Former Alberta Health Services chief executive officer Vickie Kaminski resigned because she believed she could no longer independently do her job as political interference worsened under the new NDP government and Health Minister Sarah Hoffman.

Kaminski's Nov. 25, 2015, resignation letter — obtained exclusively by CBC News — reveals the veteran health-care executive felt her professional reputation was at risk because political considerations repeatedly trumped proper, evidence-based management of Alberta's health system.

Many (examples of political interference) are simply rooted in an ideology of the new government that does not allow AHS to do what needs to be, and should be done. - Vickie Kaminski , in her resignation letter

"There are many examples of how this has played out over the past several months," she said. "Some of the examples transcend both the former government and the newly elected government of Alberta.

"More recently however, many (examples of political interference) are simply rooted in an ideology of the new government that does not allow AHS to do what needs to be, and should be done," Kaminski stated in the resignation letter, addressed to Linda Hughes, the incoming chair of the AHS board of directors, and AHS official administrator David Carpenter.

Kaminski provided several examples of political interference and unethical behaviour, including:

Government 'blocking' good management practices

In the letter, Kaminski said the political interference in AUPE bargaining and Calgary ambulance dispatch represented only a few "particularly troubling" examples among many.

She told Hughes and the AHS board of directors they may also wish to review briefing notes related to "linen, laundry and food services outsourcing, Edmonton and North Zone Lab Services, workforce initiatives that are simply everyday good management practices that the government is now blocking.

"All the items have solid business plans, are more effective and efficient, and would save significant public dollars," Kaminski wrote. "Even though we have identified the right things to do, and the right way to do them, we are being stopped."

Kaminski, reached through email, declined comment. Amrhein did not respond to an interview request.

In an interview Tuesday evening, Hoffman said she had never seen Kaminski's letter until CBC News showed it to her, and she insisted she was never told that Kaminski had resigned due to what she viewed as political interference in AHS.

Hoffman said she knew Kaminski was frustrated by her repeated requests for evidence to support recommendations related to the mix of private and public delivery of health care services that was being recommended.

But Hoffman said she considered those requests for evidence simply to be "good governance.

"I understand that from the tone of the letter she feels there was interference; I think it was governing," Hoffman said.

AHS has historically operated as an arm's-length agency from the Alberta Health ministry. AHS is governed by an appointed board of directors. With a budget of about $13 billion, it is the largest health authority in Canada. With 110,000 employees, it is the province's largest employer.

The health authority has a troubled history of senior executive turnover, at least some related to political interference in its operations. When the government hired Kaminski — a registered nurse with an MBA and 35 years of management experience — in March 2014, she became the fifth chief executive officer (CEO) in five years.

When her resignation was officially announced Nov. 27, 2015, two days after writing her internal resignation letter, Kaminski publicly stated her departure was a "personal decision." But her letter paints a picture of escalating political interference stemming directly from the health minister's office.

'More in voice mode'

In the letter, Kaminski said she had become increasingly concerned about communications between the Alberta Health ministry, through Amrhein, and AHS.

"With more and more frequency, cryptic emails are accompanied by the phrase 'more in voice mode' meaning there should not be any email trail," she wrote.

It has begun to feel very much like an environment lacking in trust and transparency. - Vickie Kaminski , in her resignation letter

"This verbal communication often contains specific direction with no substantiating documentation. I have taken to documenting the calls, and making notes that I often send back to the deputy (minister). It has begun to feel very much like an environment lacking in trust and transparency."

Kaminski also told Hughes and Carpenter in the letter that she was "apprehensive that (the AHS board) will not be allowed to function as a board should, especially since the regulations were quietly changed to allow government to appoint the clerk of executive council to the authority's board.

"This decision removes any illusions about whether or not the Government of Alberta will continue to overly influence the work of AHS or that there is any degree of independence," she wrote.

