A mess in the government access and privacy world #nlpoli

Two recent stories about the province's access to government information and privacy laws.

Both of them are essentially nonsense.

Short version for the new administration:  cock-ups in comms and access to government information helped destroy the Conservatives.  Since you've already got big communications problems, adding screw-ups in ATIPPA to the mix is just no good at all.

Mismanagement and Media Math #nlpoli

CBC’s online story takes a weird tack on the tale of recent financial and management problems at Eastern Health, the province’s largest regional health authority.

CBC headlines its story “Hospital Tim’s never came close to predict profit”.

That’s true but the full story is so much more interesting. While the profit may have been less than originally predicted, the facts are the outlet worked as intended for most of the time its been in operation:  it made money.

The losses, though, are spectacular and recent.

Anger, personified

The raw scrum video, via cbc.ca/nl of the response by Premier Danny Williams to an ongoing story at Eastern Health.  There’s also the full cbc.ca/nl online story on the ongoing controversy.  If that doesn’t work, try another link here:   http://tiny.cc/TEJTJ.

CBC news obtained documents through the province’s access to information laws that shed more detail on the release of information in early April related to the ongoing breast cancer testing issue.

Officials  - especially communications vice-president Jennifer Guy - at Eastern health,  New Democratic Party leader Lorraine Michael, all on the receiving end of the Premier’s anger including an accusation of  political opportunism on the part of the NDP leader. 

This is radically different from anything ever fired at people like Stephen Harper.  There’s none of the characteristic hyperbole, for instance.  You can feel the anger coming clearly through the audio portion. Eastern health chief executive Louise Jones held a newser later in the day;  that isn’t available online yet.

Williams recently criticised the province’s access laws for bogging down government officials with “frivolous” requests and used that an excuse for failing to deliver whistleblower protection legislation in the first session after the 2007 general election as Williams promised.

In a scrum with reporters last Friday, Williams also claimed there was not much experience globally with whistleblower protection laws

He also accused an unnamed witness at the Cameron inquiry into the breast cancer scandal of being motivated at least in part by a personal vendetta. Williams said someone “came on pretty strongly” and decided “to have a crack at government after they did not get their own way’ on employment for a relative with government.

Political opportunism by opposition leaders is not an unusual phenomenon in Newfoundland in Labrador, by the way:

“We told them it was only print-sharing and that there was no threat but, regardless of that, they did take the action they did,” he said.

“What happened wasn’t a breach. Their staff, we believe, knew it wasn’t a breach.”

The action referred to there by a police officer was a public accusation a Liberal political staffer had attempted to hack into the opposition Progressive Conservative computer system.

The story broke in early February 2002:

"The premier's office knew right away that this had happened and, in my opinion, they've acknowledged that a political staffer has interfered with our (computer) system," Conservative Leader Danny Williams said Friday.

"That's very serious stuff."

The language from then opposition leader Williams was strong and, as it seems people in his office knew at the time their version of the story was nothing that would warrant the over-the-top language their boss used:

"Here we have a political staffer trying to break into our computers," Mr. Williams added. "It's very disconcerting to us. There's strategic information in our offices."  [“Liberal tried to hack our computers, Tories say: Newfoundland probe”, National Post Richard Foot, Saturday, February 9, 2002]

or from a Telegram story headlined “Tories sweep offices for bugs”:

"An attempt at access is just as serious as access - no different than attempted robbery is as serious as robbery itself," said Williams, who is a lawyer.

"From our perspective, we're treating it as a very, very serious matter."

 

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Lessons not learned

“They should be shot over there.”

So said Premier Danny Williams when the public reacted angrily to a news release from Eastern Health late on a Friday afternoon that buried the kernel of hard news in the middle of the release.

Turns out senior government officials knew about the whole thing in advance, had a hand in drafting the release and that cabinet ordered the disclosure immediately, despite the objections of officials at Eastern Health.

The documents, released under the province’s open records laws, are available on the cbc.ca/nl website. Interestingly, they appear to have been processed electronically.  This is contrary to standard government practice in some departments which seem to favour using only hard copies as a way of maximising the cost to the applicant.

When asked in the legislature on April 5 (the first sitting day after the Friday news release) when he and officials of his department first learned, health minister Ross Wiseman initially ducked the question, talking instead about research done previously to identify all patients involved in breast cancer testing.

On the second and third questions, Wiseman finally relented, but claimed he had only learned of the matter on April 2, presumably at cabinet:

Yes, I was aware that they were going to be doing that release. The conversation that my office had with Eastern Health was midday on Thursday (April 2, the day cabinet met) , and the understanding and direction was pretty clear: that this information needed to get out immediately. The fact that they were late on Friday afternoon releasing it, I had no control over, Mr. Speaker. That was their call, their decision to release it. I received the notice of the release just moments before it was out. I was out of the Province on government business, meeting with my colleagues in Halifax and with other health regions.

