Provincial government limits patient use of own health information

Lorraine Michael raised an interesting question in  the legislature today about regulations governing patient records  held by the province's regional health authorities.

The question is interesting not only for what it contains but for the response of the Minister of Justice and Attorney General.

As the New Democratic Party leader noted, the regulation (NLR 18/08, s. 6) regional health authorities may release records to patients - referred to as clients - however under subsection (5):

A person to whom information is provided or who is permitted access under subsection (3) or (4) shall not publish or disclose information obtained from the client records of the regional health authority where the publication or disclosure may or could be detrimental to the personal interest, reputation or privacy of

(a) a client;

(b) a physician;

(c) a member of the staff of the regional health authority; or

(d) a person employed by the regional health authority. [Emphasis added]

That section of the legislation covers not only individuals who may be using patient records for research purposes but also covers the patients themselves.

Justice minister Jerome Kennedy indicated he wasn't aware of the regulation but undertook to look into it:

I am not aware of that amendment or the regulations you are talking about. I certainly will have a look at them and come back. It does strike me as somewhat strange in terms of restricting people’s ability to use their information, but there would have to be an overriding of public interest. So, I certainly will check into that and we can continue this discussion further.

The Minister might note that the regulations start by establishing that records involved do not belong to the patient (client). They are the property of the regional health authority.

The saving grace here is that the access to information act doesn't contain such a restriction and its provisions supercede the regulations involved.  The access act applies to regional health authorities just as it does to all public bodies, with the exception of the Auditor General. It seems he can decide to exempt himself from following the law by his own decision.

-srbp-

Wells for SCC

He turned 70 last fall but he's still in great shape and his mind is as sharp as ever.

Who better for the Supreme Court of Canada than Clyde Wells, currently Chief Justice of the appellate division of the Supreme Court of Newfoundland and Labrador?  He can take the seat vacated by Mr. Justice Bastarache.

We'd suggest in the alternative Madame Justice Margaret Cameron but she's got more valuable things to do right now sorting out yet another major problem in the provincial government. 

Besides, since the mandatory retirement age for justices is 75, Madame Justice Cameron can take the spot when Wells steps down in three or four years.

I'll start working on the tee-shirt design and we'll have them at the Bond Store ASAP.

-srbp-

BondFlash: Memo to National Media

Today's best scrum opportunity.

-srbp-

Timely blog discoveries

Comprehension, the Public Relations Society of America blog.

crisisblogger, the blog for crisis managers and communicators.

-tpb/srbp-

The Potemkin Cabinet

Newfoundlanders and Labradorians must surely be wondering about the government which they support through their tax dollars.

It does not function according to law, apparently.

Ross Wiseman, currently holding the title Minister of Health and Community Services told the Cameron Inquiry on Thursday that deputy ministers are appointed by the Premier. Wiseman said he was not consulted by the Premier and, indeed, had no knowledge of the appointment of a new deputy minister in his department in May 2007 until the deed was done.

Wiseman is misinformed.

All Canadian provinces operate according to the rule of law and Newfoundland and Labrador is no exception. Laws are approved by the elected representatives of the people in the House of Assembly and all people, including cabinet ministers are obliged to follow the rules established by law.

Wiseman would do well to check the statute books to see what his powers, duties and responsibilities are.

Under the Executive Council Act, deputy ministers and assistant deputy ministers are appointed by the Lieutenant Governor in Council.  As with the conventions long established in Westminster style governments, the first minister recommends the appointments to these positions but it is the Lieutenant Governor, on the advice of his or her council that approves the recommendations.

This is no small matter.

While the first minister may have the sole right to make the recommendations, it is not the first minister who holds the authority to make the appointments. Constitutional lawyers may now begin to quibble but the distinction is important.

Deputy ministers, after all, are supposed to be accountable for their management of the department to the minister appointed to the department. There are several lines of accountability for both the minister and especially for the deputy minister, but there is not supposed to be a situation in which the deputy minister does not, de facto, have to answer to the minister.

The federal approach is typical:

Because deputy ministers are appointed on the recommendation of the prime minister (usually with the advice of the clerk of the Privy Council), a minister who is not satisfied with the administration of his or her department by the deputy minister and who is unable to resolve matters directly with the deputy may bring these concerns to the clerk or, ultimately, to the prime minister.

Those words have great importance for the matters currently the subject of the Cameron Inquiry. Former health minister Tom Osborne has testified under oath that officials of his department did not provide him with a copy of an important briefing note prepared in late 2006 for the Premier. Osborne's predecessor, John Ottenheimer, has described a similar situation, one in which he was not sure of his own authority - that is, his power under law, to direct certain actions within his own department.

Both Osborne and Ottenheimer appeared to have been sidelined in the management of this very significant issue and there are other signs that this is so. There is some evidence to suggest that departmental staff reported to central agencies, i.e. those directly responsible to the Premier, before they passed information to the minister. It appears so at this stage, but there is much more testimony to come.  Final judgment will have to be reserved but even at this relatively early stage, we may sketch in the outline of how this particular administration appears to function.

And it is a most peculiar functioning indeed.  It is a government which has all the external trappings of cabinet government but which, in practice, holds that everyone is accountable directly to the Premier. If this sketch holds true, cabinet government and collective responsibility  - and collective authority - has been replaced by one large organization with notional subdivisions all reporting to a single individual.

A deputy minister would only ignore his minister   - such as by withholding crucial information - if he or she believed, rightly or wrongly,  that authority rested somewhere other than in the minister's office. In a world where the deputy minister's job tenure is solely the prerogative of the Premier and where the most senior public servant has only irregular meetings with the first minister, there is no value in keeping happy a minister who asks inconvenient questions.  Why bother to do anything but humour the poor minister when the person or people who count have offices on the eighth floor of the East Block?

As noted already, this is a sketch -  a hypothesis if you will allow  - based on a portion of the total evidence to be received by Madame Justice Cameron.

Sometimes, the outline of the mosaic can be seen, though, even if one hasn't finished pulling back to see the whole thing. You just have to look at the individual tiles and see how they fit together.

-srbp-

And on the fourth day, he headed out of the province...

The announcement from the Premier's Office is old news for people who read Bond Papers.

-srbp-

Math tudors beware

A blog and a mission to stamp out typos in America.