"As I recently told the Minister of Health: if all AHS activities are going to be micromanaged by the government, and if all decisions I make are having to be reviewed and vetted by the minister before they can be acted upon, then there are too many decision makers," Kaminski wrote.

NDP politically interfered in AUPE contract negotiations

The letter details how the NDP government repeatedly interfered in contract negotiations with the AUPE both in terms of timing and the wage increase offered.

Kaminski said the previous Tory government had mandated a zero per cent offer for several AUPE contracts, including general support services and auxiliary nursing staff. That caused negotiations to break down and the union filed a labour board complaint against AHS.

We were given a mandate of one per cent per year, for three years — far less than any other union has received, far less than government gave its own employees. - Vickie Kaminski , in her resignation letter

When the NDP took power, both sides were optimistic a fair offer would be made. But she said that never happened despite repeated attempts by herself and others.

In late October 2015, the deputy minister asked her to get everyone quickly back to the bargaining table. She said this was done based on a "promise of a reasonable mandate, akin to settlements with other unions and reflective of what we were accruing for this union's anticipated salary increase.

"The reason for getting negotiations re-established quickly was to avoid any embarrassment for (Premier Rachel Notley) when she attended the AUPE (annual general meeting) in October," she wrote.

But Kaminski said once both sides were back at the bargaining table, it became clear the NDP government would not allow AHS to make a reasonable offer.

"We were given a mandate of one per cent per year, for three years — far less than any other union has received, far less than government gave its own employees, and far less than we are accruing for wage settlements."

Political interference in Calgary ambulance-dispatch plan

Kaminski details how AHS had developed a business plan under the previous Tory government to end its contract as of April 2015 with the City of Calgary to provide ambulance-dispatch service.

AHS would instead provide an independent service similar to those across the rest of province, in line with what Kaminski said were the best practices for EMS dispatch across Canada.

In her letter, Kaminski said health deputy minister Carl Amrhein gave her specific directions verbally so there would not be a paper trail. (CBC) The Tories, however, did not want the ambulance-dispatch issue to become a "provincial election football" so the plan to notify Calgary of the change was delayed until after the May 2015 election.

Kaminski said after the election, Hoffman and her then deputy minister, Janet Davidson, confirmed the plan would proceed. She and Davidson's successor, Carl Amrhein, subsequently notified Calgary Mayor Naheed Nenshi, through a phone call, that the change was coming.

"The very next day, the government stopped us from moving this plan forward," Kaminski wrote.

"The Minister of Health is now dealing directly with Mayor Nenshi and, in our latest meeting, informed me that AHS will not be moving this forward in the immediate future despite the costs the organization is incurring (unused staff and space) and the fact that continuing with the current service arrangement with the City of Calgary is costing $6 million more than it would cost if provided in-house."

The government has publicly revealed the province had built a dispatch centre in Calgary to handle EMS calls separately from police and fire and is paying $60,000 in monthly rent since April 2015, although it is not in use yet.

But Kaminski, in her letter, said AHS leased the space for at least 20 years at an estimated cost of $750,000 a year. She said a "large number of staff" had already been hired.

Kaminski: political interference makes CEO job useless

Kaminski said in her resignation letter that she had built a professional reputation in health care in Canada for "taking on big challenges, doing the right things, and doing things right. I find myself in a position in Alberta that no longer allows me to perform that way."

Therefore, before my professional reputation suffers irreparable harm, I have decided to leave. - Vickie Kaminski , in her resignation letter

On the final page of her letter, Kaminski said the job she had been hired to perform as CEO no longer existed.

"Therefore, before my professional reputation suffers irreparable harm, I have decided to leave prior to the end of my three-year term by invoking the notice clause in my contract," she wrote.

By resigning midway through her three-year-contract, Kaminski, who was paid $540,000 a year, effectively forfeited another full year of salary in severance.

She is now chief transformation officer with South Australia Health in Adelaide, Australia.

AHS is still searching for her replacement.

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