Former Health P.E.I. CEO Michael Gardam said he was not surprised to see Melanie Fraser leave the role, and said the province’s health-care system is being undermined by political interference.

In an interview with CBC News, Gardam describes a governance structure he calls “a mess,” where health leaders are pulled in multiple directions by politicians who “typically have no knowledge of health-care delivery.”

“Sometimes your board was the boss, sometimes the minister was the boss, sometimes the premier was the boss, sometimes the premier’s chief of staff was the boss. And they may not even necessarily talk to each other, but you’re getting directions from all these different places,” Gardam told Island Morning host Mitch Cormier on March 13.

“It’s just exhausting to try to keep all those balls in the air.”

The province announced last Wednesday Fraser would be “departing the role” as Health P.E.I.’s CEO. Premier Rob Lantz would not say whether she had been fired. Her departure will cost taxpayers about $400,000 in severance.

All this came on the same day that 93 doctors sent a letter to the premier and health minister saying they’d lost confidence in Fraser’s leadership. In that letter, they said the relationship between the physicians and Health P.E.I. had suffered “deep damage” that is “beyond repair.”

‘The governance of Health P.E.I. is a mess’

Health P.E.I. was created in 2010 following a 2008 review of the province’s health system conducted by consulting firm Corpus Sanchez International.

In its final report, the consultant recommended creating a Crown corporation to oversee the health system and operate at arm’s length from government.

But Gardam said that is not how the system functions in practice.

“The governance of Health P.E.I. is a mess. So when the CEO was taking direction directly from politicians — who, I will be blunt, typically have no knowledge of health-care delivery — you get into real trouble because they have a particular lens, which is getting re-elected,” he said.

“When you’re relying upon non-experts to direct the health-care system, you get into trouble.”

Gardam also said politicians sometimes make unrealistic promises about health care, such as pledges to provide every Islander with a family doctor, and then hold the health system responsible when those goals cannot be achieved quickly.

“So then you hold the health-care system accountable to a completely unrealistic promise, and what do you end up doing, forcing stuff on the doctors, getting into trouble, firing the CEO, etc,” Gardam said.

“Whereas in a well-functioning system, the government sets high-level goals that are realistic: ‘We’re going to expand primary care, we need to wean ourselves off of travel nurses, and Health P.E.I. you are empowered to figure out how you’re going to do that, but we expect results’ — and then get the hell out of the kitchen.”

Gardam said Health P.E.I. should still be held accountable, which is the role of its board, but he believes the current governance structure makes that accountability unclear.

“Having a board in there that we’re accountable to on paper, but not really, it just makes it so messy. And ultimately, I mean, by the time I left P.E.I., I was fried, because it’s just so hard to keep turning your head in all these different directions.”

Gardam said larger hospital networks have clearer boundaries, such as the University Health Network in Toronto where he worked for years, where the premier is not “calling the CEO every day and telling them how to move patients around the emergency room.”

“There’s a level of involvement on the Island, because the Island is so small that politicians are right in there. They need to be guiding. They need to set, you know, these different goals that we need to meet, but then get out of the kitchen.”

Gardam said he spoke with Fraser around the time she began her role and told her the job in P.E.I. is “highly political” and far more connected with government than in Ontario.

“I saw my job as doing what the politicians wanted to a degree. If I felt that it was fundamentally undermining what we were trying to do, or would harm the health-care system, I would speak up,” he said.

Gardam’s tenure as CEO ended in December 2023. The following month, he appeared before a legislative committee that led to a tense exchange with then-Progressive Conservative MLA Steven Myers. Much of Gardam’s testimony, which went on for almost three hours, focused on his concerns about planning for the new UPEI medical school.

Fraser’s contract, meanwhile, included a non-disparagement clause stating she could not make comments that “defame” or “disparage” the agency or the provincial government “or any of their respective representatives.” No such language appeared in Gardam’s contract.

“I think that was the difference between us. She was not going to speak up,” said Gardam.

Questions about recruiting the next CEO

With tensions mounting between the medical community and Health P.E.I., Gardam questions who would now want to take on the CEO role.

“I think it will be hard to recruit a top calibre CEO without fundamental changes, because, I mean, people can Google, right? It’s very easy to find out what the job is like in P.E.I.”

Laurae Kloschinsky, who served as the assistant deputy minister of mental health and addictions with the Department of Health and Wellness, will serve as interim CEO.

She told CBC News on March 16 that she was asked to do the job, and that her aim is to “support the Health P.E.I. strategic plan” and work with staff and the board to meet their goals.

When asked if she thinks there is too much political involvement in the health authority, Kloschinsky said that, while she’s been in the job for less than a week, she feels supported and feels that “collectively Health P.E.I. gets to work through these next steps.”

“My number one priority is just to provide stability, to support the team. It’s been a lot of change. It’s been hard. They have questions and I’m hoping to provide answers where I can.”

Gardam said the governance model needs to change.

“You’re keeping it exactly the same way it’s been ever since 2010. You’re not changing a damn thing. And so we’re just going to repeat ourselves.”

More than two years after leaving the role, Gardam is now still an outspoken voice on health care on the Island and continues to share his views through opinion pieces.

“I really do care. I really do believe that there’s an opportunity to make things better. I can imagine when this airs that people will say, Well, I’m, you know, meddling, yet again. I don’t see it as meddling. I see it as trying to be an advocate for a system that could improve if we let it.”