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

Posted on June 12, 2011 by susanonthesoapbox

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

Posted in Alberta Health Care, Politics and Government | Tagged , , , , , | 3 Comments

Heathcare Providers…and robins

Posted on June 5, 2011 by susanonthesoapbox

Why do robins sing at 4 a.m.?  The sun isn’t up, the worms are asleep and yet the robins are out there chirping their little heads off.  This inane question ran through my mind because I was trying not to think about a more serious question—how is Roy doing?  On Tues June 7 my husband had a stroke.  Before I go any further let me assure you that Roy is well on the way to a complete recovery.  However last Tues and Wed his condition was less certain.  Here’s what happened.

On Tues morning Roy collapsed while making the morning coffee.  The next 20 minutes were a blur of 911 calls, firemen, EMT guys and an ambulance that deposited us at the Foothills Emergency Department.  I fully expected to be forced into “bulldog” mode in order to get the attention we required, but we were immediately taken into triage.  (Stroke patients get priority over others because early treatment is critical).   The doctors and nurses quickly assessed Roy’s condition, scheduled the required tests and continued to monitor his status while we waited for a bed in the critical care unit.

I had a chance to observe the ED staff while we waited for a bed to clear.  It became obvious that not only were these people skilled professionals, they actually liked their jobs and their co-workers.   They were open and empathetic, offering us everything from explanations to extra chairs when my daughters showed up.  Our attending physician stopped at the end of his shift to have a conversation (rather one-sided in the circumstances) with Roy, an urban planner, about the state of planning in Calgary versus his home town of Mexico City.  The morale of the place was epitomized by the screensavers that scrolled across the computer monitors:  FMC—ED ROCKS!   (FMC = Foothills Medical Centre, ED = Emergency Department and ROCKS! = no explanation required).

Within 4 hours Roy was transferred to the critical care unit for additional tests and close monitoring.  Here we met more doctors, residents, fellows, practitioners, nurses, practical nurses, physical,  occupational and speech therapists as well as aides and the housekeeping staff.  Luckily Roy continued to make remarkable progress and would not require many of these services.  What was crystal clear however was the quality of the care available and a sense of professionalism and pride in a job well done.

A day later Roy was moved to the stroke unit where he shared a room with 3 other patients.  The patients on this floor are healthier (relatively speaking) than those on the critical care floor so the number of healthcare providers per patient is reduced.  The halls were cluttered with hospital paraphernalia—computers, chairs, stretchers and equipment—and the staff were very busy, nevertheless they maintained the same high standard of professionalism and care we’d experienced on the critical care floor.

Roy is home now.  He’s adjusting to his new regiment, more pills, less work and no driving for a whole month!  I am grateful to the healthcare providers at the Foothills because they know only too well what it is like to work in a difficult environment.  I’m not talking about the stress of working in a place where people are suffering and some actually die, but rather the stress that comes from working in a place that is at the mercy of politicians and bureaucrats who have not yet figured out how to provide optimal healthcare to Albertans but are too proud to reach out to workers on the front line and ask for assistance.*

I ask myself:  how do our healthcare providers maintain their morale, how do they continue to rock?  Then I remember the robins that sing at 4 a.m. and realize that healthcare providers, like the robins, do what they do because that’s their job and they will do it to the best of their ability even when the sun is low in the sky and no one is watching.  Healthcare workers are professionals who will do their very best even when their short sighted bosses change the rules over and over again.  For this I thank them from the bottom of my heart.

*Despite political and bureaucratic roadblocks, many healthcare organizations have taken a proactive approach to solving provincial and federal healthcare delivery problems.  The Canadian Nurses Association has launched an expert commission to make recommendations on the evolution of Canada’s health system.  The Commission is co-chaired by Maureen McTeer and Marlene Smadu.  Heather Smith, the president of the United Nurses of Alberta sits on the expert panel.  Closer to home, a recent independent study has reconfirmed the wisdom of the Alberta Medical Association’s push for more primary care networks (PCNs) as a critical element of Alberta’s primary care strategy.  You’ll recall that the government threatened to cut funding to the PCN program in the last round of contract negotiations.      

 

 

Posted in Alberta Health Care, Uncategorized | 6 Comments

Keys to the Kingdom

Posted on May 29, 2011 by susanonthesoapbox

Let me tell you a secret.  The key to Alberta’s future prosperity was discovered 65 years ago—by the Alberta Post-War Reconstruction Committee.  The Committee was created by the Social Credit government in the twilight of the war years in order to transition Alberta from a wartime economy to a peacetime economy.  Various subcommittees met with Albertans to develop transition plans in the areas of agriculture, soldier settlement, education, finance, natural resources, public works and social welfare.

In a dazzling example of prescience the Finance subcommittee made a bold recommendation:

At Fort McMurray…enough oil exists to supply the world for more than a century.  Extraction…has been difficult, but the sands will prove invaluable in the future development of Alberta…It would, therefore, be essential that any such development shall be orderly and economically sound, and that it should be free from any of the destructive features accompanying wild speculation and commercial imperialism under monopoly or combine control.  Therefore, a definite and clear-cut policy should be laid down in regard to development, and it should be rigidly observed in the face of every kind of pressure from outside influences.” *

In 1945 the Finance subcommittee was disbanded and its recommendations lay dormant for 65 years.  It’s not that nothing happened in 65 years—technological advances were made, oil prices peaked and remained high and the oil sands are being developed—however, nothing strategic has happened in 65 years.  Alberta is no further ahead today than it was in 1945 when it comes to the strategic development of this extremely important non-renewable resource.

