Lessons from a scandal; ORNGE affair has shaken the confidence of citizens who expect tax dollars to be treated with respect
For the past eight weeks readers of the Toronto Star have watched with mounting disgust the revelations about ORNGE, the entity created to operate Ontario's air ambulance service. These disclosures have included what appear to be vast overpayments to executives, to lawyers and to others, as well as dubious expenditures on a range of executive perks, including Harley Davidsons, a ski boat and expensive European MBAs.
There is also a series of more troubling questions regarding patient safety. Were the right helicopters purchased from a patient care standpoint? Were dispatch policies based on best patient care or financial requirements? Did any patient die as a result of decisions motivated by financial imperatives?
Once the ORNGE story landed on the front page of the Star, Health Minister Deb Matthews moved swiftly. In less than eight weeks, the board and management of ORNGE have been dismissed and replaced and a large team of auditors has been combing through its records. Ontario Auditor General Jim McCarter, who delayed his report on ORNGE in December to do more work, is set to release his findings shortly. Coroners are reviewing a number of patient cases.
Some lessons can already be drawn about preventing the next ORNGE.
Listen more carefully to front-line staff: Paramedics, who had their requests for air ambulance denied, believed something was wrong. So did those who found the new helicopters a difficult environment for patient treatment. Listening to front-line providers is always essential. At times complaints have no real basis but sometimes where there is smoke there is fire. Complaints from within should not have been dismissed.
Update the sunshine list: The Public Sector Salary Disclosure Act requires annual publication of the pay of vast numbers of public servants, employees of Crown corporations, hospitals, universities and others, earning more than $100,000 per year. As a consequence, a long list of hydro linemen and others who work considerable overtime are swept onto the list. However, ORNGE's related companies were not subject to salary publication under the act. Excluded from salary disclosure are many quasi-public entities that are nearly completely funded by government because of loopholes in the legislation that provide justification not to disclose.Provisions should be expanded to cover all those whose pay is overwhelmingly funded by taxpayers, including doctors whose payments from government are disclosed in other provinces. Arguably, the threshold is too low after 15 years of inflation and should be raised to perhaps $200,000 per year, which would allow a greater focus on managerial pay.
Transparency is a terrific solvent when applied broadly and rigorously. Greater transparency could have alerted the public, the opposition and even the government far earlier that ORNGE was off course. As we enter a period of slower growth in funding for public services and harder choices, the credibility of claims advanced by providers as to their financial needs will be strengthened by greater disclosure.
Competitive bidding: When the government seeks to move a function such as air ambulance to an arms-length organization, there should be competitive bidding. E-Health Ontario provided ample evidence of the additional cost to taxpayers of sole-source contracts. Rules were tightened on contracts but ORNGE, the outsourcing of an entire division, was not put to competitive tender either at the beginning of the process or later on. This was wrong. Where government decides that a private sector or arms-length entity can do a better job, there should be tangible evidence of that improved efficiency. Tendering is well established as the best means of achieving that end.
There are many entities operating at arms-length from government that do so with proper regard for the public interest and the taxpayer dollar. The challenge is to subject all such agencies and arrangements to transparency and competitive bidding that encourages behaviour that is fully in the public interest. A cynic might say that the real problem governments have with competitive tendering is that their friends don't always win.
ORNGE shakes the confidence of citizens who expect their tax dollars to be treated with greater respect. It also breeds the cynicism that has afflicted other democracies such as Greece. When taxpayers do not have confidence they seek to avoid paying the taxes needed for public services. The real and continuing challenge for government is to prove to the public that their tax dollars are being carefully and wisely spent and the quality of their services has not been compromised.
About the Author(s)Michael Decter is a former Ontario deputy minister of health and founding chair of the Health Council of Canada.
Acknowledgment© 2012 Torstar Corporation Illustration: • A paramedic loads a stretcher in an ORNGE helicopter after delivering a patient to Sunnybrook. Some staff found the helicopters a difficult environment for patient treatment. Chris So/Toronto Star
Reprinted with permission of the author
Originally printed in the Toronto Star, Wednesday, Feb 8 2012, Page: A25
Byline: Michael Decter
Anna Di Pietro wrote:
Posted 2012/02/14 at 03:39 PM EST
Very interesting article and some good points are raised. Unfortunately the VOR system is stifling competition as it precludes many small players from bidding.
Faisal Siddiqui wrote:
Posted 2012/02/22 at 02:08 PM EST
Interesting article and like many I feel that this was an avoidable fiasco. The point here is more than the executive salaries alone.
I would like to see more evaluation of the business model of ORNGE, its value addition to the trauma services of various acute care hospitals in the region that ORNGE serves. Have the various trauma programs seen ORNGE as a complementary service that enables timely access to care?
More than transparency, did we build in a mechanism of quarterly or half-yearly audits? If yes, who was responsible and why did we slip on such big spin-offs? Was the governance model of ORNGE such that it allowed for business-prudence and control across functions?
Going forward, I believe that ORNGE can have a self-sustainable model. I would like to share the same in an article shortly.
Alex Franklin wrote:
Posted 2012/03/14 at 01:30 AM EDT
Mr.Decter knows there are juicy perks for Government agents especially when they have a long shopping list.
The satirical press were given a gift with the Ontario purchase of Italian helicopters by ER Doc C. MAZZA..MD(Tor.89).
At the same time Primary Docs are told not to take mugs,pens and scratch pads from Pharm reps. A Pharm-paid CME-Dinner is now a Cardinal sin.
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