Column for July 16, 2006

Health department’s proposed bylaws

make bad situation worse

It is hard to imagine at first blush, but the department of health’s belated, half-hearted attempt to head off future embarrassments like the still-ongoing Gabrielle Horne affair may only end up making the situation worse.

Horne, of course, is the cardiac research specialist whose promising career was derailed four years ago when officials at the Capital District Health Authority took the unusual step of varying her medical privileges on an “emergency basis,” effectively ending what had been described as a globally pioneering research program.

Although the initial reasons cited for this drastic measure had to do with patient safety and research ethics, those excuses were exposed for what they were within days of the initial edict. Instead, it appears — as should have been clear from the outset — that the case against her revolves around professional jealousy and personality conflicts.

Many things went horribly wrong in the Horne case, including, most obviously, the disciplinary process the hospital used to try and resolve it. That process has still not settled the dispute, nor accomplished anything of significance beyond significantly running up the health authority’s legal bills. (The latest on the Horne case itself is that the most recent attempt to reach a settlement between the parties has failed, and the health authority board has — finally — scheduled a full-fledged hearing on the case for early September. Given the “volumes and volumes” of material accumulated over the past four years, including a recent 500-page report from the privileges review committee, Horne says it will be “a daunting task to try and fit the case within the three days” set aside for the hearing.)

Although no one will admit it, Horne’s case — and another similar one involving oncologist Michael Goodyear, also still unresolved — prompted the health department to review its medical staff (disciplinary) bylaws last year. In May, it circulated its proposed amendments for review.

What is surprising — stunning, really — is that those proposals, in the words of a recent letter from the Canadian Association of University Teachers to the Minister of Health, “would exacerbate problems, not resolve them.”

One of the biggest flaws in the handling of the Horne case, for example, had to do with timelines. The existing bylaws include strict deadlines for various review committees to deal with allegations against a doctor, but those provisions were largely ignored in the Horne case. The result is that a process that should have been completed within a month is still festering almost four years later.

The department of health’s proposal to deal with this issue? “The chair of any committee,” its draft bylaw reads, “has in their sole discretion the absolute authority to vary such timelines as he or she sees fit.”

Huh? Instead of ensuring a speedy resolution of disputes, such an amendment would effectively, arbitrarily and unilaterally allow the hospital to drag out the process forever.

Perhaps not surprisingly, members of the district medical staff association rejected that proposal, endorsing — by a vote of a 148 to 7 — their own alternative, which requires mutual consent to change the timelines, with the proviso that if the hospital or individual making the allegations can’t meet the required timelines, “the physician should be reinstated pending the ultimate outcome.”

There were other problems with the Horne process too, including the fact that the health authority claimed its own CEO didn’t have the authority to sign off on a “full and final” settlement with Horne after he had done so in the presence of an arbitrator and the board’s own lawyers, and the lack of adequate medical staff representation on the oversight committees dealing with such clearly professional issues.

The health department’s proposed bylaws don’t address those concerns either.

“The big question,” suggests Dr. Kenneth West, the Secretary-Treasurer of the District Medical Staff Association, is why the department came up with “such a problematic document.”

A good question. As is the question of why the Horne case still hasn’t finally been resolved.

Too bad there aren’t better answers.

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