My view of health care in Alberta

I know that Sue Huff is going to release the Alberta Party’s view on health care soon.  Given that it’s such a hot issue in this province, I wanted to get my thoughts out ahead of her (I hope) and see just how they correlate.  

I am not a health care administrator.  I am not a doctor or a nurse.  I do not manage a hospital or health care facility.  I do not work for Friends of Medicare, nor do I work for any form of private medical services.  I do not meet with the minister of health, although I most certainly like his stylish and jaunty last name.  I’m occasionally a patient - I’m currently recovering from another round of antibiotics that fixed a lung infection - and otherwise just a plain ol’ typical Albertan.  Most of the view I have of the system comes entirely from without and via what I can obtain through the media.  

Let’s not forget, I’m not normal.  Normal people, so I’m told, don’t write 3000 word epistles on their opinions.  So I’d like to think that I’m a little more tuned in to the issue than the average person.  But I’m no expert.

I’m not quite sure where this is going to lead me, so I’m going to put this paragraph in now and hopefully I’ll catch it while I’m proof reading.  If I missed deleting it, what you’re reading now is a reminder to myself to give a quick synopsis of the points I want to raise - almost as if this entry was planned.  Things that I know I want to hit are the superboard and the necessary side trip regarding Mr. Duckett.  I want to address emergency rooms and that sends me down a necessary side trip to talk about Dr. Sherman.  I want to talk about long term facilities, then family doctors, and that missing piece I haven’t put together yet.  If I get that far, I want to talk a bit about the heart and the soul and if anyone gets that far they’re a bigger geek than I am.  

The Sooper Superboard

How can I possibly cover this in a few paragraphs?  It could nearly be a week’s worth of blogs as a sooper topic all on it’s own.  In an attempt to reform our health care system, the government dissolved the nine regional boards which were supposed to have consolidated all the smaller regional boards around the province.  This was how the government was going to show us leadership on health care in Alberta..  It did consolidate everything to a central command and control, but I think that (Minister at the time) Liepert’s statement that amalgamation wouldn’t directly affect health professionals or patients was… let me be extremely charitable and say it proved to be incorrect.  Alternative viewpoints would be to call it, on my more cynical days, a “bald-faced lie” and on my less cynical days I’d say it was “clearly and presumptuously an overly optimistic and unrealistic assumption to make.”

In case I haven’t been blunt enough, we hadn’t had time to fully resolve consolidating to nine regions and it was utter folly to disrupt the system once again.  Dissolving the Alberta Cancer Board, Alberta Mental Health Board and AADAC are on my list of ideas that never made any sense whatsoever to me - and they are where some of our most critical issues lie today.  This is the shining example of the government dinking around in the back end way too often to the detriment of the whole system.  Could they waste more time and money addressing the wrong issues?  I think it would be a challenge.

I think that amalgamation has proven to be a poor idea, but I think the problem is equally about how it was handled.  No good can ever come from tipping the table on it’s side in order to clear it off.  There wasn’t planning, there wasn’t foresight, it was just a way to get rid of nine regional political problems with deficits and replace them with something more government friendly and “willing to change.“  Different standards of care depending on which side of the road you live on is never going to change - we’ve just moved the affected roads once again - in this case it’s the border.  That has nothing to do with overall care.  That’s what makes amalgamating boards twice in a row such a horrible idea.

So what did we get for our effort?  Clearly we have an AHS board set up on the presumption of being able to do imaginative and innovative reforms of the system that is held under the government’s thumb via the health minister.  At this stage I’m apoplectic over what they actually do.  Hey, board members, tell me what your plans are or I’ll fire you!  Waitasec…  they aren’t even accountable to me and the rest of the citizens of Alberta.  This is terrible.

The firing of Steven Duckett demonstrated just how much we’re paying to a board that appears redundant since everything is being run by the minister anyhow.  

Look, I’m just a guy out here in the real world.  I can get fired two ways:  “with cause” and “without cause”.  Fired with cause means I get a “Don’t let the door hit you on the way out.“  Fired without cause we talk severance.

When Mr. Duckett (yeah, I know he’s a “Doctor” but I want to differentiate between MD’s who deserve the esteem) was fired he walked off with more money than I’ll see in the next ten years.  This sets up an interesting situation.  If he was fired “With cause”, his cookie crumbling, why is he getting that kind of severance?  If he was fired “Without cause” then just why the hell was he fired?

Now in my view, Mr. Duckett should have shown much more experience and class than he did.  As the head of the Superboard, I expect him to comport himself appropriately, to be experienced with speaking to the media and to deal competently in those situations.  He didn’t and that’s part of the job.  If my job was media relations and I screwed up like that, I’d expect my two weeks pay and be happy to have it.  However that’s a pretty small slice of that job and I’m in no position to be able to judge how he performed in total.

