If you think bodies stacked up in freezers next to the Janeway is appalling, consider another related problem that’s been going on longer, has likely gotten worse over time, and is related.
Funeral directors need a death certificate before they will touch a body. Some of this reluctance is related to liability even where there is allowance in the existing law. People are dying at home in ways that are sometimes expected (terminal illness etc) or may not be fully expected but other circumstances (age etc) make the death unsurprising. These folks don’t always have someone caring for them regularly or their usual primary care provider may not be available when they die.
And to be clear these are cases where there is no need for medical certainty as to cause of death - that’s its own rabbit hole - or any reason to be suspicious. Like finding a woman’s body in an abandoned house.
Nor are they lacking money for funerals. The cases were getting pushed onto the medical examiner’s workload because the law gives that office responsibility for cases where no one is available to certify death. Problem was and remains that these cases aren’t what that part of the ME law was supposed to cover. It's just one where there was a policy hole.
At one very recent point in my varied history, I was pulled into this issue, did the research, and drafted the solution (some minor legislative change and new set of regulations and policies) based on what happens in other provinces. Pretty simple actually but as the issue was happening primarily in rural Newfoundland and Labrador at the time and involved work across a few government departments, the thing died. Wasn't up to me to deliver.
No one claimed the body of this problem after me and solution that went with it in the meantime. It’s still out there and the situation has undoubtedly gotten worse to the point where no one should be surprised if they found out that bodies sometimes lay in the rooms where they died for days - not the hours it used to be - until someone gets the paperwork and takes the corpse away to be buried or cremated. And that’s people with families and loved ones and the financial means to lay the deceased to rest, by the way.
Now we’ve got a new story.
Five big white freezer containers laid out in the space where the medical school, the provincial children’s hospital, and the provincial medical centre meet.
Given the size of the containers there could easily be space for 60 corpses although the official numbers in CBC’s story were 28 and 36. Even the number of containers wasn’t clear: the news reports said three and four but the drone video clearly shows five identical containers.
Not temporary either.
There’s a wooden ramp built to limit access from one direction but to allow health workers to use a wheeled table to take bodies to and from the containers.
All are unclaimed and fall into two categories:
People who have no next of kin and no one to look after their affairs after death, and
People who have family or friends but both their estate and the friends don’t have the money to pay for the burial.
There is a government program to cover the cost of burials for people who don’t have the means themselves to buried a friend or family member. But getting the money involves filling out a massive form and navigating a bureaucracy in a province where half the adults lack the writing and math skills to function in modern society. To make it worse, the amounts available haven’t been changed in more than 15 years and no longer cover the costs of burial even at the bare minimum service levels.
Until CBC’s Anthony Germain asked about the big white boxes, no one in the regional health authority had briefed health minister Tom Osborne on the issue. CSSD minister Paul Pike apparently knew about the problem in mid-February but that wasn’t clear on Wednesday and became a controversy in itself on Thursday. As it stands, the department responsible for covering indigent funerals hasn’t updated its fees and doesn’t plan to. The health department isn’t doing anything either, except wasting time trying to figure out why people are not collecting the bodies - d’uh - and plan to add more storage boxes until they can get the big construction project started.
At any point since the middle of February, the social development department had the power to simply update the fee schedule, make the way to get the money easier to understand, and put a policy and any new laws needed to allow for the easy burial of unclaimed remains. Other provinces have done that last bit for decades without burdening the medical examiner.
Could have but didn’t.
Two days into the controversy, CSSD and the health department insist the most expensive - and unnecessary - solution is the official and only answer, reinforced since it wound up in Osborne’s briefing notes and he repeated it endlessly inside and outside the House of Assembly on Wednesday and Thursday.
This building project is more than just dealing with the increased workload at provincial medical examiner Nash Denic’s office (Denic is pronounced "denitch”). The bodies in storage are part of a larger issue that can be handled far easier than adding a new building or adding onto the already large space.
Yet what we have here is a top-down solution, divorced from the actual need. It came from people who had a bad news story and wanted to make it go away. That was their sole motivation. The simplest way to clear off the story is commit to building something in the future. The folks who came up with it are - as far as the health bureaucracy goes - far removed from the people who do the real work of health care in every sense of the word. Same goes for Osborne and his people, none of whom read the briefing note and thought this was out of line any more than Tom or his predecessor questioned the authorizations to allow the health authorities to go over budget on contract nurses before they signed them.
The problem here is not Osborne or any other particular politician or government official. It’s not really about isolated events. It’s about a pattern that repeats across departments, across issues, and over time. The problem is the way government works and frankly, the way it works since 2003 in spite of laws, evidence, and even common sense all of which would produce lead to more sensible decisions than the ones anyone in government made.