Readers know there are a few typos around these parts.  With any luck, they don't distract from the rest of the content.

One local blog author seems to have missed the spell check button orientation briefing, hence one of the more hilarious phrases lately about two people who teach arithmetic.  Unfortunately, it came out as a couple who run about doing ye olde sums in codpiece, tights and puffed collar.

Then there was Gary Cake [note only one "r"]  - assistant secretary to cabinet for social policy - who in the rendering became Garry Cake, morphed to Carry Cake but never quite made it through the typo evolution to the anthropomorphized Cherry Cake.

Suddenly people are feeling a bit peckish, no doubt. A delicious treat with tea or coffee that can route e-mails using a blackberry.  Coat the letters with flour to keep them from sinking to the bottom of the page while they are being typed or baked or whatever.

Coffee and cake.

Cake and Coffey. 

Words are pesky things.

Others, meanwhile, may be having visions of Cherry Cake, the stripper.

Pole-dancing at the Cabinet Secretariat.

The Clerk must be doing something besides keeping his boss up to speed, and watching strippers or eating  are as likely as anything else.

The thought of Gary - by the by, as thorough a professional as one might find in his job -  in pasties and garters prancing about the 9th Floor to some raunchy concertina version of "Star of Logy Bay", is an image that those who know Gary may find arresting, if not downright disturbing. 

It is an incongruity to trump all other incongruities even if it is placed in a suitably folky context for the current crowd of nationalists, courtesy of the squeezebox grinding away in time to the flicking of hips.

Or maybe the Clerk's boss is the one who finds distractions that keep him from keeping up on what he gets paid to do.

But anyway, said typo farm raised even more puzzled stares the other day by ending a comment with three words:

"Your obsessed boy."

It gave the comment the feel of a haiku but without the adherence to form, at least in the front bit of the comment.

The sentence fragment remains curious since the preoccupations of my eldest child were totally unconnected to the discussion at hand.

Typos can be fun.

Feel free to share your favourites.

-srbp-

and on the third day, the Premier had no control of anything...

Wednesday turned out to be a day of bizarre contradictions.

Consider, for example, that on Monday the Premier insisted he took full responsibility for what was done or not done by anyone involved in the breast cancer debacle. He spoke consistent with principles of modern, public sector administration.

By Wednesday, as questions swirled around why a briefing note prepared for him was not sent to the minister at the time, he had a different view of control and responsibility:

So, you know I cannot attribute any blame. I cannot pass my own personal opinion on it. What we have seen is we have seen instances where Eastern Health had omitted and deleted information from briefing notes that were being released under ATTIP requests, and that was done. They have gone off - they have actually had press conferences where, in fact, all of the information was not revealed. Those are actions that are beyond the control of the minister. The minister cannot be responsible for every single person all the way down the line in the health care system because they have no possible, tangible means of doing it.

"Those are actions that are beyond the control of the minister. "  How odd. 

The Premier makes this comment after claiming that officials of Eastern Health had edited documents being released under the province's access to information laws. This is certainly news on the order of the allegations of forged documents that led to the Somalia Inquiry.  It's a curious parallel for the Premier to draw, even implicitly, since Somalia was a tale, in part, of great intrigue including the destruction of documents and problems in presenting documents to an inquiry.

But even if this allegation about the production of false documents were true - and there doesn't appear to be any evidence thus far that it is - the subsequent part of the Premier's comment undermines any notion of ministerial responsibility and ministerial accountability which he laid claim to on Monday.

Legally, ministers are indeed responsible for the actions of the department and the people within the department.  They are accountable to the public through the legislature for those actions.  They have tangible means of directing action and of monitoring activities within the department.  Departments are organized specifically to provide direction and control from the minister through to the front line workers of a given agency.

If there is no "possible, tangible means of doing it", i.e. of being responsible, then the department cannot function and government would grind to a halt.  think about it for a minute.  If a minister cannot direct action within a department there is no need for the legislature to pass laws directing a program to be implemented.  If a problem is detected, as in the breast cancer case, then it will be impossible to ensure it never happens again nor is it possible to produce the "best system in the country."  An absence of control and accountability - the essence of the Premier's comment - makes it impossible for government to function.

A minister cannot micro-manage, of course, if that is what the Premier meant.  It is impossible for anyone to direct the specific, detailed actions of every person in any organization, irrespective of its size.  Only fools try to do it and those fools that do usually create a dysfunctional organization full of unpleasant, unhappy and unhealthy people in the process.

The Premier's contention is, on the face of it, sheer nonsense.  Ministers can and do control their departments in a variety of ways. One of them is through the simple issuing of direction on what will be done in a given instance or, when something is not done, to have it sorted out and done to the satisfaction of the minister.

One of the enduring unanswered questions in the breast cancer debacle thus far relates to this simple notion.  Once ministers - including the Premier - became aware of certain issues, such as a failure by Eastern Health to disclose information, they failed to direct other action instead.  For example, if the Premier was aware - as he clearly was - that Eastern Health was no disclosing certain information - he failed to issue instructions to correct the situation. 

That is, by his own account he failed to exercise his legal responsibilities as first minister to direct the actions of government officials or those of Crown agencies.

With regard to the minister’s comment on, if he had it, he would have gone public. Well, I do not know what he had or what he did not have. He did not have that briefing note. The following month there was a press conference whereby Eastern Health disclosed information, even though they did not disclose all of it, and I have no control over that, that was in the public domain. Why the minister at that point did not decide to come to me or go public with it, he is the only one who can answer that. [Emphasis added]

Contrast that with the Premier's words and actions as the House of Assembly scandal broke in June 2006.  He took action.  He issued instructions.  He took credit for bringing the Auditor General into the House of Assembly. He had no executive authority to do so - the House is not a government department -  but he claimed credit for it anyway.

Yet, on a far more serious matter in a department over which he, as first minister had executive control through cabinet and successive ministers, the Premier had "no control over that." One wonders why, if that were the case, he would request a briefing note on a matter over which he had no control. Idle curiosity?  Why would he have bothered to give up the life of a successful lawyer to take on a job where he had no control over anything of substance? How is it that he can be consumed with trivialities enough to threaten legal action against your humble e-scribbler for some still incomprehensible reason and yet he cannot control the actions of government officials nor recall whether or not he received briefings on key issues?

