Both Dr J.A. Wilson and Dr Marshall Dahl have drawn attention to the abysmal lack of medical direction in the regional hospital boards (BCMJ 2001;43(2):60  [9]and 65). From a doctrinaire political viewpoint, there were four valid indications for changing the Board of Hospital Trustees who were previously elected by the public with a municipal and a provincial appointee as well as a hospital physician; i.e., president of the medical staff, elected by the hospital physicians. In contrast, the regional boards were appointed by the Minister of Health and had the advantage of providing a parking spot for party supporters and time-expired politicians; secondly, it provided a firewall between the wrath of the public, enraged by the deteriorating hospital service, and the Ministry of Health; thirdly—and the ostensible reason for the introduction of the regional boards—it prevented special interest groups from imposing their restrictions on the hospital services; fourthly, centralized control is dear to the heart of socialists the world over.

Removal of governing power from the individual hospital to the region has inevitably downgraded the peripheral hospitals, thus an undue share of the budget will tend to be appointed to the central hospitals. To quote a bucolic aphorism, “the fields closest to the farm receive the most manure.”

May I be permitted to mention a personal experience whilst serving as the medical member of the hospital Board of Trustees in 1987? The premier decreed that the Ministry of Health must charge patients having therapeutic abortions the full hospital rate for use of the operating room. When the issue came before the board, the matter was resolved when I suggested that, because those seeking terminations of pregnancy were least able to afford hospital fees, it would involve an undue hardship and on occasion oblige an individual to resort to desperate measures. It was proposed that the hospital should, in accordance with the regulations, prepare a bill but defer its presentation until a change of government or premier occurred. This was duly accepted and the smooth operation of the service was continued.

It is ironic that, of the four situations which are a standing disgrace in Britain (football hooliganism, bovine spongiform encephalitis, foot and mouth disease, and the decrepit hospital service), our politicians should have introduced the hospital control that has presided over Britain’s decline since 1948. It is unfortunate that our politicians have not been able to turn that physical impossibility—the bottomless pit of hospital care into which money disappears without trace—into a suitable repository for the Lower Mainland garbage. At least if such were the case, the medical officer of health would have a say in the matter.

The warning sounded by Drs Wilson and Dahl should be heeded and pressure brought to bear by our association upon the government. The regional hospital boards cannot be uprooted, but at the very least changes can and should be made to make them more responsive to the needs of those whose interest they purport to serve.

—H.E. Woolley, MD 
Vancouver