Dr. Rollie Nichol,

Associate Chief Medical Officer, Physician Workforce,

Compensation and Workspace

Chair, AHS Medical Bylaws Review Committee

Calgary, AB

Via Email

Dear Dr. Nichols,

Re: Tackling Systemic Racism in Alberta Health Services

We would like to make the following recommendations as our own contribution to the ongoing discussions engendered by the Ministerial request to review the AHS Medical Bylaws. This request was triggered by the egregious act of racism displayed at the Queen Elizabeth II Hospital in Grande Prairie in 2016.

We represent a group of physicians from an ethnic minority group who bear the brunt of racism both on an individual and systemic bases. We have members who have experienced significant challenges within AHS facilities due in large part to racism. It is a well-known fact that racism exists in AHS. Dr. Verna Yiu in her email dated July 3, 2020 to all AHS medical practitioners acknowledged this.

We believe that certain provisions in the AHS Medical Staff Bylaws and AHS Medical Staff Rules wittingly or unwittingly allow perpetration of individual and systemic racism within the organization. Systemic racism happens when an institution creates or maintains racial inequity. This can be unintentional.

It is often caused by hidden institutional biases in policies, practices and processes that privilege, or disadvantage people based on race. It can be the result of doing things the way they have always been done, without considering how they impact particular groups differently.

We would like to make the following recommendations with a view to greatly diminishing all forms of racism currently existing in AHS.

1. The creation of a Department of Diversity and Equity to be carved out of the current AHS Department of Physician Health, Diversity and Wellness. We believe that this will better address the issues facing physicians from an ethnic minority background within AHS. We would also like to suggest that this Department be headed by a physician from an ethnic minority group who would be better able to appreciate the challenges physicians in this group face in their daily lives.

2. The proposed Department of Diversity and Equity should be notified whenever an ethnic minority physician is the subject of a Triggered Initial Assessment (TIA) or any other process that may negatively impact such Affected Practitioner - provided the Affected Practitioner agrees with such notification. This not only fosters the creation of a database of such actions against this physician group but might also lead to the identification of specific patterns within AHS facilities indicating the existence of systemic racism within that hospital. This would allow initiation of a broader dialogue seeking to curb this practice and create an environment conducive for all Medical Staff members.

3. The AHS Medical Staff Rules should be amended to include a new section called 4.19.1 and entitled Racism and Discrimination in the Healthcare Workplace.

The suggested content for this section is as follows: Race is a social construct. This means that society forms an opinion about race based on physical traits, geographic, historical, and other factors even though none of these can be used to justify racial superiority or racial prejudice. Racism is a belief that one group is superior to others. Racism can be openly displayed in racial slurs, jokes or hate crimes. It can also be more deeply rooted in values, attitudes, and stereotypical beliefs. In some cases, people do not even realize that they have these beliefs.

Racial discrimination is the illegal expression of racism. It includes any action, intentional or not, that has the effect of singling out physicians based on their race, and imposing burdens on them and not on others, or withholding or limiting access to benefits available to other members of the medical community. Racial discrimination can often be very subtle, such as having clinical privileges held on a whim, or being denied mentoring and training. It also means being held to different clinical standards than other physicians resulting in great emotional and professional turmoil.

4. The Bylaws pertaining to this proposed Rule would fall under section 4.2: Individual Practitioner Responsibilities and Accountability.

The subsection should be called 4.2.8 Medical Staff Members Commitment against Racism and or Discrimination and should read:

(a) require all Medical Staff to undergo training on implicit bias on a 3-yearly basis.

(b) require all Medical Staff to practice and model tolerance, respect and open mindedness and peace for each other regardless of race.

(c) strongly frown on all manifestations of racism including, but not limited to, those pertaining to employment discriminatory practices, racial jokes, slurs or hate crime.

(d) it is the joint responsibility of any medical staff member that observes or believes that an act of racism and or discrimination is being perpetrated against any other medical staff member reports such to his or her immediate supervisor who in turn must ensure that such concern is promptly and adequately addressed and reported to the Zone Medical Director who should address such as Concern as prescribed by the Bylaws.

