Why I’ve Continued to Support Manitoba’s Health Minister

One may surmise from the title of this site that I’m all about the testing of assumptions. Bad assumptions lead to bad decisions, bad beliefs, and uninformed opinions. These are the crux of why I have continued to support the actions of Manitoba’s Health Minister, Cameron Friesen, in respect of his handling of the COVID-19 Pandemic.¹ Those who know me may also realize that I’m not particularly shy about calling out logical fallacies or baseless arguments, as these are often the first steps in the testing of assumptions. On to the matter at hand.

Current Situation

As followers of Manitoba’s COVID-19 situation are well aware, as of early November 2020, the province is battling large recent spikes in COVID cases which have placed more than one of the provinces regions into “Code Red” status. By most accounts, the province appears to have been hesitant to add new restrictions, and the government’s “Restart Manitoba” campaign to “reopen the economy”² along with its summer invitation to out-of-province tourists has been met with a fundamental lack of support, even derision from many Manitobans. (For the record, I’ve been opposed to both of those actions of the present government.)

Some seven or eight months into the pandemic, two issues in particular have caused some people in my Twitter timeline to start calling for Friesen’s resignation. Not that there hasn’t been criticism before now, but a lot of it has been mild or simply partisan.³ Until now, the largest outcry against health policy in the face of COVID has been against schools reopening in September 2020. I says “somewhat tangential” since this direction falls as more under the purview of the Education Minister and Premier in consultation with Health officials rather than under the Health Minister’s portfolio.⁴ The two issues I’m thinking of here relate to communication and a breaking situation with one of the personal care homes in Winnipeg.

A Doctors’ Note & Other Communication

“Good Points” by an Anti-Mask Group?

In mid-October, Friesen met in his home constituency with a group protesting the wearing of masks in schools. They made their objections known and asked questions, and engaged in what seems to have been a peaceful protest outdoors, including thoughtful engagement with the Minister. The issue came afterward, in his comments that the group had “asked good questions” and “made some good points”, along with his declining to condemn this group comprised of his own constituents.⁵ While in this instance Friesen likely passed up an opportunity to underscore the importance of masks, I noted at the time that the some of questions being asked by the group were the very same ones and in the very same context as the ones being asked by those who were uncomfortable with schools reopening in Winnipeg, albeit from differing perspectives. The nuance was different, but the essence was essentially why masks are necessary at a 1.7 meter distance but not at 2 meters, or how they can be effective (enough). In other words, the questions on both sides seem to be more about mechanics than philosophy, and here they relate to a specific context. There are science-based answers to these questions, which I believe the Education minister should have provided as part of a plan to assure parents in the midst of reopening schools.

My personal perspective is that if there’s one area that needs improvement from the current government more than any other, and particularly relating to the COVID-19 Pandemic, it’s in the area of public communication. In the current matter, better information to parents would have helped alleviate the concerns of both groups and may have avoided the protest and resulting situation in the first place. Having failed that, Friesen missed an opportunity to reinforce the importance of masks, but I don’t fault him for characterizing opposition questions or points as “good” when they have demonstrated thoughtful engagement with an issue. Opposition party leaders did not clear that bar on this issue, as both attempted to score political points in calling out the Minister on it without having themselves thoughtfully engaged with the protest or the questions they were asking – let alone the Minister’s comments.

I’d call this one a misstep for the minister, but a minor one over a missed opportunity – not to condemn the group, but to reinforce his stance on masks. I noted that this was his first real (or single largest) direct public criticism since the beginning of the pandemic some seven months prior.

I See You Have A Doctors’ Note

Two things are evident from a recent public letter to the Minister signed by some 330 doctors in the province.⁶ The Minister was caught apparently unawares (whether they were in-camera or not) in comments he made which questioned the doctors’ motives in the timing of the letter to cause maximum chaos in the system. Whether or not he should have known he was being recorded or broadcast misses the point, which is the substance of the statements he made.

