Edm. Journal: UCP omnibus bill paves way for more alternative doctor contracts, private surgeries

This article was originally published by the Edmonton Journal on July 7, 2020. You can view the original article here.

An omnibus bill introduced in the Alberta legislature Monday would make it easier for doctors to opt in to alternative contracts with the government and streamline the process for more private facilities to perform surgeries across the province.

If passed, Bill 30, the Health Statutes Amendment Act would change nine pieces of legislation meant to “modernize” health delivery in the province. Health Minister Tyler Shandro said at a news conference prior to the bill’s introduction that it will cut surgical wait times, create new options for doctors and clinics, and set Alberta on “a path to a meet our commitment to build a sustainable, accessible public health system.”

Currently, a physician would need a ministerial order to enter into an Alternative Relationship Plan (ARP), which contracts for program services rather than normal fee-for-service billing. The proposed legislation would make it easier to set up an ARP and salary option rather than putting doctors on the hook for the overhead and rent, and let them focus on care instead of administration, Shandro said.

“What we’re doing is making the process for someone entering into an ARP less cumbersome,” said Shandro.

It would also streamline the approval process for opening chartered surgical facilities, which can sometimes take two years, a move the government said would reduce surgical wait times. There are currently 43 chartered surgical facilities in Alberta with contracts to provide publicly-funded surgeries, such as low-risk cataract surgeries.

“We need more facilities like these to join our efforts,” said Shandro, who did not outline a goal for establishing a new timeline for the approval process.

The bill would also allow the Health Ministry to directly contract with private companies operating medical clinics, rather than just physicians.

“The safety of the procedures and the quality of care that’s going to be provided in these clinics (will be) the same as it’s always been and that’s going to be up to the college,” said Shandro.

Another change in the bill aims to increase diversity by involving more public representatives in the oversight of health professionals.

It would increase the number of public members on college councils, tribunals and the complaints review committee to 50 per cent from 25 per cent in an effort to involve patients, not just members of the medical profession, in the disciplinary process.

The government would require the recruitment of 130 people by April 1, 2021, but the process for appointing members and council operations would stay the same, and Shandro did not indicate that there would be any specific diversity requirements. The number of public members would simply be increased.

“This is not just about patient safety, but also about ethics, and making sure that we have the voice of Albertans with different experience coming to the table and giving a stronger voice for patients,” said Shandro.

The legislation comes after Shandro announced a third-party investigation into an incident at a hospital in Grande Prairie dating back to 2016, in which a white South African-born surgeon put a noose on an operating room door and said it was for a Black Nigerian-born surgical assistant.

The incident was reported both immediately after it happened and several more times over the next four years to the administration at the Queen Elizabeth II Hospital, Alberta Health Services (AHS), the College of Physicians and Surgeons of Alberta (CPSA) and Shandro. It’s unclear if or how the surgeon was disciplined.

‘This is ‘profit-centred’ care

Opposition health critic David Shepherd said the NDP will be proposing an amendment to ensure board appointments would reflect public diversity.

“We’ll see if Minister Shandro is truly sincere about supporting diversity or not,” said Shepherd.

The bill would undermine the public health system Albertans rely on by moving services into the private sector, which can lead to problematic outcomes, he said.

“This is not ‘patient-centred’ or ‘person-centred’ care, this is ‘profit-centred’ care,” said Shepherd.

The bill also has the potential to divide doctors and weaken the Alberta Medical Association, which represents doctors and negotiates on their behalf, he said.

“I have spoken to doctors who would appreciate having more options but they are not interested in any further contracts with this minister and this government … they’re not interested in any contracts that the government can break unilaterally,” Shepherd said, referring to the government’s February decision to terminate its master agreement on pay with doctors.

The new legislation would have the Health Quality Council of Alberta (HQCA), a provincial agency in charge of improving patient safety and health service quality, report to the health minister and amend its mandate to include “patient-centred care.”

Shepherd said while the work of the HQCA is important, “unfortunately I don’t trust that this government is going to listen to what they have to say.”

Executive director of advocacy group Friends of Medicare Sandra Azocar said in a Monday statement that the bill represents another step in the systemic process of privatization by the UCP government. “It signals that this government is unable or unwilling to learn the necessary lessons from a pandemic that has made abundantly clear the importance of a responsive public health-care system,” she said.

Mike Parker, president of the Health Sciences Association of Alberta, said the bill is dangerous for Albertans.

“What’s going to happen when things go wrong in private facilities? Are we going to see Canadian soldiers in their camouflage running into surgical suites to mop up when the private system fails like it did in long-term care centres?” he wrote in a Monday statement.