Poor Hospital Cleaning

Poor hospital cleaning revealed as major problem

'Some hospitals are a real freaking disaster'

CBC News

Posted: Mar 22, 2012 9:29 PM ET

Last Updated: Mar 23, 2012 8:23 AM ET

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The health of hospitalized Canadians and their visitors is being seriously put at risk by hospitals that have cut corners in cleaning budgets to save money, a Marketplace investigation has revealed.

The program took hidden cameras inside 11 hospitals in Ontario and British Columbia. What they found in many of them were surprisingly inadequate cleaning regimens – in short, dirty hospitals that could make you sick.

In many hospitals, Marketplace staffers applied a harmless gel to places that many people would touch – hand rails, door handles, light switches, elevator buttons.

DIRTY HOSPITALS

The full story, Dirty Hospitals, can be seen on CBC-TV's Marketplace tonight at 8 p.m., 8:30 in Newfoundland.

The gel glows when seen under an ultra-violet light. But most of the time – and this was true in every hospital where Marketplace carried out gel tests – the gel was still there more than 24 hours later, meaning the surfaces had not been cleaned at all.

The program talked to cleaners, supervisors, nurses, doctors, and hospital administrators to get a handle on what has become a major problem at Canadian health-care facilities – a shocking number of hospital-acquired infections.

While Canadians love to crow about their first-rate health-care system, it also leads in one area that doesn't get the same glowing reviews.

About 250,000 Canadians come down with life-threatening infections while in hospitals every year. That’s the highest rate in the developed world. As many as 12,000 people a year die.

Denise Ball's husband Gary became one of those statistics last year.

He was admitted to Niagara General Hospital for treatment of pancreatitis. While there, the 63-year-old retired school teacher contracted C. difficile – a life-threatening illness that is all too common in Canadian hospitals. It ended up playing a role in his death a few months later.

Denise Ball remembers the cleaning regimen in her husband's room was less than adequate, saying the cleaners would spend only 10 minutes on a room everyone knew was infected with C. difficile. She says a proper cleaning would have taken much longer.

"This has to stop," she says. "This is Canada."

More with less

Time and again, hospital insiders told Marketplace that cleaners were being asked to do more with less. "We used to have one person to one wing of a hospital to clean," one cleaner said. "Now, we have three floors to clean."

A cleaning supervisor at one hospital told Marketplace host Erica Johnson that it's "common practice" for cleaners not to change the cleaning solution in the bucket when mopping up. "They just don't have the time," the supervisor said.

Sometimes there aren't enough cleaning supplies. A nurse, whose identity Marketplace protected, said she's seen a cleaner mopping common areas after having mopped the rooms of infected patients because she didn't have enough mops to change. "She's just cross-contaminated the whole area, so there's no area that was actually clean."

Sometimes, only one cleaner would be on staff in an entire hospital during night shifts. "That kind of day-night difference is very common, and it makes no sense," says Dr. Michael Gardam, an infectious disease expert at the University Health Network in Toronto.

Gardam has seen enough in his time looking at hospital cleaning practices to know that some hospitals are worse than others – much worse. "Some hospitals are a real freaking disaster," he told Marketplace."They've been told to actually cut their number of housekeeping staff by outside auditors who are trying to help them balance their budgets."

In recent years, many hospitals have cut the portion of their budget that is devoted to cleaning. Sometimes, they've done that by contracting out cleaners or their management.

C. difficile outbreaks common

It's not like we haven't seen the devastating results of hospital-acquired illness. Newscasts and newspapers have been filled with stories of hospitals under quarantine because of C. difficile outbreaks. In the last decade, outbreaks have hit hospitals in most provinces. A huge outbreak in 2003 and 2004 led to as many as 2,000 deaths in Quebec.

Last year, there were outbreaks in at least 10 hospitals across Ontario alone. One of the worst was the Niagara Health System in Ontario. More than 100 cases were diagnosed and the infection was a factor in the deaths of 37 patients, including Gary Ball, the patient mentioned earlier in the story.

The man appointed by the Ontario government to get the Niagara outbreaks under control, Dr. Kevin Smith, denies that hospitals have been cutting back on cleaning. "I think they're experimenting with new models of cleaning," he says.

Marketplace used an ultra-violet flashlight to find hospital surfaces that hadn't been cleaned in at least 24 hours. (CBC)

When informed that workers in the Niagara hospital system told Marketplace that they still don't have the time or resources to do an adequate cleaning job, he says, "I haven't heard that message," saying "everybody" feels rushed in health care these days.