First, I would suggest he was wrong to question the motivation, whether or not he is correct about the effect of the timing. I’ve said elsewhere that one shouldn’t question the motivations of others, though that should likely not be taken as an absolute. Where motives are not demonstrable, publicly stated, or supported at least in likelihood through other proofs, they shouldn’t be questioned – and despite any suspicions, particularly in public. To build on those bases your argument on an untested and possibly faulty assumption. Unfortunately, that burden wasn’t met here, and Friesen should not have said what he did. The following outcry charges him with failing to adequately apologize in his response, and some of those criticisms appear to be fair: the statement should be retracted.

The larger concern, greater than the Minister’s comments about the letter, and even the text of the letter itself, is that in my experience, people do not write joint public letters unless they don’t feel they’re being heard. The fact of the the letter is the thing, and it concerns something I’ve already touched on: failures in communication. I have some assumptions about why this one occurred, but without being able to test it conclusively, I have to cast it aside for the present. Resolving this one will require intervention from not only the Health Minister, but also the Chief Medical Officer Dr. Brent Roussin together with Premier Brian Pallister. My presumption is not that these three are equally culpable, but that this is the level of engagement that will be necessary to allay the expressed concerns of these doctors as wall as – perhaps equally as important – for them to feel they’ve been properly engaged in this issue by their government.

While this issue is a significant one in my view, it doesn’t rise to the level of calling for his resignation as some have done. That said, I would like to see some movement to address it from the highest levels of the provincial government, which I suppose might then include Brian Pallister’s Chief of Staff, David McLaughlin.⁷

When “Personal Care Home” becomes an Oxymoron

The big issue at present concerns the still-evolving situation at Maples Long Term Care Home, where eight people died in a span of 48 hours which included a call to paramedics to care for 12 residents whose “conditions were rapidly deteriorating.”⁸ The story broke after one of the paramedics posted on Reddit about the situation they found, describing it as “something of a nightmare”.

Immediate responses included the following:

• onsite advanced-care paramedics
• dispatch of a rapid-response team created for just such needs
• insertion of provincial staff to supplement that of the privately-run care home
• announced an independent investigator would be hired to move quickly and return with advice based on events at this care home and another one run by the same private operator
• Winnipeg Police conducted a “preliminary assessment”
• WRHA directed to provide “additional supervision measures” at this care home

In addition, about 20 people from the Canadian Red Cross are scheduled to begin providing additional support, and the health authority has been directed to reach out to all care homes in the province to determine their readiness to respond to reapidly-changing conditions. No official inquiry has been called, but Friesen has not ruled it out. While opposition party leaders have called for an inquiry, I think it’s fair to assume that the currently-called form of investigation will yield a faster result than a larger formal inquiry, and that the latter may yet be called on the basis of determinations from the former.

Some of the most significant updates to the story involve staffing levels, which were originally reported to the healthy authority as being adequate or satisfactory, or meeting requirements. These reports have been disputed by CUPE,⁹ and it was later determined that staffing levels were misrepresented by the care home to the health authority.¹⁰

Already, blame has been ascribed by many who claim Friesen knew or should have known about the situation, and again some have called for his resignation or replacement. It’s not uncommon to skip most of the facts and jump to an end conclusion, but it rarely makes for good decisions. Before we lay all the blame at Friesen’s feet, we must consider what we know so far, or need to consider and understand, before making any conclusions on the matter. In no particular order:

