Ken McGeorge is a Career Health Service Executive with many years of experience largely in senior management. He possesses a wide variety of experiences that has generated a breadth of perspective and knowledge of the health and social system. His career commenced with work as a direct caregiver which has yielded a perspective that is somewhat unique and innovative.
Could you tell me about your timeline putting together the healthcare reform book?
Sure, well it was two years ago, exactly two years ago, but Brunswick News publishes pretty much all the newspapers in New Brunswick except the francophone paper, and they approached me with the idea of “would you like to write a series on healthcare reform”. And of course since I’ve been in the business for 50 years and have tried several times to retire but it’s… the whole issue of healthcare is in my heart. Big time, and so, when they offered the opportunity to do a series I jumped at it. Not because it was going to pay any money, as a matter of fact, it pays zero. It’s a labor of love entirely. And the reason it’s a labor of love is not just because I invested my life in it, but because in 1992 – as the introduction in the book lays out… I was one of several people in this province who played a major role in the introduction of the first phase of healthcare reform. Where we abandoned local hospital boards and we merged hospitals together and we cut beds and we did a number of things that really got the public, particularly in rural New Brunswick, very upset. But, it had to be done. Since that time, because it was so politically difficult, and because there was some political fallout, there were some seats lost in the election of 1995 and seats in the subsequent election, a succession of provincial governments have kind of gotten cold feet in dealing with healthcare. They’ve allowed the original vision from 1992 to drift, and so the current state of affairs in New Brunswick frankly, in my opinion, and in the opinion of many, because I’ve had lots of feedback, is that our system really is due for overhaul. So I’ve been publishing these articles, and then last summer a friend of mine, who was an academic here locally at St. Thomas said “why don’t you do a book?” The folks that I deal with at Brunswick News said the same thing. Put it together. So I said, I’ve never done anything like that before, I am not an academic. But let’s go, and so there we are, we have a book, and it looks like that.
When you were the executive director of the Department of Health in Fredericton, did you find that there was any censoring of hospital information by politicians and that there’s a difficulty in talking about things?
Oh, absolutely. Absolutely what politicians need to have out in the public eye is that which will go well for them, will not cause undue distress, will not cause offence to constituents, will not cause them problems in dealing with stakeholder groups. I get that, that’s the political process. And so, when I worked in the department of health, which was only for 18 months, one of the big roles of my branch was to write briefing notes for the government officials. For the minister, for the premier, and others… And policies taken by some things of that nature and of course, yeah we had to be very circumspect in what we said, and if you, as a civil servant got outside the guard rails, your career would be cut short. Or you would be severely disciplined. I remember during the time that I did work there, one of the assistant deputies made some remark publicly that wasn’t in tune with what the minister was saying and boy he really got it. So yeah, politics I learned the hard way is all about perception, seldom is about reality.
I didn’t actually personally see anybody get fired or anything like that but there were certainly instances. You know, “don’t be saying things like that again, don’t ever talk to the press again.” Things of that nature. I suppose if any civil servant went out and expressed a view certainly to that being expressed by the minister, I mean we just understood you don’t do that, you don’t go there. And if you do, you’re probably gonna get fired. So, what I saw wasn’t in that league, it wasn’t that bad, it wasn’t so bad as to warrant a firing or anything like that.
Without being very specific, could you talk about the areas within hospital concerns that that sort of situation came up in the most?
You know in the group that I worked with we all had our professional opinions about things like the distribution of clinical services in the province, we all had very strong views about how that ought to happen. But, as civil servants we would never ever dare to have that discussion publicly, even in a workshop. You just couldn’t do that, because it’s again, those things are very politically delicate. In New Brunswick we have several regional hospitals and they all compete for clinical programs and prestige and all that. Some of us who were involved back in 1992, we understood that we probably didn’t need that many regional hospitals, but you could never say that either. Well what we really did need as a province with our small population was concentration of clinical resources so that you have excellence in orthopaedics, and excellence in reconstructive surgery, and excellence in cardiac, and on. You don’t do that by spreading the resources all across the province you do that by consolidating resources as we have done with cardiac surgery, and some oncology services. But those are things, certainly as civil servants you could never engage in those discussions in any form or you might be quoted. Never.