Mr. Speaker, that was their call, but I would agree with the member opposite that getting a release out late Friday afternoon and not having anyone available from the organization to comment on it is not something that I would agree with either.

Wiseman is only referring here to the cabinet directive to release the information, not when his officials first learned of the issue.  The documents obtained by CBC place that time earlier that week. An e-mail from health deputy minister Don Keats shows the minister looking for a briefing on the subject on March 31.

Wiseman’s answers in the House on April 5 also leave the impression that government had no involvement in the matter:

I want to tell the member opposite and the members of the House, Eastern Health write their own press releases. They release their own communiqués. I was aware of the information that they had.  I was aware on Thursday that they were going to be releasing it. My understand was they were going to be releasing it quickly. I then went out of the Province on business, only to find that I got a copy of the release at the same time it was being released to the public.

That also wasn’t strictly accurate since, according to the released documents, cabinet had directed the release immediately without waiting until patients had been contacted directly.

By the following day of questions in the House of Assembly, April 6, Wiseman was acknowledging he had learned of the issue on April 1.

Speaking with reporters on April 5, the Premier condemned Eastern Health for releasing the information in the way they did including not disclosing the information to patients first. That’s the same scrum in which he uttered the infamous comment that “they” should be shot over there.

Justice Margaret Cameron, in a report released last month, found that Eastern Health had erred by not telling the whole truth of what it knew, Williams said. The premier slammed the authority for sending out information late on a Friday and then not making anyone available to talk about it immediately. He said patients deserve full and transparent disclosure.

"This is about people's lives … They have a right to be told," Williams said. "They have a right to be told in a proper manner. There has to be proper disclosure; there has to be someone there to answer questions. It's not something you do at the tail end of a Friday afternoon."

The documents on the cbc.ca/nl website do not appear to represent all the documents related to incident.  Missing are documents or any notes referring to having the issue placed on the cabinet agenda and what, if any communications there would have been between the department and Executive Council, the government’s central co-ordinating agency.

Some of the documents were written days after the event and around the same time Eastern Health’s vice president of communications engaged in a rather bizarre bit of public spinning about the location of information in the news release.  She wasn’t the only one spinning the story.

Coincidentally the week before the Premier said that people should be shot over the incident, courts in Ontario upheld the ruling that such language constituted uttering a threat.

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Measurement and progress at Eastern Health

Without the benefit of a transcript, it’s hard to be 100% sure but your humble e-scribbler heard Jennifer Guy - Eastern Health’s vice president of partnerships and strategic communication  - claim that information everyone is in a tizzy about was a mere one inch from the top of the news release under scrutiny.

One inch?

Let’s check.

The information in question is simple enough to find:  there were 38 additional patients who’d met the criteria for breast cancer re-testing.

One only has to look 6.75 inches down from the top edge of the page or 4.75 inches below the headline to find it. 

One inch, Jennifer?

Hardly.

The actual number “38” is one inch from the top of the paragraph containing that information but that paragraph starts three and one half inches below the headline.

That “38” appears, incidentally, in the the fifth paragraph of the news release.

Normally, releases should put the most important information at the front.  As one scans down the page, the information becomes relatively less and less important.  That’s how reporters scan them and that’s how people working in communications normally write them.

Well, at least they ought to write them that way.

Using that approach, the most important information in this release is that “Eastern Health would like to inform the public that it is moving forward with the implementation of recommendations from the Cameron inquiry report.” [PR writing hint:  “would like” is a terrible phrase since it suggests that you would like to do some but won’t or can’t.  in this case it seems to be an accurate use of the phrase but ordinarily it’s a meaningless cliché, at best.]

Then there are two paragraphs telling that a working group “has been established” that will meet bi-weekly (is that twice a week or every two weeks?) and figure out which recommendations to implement in what order. [PR writing hint:  The passive voice is bad.  Active voice is infinitely better.  In this case, we should have seen a release that told who did what, as in:  “Interim CEO Louise Jones today appointed…”.  If she did it in consultation with her successor, all the better.  Mention that somewhere.  If nothing else, this approach makes it plain that someone is actually responsible for taking action.  That would seem to be important in this case from all that has gone on.  Use of the passive voice makes it look like the whole thing is happening as if by some unseen and mysterious force.]

There will also be a “steering committee”, we are told, but what it does remains a mystery.

At paragraph four, there’s more of the “would like” stuff and here’s where we get into the problem.

