Friday, October 13, 2006

Health gag orders hurt the public interest

VICTORIA - It’s happening again. Another health authority is trying to gag doctors and nurses and front-line workers.
If a reporter - or MLA or mayor - calls a hospital in the Vancouver Island Health Authority and asks how wait times are in the emergency room today, the ER doctor is supposed to refuse to answer. Hang up, and call the communications department, says the edict from CEO Howard Waldner. They’ll tell you how to answer.
Or if a physician or cleaner becomes gravely concerned about conditions in a long-term care home - and gets no response internally - she’s supposed to stay quiet. The organization comes before the patients.
VIHA says the memo was just a reminder of existing policy and many organizations have similar rules.
And that’s true. In a past life I ran newspapers and sometimes, when controversy came along, said no one else could do media interviews.
But there were a few critical differences in circumstances. The newspapers weren’t monopoly providers; if people weren’t happy with us they could go elsewhere. That’s not true for the health-care system.
I was accountable to elected directors, put in place by the people who were paying for the whole operation. That’s not true for the health-care system.
And despite our airs, what newspapers do isn’t a matter of life and death, not remotely. That’s not true of the health-care system.
It gets stranger. Some reports suggest the memo was aimed at VIHA’s chief medical health officer, Dr. Richard Stanwick. His job is supposed to be talking about risks to health, based on his professional judgment. He hardly needs to clear his health warnings with communications types or authority executives.
But more likely it’s belated fallout from a devastating letter to the Victoria Times Colonist this summer by Dr. Anthony Barale, then VIHA's director of psychiatric emergency services. Barale went public with his concerns about the authority's substandard services for the addicted and mentally ill. The authority had failed in its responsibility, he said. Resources were pitiful and VIHA’s response was inadequate, "even by so-called ‘Third World standards.’"
Barale’s comments, backed up by colleagues, sparked a needed critical examination of VIHA’s efforts. The health authority never denied the issues were real A gag order, if followed, could have kept the serious problems from public view.
It’s not the first effort to silence health workers. Last year a veteran emergency room doctor at St. Paul’s Hospital in Vancouver told a CBC reporter that ER conditions were the worst she had seen in 14 years. The adminstration’s response wasn’t to address the problems; it sent a memo to staff warning that talking to reporters could be grounds for discipline. (The comments might have displeased the health minister, a senior administrator complained, who would as a result turn down funding requests from the region.)
Nurses and other employees in the Interior Health Authority have reported the same fear of reprisals for speaking publicly about problems in the system.
And Fraser Health employees say they have been told that all newsletters, internal and external, must now be approved by the health minister’s office before they are released - if not a gag, at least a micromanaging muzzle.
It’s natural enough for managers to want to hush up problems. And it’s true that complaints sometimes come from disgruntled or misinformed employees.
But health authorities and other organizations have the ability to deal with those issues. Employees who knowingly level false charges, for example, can be subject to discipline.
More importantly, the health authorities why employees don’t trust that there is the will or ability to deal with their concerns.
But a gag order - no matter how its characterized - is not the answer.
We are the owners and customers of the health-care system. We want and need to hear directly from people on the frontlines when there are problems that the health authorities aren’t fixing.
Footnote: The problem could best be addressed by provincial whistleblower legislation providing protection for health employees raising concerns about issues that affect patient care and safety. At the same time, the legislation could make it clear that people who make unfounded or malicious complaints would not be protected. The government has rejected past requests for such laws.


Anonymous said...

We need and deserve better from our Health Authorities. They have lost touch with the job and the little people . They should be smaller and boards elected.

Gazetteer said...

I agree that whistleblower legislation would be helpful in this regard.

However, I think the issue would be greatly defused if more folks in the working press were more vigilant in pushing back against the hackery that originates from 'communications departments'*.

More specifically, I would suggest you all take Mencken's advice one step further and, rather than just looking down, instead make a conscious decision to not even look at these people at all (or give them the time of day) given that it is their mission to obfuscate when necessary.

*I realize this could be difficult given that they seem to be populated by former friends and colleagues, but still.....


Anonymous said...

It would appear to me , that this edict sort of wasn't what The Premier had in mind while spending 5 million dollars on advetising alone for his project. It wont stop information from getting out and is an affront that taxpaying citizens should not have access to their MLA's. I would hazard a guess that the Official health critic. Adrian Dix, who of course has a email address will see a rise in his email in basket. And for the folks who want to make comments, and don't have a computer, well the local library and a lot of coffee shops provide that service for free. No overpaid character should be in any position to attempt to circumvent the dialog on health care. Better he spend his time and the 200 or so others working with him making over 100,000 a year,trying to make the system work.

Anonymous said...

A conversation on Health Care... Muzzled!

"Nurses and other employees in the Interior Health Authority have reported the same fear of reprisals for speaking publicly about problems in the system."

"The Interior Health Authority has stopped sending new patients to a Kelowna seniors home (Windsor Manor) over concerns about staffing problems. Families have been complaining about conditions in the facility since unionized care aides were terminated and replaced with non-union staff. The company that operates the facility says it's making changes that will improve care, but as Kent Molgat reports, many people who depend on the home are skeptical."

CHBC's video report "Seniors Home complaints" here:

It seems AdvoCare Health Services Ltd. - operators of the Kelowna seniors facility Windsor Manor - fired the 70 regular and part-time care aides at the facility on September 20, 2006 because they refused to accept major cuts to their wages and benefits.

So what happened after September 20?

Not enough staff... When the Interior Health Authority started to investigate AdvoCare's ongoing 'O0opsies' - AdvoCare fired the line staff who talked with the IHA.

AdvoCare will now probably shortchange their other facilities to bolster the headcount at Windsor Manor.

Dawn Steele said...

If we only focus on the Health Authorities, their leaders and/or sub-contracted agencies for such failings, we'll miss the point, IMHO. The impression I get from what Paul and others have written is that the whole approach of substituting carefully-framed "hackery", smoke & mirrors & propaganda for a truly frank discussion was set at the very top and at the very beginning of this "conversation", by the Premier, his Health Minister and his Finance Minister. I doubt Health Authority chiefs would be issuing such edicts if they didn't think it would make their bosses happy.

If we're not careful, concentrating on the evils of "the system" and "the bureaucrats" without awareness of this context will only play right into the agenda of those who understand that to discredit it makes it all that much easier to dismantle it.

I speak from the experience of the 2001 Core Review at MCFD, wich was personally headed by Premier Campbell. Hundreds of submissions covered all the little things that were wrong in the system & needed fixing. One submission by Doug Walls & co called for just dismantling the whole hog via devolution, regionalization and redesigning service to "put families in control of their own lives". (Yeah, you can guess what that was code for--cuts & DIY). And guess which submission won the day in Cabinet (before the Core Review was even closed), with all our little complaints used to justify throwing the baby out with the bathwater.

Several consulation roadshows followed, as restructuring got underway. In every case, feedback was cherrypicked to justify whatever decisions had already been made. Eventually, people stopped showing up--you were damned if you did & damned if you didn't.

Here's the conundrum: We must confront challenges in public healthcare if we want to solve them and move forward with a healthier system. But if "their" real intent is to kill or amputate rather than to cure, our system will be vulnerable as long as its lying on the table, belly-up for examination.

So in discussing problems and challenges, I see a need to be constantly tying them to root causes (and constant vigilance from the media), lest we provide convenient opportunities for more such misunderstandings.

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Anonymous said...

How bizarre that Barale should criticize VIHA after being part of Apartheid's 'Aversion Project'.