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N.B. auditor highlights number of concerns with province’s ambulance service

New Brunswick auditor general Kim Adair-MacPherson prepares to present her report to a committee of the legislature in Fredericton, Wednesday, Jan.16, 2019. THE CANADIAN PRESS/Kevin Bissett. THE CANADIAN PRESS/Kevin Bissett

The province’s auditor general released her latest report on Tuesday, highlighting several areas of concern for ambulance services in New Brunswick.

In the report, Kim Adair-MacPherson focuses on the relationship between the Department of Health and EM/ANB Inc., the Crown entity licensed to operate the $110-million-a-year provincewide ambulance service.

According to the report, since 2007, management of the provincial ambulance service has been contracted to the private sector, Medavie Health Services New Brunswick.

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The audit found the contract was poorly structured, allowing for “questionable payments for paramedic vacancies, excessive use of response time exemptions and ambiguous performance measures.”

The audit covers the 2017-18 and 2018-19 fiscal years.

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“Paramedic shortages created over $8 million in surplus payments to Medavie Health Services New Brunswick, providing a disincentive to address low staffing levels,” said Adair-MacPherson.

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She said this has allowed unrestricted cost savings to be awarded by the department as surplus payments to Medavie Health Services New Brunswick.

The audit also found “the legislative framework and governance structure does not provide sufficient oversight of ambulance services due to numerous inherent conflicts and requires significant improvement.”

According to the report, issues include legislation with an unclear mandate, a complex management relationship, board composition lacking independence, and a contract that compromises the board’s influence over its CEO.

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The report also found that rural and remote communities were at a disadvantage when it came to measuring response times.

“Following contract renegotiations in 2017, performance-based payments introduced a bias towards achieving high performance in areas of greater population,” said Adair-MacPherson.

“The performance measures put rural and remote communities at a disadvantage. Even though 19 of 67 communities fell below performance standards, it did not reduce performance-based payments to Medavie Health Services New Brunswick.”

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The auditor general made 20 recommendations for the Department of Health and EM/ANB Inc. regarding the governance and management of the ambulance service contract with Medavie Health Services New Brunswick.

The recommendations include changes to legislation, board bylaws and various contract provisions with Medavie Health Services New Brunswick to address the report’s findings.

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Government’s response to the report

In response to the report, the province said “work has been undertaken to improve governance structure and performance management.”

The government said it has implemented a comprehensive policy framework to support the EM/ANB board of directors as well as the establishment of multiple board committees to increase oversight and accountability with representation from a range of medical and clinical representatives.

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“This framework and these changes recently received the highest mark from Accreditation Canada, an independent body which provides accreditation of health-care organizations across the country,” the province said in a statement.

The Department of Health said it recognizes that there are recruitment and retention issues in the paramedic field.

“EM/ANB has been and continues to be a valuable partner in the delivery of this very important element of our health-care system,” Health Minister Dorothy Shephard said in a press release.

“I view the auditor general’s report as an opportunity. We will use the recommendations as a launch point to reach out to Medavie Health Services New Brunswick, the company contracted in 2017 to manage the ambulance service, to improve the services for all New Brunswickers.”

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