The answer to these questions is, of course, that the Premier's comments in the House today are sheer nonsense.

Some of his other comments though may not be nonsense and, if true, raise far more significant implications for the conduct of government business.  A 1998 description of the executive functioning of the provincial government describes a typical relationship of the Premier and his two chief advisors, his political chief of staff and the Clerk of the Executive Council.

A close working relationship involving the Office of the Premier, Cabinet Secretariat and the other secretariats within the Office of the Executive Council is essential. The Premier meets daily with both his Chief of Staff and the Clerk of the Executive Council. The Premier’s Chief of Staff and the Clerk of the Executive Council work in close collaboration, keeping the other apprised of political, policy, communications and administrative considerations.

At the head of the Office of the Executive Council (other than the Office of the Premier) is the Clerk of the Executive Council and Secretary to the Cabinet. This position encompasses three related roles. As Deputy Minister to the Premier, the Clerk is the senior official reporting to the Premier on all governmental matters. The Clerk receives and transmits instructions from the Premier, and, as the senior official in the Office of the Executive Council, the Clerk coordinates the operation of the secretariats.

The Clerk assists the Premier in setting the Cabinet agenda, arranges meetings of Cabinet, oversees the preparation of briefing materials for the Premier, ensures the records of Cabinet are properly maintained and, under the Premier’s guidance, plans Cabinet retreats. The Clerk is also responsible for process in the conduct of Cabinet business and, from time to time, works with Ministers and senior officials on substantive matters on Cabinet’s agenda.

It would not be unusual for the Clerk of the Executive Council to meet with the premier daily on a variety of issues.  The Clerk is after all, the deputy minister to the Premier and typically reports to the Premier on all matters of government especially those involving the administration of government.

With that as background, consider the following comment by the Premier in response to a question about whether the Clerk of the Council had mentioned to him the serious problem at Eastern Health when the Clerk became aware of it in July 2005:

Mr. Speaker, I cannot recall a conversation with Mr. Thompson on that particular issue. Mr. Thompson would brief me, not on a daily basis. It was sometimes on an extended basis, sometimes it could be as long as a month when we sat down for briefings. Mr. Thompson and his staff, I have not made a direct question to Mr. Thompson as to whether I did have it, but it has been requested as to whether there were any conversations with Mr. Thompson, and to my knowledge there were none.

A month between briefings from his own deputy minister? Those familiar with the operations of government would find such a statement leads to only a handful of conclusions none of which are good either for the province or the Premier.

The most obvious conclusion is that he is suffering from pinocchiosis but it would be rash to assume this. He may well be stating his own view of the job and of the reality of how this administration functions or dysfunctions. The Premier may well not bother himself with many of demands of his job, leaving responsibility to his unelected staff and to such cabinet ministers as Tom Rideout.

Of course, that is not the picture which has been described to date nor is it the basis on which he has received such overwhelming popular support. That's one of the political landmines Danny Williams faces:  the Cameron Inquiry may reveal much of how his administration has actually functioned.

If he continues to claim he has no control of anything and attempts to shift responsibility for action and inaction onto other people, the public may well start to wonder why they elected him and his associates in the first place.

No wonder cabinet is trying desperately to find an excuse to stop questions in the House of Assembly on the breast cancer debacle. 

-srbp-

Civics 101 for government employees

Given the layers of approval provincial government news releases go through, the glaring error in this one speaks to a problem with what public servants know about the political system in our province.

The Provincial Government has passed a new act respecting architects which replaces the previous Architects Act of 1995.

The Provincial Government?

Forget that, strictly speaking, those two words don't get capitalized in this context.

What's noticeable here is that the very first statement makes a fundamental mistake about which authority approves legislation.

The provincial government is the Government of Newfoundland and Labrador.  In other words, the provincial government is the administrative body that delivers programs and services under the constitution.  The executive power - the administrative decision making power belongs to the Lieutenant Governor in Council.  That's the cabinet by another name and while the Lieutenant Governor is largely a ceremonial position, the Council, or cabinet happens to be the executive officers of the the government.

But in order to spend money or indeed to even carry out its administrative functions, the government needs to get approval from another body.  That body is the House of Assembly and the approval comes from laws approved by a majority of the elected representatives of the people of Newfoundland and Labrador.

Following so far?

It's really pretty simple.  The Government didn't pass this new act.  The House of Assembly did.

And to be absolutely strict about it, this new law isn't even a law with full force until the Lieutenant Governor nods his head - quite literally - or signs the legal document approving it.

According to the House of Assembly website, that nod hasn't been given.  Check the progress of bills page and scan across to the column marked Royal Assent. It's blank.  While it's possible that the thing just hasn't been updated, it's actually more likely given parliamentary tradition that this bill is not law until His Honour attends the House at the end of the current session and nods after the title of each bill is read.

Aside from the capitalization thing, this news release is fundamentally wrong.  It misidentifies where the legal authority for the new bill comes from and it has been issued before the bill has completed the legal process.

Talk about contempt of the Crown, the legislature and the people of Newfoundland and Labrador and displaying a complete ignorance of how our democracy works.

Some may toss this off as a trivial issue. 

Well, those are people who likely also don't have any regard for how our democracy works both in theory and in practice. The more we minimise and trivialise the roles different people play in our democracy, the weaker our democracy becomes.

Next thing you know, some newly elected member of the legislature will be thanking his party leader for the privilege of being allowed to join the leader's team.

Or a briefing note on a major issue will skip past the office of the minister responsible and head straight to the leader's suite.

Oh wait.

Those things already happened.

[Almost immediate update:  Same minister, same department, same deputy minister, same communications director, same mistake, done a day earlier.

Same problem:  This is not legally enforceable today, but the release suggests it is.]

-srbp-

And on the second day, it was more of the same...

[Update:  CBC has provided audio of Question Period in the House of Assembly.  This one is a ram file for Monday's QP. The Hansard transcript can be found at the House of Assembly website, in case you want to follow along.]

According to vocm.com, the Premier developed a concern today about the propriety of asking questions related to the Cameron Inquiry:

Following questioning from Opposition House Leader Kelvin Parsons on what other government officials may have already been subpoenaed, Williams asked the Department of Justice to seek guidance from the Cameron Inquiry as to whether questions pertaining to the ongoing inquiry should be answered in the House.