I make a pretty average salary in Calgary.  Sure, my personal situation’s bad right now, in part because of my poor choice in financial planners, but I will eventually recover.  If you’re telling me we can’t fill that position with someone competent for less than $575,000 a year I will tell you to your face I don’t think you’re competent hiring good staff.  What is that, roughly ten times the average Albertan’s salary?  Did we get ten times the value?  We’ll never know - they aren’t accountable to us, the citizens.

So now that we’re here, what do we do?  First, I actually feel we have to keep AHS as an entity.  We have to stop this endless cycle of administrative disruptions.  But we’re going to fix a whole lot of the problems with a centralized authority by making it wide open and accountable.  Start by making their compensation public.  Ensure that minutes are made public and guidelines for redactions must be minimal, made public and rigidly adhered to.  Policies and reports are to be made public and available and must be written in plain language.

Did anyone know who a single one of the board members were before four of them resigned?  These are the people making choices on behalf of every last one of us.  We deserve to know who they are and demand they represent each of us fairly.  Every last person on that board that did not resign have the responsibility to make themselves, their views and their visions available to the citizens of Alberta.  Not just a few Albertans who know how to reach them.  If you represent us, address us all.  And be ready to take questions without waving a cookie.

We have a real problem with wait times in emergency rooms.  Premier Stelmach, you’re wrong.  If but a single person dies due to an extended wait in emergency, we have a crisis.  If a single person suffers ancillary harm because of a needless wait to get care, we are living in a crisis.  When the emergency room doctors fear that their patients are not getting adequate care and have told you so in no uncertain terms and they are not heard, you are part of the crisis.

A couple years back I caught pneumonia pretty bad.  I ended up in the emergency room at the Foothills hospital for a little over six hours before being admitted.  I felt almost ashamed when I finally saw the doctor.  I felt there were a lot of other really serious cases in there with me that needed attention before me, although I was very grateful once I had finally been admitted.  Listening to waiting times now, I hear it’s only gotten worse.

Now it was just pneumonia and in my mind that doesn’t normally require a visit to emergency, but in my case it was a bacteria that survived the first round of anti-biotics and came back with a vengeance.  It certainly changed my perspective of life when I later heard the term, “life-threatening” applied to that bout of pneumonia.  Some of the most horrifying news came after I started my recovery.  The nurse that asked out of the blue, “Did they ever find the cancer, dearie?“  Huh?  Nonono, it was just pneumonia.  Wasn’t it?  I felt best when my specialist (Dr. Van Olm - another jewel of a doctor) told me, “You’ll recover fully, but you’ll never be quite the same.”

No, I will never be the same.  I took up my broom and slider and started curling again to keep active in the winter.  I started riding my bike again in the summer.  It certainly played a role in breaking up with a girlfriend who smoked.  The first sign of an infection has me back at my doctor’s doorstep - two years on and I know I remain vulnerable.  I’ve taken responsibility to achieve better health.  I’m not healthy yet, but I’m trying.

Who’s taking responsibility for our emergency system’s health?  It’s not healthy yet, but Dr. Raj Sherman speaks up and is trying and he gets shut down, kicked out of caucus and disparaged by his peers.  He has not been recognized by his former party as the hero that the majority of the province sees from him.  Who is out of touch, us or them?

The problem in emergency comes from various pressures.  We know for certain that there is a serious lack of long term beds in Alberta right now - and we have an aging population that does not bode well for the immediate future of our health care system.  Don’t we?  Or is Alberta the land of the young, up and coming population where dreams are made and lifestyles are healthy?

I know I’m getting sold a bill of goods when we can’t even keep our narrative straight anymore.

Clearly we need long term beds right now.  It may be an ephemeral need, it may be a permanent need.  But we need more in place.  Given that it may or may not need to be permanent, this is a perfect opportunity to be looking for acceptable facilities which could modularly be turned into what we need.  I know we don’t want long term beds to be too clinical, but perhaps an aging hospital could be made “homier” just to tide us through.  The Calgary General Hospital is perfe– wait, we blew it up.

Don’t build a palace that will be empty or razed in twenty years.  Let’s start with what we have today.  It’s not going to be perfect, but it has to be better than sitting in a chair in the emergency room.

The other part of the problem is the unconscionable lack of family doctors.  I will declare right here and now to the rest of the world that I, in the most literal sense of the phrase, owe my very life to Dr. Gordon Melling.  (And I love you too, Nurse Sharon.)  You can’t have him, he’s too busy as it is.  :-)  It’s because he’s such a great family doctor.  Why don’t my children have a great family doctor?  Why don’t all Calgarians?  It’s inexcusable and part of the reason people are ending up in emergency instead of seeing a great doctor first.

