"In a hospital, an entire group of physicians or an entire department must not completely withdraw services. A physician must be available to provide for the care of seriously ill or emergency patients. Just as individual physicians cannot abandon their patients, groups of physicians cannot abandon their community."
Guidelines Regarding Withdrawal of Physician Services, College of Physicians & Surgeons of British Columbia, adopted May 28, 2002

Health Services Minister Colin Hansen is right to describe the mass resignation of emergency room doctors from the Nanaimo Regional General Hospital as unprofessional. Nurses would never do anything like that, but if they did, they would be subject to heavy fines and even jail. The question for Hansen is, what is he going to do about it?

The College of Physicians and Surgeons of British Columbia has issued several letters to physicians over the past several years cautioning them about service withdrawals. In May 2002 it adopted a policy statement on the issue that clearly says that entire departments cannot withdraw their services. Notwithstanding its policy, the College appears to be standing by and waiting for a disaster to occur in Nanaimo.

Alarmed over the passive role of the College, the Campbell government moved to implement recommendations to change the Health Professions Act so that the College could essentially be put in trusteeship if it failed in its responsibilities. When the doctors fought back, the government caved and abandoned its legislation. In the absence of a regulatory body that is prepared to enforce its ethical standards, Hansen must come up with something to protect the public. He would be well advised to cool his rhetoric and agree to binding arbitration. Of course, he might have a credibility problem since his government introduced legislation to overturn the last binding arbitration with BC's doctors.

The kind of regional "wild-cat" job action that is taking place is Nanaimo is no different from what various groups of doctors used throughout the province in recent years. In any other industry the tactic would be seen as failure to honour an agreement, but the BC Medical Association gets away with escalating demands while turning a blind eye to strike activities - that is what is usually called bad faith bargaining. When that happened under the former government, then Opposition Leader Gordon Campbell and his caucus responded by encouraging the physicians. Collin Hansen was Opposition Health Critic on September 17, 2000, when he said:

"This isn't about a head-butting exercise between the Minister of Health and doctors in this province, but that's what we've seen. In the middle of this we have patients. We have individual citizens who live in Prince Rupert, Smithers, Kitimat, Terrace. You can go across all 12 communities that now have withdrawal of services by doctors. While this head-butting exercise is going on between the minister and the doctors, it's the patients in those communities that are paying the price."'

"The reason that those communities have solid support for their doctors is because they recognize that what the doctors are doing is standing up for long-term stability in the delivery of health care in those regions. They realize that if they don't stop the bleeding now in terms of doctors that are leaving the province and doctors that are not coming to the province in the first place, then those communities are going to be in big trouble."

Hansen went on to ask the Minister what the plan was if the government's offer was rejected by the doctors. The same question can be put to Hansen today. The New Democratic government accepted the advice given by the Hon. Emmett M. Hall, one of the chief architects of Medicare, in his second Royal Commission Report. In 1980 he wrote "My conclusion and recommendation is that when negotiations fail and an impasse occurs, the issues in dispute must be sent to binding arbitration …" One of the first acts of the Campbell government was to use legislation to reject the arbitrated settlement between the BCMA and the government. That exercise in contract breaking created the instability and conflict that is unfolding in Nanaimo and that is about to be unleashed throughout the province.

The Campbell government appointed Don Wright to review and recommend changes to the collective bargaining structure for teachers in B.C. The bargaining structure for physicians in B.C. is even less functional. The government must either return to binding arbitration or find an alternative dispute resolution mechanism that is acceptable to all parties. The mechanism that Campbell and his ministers appear to have adopted is propaganda waged through paid TV advertisements and trial balloons. Gary Collins suggested that the sales tax and MSP premiums would have to be further increased if the doctors receive any award. Notice how he carefully stuck with his favorite regressive taxes rather than mentioning income tax surcharges for the six figure set. No amount of effort to persuade or threaten the public will resolve the dispute. The BCMA's website is almost entirely restricted to physician access only; little or no effort is made to communicate with the public. A settlement requires a dispute settlement mechanism like binding arbitration, not a war of words in a battle for public opinion.