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Margaret Melanson, Horizon's vice-president of quality and patient-centred care, said in a statement on Tuesday most of the people the health network employs for the incognito work are university students who are paid $16 to $18 an hour. Melanson said the first few language audits were conducted at such facilities as the Saint John Regional Hospital, The Moncton Hospital, the Miramichi Hospital and the Dr. Everett Chalmers Regional Hospital in Fredericton. She said the undercover auditors included some Horizon employees as well as students and members of the public.

New Brunswick's commissioner of official languages Katherine d'Entremont launched an investigation last May after she wasn't served in French by unilingual commissionaire Wayne Grant, during a visit to the main government office building in Fredericton. The 10-month investigation caused a storm of controversy because after she raised the complaint, Grant lost his favourable front-desk position and was reassigned to an outdoor parking lot and the backroom of a government office building. D'Entremont declined to comment on the Horizon issue.

The practice first came to light at a Horizon board meeting earlier this year in Fredericton. The Vitalité Health Network said Tuesday it has done similar audits using students in the past, "in line with our responsibilities under the Official Languages Act." People's Alliance Leader Kris Austin said Tuesday he is calling for an end to the "secret patient" exercise, which he said is intimidating unilingual Horizon employees. "We get calls from people who work in Horizon Health, unilingual employees, who are scared to death," Austin said in an interview. "They're saying things like, 'Are we going to be the next Wayne Grant if we don't provide bilingual service.' They are nervous. They don't know if they will be somehow punished. We're becoming too much like Quebec in terms of how we enforce our language policies. We have gotten so far from the original intent of bilingualism."

"As the Office of the Commissioner of Official Languages for New Brunswick will be addressing matters pertaining to official languages within the health networks in the 2015-16 annual report, comments on these issues will be made at the time of release of the annual report," said a statement from d'Entremont's office. In its last report, the Office of the Commissioner of Official Languages for New Brunswick reported three complaints about the Horizon Health Network's inability to provide care in the language of a patient's choosing. Austin said that number is tiny considering the roughly 1 million hospital visits Horizon handles annually. "It is perplexing that the health network would spend any resources on a problem that appears to be virtually non-existent," he said. But senior executives within the regional health authority said that despite the small number of complaints, the health network has a legal mandate to ensure access to service in French or English.

Horizon CEO John McGarry said at the January board meeting where the language audits were discussed, Horizon is legally obligated to provide care in both official languages. "Most people don't complain. They will convert (to another language) and not complain. But the fact is the law in New Brunswick is the law," he said at the board meeting.

We strive to live within the law of New Brunswick. Frankly, we can't answer for that. We can't decide we're not going to charge HST on our parking. It's the law. We must do it. We can't make a decision not to." McGarry said he knows many New Brunswickers find language policies frustrating. "I would say, 'Talk to your lawmakers. I would say, 'We have so much to do. We can't be involved with trying to argue our way out of the law of New Brunswick.' Argue with lawmakers," he said. McGarry said Horizon has done well at providing care in the language of a patient's choosing. Where it has struggled in the past, he said, was in making the offer of service.

"Frankly, we can do a lot better job," he said. "So what we're trying to do is to say to people, 'You've got to provide the active offer.'" Norma Robinson, president of the CUPE health-care unions, said she was unaware of the language audits and has not received any complaints from union members.

"I haven't heard one thing from any place in Horizon that would indicate there is an issue with this," she said in an interview. However, Robinson said she feels the tactic may be "sneaky." "I'm a bit disturbed as to why they would go to that length and not just survey the patients and the public to see if they are being given the active offer in French and English," she said. - With files from Adam Bowie

After leaving that hospital in July, 2005, Mr. Georgiou took a top position with the province's procurement agency, Infrastructure Ontario. But outside of his day job, the former executive began working for a private family construction business, Toronto Engineering Company (TECO). By March, 2006 - and until December, 2007 - TECO was working for St. Joseph's hospital. During this period, Mr. Georgiou became involved in a scheme to defraud York University with bogus construction invoices.

Mr. Georgiou used two family businesses, including TECO, to invoice the university for $64,800 worth of renovation work he acknowledges his company never performed. (Mr. Georgiou was not charged criminally and reached a settlement with the university.) When The Globe presented evidence to St. Joseph's last September that the hospital had also done business with TECO, the health centre hired Deloitte to investigate. The firm completed its probe this past spring. Deloitte found that over the course of nearly two years, St. Joseph's Health Centre processed 18 TECO invoices worth about $223,000 for repairs, painting and project management. The report shows Ms. Bahl approved all but five. (The hospital's thenproject manager of redevelopment, Doug Wilson, signed off on the rest.)