A walk in clinic has it’s place, but it’s not the same as the doctor that knows our personal history and is in tune with us as individuals.  Dr. Melling noted that the only time he’s seen me lately is when I’ve been coughing.  Yessir, I get the hint, I’ll be in for a check up around my birthday.

Did we not all learn the idiom, “A stitch in time saves nine”?  How about “Pay a little now or a lot later”?  Let’s address the problems before they become emergencies.  

There’s a missing piece with emergency rooms - or possibly more, I don’t really know.  I’m not the expert, but I know that if the solution was as simple as adding long term beds and family doctors we’d have a damned easy puzzle to solve and that just comes across as too much of a silver platter answer.

I don’t know the solutions, but I certainly spot problems.  I may not have the answers to our health care crisis, but maybe I can figure some of it out.  Just by chance I may spot something around me that some AHS board member in Toronto doesn’t have access to.

The biggest problem with the emergency rooms and Alberta Health Services and the Ministry of Health and Wellness is that it’s all somebody else’s problem.  We, the citizens, are not being treated as citizens.  We’re being treated like spoiled children who are only grasping votes that have to be teased from our hands.  It’s our health - we need to be in charge here.

Our health care crisis urgently needs two things:  
1.  Honest real consultation with all Albertans and
2.  A genuine perspective of our situation.

The perspective will inherently stem from the conversation we have during the consultation.  We don’t have time for yet-another-year-long-province-wide-steam-whistle-bring-your-axes-for-grinding-health-care-reform-tour.  Just start talking and listening and put real data on the table.  When the Raj Shermans start speaking out, that’s the time for the politicians to shut the hell up and listen.  The doctors have the most knowledge, the patients have the most at stake, the politicians need to stop being a road block through their efforts to reform the system.

Regardless of what I said above, I know for a fact that although we have some localized health care crises, our health care system is not locked in crisis.  We have some of the most exceptional, caring, intelligent health care professionals anywhere right here in this province.  They have to be, because you’re not going to last long in Alberta unless you are willing to hang your dedication on your sleeve.  The perspective is what will strike the balance between the Premier’s crisis denial tactic and the problems we all perceive.

We need tangible information out here that says:
- “You know what, cancer rates are up an extra ten percent, but seventy percent of patients can recover with adequate treatment.  A new cancer centre would make a big difference and extend a lot of lives.“  Or
- “Perhaps we only need one state of the art cardiac facility to deal with the really serious issues, and the rest of the province is okay with the emergency care.“  Or
- “Maybe we want children born in rural hospitals so we can keep moms closer to home, but we have a really fantastic neonatal unit centralized (in Red Deer, of course) when we need it.“  Or
- “Our nurses are working way too much overtime, we could hire 5% more just in what we’re paying in overtime.”

I don’t know what that conversation sounds like yet.  We can’t even have these discussions because we aren’t deemed worthy of that kind of information.  Read everything I’ve ever written.  Do I not sound like the person you can have a serious, reasoned conversation with?

The heart and the soul of health care is..  what?  

The doctors, nurses, technicians, ambulance drivers, cleaning staff and all the people who protect our health?

The patients who get better - or not - in the care of our system?

I think we can all agree that it’s not a board of bureaucrats, but those bureaucrats have to have a huge amount of heart and soul just to be willing to sit on the board.

Whatever it is, I don’t feel that the government has devoted their full heart and soul towards improving the health care system.  We’re not having the conversations we need to have.  We’ve wasted too many years purporting to support the principles of the Canada Health Act - but we’re going to do it a Third (somewhat nebulous and undefined) Way.  We’ve had the ultimately failed Health Resources Centre experiment and messed around with what we eventually pulled back under the umbrella (sorta) anyways.  We spent way too much time messing around with administrative boards and spent far too little time letting the administrators actually running the show we’ve entrusted them to do.

We have collectively decided as a society that the Canada Health Act is what we want and shall not be contravened.  We need a government that will support that decision and not keep looking for these loopholes that let our system get nibbled to death by ducks.

I want to see that we are dedicating ourselves - heart and soul - into improving what we’ve got.  Enough trying to continually reform it.  Let’s sit down and have some honest, grown up discussions about what we have, what we need and where we want to go.  That way we can stop arguing about whether we should use the word crisis and instead discuss possible solutions we can find together.  It starts with the Ministry opening up a little - no, a lot - and bringing the conversation to all of us.

At no point did I ever say we’re problem free and living in public health care happy land.  We’re facing major issues.  But how dare we even have a public vs. private conversation when we can’t even address the system that’s in place today?  We need that conversation first.