Think of every department of government as a tall thin tower that stretches up to the sky so high you cannot see the top from the ground. On the ground level are all the folks doing the real work delivering services people of the province need. Keep going up and you eventually get into layers that are shrouded in fog. The fog is inside the building too. Messages from down below seldom get into these upper layers and the upper layers only know their own work. The people inside the fog shrouded layers don’t know much about folks in other parts of the tower at their level or higher and they really have no idea what goes on down below.
The folks up top talk to the folks in other towers - the other departments - but only when needed and even then it might be to find out who is firing rocks at them trying to get their attention from out of the fog outside their windows. They sometimes get big rocks chucked from the Big Tower - the Premier’s Office - and then everyone rushes to make the rock chucking go away in a hurry if only because they could crack the windows and let folks fall out the holes to the ground far below.
There’s always been a problem inside government with connecting up people on issues that cover more than one functional department. There’s also been a problem connecting the people on the ground and their reality with the reality of the folks at the top end of the towers. But until recently, governments including the ones in this province had ways of coping.
In Britain, Tony Blair’s crowd came up with “deliverology” and joined-up government, which was really just a new twist on the old idea of co-ordination. In this province, we had a few examples, including the strategic social and economic plans of the 1990s. Multiple departments, multiple issues in two documents that applied - among other notions - the social determinants of health as guiding ideas.
Compare that to the Health Accord. Done solely within the health tower. Ignored the education tower, the housing towers, and all the other elements in the other towers, each of which will now fill in its own Accord, separately.
Looks a lot like this pile of corpses. Two departments, each of which had a piece of a related issue. Either could have acted alone and fixed its own bit and we’d have the problem solved. Instead, we have a spasmodic reaction, and a commitment to spend tons of money. In the end, we’ll see both a big permanent corpse warehouse, which will be powered by green electricity and help pay for Muskrat Falls, as we’ll be told by way of explanation and excuse after the fact. And we’ll see increased payments for indigent funerals but not easier ways for folks who need the money to get it. Double the cost and more, all of it unnecessary.
Fundamentally, not much different from Muskrat Falls itself either Danny Williams wanted to build the Lower Churchill project. When he couldn’t make Gull Island happen because it was just too expensive for anyone outside the province to buy, Williams and a gaggle of bureaucrats and politicians cooked up a scheme to build Muskrat Falls and make local ratepayers foot the bill even though there were no firm plans for it anywhere, no demonstrated need, and no evidence it was the cheapest way to meet what small need there was for new electricity on the island. All of the explanations for it - replace Holyrood, it’s the cheapest and so on - were things the people behind Muskrat Falls made up *after* they’d decided to plough ahead. That's the simple version of how a $5 billion project became a $15 billion boondoggle that will more than double local electricity rates.
If you understand the metaphor of the Towers in the Fog, you can see three implications besides the explanation for Muskrat Falls.
First, for all the political folks out there, your job is to connect the reality on the ground to the completely different reality up in The Fog without getting sucked off into The Fog. Your constituents live on the ground reality and you need the Towers to meet the Groundlings needs to get re-elected. To make that happen, you also have to connect the tops of all the towers in The Fog not just within their own reality but to make it connect to the reality on the ground.
On almost every issue, you will be faced with a question of which reality you work with more: the one in the tops of the towers or the one down on the ground. Sadly, at some point, most political people lose track of the two realities either because they’ve been absorbed into The Fog levels themselves or because they are tired and distracted by other issues or some combination of the two. That’s why for example, the health minister this week blamed people on the ground for problems with access to MRIs when the real problem is that we don’t have enough MRIs and the folks in The Fog don’t manage the ones we have as efficiently as they could. Same thing happened with the “permanent storage facility” or when a cabinet minister in a Pea Sea government a few years ago attacked the parents of a child in custody who were upset with the treatment they were getting. The politicians just recited a briefing note prepared by people in The Fog.
Second, the Towers in The Fog will help you understand why the recent addition of more floors on top of the Health Fog Tower won’t do anything to improve service delivery or control costs on the ground. Should have been obvious given all the management and organization thinking about *flatter* organizations but this metaphor gets you to the same place. If you want better, the answer is to root decisions and the power to make those decisions as close to the ground as you can. What they do in health - what the Government of Newfoundland and Labrador prefers across the board - is to make decisions as far from the ground as possible.
That explains why government people make so many decisions that make no sense to the folks on the ground. And once the Groundlings think a government is sucked off into The Fog, the people on the ground look to another party who might for a while make decisions that make sense to them. Politics then becomes a cycle of replacing Fog People with Groundlings who eventually become Fog People who get replaced with new Groundling. Rinse. Repeat.
