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Commission of Inquiry Justice Paul S. Creaghan is questioning how recent policy changes regarding checks and balances in the health care system will have any effect if there is no certainty the policy is actually being followed at a hospital.

He said there is no way of knowing if a hospital is adhering to provincial policies if the department administering the policy does not have policing in place.

In particular, Creaghan was referring to quality controls as laid out in new health plan initiatives introduced in April 2008.

The issue arose while the inquiry was hearing evidence from deputy minister of health Don Ferguson, the last member of the health department scheduled to provide evidence during the first phase of the inquiry.

Ferguson told the inquiry the government's Making quality count, one of the six strategic pillars identified in its health plan, is based on a health care system that will allow for better priority planning, a more evidence-based process, more research capacity processes, along with more evaluation of the health care system at all levels

Ferguson spent Wednesday afternoon responding to questions from Creaghan and commission counsel Remy Boudreau. His testimony is part of the ongoing inquiry regarding the pathology scandal at the Miramichi Regional Health Authority.

A review of 227 of approximately 24,000 cases previously handled by former MRHA pathologist Dr. Rajgopal Menon resulted in the provincial health minister launching the commission of inquiry after 18 per cent of the cases were found to be incomplete and a further three per cent were found to have been misdiagnosed.

Ferguson gave testimony on Wednesday afternoon following two-and-a-half days of evidence from former deputy minister of health Nora Kelly, department of health work-force unit director Lynn St. Pierre-Ellis and executive director, hospital services, Lise M. Daigle.

Ferguson told the commission that going forward the department of health is looking at three major areas of change:

1. dealing with the results of the inquiry;

2. governance; and

3. further reorganization of the provincial health plan.

In addition, Ferguson said, the department is looking at the standardization of administration as the regional health advisory committees are restructured from eight to two, based on the restructuring of the regional health authorities, scheduled for implementation on September 1, 2008.

"There is a lot of work being done to provide proper structure. A number of groups have been formed," said Ferguson. "The six strategic pillars identified in the health plan will look at reorganizing, better priority planning, more evidence-based, more research capacity, more evaluation, …We want to become more strategic."

Creaghan reiterated his concerns for the policing of the system. "It is one thing policing the system and another policing those involved in the system. The fact is, as far as the department of health, it does not and did not have the capacity to monitor quality control."

Creaghan said it was his understanding through the information provided that up to this time, the policing of the system was done through the accreditation process of a hospital; that, indeed, when accreditation was given to a hospital, it verified that quality assessment and quality control was in place.

"My understanding is that the department is rethinking this policy," Creaghan said.

Ferguson said it is his view they have to reorganize around the six strategic pillars identified in the new health plan.

MRHA director of hospital services Jeff Carter was on the stand yesterday and is scheduled to continue giving evidence today.