The outbreaks are officially over in the Niagara Health System. But when Marketplace showed Smith several areas where researchers had applied test gel in three hospitals he supervises, most of the surfaces showed no evidence of cleaning. The ultra-violet light showed uncleaned hand rails outside an isolation room, uncleaned support rails in a public washroom and uncleaned hand rails in a ward with highly contagious patients.

"I'm obviously very disappointed to see that. That is a less than optimal cleaning opportunity. We need to fix it," Smith said.

There's something else that some observers think is helping to drive the pressure to skimp on cleaning. In Ontario and British Columbia, for example, hospitals are given bonuses for turning over beds quickly – hundreds of extra dollars each time a hospital gets a patient out of a room before a certain time. More money is dangled for quickly transferring a patient from the emergency ward to a room. Hospital CEOs, already well-paid, receive bonuses that depend, in part, on reducing wait times.

While the goal of such rewards may be admirable, critics say the actual effect has been to speed up cleaning to an unhealthy degree.

"They just don't get it," says Denise Ball. "And maybe until one of their loved ones that went in healthy and … a few months later ... they're going to their grave. Maybe that's what will wake them up."

http://www.cbc.ca/news/health/story/2012/03/22/marketplace-dirty-hospitals.html

Reflections

1.    What is the link to Crisis Management?

The story identifies problems with the cleaning and disinfecting practices of hospitals in Ontario and British Columbia. The investigative report reveals that many hospitals are not cleaning common areas properly and this may contribute to more people being infected with diseases that could have been avoided if the hospitals were appropriately resourced.

2.    What stage of Crisis Management does the system appear to be at?

This is a risk for the healthcare industry and especially hospitals. This could lead to stricter guidelines on hospitals and more audits on their cleaning practices. This is also a risk for hospital senior leadership such as CEOs because the article talks about their high salaries and hints at the fact that they are cutting corners and putting patients in harm’s way to benefit from pay outs that they get for discharging patients faster.

3.    How well does the system appear to be handling the situation?

The healthcare industry is already aware of the issue of infection control. Hospitals need to use this report to make them more aware of issues in their organization and need to ensure that they are putting systems in place in order to manage the risks. They also need to make the public and their patients aware of the infection control systems they have in place for reputation management. That way, if they do have an outbreak such as C. Diff., they have built up enough reputation capital before the crisis so that their reputation, brand and public trust can be built up again after the crisis ends.

4.    What level of crisis preparedness does the system appear to have?

Most hospitals have risk management and quality departments that monitor signals of crisis such as infection outbreaks. However, the article mentions that Dr. Kevin Smith who has been appointment by the Ontario government to get the Niagara outbreaks under control denied that hospitals have been cutting back on cleaning and that he thinks they are experimenting with new models of cleaning. This is an indication that hospital leadership has not accepted this as a risk and this could become a crisis if an outbreak were to occur again and could further damage the Niagara Health System’s reputation and their public trust.

5.    What personal reactions/feelings does the description trigger in you?

After reading this article, it has made me a bit fearful of the risks that I or my family members would take if we ever had to visit a hospital. As this article points out, patients are exposed to infections that they would not normally be exposed to in their environment in a hospital. It is the responsibility of all hospitals to ensure that they are following strict infection control guidelines in order to protect patients, staff and visitors to the hospital.

6.    What advice would you offer to those involved?

I would tell the hospital industry to do an internal audit of their housekeeping staff and their infection control practices so that they can identify areas of risk in the pre-crisis phase. This will protect them from a public loss of trust such as the one that has taken place in the Niagara Health System. This will also protect the senior leadership of the hospital (CEO and Board of Directors) from facing consequences such as losing their jobs if an outbreak does happen.

The Ministry of Health and Long Term Care of Ontario is already aware of this issue and has required hospitals to publically report their hospital acquired infection rates through the Excellent Care for All Act which was put in place in April 2011. The ministry may want to give hospitals more funding or incentives to spend more on infection control practices.

 

Patients or their families need to be informed of this issue and the health risks associated with it and need to remind their healthcare providers to follow the proper infection control procedures to ensure that they are not exposed to infections unnecessarily.  

Kony - The plot thickens...