Deloitte found no evidence that Mr. Georgiou declared his TECO ties to the hospital, although internal hospital e-mails suggest Ms. Bahl was aware of his connection, the review states. Through their lawyers, Mr. Georgiou and Ms. Bahl criticized the fairness of the reviews. The report was not a full-blown audit and drew no conclusions. Deloitte did not interview Mr. Georgiou, Ms. Bahl or any other former hospital employees or vendors.

In a letter to The Globe, Mr. Georgiou's lawyer, Gavin Tighe, said TECO's dealings with St. Joseph's began after Mr. Georgiou left, so there was no conflict, but that, regardless, his client disclosed those ties. "TECO competitively bid on work at St. Joseph's Health Centre," Mr. Tighe wrote, adding that "TECO did not at any time contract or pay BJ Quality Flooring or Darwin Fisher Flooring to perform work." Deloitte also determined that there "may also have been an attempt to conceal" the involvement of Ms. Bahl's husband in the renovation projects.

Travis Walker, a lawyer representing Ms. Bahl, wrote to The Globe that Ms. Bahl "denies any impropriety" and that "any potential conflict of interest was disclosed to senior management" and "no concerns were ever raised." It is not clear exactly what policies Mr. Georgiou and Ms. Bahl may have violated, because St. Joseph's has refused to comment on the rules it had in 2007. A hospital spokesperson said "gaps in the procurement process at the time are historical and have since been mitigated" and that Deloitte unearthed "no substantive findings that indicate any further exploration is required." St. Joseph's would not answer questions on the report. When Mr. Georgiou left St. Joseph's Health Centre, he was one of the most powerful and connected members of the hospital, having served as vice-president for five years and interim CEO for 10 months.

About a month before he began working for Infrastructure Ontario in January, 2006, Mr. Georgiou's family members registered TECO in Ontario. Mr. Georgiou's wife, Helen Saoulli, and her parents were listed as directors. Mr. Georgiou acted as a project manager for TECO, according to a statement he made during the York investigation. Over the next two years, TECO invoiced St. Joseph's for work that included installing a new security gate for the emergency department, wall patching and painting, and disposal of chemical waste, documents obtained through a Freedom of Information request show. BJ Quality Flooring, the company owned by Ms. Bahl's husband, Bojidar Danef, was listed as a subcontractor on seven of the quotes, the Deloitte review found.

The auditing firm noted there may have been an attempt to conceal Mr. Danef's involvement because, at some point in the process, BJ Quality Flooring was changed to "Darwin and Fisher" [sic] - except that the contact name, telephone number and price stayed the same. Doug McDonald, owner of Darwin Fisher, a commercial flooring company in Mississauga, says his company has never done business with TECO and he has no idea why TECO invoices would include it. Mr. McDonald noted that during that period, Darwin was doing extensive work for St. Joseph's, and that on some occasions, he hired Mr. Danef as a subcontractor. Last November, Mr. Georgiou's employment as vice-president of St. Michael's Hospital was terminated after The Globe revealed his involvement in the York fraud, and later the fact that he had private business ties to the president of a construction company that won a $300-million contract with the hospital that Mr. Georgiou had overseen and helped award. After those stories were published, Markham Stouffville Hospital - where Ms. Bahl was then a senior executive overseeing a redevelopment project - launched an internal probe when a whistleblower came forward with concerns. The findings brought a wave of departures, including those of Ms. Bahl and Mr. Wilson, who had left St. Joseph's and was working with Ms. Bahl in Markham. Mr. Wilson could not be reached for comment.

The Markham Stouffville review, which Deloitte also conducted, found that Ms. Bahl hired five of the hospital's contractors to renovate her 6,480-square-foot home, received favourable pricing from some and awarded renovation contracts at Markham Stouffville to her husband's flooring company and her late uncle's window-covering business. It appears Ms. Bahl also mixed her professional connections with her personal life when she was at St. Joseph's hospital. Deloitte found evidence that one of the hospital's furniture vendors "assisted Ms. Bahl in procuring office furniture for her home at a 50-per-cent discount from the list price," the report said. In another instance, Deloitte noted Ms. Bahl may have tried to circumvent hospital procurement policy by counselling an art supplier to invoice through a company that was already doing work for the hospital, rather than submit a payment request directly.

