A dangerously misleading statement appeared in an op-ed story under Health Minister Adriana LaGrange’s byline Thursday in the Edmonton Journal. To wit, “that Alberta Health Services has evolved beyond its original acute-care hospital system mandate.”
Everyone makes mistakes and most politicians spin the facts their way.
But this statement, which Premier Danielle Smith has also put forth before, is so obviously at odds with the facts of the creation of Alberta’s province-wide public health agency in 2009. It is easy to refute with solid documentary evidence. This suggests something more sinister than mere error or spin.
Even the authors of government press releases, after all, normally check the facts before they publish.
The op-ed was plainly not written by LaGrange herself – such bylines are a small fiction perpetrated by public relations departments and permitted by a certain newspaper chain desperately on the hunt for free copy that doesn’t require much editing. Still, as health minister, LaGrange has some responsibility to ensure the general accuracy of what is being attributed to her.
So if it turns out this was a case of out-of-control spin or an honest mistake, at least, the claim needs to be publicly retracted. We will watch and wait, but not hopefully.
The Regional Health Authorities Act
So what are the facts about the establishment of Alberta Health Services in 2008 and 2009 by the Progressive Conservative government led by Premier Ed Stelmach?
We need to start with the Regional Health Authorities Act of 2000. The legislation was created by the government of Ralph Klein, Alberta’s Progressive Conservative premier from 1992 to 2006, and established Alberta’s original 17 health regions.
Section 5 of that law states that the health authorities exist to promote and protect the health of the population in each region, allocate resources appropriately, and ensure reasonable access to health care is provided throughout the region.
It notes that authorities must provide “health services in a manner that is responsive to the needs of individuals and communities and supports the integration of services and facilities in the health region.”
This matters because the Regional Health Authorities Act is still the statute that governs Alberta Health Services.
When the regional health authorities were created, in addition to hospitals, all health units and nursing home districts were dissolved and moved into the RHAs.
The origins of the AHS
In 2003, the Klein Government cut the number of regions from 17 to nine.
On May 15, 2008, frustrated with the independence of the Calgary Health Region’s powerful president and CEO, Premier Stelmach and his health minister Ron Liepert rolled the remaining health regions into a single province-wide entity to provide a wide range of health care services to Albertans in and out of hospitals.
But while significant, neither of these changes required amendments to the Regional Health Authorities Act.
In addition to the troublesome Calgary Health Region, Liepert’s plan eliminated the Aspen, Capital (Edmonton and area, that is), Chinook, David Thompson, Northern Lights, Palliser, and Peace Country health regions.
Only the East Central Health Region remained, effectively becoming Alberta Health Services without debate in the Legislature. Importantly, though, Section 5 did not change – the sole health region’s broad mandate remained untouched.
The details of this administrative sleight of hand were missed or ignored by journalists at the time and are all but lost to history now.
The day after the ministerial order, journalist Jason Markusoff, writing in the Calgary Herald, quoted Liepert saying that “the past governance structure would not guarantee that we can get to the next level of ensuring equitable, basic health care throughout Alberta.”
“MLAs have brought to me instances of where one side of the road in one of the regions delivers services different from people who live on the other side of the road,” Liepert continued – in 2008, at least, this was considered to be a bad thing. Apparently, this is no longer true in 2023!
As if to confirm that AHS’s mandate was all-encompassing, the Health Governance Transition Act took effect on April 1, 2009, dissolving the Alberta Mental Health Board, Alberta Cancer Board, and Alberta Alcohol and Drug Abuse Commission – all province-wide health care agencies that operated in a variety of venues – and rolled them directly into AHS. Health services in provincial jails also became an AHS responsibility.
Alberta Health Services became a legal entity in its own right the same day, April 1, 2009.
Later, provincial ambulance services and ambulance dispatch services were integrated into the system, but that hardly amounts to the evolving mandate for AHS that LaGrange’s op-ed describes. Rather, it was merely confirmation of the existing one.
So we can see that right from the get-go, even before AHS technically existed, its mandate, in LaGrange’s words, was to be “a comprehensive health organization that serves Albertans across various settings, from hospitals to clinics, continuing-care facilities, and beyond.” This was to include mental health, inmate health, cancer treatment, substance abuse treatment, community health and so on. Not just acute care hospitals.
Troubles ahead for Alberta health care
So why does this matter?
It matters because, despite the controversies in 2008 and 2009 associated with the creation of AHS, it has by and large been a success!
Such success is unusual among the major policies implemented by Conservative Alberta governments since Peter Lougheed stepped aside as premier in 1985.
Researchers from the respected Canadian Institute of Health Information have reported that AHS has the lowest administrative costs for provincial health care in Canada – 3.3 per cent of total spending, compared with a national average of 4.5 per cent.
Moreover, during the pandemic, AHS’s province-wide structure co-ordinated the discharge and care of patients, eased use of hospital capacity across the province, made management of surgeries more effective, and gave Alberta a huge advantage in purchasing personal protective equipment during a worldwide shortage.
It also matters because, as is universally acknowledged, health care is in crisis throughout North America and the world – beset by an international shortage of medical professionals, surging rates of drug addiction, and the aftermath of the COVID-19 pandemic.
The doctor should be ordering stability and focus on the obvious problems facing health care everywhere – not a vanity restructuring to satisfy Premier Smith’s anti-vaccine base in the United Conservative Party and her well-established ideological opposition to public services!
But the most powerful reason for concern is that Albertans cannot trust their provincial government to refrain from privatizing vast swaths of the health care system outside acute care hospitals if they are conveniently hived off into separate silos.
This would be a disaster for everyone except multinational for-profit corporations. They are salivating to fill gaps abandoned by the province and the retired politicians invited to sit on their boards.
It is not comforting in the least to know that, despite her carefully orchestrated change of tune lately, Smith is a market fundamentalist ideologue who has spent her entire adult life advocating U.S.-style for-profit health care in Canada despite unending evidence of its catastrophic effect.
Can this leopard change her spots? I think we all know the answer to that one.
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