Anti-Kony campaign in turmoil after filmmaker's breakdown

By Mary Slosson, ReutersMarch 23, 2012

Jason Russell, co-founder of non-profit Invisible Children and director of "Kony 2012" viral video campaign, poses in New York, March 9, 2012. The director of a viral video that calls for the arrest of Joseph Kony, the fugitive rebel leader of Lord's Resistance Army militia group in Uganda, agreed on Friday with skeptics who have called the film oversimplified, saying it was deliberately made that way.

Photograph by: Brendan McDermid , Reuters

LOS ANGELES, March 23 (Reuters) - The public meltdown of the man behind the viral “Kony 2012” video has thrown his campaign into turmoil even as the film succeeded in turning the world’s attention to capturing an elusive and brutal Ugandan warlord.

Jason Russell, whose 30-minute video sensation shone a spotlight on Joseph Kony’s use of child soldiers in Uganda, was taken by police to a hospital in California last week after suffering what doctors described as a brief psychotic breakdown.

Videos posted online showed him pacing back and forth on the sidewalk, naked, in broad daylight, in an incident certain to raise questions over the viability of Russell’s Invisible Children group.

“You always hear people say, ’I’m so stressed out, I’m about to go crazy,”’ said Robert Thompson, director of the Bleier Center for Television and Popular Culture at Syracuse University. “Still, the story of all this happening and then he literally is wigging out is very odd.”

He said the episode could serve to divert attention from the warlord to Russell. “Now whenever you see a Kony story, it’s about the guy, not Kony.”

Kony, accused of terrorizing northern Uganda for two decades, is wanted by the International Criminal Court for war crimes. He is accused of abducting children to use as fighters and sex slaves and is said to like hacking off limbs.

Russell’s wife, Danica, has said her husband would remain under hospital care for a number of weeks, and might not be able to return fully to his work at Invisible Children for months.

In downtown San Diego, Invisible Children’s office has been locked up.

Russell’s Invisible Children co-founders, Laren Poole and Bobby Bailey, declined through a spokeswoman to be interviewed, as did the organization’s CEO, Ben Keesey.

Keesey has attributed Russell’s breakdown to the severe emotional toll of the previous two weeks in which the Kony video went viral. Even as the video drew attention to the warlord, it sparked criticism over what some called its misleading portrayal of current events in Uganda.

A spokeswoman would not say how or if Invisible Children planned to proceed with a planned April 20 day of action, in which viewers of the video were asked to paper their homes, lawns and cities with Kony posters to turn him into a household name.

RENEWED EFFORTS TO HUNT KONY

Analysts said the fate of the group may be largely irrelevant because it had already served the purpose of persuading millions to care, and policy decisions were taking shape.

“It’s rare that we have literally millions of Americans calling for more engagement in Africa,” Senator Chris Coons, chair of the Senate Foreign Relations subcommittee on African Affairs, told Reuters in an interview, noting his subcommittee normally received far less attention than it had since the “Kony 2012” video was released.

“I was both amused, pleased and proud that all three of my kids asked me what I was doing to stop Joseph Kony,” Coons said.

Attempts by regional forces and foreign troops to corner the fugitive warlord have so far failed. But on Friday, the African Union said it would launch a 5,000-strong force in South Sudan to hunt him.

The African Union move is in addition to 100 U.S. military advisers President Barack Obama sent to the region last year to help Ugandan forces track Kony down.

Kony’s Lord’s Resistance Army is a shadow of its former self, numbering about 250 members, according to a December 2011 report published by the Social Science Research Council.

Some 200 of them are with Kony in the Central African Republic, and 50 others are in the Democratic Republic of Congo, the report said.

The video Russell directed, interspersing shots of his own young son with those of suffering Ugandan children, depicts children walking into the city center of the Uganda city of Gulu at night to avoid capture.

But active violence like that has not been seen in northern Uganda in seven or eight years, according to Laura Seay, a professor at Morehouse College, who studies conflict and community in central Africa.

“LRA victims are depicted as absolutely helpless,” Seay said, characterizing the portrayal as neo-colonial and saying the film may have mischaracterized the nature of Gulu, where the number of children taking nightly refuge dwindled after a truce between government forces and the LRA in 2006.

“You have coffee shops and pizza places in Gulu. It’s absolutely peaceful,” she said.

Seay suggested that those whose interest in the region were piqued by the Invisible Children campaign turn their attention next to more active warlords in the region such as Bosco Ntaganda, nicknamed “The Terminator,” and also wanted by the ICC for war crimes.

Ntaganda, a Rwandan operating in the Democratic Republic of Congo, is accused of conscripting child soldiers under age 15 to carry arms and fight in open conflict.