Other media have reported the same basic idea.

That conversion on the road to Damascus lasted only long enough for the Premier to turn up on Out of the Fog on Tuesday evening to discuss...wait for it...the Inquiry and, among other things related to it, the testimony of some of his former ministers. 

Out of the Fog is the local Rogers community access channel show.

No word so far on what Madame Justice Margaret Cameron's answer to the query or if the query has even been relayed.

As with Day One, the Premier played many parts and displayed different moods.  He displayed agitation when asked about the number of people with government who have received subpoenas to testify at the Cameron Inquiry.

The Premier also got a bit annoyed with suggestions that the head of the Cameron Inquiry liaison team (CILT) might be in a conflict of interest since he was involved in handling the issue in his capacity as Clerk of the Executive Council up to last year when he was appointed to head the liaison team and serve as acting deputy health minister.

It will be interesting to see what Madame Justice Cameron responds to the question about public comment on her inquiry.  After all, if she says nothing or declines to direct the Premier, he will take that as a green light to say what he wishes. If she points out that ministers should be restrained in their comments, that will be an excuse to say little if anything in answer to questions that the Cameron Inquiry may not ask.

Then again, the Premier reminded everyone yesterday he is a lawyer and tends to think of these issues differently from other people.  If that was really the case, then he would have refrained from commenting much earlier  - like say before Day One - and kept his ministers in check much earlier.  If the gags go on now, people might wonder why it is that he suddenly remembered legal niceties only after he'd finished saying what he wanted to say.

-srbp-

And on the first day, he was highly agitated...

Premier Danny Williams didn't look very refreshed from his extended southern vacation when he faced questions in the House of Assembly.

In fact, he looked as pinched an angry as he usually does when he doesn't have absolute control over an issue.

Monday's Hansard is online and it makes fascinating reading.  Too bad there isn't video to go with it. overall, Danny Williams played two roles, that of defence lawyer to government and as witness.

He's done the defence lawyer thing before on other scandals and crises.  The big difference in this case is that he's also acting as his own lawyer for some of it.  you can tell those parts because they contain lots of explanations of how tough the job is, how many messages they get in the run of a day - this will be important in a second -  all the righteous indignation and the best rage he can muster.

That's the bit where he raised what is colloquial known as a red herring.  Others may know it as a non sequitur, an unrelated bit of stuff.  Ross Wiseman did it last week, likely on direction from the senior Crown counsel in Florida.  The counsel took up the line himself yesterday talking about an internal memo on the health labs that we know from the evidence presented thus far, never made it out of Eastern Health. 

The two are completely different, though.  Williams ties that earlier situation with his own situation where his office knew about the problems apparently before the minister did.  The idea of such a tactic  - the non sequitur - is to muddy the waters a bit, to raise reasonable doubt where there may not be reasonable doubt on the face of it. Defence lawyers are good at raising doubt and Williams gave it his best shot yesterday.

The lawyer/premier portion of the pre-inquiry testimony also included the now-standard "Get Out of jail Free" card:  Danny Williams will take personal responsibility for anything done or undone, except for illegal acts.  In other words, your job is safe.  Don't worry about the public criticism of your actions or anything else, for that matter,  you will have a job.  He used it when Tom Rideout was revealed to have been renting a house in Lewisporte contrary to House spending rules at the time.  It reminds people, though, that the ethical benchmark for the Williams administration is far as far can be from what they thought they were voting for in 2003.

In other places, Williams is giving evidence, as a witness.  It's sort of like pre-discovery since Williams is speaking on the public record but before he testifies for real, under oath before the Cameron Inquiry.  That's the part where Williams' memory of a very significant event fails utterly.

It's a problem that seems evident already with John Ottenheimer. 

"I cannot remember...".  I have no recollection.

That doesn't mean it didn't happen, he reassures;  it only means he can't recall.

And that's where the busy-ness of the office comes in.  In the sequence, it came after the failed memory, but the purpose is obvious:  it sets up the explanation for the failed memory in a fashion which is plausible even if some are already dismissing it as improbable.

It is context, to be sure and potentially relevant context, but it is a form of defence that is bound to come back again and again right up until the time the Premier responds to the subpoena he'll almost surely receive to give evidence at the inquiry.

It also reduces serious government business to the same status as other less serious stuff.  Likening the first word of the breast cancer thing to remembering on what specific day he attended the swearing-in of a back bench MHA is an example of that. Clayton Forsey - the guy who got mentioned likely because he won Roger Grimes' old seat - is not a routine thing but compared to the scandal, we pretty much all are.

There's plausible denial and plausible explanation and reasonable doubt.

Then there's beggaring credulity, let alone the imagination.

For those who do not know, your humble e-scribbler worked for seven years in the Premier's Office.  It is a busy place. The pressure can be intense at times. But the huge volume of information flowing through the office and the busy nature of the place is why the Premier has a staff.  Not just two or three people but a dozen or more, depending on the administration. There are others in the government offices, especially in the Executive Council, who are busy too but whose job is, in part, to assist the Premier in discharging his responsibilities.

Their job is to filter information and any competent Premier relies on a competent staff, a staff that can tell the difference between the request for a birthday message for Aunt Minnie who just turned 100 years of age or a congrats letter for the local basketball team from  word that as many as 1500 people may be affected by something going on in the local health authority.  The first two wouldn't cross the premier's desk, typically. 

The last one?  It would cross his desk, flash on his e-mail screen, come through the telephone, or be subject to a verbal briefing from the senior staff - chief of staff and director of communications - if not all three.  Given the evidence presented thus far at the Cameron Inquiry, the Eastern Health issue was certainly at that level of concern.  Otherwise, it wouldn't have been flashed to the most senior bureaucrat in the government and, around the same time, to the two most senior officials in the Premier's Office.  People passing that information - senior and with Queen's Park experience, like say Carolyn Chaplin  - would expect that the information was passed to The Boss without undue delay.

Those e-mails, entered already as evidence, are warnings of a significant issue.  They are both understandable and evidence of people who know their jobs well.

A subsequent e-mail from Chaplin warned that the issue was now not as urgent as earlier understood. It is most emphatically not - and let us be absolutely clear on this -  a direction to stand down.  The afternoon e-mail from Chaplin is not an Emily Litella admonition to "never mind".