Paragraph five, which has the real information in it, starts out by giving all the background bumpf about “challenges” in internal information systems and how some organization had been “engaged” to help out.

In short, before we get to the news here, someone first wanted to give the explanations that sound more like excuses again.

Then there’s the bit about the patients and retesting.

This is a lousy piece of work, by any measure.  if all the rest weren’t true, it is unfocused in that it draws together a raft of different elements and crams them in the one place.

The second last sentence commits Eastern Health to “full disclosure” of the results of the retesting process.  That sounds like a pat phrase that someone figured might be good but that really doesn’t convey the accurate information; “full disclosure” suggests that Jane Jones will have her test scores posted to the web along with her medical records and the complete details of how her case got lost.  Well, Jane and her 37 sisters in re-testing.

This was pretty much a bad release, badly handled and as it turns out since the thing became a controversy, badly handled yet again.

If we measured Eastern’s progress on implementing changes by the same standard the new vice president used today in measuring a news release from her department,  we’d find ourselves moving backwards rather than forwards.

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The External Review Reports decision

While this will eventually make it to the Internet in other legal databases, here's a copy of the decision rendered by Mr. Justice Wayne Dymond in the application by Eastern Health on certain documents requested by the Cameron Inquiry into breast cancer screening.

This is an extremely enlightening document since it demonstrates fairly clearly that even the evidence led on direct or cross examination of Eastern Health's own witnesses contradicts acting chief executive office Louise Jones claim on Friday that these external reports are peer reviews and were considered so by Eastern Health.

At paragraph 39 and subsequently, for example, it is clear from testimony by Dr. Oscar Howell - current vice president medical services - that the work done by two external consultants did not conform to establish Eastern Health policy on peer reviews:

More than one doctor was subject to the review; at least one of the doctors subject to the review had a hand in selecting the reviewers and ultimately, the reports continents were not distributed to the review subjects in the form of a "sentinel report."

On the related issue of the reviews being quality assurance reports, according to Howell's testimony:

Q. So, if the Health Care Corporation, because we’re going back, in fact there isn’t even a Peer Review Policy for Eastern Health – they’ve adopted and continued to apply for positions, the Health Care Corporation’s right?

A. That is correct.

Q. I think it’s important that the Court understands that there is nothing written, there is no Quality Assurance Committee written down anywhere is there?

A. No.

Q. You are going about setting in place a written Policy, aren’t you?

A. We are working through that process, that’s correct.

Q. And with a view to ensuring that, and being able to identify that committee as a s. 8.1 committee isn’t it?

A. That would certainly be very important.

No quality assurance committee. No policy currently in place. Dr. Howell was asked if it was his view that the two experts were being retained to conduct a peer review. He replied: "It is not."

Then there's the famous testimony of the doctor who organized the reviews:

Q. Yes, you -- sure you would, of course you would and this idea that the statement that Bannerjee and Wegrynowski [the external consultants] were designated Peer Review Committees or Quality Assurance Committees, that’s covered by the [Evidence] Act, that notion, or that whole idea only came up long afterwards, didn’t it?

A. That came up in the past six months, the past year or so, yes.

Q. Yeah, but it didn’t occur in the fall of 05?

A. No, I wasn’t thinking about that in the fall of 05.

Q. And, no one spoke to you about it at that time?

A. No.

The idea that the external reviews were peer reviews or quality assurance reports covered by the Evidence Act only emerged within the past year, i.e. since the Cameron Inquiry was established.

The entire decision is rendered in about 39 pages, including the obligatory title page. It's not a long document nor are the issues complex or convoluted. The words used are pretty straightforward, as legal decisions go.

What is fascinating is the information obtained from the sections of evidence - only some of the testimony entered - about the whole issue. We are starting to see the first glimpses of detail of this highly controversial issue.

In particular, though, at this early stage, it is really instructive to look at the position being taken by Eastern Health on certain issues and compare them to what was actually said in court. In some respects, it's not far off the gap between the public statements and the facts - as demonstrated in court - related to the Ruelokke Affair.

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Eastern Health: only 4 of 21 accreditation requirements met

In the most recent accreditation review of Eastern Health, the authority met only four of 21 practices required for accreditation according to CBC News.

The report expressed concern that there were no regional policies for keeping track of patients' medications, as well as no regional procedure for sterilizing equipment and no policy on equipment maintenance.

The report highlighted problems with temperature controls, and how lab samples are taken and transported.

"The likelihood of improper samples reaching testing sites is high," said the report, which added, "incorrect results could lead to improper patient diagnosis and treatment."