“He walks freely,” Seay said. “I know where he eats dinner every night.”

© Copyright (c) Reuters

Reflections

1.       What is the link to Crisis Management?

The story of Invisible Children and their Kony2012 campaign has unfolded and taken a bizarre turn. It seems that Jason Russell, one of the co-founders and the narrator of the Kony2012 video has had a very public psychotic breakdown. Russell ran through the streets of San Diego naked and was later arrested by police for lewd behaviour. This has put his organization Invisible Children in crisis. Their head office in San Diego has been shut down and their campaign has been tainted by this event. Their supporters are now unsure of what they should do on April 20^th, which the video had marked as a day of action by putting posters of Kony up all over the world in order to make more people aware of the warlord and his crimes against humanity.

2.       What stage of Crisis Management does the system appear to be at? 

The organization Invisible Children is now in a full blown crisis. This is because their head offices in San Diego have been closed since this incident. This incident has directly affected the organization’s business continuity and has adversely affected the services they provide to their primary stakeholders because their campaign and the organization are now under further scrutiny and have lost credibility and the trust of the public. The speed at which news travels through social media has further amplified this crisis. Videos of Russell screaming profanities and running through the streets of San Diego have been shared through social media and traditional media outlets. Since the organization’s video campaign (Kony 2012) went viral through social media, this is the same medium being used by the public to share the crisis that the organization is going through now.

 3.       How well does the system appear to be handling the situation? 

The Invisible Children is not handling this situation well. They have refused to make any statements about this event to the media and have not responded through social media or through their blog on the Invisible Children website. Before this particular crisis, the organization had been responding to all the criticisms of them and their campaign through their blog but has not responded to this event through that medium either. Jason Russell’s wife is the only one that has made a statement to the media but that is a personal response. The organization needs to have a spokesperson that can respond to this event and this crisis. This spokesperson should be someone that had been prepared beforehand and who had addressed the previous para-crisis of criticisms in the media. This spokesperson should also be a subject matter expert on the organization, its finances and the health of the founder and what lead to his breakdown. Lastly, this spokesperson should address the public and their supporters’ concerns about the business continuity of the Invisible Children and the “action day” that is planned for April 20^th of this year.

Because of the peculiarity of this event, the media has picked up on the story and is using it to justify the criticism of the campaign that was brought to light when the video first went viral. This also seems to justify their critiques of the organization and the intentions of the founders.  

4.       What level of crisis preparedness does the system appear to have?  

The organization did not seem very prepared for this crisis at all. They should have seen that Russell was “overworked and overstressed” and told him to take a break before he had his psychotic breakdown and ran through the streets of San Diego naked. If his breakdown was caused by all the criticism that his organization or campaign had attracted, the organization should have been prepared for this as this criticism came about in less than a day after the video went viral. Furthermore, the organization should have learned from the para-crisis that had started with the criticisms and been better prepared for this one. They should have made a public statement about the incident and posted it on social media.

5.       What personal reactions/feelings does the description trigger in you?

Although this event taking place is very sad because Russell seems to have good intentions and couldn’t cope with the public pressure and sudden limelight, I am not surprised that the organization went through some sort of crisis so early after they gained notoriety. As mentioned in my last blog post, the organization should have seen the criticisms as a para-crisis and should have prepared for an actual crisis by having a crisis management team and spokesperson. It is not likely that this scenario would have been thought of when they did their crisis planning, but they could have at least had some sort of crisis communication when it did occur. Invisible Children spends almost 30% of its funding on advocacy and campaigning. This should have alerted them to the fact that their primary and secondary stakeholders would be affected by the type of media coverage that their organization received. This is why they should have responded to this crisis right away and not refused to comment on it.  

6.       What advice would you offer to those involved? 

I would tell the Board, CEO and co-founders of the Invisible Children organization to put together a crisis management team and prepare a plan to deal with this and other possible crisis that could happen. Next, I would tell them to immediately draft a crisis communication plan and implement it through their own blog on their website, social media and traditional media. Finally, I would tell them to monitor other signs of crisis and ensure that they address these early, in the pre-crisis phase so that an event like this does not catch them off guard again.

Kony

Kony 2012 campaign to capture warlord goes viral, but also draws some critics

Published On Wed Mar 7 2012

On April 20 you might just wake up to find Joseph Kony all over Toronto.

Screen grab/Toronto Star

Liam Casey Staff Reporter

Joseph Kony has been terrorizing Uganda and other African countries for 25 years, killing thousands and kidnapping 30,000 children to use as soldiers in the Lord’s Resistance Army.

