Experts say the lack of transparency and the political lobbying surrounding a proposal to build what would be the largest private surgical facility in Alberta’s history is troubling given what they say could be a major upheaval of the province’s publicly funded health-care system.
They say the project could represent the advent of the exponential growth of privatized health care in the province, a model they say ultimately would cost more and increase pressure on a public health-care system already under significant strain.
“It is concerning to me that we are pursuing [privatized health care] at such an aggressive pace and we really haven’t seen much of anything from the government in terms of how this will reduce wait times or will save money,” said University of Calgary health law professor Lorian Hardcastle, who has studied this issue.
“I am concerned that the easy cases, the people who are less sick, will get treatment quite quickly in this orthopedic [facility], whereas those with more complex medical needs will end up waiting longer for care in public hospitals.”
On Monday, CBC News revealed a group including a developer, orthopedic surgeons and high-powered lobbyists, says it has gained tentative political support from Health Minister Tyler Shandro for its proposal to build and operate a private orthopedic surgery facility.
During the meeting, the group expressed confidence in its politically connected lobbyists: Elan MacDonald, former deputy chief of staff to premiers Ed Stelmach and Alison Redford, and former senior Alberta Health bureaucrat Glenn Monteith.
After a conversation between orthopedic surgeon Dr. David Sheps and Shandro, the minister directed Sheps to his principal adviser, Ivan Bernardo.
MacDonald told the surgeons Bernardo was “very warm” to the project and was personally handling the file.
Monteith told the surgeons their focus as lobbyists was on ensuring the surgeons controlled the facility’s operation, something they couldn’t do within the public health-care system under AHS.
There was no discussion at the presentation of any meetings with Alberta Health Services (AHS), which is responsible for delivering health services in the province.
“Our strategy is to apply pressure from below — by being committed as a division and unified in supporting the project because we believe it will be better for delivery of orthopedic care for the patients in the zone — and applying pressure from above from the government, basically telling AHS that this is too good an idea or a venture to say no to and we need to make this work.”
It said “proposals for chartered surgical facilities will be considered through a competitive public procurement process.” They must then participate in a request for proposal to qualify.
Buick said Shandro respects the formal process by which these projects will be approved and he said the minister “awaits the outcome of that process.”
As part of efforts to woo the surgeons at the presentation, the group highlighted the increased freedom they said the facility would bring.
To the contrary, he said the contract would seek to ensure the surgeons would profit.
McKee did not respond to interview requests.
“Consolidating that orthopedic care will make access much better for all patients in the zone, will make it much more cost effective and will reduce wait times where it really matters,” Paul said.
He rejected criticism that this sort of facility will lead to two-tier health care.
“We’re just changing the venue of where we are working but not how,” he said.
Under the proposal, still in the formative stages, the Ericksen family and a corporate entity spun off from the Royal Alexandra Hospital Foundation would build the facility and lease space to the surgeons and potentially services such as medical imaging and physiotherapy.
It is not clear if the Ericksen family stands to financially benefit from the project. Grant Ericksen did not acknowledge an interview request.
In a statement, the Royal Alexandra Hospital Foundation said a separate corporate entity of the foundation has been exploring an investment in that facility, but has not made a recommendation to the foundation or a request for funding.
The Opposition NDP and advocates of public health care believe the bill is designed to allow, and encourage, the exponential increase in privately provided health care in Alberta.
Both Hardcastle and Sandra Azocar of Friends of Medicare said they are concerned this project, and those that may follow it, would take resources from the province’s public health-care system.
“The more staff that you shift to the private system, the fewer people that will remain to treat the complex cases that aren’t suitable to be treated in a private [facility],” Hardcastle said.
Azocar said there are already acute shortages of some medical staff in the public system.The proposal would require hiring surgeons, anesthesiologists, nurses and other support staff.
“They are talking about bringing in staff that are non-unionized as a way of saving money. Where are you going to get the nurses? Where are you going to get the housekeepers?” she said, adding that other countries that created parallel systems did not have reduced surgery wait times because there weren’t enough staff for both systems.
Hardcastle and Azocar both spoke about the failed Health Resources Centre (HRC) in Calgary, a privately operated orthopedic surgery centre that performed about 900 surgeries a year under contract to the government. A creditor forced it into bankruptcy in 2010.
Paul rejected the comparison between the facility his group is proposing and HRC. He said HRC only performed surgery while the Edmonton proposal would provide total care, including assessment and follow-up treatment.
“We were still discussing private delivery,” she said. “And then while that was going on, and that democratic debate and discussion was happening, on the side it seems as though this was almost a foregone conclusion that this was going to go ahead.
Charles Rusnell and Jennie Russell are reporters with CBC Investigates, the award-winning investigative unit of CBC Edmonton. Their journalism in the public interest is widely credited with forcing accountability, transparency and democratic change in Alberta. Send tips in confidence to [email protected]. @charlesrusnell @jennierussell_
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