By the time it's finished playing itself out, when the schemes have all been unravelled and the books fully opened up and the police investigation concluded, the sorry mess at the air-ambulance service Ornge could wind up costing Ontarians tens of millions of dollars.
The much bigger cost – the one that the province really can't afford as it tries to wrestle down a $16-billion deficit – might be the loss of an effective health minister.
Deb Matthews will keep her job for the foreseeable future; she's too well-regarded in government circles to be a sacrificial lamb. But as she stood there on Wednesday, trying to keep her cool during the brutal press conference that followed Auditor-General Jim McCarter's damning Ornge report, it was hard not to see her as a diminished force.
Two years ago, shortly after being named to her post, Ms. Matthews won a very public fight with pharmacies to find big drug savings that had eluded her predecessors. The communication skills and the iron will that she displayed on that file gave some hope that she'd be able to win other, tougher battles to limit health-care costs.
But with those battles now looming large in the form of nascent contract negotiations with the Ontario Medical Association and a push to restructure the way hospitals are funded, Ms. Matthews has lost much of her political capital.
Until recently seen in the health sector as a force to be reckoned with, she's now perceived as vulnerable. While there's a sense that she's a good minister dealt a bad hand, there's also an awareness that – having failed to stop Ornge from abusing public dollars – she's lost her ability to rally the public behind her by presenting herself as a tireless defender of the public interest.
Just as importantly, Ms. Matthews has been unable to drive reforms the way they need to be driven behind the scenes because she's been spending so much time managing a scandal.
Those who have worked with her say she is not the sort of minister who quickly memorizes a few talking points and goes out in front of the cameras; before speaking publicly on something, she wants to make sure she fully understands it.
That's to her credit, but on a file as complex as Ornge, it has its drawbacks. Looking at the murky public-private hybrid described by Mr. McCarter on Wednesday – a shadowy web of corporate entities that even the Auditor-General had trouble wrapping his head around – it's no wonder Ms. Matthews has been distracted from her other files.
Air-ambulance services are such a marginal portion of her enormous ministry's responsibilities that, until recently, Ms. Matthews barely paid them any attention – probably the best defence for her failure to crack down on Ornge sooner. Now, she's by some accounts spending more than half her time on a file that accounts for roughly 0.3 per cent of Ontario's annual health spending.
There's some hope for Ms. Matthews, who introduced legislation on Wednesday to put Ornge on a much tighter leash going forward, that the worst is over. She can at least count herself lucky that Mr. McCarter's report came out during such a busy pre-budget week that it's unlikely to get much extended play.
But already, she has spent far too much time in survival mode. And in the meanwhile, her potential to get the health system onto a sustainable footing may have been lost for good.