A film about Kony’s atrocities in Uganda, along with a social media campaign to stop him, blew up on the Internet Wednesday. The Kony 2012 campaign by a group called Invisible Children “aims to make Joseph Kony famous, not to celebrate him, but to raise support for his arrest and set a precedent for international justice.”

But some are questioning why the campaign is happening now.

“It’s not really news — we know what Kony’s been doing for decades,” Kampala resident Jeff Anguyo told the Star.

Filmmaker Jason Russell said there was no reason for the timing, except that they decided last summer to push the brand Kony 2012.

“It took us nine years to make this movie and we just needed to finish it,” Russell told the Star. “We decided 2012 was the last year for Joseph Kony to continue his crimes against humanity.”

Kony has been indicted for war crimes and human rights atrocities by the International Criminal Court, yet he still roams free. The Ugandan army has been searching for Kony throughout Central Africa for years without luck. The United States recently sent 100 Special Forces advisers to help out.

The Ugandan warlord’s shadowy army now finds refuge in South Sudan, Central African Republic and the Democratic Republic of Congo, always on the move and only seen when it attacks villages for food and supplies. It no longer has any ideological purpose for fighting, according to Human Rights Watch — it simply fights its own survival, and continues to kidnap children, some as young as 10, to serve as soldiers.

After a lull in violence in 2011, there has been upsurge in attacks in early 2012. Since January, the group has killed at least 35 people, abducted 104 others and displaced more than 17,000 in Orientale province in northeastern Congo, the UN refugee agency said last week.

“If Kony was kidnapping children in the United States, giving them guns and killing dozens in towns across the country just to steal food and supplies, this would have ended a long time ago,” said Anneke Van Woudenberg, a researcher with Human Rights Watch who specializes in the Lord’s Resistance Army.

But it was Russell’s 30-minute film about Kony that made news Wednesday. It begins with the story of Jacob, a north Ugandan boy whose brother was killed by Kony’s army and who fears abduction. “We are also going to do everything that we can to stop them. Do you hear my words?” Russell tells him.

Invisible Children hopes its awareness campaign will help track down Kony. Among its initiatives, it has planned an international poster plastering event on April 20.

But Mark Kersten, a Canadian at the London School of Economics who is working on his doctoral thesis about the International Criminal Court, questioned the group’s focus on Kony.

“(To say) all that is needed to end this conflict is to cut off the head of the army, which the film suggests, and everything will be resolved, is narrow-minded,” he said.

Human Rights Watch also points out that Kony’s army is down to several hundred and hasn’t been in Uganda for years, which the documentary left out.

A blog set up to criticize the campaign, called Visible Children, said money from Russell’s group “supports the Ugandan government’s army and various other military forces” according to GlobalPost. “Both the Ugandan army and Sudan People’s Liberation Army are riddled with accusations of rape and looting.”

Russell emphatically denied that any money from his organization is in the hands of any army.

“I’m for peace, not war,” Russell said. “Why would we ever fund an army?”

Critics also say raising awareness through campaigns like this isn’t enough. Only 31 per cent of Invisible Children’s charity dollars go to helping Ugandans, according to an audit of the organization by Considine and Considine.

“That is the old way of thinking,” Russell said in response to the criticism. “We stand by our use of a third of our money going to our film budget so we can build a real-time website of sightings of Kony’s army.”

Anguyo, who noted few people in Uganda have seen the documentary, said victims of Kony and the LRA need attention, too.

“A whole generation of kids got destroyed because they did not go to school and were used as soldiers,” Anguyo said. “Now those people are back in the north and need help.

“If (Kony) was caught, it would be cause for a celebration in Uganda, but that would only be the start of change.”

My Reflections 

1.    What is the link to Crisis Management?

Now that “Invisible Children’s video named Kony has gone viral all over the internet and has had over 55 Million views on YouTube to date, the non-government organization has also attracted some negative attention is under close scrutiny by said critics. A blog has already been set up called Visible Children which is for the sole purpose of criticizing the Kony 2012 campaign and Invisible Children as an organization. It is criticizing the campaign, the organization’s tactics, intent and their finances. This is an issue for Invisible Children and possibly a risk if they have something to hide. They need to keep a close watch on their internal environment, being the company’s employees, how they are achieving their mission, and how they are allocating resources. They also need to do continual environmental scans to see if there is anything going on it their external environment that could cause their company to go into a crisis.