Third, notice the dead bodies story involved just one or two departments that couldn’t fix their own problems by simply talking to each other even though they’ve been doing it for literally decades.
Now imagine you are Fred Hutton, the minister who thinks he is responsible for all housing but really is just in charge of a new rump tower made up of of part of what used to be a single department for dealing with the people living in tents. Not only does his department create two towers where there used to be just one, Fred actually thinks and has been telling people that he is responsible for an issue that actually covers what used to be six departments and is now seven departments.
What’s worse, Fred thinks of it only in terms of the tent city folks. Just look at the list of people he’s met with already: all the folks who’ve been dealing with the tents since just before Christmas. But housing - even if we put the word “affordable” in there - involves the bits of forestry and agriculture that manage Crown land, the bits of Service NL that handle all the deeds and mortgages registries, Justice and Public Safety, finance, business development (they are paying for a housing incentive program), the Child, Seniors, and Social Development development, and now Housing Corp Department.
No one in government is even thinking about housing in its full dimensions, in other words. And even in just the bits they are thinking about, no one up in the Fog Level cares how hard it is to get anything done across two departments let alone six, which they have now made into seven. Before you even think of it as a counter-argument, just understand that GNL got a handle on wind energy largely because it wound up in the hands of a minister who is not only politically able and influential but has a department with the budget and clout along with the lion’s share of the responsibility for the issue anyway. The bits of environment and land that aren’t already under Andrew Parsons’ direct control were and are easy to sort.
That’s not housing. That’s not Fred Hutton. Fred doesn’t even own the largest bit of anything connected to any part of the housing topic. In fact, he controls the smallest bit, which means he doesn’t have the clout to persuade any of his colleagues of much unless they want to be persuaded. What’s worse, some of the housing issues Fred should tackle have already been buried or ignored. Sections of the the PERT report, for example, proposed fixing huge housing related issues that are also massive drags on the economy. Not a word about them. Not a priority. Even though they would create more, sustainable jobs and bring government more money in taxes and other fees.
In another sense, Fred is now the minister of another policy ghetto. He sits alongside Labrador Affairs, Indigenous Affairs, Women and Gender Equality, and Francophone Affairs. They exist for show. They have no policy clout within government because they control nothing. They’ve been created as ministerial portfolios. In some cases they have stand-alone ministers, deputy ministers, assistant deputies, and the other trappings of power but that’s purely for show, not substance.
To see how the clash across departments works, look no further than the opening question for Fred Hutton in the House of Assembly. Not deliberate. Not malicious. Just as unco-ordinated as the gaggle in front of the cameras trying to figure out who actually visited the tents, even with the Premier standing at the microphone to control things.
The justice minister took the question about the right to housing and set a foggy tone around what should have been a clear political reply from the beginning. That’s actually what Fred did when he answered the second question.
Safe and affordable housing is fundamental. It's fundamental for a person's well-being. We understood that and we understand it even better now. Further, thanks to the Health Accord which was referenced by our Health Minister just a moment ago.
Dr. Parfrey and Sister Elizabeth Davis pointed out that everyone's social and economic well-being is based on housing. It is important, we understand it. The Member Opposite knows that I understand that. We worked together on the weekend trying to help somebody who was in a precarious position with respect to housing.
Sadly, that isn’t what he said outside the House. The media understandably went with the weaker answer that was in part off track because it started out by dealing with the non-issue of whether or not housing is a right. The tops of government towers are not the only places lost in the fog but Fred’s good political response in the House got sucked into the Fog of the scrum thanks in no small part to his cabinet colleague. That’s why Fred had a bad news day Tuesday and he was still answering questions about housing as a right on Thursday.
Most of government involves working in the fog and getting things done regardless. That’s hard enough in the best times. It is far harder in modern times, that is since 2003, as a combination of changes inside government and the collapse of accountability - weak opposition parties, lightweight news media - let the Fog People get away with their fogginess. And it is harder yet again when you add more layers in the fog and more towers to the co-ordination. Ghetto ministries add even more to the problem by creating one perception for people down on the ground and leave another reality inside the towers and up in the fog layers. Remember the bit about the political job of connecting the realities. Well, promoting misunderstanding just makes that job impossible, which is another reason why governments get into trouble with voters, cannot get things done, and lose power sooner than they should.
The ghetto policy ministers are Children of the Fog and politically and as far as policy goes, the Children of The Fog are orphans.
They are so powerless and the Fog People so addled that they cannot even house dead people cheaply even though humans have done it for millenia.