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As Alberta Pushes Private Clinics, Surgeons Allege Conflict of Interest

A whistleblower complaint obtained by The Tyee slams a top public health administrator. First of two.

Charles Rusnell 8 Jan 2024The Tyee

Charles Rusnell is an independent investigative reporter based in Edmonton.

Six weeks ago, Alberta Health Services appointed head and neck surgeon Dr. Daniel O’Connell to a senior administrative position.

O’Connell had served as the interim head of the authority’s ear, nose and throat, or ENT, section in Edmonton for nearly two years.

His permanent appointment means he will continue to wield influence over where patients are seen and ultimately undergo surgery — in a province where private clinics and surgical facilities are rapidly expanding.

But more than a year before AHS permanently appointed O’Connell, the authority knew that five of the surgeon’s Edmonton colleagues had accused him of using his position to benefit a private clinic, of which he is part owner.

The allegations, contained in a confidential whistleblower complaint obtained by The Tyee, are unproven and still under AHS investigation.

The 13-page complaint, dated Nov. 21, 2022, details an alleged pattern of conflict of interest, secretive, dismissive and authoritarian behaviour by O’Connell. The complainants allege O’Connell used his authority, to their detriment, to support and promote the private delivery of surgery and clinical care, including at the Canadian Cancer Care, or CCC, clinic in Edmonton.

O’Connell is prominently featured on the clinic’s website, and sources say he owns about five per cent of the facility.

With a few exceptions, every head and neck surgeon with AHS operating privileges is part of the ENT section, which means most, as part of their employment contract, also teach in some capacity at the University of Alberta’s faculty of medicine and dentistry. Some surgeons perform surgeries in both public hospitals and private surgical facilities, and some surgeons are part owners of private clinics and surgical facilities.

Five surgeons’ allegations

The whistleblower complaint alleges O’Connell initially failed to disclose his relationship with the CCC clinic and, without the complainants’ knowledge, patients were directed from the public system to the private clinic.

It is also alleged O’Connell arbitrarily reduced hospital operating room hours for a senior surgeon and appointed one of his clinic business partners to a senior administrative position at a hospital without any competition.

O’Connell is also accused of blocking the hiring of a talented, highly trained young surgeon and academic who preferred to work in the public system.

Dr. Daniel O’Brien told The Tyee that O’Connell not only blocked his hiring but also arbitrarily refused to extend his University of Alberta Hospital privileges.

O’Brien said that within a week of the refusal, one of O’Connell’s CCC business partners tried to recruit him to work in the CCC clinic.

The surgeon/academic research job, for which a committee had recommended O’Brien, still has not been filled.

After months of waiting to be hired, O’Brien gave up. He and his wife, University of Alberta PhD student Andrea Dekeseredy, and their young son now live in Omaha, Nebraska.

“I recognize that we are probably not coming back,” O’Brien said. “We would very gladly have taken less to stay because we were very happy to be there.”

O’Brien was one of the complaint’s five signatories. The other four — surgeons Hamdy El-Hakim, Jeffrey Harris, Hadi Seikaly and Erin Wright — declined to comment because the matter is still under AHS investigation.

O’Connell declined an interview request and instead directed The Tyee to an AHS spokesperson, who, in an email, said: “Internal investigations are active and ongoing, and AHS will take all necessary actions following the investigations.”

Headshot of a white man with short reddish hair and blue eyes, wearing a blue and white patterned shirt, red tie and grey jacket.
After serving as interim head of the ear, nose and throat section in Edmonton, surgeon Daniel O’Connell was permanently appointed to the role by Alberta Health Services despite a year-old complaint against him, still under investigation, by five surgeon colleagues. Photo via CCC website.

“This is not trivial; this is serious stuff,” said former University of Calgary adjunct professor Steven Lewis, who reviewed the complaint at The Tyee’s request.

“If you have someone who is a program head in the public system, who is also a shareholder and beneficiary of work that is decanted to the private option, it seems to me that person is in an inherent conflict of interest.

“And if AHS ever did or still does permit it, then it strikes me as an ethical lapse. I don’t see how that would pass muster in any enterprise — public or private,” said Lewis, who has more than 45 years of health-care policy and consulting experience.

Under the AHS whistleblower bylaw, the investigation should have been completed within 120 days.

University of Calgary health law professor Lorian Hardcastle said no one should have been appointed to that position until the outstanding conflict of interest allegations had been dealt with.

The complaint, said Hardcastle, highlights what health policy experts anticipated would be ethical and commercial conflicts created by the United Conservative Party government’s rush to expand the privatization of surgeries.

In 2020, the government of then-premier Jason Kenney announced a massive expansion of chartered surgical facilities. It claimed they were needed to address the surgical backlog created by COVID in public hospitals.

Hardcastle said the government has “fed a storyline” to the public that it doesn’t matter whether their surgeries are provided by a public hospital or private surgical facility, since they are both publicly funded.

“I think this will illuminate for the public that that is not the case,” she said. “There are significant financial interests at play in these clinics. And the public should be concerned if decisions are being made with these private clinics in the back of someone’s mind.”

