The recent scandals at ORNGE showed how executives tried to use a series of for-profit companies within their non-profit structure to evade compensation disclosure.
For-profit companies do not have to disclose salaries under the Public Sector Salary Disclosure Act. They can pay their CEOs whatever they like, and we have no right to access that information no matter how much public money is poured into that company.
As the government expands the use of private companies (both for-profit and not-for-profit) to deliver more public health care, the less we will know about how it is spent.
Speedboats and European MBAs anyone?
And as much as we were shocked by the $1.4 million compensation received by the now former CEO of ORNGE, we don’t really know how that compares to other private sector entities which rely heavily on government funding. That includes the not-for-profits.
Take St. Elizabeth Health Care. According to their web site, they have 6,000 nurses, rehab therapists, personal support workers and crisis intervention staff that deliver nearly five million health care visits annually in Canada. Many of these visits take place here in Ontario. They have public contracts with 13 of 14 Community Care Access Centres (CCACs).
St. Elizabeth is currently playing some feel good TV Commercials about delivering community care, and encouraging people to call them – not the Community Care Access Centre – for more information. They’ve clearly got a mission to become the dominant provider of home care in the province.
In just one CCAC — Erie-St. Clair — St. Elizabeth is doing $6.7 million worth of business.
Any not-for-profit organization that receives $1 million or more in funding directly from the Province of Ontario is subject to the Public Sector Salary Disclosure Act. The Act also includes organizations that receive at least $120,000 but less than $1 million in direct funding if that funding represents at least 10 per cent of that organization’s gross revenue for the year.
Most home care contracts flow through the Community Care Access Centres, which in turn receive their money from the Local Health Integration Networks. The LHINs in turn receive their funding from the Ministry of Health and Long Term Care.
While it appears that St. Elizabeth should be required to post their executive salaries on the sunshine list, they presently aren’t. The Ministry of Finance, when contacted by us, said they are requesting further information from St. Elizabeth.
We similarly could find nothing from the VON until directed to an addendum to the list.
In fact, most of the not-for-profits in home care do not post on the sunshine list. Nor do most show up on the list of agencies that have no employees above the $100,000 threshold. The rules already exempt the for-profit players, such as Bayshore or CarePartners from disclosing their executive salaries. Of the not-for-profits that do disclose, such as VON Canada, their head office appears to be left off the list. We don’t know what the CEO of VON Canada earns, even if a substantial amount of work – and funding — comes from the Province of Ontario.
Could it be these agencies are arguing the three-step process no longer makes them “directly” funded?
What is even more disturbing is that most of these not-for-profit agencies are also charitable institutions. Yet if you download St. Elizabeth’s most recent annual report, there are no audited statements. In fact, there are no financials at all.
While the hospitals have been posting entire contracts on-line to let us know the terms and conditions of their executives, we get no such transparency in publicly funded home care.
Michael Decter, the former Ontario deputy minister of health and founding chair of the Health Council of Canada, recently wrote in the Toronto Star that transparency is a “terrific solvent” when applied broadly and rigorously.
He says transparency could have alerted us all much earlier that ORNGE was off course.
Yet the direction of government is to move more of the system into the private sector where public accountability will be much more difficult.
Decter says the sunshine list should be reformed to increase the threshold to something more meaningful – say $200,000 per annum – and loopholes should be closed that allow quasi-public sector agencies to evade disclosure.
That, one would think, would include St. Elizabeth Health Care, where Michael Decter has been on the board of directors.