"This is the only way I can cover the cost," Ms. Bahl wrote to the art supplier in an e-mail obtained by Deloitte.

Thus the board's justification for putting him on contract to provide advice on projects: "The former CEO has specialized knowledge and experience with partnerships solutions." Still, the Partnerships brass were not oblivious to the conflicts that might arise if Blain were retained as a consultant on a project that was also being vetted by the board.

"In order to mitigate the risks of any conflict of interest arising from this arrangement," the review reported, "the board chair was required to recuse himself from any meetings where his projects or his contract were being discussed." Instead, another member of the board was designated to serve as temporary chair. The designated lead director also oversaw the authorization of Blain's consulting contract. "While this conflict of interest issue appears to have been generally well managed," the finance report went on to say, "there could be the perception by some stakeholders that the contractor role still conflicts with the board chair's role of providing independent oversight." Any such perceptions were history by the time the report was completed in July 2014. Blain had already departed as board chair earlier in the year, replaced by Dana Hayden, a former deputy minister turned private consultant.

The internal auditors didn't let Partnerships entirely off the hook for tolerating the unorthodox arrangement in the first place. "The government should consider reinforcing the conflict of interest guidelines for board members of crown corporations and government agencies and ensure that those guidelines are appropriately followed." In other words, "not guilty, but don't let us catch you doing it again." The audit findings, including recommendations to rectify other questionable procedures at Partnerships BC, were forwarded to a steering committee of government and industry representatives, chaired by deputy finance minister Peter Milburn. The committee reported back to Finance Minister Mike de Jong on Oct. 23 with further recommendations for tightening up procedures at Partnerships.

De Jong released both reports and accepted both sets of recommendations in the course of announcing the change of direction for Partnerships BC on Dec. 16 of last year. That was the same day the Liberals chose to announce they were greenlighting construction of a hydroelectric dam at Site C on the Peace River. Just one of those amazing coincidences, but it goes some way to explaining why there was relatively little reporting of the findings regarding Partnerships BC.

There matters stood until this week, when the New Democrats, drawing on a wealth of material gathered by their research department, challenged the Liberals over Partnerships' dealings with Larry (Two Hats) Blain. The highlights package: The contract with Blain's delightfully named consulting firm, Aardvark Insights, was worth $219,000. During that same four-year span he also collected $188,836 in fees and expenses as chair of the board. All this atop the $264,000 he was paid to serve as a director of three other government-owned corporations, and the almost $4 million he was paid for his eight-year service as CEO.

"There's plenty of Blain to go around," quipped one press gallery wag as the New Democrats built their case against the Liberals during question period Wednesday. Another joke making the rounds rebranded P3s as B3s, for "Blain, Blain and Blain" Responding for the government, de Jong paid tribute to Blain's well documented contributions to the agency and cited the audit findings that "the conflict issue appears to have been generally well managed." But he also said this: "Whilst one can suggest that by recusing and taking (other) steps ... the procurement process is properly followed, the standard that we set and expect of agencies, the leadership within those agencies, goes beyond that. There must not only not be a conflict; there must be no appearance of a conflict." Which is as close as the finance minister came to admitting his sense of relief that when the audit branch blew the whistle on this arrangement, Blain had already left the building at Partnerships BC.

The auditor's findings come after a report to the government from a blue-ribbon panel in the spring that called on the province to make home-care services easier to navigate and more accountable. An investigation by The Globe and Mail also found a system plagued by uneven access to care, byzantine processes and a troubling lack of transparency for both patients and family caregivers.

"The time has come for the government to take a hard look at how CCACs deliver services to patients," Auditor-General Bonnie Lysyk said. "The solution is not simply to add new programs and make adjustments to existing services," she added. "This will only leave core problems and inconsistencies entrenched."

Catherine Brown, executive director of the group that represents the province's 14 CCACs, took issue with the audit's definition of direct-care spending, noting that time spent in consultations, case management and travelling to homes is a necessary part of delivering care and should not be considered part of overhead costs. "I don't think people understand the complexity of getting service to people in their homes," she said. Kevin Smith, the chief executive officer of St. Joseph's Health System in Hamilton and a member of the expert panel, said the audit provides valuable numbers on which to base future discussions.