2.    What stage of Crisis Management does the system appear to be at?

The stage of crisis the organization seems to be at is pre-crisis. This could also be categorized as a para-crisis because it resembles a crisis in that it is threatening the organization’s reputation and financial assets if an external audit is ordered to be conducted at the organization. Furthermore, this negative attention on the organization is not disrupting the organization’s day-to-day activities but it does warrant the attention of Invisible Children’s leadership as mismanagement of this criticism could result in an actual crisis.

3.    How well does the system appear to be handling the situation?

Currently, the Invisible Children not-for-profit organization seems to be handling the situation very well. They have posted a response to their critics on their website and have addressed specific issues that have been raised. They are being transparent about their finances and have even addressed a picture that has surfaced of the founders posing with the army holding guns. Not only have they addressed the picture, they have posted it as the banner on the page that they posted their response on. This will give them credibility in the eyes of their primary and secondary stakeholders such as bloggers, their donors and the media.

4.    What level of crisis preparedness does the system appear to have?

The system seems to be well prepared for crisis in that they are scanning their environment and detecting signals that could lead to crisis and are proactively responding to these signals before they get to the crisis phase. They also have a blog that addresses issues and criticism that come up in social media as soon as they become aware of them. Since the video was primarily shared on social media, the organization is responding through social media and their own blog on their website. This is advantageous as they “are where the action is”. (Coombs)

5.    What personal reactions/feelings does the description trigger in you?

This article addressed some of the concerns that I felt as soon as I watched the movie. It made me question what the organization is actually doing to improve the lives of Ugandans that have suffered at the hands of Kony. I was also curious about how they allocate the donation money and how much of it went into making such a high quality video. I was happy to see that I wasn’t the only one with these questions and am impressed by the Invisible Children’s timely response and the level of communication they are maintaining with their stakeholders. This shows that the organization is aware of the importance of crisis management, especially in the pre-crisis phase.

6.    What advice would you offer to those involved?

I would tell the organization to continue to monitor the social media world and to be transparent about their organization and to address criticisms as they come up. I would tell their supporters to do more than just “like” or “share” the video. That is one of the criticisms that the Kony video faced; people may end up being complacent and feel that they have made a difference by just sharing the video on their facebook. I would tell them to do all their research on the organization and the cause before supporting it and reflecting on what actions they could take to actually make a difference.  

ORNGE

Ontario health ministry was warned of serious problems at ORNGE in 2008

Published On Thu Feb 2 2012

An ORNGE accountant told the province’s health ministry and financial investigations team in 2008 that ORNGE was “handing out money like water.”

Ron Bull/Toronto Star

Kevin DonovanStaff Reporter

Ontario’s health ministry and the province’s financial investigations team were warned of serious problems at ORNGE three years ago, documents reveal.

An ORNGE accountant blew the whistle in 2008, telling the province that the publicly funded ORNGE was “handing out money like water.”

In an interview audio taped in 2008 by Ministry of Finance investigators, Keith Walmsley said former ORNGE boss Dr. Chris Mazza (who was terminated Thursday) and other executives were paying themselves whopping bonuses and had set up a spiderweb of for-profit companies. Walmsley went on to provide detailed allegations of numerous abuses of taxpayers money and said ORNGE was deceiving the cash-strapped health ministry, hiding a $5 million annual surplus in taxpayers funds by using a double set of books.

Walmsley had first brought his concerns to his bosses at ORNGE in 2007 and was told “what the Ministry (of Health) doesn’t know won’t hurt them.” When he complained further, ORNGE let him go just before his three-month probationary period was up.

Walmsley put his issues in writing to provincial officials, was interviewed by investigators in November 2008, then the health ministry told him the next month that the problems were solved.

A spokesperson for current Health Minister Deb Matthews confirmed that Walsmsley’s allegations were received by the ministry and passed to finance for investigation. Zita Astravas said ORNGE assured the investigators that all was well at the province’s air ambulance service. The probe was dropped.

Astravas said issues first raised by Walmsley are now being probed by a team of forensic auditors from the Ministry of Finance.

At ORNGE this week, there are now 43 auditors going through computers and paper files. A guard has been posted on the ORNGE file room to stop anyone from removing documents.

ORNGE was created in 2005 by then Liberal health minister George Smitherman and Mazza, a former Sunnybrook emergency doctor. It was set up as a not-for-profit agency to deliver air ambulance service across the province. At the time, ORNGE received about $115 million a year and they now receive $150 million annually.

