Many doctors in Alberta's health system say they are being punished, ostracized and pushed out for complaining about problems with patient care, a panel of experts reported Thursday.
Dr. John Cowell, head of Alberta's Health Quality Council, says the problem reflects a system so muddled by bureaucratic rules and riddled with cross-competing concerns, no one knows who to turn to or how to solve it.
"There is very little consistent process or guidelines on how physicians in their various roles should conduct their advocacy," Dr. Cowell told a news conference called to release his interim findings.
"There is a communication disconnect.
"We have spoken with some who have been characterized as the intimidators. What we find is they had no idea they were intimidating and, in fact, they felt intimidated themselves."
But he says the human fallout is nonetheless sobering: doctors say they are being shunned by their colleagues, losing contracts to perform work, or being denied hospital privileges without due process.
"I can tell you the stories are very disturbing and often very sad," said Dr. Cowell, who said he couldn't give details to protect personal privacy.
The loss of hospital privileges without a fair hearing is particularly galling, he said.
"If a physician loses privileges in a hospital, this is quite catastrophic for them. They literally cannot practice their craft in that location."
He said the recent centralization of all regions under one superboard means a physician who loses privileges in one region has nowhere to turn.
"In some circumstances we now know there have been instances where very highly qualified individuals had no option but to leave the province."
He said doctors are told to advocate but aren't told how to do it.
"They've had little coaching or education on how to advocate effectively, reasonably and responsibly. Somehow I guess it's expected physicians would intuitively know how to do this."
Dr. Chris Eagle, the head of Alberta Health Services — which carries out the day-to-day policies of the health department — said they share Cowell's concerns.
Dr. Eagle said they are implementing measures, such as a hotline, and developing reporting guidelines to encourage doctors with concerns to step forward.
"We still have a lot of work ahead of us," said Dr. Eagle.
The council's review is at the vortex of a raging debate that has dominated Alberta's political landscape for a year.
It began last November when the government faced allegations from emergency room doctors at the University of Alberta Hospital in Edmonton that the system was breaking down, with long lines for surgery and patients dying while waiting for emergency care.
That political brush fire became a forest fire for the governing Progressive Conservatives in February when Raj Sherman, a former government member on the health file, crossed the floor and levelled allegations that 250 patients waiting for lung cancer surgery had needlessly died years earlier awaiting help, and that doctors were punished or paid off to keep it quiet.
Former premier Ed Stelmach rejected opposition calls for a full judicial inquiry and instead directed the arm's-length Health Quality Council to investigate.
Almost daily during the spring legislature session, the Opposition Liberals, who are now led by Mr. Sherman, revealed stories and testimonials from doctors who said they were intimidated or abused.
They say the intimidation is the result of a government more committed to squelching dissent than fixing problems.
The government dismissed the testimonials as one-off cases not indicative of a pattern.
Dr. Cowell says his evidence shows there is indeed a pattern.
"I would not have not put it in the report if we didn't have validation this wasn't just one or two stories," he said.
But Dr. Cowell said he has not found evidence to substantiate Sherman's claims.
He said a comparison of lung cancer patient deaths didn't spike in Edmonton during the time period in question and were comparable to the rates in Calgary.
Mr. Sherman challenged Dr. Cowell with different numbers, noting the prestigious medical journal "The Lancet" reports Alberta has amongst the lowest cancer survival rates in Canada.
And he said the doctors who could corroborate the lung cancer deaths can't speak publicly due to gag orders under lawsuits or won't speak publicly without the security of a judicial inquiry.
"(Cowell) is absolutely correct. I agree with him. He doesn't have any evidence," said Mr. Sherman. "That doesn't mean the evidence isn't out there."
Sherman and other political opponents still want a judicial inquiry and took heart from promises made earlier this year by Premier Alison Redford to call one. Ms. Redford has since backed away from that promise, suggesting a beefed up Health Quality Council can do the job.
NDP Leader Brian Mason says problems of intimidation could reach into the offices of former health ministers now sitting in different portfolios in cabinet.
He said only a judicial inquiry with the power to compel reluctant witnesses to testify, and with a judge who makes his or her living scrupulously weighing evidence, will do.
"That's enough confirmation (in the Cowell report) for me that the physician intimidation was real," said Mr. Mason.
"We need to go further now and have that judicial inquiry."
Danielle Smith of the Wildrose party agreed.
"Ms. Redford is obviously mistaken if she thinks this Health Quality Council review is enough," said Ms. Smith.
Dr. Cowell's report also found that while they could not find evidence of patients dying while awaiting emergency care at the University of Alberta, "the care was often provided in challenging and very difficult conditions."
He also said there's no reason not to believe there were similar overcrowding strains on other emergency departments in Alberta.
Health Minister Fred Horne was not immediately available for comment.