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Comment: Dix needs to listen to health-care providers

Health Minister Adrian Dix uses the findings of adviser Harry Cayton to defend the rapid introduction and approval of Bill 36, but refuses to comment on the contradictory content from the report and snubbing the issues raised by the Doctors of BC.
B.C. Health Minister Adrian Dix speaks at Langara College in Vancouver, on Monday, Jan. 9, 2023. THE CANADIAN PRESS/Darryl Dyck

A commentary by a family physician in Sechelt.

In 2019, Harry Cayton, a non-partisan adviser on professional regulation and governance, was commissioned by Health Minister Adrian Dix to provide a report of an inquiry into the College of Dental Surgeons of British Columbia.

In his analysis, Cayton noted multiple issues (such as registrant confusion of the role of college, lack of transparency of elected officials, loss of democratic process within the college) and proposed changes to the framework of health professional regulation.

The report called for increased accountability for health professionals, improved transparency for the public, and reinforced anti-discriminatory and anti-racism policies.

Fast forward to October 2022, when Dix acted on Cayton’s suggestions and introduced Bill 36 to replace the Health Professions Act.

However, only a small fraction of the bill was debated, as Premier David Eby invoked early closure, denying politicians, health-care providers and concerned constituents the ability to voice their concerns.

Hundreds of sections remained incontestable and it was enacted as the Health Professions and Occupations Act by the legislature.

Dix uses Cayton’s findings to defend the rapid introduction and approval of Bill 36, but refuses to comment on the contradictory content from the report and snubbing the issues raised by the Doctors of BC in 2020.

The Cayton report notes the implementation of such sweeping regulatory changes requires meaningful and extensive consultation, saying consultation “will be needed to ensure clarity and avoid unintended consequences.”

In 2020, Doctors of BC submitted a letter to the Health Ministry requesting that “the Steering Committee and/or Ministry of Health … meaningfully consult with stakeholders as this takes shape and regulations are formulated.”

Such consultation never happened with Doctors of BC.

Dix ignored their concerns and blindsided them by steamrolling ahead with the 600-section bill.

DoBC members were recently notified via email that Doctors of BC “was not involved in the development of the [Health Professions and Occupations Act]. In our two submissions, [Doctors of BC] asked for the opportunity to provide further input into the details of the Ministry’s plans. However, we were not consulted on the legislation itself; the announcement of the 600-page legislation came as a surprise.”

Evidently, Dix snubbed any request for further consultation from the Doctors of BC.

In that same letter, Doctors of BC noted their concern about registrant fees. The minister ignored this concern; under the new act he and his partisan-appointed board can simply establish arbitrary registrant fees.

There was also concern about appointed board and discipline panel members. The minister ignored this too; he can unilaterally dictate the construction of board members and appoint the director of discipline.

Unsurprisingly, that same partisan-appointed director of discipline can independently appoint discipline panel members, consultants, experts, and specialists.

When questioned about the murky and dubious appointment, process Dix answered tersely: “The minister appoints because the minister appoints.”

Evidently, Dix has zero disregard for the concern of potential partisan conflicts of interest in health-care delivery, regulation and reform.

That is terrifying given the recent uncoverings of the cross-border radiation therapy program, bloated health-care administrative costs, questioned lack of transparency within the Fraser Health Authority, and a lawsuit involving Vancouver Coastal Health and Seymour Health, to name a few.

The minister also ignored the concern of partisan conflicts of interest with respect to the complaints and disciplinary processes.

Doctors of BC proposed that “the College should be able to rule on low level complaints” and to “allow for a distinction to be made regarding which complaints are disclosed.”

Similarly, the Cayton report stated: “Publication is a difficult part of the process … Overall, it is difficult to discern any benefit to the public.”

These concerns were also ignored.

The minister can unilaterally make regulations regarding what information must be provided by health-care providers to both patients and the public.

Similarly, a complaint can be filed based on a media or public source and a formal investigation can be initiated even before a complaint has been made against a registrant.

Lastly, a regulatory complaint with personal and protected information can be disclosed to the public.

It is appalling for the minister to claim there was “extensive consultation” when physicians have direct evidence that every invitation for consultation and concern by Doctors of BC was unheard, unappreciated, and ignored.

Health-care providers have also voiced their uneasiness allowing the government to define and influence “false or misleading information.”

Speaking out against policies which lack any scientific basis would hold a health-care provider liable on conviction of a $25,000 fine, six month imprisonment, or both.

Overall, Bill 36 was introduced to the legislature prematurely without a proper, democratic, and collaborative consultation process and completely blind-sided physicians and Doctors of BC.

When discussing the Surrey Memorial Hospital crisis, Dix stated: “What I think doctors said to me, specifically, is they want to be involved, and I want them to be involved because at a detailed level, at a patient level, they have the insights required to make the right decisions.”

What shallow and insincere remarks to make given he stymies any request to engage and discuss the Health Professions and Occupations Act in an actual collaborative process.

The C.D. Howe Institute, an independent, non-partisan, research institute recently published an article discussing the issues of access to primary care, long wait times, and the lack of confidence in the healthcare system.

It noted: “Politicians ignore this public sentiment to their peril. They should … engage the public and health service providers to address these concerns.”

Dix needs to stop the political gamesmanship and listen to health-care providers, not politicians, on how to improve provider accountability while protecting the public and enforcing anti-discriminatory and anti-racism policies.

Will Dix follow his own advice and listen?