Friday, August 10, 2012

When sweet dreams become nightmares (Musings on health officials & Big Pharma)

Updated 17 Sept. 2012

August's blog is stimulated by disappointment, even disgust, with those associated with health care who turn out to be dishonorable, i.e., liars and thieves who put their welfare above those they serve.

Would be nice to write a cheery, upbeat theme for the dog-days of summer (in northern hemisphere), but recent news items are enough to make me, and I'd guess most readers, gag.

Regardless of your location, the blog has much food for thought because the issues are global. Honest, you could not make this crappy behavior up.

The title comes from a song by Annie Lennox, a Scottish singer-songwriter and political activist.

These events happened in my backyard but I know it could happen where you live and probably has.

The gist of this sad tale is that Allaudin Merali, hired by Alberta's provincial health system (AHS) as CFO in May 2012 at a salary of $425,000, resigned in July after a CBC reporter broke the story of his exorbitant expense claims ($346,208).

The expenses occurred during his previous employment with Capital Health (before AHS was created) as its CFO (Jan. 2005 - Aug. 2008). For interest, a CFO's responsibilities.

Is Merali an outlier? I suspect not. This type of abuse had to be normal for the health system or it would have been flagged and stopped.

The health region's CEO kept signing off, and who knows for how many others pigs at the trough. You know, all the senior political cronies (oink! oink!) our provincial government appointed to make decisions for us, invariably with minimal or no input from health professionals in the trenches.

To think that my colleagues and I would never include liquor in our expenses (makes sense as it's discretionary spending and not allowed). We'd fly the cheapest airfare, as required, despite inconvenient schedules like red eye flights. Being good employees with integrity, we'd meticulously  use time-inefficient airport shuttle buses so as to keep our expenses minimal in the interest of fairness to those paying.

Not this Merali dude, though. And to top it off, after losing his job in 2008 (when Alberta's health system was reorganized), he received $1 million in severance and a $1.6 million retirement plan over 10 years ($13,303/mth).

17 Sept. 2012: AHS chair whines on cost of audit & info requests into executive expenses (Ya gotta love these guys)

Pretty sweet, eh? (Said the Canuck with a grimace, not a smile.)

News items:
Fascinating stuff. Many routine charges (e.g., conference registration), but who knew the nobs also charge for booze? Fact is, Merali, earning a substantial salary, charged for everything. I bet if he bought a small packet of kleenex or gum drops at the airport he'd have charged them. 
It's a saga of greed and privilege rampant at the highest levels of a health care system. Leaders are supposed to model expected behavior and instill confidence in a shared vision to benefit all. Gak!

The behavior of this particular Alberta health official falls so short. But he cannot have been alone. If you or I behaved as Merali did (and who knows who else at the top did), we would not, indeed could not, get away with it. Adding to the odious conduct, the situation indicates a double standard that undermines the entire system.

At the same time as Merali was at the trough, Alberta's health professionals struggled to do more with less, as did the entire health care system (too few staff, too few beds, too few long-term care facilities, etc.)

During this time (2005-8), when lunching at a nearby hospital I'd occasionally talk to laboratory technologists who were former students. When asked how things were going, they'd invariably reply anything from not good to brutal.

My next question was, "What's the main issue?" The reply was always a variation of, "Too few staff." So few, that existing staff could not take holidays as there was no funding for part-time or casual staff, even if suitable replacements existed.

Once a PhD lab director stopped by and looked positively ashen. In conversation he noted that what was happening (Alberta's restructuring from multiple health entities to one) was even worse than the 1990s when cost cutbacks were severe and uncertainlty reigned:
One lab technologist told me that they had a gag order not to talk to outsiders on threat of firing. If Alberta's physicians were bullied, you can bet everyone in the system was.

Charming. What a way to run a health system.

As cost restraints prevailed in the trenches, Merali (and who knows which other senior health officials) was living the high life at tax payers expense. Dining at the most expensive restaurants, getting a phone installed in his Mercedes (Who does this in the age of cell phones?), repairing his Mercedes. It must have been hard to rack up almost $350,000 in expenses over 3 1/2 years.