Why hasn’t Alberta developed a strategy?  Because it didn’t need to.  In Feb 1947, just 2 years after the Finance subcommittee filed its recommendations, oil was discovered at Leduc.  Albertans climbed on to the resource revenue rollercoaster and went for the ride of their lives.       

Fast forward to today.  The Premier’s Council’s report on economic strategy, Shaping Alberta’s Future, has exhumed the Finance subcommittee’s recommendation in a discussion of the stark reality facing Albertans today:  Whether it’s conventional oil, natural gas or the oil sands, it is no longer sensible or even possible to tie Alberta’s long term economy to non-renewable resource revenue.  The report states that the Alberta government must start acting like other governments, spending only what it collects in tax revenue without relying on resource revenue which is 4 times as volatile as ordinary income but is used to underwrite 30% of the cost of public services.** This raises the politically unpalatable spectre of increasing personal and corporate taxes.

And that recommendation is the second key to Alberta’s future prosperity.  Not surprisingly, this key has also been around for a number of years.  Recently it was reinforced by none other than Peter Lougheed.  Mr Lougheed not only advocated for an increase in corporate and personal taxes and a reduced dependence on non-renewable resource revenues;  he also joined the chorus in favour of orderly development of the oil sands, suggesting that to avoid the inflationary pressures of an overheated economy, the government should control how many oilsands projects proceed at a given time.***

The Alberta government has been extremely reluctant to address this issue head on.  Instead it tinkers around the edges of the problem with initiatives like the Regulatory Enhancement Task Force which is attempting to streamline policies and regulations to ensure that Alberta’s oil and gas industry remains competitive (read is exploited as quickly as possible) while still protecting the environment, public safety and resource conservation.  (Given the difficulty in aligning these conflicting objectives, the report promises to be an interesting read).

While the Alberta government dithers we sink deeper into the quagmire of increasing debt so consider this:  There are two keys to Alberta’s future prosperity lying right there on the kitchen table.  Ask your political leader (or leadership candidate) whether he/she is prepared to pick them up.  If he/she says yes, you’ll have taken the first step toward a strategy to ensure our future prosperity.

*Shaping Alberta’s Future, p 28

**Shaping Alberta’s Future, p 99, 97

***Calgary Herald, May 23, A8

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The Rapture vs Alberta’s 30 Year Strategic Plan

Posted on May 22, 2011 by susanonthesoapbox

4:45 p.m. May 28, 2011.  On the off chance that I am not going to be sucked up into the heavens at 6 p.m. May 28, the Day of the Rapture, and will still be kicking around 30 years from now I thought it might be useful to read the Report of the Premier’s Council for Economic Strategy.  It’s called Shaping Alberta’s Future and lays out 5 strategic priorities or themes which the authors suggest must be addressed now in order to ensure that in 2040 Alberta will be a good place to live, work, raise families, contribute to and enjoy society.

I don’t intend to discuss the 5 themes today (that would take a while and what if I’m wrong about the Rapture) instead I want to focus on an interesting paradox that became apparent when I read the Report against the backdrop of the Conservative leadership race.

But first, a little background about the authors.  The Premier’s Council was chaired by David Emerson, former MP who held positions in Industry, International Trade and Foreign Affairs.  It included Anne McLellan (former Deputy Prime Minister), James Gray (former CEO of Canadian Hunter), Sir John Bell (Oxford professor and Chair of the Bill and Melinda Gates Foundation) and other luminaries.*  The Council spent 21 months reading, listening, talking and thinking about how to ensure that in 2040 Albertans would enjoy a desirable quality of life and the province would prosper.

The Report was published earlier this month.  But I don’t think that any of the Conservative leadership candidates have read it—or are even aware of its existence for that matter.  Was Premier Stelmach off on a frollick of his own or are the leadership candidates deliberately ignoring the Report in the hopes that their own contradictory positions will not brought to light?

Let’s examine two glaring examples of this disconnect:  electrical infrastructure and land stewardship.  The Report highlights the need for a reliable, cost effective, supply of low carbon electricity as a platform for sustaining economic growth.  The Council is firmly of the view that Alberta’s transmission infrastructure is inadequate to achieve this strategic goal.  More importantly, the Council acknowledges the conflict between the government, landowners and Aboriginal groups over power line siting and infrastructure placement and urges the government, landowners and Aboriginal groups to find a solution and move forward.

Compare this straight forward approach to how Ted Morton responded to the controversy.  Since declaring his candidacy for PC leadership Mr Morton discovered that he has serious reservations about how his government has handled this issue.  Mr Morton states “…I have never been persuaded of the need for two DC lines between Edmonton and Calgary.  I was not persuaded as a private member, I was not persuaded as a cabinet minister, and I am still not persuaded today”.**  And yet, Mr Morton managed to overcome these reservations and support Bill 50.  Mr Morton also notes that Cabinet does not have the expertise to decide whether additional power lines are required and the resolution of this issue requires a high degree of expertise and also independence and impartiality.  Perhaps Mr Morton would care to review the resumes of the 12 Council members.  Their sterling credentials may put his mind at ease.

Turning now to the land stewardship issue, the Report identifies the risks posed by expanding energy development and its impact on natural habitats, agricultural lands and Aboriginal communities.  The Report calls the Land Stewardship Act and the integrated planning approach through the Land Use Framework a transformative step—one that is required to balance the need for urban and industrial development lands and agricultural and conservation lands.  Rather than suggesting a delay in the process, the Report urges an acceleration of the work required to develop regional land use plans and recommends strengthening the consultation process with people who live and work on the land.