Ontario's Minister for Health and Long-Term Care, Eric Hoskins, has vowed to repair the home-care system, laying out a 10-point plan in response to the expert panel report and setting up working groups with a threeyear time frame to make changes. He accepted all of the auditor's findings on Wednesday, saying he intends to "deepen" reform efforts and singling out the recommendation for a review of the way home care is delivered.

"This gives us the opportunity to be bold and be transformational," he said, but stopped short of saying what form such change would take. Dr. Hoskins said it is "premature" to say if the current system of access centres should be scrapped, as critics of the system have long suggested.

Getting it right is crucial for the Ontario government as it, like other provinces, looks to shift an ever-increasing share of health care out of expensive beds in hospitals and long-term care and into the home. The increasing emphasis on home care for the sick and the elderly is also what patients are demanding, and comes as many, including the Canadian Medical Association, say it's a change that is needed as the country's population ages.

The experience in the province of cutting wait times, he said, showed that "data, money and embarrassment" are a powerful combination to lead to change. NDP health critic France Gelinas, a member of the committee that asked for the report in the spring of 2014, said the audit confirms the system is broken.

"The structure has failed us and it is costing us a pile of money," she said. Among the audit's findings:

The province's 14 CCACs manage 264 separate contracts with 160 different agencies, and there is no standard rate for the same services among those contracts. The cost of an hour of care varies even among contracts involving the same CCAC and service provider.

In a sample of three CCACs, the nursing costs ranged from $49 to $73 an hour and personal support costs from $26 to $49 an hour. Pay for top executives jumped by 27 per cent between 2009 and 2013, to an average of $249,000.

Compensation for other senior executives increased 16 per cent during that time. Rapid-response nursing teams, created in 2011 and employed directly by the CCACs, failed to see patients within 24 hours about half the time, with some teams not available on weekends.

CCACs report 92 per cent of expenses are for direct patient care. That drops to 81 per cent when overhead and profit for service providers are taken out, the auditor finds, and to 72 per cent when documentation, travel time and training are not included. When case co-ordination is removed, it falls to 61 per cent.

The report is the first of two on home care by the AuditorGeneral. The second part, to be included in her annual report later this year, will focus on personal support workers. An examination of Ontario's 14 Local Health Integration Networks is also expected at that time.

The trial was set to begin on Monday but now has been postponed as both sides examine the newly found ministry files. NDP health critic Judy Darcy says she hopes the government will throw everything it can at Dr. Day, because if he wins, she believes, British Columbia will be opening the door to a new twotiered health-care system for the country. She isn't convinced the B.C. Liberals wanted to fight this battle. "I think the government is under tremendous pressure to defend the Canada Health Act," she said in an interview. But at least at the outset, the province needed some prodding to engage.

The B.C. Nurses' Union led the charge in 2003, challenging the provincial government to enforce the law and stop private clinics from treading on publichealth turf. It was 2008 when the province finally sought an audit of the books of Dr. Day's two clinics. The two sides then spent four years arguing about the scope of the audit. Finally, in 2012, the Medical Services Commission concluded the clinics were extra billing patients and threatened an injunction, which is still up in the air. The audit was limited to a small sampling of a few hundred cases. "The only thing we saw was a one spot-check audit and it showed $150,000 worth of extra billing in a single month," Ms. Darcy said.

"So we are talking about millions of dollars over the years, and nothing has been done about that." The B.C. Health Coalition is an intervenor in the case. While the province may have been slow to get started, Steven Shrybman, a member of the group's legal team, says he is impressed with B.C.'s case as it stands now. "The province has demonstrated a very serious commitment to this case," he said. "I can't fault them for the job they have done in defending the validity of our medicare model under the Charter." Dr. Day has been angling for this day in court for many years, and all the while he says his case has grown stronger as the province's surgical waiting lists have grown.

"This is a case about patients being able to care for their own health when the government won't provide it," he said. The B.C. Supreme Court will hear, possibly later this spring, his argument that Canadians have a right, under the Charter, to access necessary and appropriate health care within a reasonable time - something he says does not exist in B.C. "The only way the government can win, in my view, is if they can show that wait lists are not a problem." Health Minister Terry Lake told reporters last week that the reason some waiting lists are growing is because the healthcare system is doing more surgeries. "But I have asked our provincial surgical advisory committee to look at the situation, because I think we can do better ... One of my real desires is to reduce those wait times."