To be clear on the point, let's quote two e-mails in their entirety.  First, there is one from the assistant secretary to cabinet for social policy to the Clerk of the Executive Council:

»> Gary Cake 7/19/2005 10:32 AM »>
Robert!
Carolyn Chaplin just called from RCS to provide a heads up that a major story will break from the Eastern Health Board as early as this Thursday! but more likely next Monday.

The Eastern Health Board has recently discovered errors in its breast cancer testing program. This matter affects clients who were subject to breast cancer testing from 1997 to April! 2004. I understand that an estimated 1200 to 1500 clients will need to be retested. The Eastern Health Board is currently working on a strategy for communicating this news to affected clients and the public at large. Legal advice is being engaged in this process.

HCS will be advised of the communications strategy.

briefing note is currently being prepared.

Carolyn has also alerted Elizabeth to this matter.

The first sentence conveys the urgency of the issue:  this is significant and may become public a mere two days hence.  19 July was a Tuesday.  He then describes the issue, concisely, as it was then understood. He also discusses the standard responses:  drafting of a communications strategy, engagement of legal counsel and preparation of a briefing note for the minister and presumably the whole cabinet including the Premier.  The last sentence advises that the Premier's communications director was also aware.

Now, let's look at Chaplin's e-mail about four hours later:

From: Chaplin, Carolyn
Sent: Tuesday, July 19, 2005 2:37 PM
To: Cake, Gary
Cc: Abbott, John G. [deputy health minister]
Subject: Re: Update - Eastern Health Matter

Further to this morning and incoming information this afternoon, no action is required at
this time. We have arranged a briefing with the health authority for the latter part of
this week and will be in a better position to forward relevant briefing materials at that
time. No public announcement will be forthcoming this week and there is a possibility that
the significance of any announcement will be minimized.

Carolyn Chaplin
Director of Communications
Health and Community Services

The first sentence advises that no action is required, but only "at this time."  It then describes, generally, the reason for the reduced urgency.  Not eliminated urgency - as in "stand down" - but reduced urgency:  "No public announcement will be forthcoming this week...", but more information will follow.

In other words, things are not going to happen on Thursday.  Instead, action has been delayed pending a briefing from the health authority at which time the department would be better able to advise higher authorities of the issue and possible actions.

Take a look at the actual words and you see something dramatically different from the way the Premier has characterised it and the way other officials have described it.

Danny Williams' performance in the House of Assembly yesterday was of the type we've come to expect of him when he's under pressure:  excited, full of threats and admonitions of caution. He played many roles, consistent with the varied roles he has in this matter.  He covered many bases, some of them quite well.

The political problem for Williams is that for the first time in his administration, he cannot control the flow of information and the interpretation of events. That is the major political problem he faces.  If he is as agitated on the first day, it will be fascinating to see if he can sustain that intensity and if his version of events stands up to scrutiny.

That will determine the future of his tenure as Premier.

-srbp-

Some uncomfortable truths

Some years ago, as the story goes, one crowd of local political staffers branded some of the crowd from another party that ousted them as the Four Horsemen of the Apocalypse.

It's all fun because no one lost an eye.

And it's also funny to see someone else make a crack about your humble e-scribbler and a local posse.

Well, you don't have to ride a horse to recognize the stuff that comes out of the back end of one.
Take, for example, this comment from another corner of cyberspace:

However the federal government still reaped the main share of revenues from provincial resource developments through a combination of federal tax increases and equalization savings. As well for a couple of years the feds lifted the equalization ceiling (2000-2002). The introduction of equalization protection mechanisms acknowledge the issue but it did not address the fact that more had to be done to ensure equitable sharing of our resources. Notwithstanding this, the Province did not recieve [sic] the full benefit of the government revenue from these offshore resources as equalization offsets resulted in the lionshare [sic] of the fiscal benefits going to Ottawa. That did not change from 1990 to 2005 and the campaign for fairness failed as well. [Emphasis added.]

Let's tackle the nonsense in order. 

First there's the claim that the "main share" of revenues, from oil development incidentally, supposedly go to the Government of Canada.  Related to that is the idea that the "lionshare" of fiscal benefits go there as well.

To find the facts, one need look no further than Wade Locke's assessment of net cash flows accruing from offshore development. 

The slide at right came from Locke's public presentation about a year ago on what constituted a "fair share" for the provincial government of offshore cash.
Take a hard look. 

Of all cash flows, the federal government takes the smallest in each case, except Hibernia.  In that case, it is only 1% above the provincial share and then only by virtue of the 8.5% invested to keep the project alive in the first place.

As a share of government cash flows, the provincial government takes 72% of Terra Nova flows and 73% of White Rose flows.  That doesn't include any revenues from the White Rose extensions. In Hibernia, and leaving out the federal equity stake's 4% of cash flows, the provincial government takes 53% of government's share.

By no measure is the the federal share the "main share" or the "lion's share."

Second, let's take the comment about "the full benefit" of the government revenue.

That is a reference to the idea that by gaining more of its own revenues, a provincial government loses money under the Equalization top up scheme. Of course, that is exactly the way Equalization works. Gaining more own-source revenues is exactly what Clyde Wells was referring to in a 1990 interview with the Sunday Express:

By doing this, and by having equalization cut this way, we are coming closer to looking after our own needs and we are coming closer to recovering some of the dignity and self-respect you lose when you depend on the federal government for 47 percent of the revenue [in the provincial budget]. 

I can't wait to see the day when we don't get a dollar.

The problem in 1990 was that the best estimates of experts was that the offset formula contained in the 1985 Accord, coupled with the Hibernia project's royalty regime and the price of oil at the time wouldn't produce any improvement in the provincial government's overall financial position. 

In two Sunday Express stories in the fall of 1990, both Wells and then energy minister Rex Gibbons referred to a net gain in provincial revenues of only 30%, as Equalization payments declined.  That was at a time when the economy was otherwise in severe recession and the provincial debt and the economic output were the same number.

The analysis used by Wells and Gibbons wasn't the bleakest, either.  Wade Locke's assessment at the time was that the net gain to the provincial treasury was a mere three cents of each dollar.

We need to compare those assessments made before first oil with the actual experience.  In practice, the situation was substantively different.  Far from merely staying in the same financial place, the provincial government today is bordering on being a so-called "have" province for the first time since 1949 solely due to the revenues flowing from offshore oil projects due to the provincial royalty regimes.

