This letter was not permitted as an addition to the agenda of Monday night's Owen Sound City Council. It was supplied to us after the meeting. The Chair of the Board of Health, Sue Patterson, and Dr. Ian Arra, Medical Officer of Health, made a delegation to council, apparently responding to this letter.
Re: Recent Developments at the Grey Bruce Public Health Unit (GBPHU)
We write as elected members of separate local municipal councils. We write on our own behalf and not on behalf of our councils. With others, we are very concerned about recent developments at the Health Unit. We speak both of what the Board paid its chief executive last year and of the very high rate of management turnover since his appointment.
Thank You
We thank you all, and particularly the front-line staff, for all their diligence and hard work since COVID-19 first entered our region. Nothing in this letter detracts from that. Indeed, we write with their morale in mind as we express our concerns. It is critical to have a strong, vibrant, trusted public health unit as we move forward to defeat the pandemic in our region.
Our Requests
1. We ask that Dr. Arra return the excess money he was paid and that it either be returned to the province or bonussed out to front line workers employed by the Board to fight the pandemic.
2. We also ask that the Board bring in an Ontario Public Health consultant (HR and otherwise) to advise the Board and Dr. Arra on improving the management of the Health Unit.
3. We also ask the Board and Dr. Arra be transparent with the public and answer the questions regarding process which we put to the Board at the end of this letter.
Dr. Ian Arra’s 2020 Compensation: What it Represents
With all of Ontario, we recently learned that in 2020 Dr. Ian Arra, our Medical Officer of Health (MOH), was paid $631,510. This represents:
A 60% increase over his base annual pay of $385,000 in 2019
The highest pay received by any of the 36 Medical Officers of Health in Ontario
$220,000 more than the next highest paid MOH (Middlesex)
$290,000 more than what Toronto paid its MOH, who works for a population of 3.4 million (Grey-Bruce has 160,000 residents)
Almost $200,000 more than what Ontario pays Dr. David Williams, the Chief MOH for the entire province
Reactions and Explanations to Date
This compensation has received national media attention. We have each heard (loudly) from ordinary residents across Grey and Bruce, front line health care workers and those familiar with the internal affairs of the Health Unit.
Remarkably, some councillors and Board members have said that there is nothing to see here, that we should move on and rally together lest public confidence in the Health Unit be shaken.
We respectfully disagree.
That is precisely the wrong course of action and is, frankly, not an option for elected representatives. Through the twin counties, our municipalities are partners with the province when it comes to public health. It is our obligation to seek answers to questions which we or members of the public may have.
It is unfortunate that, with possible health unit mergers still very much on the table, Dr. Arra’s actions and those of the Board have drawn negative publicity. But that is hardly the fault of those who now ask for answers.
The explanations received to date from the chair of your Board, Ms Sue Paterson, have not been satisfactory. Let us review them:
We are told that in 2020 Dr. Arra was working the job of two people, since he did not have an Associate Medical Officer of Health (AMOH). We note:
i) This is simply not accurate. We understand that Dr. Arra was out of the country during part of the late winter of 2020, after which he presumably
quarantined for several weeks. During that absence, the Board relied on his acting AMOH, Dr. Linni Li. Dr. Li remained with the Health Unit until mid-2020, when she joined those others who had left (see below). Other physician consultants were hired at that point, again, sharing the load.
ii) Even if Dr. Arra was bereft of an associate for part of the year, such should not trigger a doubling of his income. We note in this regard that the public health unit of Hastings-Prince Edward, with an identical population to ours and with no AMOH at all, paid its MOH $282,000 last year, less than half of what was paid Dr. Arra.
iii) Finally, as detailed below, working 24/7 for a year is not a metric of managerial competence and, indeed, when coupled with the loss of key staff, may suggest the very opposite. Communications, testing, contact tracing and vaccinations can and should be the purview of senior managers, not the CEO.
Ms Paterson also rather glibly asks how one can “put a price on lives”. That is not a serious argument. Why stop then at a doubling of his salary? Why not move to seven figures? Surely Board oversight of his remuneration does not go out the window because COVID can take lives. Are lesser paid MOHs not saving as many lives?
We are told by Ms Paterson that Dr. Arra acted in a “visionary” manner for his use of hockey arenas as vaccination sites and because he obtained four deep freezers. We choose not to comment.
We were also told that these monies were a special injection of overtime funds made available by the province specifically to help out health units with overtime. We question whether the Board in fact was compelled to pay out such monies to Dr. Arra. We ask why such funds were not either declined (salaried persons do not usually receive overtime) or distributed more widely among staff. Other Medical Officers of Health reported their actual numbers of overtime hours. As of the date of this letter, to our knowledge, our Board has not released this same data. Our citizens pay local taxes that go towards our local Health Unit, and they also pay provincial taxes. Either way, this payment is coming out of their pockets. Per the cliché, there is only one taxpayer.