Walmsley, a certified general accountant, was hired in September 2007 as senior business analyst at ORNGE. His salary was $80,000, and he was told he was eligible for performance bonuses of up to 7 per cent.

In an interview, Walmsley said ORNGE gave him the task of setting up the next year’s budget. Walmsley, who currently works at a Toronto hospital, had spent his career as an accountant in hospitals and private industry.

What he saw in the fall of 2007 shocked him. He presented the following information to government investigators as serious allegations that should be probed:

• Big bonuses. Mazza was getting a $250,000 bonus on a salary that back then was in excess of $300,000 (his compensation package grew to $1.4 million in 2011). Even junior employees were receiving a $16,000 bonus in 2007. Walmsley counted $2.4 million in bonuses in 2007, which he told investigators was unusual in what was supposed to be a non-profit, government-funded agency.

• For-profit companies. Walmsley said ORNGE Peel and other companies recently shut down by the province were being used to pay “stipends” or consulting fees to ORNGE executives. This shielded their salaries from the public Sunshine List.

• Perks in the woods. Walmsley tripped over information he said revealed weekend trips by ORNGE executives to Muskoka Woods, a high-end summer camp ORNGE was using as a base for its J-Smarts charity program. J-Smarts was supposed to teach youth how to safely do extreme sports. ORNGE had purchased a $50,000 water ski boat and Walmsley said executives would go to the camp on the weekend at ORNGE expense. A woman who became one of Mazza’s vice-presidents was a former water ski instructor.

• Untendered consulting contracts. ORNGE was handing out contracts with no tendering or advertising. Some people who were high-level ORNGE employees were also paid through consulting agreements. “And T4 (tax) slips were not being handed out,” Walmsley said.

• Big surplus. With health-care dollars scarce in Ontario, Walmsley was surprised to see ORNGE had an annual surplus of $5 million. He said he approached his boss and they both went to talk to then vice-president Maria Renzella (terminated Thursday along with Mazza and one other executive).

“I complained and was told they would hide the surplus,” Walmsley recalled. That $5 million, he said, was spread out among executives and used to pay for what he later described as “luxurious” company purchases.

Shortly after he complained to Renzella, Walmsley was told his employment at ORNGE was “not working out.”

That was just before the end of 2007. That December, with ORNGE complaining it was strapped for cash, then health minister Smitherman authorized a one-time $2.9 million funding to ORNGE for an increase in “salaries and wages and other operating expenses,” according to a letter written to ORNGE by Smitherman in December 2007.

After being let go by ORNGE, Walmsley waited until he found a new job, then wrote on April 14, 2008 to Margaret Best, the provincial minister for health promotion. In his letter, he set out allegations of financial wrongdoing. Walmsley realizes now he should have sent it to Smitherman, who had responsibility for ORNGE.

Best’s office forwarded Walmsley’s letter to the health ministry on Nov. 14, 2008. By that time, David Caplan had replaced Smitherman as minister. The letter was received by Ruth Hawkins, a senior health ministry official. Hawkins forwarded it to the Ministry of Finance and two investigators from the Sudbury head office were sent to interview Walmsley.

In a 45-minute tape recorded interview he set out the problems he had seen and urged investigators to take action.

His letter of complaint to the ministry stated he saw “several eye-opening situations” at ORNGE, including two sets of accounting records, hiding the surplus and executives “benefitting far too luxuriously.” He asked the ministry and investigators if it was possible that the ministry was supporting what ORNGE was doing (that question was not answered). Walmsley told the ministry he thought health-care dollars were supposed to be spent only on health care.

On Dec. 29, 2008, Hawkins wrote on behalf of the Ministry of Health to say that all of Walmsley’s allegations had been investigated by the “Ministry of Finance’s forensic investigation team.”

“I am pleased to say that the issues identified in your letter have been addressed and once again thank you for bringing forward your concerns.” Hawkins wrote.

This week, the aide to current Minister of Health Matthews said that after the investigators met Walmsley they “followed up with senior officials at ORNGE and the ministry’s Health Audit Services Team and concluded at that time that evidence did not exist to support Mr. Walmsley’s allegation of a second set of books.”

Astravas said “senior officials at ORNGE also provided assurances about their compensation policy to the ministry in December 2008 that led the ministry at that time to conclude that Mr. Walmsley’s concerns had been addressed.”

The Star revealed in a series of articles over the past two months that ORNGE was paying exorbitant salaries to executives, had set up a series of for-profit companies at taxpayer’s expense, and executives — including Renzella and Mazza — had many perks (Renzella received $110,000 to fund an executive MBA including international study in Belgium).