That's why those freshly discovered Health Ministry files may be revealing, and if nothing else, Dr. Day's battle may drive the provincial government to find not just the desire, but the means, to take aim at surgical waiting lists.

food that accounted for nearly half (43 per cent) of its $194 million spending in 2011/2012

A year after it was created, the Lower Mainland BISS contracted out patient food services and house cleaning operations, both to Sodexo

10-year, $330-million agreement

Sodexo is responsible for conducting audits and surveys

a 2008 independent survey of patient experiences in acute care across all VCH facilities reported a dismal 52 per cent for "overall quality of food"

The glowing audits had been done by Sodexo's own kitchen staff

getting awarded these contracts is very competitive. Providing recipes opens the door to determining food costs and therefore profits.

Nor does Sodexo reveal its suppliers for specific clients.

there's zero accountability,"

"There's no traceability

"There's a reason why hospital food feels like it's sort of a last frontier in the good food movement. And I think it is in part due to the fact that it is the place where some of the stickiest, deepest, dirtiest corporate contracts exist."

in 2011, Sodexo paid $20 million to settle an accusation of fraud levied against it by the state of New York.

former Sodexo managers turned whistle-blowers, claimed that the company had pressured its suppliers for huge "off-invoice" rebates that were never shared with its clients.

The New York State Attorney General's office investigated, and found that Sodexo had in fact failed to disclose supplier rebates it received, and to pass the savings on to state facilities, including a treatment centre for at-risk youth and a service organization for developmentally disabled children, as its contract required.

Sodexo has "vendor discount agreements;" discounts on based on large-volume orders. "But there is nothing in our contracts to say that clients are entitled to that,"

Vancouver Coastal Health has actually reduced the reporting it requires from Sodexo. A Freedom of Information request showed that VCHA does not collect food purchase records from Sodexo, an item of information the original contract required.

Neither are there any records available for patient tray audits.

"While this documentation is indeed a requirement in our agreement with Sodexo, it is one that we ourselves have waived."

"patient food user committee." VCHA's 2004 contract with Sodexo stipulated that each of its facilities would set up such a body to provide ongoing patient input and feedback.

UBC Hospital never created the envisioned committee to seek patients’ views

"In order to protect patients, the B.C. government must hold private clinic owners and operators accountable when they break the laws prohibiting extra-billing and user fees," said lawyer Steven Shrybman, a partner at Sack Goldblatt Mitchell who is acting for the B.C. Health Coalition and Canadian Doctors for Medicare, intervenors in the court challenge. Shrybman is well-known for his successful Supreme Court challenge against Ontario's attempted sale of Hydro One and the recent election fraud cases in Federal Court. "Though the challenge was launched in British Columbia, it has the potential to bring two-tier care to Canadians across the country," he warned. "Advocates of public health care from Ontario and across the country are calling on the B.C. government to take a tough stand in these negotiations. These are the laws that uphold Medicare and defend patients," said Dr. Ryan Meili, Vice-Chair of Canadian Doctors for Medicare. "A simple slap on the wrist encourages more violations in provinces from coast to coast."

The problem is already creeping into Ontario, according to Natalie Mehra, executive director of the Ontario Health Coalition, where the government is proposing to expand private clinics. "Patients are being confused by private clinic operators who are manipulating them into paying thousands of dollars for health care services that they have already paid for in their taxes," she warned. "The public should know that you cannot be charged by a doctor or private clinic operator for surgery, diagnostic tests or any other medically necessary hospital or physician service. Extra user fees charged to sick and elderly patients are unlawful and immoral and governments should be delivering that message." Advocates warned that this court case should also raise alarm bells in Ontario's government about the dangers of private clinics. At risk is our public health system in which access to health care is based on need, not wealth. SOURCE Ontario Health Coalition

Legal precedent: Whatever way the case is decided at trial, it is likely to be appealed and eventually reviewed by the Supreme Court of Canada. A decision from this level will mean all provincial and territorial governments will have to revisit equivalent laws. The foundational pillars of Canadian medicare - equitable access and preventing twotier care - could well be vanquished in the process. Wait times: Day will likely argue that Canada performs poorly on wait times compared to other countries, and that other countries allow two-tier care; thus, if Canada is allowed two-tier care, our wait times would improve. But this approach is too simplistic. Comparisons to the British health system, fail to recall that, despite having two-tiers, it has in the past suffered horrendously long-wait times. Recent efforts to tackle wait times have come from within the public system, with initiatives like wait time guarantees and tying payment for public officials to wait times targets.