(e) make it clear that any incidence of suspected, covert or overt racism will be investigated and may form grounds for a Triggered Initial Assessment (TIA), Triggered Review (TR) or referral to the CPSA for further action.

5. Part 6 of Medical Staff Bylaws – Triggered Initial Assessment and Triggered Review should be updated to allow for greater transparency and fairness in the investigation.

5a. A Section or Subsection should be created to outlaw Retaliatory, Malicious and or Vindictive Concern against any Medical Staff Member.

5b. Section 6.2.1 of the Bylaws should include the following amendments:

(a) Subsection (d) should be amended to read that the Affected Practitioner should have the right to respond to the concern and such response should be objectively reviewed before any adversarial action or sanction, if any, is taken against the Affected Practitioner. 


(b) Subsection (g) should be amended to read that there should be timely disposition of the TIA consistent with the nature of the Concern, but not to exceed a total of one hundred and eighty days if the Affected Practitioner’s practice is unaffected or ninety days if any of the scope of practice of the Affected Practitioner is negatively affected.

(c) Subsection (j) should be amended to include the following

i. In cases where the Affected Practitioner is a member of an ethnic minority group, at least one member of the Hearing Committee must be from a similar or other ethnic minority group like the Affected Practitioner.

ii. In cases where the Affected Practitioner is a member of an ethnic minority group, the Department of Diversity and Equity in the AHS should be notified so that it can have a representative to serve as an observer or participant in the Hearing Committee procedures and sittings.

iii. The Zone Medical Director or designate(s) shall, upon receipt of a Concern, and/or other information/complaints ensure that Facility

Medical Director and or Complainant that submitted the Concern has no conflict of interest against the Affected Practitioner that might serve as incentive for such complaint or concern. If the Zone Medical Director believes such conflict of interest exists and serves as motivation for such complaint or concern, he or she must treat such Concern as Retaliatory, Malicious and or Vindictive Concern and should communicate such decision the Complainant and the Affected Practitioner.

(d) Section 6.2.2. subsection (j) of the Bylaws should be amended as follows: timely disposition of the Triggered Initial Assessment and/or Triggered Review consistent with the nature of the Concern, the completion of Consensual Resolution process including any recommendation therefrom, must not exceed 180 days if the Affected Practitioner’s scope of practice is not affected or 90 days if any aspect of scope of practice of the Affected Practitioner is negatively impacted.

(e) Subsection 6.3.2 of the Bylaws should have the following addition:

i. 6.3.2.3 – the identity of the witnesses for a Triggered Initial Assessment must be revealed to the Affected Practitioner ahead of time and those witnesses must testify under penalty of perjury to ensure that false testimony is not given against the Affected Practitioner. The physician should also be given the option of providing a list of witnesses that he/she believes is relevant to the concern.

(f) Section 6.4.11 of the Bylaws should have the following amendment – Completion of Consensual Resolution process, including any recommendation therefrom, must not exceed 180 days if the Affected Practitioner’s scope of practice is not affected or 90 days if any aspect of scope of practice of the Affected Practitioner is negatively affected.

(g) The Hearing Committee Section 6.5.4 of the Bylaws should have the following addition:

i. 6.5.4.8 - witnesses for Hearing must be selected with consultation with the Affected Practitioner and those witnesses must testify under penalty of perjury to ensure that false testimony is not given against the Affected Practitioner.

(h) Immediate Action Section 6.7 of the Bylaws needs addition of the following subsection:

i. 6.7.11 – Notwithstanding the foregoing, no Affected Practitioner shall be subjected to or threatened with Immediate Action without due process and without being given opportunity to receive a copy of and

respond to the Concern or Complaint engendering such Immediate Action.

6. We would like to suggest the following amendments to Section 2.5 of the AHS Medical Staff Bylaws - Facility and Community Medical Directors: 


Subsection 2.5.1 Appointment and Accountability

2.5.1 (a) Each Facility will have a Facility Medical Director. The Facility Medical Director is the most senior administrative leader for a Facility. Vacancy for Facility Medical Director shall be announced to all Medical Staff Members of the involved facility by the Zone Medical Director. If more than one candidate applies for the vacant position, the Zone Medical Director shall conduct an election among the physician staff members of that facility to determine the most suitable candidate for this position.

