• Ministry of Health firings: a stunning lack of accountability


    Alan Cassels

    The Ombudsperson’s 500-page report delivers condemnation, but leaves us hungry for an answer to “Why?”

     

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    IN JANUARY OF 2013, I took a felt pen, and wrote on a sticky note: “Who killed Rod MacIsaac?” I stuck it in the corner of my computer monitor and it stared at me for the next two years, a daily reminder of a big unknown that many of us have struggled to piece together and understand. What kind of cruel, twisted logic operating within the bowels of the BC Ministry of Health would have ordered the termination of this UVic co-op student three days before his work term was set to complete, an event which undoubtedly contributed to his suicide three months later? 

    While the 2012 firing of six other Ministry drug safety researchers and a contractor was utterly dumbfounding, nothing was more inexplicable than the brutal efficiency of MacIsaac’s termination. With the April publication of the BC Ombudsperson’s report Misfire: The 2012 Ministry of Health Employment Terminations and Related Matters some say the whole sordid episode is over and we now have answers.

    The report is a complete and total vindication of all of those fired employees, and is a monumental attempt to explain how this train wreck happened. While its 512 pages identify many wrongs, and recommend measures to ensure no fiasco like this ever happens again, one can still be left feeling hungry after parsing its contents. It explains in great detail how Rod MacIsaac and his colleagues were fired, but it fails to deliver on the most important question of all: “Why?”

    Maybe the best way to describe the health firings scandal as summarized in the Ombudsperson’s report is: “Mistakes were made (but not by me).” Carol Tarvis’ excellent book by this title delves into the self-justifying human brain that, in response to mistakes of our own making, creates fictions which “absolve us of responsibility, restoring our belief that we are smart, moral, and right.” The corollary to this, of course, is that these fictions can work to keep us on a “course that is dumb, immoral, and wrong.”

    The most obvious missing ingredient in the report is responsibility. No one owns this mess, and no heads will roll—neither the premier, the various political operatives, ministers of health, their deputies and assistant deputies who oversaw the investigation and firings, nor the staffers who carried out the investigation with the élan of Gestapo police. The biggest human resources scandal in BC government history, and not a single person will be punished. Astonishing, no? Produced after apparently reviewing millions of documents, and interviewing 170 people under oath, the Ombudsperson has officially captured the obvious: This has been an unmitigated disaster, a gross miscarriage of justice, and was followed by a cover-up that has left an essential part of BC’s health system in smoldering ruins.

    Despite the apologies, settlements and promises of ex gratia payments to demonstrate goodwill to those who were so wronged, the lack of any accountability is stunning. In fact the opposite has occurred. The deputy minister who signed the letters terminating the employees was himself fired, with a nice $461,000 golden handshake to guide him on his way as he turns his health file connections into a lucrative job in the medical marijuana industry. Other high officials who dishonestly said the RCMP was involved, and tainted everyone with an unjustified criminality, are still in office. Some of the staffers have been promoted, moving on as people do in a government town to other ministries and other jobs. And other senior executives have retired and moved to warmer climes, living worry-free knowing that whatever destruction they may have helped orchestrate in the Ministry of Health, it will never come back to haunt them.

    The investigation which led to the firings, was, according to the Ombudsperson, heavy-handed, mean-spirited, and acted far beyond the standards expected of the public service. The descriptors “flawed,” “biased” and “unfair” litter the document, yet any fingerprints that may have linked the fiasco to the BC Liberals, and their pharma-friendly policies, have been “disappeared.” Nothing to see here, folks.

    Most of us knew all along that the investigations and the firings were unjustified, but the most troublesome thing is how long it took to try to refloat the ship. Once eight people were thrown out the door in September 2012, it took nearly two and a half years of foot-dragging, public demands for justice, and one failed mini-inquiry (the Marcia McNeil Report) before the matter got handed over to Jay Chalke, the Ombudsperson.