The Canadian Council on Health Services Accreditation conducted a site visit in September and issued the report in November 2007. CCHSA is an independent body that audits health service practice ac4ross Canada according to nationally accepted standards.

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Docs finger short time span in review foul up

Dr. Joe Tumilty, president of the Newfoundland and Labrador Medical Association, said on Thursday that errors in the review of radiology reports from the Burin hospital can be traced to the speed in which the review was conducted.

In late May, health minister Ross Wiseman ordered the review completed in 10 days, while Eastern Health had indicated (likely as Wiseman had been briefed as well) only two days earlier that Eastern Health would need four to six weeks to complete the assessment of records on what was estimated at the time to be 3,500 patients.

Tumilty comments echo ones he made in late May that the review "must balance timeliness with quality control."

Tumility's comments Thursday came in the wake of revelations that an administrative error led to the omission of as many as 1,000 reports from the initial review. Tumilty did not comment on whether or not the review to date had actually balanced timeliness with quality control.

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The Darwin Awards of Crisis Communications

Health minister Ross Wiseman and how not to handle a crisis, a detailed commentary at Persuasion Business.

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Burin radiology timelines

The tick tock:

February 2007: Concerns raised within Eastern Health of reports by a radiologist at Burin hospital. Eastern Health initiates preliminary review of sample of records [Source: News media coverage//Hansard]

May 10: Unidentified officials in Department of Health and Community Services advised of issue by EA officials. [Source: Hansard, Question Period, Answer by Ross Wiseman, May 23]

May 18: Wiseman briefed by department officials on Burin radiologist issue. [Source: Hansard, May 22, May 23]

May 22: Eastern Health announces suspension of radiologist at Burin and a review of 6,000 patient records involving 3,500 patients.

Announcement made immediately before news conference announcing public inquiry into breast cancer testing.

EA chief executive George Tilley states it will take four to five weeks to complete the review, initially stating it would take "several" weeks.

May 24: Minister of Health and Community Services Ross Wiseman publicly orders completion within 10 days. [ Source: media coverage//Timescale - Hansard, May 24]

May 29: End of Week 1 from date of announcement.

Jun 05: End of Week 2.

Jun 08: (Two weeks after announcement) EA announces review of 4,600 records completed. Review did not include an unspecified number of bone density scans that would be completed at an unspecified later date.

Jun 12: End of Week 3

Jun 19: End of Week 4

Jun 22: Through his lawyer, suspended radiologist expresses confidence in his own abilities despite media reports.

Jun 26: End of Week 5

Jul 03: End of Week 6

Jul 05: Wiseman meets with Tilley, accuses Tilley of mismanaging Burin radiologist case. [Source: Wiseman news media briefing, July 11, media debrief by CBC Radio.]

Jul 09: Tilley tenders resignation. EA announces resignation, which came as a "surprise".

Asked about government involvement in Tilley's departure, Wiseman ducks the question, stating that the matter is between EA and Tilley:

"Keep in mind Mr. Tilley is an employee of Eastern Health, and the board chair [announced] the board has accepted his resignation, and those issues in and around that employment relationship are better directed to Mr. Tilley himself," Wiseman told CBC News.

Wiseman described the departure "as a personal decision that Mr. Tilley came to an understanding with his board as to what his future was going to be." [Emphasis added]

Jul 10: End of Week 7

Jul 11: EA announces 1,000 - 1,100 reports from review unread due to apparent discrepancy in list of patients and reports. Acting EA CEO says list reconciled manually based on scheduling and billing records.

Jul 11: Wiseman admits meeting with Tilley on 5 July and accusing Tilley of mismanaging radiologist issue. [Source: CBC Radio news debrief] vocm.com attributes comment toWiseman that "Eastern Health of Eastern Health did not advise government they needed more time." Wiseman apparently made no reference to his insistence that 10 days was sufficient to read 6,000 radiology reports.

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More on Tilley departure

cbc.ca/nl has an updated story on the sudden resignation yesterday of Eastern Health region's George Tilley.

Meanwhile at Persuasion Business, there's a piece on credibility titled "The Gorge of Eternal Peril" that discusses the Tilley announcement yesterday and another government interview for some of the public relations implications. The reasons behind the difference in performance are not important for the purpose of the commentary. Rather, the key idea is how different approaches affect or may affect key relationships for the organizations involved. The CBC piece gives some of the vacuous answers Eastern Health and provincial government representatives used yesterday.

There'll be more as the story unfolds.

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Tilley pulls pin

George Tilley resigned today as president and chief executive officer of Eastern Health authority, based in St. John's.

He will be replaced temporarily by Louise Jones, formerly the chief operating officer for acute care facilities in the St. John's area.

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