This is a helluva way to run a railroad

Giving full deference to the enormous challenges in managing a once-in-a-century pandemic, one still has to wonder sometimes. The above quote, from 1906, might apply to managing a health care system as well as railroads. On April 20, 2021, without prior notice to key stakeholders, the Chief Medical Officer of Health (CMOH) issued a replacement Medical Directive #2 addressed to “Health Care Providers (Regulated Health Professionals or Persons who operate a Group Practice of Regulated Health Professionals)”. Thus the Directive appeared to be aimed at health practitioners generally, not the hospital sector. The Directive stated: “The following steps are required immediately: All non-emergent and non-urgent surgeries and procedures should be ceased.” In the fine print there was a disclaimer about the provision of other health services, but that disclaimer was unclear. The most reasonable reading of the document as a whole was that it was directed at limiting exposure to COVID by drastically reducing the provision of health services in the community. The Directive can be found at:

Regulators of health care practitioners were blindsided. Most posted the Directive on their website immediately (as is their custom to support the CMOH during the pandemic), but offered no commentary. Instead urgent calls were placed to the authorities in an attempt to understand the intent and meaning of the Directive. Were health care practitioners who do not provide non-urgent services to cease all services immediately? Word drifted back from helpful Ministry of Health contacts that the Directive did not really mean what it appeared to say.

Three days later Ministry of Health officials issued a Question and Answer document stating that “procedures” meant something that “requires surgical nursing support or anaesthetist support or carries a risk of resulting in the use of emergency medical services or other hospital services due to serious intra-operative or post-operative complications.” See: In other words, the Directive was about conserving hospital resources. Procedures that were unlikely to require use of hospital resources were not restricted.

This unnecessary panic of regulatory partners could have been avoided by a better initial communication rather than sending confusing messages to those trying their best to support the orderly provision of health services during this pandemic.

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