Second privacy breach complaint filed against Alberta Health Minister Tyler Shandro

Alberta Health Minister Tyler Shandro is the subject of another privacy breach complaint — his second in a month — after his political staff accessed and released billing information from an Edmonton clinic to rebut allegations made during an NDP news conference.

The billing information had been anonymized — stripped of data that could identify patients.

A health law professor said it is unlikely there was a breach of the provincial Health Information Act (HIA).

The act, the professor said, allows the minister to access health information for a variety of purposes, including health system management and health policy development.

"There is an argument to be made that using this information in the media in the way that it [was] isn't maybe in keeping with the spirit of the [Health Information] act," said University of Alberta professor Erin Nelson.

"But I don't think it is a contravention of the act for them to see billing information, even if that billing information includes identifying health information [of patients], as long as they are using the information for one of the purposes outlined in the act."

The Edmonton Zone Medical Association filed the complaint May 1 after Shandro's press secretary Steve Buick and issues manager Tara Jago publicly released billing information from the Garneau Pediatric Associates clinic in Edmonton.

One of the clinic's doctors, Dr. Rehana Chatur, had appeared at an April 28 news conference, hosted remotely by NDP Health critic David Shepherd.

Billing info accessed after NDP news conference

Chatur told the news conference more of the clinic's patients with complex medical issues will be forced to seek treatment at hospital emergencies due to a cap on fee-for-service payments unilaterally imposed by Shandro.

As of April 1, doctors can only charge for up to 65 patients a day. And of those, doctors will receive full payment for 50 patients and 50-per-cent payment for the next 15 patients.  

To handle its high volume of patients, the Garneau clinic employs 11 registered nurses and 10 administrative staff. Chatur told the news conference the clinic would be forced to lay off staff and divert patients to hospital emergencies for treatments the clinic now provides.

On Twitter, and in a statement to The Edmonton Journal, both Buick and Jago said the Garneau clinic would suffer no revenue loss because patient billing information showed the clinic doesn't see 50 patients a day per physician.

In the legislature last Wednesday, Shandro was asked about accessing the information.

"A clinic expressed concern about the cap of 50 patients per day per physician. These are office visits. They're concerned that this would force them to reduce their services," he said. 

"Naturally, I was concerned, so my staff asked the ministry to check if that was at all true. The department compared the recent billings to the cap and found that there should be no material reduction for that clinic."

Appropriate to access billing info for political purposes?

But in an interview with CBC News, Chatur and Dr. Lyle McGonigle, her senior colleague at the Garneau clinic, disputed Shandro's claim. Chatur said that more often than not, one of the clinic's physicians will see more than 50 patients a day.

Chatur also said calls to patients, or to specialists on their behalf, are counted as part of the 50-patient-a-day cap. 

"We easily get calls from 10 patients a day and we have to call them back," she said.

Chatur suspects Alberta Health looked at their patient billing information for March, which had a reduced number of patients due to the COVID crisis.

McGonigle said the Edmonton Zone Medical Association filed the complaint because a number of doctors raised concerns about the minister accessing a clinic's billing information for political purposes.

"Which seems inappropriate to me," McGonigle said.

Scott Sibbald, a spokesperson for privacy commissioner Jill Clayton, confirmed the complaint had been received.

Sibbald said it would go through the normal process of determining whether an investigation is warranted, which could take three to six months.

Edmonton Zone Medical Association president Dr. Ernie Schuster said the association also filed the complaint to determine if the minister's staff accessed identifiable patient information.

"Is it really right that Steve Buick, who is a press secretary, and his staff, can actually have access to health-care billing information in order to use that for political purposes?

"We thought this was a grey area," Schuster said.

He acknowledged that Alberta Health needs to have access to doctor's billing information since the ministry pays them.

In a brief interview with CBC News, Buick said Alberta Health provided the anonymized billing information to him.

"I would never receive information identifying an individual patient from the department," Buick said.

"I would never ask for it; they would never give it. And it certainly was not provided in this instance."

In an emailed statement to CBC News, a ministry spokesperson said "the Health Information (HIA) Act authorizes the health minister and his office to use health information for specified purposes.

"Where concerns about the health system are raised, including via Twitter, information provided by the department can be used to assess and address concerns raised by individuals and the media."

The ministry statement said "this is part of 'health system management' which is an authorized purpose under s. 27(2) of the HIA."  

The statement also said the review of billing data from the Garneau clinic "was not limited to this past March."

"Based on this information, the billing data showed small numbers of visit services over the cap, so that the cap would not materially reduce overall billings," the statement said.  

CBC News asked the ministry to provide it with the same information it had provided to Buick and Jago. 

"You can make an access request and the department will process this request in accordance with the FOIP and [Health Information Act]," the spokesperson said.

Second privacy complaint against Shandro

This is the second privacy complaint filed against Shandro in the past month.

In early April, Dr. John Julyan-Gudgeon filed a complaint with the privacy commissioner after Alberta Health Services provided his personal cell number to Shandro. 

Shandro used the number to call Julyan-Gudgeon at home, at night, after the doctor confronted the health minister in February during a public funding announcement at the Red Deer hospital.

Julyan-Gudgeon said he did not give permission to AHS to provide his personal cell number to Shandro. Another doctor, who attended the same event, also received an after-hours call from Shandro on their private cell.

In March, Shandro and his wife went to the home of a Calgary doctor and berated him in front of his wife and children after the doctor reposted a derogatory meme on his Facebook page  about an alleged conflict of interest. Alberta's ethics commissioner subsequently found no conflict.

Shandro also exchanged emails with private citizens over the alleged conflict involving his wife.

The emails included a threat to send the legislature's security services after one person and called another "crazy" for raising concerns about the alleged conflict.

McGonigle, of the Garneau clinic, sees a pattern in Shandro's behaviour.

"The pattern is that the government is bullying physicians and trying to squash us," he said.