1. The response from the Health Minister’s Office and the Health Authority as outlined above was quick, decisive, and direct. It looks for additional information before implementing further measures, but the two problem care homes are now getting a close look, and there is increased supervision and scrutiny happening there, while other care homes throughout the province are getting a status check from the health authority.
2. Amid all the “why didn’t…?” objections, we need to take note of the existence of the rapid-response team that had been created for exactly this type of scenario. This is a precautionary preparedness measure that worked as designed, and hasn’t had any real fanfare associated with it.
3. Within the same group of “why didn’t you…?” questions, we have to acknowledge that as they say, “hindsight is 20/20.” Elsewhere the problem is known as “Monday-morning quaarterbacking,” where you have the benefit of knowing the outcome before you get to make the suggestion of how to avoid it. While it’s tempting to imagine that by virtue of someone’s position that they should have known even though you didn’t, it’s simply not always the case. Further, if you can imagine that the someone else’s position should give them knowledge you don’t have, you will also need to imagine that there are reasons you’re unaware of why a particular outcome may not be foreseeable.
4. Revera lied. Some have suggested Friesen should have known about staffing levels, but this is a hard objection to sustain when steps have been taken to hide the truth from the health authority.¹¹
5. There’s a limit to what someone “should have known.” In any enterprise, a leader or manager must assume as a matter of routine that things under his direction are being handled by those whom they supervise. To do otherwise would be be what’s called “micro-management”, a term that’s never used with good intent. At times, specific checks might be made on important matters, but when someone juggles a hundred priorities, they can’t all be at the top. Yes, this is an important one, but at the end of the day, you have to trust your team, replace them, or work around them (the latter only being offered as the untenable comparison). This leads to
6. The extent of one’s responsibility has both limits and nuance. When asked directly during the press conference of Sunday November 8, 2020 if he “took responsibility”, his response was (in effect) that he was accountable for it. While someone on Twitter summarized the response as “not my fault”, I think such an assessment widely misses the Minister’s meaning and intent. The language is tricky, and Friesen’s avoidance of the word “responsible” was not only accurate, but astute. In context, there is a real danger that nothing would be heard past this one word, whether in the affirmative or the negative. In light of President Trump’s now infamous response to a similar question about COVID (“Well, I take no responsibility at all.”), the question can almost become a trap. His response, while not saying he was “responsible” – as in, “I’m the one who did it” – is a far better one: he said he was accountable, which in the grand scheme means that it doesn’t matter whether he’s “responsible” in any particular sense of the word, because he’s accountable for it, and he knows it. It happened on his watch, and now he’s got to both answer for it and fix it.
7. Back on the subject of Revera, the operator of both the care home in question and the one that has been the site of the province’s largest PCH outbreak of COVID-19, it must be noted that the health authority does not directly operate the facility. Revera is in fact under scrutiny nationally, as Federal NDP leader Jagmeet Singh has called for the government to step in and asssume control not just recently, but for the past several months.¹² Similar calls are now being made within Manitoba, with Provincial NDP Leader Wab Kinew even quipping, “I don’t know if this is being too alarmist, but I feel like we should gather our pitchforks and our torches and run Revera out of town.” Whether or not Friesen’s comment that “nothing is off the table” extends to this scenario, it must be acknowledged that even though Revera is a Crown corporation, it would be extraordinary for a government (and in particular the military in this case) to step in and assume operations of a privately-run for-profit entity. You don’t have to change many of the factors to imagine that the public reaction to such a course would be accusations of a fascist response, so clearly it would have to be a last resort rather than the knee-jerk nuclear response that several are calling for.
8. Not all PCHs are the same. A lot of the calls for action are widespread based on reports from a smaller number of care homes. In Manitoba, the two worst reports have at least one noteworthy thing in common: Revera, a for-profit operator. I counted 39 personal care homes in Winnipeg alone, but we aren’t getting the same level of dire news out of all of them (let alone elsewhere in the province), which is what one should reasonably expect if the management of COVID response was systemically bad rather than situationally bad in specific instances. This is another way of saying it’s working in most places, and then asking why it’s an issue in specific instances. This would require an investigation – very much like what’s been announced now. At other times, Friesen and other health professionals have talked about “learnings”¹³ and about sharing knowledge throughout the system. This is precisely the appropriate response.
9. Particular problems don’t necessarily need universal responses. Particular problems are far more likely to need particular solutions, and in a large organization, universal solutions in those scenarios often introduce bureaucracy and reduce performance. When you force everyone to follow rules that are only needed in some situations, over time it creates a distrust in the system and an assumption that all its rules are superfluous. In the case at hand though, things need to happen quickly, and often solutions in situ can be implemented more efficiently and more effectively. If those then produce a “learning”¹⁴ that is applicable elsewhere, then it’s time to share the knowledge gained and the effect of the implemented (i.e., tested and proven) solution.

