Last week Health Minister Horne out-trumped Donald Trump by firing not one but all 10 members of the Alberta Health Services Board—the board his government created in 2008 to deliver healthcare under a centralized delivery model.
One expects such theatrics from Donald Trump, after all he’s a showboat; but not from Mr Horne, the cabinet minister entrusted with the stewardship of Alberta’s $16.6 billion healthcare system; $13.4 billion of which goes directly into Alberta Health Services.
On June 12, 2013 Mr Horne issued a press release berating the AHS Board for ignoring his directive to rescind pay-at-risk compensation for AHS senior staff. He’d “informed” the AHS Board Chair and members that he was terminating their appointments, effective immediately, and thanked them for their service. Apparently the “informing” took place by email. Ouch! He appointed Ms Janet Davidson to take over as Official Administrator.
Now here’s where it gets sticky. I don’t believe that Mr Horne has the power to fire the Board under these circumstances.
Minister Horne’s source of power
Unlike Donald Trump who gets his power from his uncanny ability to raise money, Health Minister Horne gets his power from legislation, primarily the Government Organization Act and the Regional Health Authorities Act (RHA).
The RHA gives Mr Horne the power to provide health services to Albertans by appointing a board to administer health services. The Alberta Health Services Board is the only such board in Alberta. It is responsible for promoting good health for Albertans, assessing their health needs, setting priorities, ensuring reasonable access and being responsive. AHS Board delivers on these responsibilities through the organization known as Alberta Health Services. Most importantly, the AHS is the “final authority” with respect to all of these matters (section 5). Hold that thought.
“Strategic” versus “operational” decisions
Mr Horne has gone to great lengths to explain to anyone who will listen that Alberta Health (the government department run by Mr Horne) is the “strategic” arm of health service delivery and Alberta Health Services (the organization chaired by the now defunct Mr Lockwood) is the “operational” arm of health service delivery.
By happy coincidence this distinction was recently confirmed by the Health System Governance Review Task Force in a Governance Report submitted to Minister Horne in February 2013.**
Minister Horne buried the Governance Report so deep that no one knew it existed until ousted AHS Chairman Mr Lockwood criticized Minister Horne’s plan to conduct yet another governance review, suggesting that the Minister could save taxpayers’ dollars by simply referring to the Governance Report already in hand. What a novel idea!
The distinction between strategic and operational decisions is critical because decisions relating to compensation are operational not strategic and therefore fall within the purview of the AHS Board, not the Minister.
That’s why the Terms of Reference for the AHS Compensation Committee give the Committee the power to recommend compensation payouts to the Board. The Board in turn had the power to decide whether it would make the pay-at-risk payments or not. And as noted above, Section 5 of the RHA gives the Board “final authority” over matters within its purview.
Does Mr Horne have the power to fire the AHS Board?
The RHA gives Mr Horne the power to dismiss the AHS Board and appoint an “official administrator” in its place under two scenarios: (1) if the Minister considers the Board is not properly exercising its powers or carrying out its duties under the Act (we just agreed that the AHS Board was properly exercising its powers and duties because compensation matters are solely within the AHS Board’s purview) or (2) if for some other reason the Minister considers it is in the public interest to dismiss the Board.***
Would Minister Horne care to explain how it is in the public interest to fire the entire AHS Board because the Board refused to breach 99 employment contracts?
If the AHS Board bent to Minister Horne’s will and ripped up those contracts the message the government would be sending the public is this: the government is not bound by contract law in tough economic times.
If this were the case, there’s nothing to stop the AHS from refusing to pay construction companies building new hospitals or laundry service companies washing hospital linens or catering companies bringing in hospital food. Indeed, all of the government agencies and government departments could easily meet their new budget targets by simply ripping up their existing contracts and starting over again. It’s lunacy.
Power and control
Minister Horne’s beef with the AHS Board may have started with pay-at-risk but it escalated into a battle for power and control. The AHS Board was under the illusion that it had a modicum of autonomy and it could moderate political influence on decision making. Clearly it was wrong.
The Governance Report states that it is a “failure in governance…when the government disagrees with a decision of the AHS Board and imposes its will on the agency.” (p 24)
Given Minister Horne’s rout of the AHS Board I’d go even further. The question now is not whether Mr Horne’s imposition of his will on Alberta Health Services is a failure in governance; it’s whether Mr Horne, a cabinet minister in Alison Redford’s government, violated the Regional Health Authorities Act by dismissing the AHS Board without having the legislative authority to do so.
“You’re fired” is entertaining when it’s uttered by Donald Trump on a reality TV show. It’s downright scary when it’s uttered by a government minister to remind government-appointed boards and agencies that when the boss says jump, the correct response is how high.
*News Release, June 12, 2013
**Working Together to Build a High Performance Health System, February 2013
***Regional Health Authorities Act, Section 11