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Saskatchewan doctors explain mixed messaging, role of chief medical health officer

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WATCH: The public has heard mixed messages from Saskatchewan's chief medical health officer and the health minister, raising a number of questions – Nov 25, 2020

As Saskatchewan’s COVID-19 cases continue to reach new highs, some doctors are noticing a change in the chief medical health officer’s (CMHO) messaging, which doesn’t always align with what we hear from government officials.

“He is sending more urgent messages to stay home, if possible, unless you have to go for essential services,” said health policy consultant Dr. Dennis Kendel.

“It’s interesting, the premier or minister, whoever is beside him at the press conferences, really don’t echo that message.”

Last week, Dr. Saqib Shahab, Saskatchewan’s CMHO, recommended people limit their time in stores and restaurants.

However, in that same press conference, Premier Scott Moe told the public to go to restaurants, if they want to gather with more than five people.

Read more: Saskatchewan Premier Scott Moe self-isolating after potential coronavirus exposure

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Mixed messaging confuses the public, Kendel said, adding it undermines cohesive action on the part of the public.

“The public just doesn’t know what really would be the preference of the CMHO,” Kendel said.

“It would be like going to see your doctor in a clinical setting and wondering is your doctor recommending the very best thing for you or is his or her judgement being influenced by some external factor that you’re unaware of.”

While under legislation the health minister can grant authorization for the CMHO to make orders, it doesn’t mean the CMHO has “unfettered professional autonomy,” according to Kendel.

“My perception is there is probably both explicit and implicit controls on what he is permitted to put into orders,” he said.

Read more: COVID-19 outbreaks in Saskatchewan

Kendel suggests Saskatchewan’s COVID-19 response is driven by politics, not public health.

He believes the premier is sticking to his campaign promise to not enter a second lockdown, no matter the recommendations made by the CMHO.

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“Even if Dr. Shahab felt at some point that some type of shutdown… was appropriate under the current circumstance, he would probably be precluded from doing that,” Kendel said.

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Shahab is a government employee and his office is not independent from the ministry.

Read more: Coronavirus death toll in Saskatchewan rises by 4, hospitalizations over 100

Dr. Anne Huang, a former deputy medical health officer for the Saskatchewan Health Authority, says that type of relationship can create conflict when the CMHO’s scientific recommendations don’t line up with government priorities.

“[Medical health officers] have to speak to the public on the affirmative what they believe and what they recommend without ever publically refuting statements from the government official directly because that’s career suicide,” Huang said.

“That’s just the reality of how our public health system has been set up in Saskatchewan and also in Canada in general.”

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Roles defined under the Public Health Act

The CMHO’s role isn’t black and white.

Under the Public Health Act, the health minister can authorize the CMHO to give orders. However, the minister can also limit the role of the CMHO.

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Under section 11 of act:

(3) The minister may restrict the powers and responsibilities of a medical health officer.

(4) The minister shall designate as the chief medical health officer a person who: (a) has the prescribed qualifications for a medical health officer; and (b) is either: (i) an employee of the Government of Saskatchewan; or (ii) under contract to provide services as a medical health officer.

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In a statement to Global News, the Ministry of Health says the pandemic response requires work in areas beyond the mandate of the health portfolio.

“Public health’s recommendations have impacts not only on the physical health of people, but their mental, social and economic health, and the policies that are required to respond to a pandemic event extend beyond the Public Health Act,” the statement said, adding Shahab, the minister of health and the premier continue to have a close working relationship.

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Read more: Opposition accuses Saskatchewan premier of delaying COVID-19 response

Health Minister Paul Merriman said the government of Saskatchewan has received sound advice and guidance from the CMHO and public health officials throughout the pandemic.

“We will continue to follow the recommendations of Dr. Shahab as Saskatchewan works to reduce the spread of COVID-19.”

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Calls for improvements

Kendel and Huang both say the Public Health Act needs to be revised to create more transparency.

Kendel says the pandemic highlighted flaws in the public health system. He suggests making the role of the CMHO similar to that of the provincial auditor.

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“In other words, it’s an appointment with accountability to the legislature as a whole as opposed to just the government,” Kendel said.

To increase transparency, Kendel also wants the CMHO’s unfiltered recommendations to be made public, then the government would openly choose which recommendations to accept.

Read more: Coronavirus may have boosted Canadian trust in scientists, survey finds

Huang agrees.

“I don’t think we’ve seen that transparency that’s much needed to garner public’s trust,” Huang said.

“I think there will be tremendous value for the public to hear the independence, scientific and public health assessment from the CMHO of the province.”