Ian Fleming, the creator of James Bond, famously observed: "Once is happenstance. Twice is coincidence. Three times, it's enemy action."
To put this in medical terms, we might add, "Four times is a chronic condition."
Whatever skepticism one may have felt about the way Independent MLA Dr. Raj Sherman introduced the topic of intimidation and payoffs to the Alberta Legislature on Feb. 28, it's reasonable now in light of the CBC's repeated reports for Albertans to reach the conclusion something was seriously wrong in the Capital Health Region and that allegations of mental instability were routinely used to silence physicians who criticized the system.
Sherman claimed to the Legislature that physicians who complained "were either punished or driven out of the province, or paid out in millions to buy their silence, and the costs buried in the books under the former Capital Health Region."
The former Conservative Parliamentary Assistant for Health, fired and kicked out of caucus by Premier Ed Stelmach last November, was widely criticized for not backing this up in the House with evidence. Supporters of the government also suggested he was showing signs of mental instability.
On March 10, CBC investigative reporter Charles Rusnell revealed details of a 2001 lawsuit filed against the CHR by Dr. Ciaran McNamee, a thoracic surgeon who claimed he was forced out when he complained about waiting times faced by his patients. McNamee, who now works at Harvard, also said in court documents that health officials suggested he was suffering from mental instability.
On March 14, Rusnell reported the case of Dr. Anne Fanning, who lost her job leading Alberta's tuberculosis program in 1996 after publicly criticizing government plans to cut the program. She went to work for the World Health Program in Geneva and eventually retired. She too said she was subjected to accusations of mental instability.
On March 16, another story by Rusnell told how Dr. Abilio Nunes, an anesthesiologist, was more recently accused of mental instability and had his right to practice medicine threatened when he made a complaint about surgical practices. This case was only wrapped up -- in Nunes's favour -- in 2009.
So here are four cases over a span of a few years of intimidation and dubious claims of mental instability involving physicians who criticized or questioned the way Alberta's health care system was being run. And who knows what Rusnell may have waiting in his journalistic kitbag!
This is powerful evidence of a pattern of behaviour, a modus operandi, and it is reasonable for Albertans to assume it happened in other cases as well.
That is why, at this point, just about everybody except Premier Stelmach, Health Minister Gene Zwozdesky and most of the candidates for the leadership of the Alberta Progressive Conservative Party, is supporting the call of the four opposition leaders and Sherman for an independent judicial inquiry into the situation.
This situation creates a serious political problem for all the Tory leadership candidates except Battle River MLA Doug Griffiths, the only one who was a not a cabinet minister while some of this saga was unfolding.
The problem is particularly severe for the current front-runner, Calgary lawyer Gary Mar, who announced his candidacy only the day before yesterday, and painted himself as an outsider who would offer a completely different approach from Stelmach's stumblebum ministry.
Fair enough, one supposes, but how can Mar portray himself as something new and different when he was a health minister under premier Ralph Klein and had two former health ministers, both still members of Stelmach's cabinet, show up at his March 15 campaign launch?
As things stand, there are enough examples of claims of mental instability being used as a bureaucratic weapon in Alberta medical circles to lend credibility to Sherman's more startling accusations -- such as the suggestion of taxpayer-financed payoffs to silence doctors.
This is true even if, as Mar pointed out Wednesday, Sherman is now a candidate for the leadership of the Alberta Liberals.
Another reasonable question for the rest of us chickens is whether this pattern of intimidating dissidents by questioning their mental stability has continued under Alberta Health Services?
This is not to say it has. Indeed, while former Alberta Health Services CEO Stephen Duckett had his faults, including a tendency to speak his mind when he would have been wiser to keep his own counsel, this kind of thing does not seem his style when it came to dealing with criticism.
More likely, one imagines, he would have simply told a persistent critic to choof off, or some similarly colourful Australianism.
By the same token, Duckett's replacement, Dr. Chris Eagle, seems to be making a genuine effort to encourage physicians and others in the health care system to speak up on behalf of their patients.
But anyone who has worked for a large institution knows that top leaders can only do so much, and that a bureaucracy will go back to its old bad habits given the opportunity.
That's why, whether Premier Stelmach likes it or not, the only way to really clear the air and possibly solve a serious problem that endangers Albertans' health is to hold a judicial inquiry.
There are now just too many documented cases of medical bullying in Alberta for us not to do this.
This post also appears on David Climenhaga's blog, Alberta Diary.