The facts are uncomfortable, but only for those who insist on making arguments that simply ignore the facts altogether.

NSDQ.

-srbp-

Food for thought on LNG: a matter of supply

There are 60 liquid natural gas regasification projects proposed for North America, while the market will likely support only 10 to 12.

One of the major challenges facing the projects, according to Calgary-based consultant Angela Tu Weissenberger, is secure supply of sufficient quantities of natural gas at commercially competitive prices.

Interestingly enough, Weissenberger's latest assessment of the opportunities in north eastern North America doesn't include any reference to Newfoundland and Labrador.  That might have less to do with her knowledge of the project proposed for Placentia Bay as it does about the project's development timeline. 

Proposing something is one thing.  In a market where one in six proposed projects is likely to make it through to construction, maybe the Placentia Bay project doesn't enter the realm of being probable.

-srbp-

"I can't wait to see the day when we don't get a dollar."

One of the latest documents to emerge from the Halifax-based Atlantic Institute for Market Studies challenges many of the assumptions about Equalization and about the relative positions of the provinces across the country.

For example, consider the provision of basic services like healthcare and education:

• Ontario had 2.8 hospital beds per thousand and Alberta 3.30. Manitoba had 3.82 and Newfoundland and Labrador had 4.35;
• Newfoundland and Manitoba had 10.7 and 9.6 nurses per thousand respectively. Alberta had 8 and Ontario 7.1.
• The student-teacher ratio in elementary and secondary schools are 13.6 for Newfoundland and 14.5 in Manitoba. For Ontario and Alberta, the figures are 16.6 and 16.9.
• Ontario has only half the number of judges, in relation to population, as Newfoundland and has by far the fewest of all provinces;
• Total public sector employment per 1000 population in Ontario is 81, Alberta, 83. Quebec, 92, Newfoundland is 105, and Manitoba, 117.

Not exactly what you are used to hearing.

On the issue of provincial leadership, David MacKinnon's speech to the Empire Club of Toronto in February might sound a bit more familiar, but it is worth taking this commentary more seriously than some might at first blush:

Demands from other provinces are also made in wildly inappropriate ways that are little more than political blackmail – a game more easily played in the last few years of federal minority governments. A few years ago Premier Williams came to this club and noted that Newfoundland came into Confederation with a government surplus and now faces major deficits, with the clear implication that the relationship with Canada was the problem.

Conveniently, he did not mention that when Newfoundland entered Confederation it was under the supervision of the British Government due to disarray in its finances and that the only reason it had surpluses is because Canada, then a foreign country, and the U.S. had spent the war years building large military bases on the Island. The omission of those two facts was simply disingenuous.

For the past five years or more, provincial governments in this province - irrespective of political stripe - have emphasised the supposed poverty, backwardness and generally hard-done-by nature of Newfoundland and Labrador.

Simply put, the stories aren't true, especially when measured by standards across the country. The Government of Newfoundland and Labrador outspends ever provincial government in the country on a per capita basis save one:  Alberta. One of the things that the Premier's $10 billion settlement claim misses is that sort of fact.

Successive provincial governments in this province have looked forward to the day when Newfoundland and Labrador no longer qualified for Equalization.  Even in raising the issue of Equalization offsets with the federal government in 1990, then Premier Clyde Wells told the Sunday Express:

By doing this, and by having equalization cut this way, we are coming closer to looking after our own needs and we are coming closer to recovering some of the dignity and self-respect you lose when you depend on the federal government for 47 percent of the revenue [in the provincial budget].

I can't wait to see the day when we don't get a dollar.

The Auditor General recently noted that the provincial government's dramatic increase in public sector spending is built on the volatile foundation of commodity prices that have risen to almost unprecedented heights in recent years.  By the same token as they have risen, they will drop, likely sooner rather than later.

The need for responsible government fiscal policy has been an enduring theme in the three years of Bond Papers and in this anniversary year of the democratic vote to restore responsible government in Newfoundland and Labrador, the need for a fundamental shift in public thinking about public money could not be more appropriate.

Dignity and self-respect are lost when a provincial government depends on substantive amounts of cash from another government to pay its bills. It is beyond irony - if such a thing is even possible - for a government that talks about self-reliance to have, as the centrepiece of its federal policy,  a demand for further billions in Equalization and Equalization-type transfers at the same time that the long dreamt of day of going off the federal dole is around the corner.

It's worth noting in that context that the current provincial administration began its plea for federal cash, in 2003, with a demand that the federal government transfer a sum equal to annual oil and gas revenues for as long as oil and gas revenues flowed.  Even if the provincial coffers would be stuffed to overflowing, the initial demand was for ever more federal hand-outs like Equalization.

While it ultimately settled for a simple cash payment of $2.0 billion, the government's subsequent drive for $10 billion is little more than an effort to keep the federal dependence alive. The tortured logic of the so-called claw backs was never more plain than in premier Danny Williams' October 2004 interview with CBC television. It is no better with the  demand Stephen Harper honour a promise which Premier Williams himself rejected in 2004 and which was the polar opposite of the policy he himself proposed as provincial government policy in the 2005/06 letters to federal party leaders.

The $10 billion demand and its associated Anybody But Conservative campaign is really little more than a political distraction, though.  That point is surely not lost on anyone not living in Newfoundland and Labrador and it is likely being realized by more and more people within the province.

An objective assessment will confirm that Newfoundland and Labrador is on the verge of a truly remarkable change in its economic status.  That change, however, has been built in largest measure on factors beyond the control of any government in the province.

To ensure that status of being a "have" province endures, well, that depends on factors very much under the control of the people who live in Newfoundland and Labrador.  It requires a shift to responsible government and responsible politics and away from the democratic poverty we've borne for too long.

It remains to be seen if the descendents of the people who voted in the 1948 referenda can fulfill their ancestors' dreams.

-srbp-

Yep, it's on the Internet.

Too bad Joan Dawe thinks otherwise.

Crisis response isn't rocket science.

That doesn't mean it's easy but half the battle is won if one merely looks around for possible assistance or advice.  Imagining that your situation is unique, or worse, trying to excuse events after that fact with the "uniqueness" canard is to set your organization up for a fall now and in the future.

