Bill 11 under the microscope

Critics examine the controversial health care legislation for conflicts of interest, potential US connections

By: Penney Kome

  Staid, conservative Alberta is the unlikely scene of vocal popular antagonism toward the provincial government. Thousands of people in Calgary and Edmonton have thronged to protest rallies and raucous demonstrations, night after night, to defend free universal health care, but more than that - to demand reassurance that there's no corruption afoot, despite appearances.
  Critics of Bill 11, the so-called "Protection of Health Care Act", have put apparent conflicts-of-interest within the existing healthcare system under the microscope, looking for pathology that would be magnified by the proposed changes. They have raised serious questions in many Albertans' minds about the ethics of Bill 11.
  The names on the flow chart at the Calgary Regional Health Authority (CRHA), especially, give rise to a widespread perception that a small powerful group of wealthy people has put themselves and their friends in charge of changes that could benefit them substantially. In the event that private "surgical facilities" are approved, the line-up of doctors and investors who stand to make huge profits starts right in the CRHA's boardroom.
 

Some Calgary doctors are circulating a recent article in The Lancet that warns [about changes in the UK], "These changes give the private sector access to public funds, but are presented as offering the public sector access to private funds."

  CRHA Chief Medical Officer Dr Kabir Jivraj is an investor in Surgical Centres Inc, which has surgical contracts with CRHA. Dr Peter T Huang (pronounced Wong) is CRHA Chief of Opthalmology, and a partner in Enterprise Universal, Inc, which has surgical contracts with CRHA. Dr Chen Fong is CRHA Chief of Radiology and an investor in Western Canada MRI Centres.
  Then there's Health Resource Group (HRG), a private facility that does day surgery now and has been lobbying hard for permission to do surgeries that require overnight stays. Dr Steve Miller, CEO of HRG, is also Chief of Orthopaedic Surgery for Foothills Hospital as well as Chief Medical Officer for Columbia Health Care (community rehabilitation), which has a number of centres across Canada.
  Columbia was owned until recently by Sun Healthcare of Albuquerque, NM, but bought back for $4 million when Sun filed for Chapter 11 bankruptcy. As a rehab facility, already offering physiotherapy, Columbia could become a hot property if it managed to get approved for overnight surgeries as well.
  Some Calgary doctors are circulating a recent article in The Lancet that warns [about changes in the UK], "These changes give the private sector access to public funds, but are presented as offering the public sector access to private funds." The public money involved in Alberta runs to the tens and hundreds of millions.
 

All private healthcare facilities in Calgary are gaining market value in anticipation that Bill 11 will open the door to more and more private services

  Alberta Health and Wellness budget items indicate that the CRHA has earmarked more than $24 million for private laboratory diagnostic services in 1999-2000. Calgary Laboratory Services, in particular, reportedly has a long-term contract with the CRHA for $88 million.
  Community rehabilitation services, (physiotherapy, occupational therapy, speech therapy, respiratory services), also provided privately, have a 1999-2000 Alberta budget of $41 million annually. Radiology, including "diagnostic imaging" services, has a budget of $251 million.
  Then there's owner's equity: All private healthcare facilities in Calgary are gaining market value in anticipation that Bill 11 will open the door to more and more private services.
  "Is the evidence of conflicting interests at the CRHA sufficient to warrant a public inquiry into its operations?" asked an unscientific survey on the Calgarians for Ethical Health Authorities website. And a whopping 96% of visitors voted, "yes".
  The Alberta government has recognized how widespread this concern is, and has introduced eight amendments to Bill 11, including "Strengthening conflict-of-interest provisions - health authorities will have to monitor physician practice to ensure that the College of Physicians and Surgeons' conflict of interest and ethics bylaws are not violated during the contracting process. Health authorities will be required to have conflict of interest rules for their own staff."
  However, the Alberta Medical Association has rejected this amendment as inadequate: "There are now province-wide standards for conflict-of-interest rules for physicians in the form of the CPSA guidelines," said a letter from AMA president David W Bond, MD. "Under Bill 11, however, RHAs are being asked to develop their own standards for submission to the minister, i.e., 17 different codes."
  Bioethics Professor Laura Shanner believes that conflict-of-interest starts when physicians are allowed to own shares in any diagnostic or treatment facilities. "Trust is essential in caregiving relationships," she wrote in an analysis of the Ethics of Bill 11. "Even the appearance of a conflict of interest, not to mention an actual conflict, must therefore be avoided.
  "Providers who profit by selling unneeded or more expensive options to patients are caught in an untenable conflict of interest: their professional codes require them to consider the interest of the patients paramount, but the lure of profit may draw attention from the patients' needs. Practitioners who own diagnostic facilities face a similar conflict of interest when they refer patients for more tests that might not be needed."
  Shanner also noted that nothing in Bill 11 prevents the sale of an approved surgical facility to non-Canadian owners. "A US firm could buy an existing Alberta business, thus gaining entry into Canada under NAFTA even if US proposals were not accepted for initial contracts by the Minister. Already, a Calgary physiotherapy clinic [Columbia] has been owned briefly by the Sun healthcare corporation in the US." This is one of a number of ways that, depending how a trade tribunal rules, Alberta's experiment with private surgical clinics might end up determining health care policy for all of Canada.
  After crowds stormed the legislature for the fourth night in a row, Premier Ralph Klein backed away from his stated intention to use closure to pass Bill 11 and the legislature adjourned for the Easter holiday. At this writing, debate on Bill 11 has been suspended until May 1. When debate resumes, so will the demonstrations and rallies.

Penney Kome is an award-winning journalist and author based in Calgary.

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Are you concerned about the potential impact of Bill 11 on public health care in Canada?
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Read the Lancet article, "How the World Trade Organisation is shaping domestic policies in health care," by David Price, Allyson M. Pollock, Jean Shaoul, Vol 354, November 27, 1999

View the conflicts-of-interest chart and vote at: pub3.ezboard.com/ falbertapoliticsceha

Follow the Legislature debates at the Government of Alberta Bill 11 website: www2.gov.ab.ca/healthfacts

Read what is actually said in the Alberta Hansard: www.assembly.ab.ca/pro/ han-sim.shtml

Follow the Alberta Medical Association responses to Bill 11: www.amda.ab.ca

Labour Net Canada's Bill 11 site (links to many articles on the subject): www.labournet.ca/abhealth.html

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