Time for a Leadership Change?

I’ve said at a few points that a particular presenting issue is not enough to warrant a cabinet shuffle. A premier may shuffle his cabinet for any number of reasons, not least among them being the goal of finding the best fit for each portfolio from among the stable of MLAs. Setting aside the variable of whether the Minister’s statements or actions to date warrant a change, the call to do so with respect to the health portfolio begs the question who one would rather have in place of Cameron Friesen. Personally, I don’t feel that his immediate predecessor handled the portfolio as well as Friesen is doing, and that was without the impending gloom of a global pandemic. Prior to Kelvin Goertzen, the job was held by members of the NDP government,¹⁵ dating back to 1999. I did some calculating, and discovered that in the past 20 years, of seven people who have held Friesen’s position, only two have held it longer than he has (Theresa Oswald and David Chomiak, both NDP). In the past 40 years, the number of people holding the portfolio longer increases to only 5 (adding James McCrae and Donald Orchard, both PC, and Laurent Desjardi, NDP).

We’re in the midst of a global pandemic more severe than anything similar that we’ve seen in living memory. It’s more widespread with greater public impact than H1N1, SARS, or Ebola. This is not the flu. Prior to 1927, including at the time of the Spanish Flu pandemic, Manitoba, there didn’t appear to even be a designated minister of health in the cabinet. Nobody has had to deal with these extremes in this position before. Of people who held the position of Health Minister in the past 40 years, Friesen is one of the 5 most experienced at it, and the only one of those 5 still in office. Given the need to get up to speed quickly because of the pandemic, the most likely person to take Friesen’s place – if it came down to it – would be Kelvin Goertzen, who to be fair, had held the post for virtually as long as Friesen has.¹⁶ Given the disruption of change (and my subjective assessment that Goertzen was not as good at the portfolio), I would suggest that changing horses now would be exceptionally unwise, and that currently there isn’t an obviously more-qualified person at hand to take the helm. Some of this sounds a little more grandiose than it’s supposed to. I’m not suggesting that Friesen hasn’t made mistakes, or that he won’t make more in the future, but from a risk management perspective, unless there’s a compelling reason for a change it’s far safer not to make one under the present circumstances.

It’s important to set reasonable expectations for any cabinet minister. In most cases, they come to their role from political and professional backgrounds which don’t apply directly the the portfolios they handle, and rely heavily on the bureaucrats and other staff and resources in their departments to not only to help achieve goals which are set, but to provide continuity and advice. With the Premier setting direction, each Minister has to move their file along the set course using the best information they are given to deploy the resources at their disposal. Obviously this is very generalized, but it must be understood that some decisions are made or signed off on by the Premier.¹⁷ Final decisions concerning public COVID restrictions are coming from the Premier’s office, and it’s been well-noted that the Premier is working on a program of austerity and restarting the economy as priorities. Even if Minister Friesen and Dr. Roussin are the public faces of Manitoba’s COVID response, some of the decisions – including many of the ones that Manitobans are most frustrated with – are coming from the Premier’s office.

On the Assignment of Blame

I get it. It’s a natural human tendency to want to assign blame to someone when things go wrong. When those things are high-stakes and public, and when they are causing extreme levels of stress generally, I think it tends to “amp up” the urge and tone down the clear thought that we might experience at the best of times. In other words, we lash out with quick responses that we haven’t thought through. What I’m suggesting is that if we thoughtfully considered the matter, we’d be unlikely to stick with our first reactions, many of which are born of pure frustration. To spread them without a firm factual basis with consideration of alternatives serves merely to spread the same anger and frustration while undermining public confidence in the health supports they have.

Personally, I find it draining to see repeated calls like that from people jumping to and then persisting in their conclusions without adequate consideration. In general, these calls are often characterized by partisanship, general outrage, or disappointment, and are rather thin on reasoned argument. Sometimes these things get stuck in my craw, and I can’t get them cleared until I’ve written them out. These are exceptional times we’re in, but such times call for an even greater commitment to thoughtful engagement with the issues if we have any hope of productive dialogue, well-informed opinions, and wise policy decisions. These are the types of discussions I long to have.

