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Public Bodies, Private Parts
Surgical Contracts and Conflicts of Interest at the Calgary Regional Health Authority
By: Gillian Steward for the Parkland Institute
CALGARY: In September 2000 The Health Care Protection Act (formerly Bill 11) was proclaimed and established as law in Alberta. Since the Act permits private, for-profit surgical facilities to keep patients for more than a 12-hour stay, it is only a matter of time before for-profit hospitals are approved and operating in Alberta. The first ones are likely to appear in Calgary.
If current practices at the Calgary Regional Health Authority (CRHA) are any indication, these private hospitals will become part of a confusing web of partly public, mostly private, for-profit health care services that will further erode Medicare as most Canadians know it. Doctors will be allowed to work in both the public hospitals and the for-profit hospitals thereby draining the public hospitals of staff and resources. In addition, senior medical officers of the CRHA will be allowed to hold financial interests in these private hospitals just as they now do in private surgical clinics that contract with the CRHA.
The CRHA currently contracts out more surgical services to private, for-profit clinics than any other regional health authority in Alberta. But these contractual arrangements raise many serious questions about conflicts of interest and appear to favour private interests rather than the public interest.
Major Findings re the CRHA and Conflict of Interest
Three of the private, for-profit surgical facilities that have current contracts with the CRHA are owned or partly-owned by senior medical officers of the CRHA.
The largest contract for the provision of surgical services was awarded to a private, for-profit clinic owned by a CRHA medical officer and his business partners.
Two of the five private, for-profit surgical clinics that provide virtually all the eye surgery in Calgary are owned or partly owned by CRHA medical officers.
The private, for-profit eye surgery clinics in Calgary appear to cooperate with one another in regards to the facility fees they charge to the CRHA rather than compete with one another.
Two of the private, for-profit surgical facilities that have contracts with the CRHA are located in former public hospitals once owned or operated by the CRHA.
An internal CRHA review regarding conflicts of interest and the purchaser of the former Holy Cross Hospital raises serious questions about the sale of the hospital that could only be resolved by an independent inquiry.
The new owners of the Grace Hospital site are planning a development that would include "all levels of medical services." A CRHA medical officer stands to benefit financially from the proposed complex.
Recommendations
The report recommends that:
The Alberta government prohibit physicians and surgeons from working in the public health system and with private health care providers simultaneously.
The Alberta government adopt strict conflict of interest guidelines that apply equally to all regional health authorities.
Conflict of interest guidelines for RHAs that prohibit RHA senior officers from having financial interests in private clinics/hospitals that contract with RHAs.
Conflict of interest guidelines for RHAs that prohibit rather than manage apparent, potential and real conflicts of interest.
A Code of Conduct and Ethics for RHAs that clearly delineates their responsibilities to the public.
An independent public inquiry into the circumstances surrounding the sale of the Cross Hospital by the CRHA to Enterprise Universal Inc.
Election of RHA Board members so the RHAs are more accountable to the public.
Conclusion
Given that it is only a matter of time before the first private, for-profit hospitals are approved and operating in Alberta it is not unreasonable to suggest that the contractual model established by the CRHA, and condoned by the Alberta government, will continue, but on a wider scale. Since both the Alberta government and the CRHA have chosen to overlook serious conflicts of interest arising from the contractual arrangements some medical officers of the CRHA and their business partners stand to be among the first, and few, to benefit.
Gillian Steward lives in Calgary has worked since November researching the report Public Bodies, Private Parts for the Parkland Institute (www.ualberta.ca/Parkland), a public policy based at the University of Alberta.
Posted: March 05, 2001
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