Headshot of a white man with short brown hair and brown eyes, wearing a blue and white patterned shirt, blue striped tie and dark blue jacket.
Daniel O’Brien, one of five surgeons who signed the whistleblower complaint against O’Connell, claims the ENT administrator used his power to block him from making a career in Alberta’s public health system and so he moved his family to Omaha, Nebraska, to pursue his academic and surgical work. Screenshot via CHI Health.

The complaint says doctors first confronted O’Connell in a March 2022 meeting about his association with the CCC clinic.

O’Connell denied “any formal relationship” with the clinic, the complaint states. But later the same day, he admitted in an email he did have a “formal relationship.” He acknowledged the AHS conflict of interest policy and promised to remove himself from decisions related to the private clinic.

But the complainants allege that, to the contrary, O’Connell has acted as “an intermediary on behalf of the CCC clinic,” and he continues to make and support decisions that directly benefit the clinic and its employees.

Private clinic ‘monopolized’ referrals, say whistleblowers

Every ENT surgeon with operating privileges is part of what is known as the zone section. Some work in private surgical facilities and clinics as well as public hospitals.

In June 2020, the ENT section discussed transitioning to the AHS Facilitated Access to Specialized Treatment, or FAST, referral program.

The FAST program essentially creates one large pool of cases. They are supposed to be equitably triaged among surgeons based on various factors, including the length of the surgeons’ wait-lists and the type of surgery needed.

The complainants say they subsequently learned the CCC clinic had joined the FAST program at least three months earlier and had been “directing adult and pediatric referrals exclusively to their clinic physicians, thus monopolizing the potential referral source to their advantage, and to the detriment of the remainder of the section.”

The complainants said neither O’Connell nor anyone else at the CCC clinic disclosed the “monopoly” on referrals, behaviour which some of the complainants called “predatory” in a meeting.

At a February 2021 section meeting, “the CCC Clinic surgeons confirmed the situation, blaming an ‘administrative error’ for the practice,” the complaint says.

But after the complainants joined the FAST referral program, they allege, O’Connell used his authority at least twice to remove surgeons not affiliated with the CCC clinic from triaging roles.

Asked about this in a meeting, O’Connell blamed the surgeons’ removal on the FAST program. But, according to the complaint, FAST officials said it was O’Connell who directed them to remove the non-CCC surgeons.

And the FAST officials said O’Connell told them he had discussed the decision to remove the two surgeons with them before they were removed. Both, however, denied any such discussion took place.

The complainants allege O’Connell used his position to cut operating room resources for some surgeons while encouraging surgeons to work for private surgical facilities.

“Dr. O’Connell has on numerous occasions used section meetings to state that if any section surgeons would like to move part of their surgical practice into a chartered surgical facility, that they should contact him directly to discuss this further,” the complaint states.

O’Connell mentioned a specific private facility and that “the CCC clinic, or affiliated surgeons, has purchased, or agreed to purchase, an interest in this surgical facility.” The complaint says O’Connell refused to disclose if anyone from the CCC clinic owned the private facility.

In September 2022, O’Connell cut operating room time for Dr. Erin Wright, a senior surgeon, when data didn’t support it.

O’Connell claimed he discussed the operating room time reduction at a private meeting with Wright and Dr. Jeffrey Harris, and later with operating room administrators. But neither Wright nor Harris nor any of the administrators recall any such discussion with O’Connell.

Chain of command appointments challenged

Dr. Raiyan Chowdhury is a major partner in the CCC clinic. On Dec. 6, 2022, O’Connell informed a section meeting he had appointed Chowdhury as interim ENT section site lead at the Leduc hospital.

O’Connell made the appointment, the complainants said, without a formal hiring process and no other surgeon was given an opportunity to apply.

“This appears to be an example of leadership appointment by cronyism related to financial and personal relationships within the CCC Clinic group,” the complaint states.

At that same Dec. 6, 2022, meeting, O’Connell announced he himself had also been appointed as acting facility chief of surgery at the Leduc hospital. The complainants said that meant Chowdhury would report directly to O’Connell, his CCC business partner, and both would effectively control operating room time scheduling at the Leduc hospital.

“We are deeply concerned about the fairness of the distribution of these operative resources to non-CCC clinic-affiliated surgeons, as the Leduc OR Site appears to be functioning administratively as an extension of the CCC Clinic,” the complaint states.

Both Hardcastle and Lewis independently noted the whistleblower complaint contains no reference to patients.

“A lot of what is being discussed in this complaint is who gets what OR time, who gets what schedule, who gets promoted, and missing in all this are the patients,” Hardcastle said. “I think this illuminates how, when we embrace for-profit delivery in these kinds of facilities, issues like this can overshadow issues around quality and safety of health-care services.”

On the phone from his new home in Omaha, O’Brien said the problem goes far beyond the obstacles he said were thrown in his way because he preferred not to perform surgeries at a private clinic.

“I don’t know how you fix this process, how you fix the system. But when people are leaving, not because they want to but because there is no opportunity, it just sucks even worse.”

More on O’Brien’s story and decision to leave Canada tomorrow in the second of this two-part series.

If you have any information for this story, or information for another story, please contact Charles Rusnell in confidence via email.  [Tyee]

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