Contrast this desire to meet the issue head on with Alison Redford’s comments about the controversial legislation.  Shortly after she joined the PC leadership race Ms Redford took issue with the Land Stewardship Act and the amendments that had been proposed in an effort to satisfy disgruntled landowners.  She suggested that all planning and development work related to the Act be suspended.  She described the legislation as unclear and confusing and noted that people didn’t “…feel they were consulted on it..(t)he legislation and the process of developing the legislation (were) not transparent”***  What makes Ms Redford’s comments particularly troubling is (a) she’s a lawyer who is more than capable at identifying confusing legislation and (b) she was Justice Minister when the legislation came into force.  In other words this happened on her watch.

1:30 p.m. May 29, 2011.  I haven’t been swallowed up by the Rapture and neither have Mr Morton and Ms Redford.  So think about the message that these two leadership contenders, each from the opposite ends of the Conservative spectrum, have delivered:  A long term strategy, no matter how well thought out, will be delayed (if not sacrificed) in the interests of political expediency.  Unfortunately a good strategy cannot be pushed aside while a politician is advancing his or her own political agenda.  Any politician who tries to do so creates a lack of trust and credibility—rather  like Harold Camping who predicted the Rapture (again) and must now explain why it failed to materialize.

*Premiers Council For Economic Strategy Membership:  David Emerson, Elyse Allan, John Bell, Robert Brawn, David Dodge, Jauan Enriquez, James Gray, Clive Mather, Anne McLellan, Courtney Pratt, Lorne Taylor, Jennifer Welsh.

Shaping Alberta’s Future, p 78

**Calgary Herald, May 20, 2011, p A14

***Calgary Herald, May 16, 2011, p A3

Posted in Politics and Government | Tagged | 4 Comments

The Pause Button

Posted on May 15, 2011 by susanonthesoapbox

That’s it…they’re gone.  On Thursday May 12, 2011 after tributes to Premier Stelmach and Dr David Swann and the usual skirmishes during  question period the Legislature wrapped up the last day of the spring session.  The Legislative Assembly will be on “Pause” until Oct 24, 2011 when the MLAs will return to engage in the work of setting the policies and laws that govern us all.

A quick review of Hansard and the media over the last week demonstrates that the PCs lost some ground, but not much, on the challenge to its ability to manage and deliver healthcare services in Alberta.

While Minister Zwozdesky successfully faced down the call for a public inquiry into the culture of intimidation in healthcare, Alberta Health Services (AHS) quietly put into place an internal patient advocacy committee with the objective of improving a doctor’s ability to advocate for his patients.  Dr Lloyd Maybaum is a member of the committee and one of the many doctors who has been threatened for “inappropriate” patient advocacy.  He noted that the committee will not address any of the past examples of intimidation and reconfirmed his belief that “…only an inquiry can get to the bottom of what has happened.”* 

The PCs also refused to admit that Ron Liepert’s ill-conceived decision to centralize the health regions into the Superboard (aka Alberta Health Services) created nothing but chaos and dysfunction.  Nevertheless, AHS has begun the slow process of decentralization by announcing the creation of 5 management regions in order to bring decision making to a local level.

Earlier in the week Mr Stelmach bristled at the suggestion that the $1.9 billion Superboard decision was misguided.  “Now there’ll be more decision-making at the local level which will deal with very simple situations like when to put a light bulb in a surgical suite, all of those things that will now be taken care of through a common-sense approach”.**

One hopes that he’s kidding about the light bulb.  But recall Dr Duckett, the ousted AHS CEO, insisted on approving all hiring decisions in the 94,000 strong organization and nurses were instructed to supply their own pens as a cost cutting measure, so one can’t be too sure.  Minister Zwozdesky explained the swing to decentralization as a change in capacity:  “What is changing is more capacity for local decision-making because the circumstances today are vastly different than they were two, three years ago.”*** I’m not sure about the increased capacity for local decision making but I am convinced there has been a change in circumstances with respect to decreased morale and an increased demand for results from a better informed public.

These small victories were offset by two disturbing announcements from Jay Ramotar, Health Deputy Minister.  Mr Ramotar will be taking “a hard look” at HealthLink, the 24/7 medical hotline service through which registered nurses provide medical advice by phone.  Mr Ramotar complains that HealthLink nurses send too many people to hospital emergency departments (HealthLink says only 14% of callers are advised to go to ER;  in my view erring on the side of caution in this case is a good thing).  He also thinks that the RNs might be better utilized in busy hospitals.  One can’t help but wonder whether the PCs have found a creative way to reduce the patients waiting in ER by eliminating the HealthLink RNs who send them there.

Mr Ramotar also wants a comprehensive review of the 40 primary care networks (PCNs) in the province.   He admits the PCN concept is a “very very good one” but wonders whether there should be a system to measure the performance of the teams of specialists.  He expects to “tweak” the program so as to avoid increasing the number of family physicians per captia.  He muses:  “Do we have a report that would tell us today about the benefits we’re getting for $109 million?  I would say not”.**** 

In both of these cases Mr Ramotar appears not to have read the his own 5 Year Health Action Plan.   Not only does it describe HealthLink as a key initiative to improve accessibility to healthcare, it sets an aggressive target of reaching an RN by phone within 1 minute.  Furthermore, the 5 Year Action Plan characterizes PCNs as a significant success story and one of the 5 key strategies (it’s Strategy #3: Strengthen Primary Health Care) to drive further improvements in Alberta’s healthcare system.