What do you think of the role of the press and publishers? How do you think that they might be able to help with that situation or what they’re maybe doing wrong that they should be changing?
That’s a good question and that’s exactly why I have been writing these articles and why I’ve put some of them together in the form of this book.
“I think publishers and the press can help to get the real issues out in front of people. For instance, in this province right now there are some big issues going on with trade unions, and registered nursing assistants, and EMTs. I did an article just the other day, on that very topic because it was being cast in the public eye as a labour struggle, it’s not a labour struggle at all it’s a professional quality of care issue and so I think that when you go through my book and the columns that I’ve written, I’ve talked about things that never get talked about in policy meetings with government, and certainly never get discussed in election campaigns.”
For instance, in this province there are 60,000 people who do not have access to a family doctor. Now… I mean that’s-that’s a huge issue! Particularly if we’re trying to grow our population, encourage immigration, I mean one of the first things people want to know about is healthcare and about education for their kids. If you can’t show them good access to both of those, you’re gonna be in trouble. So 60,000 people, that’s in a population base of roughly 700,000 people, that’s about 8% of the population, that’s-it’s terrible! I’ve run into several who are dealing with dementia, and related diseases of aging, and the only medical care they get access to is an after hours clinic which is really not good medicine at all, under any circumstance. Sso, in some of my columns I’ve talked about how we get around that, exposing the whole idea of property integrated, multi-disciplinary primary care systems… Kind of like the Sault Ste. Marie model, which Roy Romanow described as “Canada’s best kept secret in primary care”.
“There are all sorts of other models across the country, and across the Western world that could be looked at, adapted… we’ve lobbied in this province for special clinics for frail seniors who have multiple chronic diseases underlying, and again those things get nowhere. So I’m dealing with some of those things in my columns, just to get them out there in front of people and create some discussion, and based on the feedback I’m getting, I think it’s starting to sink in.”
I hear from civil servants, I hear from politicians, and I hear from members of the public. One of the big issues in this province of course is that each of the major regional hospitals have been, for the last few years, notorious for having overcrowded emergency departments. So, if on a Saturday evening you got – what to you is an urgent healthcare problem, may not be life or death, but it’s urgent – and you go to the local regional hospital you’re likely… I mean if the stars lined up you might get in fairly quick but chances are you gotta sit there for anywhere from 3, to 8 or 10 hours. On my smart phone I have a picture of all the signs in the local hospital emergency department that says, “waits today will be between 8 and 13 hours”. Well I mean that’s unconscionable. What’s worse is that it is totally manageable and avoidable. We never talk about what is avoidable, we just talk about adding more emergency room positions, expanding emergency departments, all that stuff. We don’t talk about the root cause… and solutions to fixing those issues. I’m gonna keep writing these articles, maybe I’ll do a second book later on. Until I see some evidence of traction on some of these issues that keep-I mean, these things, overcrowded emergency departments for heaven’s sakes we’ve been talking about that for 30 years.
“We’ve been talking now for 20 years about members of the public who don’t have access to a primary care physician. I mean come on! We’re paying Medicare, we’re paying big taxes to the government to provide our healthcare system, and 8% of the population can’t get any kind of access to primary care? Not acceptable.”
The general public, I mean just watch the letters to the editor, social media for sure, I see a lot of stuff on social media. Health care advocacy groups, in this province there are any number of senior’s groups, and consumer groups. Stakeholder groups for sure, I’ve been involved with some associations in the province and I’m involved with one right now. The Special Care Home Association, as a matter of fact, I just got off a board meeting with that group and we’re talking about issues that have been talked about now for 20 years, with no traction. So the “we” is a big we, I mean even politicians know that the public is not happy about a lot of these things but when you talk with them they seem almost powerless to do anything.
You have travelled quite a bit. From New York, to Toronto, to Nova Scotia, to New Brunswick… As somebody who has spent time in both the U.S. and in Canada with vastly different healthcare systems in a way, how do you think that that perspective has influenced your writing?