Four missteps leaders make when dealing with a crisis, courtesy of Fred Garcia, a well-known crisis response expert, who, it should be noted just conducted a workshop for the Public Relation's Society of America's healthcare specialty subgroup on leadership in a crisis:

1. Ignore the problem: management seems unaware and is surprised by a crisis that others
saw coming, or that they themselves were warned about but chose not to take seriously.
We saw such behavior in the early days of the New Orleans flooding; the Catholic Church
sex abuse scandal; the Ford Explorer/Firestone Tires recall; and when accounting firm
Arthur Andersen ignored numerous internal warnings that it was compromising auditor
independence in its dealings with Enron.

2. Tell misleading half-truths: management tries to misdirect attention by speaking literally
true statements with the intention of misleading, which challenges adversaries or
whistleblowers to uncover the full story. On the first day the Monica Lewinsky story broke
in the Washington Post, President Bill Clinton told MacNeil/Lehrer NewsHour host Jim
Lehrer a literally true but misleading statement: ‘‘There is no sexual relationship.’’ The
media and the President’s critics noticed the use of the present tense, and turned up the
pressure to get the president to address past behavior.

3. Lie: management tells a deliberate untruth with the intention of deceiving. Four days after
telling Jim Lehrer that ‘‘there is no sexual relationship,’’ President Clinton hosted a White
House ceremony during which he told the media the lie that has become the defining
soundbite of his administration: ‘‘I did not have sexual relations with that woman, Miss
Lewinsky.’’ The lie challenged his critics and special prosecutor Kenneth Starr to seek
evidence to prove the relationship. When the evidence surfaced, President Clinton went
on television and admitted both the relationship and the lie.

Martha Stewart was indicted, tried, convicted, and imprisoned not for violation of
securities laws, but for lying to federal authorities investigating whether securities laws
had even been violated.

4. Assign blame to others: rather than taking meaningful steps to solve the problem,
management tries to redirect attention away from itself and to someone else. When the
Ford Explorer/Firestone tires crisis first became public, Firestone tried to shift blame to
Ford, saying that Ford instructed customers to inflate tires to the wrong pressure. Ford
blamed Firestone for making defective tires. Consumers were left to wonder what would
become of them.

 

-srbp-

Revisiting the Gorge of Eternal Peril

An e-mail from a seasoned political observer prompted a second look at a post original made at Persuasion Business in the summer of 2007.

The e-mail exchange centred on the political implications of sudden discoveries of e-mails previously not thought to exist or of the question of what the Premier knew of the Eastern Health crisis and when he knew it. The notion of credibility came quickly to mind since it is a core concept in public relations and it is certainly a core concept in the entire Eastern Health debacle.

The whole idea is the focus of a post titled "The Gorge of Eternal Peril."

One of the examples cited is a pair of comments made on George Tilley's resignation.  In hindsight, it is remarkable to see how consist Eastern Health and the health ministry have been in trying puffery and palaver when simple straightforward statements would do.  Tilley's replacement taxed the ears of her audience on Thursday with her endless talk of stories being told at the end of the day.

At the end of the day

...it is very concerning that we do not understand the story, and that people are starting to talk to us, but at the end of the day...

Louise Jones needs some serious interview coaching.

Quickly.

One of the ways Eastern Health can help to restore public confidence in its operations is by speaking in plain English about things that are usually masked behind the cold impersonal language of health care bureaucrats.

Or, as in the examples used above, in the meaningless phrases people rely on when they really don't have anything of substance to say.

With some help, Jones could likely find those words that show she gets it.

But she needs help.

One of the other ways in which Eastern Health will restore public confidence is by demonstrating confidence and an understanding of the issues involved in breast cancer screening and what was done about it.

That didn't come out of Louise Jones' interview on Thursday with Jeff Gilhooley.

Rather, we heard a chief executive officer who had plenty of pat phrases on which to reply - at the end of the day - but nothing of substance to say.

The public will likely find it "concerning" that even two years after this issue first came to light, Eastern Health's senior management doesn't understand the simple maxim of disclosure when 300 to 500 patients are involved versus just one. 

It's the same maxim one that applies for the one:  "maximum disclosure with minimum delay".  It really doesn't matter that you don't have exact answers. It matters that you say something and keep talking as you learn new information.

And surprisingly, once there is some disclosure of what is known, people get remarkably good at understanding.  One of the things they can understand - as in the infamous Tylenol case from the early 1980s - is how to distinguish people genuinely affected by the incident from the people who aren't. Reporters learn how to do it and therefore other people do.

The examples of effective crisis management in situations with similar issues pop to mind:

Tylenol.

Toxic shock.

There are  - undoubtedly - a raft of others from the healthcare sector that come close enough to the breast cancer screening problem to serve as a guide to action.

Maximum disclosure with minimum delay.

Keep updating information as it comes in.

No one expects anyone to know everything, perfectly, right at the start.

But they do expect to see action and they do expect to know what's going on.

And "at the end of the day", "it is very concerning" that this aspect of "the story"is "till not understood"by the people who deliver "service" to "clients."

That's okay, though.  The Cameron Inquiry is a lengthy process that may help to drive some rather simple messages home with people who clearly still need to do some thinking about all this.

That's okay, because fundamentally the medium is the message, in this case.

The Cameron Inquiry is a process.

Treatment is a process.

Communication is a process, too.

-srbp-

A pattern of behaviour

Ross Wiseman.

Ross gets an angry phone call or calls from Florida.

He's not alone, most likely. Plenty of people are getting calls. It may be "personal time" but since everything is personal, all the time, to some people, that means you are never really off the job.

See Ross Wiseman turn up at a hastily called news conference to "correct" comments made by someone else which actually didn't need correction since they were accurate in the first place.

In the first instance, see Ross blurt out something about facilities reports, then deny the reports existed and then realize he can't keep up the charade.

In the second instance, there were no leaks but there was the dubious business of characterizing evidence about to come before the Cameron Inquiry before it was actually presented.

In both cases, the Wiseman scrum was a bit of political "spin" management on a story that can't be spun using the ham0fisted approaches of the recent past.

A pattern is starting to develop.

-srbp-

Healthcare Crisis Public Relations - what makes a crisis?

