In The Wake Of AHS Board Firings ...

Yesterday, Minister of Health Fred Horne fired the entire board in charge of running Alberta Health Services.

This is perhaps the second time since Redford came to power that she's done something I agree with.  (The first was reinstating funding for Gender Reassignment Surgery which was axed in 2009 in a fit of pique on the part of the Stelmach government).

Let me be clear about one thing.  Alberta Health Services is a mess.  As experiments in consolidation go, it is a disaster of unprecedented proportions.  There are serious issues when we are talking about handing out bonuses (retention, performance or otherwise) to executives at a time when front line services are being axed left and right is ridiculous.  I don't give a damn how "vital" it is to retain these executives.  If you are cutting front line services and the fat cats at the top are still getting bonuses, then something is seriously wrong with the priorities.

The issues in AHS are systemic - they start at the top and go all the way through the system.  AHS was created in large part as a way for the Stelmach government to continue the process of dismantling public health care in Alberta - a hobby horse issue that the Klein conservatives only took feinting strikes at, largely because Klein himself took a lot of the heat from Albertans.  Under Stelmach, the moves were more definite, and the results are predictable:  those at the top line their pockets and the staff on the front lines and patient care suffer.

I have personal experiences where a relative became ill with cancer recently which underscore the fundamental problems that exist when it comes to getting treatment initiated for a critical illness.  The cancer was first detected six months before treatment.  For six months, we went from doctor to doctor, specialist to specialist trying to get a clear diagnosis and more importantly, treatment.

I won't go into the number of dropped balls that I saw happen during that time.  Suffice it to say that it was appalling.  Treatment didn't start until the cancer had become a threat to the patient's life.

The problems we witnessed?  You name it.  I'm going to focus on the systemic and communications problems because those are the ones that AHS was supposed to address when it was created.

The first point is that emergency rooms and the doctors in them don't communicate with each other.  If you go to an emergency with a changing set of symptoms, and that hospital doesn't have the facilities to treat it directly, they send you home.  They don't refer to you another hospital which has the facilities unless they think your life is in danger.

This is complete nonsense.  When you are talking about diseases like cancer, early treatment is absolutely critical.  Cancer is life-threatening.  Period.  For the patient, sending them home is doing them a disservice.

Even more frustrating is the fact that there is no avenue to raise concerns over rapidly changing conditions.  When things are changing as rapidly (near daily) as they were, the system needs some kind of mechanism where a patient can demand a reassessment of their situation.  Instead, all that you get is a run-around that basically tells you to "talk to the hand".

We lack sufficient specialists to adequately diagnose and treat people.  In Calgary, there are 4 ENT specialists - for a city of over 1,000,000.  The wait times to get into see these specialists are months long, and yet that is an essential part of the diagnostic process.  With a fast moving cancer, it can go from localized and tiny to enormous and pervasive in that time.

To the credit of the treatment professionals, once you are connected to the treatment system, they do awesome work in absolutely terrifying conditions in terms of workload.

The issues I am raising speak to the fact that the parameters that exist for the front lines do not enable taking the correct steps to get issues dealt with.  If you don't have the connections already, you're stuck on the outside and it is just about impossible to get in.

Horne and Redford have an opportunity to start correcting the systemic problems that exist within AHS.  Let's hope that they take it.

Well, Isn't This Special?

Those who have had dealings with Alberta Health on issues related to mental health have known for years how parochial our government can be. In yesterday's Vancouver Sun, we learn that the government is using a diagnostic coding scheme from 1975 ... and it was out of date then!

Alberta’s current diagnostic codes were last updated in 2005, the same year that British Columbia removed homosexuality from its list of mental disorders and four years after China did so.

In Alberta, homosexuality still falls under the heading of Mental Disorders: Sexual Deviations and Disorders. It is at the top of the list and is followed by bestiality, pedophilia, transvestism, exhibitionism, transsexualism, disorders of psychosexual identity, frigidity and impotence.

Neither Zwozdesky nor Alberta Health and Wellness spokesman Howard May could explain why Alberta’s diagnostic codes have not been revised.

“These are not Alberta’s codes, they were developed by the World Health Organization, under international guidelines, and are in use in many provinces,” May said.

Asked why Alberta’s current codes are based on the 1975 ICD-9 and not on the 1990 ICD-10 that drops homosexuality from the list of mental disorders, May said in an email: “The codes are extremely complex. It would be a vast undertaking to change them.”

"A vast undertaking"??? WTF? Horsefeathers. Even if it is a large amount of work, it is a gross injustice to Albertans that our health care system has chosen to remain in the dark.

It also explains why Alberta's approach to funding GRS prior to 2009 looked like one of the Gender Clinic programs out of the 1970s in terms of the hoops that it insisted transsexuals jump through - and was dramatically out of step with the Standards of Care that HBIGDA/WPATH publish. (like them or not, they do represent an evolving protocol).

iberal MLA Laurie Blakeman first raised the issue in the legislature in 1999.

“It’s just so wrong, it’s sickening,” she said. “Here we are in 2010 and the Conservatives are still living in 1950 ... I still hear some of them talk about how this is a ‘lifestyle decision.’ ”

[Note:] CBC Radio is reporting that Alberta is changing its position on the listing of homosexuality this morning - I'll be watching to see if I can find a confirming article for this. [Update 17:30] Here it is

H/T: Commenter "SB"

Who Will Replace Duckett

I won't miss Duckett as head of Alberta Health - the man guided AH down a path where it has gradually crumbled while he has built up the edifice of the "superboard" under Liepert's direction.

There's not much to miss about a man who has overseen the degeneration of Alberta Health into needing critical care.

Unfortunately, I don't think Stelmach and company are going to do anything much about it. Duckett was the obvious fall-guy in recent weeks, and the 'cookie incident' is little more than the pretext to terminate him.

With Dr. Sherman evicted from the PC caucus for blowing the whistle on the incompetent management in AH, and by inference in the Minister's office and the Premier's offices as well, Duckett ousted, I'm sure that "Steady Eddie" thinks he's got things settled down and can go back to dismantling Alberta Health in peace.

Albertans should take note that the instigators of the fiasco we face today haven't paid a price for what they've done. Liepert is still in cabinet, and in spite of cuts made a couple of years ago to supposedly focus resources in key areas, Alberta Health is still in a pretty nasty crisis state, with emergency room waiting times getting longer and longer; and it gets harder and harder to find a family doctor in Alberta.

As much as Duckett's departure won't be met with many tears, I don't expect to see any real improvements in the near future - not until we have a party in power that understands the value of investing in public health.