not work. The answer is to make sure the private system does not have the right to dump
    clients on to the public system just because patients are high risk or too old, if Private Health care providers have a client for 10 years they have to give that client health care coverage for life at the same fee structure that the public has to provide. Also prevent WCB from dumping chronically sick and injured workers on to the public system which they do every year because they feel the worker, just because he/she has retired is cured, this would also free up millions of dollars for new doctors, nurses etc. The system is also top heavy with too much administration, this needs to be stream lined too an absolute minimum.
    Finally we need to keep the Lawyers out of the Health care system, we need to trust the system to take care of the sick and not fear that they are all incompetent and need Lawyers to protect us from Doctors and Nurses all the time, the process should be simplified to allow the public to the right to complain to a board if they feel they have a problem with a Doctor/Nurse and state their case.
    Who would you trust a Doctor or a Lawyer?
    All treatments fees should be the same for all Doctors private or other wise, this will stop the queue jumping. Keep the system simple and it will serve us well complicate things with Lawyer and Privatization and things can only get worse.

    • Mark, your point about the consequences of privatization is well taken. Approximately 30% of Alberta’s healthcare delivery system is privatized. Every day we learn of another case of a patient, generally the sickest, the oldest, or the weakest, who has suffered in private care. The reason for this is obvious–it costs more to care for these patients and increased costs means decreased profits. So the company has two choices: jettison the costliest patients back into the public system or reduce costs by cutting staff and pay those that are left even less (thereby impacting the quality of care). Not a recipe for success.

      Your comment about the WCB is interesting. I didn’t realize this was going on but it fits the privatization model–rid the organization of costs by dumping them on the public system.

      I also agree with your comment about keeping the lawyers out of the mix as much as possible. I’m a lawyer myself and I know that lawyers serve a purpose, but it’s not to throw up firewalls to keep patients who’ve suffered at the hands of incompetent doctors from stating their case. The problem here is that the patient isn’t dealing with the doctor’s lawyer but rather the doctor’s insurance company’s lawyer. And it’s the job of the insurance company the avoid payouts at all costs. Unfortunately the insurance company has more money than the patient and can tie him up in legal battles until the patient gives up due to lack of funds. I’m not sure how this can be rectified in the existing system but it deserves a look.

      The issue of public healthcare funding and public health care DELIVERY is one of the key issues in this elections. I really hope that Albertans are paying close attention. We’ll know soon!

      • Mark Barker says:

        Susan,
        sorry if I offended you or your profession that was not the intent. I was saying that with the proper Government insurance in place all patients would be covered to proper degree. That requires more money in the system not less and private companies take money out of the health care system. I agree that the incompetent Doctors must be weeded out system by other Doctors, the same way that Lawyers police their profession.
        I am living proof that the WCB is dumping injured workers on to the public system, and also that my companies health care plan dumped me as soon as I turned 65. That private insurance companies had my companies money for my best health years and it should not surprise any one they dumped me as soon as they could they are in the business of making money and not providing health care to the sick and elderly. What should also be stopped is the uneven playing field that public health care has to play on with these companies, public health care cannot refuse a person for what ever reason private companies can and do. It is not the public health care system that is broken it is the way government has allowed private insurance to dictate who can be insured and who is to find a answer to their health problem, that is why I say that the private health care insurance companies has to cover the people they have had for 10 years for life and at the same rate as the public system.
        Albertans are paying attention but we are unsure who we can trust that is why you are seeing the huge swing in the voting right now, I for one do not want to see any one party have a huge majority, it makes more sense to have a multi- party consensus for important matters like health care and education that way all members have to agree and we stand a chance of getting what we want, good education and healthcare we all have access too.

      • Mark, your comments about the lawyers were valid…no offense taken. Your point about private insurers cherry picking who they cover and for how long is also well made. My family and I worked in the US for 8 years and knew of many cases where someone was denied coverage because of a “pre-existing” condition. Nice outcome for the insurance company but downright inhumane for the person without insurance.

        I hope you were able to find a solution to the difficulties you faced due to the lack of coverage from the WCB and your company’s health plan. No one should go without the proper care.

        All of the political parties are focused on healthcare right now…hopefully something productive will come of it.

        Thanks for sharing your story.

      • Mark Barker says:

        Susan,
        thank you for your good wishes I hope the good Albertan’s get a chance to put the health care problem to rest and we can all sleep at night. As for my story it is what it is and I will have to live with what ever WCB does or does not do, I am just a very small person in a very complex World, but right now the people who can make a difference are listening to what I have to say because they need my vote.
        I will vote when the time comes and I hope it helps some other poor soul who thinks that Alberta has an advantage over the other province’s, as hard working people we do not have enough say in the running of Alberta. Thank you for listening to my story, I know there are many more of us out there so please keep an ear open for us.

      • Mark, you nailed it when you said right now the people who can make a difference are listening to your story because they need your vote. Now is the time for us all to vote for the party that will listen and then act in our best interest. We will turn this government on its ear one day, I really hope that day is Apr 23, 2012. Best of luck.

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