By looking to Britain, we are comparing apples to oranges. British doctors are generally full-time salaried employees while most Canadian physicians bill medicare on a fee-forservice basis. Consequently, the repercussions of permitting extra billing in Canada could eviscerate our publiclyfunded system, whereas this is not the case in Britain. Imagine if most doctors in Canada could bill, as those at the Cambie clinic have done, whatever they want in addition to what they are paid by governments?

Conflict-of-interest incentives: Evidence suggests there is a danger in providing a perverse incentive for physicians who are permitted to work in both public and private health systems at the same time. Wait times may grow for patients left in the public system as specialists drive traffic to their more lucrative private practice. Sound improbable? Academic studies have noted this trend in specific clinics that permit simultaneous private-public practice. And recent U.K. news reports have profiled a case where a surgeon bumped a public patient in need of a transplant for his private-pay patient.

Competition: Proponents of privatized health services often claim it would add a healthy dose of competition, jolting the "monopoly" of public health care from its apathy. But free markets don't work well in health care. Why? Because public providers and private providers won't truly compete if the laws Day challenges are struck down. Instead, those with means and/or private insurance will buy their way to the front of queues. Public coverage for the poor will likely suffer, as is clearly evident in the U.S., with doctors refusing to provide care to low-income patients in preference for those covered by higher-paying private insurance.

Of course, this is all based on an outcome that is not yet known. It may be that the charter challenge in B.C. will be unsuccessful, but clearly the stakes for ordinary Canadians are high. Sadly Dr. Day is not bringing a challenge for all Canadians. Isn't it past time our governments and doctors work to ensure all Canadians - and not just those who can afford to pay - receive timely care? Colleen Flood is Professor and University Research Chair in Health Law Policy at the University of Ottawa. Kathleen O'Grady is a Research Associate at the Simone de Beauvoir Institute, Concordia University and Managing Editor of EvidenceNetwork. ca

Boudreau has said the move will save the province millions of dollars through efficiencies brought in by a private company. However, the union's document paints a poor picture of privatization of services in health-care facilities in other jurisdictions. "We believe it is important for New Brunswickers to understand the impact of such a move, especially when it comes to the cleanliness of a building which the public relies on everyday," Robinson said. Last year, the Horizon Health Network started a regular audit of the cleanliness of hospitals being serviced by unionized public sector workers. Auditor General Kim MacPherson reported that health-care workers weren't cleaning their hands as required and that the standards to do so weren't even the same within the two regional health authorities.

Robinson said Friday that policies have been established and changes made that are addressing cleanliness concerns. "And they have improved on their targets of cleaning in the hospital sector," she said. The union claims its research into the three companies they believe are being considered to take over those services - Sodexo, Aramark and Compass - shows a poor track record. The union said it's also concerned about the quality of food declining. The union wants to keep the management of hospital environmental services in-house. It also wants fair wages and benefits for cleaning and food services staff to ensure against high turnover and gaps in training. The union also stated lay-offs and staff reductions would be a poor way to balance the budget.

"The cost associated with treating hospital-acquired infections, managing public relations fiascoes and defending lawsuits would defeat any possible savings while destroying the public trust." The Province of New Brunswick expects to have completed talks with a private contractor for the management of health-care cleaning and food services before the end of the year.

Bruce McFarlane, Health Minister Victor Boudreau's director of communications, said Friday that the province is "still in current discussions with the preferred proponent and we hope to have completed the process sometime this fall." McFarlane sent The Daily Gleaner an email statement Friday afternoon after the New Brunswick Council of Hospital Unions CUPE local 1252 released a 20-page document critical of the government's plan to privatize housekeeping, food services and porter services at hospitals. "We want to clarify that we are only outsourcing the management of the services," said McFarlane, who added that the ministry had not yet received the document.

"CUPE staff will remain in their union and will continue to be employees of the Province of New Brunswick." Norma Robinson, president of CUPE Local 1252, said she is "very concerned that the Liberal government is negotiating with a private firm to take over the management of food and cleaning services in the province's hospitals." Robinson said she's worried the move could lead to further privatization. In an interview with Brunswick News in April, Boudreau said the government wants to give the private sector a greater role in the province's health-care system.

