How province kept rein on health contracting, despite what Danielle Smith says

The provincial authorities has for years kept a manus successful the contracting-out of backstage surgeries done Alberta Health Services, contempt repeated comments by the premier and wellness curate that immoderate imaginable issues with procurement are AHS's ain responsibility.

Multiple documents obtained by CBC News amusement nonstop interventions by Alberta's wellness curate into AHS contracting matters, arsenic good arsenic entities specifically acceptable up to springiness the wellness ministry much oversight and power successful recruiting and dealing with backstage contractors.

The RCMP, auditor wide and the authorities itself person launched investigations into AHS contracting successful the aftermath of allegations made by erstwhile AHS CEO Athana Mentzelopoulos, including those successful a wrongful dismissal lawsuit.

Statements of defence from some Health Minister Adriana LaGrange and the bureau accidental Mentzelopoulos was terminated not due to the fact that she was investigating contracting issues, but due to the fact that she was failing to transportation retired her duties.

Both Premier Danielle Smith and LaGrange person insisted respective times successful caller weeks that immoderate improper procurement decisions made regarding chartered surgical facilities would autumn to the wellness bureau alternatively of government.

"This is each interior to AHS. This is each AHS procurement," the premier told reporters connected Feb. 19.

"They were the ones who drafted the directives. They were the ones who went retired and received the bids. They were the ones who chose the proponent. And past they were the ones who were charged with the task of negotiating the presumption of the agreement. The lone relation that the curate oregon authorities had was saying, 'Are you done yet? Have you got to the decorativeness enactment yet?'"

But 4 months earlier the premier's remark, LaGrange issued a ministerial directive that specifically ordered AHS to widen a declaration with an Edmonton backstage country clinic, and laid retired the circumstantial country volumes arsenic good arsenic the prices Alberta Surgical Group (ASG) would beryllium paid per process — up to $10,500 for each genu oregon enarthrosis surgery.

According to a transcript obtained by CBC News, LaGrange's directive connected Oct. 18 besides allowed her section to "direct and pb immoderate negotiations that AHS is having, oregon volition have, with respect to immoderate agreements oregon imaginable agreements touching connected oregon concerning CSFs."

In precocious December — weeks earlier Mentzelopoulos was terminated — an Alberta Health elder authoritative wrote to the then-CEO that based connected the directive, the ministry would instrumentality implicit each "due diligence" regarding proponents of projected chartered country centres successful Lethbridge and Red Deer, according to a missive CBC News obtained. 

According to LaGrange's connection of defence, the curate took enactment due to the fact that the ex-CEO was "dragging her heels" connected wellness reforms and the declaration with Edmonton's ASG was acceptable to expire astatine month's end.

With the directive, the curate "intervened and expedited the removal of the declaration with ASG from AHS's oversight" and "to mitigate the evident adverse effects connected patients" owed to determination being nary alternate surgical capableness if ASG's declaration expired.

In LaGrange's ineligible connection and during question period, she's said she had to contented respective directives during Mentzelopoulos's tenure astatine AHS to get the CEO to transportation retired provincial reforms.

But implicit the aforesaid period, the state was making structural reforms to presume power implicit AHS procurement.

In November 2023, erstwhile LaGrange announced the dismantling of AHS into 4 antithetic oversight agencies (and earlier Mentzelopoulos became CEO), the state launched a Procurement and Systems Optimization Secretariat to negociate contracting for those agencies and AHS.

"As portion of the stand-up of the secretariat, definite functions from contracting, procurement and proviso absorption person transferred from Alberta Health Services to Alberta Health," LaGrange spokeswoman Jessi Rampton said successful an email. This transportation has been occurring incrementally since precocious 2023, she added.

LaGrange's procurement secretariat and directives are not the afloat grade of the minister's oregon government's interventions into AHS's contracting with backstage vendors. It's gone backmost respective years, and adjacent respective wellness ministers, to the earlier days of the UCP government.

In 2020, erstwhile Tyler Shandro was wellness minister, the section created a antithetic secretariat. This one, called the Health Contracting Secretariat, had a stated mandate to "advise connected the plan and implementation of innovative procurement approaches, contracts and backing models for objective services with autarkic providers."

CBC News has learned the ministry's secretariat was overseen by a steering committee, composed of elder officials from the ministry and AHS. Several committee briefing presentations and enactment logs obtained by CBC News item the assorted occasions connected which a curate oregon the ministry influenced the contracting process.

In fact, decisions from the secretariat required support from some the AHS committee and curate until March 2021, astatine which constituent the curate lone needed to beryllium "consulted arsenic needed."

But adjacent weeks aft that, a "decision by minister" led to grow the scope of services for a chartered orthopedic country contract.

The papers mentions respective "minister requests." Among them for the secretariat to sermon declaration bidding opportunities with the then-chief of Enoch Cree Nation — wherever 1 contracted installation is slated to beryllium located — to trade process outgo comparisons, and to research the feasibility of a short-term declaration for surgeries successful Lethbridge. 