Managerial Turnover at the Health Unit
The ultimate strength of any health unit is the quality and experience of its people. On first glance, something seems seriously “off” at our Health Unit.
Staff turnover at any organization is natural. As well, there had been an effort to prune the size of the Health Unit for budgetary reasons.
But since Dr. Arra’s appointment, such turnover has been substantial and unprecedented. Dr. Arra joined as acting MOH in October, 2018 and, once he passed some exams, assumed the full title in January, 2019. In a little more than two years under his management, many non-unionized positions have been vacated. The positions that have seen turnover include senior management and others:
Acting Associate Medical Officer of Health/Physician Consultant
Part-time Physician Consultant
Human Resources Managers (two)
Senior Epidemiologist
Contract Epidemiologist (contract not renewed)
Director of Operations and Program Development
3 Public Health Managers
There has been turnover at less senior levels as well, including health data analyst. Doubtless, some left on good terms. Others, not so much.
But for a relatively small public health unit, this loss of management and other staff raises the issue of organizational dysfunction. It certainly erodes the institutional memory essential to navigate these pandemic waters.
The loss of senior and experienced staff is of particular concern given that Dr. Arra is new in this vocation and only recently completed his certifications. He has never before managed a health unit.
Questions for the GBHU Board
As a first step to restoring public trust, we respectfully request that the Board respond to the questions below. We anticipate that the Board will rely on privacy concerns to argue that it cannot respond to some of these queries.
But nothing prevents Dr. Arra from voluntarily agreeing to release this information. His actions have triggered all of this and we trust he will do just that. This is public money being spent. Further, the integrity and morale of the health unit deserves that gesture from him. In addition to written answers, we ask for copies of relevant documents which ground those replies, including Board minutes, contracts and correspondence.
1. Will you ask Dr. Arra to voluntarily disclose all aspects of his compensation?
2. What was Dr. Arra’s contractual annual base rate before the pandemic?
3. What “normal” hours were assumed for that annual base compensation?
4. What “overtime” hours were worked in addition to those assumed base hours?
5. Please provide a breakdown of all such hours, on a weekly basis.
6. What was he paid per overtime hour?
7. Did Dr. Arra vacation outside the country last year? If so, for what period of time did he both travel and quarantine at home?
8. Were other managers paid overtime or denied same?
9. Did the Board in fact have prior knowledge of and approve all of his compensation for 2020 including overtime pay?
10. Did the Board as a whole have an ongoing idea of how much Dr. Arra was billing for his overtime or were Board members as surprised as the public when the Sunshine List was published?
11. Was any such approval of any aspect of his compensation made retroactively?
12. Did the Board seek and obtain legal advice on whether the overtime payments to Dr. Arra were absolutely compulsory? Could the Board have said no?
13. Did the Board consider either declining available overtime funds from the province or sharing it more equitably among staff at the unit? If this was not possible, please explain why.
14. Were any constraints of any kind placed on Dr. Arra’s overtime billings?
15. Did the Board consider whether, in addition to his dedication, the claimed overtime may have also reflect:
i) his inexperience;
ii) a refusal or inability to delegate; or
iii) the loss of middle and upper management under his tenure?
16. If the Board did not entertain these possibilities and intervene to reduce his claimed overtime, why not?
17. Did the Board know that Dr. Arra’s compensation was going to outstrip by far every one of his Ontario peers in 2020, including very experienced MOHs?
18. Did the Board consider the impact of such compensation and its inevitable disclosure on staff morale?
19. Does the loss of management staff reflect a level of dysfunction within the organization?
20. We urge you to examine whether women in particular are having difficulty fitting within the Health Unit, given that most of the remaining senior management is male.
We ask for fulsome answers to these questions from the Board, while reserving the right to request an investigation down the road. Under the circumstances, we see no reason why answers cannot be provided within 30 days.
Concluding Comments
It brings us no pleasure to write this letter. One of us (Councillor Moore Coburn) worked with pride for a quarter of a century with the Health Unit. Another (Councillor Tamming) toured the health unit many months ago with Dr. Arra, and was so impressed with both his deep understanding of epidemiology and the systems he had put in place that he publicly praised him in writing.
Thank you for your kind attention to this matter. We assume you want what we do – a healthy organization that is transparent with the public it serves.
We look forward to your response.
Sincerely,
John A. Tamming
Councillor, City of Owen Sound
Cathy Moore Coburn
Councillor, Municipality of Georgian Bluffs
Melissa Kanmacher
Councillor, Municipality of Arran-Elderslie
Ryan Greig
Councillor, Municipality of Arran-Elderslie