(b) Vacancies for Facility and Community Medical Directors shall be announced to all physician staff members of the involved facility by the Zone Medical Director. In case more than one candidate applies for the vacant position, the Zone Medical Director shall conduct an election among the physician staff members to determine the most suitable candidate for this position.

(c) Facility and Community Medical Directors shall be directly accountable to the Zone Medical Director or designate and shall also be responsible to the physician staff members that they lead.

2.5.2 Responsibilities and Duties. The following subsections should be added:

f) Ensure that all medical staff members are treated with equity without racist and or discriminatory animus, action, treatment and or behavior.

g) Declare any conflict of interest that may affect the fiduciary responsibilities as Facility or Community Medical Director.

h) Recuse self from any action or activity or decision-making process that he or she may be considered or adjudged as having conflict of interest.

i) Desist from any retaliatory action against any opposition or business competitor and avoid abuse of power against any member of Medical Staff or anyone else.

k) avoid appointing leader of any section or department without appropriate consultation with members of medical staff that such leader will be leading.

7. We would like to suggest the following amendments to section 2.6.10 of the Bylaws - Facility or Community Clinical Department, Medical Staff and Physician Recruitment Committee Meetings:

i. 2.6.10.1 Facility or Community Clinical Department, Medical Staff and Physician Recruitment Committee Meetings shall be defined by the Facility Rules. The agenda for such meetings shall be prepared by the Facility or Community Clinical Department Executive Committee. Active and Probationary Staff members shall attend Facility or Community Clinical Department and Medical Staff Meetings while Physician Recruitment Committee shall be attended by members of that committee typically comprising representatives from every community clinic and the community that the Facility and or Community Medical Director is serving. Community, Temporary, and Locum Tenens Staff may attend Facility or Community Clinical Department and Medical Staff Meetings. 


ii. 2.6.10.2 Facility or Community Clinical Department and Medical Staff Meetings shall address internal organization, resource allocation, the facilitation of teaching, research and other pertinent Facility Clinical Departmental matters while the Physician Recruitment Committee shall address recruitment and retention strategies and plans. 


iii.2.6.10.3 Quality of patient care and safety activities shall be conducted by each Facility or Community Clinical Department in accordance with requirements established by the Facility Medical Director, the Zone Medical Director or Chief Medical Officer. 


8. We would like to suggest the following amendment to section 2.1.2 of the AHS Medical Staff Bylaws – General Provisions – Term of Appointment - Unless otherwise specified in the vacancy posting, the term of appointment for AHS medical administrative leadership positions shall be up to three years, renewable once.

9. In section 2.12.2 of the Medical Staff Rules - Composition of Bylaws and Rules Review Committee – we would like to suggest that a provision should be made for mandatory membership by a physician(s) from a minority group in this committee.

10. In section 2.13 of the Medical Staff Rules - Hearing Committees, Immediate Action Review Committee and Pool Membership Section Process – we would like to suggest the following amendments:

i. 2.13.6 – criteria for selecting hearing committee and IA review committees should include provision for mandatory membership by a physician(s) from a minority group as the rule foresees that a population of physicians may not be fairly treated by a committee that lacks diversity in its membership.

11. In Section 2.17 of the Medical Staff Rules – Zone Application Review Committee – should include provision for mandatory membership by a physician(s) from a minority group.

12. In section 3.2.1 of the Medical Staff Rules – AHS Practitioner Workforce Plan, we would suggest that subsection 3.2.2 (Recruitment) should give greater say to the medical staff members in a facility or community when it comes to recruiting new physicians.

We humbly hope that these policy changes would help in stemming the systemic racism and injustice that currently exist in AHS creating space for all physicians to contribute maximally to the delivery of quality healthcare to Albertans.

Thank you for taking on this onerous task of revising the Medical Staff Bylaws.

References:

1. https://www.ontario.ca/page/ontarios-anti-racism-strategic-plan?

2. http://www.ohrc.on.ca/en/racial-discrimination-brochure