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As Danielle Smith sets out to overhaul healthcare leadership in Alberta, some health professionals are concerned about health system stability.

Update: Alberta premier charts rapid healthcare reform

Alberta Premier Danielle Smith acknowledged the coming months will be “bumpy” as she seeks to rapidly reform healthcare leadership in the province ahead of an election in May.

“It’s going to be a bit bumpy for the next 90 days,” Smith said in a speech to Edmonton’s chamber of commerce. “I know that it’s perilous to try to reform an area this big this close to an election, but we must do it.”

Smith succeeded Jason Kenney as premier and leader of the United Conservative Party in October, promising to restructure Alberta Health Services and the role of the province’s chief medical officer of health.

“We have far too many managers and consultants and not enough frontline staff,” Smith said at the UCP annual general meeting. “Most of those managing AHS today are holdovers from the NDP years; they have had their chance to fix this bloated system and they have largely failed on almost all accounts.”

Smith has also promised to forbid discrimination based on COVID-19 vaccination status, seek legal advice on pardoning people who have broken public health rules, and never reinstate pandemic restrictions on businesses and schools.

Representatives of medical and nursing associations have stressed the need for stability as the province faces seasonal surges in respiratory illnesses.

However, Smith said that keeping things the way they are is not an option.

“I believe that Alberta Health Services is the source of a lot of the problems that we’ve had. The experts let us down, so I’m not interested in taking any advice from them,” she said following the AGM. “There has to be some accountability for what happened over the past two and a half years.”

Revamping Alberta Health Services

Smith has replaced the 12-member AHS board with an interim commissioner, John Cowell, who will report directly to her until a new board is named.

This is the second time in a decade Cowell has helmed the health authority. In 2013, he took over as the official administrator of AHS following the elimination of five senior executive positions. Cowell is now charged with reducing wait times for ambulances, emergency care, and surgeries.

According to Health Minister Jason Copping, the interim commissioner role “provides a dedicated full-time focus to issues instead of a part-time strategic board.”

Smith has blamed the former board for mishandling the province’s COVID-19 response by failing to deliver on a government directive to increase the number of intensive care beds.

“What happens in a business, when they fail to meet targets and they fail to meet direction, you change the management,” Smith said after her swearing-in as premier.

The premier has also linked ongoing staffing problems with AHS implementing a vaccine mandate for workers, even though 97% were fully immunized when the order came into force in December 2021, and the mandate lifted only a few months later in March.

“I think that the staffing shortages have been manufactured by the bad decisions at Alberta Health Services,” Smith said at the UCP AGM. “Once the world knows as well that we aren’t going to have vaccine mandates, I suspect that those who have been fired in other jurisdictions will know that they will have a home here.”

At least one member of the AHS board resigned ahead of the firings, citing concerns that Smith’s proposed reorganization “will further destabilize the workplace environment for all healthcare workers.”

Other former board members have criticized Smith’s “warped stance on COVID,” and noted the board has little influence in decisions about the allocation of hospital beds or enforcement of public health orders.

Leadership at the health authority has been in flux since its creation in 2009. The organization had six CEOs in its first six years of operations and is seeking a new CEO to replace Verna Yiu, who left the position in April.

Alberta’s health system “needs all the calm we can manage, not more chaos,” said Fredrykka Rinaldi of the Alberta Medical Association in a statement. “New ICU beds will help but we are short of staff to care for the patients who may use those beds.”

Rethinking the chief medical officer

In addition to firing the AHS board, Smith has replaced Chief Medical Officer of Health Deena Hinshaw with Mark Joffe, a senior official with Alberta Health Services, who will hold the role temporarily until Smith announces a permanent replacement.

Joffe will continue in his roles as an AHS vice president and medical director as he takes on the role of chief medical officer. He will not be additionally compensated for the new position, according to the government.