Mr Ramotar’s announcements demonstrate the PCs approach to providing healthcare has not changed.  Despite promises to reduce ER wait times by increasing the number of continuing care beds and staffing empty new hospitals, Mr Ramotar is focusing on reducing the referrals to ER made by trained registered nurses on HealthLink.  Rather than increasing accessibility to healthcare by increasing the number of family physicians, he proposes an evaluation of the “effectiveness” of the healthcare workers in the primary care networks in order to do the exact opposite.  The evaluation of these two programs will take 2 years.  I hesitate to speculate on the cost—both in tax payer dollars and ongoing churn in the system.

No wonder Mr Zwozdesky was content to let Mr Ramotar handle this one alone.  But here’s a suggestion, when the MLAs return on Oct 24, 2010, instead of hitting the “Play” button, let’s all hit “Eject” and start fresh.

*Hansard, May 10, 2011, p 1042

**Hansard, May 9, 2011, p 979

***Hansard, May 9, 2011, p 985

****Calgary Herald, May 12, A4

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Oh Look…A Shiny Object!

Posted on May 8, 2011 by susanonthesoapbox

They say you should never look a gift horse in the mouth, especially one worth $33 million, so it was with eager anticipation that I set about exploring the Government’s new health and wellness website.  The site was unveiled last week and will be fully operational by 2015.  It provides 2 new services, both aimed at “empowering” Albertans to make informed choices to stay healthy and access healthcare when they’re unwell.

The first initiative is MyHealthAlberta .  Minister Zwozdesky says it’s tailored to Albertans, having been compiled and vetted “…during 75,000 work hours by physicians and professionals on 8,750 topics.”*  A quick review reveals general information on disease diagnosis, treatment and finding a doctor, not unlike what you’ll find on the Alberta Health Services website or Netdoctor for that matter;  as well as information on allergies, insect stings, shin splints and bedbugs.  Assuming that Albertans are no more susceptible to pestilence and boils than the rest of the country, much of MyHealthAlberta is a duplication of existing information readily available elsewhere.

To be fair, MyHealthAlberta will become more Alberta-centric over the next 3 years.  Albertans will be able to input their own health data (blood pressure readings, insulin levels, weight, etc) in order to track their progress over time.  Eventually Albertans will be allowed to access their electronic health records.  Both of these initiatives should enable Albertans to better understand their health and take responsibility for their own wellness.

Given that neither of these two initiatives will be in place for a couple of years, one questions whether Minister Zwozdesky’s $33 million announcement was premature and simply an effort to deflect attention away from more pressing healthcare problems such as the call for a public inquiry.

But back to the website.  The second service is a new link that sets out wait times for 55 procedures which have been sliced and diced by region, hospital and physician for the preceding 3 months.  It replaces a similar website which was taken down in Sept 2008, ostensibly because the 2008 website (which was based on information from the 9 health regions) was unreliable and inaccurate.

The wait time website is Minister Zwozdesky’s personal favourite.  He’s been waiting for it for a “long time” and waxes eloquently about the site’s potential.  “If we’re able to show you what the reported wait times are by physician and by facility, family physicians will be able to work more quickly with their patients to find specialists with shorter wait times and to ensure Albertans receive timely care where and when it’s needed.”* 

Just think about this for a minute.  Minister Zwozdesky thinks that the mere fact that wait times are posted on line will ensure that Albertans will “receive timely care where and when it’s needed”.  Really?

I decided to test this theory by searching for wait time information for cataract surgery in Calgary.  I sorted through my hypothetical level of eye disease (semi-urgent to non-urgent) and selected the time period within which 90% of the surgeries were performed.  I hit the big green search button and found—nothing.  The two physicians who perform cataract surgery in Calgary are shown as having completed 0 surgeries in the first 3 months of 2011.  There was no explanation for this lack of data although there was an unrelated comment about the lack of diagnostic imaging data which requires system upgrades.

You’ll recall that in February 2011 Minister Zwozdesky announced that an additional 3000 cataract surgeries were added to the surgical roster.  He also noted that the average wait time was 41 weeks in 2010 versus a target of 36 weeks in 2011.**  Notwithstanding the availability of this information (from the Health Minister no less) as far as the on line cataract patient is concerned the wait time website is a complete bust.

Not prepared to give up, I tried a second search, this time for mastectomy wait times.  I classified the search as semi-urgent and pulled the wait times to treat 90% of the patients in all Calgary hospitals.  This produced a list of 20 doctors who performed between 1 to 64 surgeries within a 1 to 9 week wait time period.  So what should I do—pick the doctor who performed one surgery over the last 3 months but could get me in within a week or the other doctor who performed 64 surgeries over the last 3 months and had a wait time of 5 weeks?

Obviously I’d need to work with my family doctor to get his views on which specialist would be the best choice.  Ah, but there’s the rub.  Minister Zwozdesky’s assurance that the website will ”…ensure Albertans receive timely care where and when it’s needed”  is based on the premise that Albertan’s already have access to a family doctor who can help them make these difficult decisions.  The website neatly side steps this issue by defining “wait list” as the period of time between when the specialist decides a procedure is required and when it is performed.  It does not take into account the month it takes to get in to see your family doctor (assuming you have one—20% of Albertans do not) and the 1 to 3 months (or more) it takes to get in to see the specialist and run the diagnostic tests required to determine which procedure would be best in your case.

Bottom line:  posting a link to wait times does absolutely nothing to “…ensure Albertans receive timely care where and when it’s needed”. 