Is this narrative unique to Alberta, Canada? I doubt it. My take is that it's happening somewhere near you, but you may not know about it yet or ever, unless you have professional reporters who can investigate.

And we know what's happened to real reporters in print journalism in the Internet era. Sites that compile news have gutted the system and users expect news and everything else on the Net to be free.

Big Pharma presents a similar tale of corruption, indeed a worse one. Seems reports of bribery and putting corporate benefit above vulnerable patients never stop.
GSK admitted misbranding 2 drugs and withholding safety data for another:

GSK had total disregard for the health of vulnerable people they were supposedly helping - knowing their actions could cause harm, but doing it anyway for self-advantage.
If I did that as a health care professional, I'd be guilty of criminal negligence.
With USA regulators clamping down, drug firms seem to have stopped (I say seem because who knows) perks for doctors and similar bribery. But not so in developing countries.

Pfizer's conduct seems to be normal for Big Pharma. 8 of the 10 biggest firms on the planet mention costs for corruption charges as a risk.

Big Pharma's behavior is similar to tobacco firms selling cheap disease-causing cigarettes in developing countries, not caring about those who die. With a decrease in sales in industrialized nations, multi-national companies in the UK and USA decided to spread smoking to developing countries:
Or take the case of our Canadian government (the Harper government as they like to be called), which for a few jobs in Quebec in the asbestos industry, refuses to support a global ban on the well documented killer, asbestos:
Shameful. Disgusting. Sickening. Criminal. Tobacco companies, Canada's Harper government, and drug companies  - all behave similarly.

The spectre of senior health officials in my province and their culture of privilege is one thing. I expect it's the same whether in countries with national health care systems (most of the world) or the USA, where private health competitors do whatever it takes to survive and make profits.

What also gets me is that I know several industry reps who are decent individuals. It's hard to think that they work in an environment where bribery and lying are normal. But to think otherwise would be naive. Sadly, evidence to the contrary abounds.

When first entering the health professional many years ago, I had dreams of helping others and being one of the good guys. Definitely a profession that was a notch above used car salesmen, who had a well deserved reputation for lying and cheating customers. But I've learned that health care is also a business, and a nasty, nightmarish  one.

What to do? Focus on the positive in daily work, shine a light on the rats among us, and hold those who tarnish the field to account, a lifelong challenge. Or say nothing, do nothing, be nothing?

Can there be any fun after such all too real events? Of course. First, a great song that outlines the reality described above:
  • Sweet dreams (Annie Lennox) Some of them want to use you...Some of them want to abuse you...
Next, a slightly sappy 1960s ditty that expresses what we hope for all those involved:
Lastly, to end on a positive note, and just because I love the song and its fabulous artist appears at the Edmonton Folk Festival this weekend:
As usual, the views are mine alone. Comments are most welcome BUT, due to excessive spam,  please e-mail me personally or use the address in the newsletter notice.  Great comments below - be sure to read them.


  1. Pat I share your sentiments (too much), when I first moved from research to health administration - actively promoting public health, I was told by a veteran in the field. "You will not survive, you care too much". Whether I survived is a matter of opinion, but I can proudly say (30 years later) I did not compromise my principles, tried to keep my focus on the ultimate purpose and got much satisfaction trying to help the patients and those at risk.

    But equally I get so upset and frustrated at abuses, inconsideration and injustices.

  2. Thanks, Penny.

    I know many health professionals who learn to 'survive' in toxic workplaces in different ways:

    1. Ostriches: Continue to do their jobs well, 'keep their noses clean', don't want to know bad stuff, but stop giving anything extra, e.g., so-called 9-to-5ers. No company loyalty because they feel the organization has not been loyal to them. Cannot fly anymore and in danger of becoming extinct like other flightless birds (e.g., moa).

    2. Parrots: Adopt the values of employers and managers, even when not initially shared, so that they can advance and be one of the 'in-crowd'. Spout the usual claptrap about working 'smarter not harder', 'lean', and other management bafflegab that takes hold each decade. Soul destroying strategy but it's a price they seem willing to pay.

    3. Snipes:Do their jobs perfunctorily and morph into miserable boo-birds who gripe at every opportunity and undermine the motivation of colleagues. Other employees try to avoid them at coffee breaks, etc.