    While it was even clear several months after MacIsaac was terminated that mistakes were made, no one owned up or tried to fix things. Why? That question still haunts me. I know I’m not the only one to notice the happy coincidence between the needs of Big Pharma (not wanting independent drug safety research done on their products) and the politicians (on the receiving end of drug lobbying and political donations) who kept staff in the Ministry from really trying to get to the bottom of this and fixing things.

     

    JAY CHALKE'S REPORT contained 41 recommendations, all of which were accepted with alacrity by the government. Those 41 items mostly relate to reparation payments to those affected, and suggestions to improve Ministry policies. The most important, in my mind, relate to resuming the culture of research we used to have in the Ministry of Health. For instance, the report recommends: “By September 30, 2017, the Ministry of Health review and assess the extent to which the termination of evidence-based programs during the internal investigation may have created gaps that now remain in providing evidence-informed, safe, effective and affordable drug therapy and related health care services to British Columbians.” The government promised to release a plan to address any identified gaps by December 31, 2017.

    These so called “gaps” are what affects us all, because halted research doesn’t just affect the people who do it (including myself), it endangers public safety. Anyone in this province who takes drugs for cholesterol, high blood pressure, infections, Alzheimer’s disease, smoking or ADHD is affected because programs we had to study drug use, and try to educate physicians, have been halted and not resumed. The state of data analysis paralysis, which consumed the Ministry of Health in the wake of the firings, continues to haunt it today.

    If the Liberals wanted to kill the research and evaluation activities of its Pharmacare branch, they couldn’t have found a more effective way to do it. Many of the staffers in the Ministry of Health know this, and want to fix things—and they need to know that the public and the politicians have their backs. But it’s going to take time, and, most of all, political will.

    BC has an asset that is truly “world class,” established by an NDP government back in 1994. It is PharmaNet, one of the most comprehensive, linkable pharmaceutical databases in the world. Having this makes BC one of the world’s best places to study drug policies, and could also likely make it the easiest place in the world to ensure we use pharmaceuticals safely and wisely.

    The biggest potential downside to this fiasco going forward is fear about using BC data to evaluate policies. Not evaluating our own drug- use data and using it to improve prescribing will continue to foolishly sacrifice lives. The starkest example of inaction on that front is the current opioid epidemic, where BC could be a world leader in safe, appropriate opioid use, instead of the epicentre of a disaster that kills, on average, three people per day.

    What do we need going forward? We need risk-takers in government. I know it’s awfully hard to change any organizational culture, especially one that has been through the wringer like the Ministry of Health. We need people to make decisions in the right direction, and people willing to rebuild a culture of inquiry committed to using public data in the public interest.

    You don’t get let off the hook when public health is at stake. The politicians need to realize this: that what happens under their watch is their responsibility. People in the senior civil service serve “at the pleasure” of the politicians. There is no “off the hook” with public health.

    We don’t know who killed Rod MacIsaac, but maybe we can make sure he didn’t die in vain, and that the career he aspired to—doing independent analysis of drug-use decisions—is something that can grow and thrive in BC.

    The Ombudsperson recommended establishing a scholarship in memory of Rod MacIsaac at UVic. In a gesture that is highly symbolic, it could also be seen as hugely aspirational. We cannot begin to undo the damage done until we recognize that we are all wearing the mistakes that led to Rod MacIsaac’s death. We have allowed a government to be tainted by pharmaceutical interests, where a fiasco like this can happen and the perpetrators go free. Future governments that forget where the public interest lies will do so at their peril, and ours.

     
    Alan Cassels is a Victoria writer and health researcher.  His most recent of four books is The Cochrane Collaboration: Medicine’s Best Kept Secret.

     

    CTV legislative reporter Stephen Andrew filed this story about Rod MacIsaac's death in January 2013:

     

     

    City filed this report in October 2014, including a statement by Rod MacIsaac's sister:

     

     




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