But wait, the Health Minister touts a second benefit of the wait time website.  “This is a system that will make us more accountable to Albertans…an important way of measuring our health system performance”.   Great idea.  I’m all for accountability—but it’s virtually impossible to determine accountability by measuring performance against pre-set targets when the pre-set targets are not readily accessible.  The website is not linked to national wait time metrics,***nor is it linked to the targeted wait times metrics already established by Alberta Health Services.  Consequently, the wait time website fails as an accountability measure because it is nothing more than an incomplete snapshot of wait time performance over the last 3 months.

In the final analysis, the website is a very pretty shiny object with a $33 million price tag.  It’s meant to distract Albertans from the more pressing question of what is wrong with the Alberta healthcare system.  A public inquiry is one way to find out.  By happy coincidence a public inquiry would cost about the same and take about as long (according to the Health Minister) as the fully operational MyHealthAlberta and wait time websites.

So where would you rather spend your tax dollars—on a process to uncover what’s wrong with our healthcare system and fix it, or on another bright and shiny object?

*Calgary Herald, May 5, 2011, p A6

**Edmonton Journal, Feb 11, 2011, online

***  Alberta is once again at the bottom of the heap when it comes to wait time performance.  Alberta finished in a tie for 7th place ranking ahead of only PEI and Newfoundland despite being among the highest healthcare spenders per capita.  CHCI 2010 pp 21,29

Posted in Alberta Health Care | Tagged | 4 Comments

Kate’s Wedding

Posted on April 30, 2011 by susanonthesoapbox

Two billion people watched Kate Middleton marry Prince William on Friday morning.  The mainstream media and social media blanketed the globe with images of the bride and groom surrounded by wedding guests in outrageous hats and Grumpy Grace, the little bridesmaid who covered her ears to shut out the noise of the crowd.  Some of us watched out of curiosity, thankful of the opportunity to escape the grim reality of political upheaval, financial meltdowns and environmental devastation.  Others watched simply because they love the Royals.  The point is if we’re interested in an event we’ll get up at the ungodly hour of 2 a.m. to witness history in the making.

So what does Kate’s wedding have to do with Albertans?  Absolutely nothing.  The real question is:  what does Kate’s wedding have to do with healthcare?  Absolutely everything.  (I know what you’re thinking…let’s see how she gets there from here).  Consider this.  Everyone on the planet knew every last detail about Kate’s wedding (well, except for the dress) and had an opportunity to enjoy the wedding with their friends through TV parties, chat room parties, facebook, twitter and email.  Or if they wanted to enjoy it by themselves, they simply turned on the TV at 2 a.m. and watched the ceremony in the comfort of their family rooms, bundled up in a housecoat and fuzzy slippers.  This demonstrates the awesome power of the media to unite a segment of the population with a common interest.

We in Alberta have a common interest.  It’s not glamorous like Kate’s wedding.  It’s deadly serious.  Over the last 12 months we’ve learned that Albertans spend more per capita on healthcare but get less in the way of services than anyone else in Canada.  We’ve also learned that this conundrum of over-spending and under-delivering (which signals gross mismanagement in my view) is further exacerbated by a toxic work environment that silences doctors, nurses and other healthcare providers who dare to advocate for better healthcare delivery.

A public inquiry into the whole mess is required.  But notwithstanding the call for a public inquiry from the Alberta Medical Association (AMA) which represents 6500 doctors, the Health Sciences Association of Alberta which represents 21,000 healthcare professionals, the opposition parties and the general public, the Premier and the Health Minister have stubbornly refused to consider the suggestion.

It’s clear that if we do nothing the Conservatives will stonewall their way through this Legislative Session in the hope that the issue will die over the summer.  So what do we do other than grabbing torches and pitchforks and taking to the streets.  How about this:  we use mainstream media and social media to send the Health Minister a very clear message.

Surely we can expend 1% of the energy we used following Kate’s wedding (for the men in the crowd substitute watching 2 men brawling on the ice in padded hockey gear) and make our voices heard.  Here’s the plan:

Send an email to the Premier, the Health Minister, your MLA saying:

  • You agree with the AMA, the Health Sciences Association and the politicians who say that a public inquiry is the only legitimate way to investigate the culture of intimidation
  • You’re very concerned (or appalled depending on your mood) by about the Health Minister’s refusal to call a public inquiry
  • This is a critical issue and you will ask every candidate standing for election in your riding where they stand on it and will cast your vote accordingly

Copy your email to the following people in a show of support:

  • Dr Patrick White, AMA President, president@albertadoctors.org
  • Heather Smith, President of the United Nurses of Alberta, ProvincialOffice@una.ab.ca
  • Elizabeth Ballerman, President, Health Sciences Association, elisabethb@hsaa.ca
  • Dr David Swann, Liberal Leader
  • Dave Taylor, Alberta Party
  • Heather Forsythe, Wildrose
  • Brian Mason, NDP

Copy your email to the newspapers who’ve continued to cover this story.  They need to know that the public is still interested or they’ll turn their attention elsewhere:

Lastly, for those of you who blog, facebook and tweet, now’s the time to put that skill to good use.  Talk about the issue on line and post links to your letter.

As you may have guessed I’ve already started.  Here’s the link to my letter to the editor which appeared in the Calgary Herald on Apr 28, 2011.  Now I’m sending it to the Premier, the Health Minister and all of the others on this list.

It’s time to show the government that we will invest at least as much time protecting democracy, transparency and accountability as we will spend watching Kate’s wedding.