Boudreau has said the move will save the province millions of dollars through efficiencies brought in by a private company. However, the union's document paints a poor picture of privatization of services in health-care facilities in other jurisdictions. "We believe it is important for New Brunswickers to understand the impact of such a move, especially when it comes to the cleanliness of a building which the public relies on everyday," Robinson said. Last year, the Horizon Health Network started a regular audit of the cleanliness of hospitals being serviced by unionized public sector workers. Auditor General Kim MacPherson reported that health-care workers weren't cleaning their hands as required and that the standards to do so weren't even the same within the two regional health authorities.

Robinson said Friday that policies have been established and changes made that are addressing cleanliness concerns. "And they have improved on their targets of cleaning in the hospital sector," she said. The union claims its research into the three companies they believe are being considered to take over those services - Sodexo, Aramark and Compass - shows a poor track record. The union said it's also concerned about the quality of food declining. The union wants to keep the management of hospital environmental services in-house. Calls made to Sodexo, Aramark and Compass were not returned by press time.

In fact, barely 62 cents of every $1 goes to actual direct patient care. For years, CCAC bosses have being boasting - falsely it turns out - that 92 cents of every dollar went to direct patient care. Lysyk's audit also found that barely half of the complex-needs patients discharged from hospitals receive the care they are supposed to get within 24 hours, often because CCAC nurses don't work on weekends or rarely after 5 p.m.

In the wake of the latest major report that blasts the way Ontario looks after home care in this the province, it is time for Ontario Health Minister Eric Hoskins to take immediate action to fix a system that is clearly broken. The latest horror-filled report, released last week by auditor general Bonnie Lysyk, outlined a system that is utterly confusing, often mismanaged, lacking in oversight and filled with inconsistencies in how patients are treated. Lysyk took particular aim at the 14 Community Care Access Centres (CCACs), the publicly funded organizations that co-ordinate nursing, therapy and personal support services for patients outside of hospitals.

Despite these two major reports and similar reports in years gone by, the Liberal government has done nothing to address the troubles within the CCACs. Now it's up to Hoskins to act boldly and quickly to fix the system.

As a first step, Hoskins should immediately create a powerful task force that can review the CCACs and look for a better way of co-ordinating home-care in Ontario. Ultimately, that could mean scrapping the CCAC system, which as Lysyk's report finds, is simply not working. The task force should be composed of experts from all sectors of the health area, including representatives of hospitals, patient advocacy groups, nurses, therapists such as speech language pathologists, personal support workers, CCACs and the 14 Local Health Integration Networks (LHINs) that oversee and fund CCACs, hospitals and other community health services. Also, Hoskins should give the task force a short deadline to report its recommendations, ideally within six months. That's a tight schedule, but it should be possible given that so much investigation has been done over the last five years into the flaws in the system. One specific mandate that Hoskins should give the task force is to determine if all planning and monitoring roles for home care now performed by CCACs can be transferred to beefed-up LHINs.

Also, the task force should study whether care co-ordination now handled by CCACs can be transferred to the primary-care sector. Hoskins, who has talked of wanting "bold and transformative change," has hinted broadly that he is willing to look in this direction. He has taken great efforts to point out the auditor's recommendation that the government revisit the current model of delivering home and community care. "We endorse this recommendation and see it as a catalyst not only to continue but to deepen our reform process," he said. The auditor general will release two more reports on home care in 2015, both to be included in her annual report to be filed likely in early December. One is on the CCAC's home-care program focusing on personal support services and the other on the performance of the 14 LHINs. But Hoskins doesn't need to wait for these reports before acting.

The evidence that the home-care system is a mess and that the CCACs are a big reason for that sorry state is overwhelming. It's time for Hoskins to appoint a task force with a mandate to propose real reforms that will improve the lives of all Ontario patients who need treatment at home. Bob Hepburn's column appears Sunday. bhepburn@thestar.ca

Mr. Georgiou, 51, is a long-time senior public servant. Between 2006 and 2012, he held various executive positions at Infrastructure Ontario, the procurement agency that was set up to administer the McGuinty government's ambitious plans to restore the province's outdated infrastructure through public-private partnerships. He was a project manager on the construction of several major projects, including some of the facilities for this summer's Pan Am and Parapan Games, eventually rising to the role of chief administrative officer. How he ended up admitting he issued false invoices - and why that information was not passed on by at least one of his former colleagues at Infrastructure Ontario - dates back to 2009, after a whistleblower complained to management at York about questionable invoices.

