Sunday, July 29, 2007

Legacy Of The Ralph Revolution

All those gold stars and awards the Fraser Institute gave Ralph Klein for his neo-con revolution in the nineties are revealed to be bronze.

Ten years after his cuts to health care and public sector workers the chickens have come home to roost.

A scandal has erupted in Alberta CEO' Ed Stelmachs backyard. The Hospital Authority and the local hospital in his hometown of Vegreville have not had adequate sterilization procedures in place since 2003. For four years it had been ignored until this spring when scandal broke.

The government has fired its appointed health board, claiming that the Premier and his Ministers did not know of the crisis in his backyard.

Premier Ed Stelmach and Health Minister Dave Hancock both suggested yesterday the government couldn't have done more to prevent a four-year outbreak of infectious disease at St. Joseph's Hospital in Vegreville because they weren't aware it was going on.
He is of course fibbing.

But area resident Connie Marcinkoski doesn't buy the province's promise to swoop in and save the day.

Marcinkoski is currently suing the hospital for allegedly exposing her father to a fatal infection a few years ago.

"The province, in fact Premier Ed Stelmach himself as our MLA, knew about the ongoing issues here years ago. I called him personally when he was our MLA to alert him to this issue and he never called me back," she said.

"The Conservative government has known about this problem for years and now wants to come in and look like they are everybody's saviour.

The government has brought in an old buddy who promotes the privatization of health care to oversee the board and hospital.

Effective immediately, Jim Saunders, of J.L. Saunders and Associates Inc., and Paddy Meade, deputy health minister, will serve as official administrators for East Central Health, replacing the board.

It has talked about hiring risk managers to assess how to avoid this kind of thing in the future.

The region is also looking to hire more staff in risk management.

What it failed to do was hire more cleaning staff, those folks who were either laid off or contracted out during the Ralph Revolution.

A scathing report issued this week found that the hospital and health board practices were a result of the 'culture of fugality', that is as Ralphs appointed buddies they knew that they had to keep costs down, which meant contracting out laundry services and cutting back house keeping services while paying big bucks to a top heavy administration. Now they want to bring in more management to resolve the crisis when what they need is more hospital cleaners.

In a “culture of frugality” the facility did not even have the proper equipment to sterilize laboratory gear, and ignored requests from the authority because of a turf war caused by fuzzy provincial legislation.

It also says the testing procedure for those potentially infected has been slowed by a lack of provincial support.

The sterilization area of the hospital was actually a converted portion of the laundry room. It wasn’t isolated from other areas. Basic procedures for sterilizing equipment were ignored as well, including using properly sterilized water instead of attempting to sterilize hospital tap water. The authority, meanwhile, did not follow up to ensure its requests were followed.

The Stelmach governments response has been more of the same. Which will not solve the problem.

In an era when hand-sanitizing stations can be found metres apart in places like the Capital Ex fair grounds, it is appalling to learn that the healthcare facilities that people in east-central Alberta count on have ignored or neglected even the most basic hygiene measures because of turf wars, confusion or because administrators were just too cheap.

Despite an outbreak of wildly contagious Methicillin-resistant Staphylococcus aureus (MRSA) at St. Joseph's that lasted years, neither hospital officials nor the provincially appointed health board took the crucial steps to bring the situation under control.

The public only learned about the problems in St. Joseph's and East Central Health when the region's Medical Officer of Health ordered the hospital closed to new admissions in March due to concern about the facility's central sterilization room and bits of flesh on hospital tools.

One of the key problems the Health Quality Council identified in its investigation is the fact that the province's varying pieces of health legislation have set up a system of rival bosses. That same conflict potentially exists throughout the province.

Despite the chilling report on East Central Health, Hancock rejected the notion this his government bears any responsibility for the problem. "This is not an issue that can be thrown back on the budget process," he said.

Hancock is ignoring the fact that when the Tory government he now represents first introduced its draconian cuts to health-care funding and decentralized the province's medical system to a series of regional boards, there were public demonstrations against the moves. Anyone with concerns was ignored by the then premier and his cabinet or portrayed as a Liberal crank.

The people overseeing the health authorities also were in a bind. If they didn't play ball, they were either turfed from their jobs or the region was simply disbanded. When budgets are everything, how can anyone be confident that a rigid budget allows administrators to spend extra for the best cleaning fluid or to buy the appropriate sterilization equipment when faced with a huge list of competing needs?

Vegreville's problems likely widespread: doctor

'These things happen everywhere'

Frank noted cardboard boxes were found in sterilization rooms in Tofield, Lamont, Two Hills and other health centres, creating concern for the buildup of fungus. Staff at St. Mary's hospital in Camrose wore jewelry while sterilizing. Frank said the cardboard could have been taken out and the jewelry removed in one day to prevent closure of the units.

But other problems were clearly more major, Frank said. Tables in the Lamont hospital's operating room weren't wiped down between patients, the report found. The sterilization room at Viking's hospital had holes in the wall and ceiling that hadn't been fixed in several years. In Provost, nail care supplies from community health clinics weren't being sterilized, only cleaned.

No sterilization records were being kept in Killam, and a January audit revealed that single-use cautery devices were being re-used after wiping the tip, even though they were meant to be disposed of after one use.

Frank, who doesn't work at these other centres, acknowledged such safety gaps may suggest a lack of a safety culture, which the report pointed out.

But he said, "I don't think there has ever been a don't-care attitude (among health care workers)."

He said such problems are likely happening across Alberta, especially since many centres are struggling with short staffing like St. Joseph's.

