The groundwork was laid long before, but make no mistake - it was an oatmeal-and-raisin cookie that cost Alberta Health Services president and chief executive officer Stephen Duckett his job and taxpayers about $680,000 in severance pay.
Observers and opposition parties warn, however, that the problems with Alberta's nascent foray into a lone, massive health board reach far beyond baked goods, saying Dr. Duckett's case was simply a symptom of a failing system.
After more than six hours of deliberation that stretched over Tuesday evening and part of Wednesday, the 14-member Alberta Health Services board came to a "joint" agreement with Dr. Duckett (who is currently on vacation in the United States) that will see him immediately end his time as head of province-wide health board.
That came five days after Dr. Duckett left an urgent meeting on a crisis in provincial emergency room care and refused to speak to the media - instead, he waved a cookie at a television camera and insisted he was busy eating.
Frustration with the system, and over the government's handling of the ER crisis, crystallized around that single, made-for-TV moment. The snub was deemed "offensive" to "all Albertans" by Premier Ed Stelmach himself, making Wednesday's announcement seem inevitable. Board chairman Ken Hughes acknowledged the cookie "incident" played a role in the decision to part ways with Dr. Duckett.
But both Mr. Hughes and Mr. Stelmach struck the same chord - it wasn't the cookie; it was the firestorm that followed that dragged down Dr. Duckett and prevented him from being able to do his job.
"His ability to carry on and conduct his role as chief executive officer was compromised by his current circumstances - one element of which was that incident," Mr. Hughes said. "The board had clear confidence in him up until that point. But the dynamic changed. The atmosphere changed."
Added Mr. Stelmach: "We just couldn't move forward."
Among those who supported the move were Health Minister Gene Zwozdesky, who felt Albertans had lost trust in Dr. Duckett and made his feelings "clear" to the board, Mr. Hughes said.
But the board itself was split - one member, Gord Bontje, has already resigned over the decision, and Mr. Hughes expects "a couple" others may follow. Whether they left because of the decision to part ways with Dr. Duckett or because of the health minister's interference with their mandate is unclear.
The departure of Dr. Duckett and the board members come two days after the dismissal of MLA Raj Sherman (the parliamentary secretary for health who broke rank and spoke out against his own party's health policies, only to be kicked out of Mr. Stelmach's party). Alberta has now lost at least three of the key players responsible for delivering health care.
The saga is the latest in what has been a controversial and drawn-out effort by the province to create the so-called AHS "super board," which was formed out of 12 smaller boards. Many have called it a failure, one that left Dr. Duckett doomed from square one.
"Stephen Duckett's actions on Friday were inexcusable, but let's not let a viral [cookie]video distract us from the real problem," Liberal opposition leader David Swann, a physician himself, said in a statement. "The Stelmach administration's failed experiment in centralized decision-making is the root cause of the problems we're seeing in public health care."
Dr. Swann and New Democrat leader Brian Mason had called for Dr. Duckett's dismissal. The Wildrose Alliance, a right-wing party threatening the ruling Progressive Conservatives' base, had not called for it specifically, saying Dr. Duckett might have taken a different job so long as AHS was done away with.
"Whatever happens to Dr. Duckett, the main issue is we have to dismantle the super-board," Wildrose leader Danielle Smith said earlier Wednesday. "Having a single government monopoly responsible for the purchasing, the provision and the evaluation of the system simply isn't working. We're getting worse and worse service.
Mr. Hughes insisted, however, that while the AHS structure could be improved and has had growing pains, "it is effective enough to achieve the primary accountabilities that we have." He pledged to stay in his role as board chairman.
Many in the Alberta health industry cheered Wednesday's move, as Dr. Duckett - an economist, not a physician - was not popular among many of the rank and file health workers who saw him as, first and foremost, a penny pincher. Many of AHS's 90,000 employees are also fundamentally at odds with the decision to run AHS like a business. The board members are veterans of corporate Canada, and not hospitals. Mr. Hughes, for instance, is a former MP who ran an insurance company.
"This was inevitable," says Donna Wilson, a University of Alberta professor and health policy researcher who urged AHS to move swiftly in finding a replacement who has actually run at least one hospital, or possibly a health board. "At this point, it's the biggest issue of who replaces him? And are they going to do anything about a health board that didn't properly supervise or guide his work?"