It influenced it quite a bit, I was brought up in the States of course. Trained and all of my professional work has been in Canada in three different provinces, but in my professional work I have had the occasion to go south of the border to collaborate with Johns Hopkins, with the Massachusetts Eye and Ear Hospital, I was a member of the American College of Hospital Administrators for many years and used to attend their meetings in Chicago and elsewhere, and compare notes there. More recently, my daughter lives in Georgia, and my son lives in rural New York state, and I see the healthcare service that they receive… and that’s an interesting, very interesting comparison with the way we’re organized here. When I’m talking with them and listening to their interactions with the system, I just shake my head and say you know what, we could be doing that here. For instance, in this province one of the big hot button issues before the last election was the ambulance service to rural New Brunswick. On the surface, the government has invested a fortune in modern ambulance equipment, technology, the whole nine yards and we have some wonderful highly trained EMTs across the province. But in rural New Brunswick, we still can’t get efficient ambulance service to them. Nobody seems to want to figure that out. So we have these ambulance vehicles out there, we have these ambulance garages, they tell us that it takes an hour, an hour and a half, sometimes just to get the ambulance to a point of service. And you scratch your head and you say “why”?
“So then I go out to rural New York where my son lives and they don’t have quite that level of sophistication, each major community in their rural area has a volunteer ambulance system, and by jolly it works well. In some cases it’s tied directly to the volunteer firefighter system. The point being that we have one extreme here, the other extreme there, and boy they get better service with their volunteer system than rural New Brunswick does here with a highly expensive system. Somebody just asked a question “why” and “what are we gonna do to fix this”? I’ve dealt with that in one of my columns and I’ll probably deal with it again because it’s still an area that hasn’t been fixed yet.”
I went down to visit my daughter in Georgia – and she lived here in New Brunswick, she was here for many years and just moved there in 2017 – she had a very complex medical problem here that never really did get diagnosed or treated, and so she gets to Georgia and boy they throw the book at her. She’s had so many investigations and therapeutic interventions, I was talking with her the other day and said ‘you look like a brand new person’. You look so healthy compared to what you were when you lived here. I mean she’s not out of the woods yet and she may never be out of the woods but at least she’s being attended to aggressively. Here in this province, it seems very-if you’re symptoms are a little bit obscure you have to work really hard to get through the primary care screen to get a specialist that may know something about your problem. She has a family of three boys and one of them at any point needs urgent care, she just drives down the street about 5 kilometers maybe and they’re in, out, across the street to the drug store, get their drugs, and that all takes about 15 minutes. That contrasted with 8 hours in the emergency here… And then she goes home, and any lab tests that have been done, x-rays whatever have you, she goes on her portal on her computer and the results are all right there, bingo. And heavens, we’ve been dealing with trying to get a proper health records integrated system here for probably… It’s been close to 30 years. Progress is being made for sure, but nowhere close to what my daughter experiences in Georgia. Their system costs a whole lot more money, I get that. But I think there’s some principals there that we need, and I’ve touched on that in one of my columns as well.
Do you have any advice for people who want to write about these issues?
Don’t be too dogmatic, raise questions. People learn by raising and answering questions well, and so there are an awful lot of highly opinionated people around and I meet with some of them quite often. Opinions are worth nothing unless they are informed opinions, and so if you want to write about some of this stuff take the time to do a little bit of research and make sure your opinion is solid. Based on fact, based on truth, based on integrity. Don’t be afraid to expose issues that perhaps the government might not like you to. Don’t worry about political correctness I guess that’s what I’m saying. So long as your opinion is based on research, truth, integrity… Let it out. And contribute to discussion. The thing that I am promoting in my little book-and I never intend to make money with this thing, it’s a labour of love, but I do it because I want to contribute to conversation. That’s the whole theme of all of this. Healthcare is, as Jeffrey Simpson from The Globe and Mail says, “Canada’s third rail”. It’s highly politically charged, and so in order to move forward we need to have informed, underscore informed, public discussion. There’s lots of discussion out there but there’s not much informed public discussion. And so make sure if you’re writing, you’re contributing to informed public discussion.
Interview by Hope Latta
Written by Zoë Swinimer
The Canadian Writers’ Exhibition
Showcasing Canadian writers from coast to coast