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Should the Health Minister take the fall in Ornge scandal?

Opposition politicians in Ontario want the head of Health Minister Deb Matthews over the Ornge air-ambulance scandal, and they smell blood.

There is, we are told, a convention that holds that a cabinet minister bears ultimate responsibility for the actions (and inaction) of their ministry or department.

There is no question that the Ontario Ministry of Health and Long-Term Care failed in its oversight of Ornge. Bureaucrats may well have been bamboozled by some slick operators, but they clearly ignored some red flags, laxity that will, when all is said and done, cost the Treasury tens of millions of dollars.

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So should Ms. Matthews take the fall for these failings?

Before deciding, let's examine the underlying story a bit.

Ontario has had an air-ambulance service since 1977. It's an expensive form of medical transport, but a necessity in a province that is the size of France, Spain and the Netherlands combined.

As technology improved, the service grew substantially, with dozens of helicopters and planes, and bases around Northern Ontario. In 2004, the ministry decided that a separate entity was required and created the non-profit Ontario Air Ambulance Services Co. The next year, Christopher Mazza was appointed the founding chief executive officer. One of his first acts was to rename OAASC Ornge. (It's not an acronym but a reference to its brightly coloured vehicles and bold ambitions.)

There was then, as now, much interest in spinning off government services (particularly in health care) in a bid to make them look leaner and businesslike. But, as the Ornge saga demonstrates, there is too often more blind faith in the benefits of private enterprise than there is sound regulation and oversight.

What followed the "privatization" of Ornge was, in the words of Ontario Auditor-General Jim McCarter, years of "questionable business practices." It would take a book-length treatise to recount the sordid details, which have been exposed over months through the terrific investigative journalism of Toronto Star reporter Kevin Donovan, but here's a taste: Exorbitant salaries were paid, a web of for-profit subsidiaries was created along with self-aggrandizing charities, a fleet of sleek but ill-conceived helicopters was purchased (for example, paramedics could not perform CPR in the small hold), and all the while the core business floundered. The Auditor-General reported that Ornge created a "mini-conglomerate" of private entities that enriched former senior officers. The Ontario Provincial Police is investigating.

The Ministry of Health funnelled $730-million to Ornge over a five-year period and gave its blessing to $300-million in loans. While the spinning off of the air ambulance was supposed to improve efficiency, costs rose 20 per cent in its first four years of operation while the number of patients transported fell.

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Clearly, someone (or a group of someones) at the ministry was not doing his job. But neither was the Ornge board of directors. Mr. McCarter called it a "textbook example of what happens when the government doesn't get the information it needs to properly do its job."

But what about the Minister of Health, Ms. Matthews?

Clearly, she cannot personally oversee the spending of every penny in the province's $47-billion health budget. If anything, health ministers in this country do too much micromanaging and too little delegation of authority.

The management structure of Ornge was so convoluted that the Auditor-General and his team were unable to fully understand it; obviously the minister is not going to be able to do so from afar. But ministry bureaucrats should never have approved these dubious arrangements; at the very least, they lacked healthy skepticism. Clearly, something was rotten in the state of Ornge. But there is no evidence that higher-ups, including the minister, were alerted.

To her credit, when the depth and breadth of the Ornge scandal became clear, Ms. Matthews did act, and pretty forcefully: The board was sacked, senior management was turfed and the OPP was called in. She is said to be furious, and rightfully so.

The most damning allegation against Ms. Matthews is this: When the preliminary report of the Auditor-General was presented last September, it was during an election campaign, and no immediate action was taken. How much the minister/candidate was told is not entirely clear, but this is splitting of hairs.

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The holier-than-thou attitude of opposition critics is disingenuous: Regardless of party affiliation, campaigning is going to come first. And the delay in acting – if there was any – probably made no difference. The Ornge web of deceit was already unravelling.

The calls for Ms. Matthews's resignation are little more than partisan squawking. The opposition is harking back to a golden age of ministerial responsibility that never really existed. Sexual and financial scandals are what bring ministers down, not the inadequacies of their bureaucrats.

Consider the worst case in Canadian history: About 60,000 people died in the tainted-blood scandal, but not a single minister lost his/her job. With Ornge, all that was lost was some face and a few bucks; the minister had no direct responsibility for the failure and did not benefit personally from the shenanigans.

Principled resignations are good and honourable – but what exactly is the principle at stake here?

The key issue – one the opposition has failed to hone in on – is that when governments contract out services, they must demand results and they must oversee the spending of public dollars with as much, if not more, rigour as within the ministry itself. Contracting out is not a synonym for washing your hands of responsibility.

If Ms. Matthews can instill that belief system – and stanch the bleeding at Ornge in the process – she deserves to keep her job.

Errors have been made. Fix them. Make sure they don't happen again.

It's time for the minister to stand tall, not walk away.

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