One by one, they've come out of the woodwork - doctors fired or forced out by Alberta health agencies after breaking rank and speaking publicly, with some then labelled as mentally ill.
The allegations, made by about a dozen physicians, portray a culture of intimidation they say pervades Canada's richest health system while raising questions of political interference by Alberta's long-ruling Tory government. They also include claims of 250 cancer deaths hastened by mismanagement.
In one case revealed by The Globe and Mail, a doctor who was forced from his job, David Candler, will appear before the Alberta Human Rights Commission next month to argue that he was fired unjustly for accusations of "mental disability."
The Alberta Medical Association believes it's altogether enough to warrant a full judicial inquiry into "issues of physician intimidation." Such inquiries are rare, powerful measures, and the AMA waited months to support a call for one.
With the AMA and doctors speaking out, the government finds itself under tremendous pressure to call an inquiry that could air any dirty laundry.
"I would definitely hope that the government will have to listen to the voice of all the physicians in the province," said Paul Parks, an emergency-room doctor who spoke out about overcrowding last fall and supports an inquiry. "I think the government would ignore this calling at its peril."
It's the latest health controversy for the resource-rich province, which spends more money per capita on health care than any other. The ordeal began with the controversial merging of regional health boards into one entity, continued with Dr. Parks' public plea, and hit its apex last fall with the firing of health board CEO Stephen Duckett and the dismissal of an outspoken doctor-turned-MLA, Raj Sherman, from government caucus.
The high-profile debacle has shaken public trust in the system, doctors say.
The government tried to calm the storm by calling a limited review by the Health Quality Council of Alberta, an independent medical-review agency. The AMA now says that's not good enough, but cabinet refuses to go a step further and call an inquiry, which it says would take years and cost millions.
Canada's longest-running provincial government is under fire from all sides. "When will this ever stop?" an exasperated Premier Ed Stelmach said in the legislature this week, insisting that "not one single fact came forward, only allegations," and an inquiry isn't necessary.
His government appears willing to hold its ground for another week, at which point the spring legislative session is expected to end, freeing it from the attacks of Question Period.
"They are deflecting, denying, ducking and running. And they keep spinning this out until the end of the session," said Liberal Leader David Swann, a physician who entered politics after being fired in 2002 from his job as a regional medical officer of health after speaking out in support of the Kyoto Accord.
It's Dr. Swann and Dr. Sherman, who has defected to the Liberals, imploring doctors to come forward. Altogether, at least 11 cases have bubbled up.
"Dr. Swann phoned up and asked if I had any examples of people being intimidated. And I sort of said, yeah - me," said Allan Garbutt, a rural Alberta doctor who came forward last week saying he was threatened at a board meeting and for speaking to media. He had stayed quiet because "there's a certain degree of fear about silent retribution."
The province continues to cling to the Health Quality Council. All sides agree the council can investigate medical issues, such as waiting times, but critics say it's ill-equipped to handle complaints of intimidation. It also could not address Dr. Sherman's unproven claims that because of interference and firing of doctors, 250 cancer patients died prematurely on a waiting list.
Council investigators can't subpoena witnesses, offer protection for doctors who break nondisclosure deals to speak out, and will meet behind closed doors.
"The last thing it will be is transparent," Dr. Parks said. The AMA agrees the council would be "inhibited" in its ability to address such questions and a judicial inquiry is "the best forum."
Another case is that of Inderjit Chohan, a forensic psychiatrist who was labelled as a "paranoid Sikh" after complaining about a culture of intimidation nearly a decade ago. He sued unsuccessfully, though a judge found he indeed had his "mental integrity questioned" wrongly. He's now among those calling for an inquiry.
"God knows how many more cases there are. I don't know. I thought I was alone," Dr. Chohan said, adding: "Until I saw it was happening to other doctors."
M.D.s who spoke out
Six cases of doctors who have come forward with varying claims of intimidation:
The thoracic surgeon was forced from his job a decade ago after advocating to the Progressive Conservative caucus for better cancer care. He was soon after dismissed as section head of thoracic surgery for Edmonton's health authority, and claims colleagues said he needed "emergency psychiatric care." He signed a severance deal with a nondisclosure clause and now teaches at Harvard University. He'll return to testify before an inquiry if legally protected. His case is critical, as it ties into unproven claims of 250 cancer deaths.
Dr. Candler was let go in 2005 from an Edmonton-area clinic affiliated with the University of Alberta. He sued, alleging the provincial health authority "misinformed" and gave "false information" to the university that he wasn't properly doing his job. He's set to appear next week before the province's Human Rights Commission, claiming he was unjustly fired for an unspecified "mental disability."
Dr. Chohan was among a group of forensic psychiatrists who questioned what his statement of claim called "incidences of racism and intimidation" in mental-health services in the province. He was subsequently called a "paranoid Sikh" by a colleague. A judge dismissed his defamation suit but agreed Dr. Chohan was justified in feeling "insulted and humiliated by having his mental integrity questioned." Dr. Chohan now works in Calgary and says he's been refused for jobs or privileges at local hospitals.
A vocal rural physician, Dr. Garbutt has come forward saying he was twice intimidated by provincial or regional employees - once by a member of a now-defunct regional health board after Dr. Garbutt pressed for more services in his town, and another time after he criticized the health authority in a newspaper article. He went public a week ago at the urging of Liberal Leader David Swann, a physician and personal friend of Dr. Garbutt.
Perhaps the highest-profile example, Dr. Sherman - now an MLA - has twice had his mental stability questioned. The first was in 1999, when he was barred from an Edmonton hospital and ordered to seek medical treatment for his behaviour. Colleagues again questioned his mental state last year, shortly after he was ejected from caucus. Dr. Sherman has risen to folk hero status in the province, but has been criticized for failing to provide evidence.
Dr. Winton took over from Dr. McNamee as the health region's head of thoracic surgery. Soon after, he took what he calls an "unexpected withdrawal from clinical practice." He is now a university researcher and has refused to speak publicly about his experience, saying he's bound by various nondisclosure agreements. He circulated a one-page statement to media outlets, including The Globe, with a veiled reference to an inquiry - saying he would "welcome the opportunity to provide evidence in an appropriate forum" but wouldn't speak to the Health Quality Council.
Editor's Note: The original newspaper version of this article and an earlier online version contained incorrect information about the date of an Alberta Human Rights Commission hearing. This online version has been corrected.