    4. Doves: Do their jobs, go with the flow, express few opinions. Hard workers who just wants to get by until retirement without conflict.

    Sure there are many more.

  3. Anonymous5:05 AM

    First, apologies for being 'anon' but as your article so succinctly puts it - I am fearful of a reprimand for voicing my opinion!

    Being non-Canadian I can confirm this is a global problem. Our recent blood service strategic plan for 2012-13 has allocated a budget of £11 million for 'travel & subsistence' (from a total budget of £432 million) = 2.5%. As I'm sure you can now work out which country I'm from ;-] you will be thinking 'how can such a small isle need so much travel?' (when I say isle I mean just the England part too!). It has shocked me rather a lot that we waste such a large amount of the NHS budget (taxpayer's money) on this frippery.

    A review of my own job description recently has seen the proposed addition of 'Required to undertake irregular hours and a frequent amount of travelling, including overnight stays, with prior notice'. This for a job which is mainly site-based!

    I love your descriptions of workers & certainly recognise many of them. I'm trying to place myself but do not fit any one quite so. I do protest at pointless & unjust actions (often to my detriment but I do feel honest & try to maintain my personal integrity in doing so). More & more, the reasons for change are becoming obscured - the promised 'open & transparent actions' are not in evidence as far as I am concerned.
    Lately I feel more like the ostrich you describe so well, because I'm so tired of rallying against those who should know better. However, I know this will not last as my conscience will not let it. I chose this career because it allows me to do some good in the world (if only a little!) - it is not just a means to an end for me.
    Penny mentions she was told she 'cares too much'. I would counteract that by accusing the person who said those words of not caring enough! It is a sad state of affairs when staff feel so beaten-down that they can no longer be bothered to care.

    Is there a type of bird that fits me & the many like-minded, dedicated, caring workers who get on with delivering the best care & improve on that despite interference from 'above'?

    Of all you mention, for me the Parrots are the hardest to work with. Occasionally you can make an Ostrich jump, Snipes can be teased & Doves are reliable, honest & upfront in what they will & won't do.

    Thank you for yet another wonderful blog!

  4. Thanks for the post, anon, and for the word frippery. Love it!

    Lots of birds to choose from. Some I thought of using but didn't, include albatross and eagle.

    About a bird for the many dedicated, caring workers who carry the system on their shoulders (broad wingspan?), year in and year out, I suggest swan. Swans usually mate for life. <;-) That type of loyalty and dedication is needed to persevere.

    We owe much appreciation to the swans among us, who form the majority of transfusion medicine professionals who I am privileged to know.

  5. Anonymous7:45 AM

    A swan it is - I'm the property of the Queen (although she is allowed to eat me) & I can break a person's arm! Unfortunately, I'm pretty sure these are both myths!!

  6. Anonymous10:32 AM

    Dear Swan,
    Had ever visited the Swannery in on the south coast of England, near Dorset after the eggs have hatched, you might have experienced a cob storming down the boardwalk, wings outspread, hissing in a terrifying manner. I certainly could see my arm being broken.

    Let the establishment not count on the swan passivity too long!

  7. Anne Halpin12:39 AM

    Hi Pat,

    Great post. For the second year running, I have been denied travel funding to attend a meeting where I am presenting abstracts and co-chair a committee. So, I pay my own way and go. Gotta love all these job perks! Boo. All while there are resources used to survey and promote employee engagement. Good grief.
    Hope to see you and your partner in crime (RM) at the tea house one day soon.

  8. Hi Anne,

    Thanks for the feedback and sharing what's happening in clinical laboratories.

    It's crazy, isn't it? Presenting and co-chairing but no funding, and all the while the organization spends resources to promote how employees should be engaged. Sounds like talking the talk as opposed to walking it, a hypocrisy that prevails in today's health care organizations.

    Won't go into the exorbitant expenses of the grand poohbahs, except to note that money spent on expenses to support their lavish lifestyle has got to be a poor ROI. And 'return on investment' is something the 'suits' in any org promote relentlessly.

    Turns out my partner in crime (aka rat) and I are gnoshing today in the 'UAH bistro'. Maybe we'll cross paths.

    Appreciate your post.