For four years, Randy Goodman had a front-row seat to the tumult at Health P.E.I. during his time on its board of directors. 

Tensions have arisen recently between the provincial government the health authority and front-line workers — capped off earlier this month by the departure of Health P.E.I. CEO Melanie Fraser — but strife within the system goes back years.

Goodman was appointed to the board of directors in 2018 by the Liberal government of the day. He would eventually resign from his position in August 2022.

“I don’t want to speak on behalf of everybody,” Goodman told This Is P.E.I.

“I’m a frustrated citizen that has some history that I just felt I needed to speak up.”

Goodman said his resignation came after plenty of frustration.

He was appointed to the board for his “multidisciplinary clinic leadership,” he said, having previously led a large public-private partnership involving 100 health practitioners. Prior to that, he owned multiple private clinics and had extensive experience in physiotherapy.

At the time, he said the board included a strong group of leaders and experts from different fields who believed they could have an impact on the province’s health-care system.

While he doesn’t blame one particular political party for the strife at Health P.E.I., Goodman said it was after the 2019 provincial election when Dennis King’s Progressive Conservatives formed government that the frustrations “became more and more visible.”

Feedback from front-line health workers began to fall on deaf ears, he said, something multiple people within the health authority would eventually express, including former board chair Derek Key and former CEO Dr. Michael Gardam.

‘Too many chefs’

On March 16 of this year, Goodman attended a town hall meeting on health care held by Liberal MLA and health critic Gord McNeilly. He stood to raise concerns about political interference with Health P.E.I., which he said he witnessed “multiple times.”

When he first joined the board, Goodman told This is P.E.I., “there was clear distinction between what Health P.E.I. was responsible [for] and what government was responsible for.”

But, he said, that distinction became less clear during his four years there — and he doesn’t think it’s improved since his resignation.

“It just seems we just keep doing the same thing over and over again, expecting different results.”

He now describes Health P.E.I. as “handcuffed.” He said the board has been reduced to “oversight” and does not manage or direct long-term health care in the province.

Goodman pointed to a statement made by Premier Rob Lantz, who said in a media interview that Fraser served as Health P.E.I.’s CEO “at the pleasure of the premier.”

“I don’t know whether he doesn’t understand the legislation. That is not the way it is supposed to happen,” Goodman said.

“The CEO has to report to the board and, if there are issues between the province and Health P.E.I., it’s between the premier and/or the minister and the board chair, and then the board chair would manage those affairs.”

Goodman said he’s seen situations when the Health P.E.I. CEO was directed by the province to go against the board’s recommendations “because the government tells them to do it.”

“There’s always that saying of ‘too many chefs in the kitchen,'” he said. “Every two or three years, you change the structure, you change the management concept, you change the priorities….

“We’re not a corporation. We’re just a simple service to provide care to 183,000 Islanders.”

Goodman said he began to feel devalued about a year and a half into his stint on the board. He said things like hiring physicians would often hit roadblocks, requiring approval from the P.E.I. Treasury Board.

He said there have been “some improvements” since. Health P.E.I.’s board and CEO can now approve a doctor’s hiring without Treasury Board approval, but there are still some hurdles to clear.

Gardam has previously criticized the P.E.I. government’s pledge to assign every Islander to a primary care provider is unrealistic.

Goodman agrees, adding there doesn’t seem to be much initiative from the province to do that.

“The public needs to understand that the system isn’t working right now and it has to change,” he said. 

“I don’t see that they’re leading the charge moving forward in determining what’s important and how to deliver that without having to answer to the government all the time.”

He said Health P.E.I. needs “bold people” to make decisions, and front-line workers and experts need to be involved in the conversations.

Colleen Flood, dean of the faculty of law at Queen’s University and one of Canada’s leading scholars on health law and policy, said the governance structure of provincial health boards varies across the country.

She said health care is often top of mind for voters, who — if things aren’t going well — may hold governments to account.

“But on the other hand, health care is not a three-year kind of affair,” she said. “It really requires a lot of long-term planning and systemic thinking.”

After reviewing some of this province’s legislation, Flood said there is a lack of clarity about who the Health P.E.I. CEO answers to.

“Governments that do tend to intervene in this way come to regret it later,” she said.

“Government should only be intervening in the rarest and most outrageous situations where … they’ve lost trust or faith in the board itself.”

How involved should governments be?

In December, a contentious agreement between Health P.E.I., the provincial Department of Health and Wellness and the Medical Society of P.E.I. — an agreement that’s since been put on pause — set more flexible models for the number of patients family doctors on the Island can and should handle.

After it was signed, the agreement received pushback from family physicians, who said it will drive some doctors out of the province.

When the province announced on March 11 that Fraser would be “departing the role” as Health P.E.I.’s CEO, the news came on the same day that 93 Island doctors sent a letter to the premier and health minister saying they’d lost confidence in Fraser’s leadership. 

Flood described Canadian physicians to be a powerful lobby group, and said politicians can often be “pretty nervous about taking them on.” 

She said the P.E.I. government should have done more consultation with Island doctors about the workload targets.

“My view is you need to give [doctors] independence,” Flood said. “If they’re not happy, the provincial government might wear it at the polls….

“What we should have hope for is perhaps better engagement with them and the process of change.”

Flood said health care in Canada doesn’t function as well as it could, given the resources that are put into it — and while the system isn’t underfunded, she said it’s also not well directed.

“We’re all not going to vote for a public health-care system or support moral resources for it if we think that when we really need it, it’s not going to be there,” Flood said.

“The mandate of the province should be to say, ‘These are the core things we want you to do in any kind of three- to five-year mandate. Here are the resources that we’re giving you to do that, and we expect you to achieve that within these resources. Can you do it?'”