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Ron Sapsford draws a $443,000 salary, walks the corridors of power and will enjoy a long and comfortable retirement if he so chooses.

Still, you'd have to be crazy to leave a good job elsewhere to take the one he'll be vacating at the start of the new year.

That the same thing applies to pretty much any high-level job in Ontario's Health Ministry, where Mr. Sapsford has served as deputy minister for the better part of five years. The result is a leadership void that threatens to make a mess of the provincial government's biggest department.

Mr. Sapsford has joined the growing list of people who toiled in relative anonymity to improve health care in Ontario, only to become widely known for their affiliation with the eHealth scandal. Surely, he did not expect to spend his final months on the job literally running away from reporters, nor to have his retirement painted as an admission of wrongdoing.

It was a particularly cruel fate for someone who, by the account of those who worked with him, disagreed with the spending practices at the heart of the scandal – and who, in general, was a process-oriented manager who worked hard to keep his political masters in check. And it was a cautionary tale for those who might be inclined to take on similar jobs to the one he is leaving.

Politicians such as David Caplan, who lost his job to eHealth, and George Smitherman, who continues to take hits to his reputation, understand and accept the risk that they will become the subjects of unpleasant public scrutiny. But that's not what civil servants or health-care administrators – or, for that matter, much-maligned consultants – usually sign up for.

That it's recently been the plight of many of them – Dr. Alan Hudson and now Mr. Sapsford are the most high-profile examples – has sent a chill through Ontario's health-care community. More to the point, it has sent a very clear message: Do not, if you can avoid it, get yourself mixed up with this government.

That's a huge problem for Dalton McGuinty's Liberals, because the people they've lost recently would be very difficult to replace at the best of times.

Dr. Hudson, in particular, has left an enormous void. The acclaimed neurosurgeon was able to command respect among fellow doctors, among whom he is a towering figure, in a way no bureaucrat could. That allowed him to throw his weight around to achieve results on the province's waiting-times strategy, which he led in a voluntary capacity, and to generally serve as a problem-solver for Mr. McGuinty and his health ministers.

It's widely acknowledged by insiders that Dr. Hudson's “clinical leadership” has been sorely missed since he severed his ties with the government last spring, and that the government would do well to find other prominent medical professionals to help do its bidding with hospital boards, doctors, and so on. But there is a perception among his admirers that the government inadequately stood up for Dr. Hudson, who chaired eHealth, once the scandal broke; as a result, few are eager to follow in his footsteps, even if any are capable.

Mr. Sapsford won't be quite as difficult to replace. But it's doubtful the government will be able to go its preferred route of recruiting a deputy minister from outside its ranks. Why would a hospital CEO, for instance, take a more thankless job, and probably a lower salary, if it might lead to so much grief?

Down the ranks, growing mistrust is making both bureaucrats and outsiders gun-shy about engaging in health policy. The Liberals would point out that it's the opposition and media that have dragged people's names through the mud, not them. But there is some sense that politicians are happy to take credit for others' work, then hang them out to dry once the going gets tough.

Into this uncomfortable climate steps Deb Matthews, who last month replaced Mr. Caplan as Health Minister. It's one thing to learn on the job; it's another to do so without the support network her predecessors enjoyed. This at a time when declining provincial revenues mean she's expected to rein in soaring health-care costs – a task for which she'll need every powerful ally she can find.

Ms. Matthews, for the record, makes much less than $443,000 a year. But she'll deserve that and more if she's able to undo the damage of the past few months.