Jim Abram doesn’t have any doubts about his role as a director on the Comox Strathcona Regional Hospital District board. Its crystal clear to him, and he’ll be happy to tell you exactly what he thinks.

“Every director on that board was elected as an advocate for their constituents, so as a board, we’re a collective of advocates. How can we walk away from what our constituents want, what they’re telling us to do?” he told Decafnation this week.

It seems perfectly clear to Abram that the board should advocate for health care issues like complete pathology services, but not every director sees it that way.

Abram made a motion at the board’s November meeting to send a second letter to BC Premier John Horgan and the Vancouver Island Health Authority (VIHA) reconfirming the board’s “strong support” for maintaining fully functioning pathology services at North Island hospitals.

Provincial Health Minister Adrian Dix did not respond to the board’s first letter of support sent in May.

VIHA, sometimes referred to as Island Health, is attempting to centralize many North Island health care services in Victoria. Earlier this year, it moved all onsite clinical pathologists’ services from the Campbell River Hospital to doctors in Victoria, a change the health authority intends to make at the Comox Valley Hospital next year.

Abram’s motion, which eventually passed, triggered a discussion about whether it is appropriate for the hospital board to advocate on health care issues, and whether the board should expand its interests into other areas of health care, such as facilities and medical services for seniors.

The board discussed this issue at its 2018 strategic planning session and in February of 2019 passed a motion that it recognized “the important role for communities and regions to advocate for health care services and programs through local municipalities and regional districts.”

But several directors said they still aren’t comfortable in a wider advocacy role and that the issue raises questions the board hasn’t yet answered for itself.

Hospital Board Chair Charlie Cornfield, a Campbell River city councillor, was one of those.

“I would like to comment on the business of advocacy,” he said at the Nov. 7 meeting. “Because this board was very clear (in the past) that we deal with acute care. And that advocacy issues around … operational issues are best dealt with by the community itself.”

That makes no sense to Abram, who represents the Discovery Islands and mainland inlets within electoral area C of the Strathcona Regional District.

“That’s an antiquated attitude to what’s going on in today’s world,” he said. “We’re advocates on everything else in local government. We’re there to represent the public. We can’t get stuck on an old concept. It’s habit. It’s historical. If people don’t recognize that things have changed, then there’s a problem.”

However, the board does have a recent history of advocacy.

When VIHA proposed building one regional hospital for the North Island, the board originally supported the idea. But later the board reversed its position and advocated for two hospitals, which caused many difficult and divisive conversations. And the board also took a unanimous vote two years ago for free parking at the hospital and most recently to restore pathology services in Campbell River.

There was enough hesitation among directors about advocating more actively and broadly about health care issues at the Nov.7 meeting that they deferred the topic to a future strategic planning session.

OTHER DIRECTORS WEIGH IN

After the 2018 municipal elections, several new directors joined the hospital board. Decafnation recently asked several new Comox Valley directors serving on the hospital board whether they felt advocacy was an appropriate role.

Courtenay Councillor Wendy Morin said she’s just getting up to speed on the board’s mandate, history and responsibilities.

“I know (advocacy) is a question the board will be exploring. As we pay 40 percent of hospital capital funding, I think we do have some role in advocacy, but I am still unclear as to how broad this should be,” she told Decafnation. “I think there is a problem if we were promised certain services and amenities during the implementation of the new hospitals, and those promises have not been fulfilled. I think we need to investigate and see what role we have in advocating for those.”

Electoral Area A Director Daniel Arbour said the board does have an advocacy role to the extent that it spends millions of dollars on health infrastructure.

He said the hospital board is primarily charged with raising tax monies to pay for hospitals, which “tends to be a lot of money.”

“Those hospitals are nothing without the health services that occur in them, and they are impacted by the “health ecosystem” as well,” he told Decafnation.

“While I would not argue for health care operations to be downloaded from the province, to me it is clear that we are a natural channel for local constituents to bring forward concerns and opportunities for improving health delivery. There are also questions as to whether we should be involved beyond just hospitals. Those questions may be explored at our strategic session next year,” he said.

Comox Councillor Nicole Minions said she thinks the 23-member board representing over a dozen diverse communities, should take an advocacy role, especially in extraordinary situations like the centralization of services, such as pathology, “that could negatively affect the health and care of our communities residents.”

But she doesn’t think the board should step into the operation of the two campus hospitals.

“However, as our taxpayers pay 40 per cent of capital costs, it is important to ask questions, listen to concerned residents and advocate to our province to find the right healthcare solution,” she told Decafnation. “As a council member in a community with an average age over 50, health care is important to our residents.
Abram says advocacy is “what we’re here for.”

“Our constituents don’t get to meet face to face and talk with VIHA or government officials, we do,” he said. “I can’t in good conscience go to board meetings and not advocate for the public.”

CAN HOSPITAL BOARD’S LEGALLY ADVOCATE?

The Comox Strathcona Hospital District has historically operated on the presumption that its only, or at least, primary role is to fund select capital projects.

By Oct. 31 of every year, the hospital board advises VIHA of its recommended annual funding allocation for equipment or project under $1.5 million in the next year, subject to final approval of its budget on March 31.

Then, by Jan. 31, VIHA tells the hospital board how they will distribute spending of those funds by equipment and projects.

The board also considers funding major projects proposed by VIHAS that cost more than $1.5 million, before finalizing its tax requisition for the next year.

That appears to comport with the BC Hospital District Act (1996), which states the purpose of regional hospital districts “is to establish, acquire, construct, reconstruct, enlarge, operate and maintain hospitals and hospital facilities. And it further requires boards “to exercise and perform the other powers and duties prescribed under this Act as and when required.”

And the Act goes on to state that the letters patent incorporating a district under this Act must specify the following: the powers, duties and obligations of the district in addition to those specified in this Act,” and “other provisions and conditions the Lieutenant Governor in Council considers proper and necessary.”

The Act does not address the role of advocacy by a board, neither requiring it or prohibiting it, although the Act does, perhaps oddly, include “operate” as one of the board’s purposes.

WHAT DO OUR LETTERS PATENT SPECIFY?

On Dec. 8, 1967, Lieutenant Governor George Peakes signed the original letters patent that created the Comox Strathcona Hospital District. Dan Campbell was the Minister of Health Services and Hospital Insurance at the time.

Section 9 of that document states that the duties and obligations of the hospital district include those in the hospital act, but also:

“… These Letters Patent, and in addition the District shall establish a Regional Hospital Advisory Committee as soon as possible. The said Committee shall, when requested by the Board, review the hospital projects proposed by the boards of management of the hospitals in the district and recommend priorities and revisions thereto if deemed necessary, and shall also recommend regional programmes for the establishment and improvement of hospitals and hospital facilities in the District for presentation to the Board and to the British Columbia Hospital Insurance Service for Approval.”

To date, the hospital board has not established an advisory committee.

But Section 9 does seem to open the door for a wide range of health care advocacy.