Walmsley’s tip off to the health ministry in 2008 came just a few months before scandal erupted at eHealth over executive perks, high bonuses and untendered contracts.

My Reflections:

1.      What is the link to Crisis Management

The company ORNGE and the Ministry of Health are in a full blown crisis right now.  ORNGE is a not-for-profit organization funded by the Ministry of Health .The crisis emerged after the Toronto Star published articles during December 2011 that exposed the mismanagement of funds and possibly unethical behaviour tied to its book keeping, executive compensation and deals with for-profit companies that were linked to some of ORNGE’s management. This has put both ORNGE and the MOH in crisis. The Ministry is currently trying to manage it by firing the Board, the CEO and 2 other executives of ORNGE. This is tied to crisis management because the company ORNGE is obviously in crisis mode but the Ministry of Health also faces the risk of losing the public’s trust in being competent enough to manage these publically funded companies.

 
2.      What stage of Crisis Management does the system appear to be at?

The system appears to be in the damage control stage. From the Ministry of Health’s perspective, the Minister of Health Deb Matthews is trying to convey to the public that this is not acceptable and that the Ministry takes the taxpayer’s money very seriously.

From ORNGE’s perspective they are in the post-crisis organizational learning stage. As an organization, the leadership must look at the warning signs of this crisis and how the company handled the crisis as it was happening. They also need to have a media communications team and spokesperson that they have trained because through this crisis, the only communications from ORNGE consist of press releases on their website and even those are few and far between.

3.      How well does the system appear to be handling the situation?

The system is not handling the situation very well. It seems that the Toronto Star has more information on the unfolding situation than the Ministry of Health does. As this news article points out, the Ministry had warning signs that something suspicious was happening at ORNGE in 2008 but they did not do their due diligence to properly investigate the situation. The management of ORNGE was also not very well prepared and was taken by surprise when the crisis hit. They were under the impression that they were untouchable and a crisis could not happen to them. This is ironic, since the company transports trauma victims who also go through crisis situations and events that we all think cannot happen to us.

 The Ministry of Health seems to be playing the blame game and is not really taking any accountability for their part in this crisis. If they had been doing their due diligence while handing over millions of taxpayer dollars to ORNGE on a yearly basis, this crisis could possibly have been averted.

 There is public scrutiny on ORNGE’s new management and the Ministry of Health and both of them will remain under the microscope for a long time (or at least until the next healthcare funding scandal hits)

 4.      What level of crisis preparedness does the system appear to have? 

The crisis preparedness of the system appears to be very poor. ORNGE was in a difficult situation because their crisis management team, if they had one, may have been involved in the allegations. Since the leadership, including the Board, CEO and COO were terminated; there was no one to guide the crisis management team. It seems that this is the reason ORNGE did not have any crisis communications and most of the communications that went out about the crisis came from the Ministry of Health.

The Ministry of Health seems to be a bit better prepared for the crisis than ORNGE. This may have something to do with the learning that it has obtained from the similar eHealth Ontario scandal that took place in 2009. The Ministry seems to have a plan that was enacted quickly when they replaced the Board and followed that with terminating the CEO and 2 other executives. They also seem to have some crisis communications that they had prepared before-hand.

5.      What personal reactions/feelings does the description trigger in you?

I am appalled at some of the allegations that have been made against the CEO and other executives. I also feel disappointed by the Board of ORNGE and the Ministry of Health whose jobs it was to ensure that taxpayer dollars were being used appropriately. All I have heard about in the media recently is the sustainability of our healthcare system and how the aging population will overwhelm it. I feel that if business practices such as the ones at ORNGE are not stopped, that may very well be the case. It also makes me suspicious of other publically funded healthcare organizations and how they are spending my hard-earned money.

6.      What advice would you offer to those involved?

To ORNGE’s new management and leadership, I would say that they need to improve their communications in order to gain the trust back of their shareholders and the public. They also need to be accountable and transparent in how the company runs and ensure that best practices are being followed.

To the Ministry of Health, I would say that they need to continuously scan their internal operations, the external environment, and companies they provide funds to in order to ensure that a crisis like this and eHealth Ontario do not happen again. Each time something like this happens, the public loses a bit more trust in the Ministry and the elected officials. I would also remind them that they are elected by the public and are paid by the taxpayers so they should be accountable to them and ensure that they do right by them.