The campaign for vindication by Stephen Duckett, fired head of Alberta's province-wide health super board, dramatically entered a new phase New Year's Eve with the media revelation he gave a private farewell speech to 100 of his top health bureaucrats in Edmonton.
The secret speech, we are informed by the Edmonton Journal, took place December 6, just 12 days after Duckett was fired by the Alberta Health Services Board on orders of Health Minister Gene Zwozdesky. Copies conveniently found their way to the media in time to start 2011 with a bang for the increasingly shaky government of Premier Ed Stelmach.
The Australian PhD economist was supposedly fired for his notorious November 19 Cookie Walk, which was undiplomatic to be sure, but he more likely lost his $700,000-per-year job because his consistently impolitic style and the government's own policies made him a lightning rod for voter unhappiness about the state of health care.
The first shot in Duckett's rehabilitation campaign was fired by his wife, University of Alberta health policy professor Terri Jackson, who asserted December 1 in a letter to the Journal that her husband was a friend of public health care and a victim of vilification by an "ill-informed scalp-hunting" media.
Duckett's carefully footnoted speech, which is now available for anyone to read, fleshes out his defence in more detail. His arguments may be summarized in four key areas:
- He supported public health care
- He didn't know about the fiscal mess he would face in Alberta
- He had many successes
- He was a victim of the media
But while he presents some valid arguments and reveals un-businesslike practices by the former regional health authorities, he leaves plenty of room for dispute.
Example: "Given the government’s previous history on Medicare … I told them that I would not do anything that would undermine the Canada Health Act. They both accepted that position and honoured it. I see myself as a 'friend of Medicare' with a small f. The capital F folk go much further and want to end private delivery, putting almost all physician practices out of business."
Fair enough to a point. But Duckett did advocate policies that would have seen the privatization of health services that belong in public institutions -- for example, moving mental health care out of an effective hospital and "into the community." As he said, "I support having private delivery within a publicly funded health system." Suggesting Friends of Medicare wants to take physicians out of private practice misrepresents the goals of that organization.
Example: "I've said subsequently to (AHS Chair) Ken Hughes that I should sue them for misrepresentation in not informing me about the financial situation as part of my recruitment. In return, he pointed out that for misrepresentation to have occurred they would have had to know how bad the problem was when they appointed me. And they didn’t of course as the oil and gas price collapse was just occurring."
Please! The conditions that led to the economic downturn Duckett complains about were obvious by late 2007 to anyone paying attention. Health region deficits were well known by the summer of 2008. Even if he missed the Alberta government's near-religious adherence to balanced budgets and its apparent inability to understand that economic cycles are cyclical, Duckett had no excuse for this misunderstanding before he agreed to take the job in March 2009.
Example: "Investment decisions have over-emphasized acute provision at the expense of seniors care. … Alberta reduced non-acute facilities over the past decade. Is it any wonder that our acute facilities had to become de facto seniors housing, contributing to the systematic problems that have created the problems in emergency care?"
True, but can Duckett really claim not to have been aware of this before he moved to Alberta?
Example: "I'd also like to list our attempted reform of mental health services in Edmonton as an achievement. … Some of the most vulnerable in our society will be moving into modern facilities, next door to a major acute hospital rather than in an isolated institution on the outskirts of the city."
Sorry, but this "reform" was a blunder from Day 1. Poorly conceived, poorly planned and poorly executed, it would have resulted in many mentally ill people ending up on the streets. The new facility Duckett lauds was designed and funded to provide long-term seniors' care he concedes is desperately needed. The cost of converting it is outrageous. His characterization of Alberta Hospital Edmonton as "isolated" is nonsense.
That said, Duckett deserves credit for the some of the successes he describes. If health regions were really contracting services without contracts, we should thank him for fixing that. If his Emergency Room and seniors' care reforms improve ER waiting times, as he predicts, he should get credit for that too.
Duckett is right, too, to argue the previous nine health regions weren't perfect. That, however, doesn't mean AHS is an improvement. His claim contracting out and centralizing security will save money and improve service can be disputed on both counts.
Example: "My relationship with the media was fraught from the start. Partly because of Canadian-Australian cultural differences (people weren't ready for direct speaking)…"
Duckett was often undiplomatic, sometimes plain rude. He sneeringly dismissed arguments against his plans as "whinging." This was no mere "cultural difference." The Cookie Incident is a perfect example. It cannot be blamed on too-aggressive media questioning. If anything, the media was deferential.
Example: "The media created a Stephen Duckett I didn't recognize, portraying me as a one-dimensional budget-cutter, a portrayal that still continues."
Duckett's criticisms of media shortsightedness hold water. But he largely created his bean-counter image himself. Albertans never heard about the "small-f" friend of Medicare until he was fired. He would have done more for his own reputation, and more for Alberta, if he'd spoken up while he was still in a position to do something.
Regardless, if Jackson's letter was the shot heard 'round Alberta, Duckett's speech was the opening artillery barrage. As predicted, Duckett is going to be a thorn in the side of this government for a while yet.
This post also appears on David Climenhaga's blog, Alberta Diary.
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