While the specific details of a crisis may be unique, the fact that crises occur and need to be properly managed is a well accepted notion.

Many organizations have some sort of emergency or crisis plan for certain types of events and the literature on the public relations aspects of crisis management is wide. These tend to focus on natural disasters like fires or floods and in more recent times, organizations have become aware of the potential for manmade disasters like terrorist attack.

Oddly enough, there are more than a few organizations  - especially government ones - that seem to miss the examples of policy-related or similar crises and realize they fall in the same general category.

But if one considers the typical definition of a crisis from the crisis management literature, it gets pretty clear the problems at Eastern Health in 2005 fit the bill.  Take for example, the definition of "crisis" contained in Crisis communications in healthcare: managing difficult times effectively, a 2002 publication of the American Hospital Association's Society for Healthcare Strategy and Market Development.

A healthcare crisis is anything that suddenly or unexpectedly has adverse effects on a healthcare organization or its patients, staff or community. (p.7)

The book also contains a useful tool for assessing the type of crisis.  It's not an absolute system but it gives some idea of what the problem is and, as the book subsequently lays out, the sort of responses that experience shows work more effectively to:

• respond to the crisis;
• maintain or restore public confidence; and,
• restore normal operations.

The following table is adapted from the assessment tool with some wording changes to save space.

Assessing the severity of a crisis

	Level 1	Level 2	Level 3
Geographic scope/duration	Single facility or location	Affects more than one location but for short period	Affects org. or region for indefinite period
Impact on operations	Temporary. Confined to one dept. Normal operations restored within 24 hrs	Significant. Routine operations may shut down temporarily.	Extremely serious. Affected organization may be closed or operate indefinitely at fraction of normal capacity
Employee Involvement	Handled without many problems.  May divert from normal routine	Employees require support from senior management and may require external resources.	Level 2 + Total workforce involved. May need support of healthcare professionals from other organizations.
Regulatory, accreditation,law enforcement impact	Minimal concern.  Phone call or written report may be required.	Appropriate agencies will investigate and may sanction/fine. Sanctions are minimal to moderate.	Sanctions are serious: closure of unit etc.
Public Concern	Limited to parties directly involved in situation	Some public anxiety. Relatives of patients, community residents and others may contact hospital for information on an urgent basis.	Substantial public anxiety. Volume of calls strains normal capacity of organization.
Likely media coverage	Maximum publicity limited to one day of local news coverage.	Regional press plus trade publication.	National and/or international media interest. major newspapers, television, radio, magazines cover issue.

This table is by no means exhaustive nor is it complete.  There is some possibility for overlap from one crisis level to another, however, it is intended purely as a rough guide.  It doesn't have to be perfect.

For our purposes, though, it's interesting to take the evidence from the Cameron Inquiry to date and apply what was known in July 2005 by government officials to this matrix.

There's no question that what occurred at Eastern Health was a crisis.

Geographic scope and duration:  Level 3.  The laboratory problems themselves were confined to one site but their impacts involved patients from the whole province. While the start date for problems was identified as possibly being 1997, there was no indication of how long the problems might last into the future.

Impact on Operations:  Level 2.  The whole hospital wasn't shut but that section of the laboratory was.  Several departments were affected by the situation.

Employee Involvement:   Level 2.  External resources were required - outside labs - and there is no question that senior management assistance was needed in several ways to cope with the incident.

Regulatory, Accreditation, Law Enforcement:  Level 2/3.  There's not enough information to judge the potential impact of these problems on Eastern health's accreditation.  if we add to this section the potential for litigation from affected parties, this one becomes a Level 3 crisis.  A minimum of 100 people seriously affected, all of whom may become party to a lawsuit raises the potential of legal costs stretching into the hundreds of millions of dollars.

Public Concern: Level 2 - Eastern Health clearly anticipated some anxiety and a volume of telephone calls from patients and relatives that may affect operations.  In practice, Level 3 - the incident caused significant public anxiety over a prolonged period.

Likely media coverage:  Level 3.  A story involving breast cancer, testing problems and hundreds of people couldn't be kept local if money changed hands.  It's big and everyone knew it was big from the outset.

Now that we've established that fairly obvious point, in our next posting in this series, let's look at a typical set of crisis responses and compare them to what senior officials at Eastern Health and the provincial government decided to do.

-srbp/tpb-

Implausible deniability

Briefing notes.

Briefing books.

The Cameron Inquiry on Hormone Receptor testing is hearing about briefing notes for ministers.

There are several different types but all have the same basic function:  they concisely convey information to a minister on a major issue or an aspect of his or her department.

Here are two types:

1.  The Hand-Over Book.  This is the set of notes covering the department, its legal authorities, responsibilities, organization, budget and everything else a minister needs to know.  They are given to ministers when they take over.  This type of briefing, often accompanied by one or a series of meetings are intended to orient a new minister to his or her responsibilities. This "book" is updated whenever there is a ministerial change.  The biggest version is done for a new administration but every time there's a new minister, the book is brought up to date. It is handed over from one minister to the next.

The notes are prepared by a senior departmental official, based on information collected from whatever sources are relevant. 

2.  House of Assembly Minister's Book.  This binder contains short notes on major issues likely to come up in the House.  Each issue-specific note includes likely questions along with suggested answers, major talking points.  There may be detailed background but most of the notes in this book give the basis for the rapid exchange in the House of Assembly and with reporters.

The Distribution List:  House notes aren't limited to just the minister.  They get wider circulation to ensure everyone is on the same wavelength.

Typically, the House Book notes would be distributed as follows:

• Minister
• Alternate Minister (a cabinet minister who may be required to fill in should the lead minister be absent)
• The Premier's Office (Distribution within this office varies by administration)
• Minister's Office (a copy for the permanent office file and the minister's personal records)
• Departmental Communications Director
• Cabinet Secretariat (Both for record-keeping and to ensure the Clerk and other key appointments are on the same wavelength as ministers.)
• Departmental Deputy Minister

It's highly unlikely that the breast screening issue didn't get a fairly large amount of discussion at the top floors of the East Block (8, 9 and 10) very early on and that the overall response wasn't discussed at those same levels early on, as well. The issue crosses over a number of departmental lines, including Justice (litigation liability) and Finance (cost of shipping test work out of province and possible costs to fix problems, plus liability costs).

-srbp-