Posted in Alberta Health Care | 2 Comments

The Eagle Has Landed–in the War Zone

Posted on April 24, 2011 by susanonthesoapbox

Dr Chris Eagle has just landed the most dangerous job in Alberta.  He’s the new President and CEO of Alberta Health Services (AHS).  He will serve a 5 year term commencing on Apr 1, 2011—assuming he survives that long.  He’s been the Acting President and CEO since the unceremonious termination of his predecessor, Dr Stephen Duckett, in Nov 2010.  Throughout that time Dr Eagle has kept a low profile.  The health minister describes him as “thoughtful, engaging and responsive”*.  He’d better be “shrewd, resourceful and politically savvy” if he’s to have any chance of survival in the minefield known as AHS.  Why?  Because hovering over AHS like an ominous cloud is the health minister—Mr Zwozdesky.

To better understand the challenges Dr Eagle will be facing, we need to examine the political and legislative web underpinning healthcare services in Alberta.  Healthcare services are delivered via 2 interlocking channels:  (1) the Dept of Health and Wellness under the leadership of the health minister who is directly accountable to the Premier (and presumably the people of Alberta) and (2) AHS, the province-wide health region under the leadership of Dr Eagle who is directly accountable to the AHS Board of Directors, which is directly accountable to the health minister.  All roads lead to the politician, Mr Zwozdesky.

Mr Zwozdesky describes the relationship between the Dept of Health and Wellness and AHS as follows:  the Dept of Health and Wellness is the strategic arm of the government, responsible for policy, strategic direction, global budgets and physician’s compensation.  “Integral to that is the leadership that we provide for the entire government with respect to health and wellness…and that trickles down to our delivery arm, which is Alberta Health Services.  They are the delivery arm.  So we have a strategic arm, a policy arm—that looks after legislation, regulation and so on—and we have a delivery arm, that then puts it all into effect”.**  The brains and the brawn, if you will.     

To his credit, Mr Zwozdesky is working hard to enable the “delivery arm” to deliver.  Of the $14.9 billion budget allocated to healthcare services, $9.6 billion is going directly to Dr Eagle and AHS as base operating costs.  These costs include:  acute care services, support and administration services, diagnostics and therapeutic services, continuing care services, and community health.

What’s interesting about this $9.6 billion allocation is that not one of these costs is subject to Legislative scrutiny.  In fact, there are only 6 lines dealing with AHS in the budget, which apparently is 4 more lines than last year.*** In other words, the health minister has free rein to spend $9.6 billion in taxpayer dollars to deliver healthcare anyway he wants to.

Given the lack of Legislative oversight of the AHS budget, one must rely on the Auditor General’s audit process to ensure that the money is properly spent.  Unfortunately, the Auditor General lacks the power to force the government to comply with his audit findings.  It recently came to light that the government ignored 53 audit recommendations (about one half directed to the Dept of Health and Wellness and the other half directed to AHS) for as long as 7 years.  Mr Zwozdesky’s excuse is that these things take time.****

Bottom line:  the Dr Eagle is accountable to no one but Mr Zwozdesky and Mr Zwozdesky is clearly not accountable to the Auditor General or the people of Alberta.  Compare this to the usual CEO/Board of Directors relationship in the real world (yes, I know that politics is not the real world but we have to start somewhere, don’t we).

A CEO is accountable to a number of stakeholders.  First he’s accountable to the shareholders who invest in his company.  Here the equivalent would be the Alberta taxpayers who are coughing up $9.6 billion this year to fund AHS activities.

Second, he’s accountable to his Board of Directors and their outside auditor.  Here the AHS Board is made up of loyal Conservatives, appointed at the pleasure of the health minister, who are incapable of exercising the slightest shred of good corporate governance without his permission.  (You’ll recall that 4 board members resigned to protest the health minister’s precipitous dismissal of Dr Duckett).  We’ve already discussed the utter lack of oversight from the Auditor General.

Third, a CEO is accountable to his employees.  AHS employs 90,000 people, including the 6500 doctors urging the government to call a public inquiry into the culture of intimidation.  Dr Eagle’s response to this outcry has been to repeat the party line—the Health Quality Council review is sufficient—clearly demonstrating that his accountability to the health minister trumps his accountability to his employees.

So where does this leave Dr Eagle?  Well, he must deliver the 5 Year Health Action Plan (he’s already late out of the starting block) to a frustrated and angry population, using a disillusioned and demoralized work force, all the while not uttering a word that upsets his political masters.  The difficulty in working to a set of political goals instead of solid business principles is that political goals shift with political expediency and unless Dr Eagle stays in lockstep with Mr Zwozdesky he won’t know he’s stepped on a land mine until it explodes.

In return for taking this risk, Dr Eagle will receive base pay of $580,000 plus a maximum performance bonus of $145,000—a total of $725,000/year.  This is about 9% more than his ill-fated predecessor, the quirky Dr Duckett, and in my opinion nowhere near enough to constitute the appropriate level of danger pay.  So who do you think Dr Eagle will listen to—his stakeholders or the man holding the $9.6 billion cheque?

*AHS News Release, Apr 14, 2011

**  Hansard, Apr 13, p 645

***Hansard, Apr 13, p 651

.****Hansard Apr 18, p 689

***** Hansard, Apr 18, p 690.  

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Whose Domain Is It Anyway?

Posted on April 17, 2011 by susanonthesoapbox

Minister Zwozdesky responded to my email last week—5 months after I’d written to him complaining about my daughter’s 22 hour wait in ER before being admitted to the geriatric ward for gallbladder surgery.  I expressed my support for Dr Parks’ recommendations to improve ER wait times.  Mr Zwozdesky thanked me for my suggestions (I made none) and told me to go away.  Well, not in so many words.  First he apologized for  “the inadvertent delay in responding” (I guess he mislaid my email).  Then he assured me that the Tories were working to improve access to emergency departments “regardless of the events surrounding the former President and CEO of Alberta Health Services (AHS) or any other individual”.  He added that “The AHS Board made the difficult decision in regard to the former CEO based on their judgment of his continued ability to lead the organization.”  Apparently Dr Duckett played a significant role in crippling access to ERs…either that or he’s become a convenient scapegoat.

