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In the line of fire

Regardless of political stripe, health minister is one of the toughest jobs going

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Health Minister Erin Selby.

MELISSA TAIT / WINNIPEG FREE PRESS Enlarge Image

Health Minister Erin Selby. Photo Store

Being a health minister isn't a cakewalk even at the best of times.

You don't have to ask current health minister Erin Selby; just ask former ones such as Don Orchard and Tim Sale.

Both sat on different sides of the legislature during their time in office and are the polar opposites in terms of their political views.

Sale, a former NDP health minister, and Orchard, who held the job for the Progressive Conservatives 20 years ago, put their own stamps on the health department for their respective governments.

Both say the job has inherent challenges that are bigger than most people can comprehend. And it can change on a dime when something horrible happens, such as someone dying in an emergency department waiting room or on a doorstep after being discharged from hospital and driven home by a taxi.

Or when a minister puts her foot in her mouth, like Selby recently did when she accused the Tories of doing nothing to prevent the deaths of 12 children during and after heart surgery in 1994.

"It's a minefield day in and day out," political scientist Paul Thomas said. "Something can always blow up in your face."

For Selby, who was promoted to the health portfolio just months earlier, it's the third incident in which she faced intense scrutiny.

12 BABIES:

On Tuesday, Selby apologized for a comment she made two weeks ago about the deaths of 12 infants during heart surgery in Winnipeg in 1994. The remark was part of a bitter partisan exchange with Progressive Conservative health critic Myrna Driedger during a legislative committee meeting.

"We know how things were done when they were in office, Mr. Chair. They ignored problems. They swept them under the rug. And it is hard for me to imagine, but they allowed 12 babies to die and still didn't take into consideration what happened to learn from such devastation that those families went through. It was actually left to us to apologize to those families and to bring in legislation to make sure that that didn't happen again."

An inquiry and a November 2000 report into the deaths did not fault elected officials.

HOSPITAL TAXIS:

Selby was also soundly criticized for a comment she made Jan. 1 that city cab drivers would be given the task of making sure discharged hospital patients make it home safely. It came after the December deaths of two men sent home from hospital by taxi.

"We're making sure that anybody who is sent home by taxi cab, there will be an onus to make sure that that person gets through the front door safely," she said. "It's what families expect. It's what I would expect."

Critics charged that Selby, as health minister, should have been focused more on hospital discharge policy than cab drivers.

A new policy for Winnipeg hospital emergency department patients being sent home by taxi is set to take effect next month, the Winnipeg Regional Health Authority said recently.

STARS HELICOPTER:

The temporary suspension of the helicopter air ambulance Dec. 2 was Selby's first appearance as health minister on a major topic.

"It was on the advice of medical professionals that told us that they had serious concerns about procedures not perhaps being followed," she said at the time.

Selby was soon criticized by the Conservatives, who said the suspension came despite the province being hard-pressed to provide emergency service in rural Manitoba.

Days after STARS resumed emergency flights in early March, the auditor general released a report blasting the Selinger government for ignoring its own procurement rules when it signed an untendered, 10-year, $100-million contract with STARS in 2011.

Sale, health minister from 2004 to 2007, said the portfolio is challenging enough without partisan bickering and uninformed cheap shots from the public.

"It's an immensely complex system," Sale said. "You're talking about more than 30,000 employees involved in the health industry in Manitoba. And in Manitoba, with its 1.2 million people, there are in the order of 10 million contacts between citizens and their health-care system in a given year."

That number of contacts means something is bound to go wrong, no matter how many fail-safes are built in, because it's a system run by humans, he said.

"It's very, very hard to say to anybody, 'we're really sorry, but somebody screwed up in your case.' No one who really understands the system can really say we're going to be 100 per cent error-free. It just isn't going to happen because it's a human system. Somebody is going to make a mistake every day, somewhere. Most of them will not be tragic, but there will be tragedies because it's a human system."

On top of that is media scrutiny -- something the 45-year-old Selby, a former television reporter, knows all too well.

She should count her lucky stars, said Orchard, health minister from 1988 to 1993 in former premier Gary Filmon's Progressive Conservative government.

Despite all the shots against Selby, at least she has the unions in her corner, Orchard said.

"That is the largest challenge that any Conservative health minister ever faces, the unions killing you every time you turn around and the media, seemingly with some enjoyment, carrying all the criticism," he said.

"That creates a background in which it is difficult to administer change in a system that's woefully crying for change."

Brandon University political scientist Kelly Saunders said the Health Department demands an experienced politician who is skilled and savvy enough to deal with a portfolio that touches the lives of every Manitoban, from the birth of a child to a senior waiting for placement in a personal care home.

It's budgeted this year to consume more than 38 per cent of the province's $12.3-billion budget.

"You want to give it to a very seasoned cabinet minister, someone that you trust implicitly and someone that you have faith in," Saunders said.

Selby, first elected in 2007, served for 21/2 years in a junior portfolio (advanced learning and literacy) before being promoted to health minister last October.

"Would she have been my first choice in terms of a solid cabinet minister to give this kind of responsibility to? Probably not," Saunders said. "Her previous experience really didn't suggest that she would be the natural candidate for this kind of challenge."

Thomas agrees.

"A more veteran minister would have fared better than a relatively junior minister," he said.

In the "hand-to-hand combat" that often takes place at the legislature, "(Selby) threw a grenade and it was a bad thing to do," Thomas said, referring to the babies' deaths.

Thomas knows more than most the kind of hurt the reference to the pediatric cardiac surgery deaths caused the affected families. He authored an implementation plan for recommendations arising out of the inquiry into the deaths and met with the affected families twice, witnessing their pain.

"It just shook me to have those events recalled in a narrowly partisan context to counter political points that were being scored from the other side," Thomas said. "I know the emotional ringer those families went through."

Thomas said Selby's predecessor, Theresa Oswald, who served as health minister from 2006 to 2013 and is now minister of jobs and the economy, had grown comfortable in the role and was able to deal effectively with many of the complaints tossed her way.

"She exuded a kind of honesty and empathy for people who had problems in the health-care system," he said.

Saunders said if Selby continues to struggle, Premier Greg Selinger will be forced to shuffle his cabinet once again -- maybe sooner than he'd expected.

"At the end of the day, he's got to salvage a government," she said.

Being a health minister means you take your work home with you every day, Sale said.

"You're forever in this competing priorities game, because there will always be more we can do and not enough money to do it all. It's a brutal process of comparing relative goods," he said.

"Health will always probably have demands that are growing faster than the economy, and so restraining that so it doesn't become not just the elephant in the room, but the only thing in the room, is a very difficult business."

Orchard said the issues in health care today are even more challenging than when he was minister.

"God willing, should the Conservatives win the next provincial election and inherit the bloody mess of the NDP, they're going to have to make some pretty challenging decisions, just as we did in 1988," he said.

 

bruce.owen@freepress.mb.ca

larry.kusch@freepress.mb.ca

Republished from the Winnipeg Free Press print edition April 12, 2014 A6

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