Health-care system mired in red tape By: Dan Roberts Posted: 7:00 PM CDT Monday, May. 8, 2023

Opinion

Hey there, time traveller!
This article was published 08/05/2023 (853 days ago), so information in it may no longer be current.

Last July we sent one of our brightest resident doctors away to specialize in neuro-ophthalmology to learn about brain-related visual problems. The local specialist that we all rely on is close to retirement. The young doctor signed a return of service agreement and was set to join us this coming July.

His office support and equipment requirements were carefully identified, vetted and costed, and the request was submitted to Shared Health Manitoba before he left. Because of my experience with this government, I felt compelled to protect this young man by having an escape clause in his agreement that would void his commitment to return if these requests were not approved by the end of 2022.

That date came and passed although I was assured that approvals were forthcoming. With that understanding, the young doctor agreed to wait until the end of March 2023.

To date, no approvals have been provided.

This week I discovered that Shared Health had bumped the request to the Diagnostic and Surgical Recovery Task Force (DSRTF) on March 15 without explanation. The head of the DSRTF has now informed me that the request is complex and will have to go through their stepwise processes.

We’re talking about $100,000 of pre-identified, commercially available equipment, a couple of rooms, a receptionist and a part-time medical photographer.

Furthermore, because our young colleague would be located at Misericordia Hospital, the request process now has to be rebooted from their end.

The young doctor is deeply frustrated and is now looking for another job. Even if these approvals come forward today, nothing will be in place by the time that he arrives.

This kind of situation, repeated again and again, illustrates the profound dysfunction that has been engineered into our health-care system by this government.

This kind of situation, repeated again and again, illustrates the profound dysfunction that has been engineered into our health-care system by this government.

It has been structured into a series of silos: Manitoba Health, Shared Health, the Winnipeg Regional Health Authority and the DSRTF. No one can provide me with an organizational chart or process maps, but I can infer as to their inner workings from what happens when any medical or surgical program submits a proposal to address wait lists or manpower issues to any of these silos.

They languish for six months to two years (personal experience) in a cycle of buck-passing interrupted by demands for revisions and clarifications. Beyond the six to 12-month mark, I’m usually contacted by an entry-level, cheerful bureaucrat in nice business attire who is unfamiliar with the request and needs more information. There is no red tape; only flypaper. And every proposal is a fly.

Beyond the six to 12-month mark, I’m usually contacted by an entry-level, cheerful bureaucrat in nice business attire who is unfamiliar with the request and needs more information. There is no red tape; only flypaper. And every proposal is a fly.

However, if a private business comes knocking at the door, claiming a special elixir, it seems that the only process required is a wink and a nod or perhaps a special handshake.

Agreements emerge in days and are eagerly signed without any scrutiny, transparency or due process.

In the past three years, with the exception of the chief operating officer at the Health Sciences Centre, I have yet to interact with a single executive or leader in any of these silos who takes personal responsibility for an outcome.

People that I worked with for years and respected seem resigned to participate in these charades. I don’t know how many times I’ve heard, “I’ve done all I can” or, “it’s in (another silo)”.

Those who can’t endure the sheer moral injury quietly resign and those who protest get reassigned.

Those who can’t endure the sheer moral injury quietly resign and those who protest get reassigned.

Someone from government or one of the silos may respond to this letter by indicating that my group has received millions in resources and hired 20 neurologists in the past two years. That’s true — but every request followed the same frustrating prolonged pathway that I’ve described.

Virtually every resource appeared within days after my reaching out to the media.

They don’t seem to mind public humiliation. They must be convinced the public either won’t care or won’t remember.

I hope, for all your sakes, that they are wrong.

Dan Roberts, MD, is the acting head of neurology at the Health Sciences Centre.