In a written statement, Shandro confirmed the secretariat gave "advice and oversight" connected contracted surgical facilities, which the UCP had intended to bring successful to assistance little surgical hold times.

"In particular, the secretariat provided marketplace probe to assistance counsel connected concern presumption that would bring predictability and stableness to guarantee that aggregate proponents bid connected RFPs," said Shandro, who was wellness curate from 2019 until autumn 2021.

But according to 1 erstwhile AHS enforcement who was connected the secretariat's steering committee, its relation was much extended and wide-ranging. "The authorities was precise progressive with the full contracting-out process, and the wellness contracting secretariat was their conveyance to determination that along," said Braden Manns, interim vice-president for provincial objective excellence until helium near AHS successful 2023.

"One of its main jobs was to negociate and summation surgical contracting to for-profit surgical facilities. What kinds of services would they declaration out? How would the process of reappraisal happen? What accusation would the reviewers see?"  

Manns, who has been captious of AHS restructuring since leaving the agency, calls Smith's assertion that procurement is each interior to AHS "absolutely false."

The ministry's contracting secretariat continued erstwhile Jason Copping took implicit the wellness portfolio aft Shandro. It would assistance usher AHS arsenic it contracted retired home-care services and immoderate diagnostic procedures.

"Pause imaginable endoscopy procurement based connected curate absorption — prioritize and absorption connected completion of determination CSF procurement(s)," stated a July 6, 2022 briefing to the secretariat's steering committee.

The pursuing week, different steering committee got a debrief of a gathering with the curate which confirmed what benignant of chartered surgical installation AHS would procure successful Red Deer and Lethbridge, and that it wouldn't prosecute a backstage supplier for the wellness portion northbound of Edmonton.

Copping did not reply to a petition for comment.

After Smith replaced Jason Kenney arsenic premier successful precocious 2022, the wellness contracting secretariat continued to oversee AHS procurement.

An interior AHS study successful precocious November 2022 updated officials connected bids for the projected Red Deer chartered country centre. Included successful "next steps" recommended earlier selecting a developer: "Informing Health Contracting Secretariat."

Although it does not look the contracting secretariat had a manus successful AHS's procurement of Turkish ibuprofen and acetaminophen successful 2022, Copping had issued a ministerial directive connected Dec 1, 2022. It ordered AHS to unafraid the medication, and guaranteed the ministry would money the purchase.

Smith and LaGrange person some declared they privation the investigations to uncover if thing went incorrect with procurement.

"If determination is simply a occupation with procurement, it is simply a occupation interior to AHS. This wellness curate is trying to get to the bottommost of it," Smith said during question play past month.

LaGrange called AHS "a large achromatic container that we person not been capable to look into for a precise agelong time, and that has to end."

Alberta Health decommissioned the Health Contracting Secretariat successful mid-2023, soon aft LaGrange became wellness minister, Rampton confirmed past week.

This was months earlier the curate would acceptable up a caller secretariat to gradually presume each contracting responsibilities from AHS.

Rampton did not straight reply a question astir however to reconcile the assorted directives and secretariat-related activities with statements by the curate and premier that the procurement process is interior to AHS.

"By the missive of the law, that's the mode it ought to be, though not needfully the mode that it is," said Tom Noseworthy, prof emeritus successful wellness argumentation and absorption astatine University of Calgary.

A erstwhile AHS enforcement himself from 2011 to 2015, Noseworthy said successful an interrogation that authorities interference successful the agency's operations predates the UCP coming to power, and that helium believes astir of his past colleagues would agree.

"If they're ever honorable with you, they'd accidental hardly a time would walk without immoderate benignant of interference, intervention, a telephone telephone oregon immoderate benignant of occupation associated with Alberta Health riding herd connected Alberta Health Services," said Noseworthy, who was an subordinate main aesculapian officer.

He was disheartened that it's going connected successful procurement, "where objectivity and high-quality owed diligence and non-interference from governmental sources is quintessential," helium said.

"You hazard having governmental choices alternatively than evidence-based choices that are successful the champion nationalist interest."

A government's champion relation is to acceptable wide goals for procurement oregon different functions of a infirmary agency, and systems to support an bureau accountable, but they should debar deeper involvement, said Rosalie Wyonch, pb of the wellness attraction argumentation inaugural astatine the C.D. Howe Institute.

But authorities cannot beryllium afloat removed due to the fact that it's the provincial government's work to administer the nationalist wellness system. "Eventually the subordinate stops with the wellness minister," Wyonch said.

In past October's directive connected chartered surgical centres, LaGrange notes that the Provincial Health Agencies Act allows the curate to "do immoderate happening the curate considers indispensable to transportation retired the minister's responsibilities for the strategical absorption of the wellness system." 

That directive came aft her vexation with the gait of advancement of chartered surgical contracts whose palmy bidders were confirmed years earlier, earlier she was minister.

"All of these contracts are pre-me," LaGrange said successful question play past month. "But, again, I privation to notify everyone that I had to taxable 18 directives to AHS to get accusation and co-operation."