The letter is curiously silent about the most critical issue facing Alberta healthcare and the Tory Government—the call for a public inquiry into the culture of intimidation which silences doctors who advocate on behalf of their patients.  It would have made political sense (an oxymoron if ever there was one) to include a passing reference to the issue and perhaps a few words describing why the Health Minister believes that the Health Quality Council (HQC) review is indeed the right way to proceed.

So let’s turn to that debate for a minute.  On Thursday, Apr 14,  the Board of Directors of the Alberta Medical Association (AMA) endorsed a two pronged process:  (1) the HQC review to investigate sub-optimal care of 330 patients in ER and 250 cancer deaths while on the surgical wait list and (2) a separate public inquiry into the culture of intimidation.  Dr White, the AMA president, said that the doctors feel that a public inquiry is the best way to change the culture and address physician disengagement from the AHS.  It should also be noted that a public inquiry is the only way compel politicians, senior bureaucrats and AHS representatives to testify under oath and to allow doctors to testify without breaching their nondisclosure agreements.

The Health Minister was not amused—but he should not have been surprised.

The Premier and the Health Minister have spend the last 3 months tripping over their shoelaces in their dealings with Dr White and the AMA.  For months the AMA, the AHS and the Government have been renegotiating the doctors’ contract for fees and services.  The Government insisted that doctors accept a 0% raise because that was (supposedly) the Government’s norm for all public sector settlements.  The AMA was prepared to accept a 0% deal until the Government announced that unless the AMA signed on the dotted line by Mar 31, 2011, nine key programs would be cancelled.  The AMA refused to succumb to bully tactics and did not sign.  Then everything went pear shaped.  Here’s the sequence of events:

  • Apr 1 (the day after the AMA was told it had to sign the 0% deal or lose 9 key programs) the Government and the Alberta Union of Public Employees (AUPE) announced an agreement which included a 4% salary hike plus two lump sum payments totalling $3000.  Dr White emailed AMA delegates to advise them that the agenda for the Apr 14-15 Board meeting would include a decision on whether to support a public inquiry.
  • Apr 2, Premier Stelmach called Dr White asking for “an urgent meeting” to address the shaky relationship between Alberta doctors and the Government.  Minister Zwozdesky applauded the “urgent meeting” but noted that the AMA had misunderstood the AUPE deal.  “Once  the AMA hears all of the facts of the deal, they will understand it better”.  Hmmm, 0% versus 4% seems crystal clear to me but perhaps politicians have a different way of doing the math.  The AMA also learned that the Government’s threat to cut the 9 programs was simply a negotiating tactic.  Others might characterize it as shoddy behaviour and a breach of trust.
  • Apr 8, the Premier, Minister Zwozdesky and Dr White met.  They agreed to cooperate, collaborate and introduce “innovations in delivery to ensure a health care system that is patient-centred and sustainable”.  They also agreed that Dr White and Minister Zwozdesky should meet regularly to “assess ways of building physician engagement and trust”.* 
  • Apr 14-15, the AMA Board of Directors formally endorsed the two pronged review/inquiry process whereby the HQC review would the 330 ER cases and 250 cancer deaths and a public inquiry would investigate the culture of intimidation.

Minister Zwozdesky reacted badly.  He categorically rejected the prospect of a public inquiry.  “I am not going to advocate for tying up $20 million, $30 million, or $40 million of taxpayer’s money to do a public inquiry that would take two, three or four years to get accomplished when we need some answers right now”.**  One wonders how the HQC, which lacks the legislative mandate to conduct this review, is going to investigate the ER cases, the cancer deaths and the culture of intimidation in just 9 months when, according to the Health Minister, a full blown public inquiry with the power to conduct a proper investigation into intimidation won’t be able to finish the job in 2 to 4 years.

But the Health Minister wasn’t finished.  He implied that the AMA decision was a negotiation tactic, noting that Dr White represents the “physicians union which is currently negotiating with the province.”  He also said something very telling:  “This is a bit of a strange way to go about putting into effect the arrangement that was agreed to in the Premier’s office last week, but that’s what people do and we have to respond accordingly” and added that Dr White had told him that the doctors planned “to stay out of the political domain”.** 

So there’s the nub of the problem.  In the Minister’s view, unless Dr White and the AMA support the Government’s position that a public inquiry is unnecessary they are meddling in “the political domain”.  No doubt this was a surprise to Dr White who described his meeting with the Government as a commitment to work together to introduce innovations in healthcare delivery and building trust;  not a sleazy backroom deal whereby the AMA agreed to stay silent in return for a 4% pay hike.

The problem isn’t that the AMA is meddling in the political domain;  it’s that the politicians are meddling in the doctors’ domain.  And that is precisely why the doctors are calling for a public inquiry into the culture of intimidation and precisely why the Government is fighting it tooth and nail.

So I’m going to heed Dr Maybaum’s suggestion that “Albertans need to lift up their heads and speak loud and clear. ”** I will respond to the Health Minister’s letter by telling him that the Government’s position with respect to the public inquiry is unacceptable.  Here’s the link to the MLA’s contact information.  Tell your MLA, the Premier, the Health Minister and all of the heads of the opposition parties that the Government better get cracking on the public inquiry because we’re all meddling in the political domain and, guess what, we’re not going away.

