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Laurie in Debate

Bill 48: Health Facilities Accountability Statutes Amendment Act, 2007

Bill 48: Health Facilities Accountability Statutes Amendment Act, 2007 debate in the 26th Legislature of Alberta, 3rd Session by Ms. Laurie Blakeman, MLA Edmonton-Centre

Alberta Hansard – December 04, 2007

Ms Blakeman: Thank you, Mr. Chairman. I’m pleased to be able to rise and comment on the Committee of the Whole debate opportunity for Bill 48, the Health Facilities Accountability Statutes Amendment Act, 2007, and also the series of 13 amendments that have been put on the floor by the minister.

At this time I will notify the chair that I ask that the amendments be severed, so that brings them into separate sections A through M. I have also notified the chair that I am willing to group the amendments for the purposes of voting, grouping together sections A to H, K, L, and M as one vote and voting sections I and J separately. Essentially, I have pulled out the sections on bylaws, particularly around medical staff and the minister giving himself the power to either order or to actually change medical staff bylaws, which I object to.

What we have here, essentially, Mr. Chairman, is that Bill 48 is the Hansel to Bill 41, Gretel, and together they are skipping through the forest of Vegreville and Lloydminster. They are companion bills, as the minister mentioned. I have the same overriding concern with Bill 48 that I had with Bill 41, which is that the minister did need to address a problem that manifested itself, and that was the confusion in lines of authority, responsibility, and communication between the regional health authority, regional hospitals, and nonregional hospitals which were under contract, and those contracted hospitals are often charitable or voluntary-based hospitals.

We had a situation at St. Joe’s hospital in Vegreville because of that situation, because those lines were not clear. The minister was right to try and address that. I think he’s wrong to go beyond it. Again, Bill 48 has gone beyond simply addressing and correcting the issue that arose around St. Joe’s at Vegreville.

In particular, when we look at the original act on pages 9 and 10 of the bill, specifically section 15 of the bill, which is amending section 17 in the original act, this is where my largest concern lies. 17.1 ( 1) The Minister may ( a) request the board of an approved hospital ( i) to amend the medical staff bylaws enacted under section 17, or ( ii) to adopt bylaws to replace those bylaws in accordance with the Minister’s directions, ( b) amend or adopt medical staff bylaws on behalf of a board where the board fails to comply . . . or ( c) prescribe model medical staff bylaws. ( 2) Medical staff bylaws amended, adopted or prescribed pursuant to subsection ( 1) prevail over the bylaws that existed prior to the amendment, adoption or prescription.

Now, that’s what’s in the act. That, as has already been indicated to me, is offensive, again, to those health professionals that would be affected by that. All of the same concerns that were raised around the autonomy of our health professionals – their self-regulatory powers, standards, training, and all of that – fall into play here. They see it, and I agree, as an imposition on their professional purview. The amendments then try and soften that a bit by saying that they wouldn’t amend the staff bylaws if it conflicts with principles of faith or ethics.

In section J – I’ll call it the consultation section – we have a clause that the minister wouldn’t do this until after he had consulted with everyone. Same problem: the minister shouldn’t be interfering in that sort of thing. I hear his argument that, you know, we have varying standards and varying bylaws across the province. Well, back to him I give the argument that we have varying levels of service because of the checkerboarding that has come into place from the regional health authority structure, period. Frankly, what’s good for the goose is good for the gander, and if he believes that he has the reason, the impetus to do that on the one level, then he’d better be prepared to do it on the larger level, the macrolevel. We have been saying for some time in the Liberal opposition that the regional health authority structure has to be examined. We have never gone back and looked at it, tested it, run performance measurements against it to see whether it actually achieved what it was supposed to achieve, which was better delivery of health services to all Albertans. I think it can be well argued – and I won’t do it here – that we have not achieved that. There are some real problems in differing standards of service delivery available across the regional health authorities. So that checkerboarding exists. If that’s his argument for implementing section 15, which amends section 17 of the original act, you know, get out your big pencil, then, because we’ve got a lot of work to do on the regional health authority level. Generally speaking, the amendments are addressing the issues around principles of faith and ethics, that are integral to, as they’re described here, those nonregional hospitals, what we would also call faith-based or charitable or voluntary hospitals. This actually flows from when the regional health authority structure was put into place in the early ’ 90s. At the time those hospitals were to be treated identical to everyone else. I gather from people who worked in the department at the time that there was a great lobbying to have this group excluded and treated differently. That, indeed, happened. I would say that the day that that happened, we were on the route to where we are today, with an amending piece of legislation.

I think it’s important that we try and bring some consistency and predictability, some clear lines of roles and responsibilities and communication between all of our service providers in the health care field. We have not had that under the system to date.

I recognize that those faith-based hospitals, also called charitable or voluntary, have an argument, that they deliver that health service with something more, with something underpinning it that is very important to them. They fought hard – and I’ve got the letters to prove it – to say: this is part of how we do things, and you cannot interfere with those principles of faith and ethics that we carry with us in our very operation. Granted, but you still have to conform to everything else that’s in place here.

I think the minister has probably tiptoed through the tulips pretty well with this set of amendments. I do object to what happened around the medical staff bylaw section. As I say, I’m happy to support the amending package that I outlined – A to H, K, L, and M – but I will not be supporting I and J.

Thank you for the opportunity to speak to those amendments to Bill 48 in Committee of the Whole. I know I have other colleagues that wish to speak to it.