1. Disclosure: I’ve know Cameron Friesen for about 30 years. We’ve not been in contact for many years now, but before he and his wife moved back to Morden, my wife and I saw them often, and for a while, we lived within a hundred yards of each other. The things I know about his character and the way he thoughtfully approaches a question, problem, or issue are the kinds of things about a person’s character that do not change over time. Based on my personal knowledge, have no doubt or question concerning his integrity, truthfulness, empathy, or capability. Despite our lack of ongoing contact, the only reason I wouldn’t say that I miss his friendship is because I’ve never felt like I’ve lost it, which does speak to his loyalty.
2. How I hate this phrase! The economy is not something you open or close, it’s a thing that chugs along regardless. You can cause it to speed up or slow down, affect its performance, but you can’t just decide to start or stop it.
3. I don’t intend to say that all partisan criticism is wrong, just that some level of it is “par for the course” regardless of actual performance or policy.
4. While a full consideration of the school reopening decision is outside my present purpose here, I would note that a lot of opposition to it failed some basic assumption-testing as well. In the months since, although there have been cases at schools, contact-tracing has so far indicated that these have originated outside the schools, which have not become the kind of vector which was feared. Also in the interim, since the province has not been forthcoming with open data for the locus of COVID cases in schools, a citizen-led public effort has arisen to track which schools have reported cases. It seems to me that particular data such as this could enable more granular anti-COVID measures than a wholesale opening/closing of schools. The province presumably has such data, but has not released it. At the time of writing, no significant school-based outbreaks have occurred, and the province appears to be gearing up for enhanced online learning capabilities.
5. CBC: Manitoba health minister won’t disavow anti-mask group that he says made ‘good points’ on use (Ian Froese, October 16, 2020) Other media also carried the story, including the Winnipeg Free Press, whose headline I found to be pejoratively misleading given the actual content of their own article, which included additional examples from the protesters.
6. Global News: Coronavirus: Health minister’s comments ‘outrageous,’ says Winnipeg doctors (Sam Thompson, November 4, 2020); Full text of the letter.
7. McLaughlin has held this position since May 20, 2020. CBC: Pallister names former campaign manager as head of Manitoba’s civil service (May 14, 2020)
8. CBC: Health minister calls immediate investigation into Maples, Parkview Place care homes (November 8, 2020)
9. CBC: Maples care home not fully staffed during Friday crisis, despite claims it was, union says (Joanne Levasseur, November 9, 2020); see also a Twitter thread from @CUPEMB (November 8, 2020)
10. Canadian Press: Care home provided false information about staffing levels, health officials say (Steve Lambert, November 9, 2020). The language is polite but unmistakably direct: they lied about staffing levels.
11. While clearly entering the realm of speculation, I can imagine staff at the facility being afraid to call in outside resources in order to maintain the facade and preserve job security – at least until it got so bad they could do nothing else. In that sense, whoever dialed the phone might be commended for saying “no farther,” knowing full well it would bring public scrutiny. As noted, this is speculative, but the very rational plausibility of this scenario indicates we can’t be quick to place blame with the health authority or the minister, at least until such a question is answered.
12. CBC: One of Canada’s largest long-term care operators is owned by a federal Crown corporation (John Paul Tasker, May 25, 2020)
13. Is that really a word? I have to hope not.
14. Why can’t they say “lesson”?
15. Goertzen’s immediate predecessor was Sharon Blady, who held the post until the NDP government was defeated in 2016. Again in the interest of disclosure I also count Sharon Blady among my friends, and one may rest assured that the subject of the pandemic has featured more than once in our discussions of the past year.
16. At time of writing, 819 days for Goertzen and 832 days for Friesen
17. Reported via tweet: “Dr. Brent Roussin says he met with Premier Pallister today to discuss the possibility of further restrictions.” (November 9, 2020)