AHS investigation into physicians' dispute draws new counter-allegations, legal warnings

An Alberta Health Services investigation into a long-running dispute involving six physicians and conflict of interest allegations has been animated by new counter-accusations and legal warnings.

The dispute involving Dr. Daniel O'Connell of Edmonton began more than a year ago and led to the Opposition NDP calling for an independent investigation. Alberta's health minister has said she's content to let the in-house probe run its course.

The allegations against O'Connell are contained in a complaint and revolve around his interim role as division director and Edmonton zone section chief for otolaryngology-head and neck surgery. Otolaryngologists are specialists who treat problems in the ears, nose and throat, along with related problems in the head and neck.

AHS is the arm's-length, front-line provider of health services provincewide.

The complaint was filed Nov. 21, 2022, by five physicians who work or had worked with O'Connell. They were notified as recently as early January that the probe was continuing.

AHS documents show O'Connell's interim tag was removed during the investigation — on Dec. 1, 2023 — and he was appointed for a five-year term.

The physicians who signed the complaint — Hamdy El-Hakim, Jeffrey Harris, Daniel O'Brien, Hadi Seikaly and Erin Wright — declined emailed requests for comment.

O'Connell also declined to comment, referring questions to AHS.

The five say in the complaint they had concerns with O'Connell before and during his term as interim leader.

They allege there were problems with his dual role as an AHS administrator and with the Canadian Cancer Care clinic.

The Edmonton clinic provides screening, monitoring and palliative care. Patients do not pay out of pocket for insured services. Those fees are covered by Alberta health care.

O'Connell is a minority shareholder in the clinic.

The complainants allege O'Connell may be in a conflict of interest with the clinic and an AHS triage protocol that puts patients in a central registry and distributes their cases to specialists.

Under the protocol, patients can get matched with the next available provider. In return, all specialists are to gain access to a fair system of referrals.

The complaint letter says Edmonton otolaryngology doctors began talking in 2020 about joining the triage program and did so in 2021.

Around that time, they learned the cancer clinic had approached the program on its own and had been referring patients for months to its physicians, "thus monopolizing the potential referral source to their advantage and to the detriment of the remainder of the section," says the complaint.

It says the clinic's surgeons blamed the referrals on "administrative error."

The complaint alleges O'Connell used his authority on at least two occasions to remove from the triage program physicians who were not with the clinic.

O'Brien also says in the complaint that a search committee voted to hire him for a position in rhinology but O'Connell did not act to fulfil it. O'Brien has since left Alberta and works in Nebraska.

The complainants further allege O'Connell disclosed his relationship with the clinic and promised to separate himself from decisions about it but failed to do so.

"Since March 4, 2022, and prior to, despite his assurances, Dr. O'Connell appears to be acting as an intermediary on behalf of the CCC Clinic and/or acting to benefit it, by continuing to make and support decisions that benefit the CCC Clinic and its employees directly," says the complaint.

There are many other allegations.

The complaint says O'Connell began reallocating operating room resources without adequate oversight or discussion. It says he pulled significant operating room resources from Wright without justification.

It alleges O'Connell left the Leduc Community Hospital off a list of available resources to be shared, despite the site being used by surgeons affiliated with the clinic.

It alleges O'Connell, without warning or discussion or justification, removed Harris from a phone consult triage role he had held for seven years, resulting in "significant financial loss" to Harris.

It alleges a hostile work environment in which O'Connell used "inflammatory and accusatory language" toward El-Hakim in meetings. At one meeting, O'Connell accused Seikaly of "dishonest conduct," says the complaint.

About two weeks after the complaint was filed, the five physicians sent a second one, containing new allegations.

In the Dec. 9, 2022, complaint, the five allege O'Connell was scheduling operating room times along with Christmas and New Year's on-call assignments to the benefit of surgeons affiliated with the clinic.

"We believe this is demonstrative of a clear favouritism towards the minority of sectional surgeons with financial and clinical ties to the CCC clinic group," it says.

The issue came to light in January news reports by The Tyee and later CTV. Citing the stories, lawyers for the clinic sent a letter on Jan. 17 to the complainants challenging their allegations and warning of possible legal action.

"Certain members of the Section of Otolaryngology have made false allegations regarding CCC and its affiliated physicians, and certain members of the Section of Otolaryngology have engaged in other concerning behaviour," states the letter.

The letter says the clinic has not exerted influence on AHS hiring, positions or operating room resources and allocations.

"CCC has never and does not inappropriately allocate AHS resources to the benefit of CCC."

The letter says O'Connell runs his private practice in the clinic "given that there is often a lack of outpatient resources to see patients in consultation in hospitals."

It adds, "Dr. O'Connell accordingly owns part of CCC's community clinic in a shared overhead model," says the letter. "For clarity, Dr. O'Connell is a minority shareholder in CCC. He is not a director or officer of CCC."

The lawyer letter makes allegations of its own, saying some section members, including some unnamed ones who authored the complaint letter, have made false statements, including that some physicians with ties to the clinic are using their roles at AHS for personal gain.

"These false allegations are bad faith efforts to damage the reputation of CCC," it said.

The letter says the accusations violate the code of conduct of the College of Physicians and Surgeons of Alberta, pointing out physicians must behave respectfully towards one another.

The letter says a complaint may be filed with the college.

After The Tyee and CTV stories appeared, NDP health critics David Shepherd and Luanne Metz called on Health Minister Adriana LaGrange to launch an independent investigation.

"It has been 400 days since this complaint was sent to the AHS chief ethics and compliance officer," wrote Shepherd and Metz in a Jan. 9 letter to LaGrange.

"In fact, during the time that this investigation was ongoing Dr. O'Connell's [interim] position was made permanent.

"There are significant financial interests at play in these clinics. And the public should be concerned if decisions are being made with these private clinics in the back of someone's mind."

Asked if LaGrange would intervene, her spokesperson, Andrea Smith, replied in a Jan. 18 statement: "The minister did receive the letter. Alberta's government does not comment on AHS [human resources] and employment matters and forwarded the letter to AHS for their attention."

AHS was asked in an email why O'Connell's job was changed from interim to a five-year term during a conflict-of-interest investigation, whether any caveats were placed on his duties, and why the investigation has stretched out for more than a year.

AHS spokesman Kerry Williamson said in a Jan. 17 statement the internal investigation will determine if there is any substance to the claims.

"Until that process is completed, it is irresponsible to draw any assumptions about the substance of any allegations," he said.

"Due to privacy and confidentiality, we are unable to provide additional detail regarding this matter."