“I appreciate the work that Dr. Deena Hinshaw has done, but I think that we are in a new phase where we are now talking about treating coronavirus as endemic, as we do with influenza. So I will be developing a new team of public health advisers,” Smith previously stated.

Lorian Hardcastle, a health law expert at the University of Calgary, noted that each province approaches the role of chief medical officer differently, with some public health orders coming from provincial health ministers and others coming from chief medical officers with ministerial approval.

In Alberta, the chief medical officer can make public health orders independently, but Hardcastle said the government has dictated the restrictions allowed.

“Should we have an independent decision maker who can speak directly to the public on public health matters and act as a check on government power, or should we leave decisions about whether to shut things down to elected officials? That’s a big debate with firing Dr. Hinshaw,” Hardcastle told CMAJ.

“We don’t really know what [the new model] is going to look like. But the idea of either wiping out the AHS board all at once or wiping out Dr. Hinshaw and her whole team all at once raises the issue of continuity.”

At a forum in Medicine Hat, Smith said she already has a “group of doctors” advising her who have reached out for a meeting with Paul Alexander, a high-profile critic of pandemic restrictions who has called the vaccine a bioweapon. “I’m interested in hearing what he has to say,” Smith said.

Smith’s office didn’t directly answer who is advising the premier or why she wants to hear from Alexander but said the premier will announce a group of “qualified and diverse group of medical experts” after a vetting process.

Courting controversy

Smith has been criticized for echoing misinformation and fringe views on the pandemic from her first day as premier.

In her first press conference, she described unvaccinated people as the “most discriminated-against group that I’ve ever witnessed in my lifetime.”

Despite calls to apologize, Smith stood by the statement, but clarified she did not intend to trivialize the discrimination faced by “minority communities and other persecuted groups.”

Smith later called for the cancellation of a health consulting agreement with the World Economic Forum – a focal point of pandemic conspiracies about a global cabal of elites resetting society – without explaining why.

Pressed on the issue, the premier explained that she “finds it distasteful when billionaires brag about how much control they have over political leaders,” but did not directly disavow the conspiracies.

Speaking about prohibiting mask mandates in schools, Smith stated that “the detrimental effects of masking on the mental health, development and education of children in classroom settings is well understood.”

Sam Wong of the Alberta Medical Association and others questioned where the premier got that information.

“I certainly have not seen it as a pediatrician,” Sam Wong told Global News. “From a developmental point of view, I don’t think there’s much in the way of issues with masking in schools because a lot of development can happen at home as well.”

Critics also point to Smith’s previous social media posts stating that mRNA vaccines “had no obvious effect on COVID deaths and may have actually increased deaths from other causes.”

The premier’s office did not respond to a request for comment.

Pivot pending?

Some political experts and strategists, however, note that the premier’s actions may prove more moderate than her rhetoric.

“It seems that her caucus and her cabinet are reining her in a bit,” Lisa Young, a University of Calgary political scientist, told CMAJ.

Notably, Smith largely kept Jason Kenney’s cabinet, including Health Minister Jason Copping, who oversaw many of the pandemic restrictions she has criticized.

Contrary to Smith, Copping has said the government would still consider reinstating public health measures in the event of an unforeseen surge in COVID-19.

COVID hospitalizations have been climbing steadily in Alberta with higher monthly numbers this October than during the same period in the two previous pandemic years.

“You can never say never,” Copping said. “If something comes at us, we’ll have to look at it.”

Some observers expect Smith to pivot away from talking about COVID and vaccines as she seeks to expand support beyond her base – not least because the UCP appears to be trailing the New Democrats in recent polls.

“There is a transition that needs to happen from being a pundit and a media personality, and opposition leader, to when you are the premier of Alberta,” Melissa Caouette, a conservative strategist and principal of MC Consulting, told the Toronto Star. “If she does not make that transition consistently and stay there, she will have trouble in the 2023 election.”

Editor’s note: This story has been updated with new developments and additional context for balance. 

Photo credit: hxdbzxy/iStock via Getty

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