Self-evaluation of sterilization practices -- done by all Alberta health regions earlier this year after the health minister ordered them to -- isn't enough, he said. Government inspections and document reviews will also be needed.

Sterilization and cleanliness problems aren't limited to hospitals in Vegreville and the East Central Health Region, says the president of the union representing surgical processors.

Doug Knight, Alberta Union of Provincial Employees president, said a "culture of cutbacks" in the provincial government and health regions dating back to the mid-1990s has led to unfilled vacancies in surgical processing and cleaning departments across Alberta.

He has heard cases of Calgary licensed practical nurses getting their scrubs back from the washers with mop strings in the pockets.

"That means they're washing their scrubs with the mops," he told Sun Media.

Knight disapproves of hospitals sending their linens out to private cleaners where the hospital has little control of the cleaning process. He suggests immediately returning privatized cleaning and laundry services to the control of health regions.

Ed Stelmach--in good times and bad - has certainly been the recipient of Ralph Klein's legacy.

In the case of the staphylococcus infection at St. Joseph's General Hospital in Vegreville, the premier clearly got the dirty end of the stick.

Health Quality Council CEO Dr. John Cowell's damning report into the incident revealed that anomalies began showing up in East Central Health authority stats as early as 2003.

By the time Cowell's team finished their investigation, they found serious breaches of sterilization standards throughout the region.

The problem was so extensive that Alberta Health Minister Dave Hancock placed the region under direct government administration and fired the board.

But somewhere along the way, a fundamental aspect of the system - proper sanitation - has been allowed to slide.

This was clearly the case in the East Central Health region.

It also puts a spotlight on the role and responsibilities of health boards, which were partially elected at one time.

They have now deteriorated into Buddy Boards that are liberally stocked with friends of the PC Party as a reward for loyal service and dedication to the cause.

As part of his mandate from Stelmach, Hancock is now charged with reviewing the governance of health boards.

But even before it began, he ruled out a return to elected health boards.

Opposition parties say Premier Ed Stelmach must should some of the blame for the hospital sterilization scandal that has rocked Alberta's health care system and forced three-thousand former patients to be tested for HIV and hepatitis.

Liberal health critic Laurie Blakeman says it's ironic that the same Tory politicians who helped created this sterilization crisis now want people to believe they're in the best position to fix the problems.

NDP Leader Brian Mason said Stelmach must shoulder some of the blame for the "mess" that is now affecting thousands of Albertans.

"This is a legacy of neglect that has affected the health of Albertans and Premier Stelmach bears significant responsibility," said Mason.

The auditor general pointed out three years ago that the committee that checks Alberta hospitals is unqualified, yet the premier has done nothing to change this, said Mason.

The premier also confirmed Thursday that the government is reviewing a master agreement for Alberta's so-called faith-based hospitals.

The controversial deal more than a decade ago kept boards in place at hospitals with religious ties at a time when other hospital boards were being dismantled as the province created health regions with new boards that would run all health facilities in the region.

The facility is run by volunteers and is known as a faith-based hospital. It works under a separate master agreement with the province. The East Central Health Region, however, also has responsibility under different legislation to run the hospital.

That was the wellspring of the problem, said Dr. John Cowell of the Health Quality Council.

He told a news conference in Calgary there there was acrimony and bureacuratic turf wars between the hospital board and the health region board. The health region didn't feel like it could step in unless asked and the hospital treated orders from the region as requests that could be acted on or ignored.

"There was a problem of two bosses and no bosses," said Cowell.

"At certain levels of both organizations there seemed to be much more focus on turf and not a focus on patient safety."

That problem flowed to people on the front line, he said. Nobody knew whom to report to, problems weren't getting solved, doctors declined to step in, morale dropped and health and safety practices spiralled out of control.

Then Cowell took aim at the board which he said had a "dysfunctional" relationship with the hospital, and did not show a "clear understanding of the seriousness of the MSRA situation and did not take action to improve the situation."

For that and much more, they are gone. But how they got there in the first place, Cowell chose to pin the tail on the political donkey.

"In terms of how these individuals are discovered and chosen and appointed," Cowell winked, "I think that's a question you should place right to the minister."

So I did.

Hancock quickly confessed that since these folks get their jobs from the government "these are political appointees."

They weren't always appointed, of course. For a brief moment in Tory time, a portion of health boards were elected.

That means you can de-elect them if they step out of line, unlike Hancock's Buddy Boards.

Part of Hancock's damage control is to develop a "culture of excellence." Including something he calls a "governance review and accountability framework."

You mean like elected health boards?

That's where Hancock started getting nervous and making Freudian slips like calling health care "haircut."

"No," the health minister blurted. "I don't foresee that."

"I'm elected and my colleagues in the legislature are elected to help set health policy for the province."

If they got their jobs in a vote, those regional health boarders would almost certainly go wild. Just like elected school board trustees do. Except they don't.

"I don't believe there has been pork barrelling of the health authorities," Hancock insisted, even though as the Minister Responsible for Edmonton, Hancock is the Grand Poopah of Pork for the Capital Region.

"In making appointments, we've always had to make sure we appoint good people," he said.

And now he's had to fire "good" people too.

Hancock calls the sideshow "irreparable and untenable" and boots the provincially appointed board. He is also expected to can a couple suits with the health region.He says he will put in provincial standards for infection prevention and control and he says he will make sure health regions know they are the boss. He also doesn't feel the health region board is clueless because they are Tory appointees.

"I don't believe there has been pork barrelling," insists the health minister. Couldn't that be cleared up if the health boards were elected as they were supposed to be?


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