Wednesday, December 20, 2017

Medavie deal cause for concern

Capacity and transparency. Both are words that have been thrown around a lot in the debate surrounding the privatization of management of the Extra-Mural Program (EMP).

Recent stories in the Telegraph-Journal highlight how both those words ring hollow when coming from government and Medavie, the company set to manage the program.

Let's begin with capacity. In a Dec. 8 commentary, "Building a health care system that works," penned by Health Minister Benoît Bourque and Medavie CEO Bernard Lord, the word is used three times.

1. "We need to build capacity in our system to provide more care in our communities so that our hospitals are prepared for the demographic demands of the future."

2. "In addition to the existing key performance indictors used in the Extra-Mural Program, several objectives are outlined in the contract, including: reduction in emergency department visits, increased EMP capacity (number of visits), maintaining patient satisfaction, time between EMP referral and delivery of care and increased community referrals. For several of the objectives, there will be incentives and penalties to encourage performance."

3. "There will also be an evaluation framework to ensure that this model respects the high performance standards of the existing programs, while also achieving the overall aim of the project of building capacity in our primary health care system."

In the first and third use, capacity is basically a buzzword. It sounds good, but doesn't carry much meaning. It's the second instance where they write "increased EMP capacity (number of visits)," they provide definition to the word.

One of the ways cited to increase EMP visits is to send paramedics to the homes of Extra-Mural clients. Here's how Deputy Premier Stephen Horsman described it in a Sept. 23 commentary in the Daily Gleaner: "For example, under the new model, if an Extra-Mural Program patient calls Tele-Care 811, the nurse could ask for assistance in determining the seriousness of an ailment from a nearby paramedic. That paramedic could visit the home and provide a more detailed assessment, which could prevent an emergency room visit."

Again, it sounds good on the surface, but underlying issues with the management of our ambulance service by NB EMS – a subsidiary of Medavie – show major flaws in this plan. The situation outlined by Horsman would see an increased workload for paramedics.

This is problematic, given recent reports of Medavie's management. I want to make clear, the problem lies with the company's management, not with the work being done by paramedics who do great work under difficult circumstances.

It's documented that the deployment of ambulances by Medavie throughout the province has lead to longer than expected response times. It's difficult to understand how adding more calls will improve this issue.

Furthermore, it was reported by the Telegraph-Journal that "a lack of available paramedics has put New Brunswick ambulances out of service 14,000 times in the last three years."

Later in the story, it states: "The Department of Health does not require ANB to report how often ambulances are taken out of service due to lack of staff, but has described them to the Telegraph-Journal as 'important' because they can impact response times."

Government doesn't require Medavie to disclose important information. And Medavie is not eager to release it to the general public.

The company has tried to keep ambulance response times, 911 dispatch times, air ambulance activity, quality assurance reports, compliance records and financial statements away from journalists who had asked for the documents in a right-to-information request.

The reason it did not want government to disclose the information was because, the company argued, data pertaining to key performance indicators were intellectual property of NB EMS.

Response times, compliance records and financial statements don't sound like intellectual property, but information New Brunswickers should be able to access them. This way, they can understand if the service is being run properly.

In an interview, Lord said he was open to sharing more information, but actions speak louder than words in this case. Fortunately, a recent decision by the integrity commissioner rejected the company's application to ignore the requests from the press.

Let's look at two more words: fear mongering. This is what former Health Minister Victor Boudreau said the head of a seniors group was doing with its public meetings opposing the transfer of Extra-Mural to Medavie.

Given the lack of information on this deal, Medavie's track record of managing the ambulance service and its unwillingness to share vital information about a taxpayer funded service, New Brunswickers have a right to be fearful.