*President’s Letter, Apr 13, 2011

**Calgary Herald, Apr 16, p A4

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Leo Marks and the Indecipherables

Posted on April 10, 2011 by susanonthesoapbox

Sometimes I feel like Leo Marks, the 22 year old cryptographer who joined the Special Operations Executive in London to support Britain’s war effort.*   Marks was a gifted codemaker.  He became convinced that radio operators working in the Netherlands had been turned by the Gestapo and the coded messages they sent to London were misinformation.  Marks’ conviction was based on the fact that things just didn’t add up—not a single Dutch agent in the field had ever made a coding mistake (known as an “indecipherable”).  This level of accuracy was unmatched by any other country section.  The Dutch put it down to their superior training and innate skill.  Marks refused to accept this facile explanation and never abandoned his search for proof that the agents had been compromised.

Okay, let’s crank this story down a notch.  Many Albertans have an uneasy feeling that the Tories want to reduce public healthcare and increase private insurance and privately delivered healthcare.  We’re also convinced that the government intends to slip this past Albertans by “consolidating” existing healthcare legislation which protects public healthcare into regulations under the new Alberta Health Act.  This would allow the Health Minister to manipulate the regulations away from the watchful eye of the Legislature.  In December 2010 a leaked government policy paper surfaced.  It supports this fear.  When questioned about it the Tories heaved a sigh of frustration and said go away, we support public healthcare.

To test this theory I sent a FOIP request to Alberta Health and Wellness (AHW) requesting information about the leaked presentation.  I wanted “any and all records and documents including but not limited to correspondence (email or hard copy), presentations, briefs, reports and studies pertaining to the private insurance options which are the subject of a government of Alberta presentation entitled Alberta’s Health Legislation: Moving Forward”.  I attached page 21 of the July 12, 2010 presentation to ensure there would be no confusion over the request.

On Feb 25 the FOIP Office called requesting clarification.  I confirmed that my request was for records regarding what private insurance options were considered and what private insurance options the department “was referring to or thinking about” when drafting the presentation

On Mar 31 I received an answer from the FOIP Office:  “We regret to inform you that a search by AHW has failed to retrieve any records relating to the subject of your request.  A search was conducted within the Department and no responsive records were identified.”

 

Now here’s where the FOIP letter gets interesting.  It states:  “The FOIP Office was advised that AHW did not look at any private insurance options when drafting the July 12, 2010 “Alberta’s Health Legislation: Moving Forward” document.  Under our current legislation, the Alberta Health Care Act, Alberta prohibits private insurance for insured services.  The question was asked whether this prohibition should continue, be removed or simply be enabled as a regulatory tool for implementation in Alberta. The presentation you are referring to is a draft document.  Please be advised that AHW did not look at any private insurance options and no work was conducted regarding possible options.  This was a question being asked at the draft stage and the policy shift of considering private insurance options was excluded from the final document.”

 

Like Leo Marks, I started to feel that there was something wrong.  Here’s why:

  • Dr Raj Sherman confirmed that a policy paper was presented to the Tory caucus in mid 2010.  It detailed changes to the Alberta Health Act which would allow private insurance to cover more services (which means more services would be delisted).
  • The presentation was approved by the Minister and the Deputy Minister of Health and was later presented to all government MLAs by Fred Horne.
  • The government discussed (1) changing the legislation to enable a shift to privatization by moving key terms into regulations (which are enacted at the Minister’s discretion and are not subject to debate in the House), (2) expanding private insurance and (3) allowing doctors to work both inside and outside of medicare (today they must choose one or the other).
  • Someone was so concerned about the contents of the presentation that they leaked it to the Liberal caucus and the press.
  • The leaked document does not indicate it is a “draft”.
  • Whether the presentation is a “draft” or the final version is irrelevant.  It would be extremely unprofessional for the presenter to suggest a policy shift of this magnitude without giving it some consideration beforehand and creating at least one scrap of paper to support the recommendation.  (Recall that I asked for information indicating what the AHW “was referring to or thinking about” when drafting the presentation.  Apparently the answer is “absolutely nothing”).
  • The leaked document is entirely consistent with the Tories push for privatization as first enunciated by Don Mazankowski (2001) and again by Ralph Klein (the Third Way, 2005).
  • In Jan 25, 2010, Ralph Klein admitted that the PC’s had tried to privatize healthcare by creating a two tier system:  “I tried it twice—the Third Way and the Mazankowski Report—and I failed”.
  • The reference to the Alberta Health Care Act in the FOIP letter appears to be a mistake.  There are only 2 pieces of legislation with the word “Care” in the title:  the Health Care Protection Act and the Health Care Insurance Act.  Both of these acts are slated for “consolidation” into the new Alberta Health Act where they can be treated as regulations and modified or eliminated at the whim of the Health Minister.

Now I’m the first one to admit that none of these points, in and of themselves, are proof that the Tories have developed a secret strategy to increase private insurance/healthcare at the expense of public healthcare, however like Leo Marks, I see enough red flags to seriously question the government’s veracity on this issue.   Unlike Leo Marks, who was locked in a battle of wits with the Gestapo, here in Alberta we’re all supposed to be on the same side.  Surely we deserve more transparency and fewer indecipherables when our government communicates with us about an issue as critical as the health and wellbeing of its citizens.

*Between Silk and Cyanide, by Leo Marks, 1998

Posted in Alberta Health Care, Politics and Government | Tagged | 4 Comments