Court records show the scheme required Mr. Georgiou to invoice the university, through two family-owned companies, for work that those companies never performed. After cashing York's cheques, he passed on about $40,000 of the total $65,000 paid by York to an intermediary who was connected to a facilities official at the university. Mr. Georgiou said he kept $25,000 to declare for income tax purposes. "Once these events came to light, I fully co-operated with the authorities and counsel for York University, and I assisted them with their investigation. In addition, I ensured that the party who requested the invoices, repaid the entire amount to York University," he said in the statement. He did not address questions about what he told St. Michael's, if anything, about his role in the scheme.

St. Michael's and Infrastructure Ontario have ordered forensic audits. "These swift and prudent actions have been taken by the Board of Directors and Management to preserve and protect the public trust invested in St. Michael's Hospital," a statement from St. Michael's said. In its own statement, Infrastructure Ontario said it was "very troubled" by some of the facts The Globe presented to four of its officials in an interview. "The activity in question goes against everything [Infrastructure Ontario] stands for," said Bert Clark, the agency's chief executive, and Linda Robinson, vice-chair of Infrastructure Ontario's board. Mr. Georgiou, who has been placed on a leave of absence from the hospital, said in an e-mail that The Globe had not provided him enough time to give proper answers to about 40 questions it e-mailed to him last Wednesday. In a statement, he said he never profited from the "exercise" at York and stressed that he was never charged criminally for his role in the false invoice scheme.

He wrote these invoices, he told investigators, at the request of a friend who had nothing to do with the university, a parking industry executive named Luigi Lato. According to Mr. Georgiou, Mr. Lato told him maintenance work had been performed and he was hoping Mr. Georgiou could create invoices for that work. But for reasons Mr. Lato never explained, Mr. Georgiou said, whoever did the work did not issue their own invoices. Mr. Georgiou said he believed Mr. Lato was doing a "favour" for a friend at York who needed to pay for the work. A lawyer and an auditor for York pressed Mr. Georgiou on why the companies that actually did this work would not, or could not, issue invoices, and Mr. Georgiou said he did not know.

York investigated and concluded it had been the victim of a $1.2-million kickback scheme involving false invoices for nonexistent construction and maintenance work. A forensic audit determined that between 2007 and 2010, the university cut cheques to eight different companies for services that were never rendered. The York investigation found that two of those companies, Arsenal Facilities Consultants Inc. and Toronto Engineering Company, were connected to Mr. Georgiou. (He was the listed officer and director of AFC, and the other company was owned by his wife and her parents.) Mr. Georgiou and his lawyer, Gary Clewley, agreed to meet with auditors in February of 2011, and Mr. Georgiou admitted writing three false invoices totalling $64,800 between the two companies. The Globe has obtained a transcript of this meeting, which was marked "confidential" but included in court filings. Mr. Georgiou created paperwork showing that AFC did $22,000 worth of door lock repairs in November, 2007. In February, and then again in April, 2008, he drew up documents claiming that TECO completed a total of $42,800 worth of watermain work.

"There were no details provided to me," he explained at one point. Pressed further, he said, "I didn't ask any questions." York paid AFC and TECO, but Mr. Georgiou told investigators he did not keep the money. He withheld about $25,000 to declare as income tax for both companies, which he said he paid. As for the rest of the money, he made two trips to see Mr. Lato in which he paid him a total of about $40,000 in cash. Mr. Lato could not be reached for comment.

William McDowell, a lawyer acting for York, asked Mr. Georgiou how the teller at his bank reacted when he withdrew $14,500 in cash for Mr. Lato's first instalment: "Doesn't your banker kind of squint when you go in and ask for $14,500 in cash?" Mr. Georgiou replied: "I didn't go into the bank and ask for $14,500 in cash, you know, like in one shot. I had, you know, some cash at home, went to the bank for some cash..." About a year later, on Jan. 26, 2012, York filed a statement of claim against all of the people and companies it believed had defrauded the university, including Mr. Georgiou. The same day, the university's general counsel, Harriet Lewis, met with a senior executive at Infrastructure Ontario, Bill Ralph, who at the time was the procurement agency's chief risk officer, both York and IO said in separate statements. Ms. Lewis informed Mr. Ralph that York had launched a lawsuit against Mr. Georgiou and others because of what the internal investigation uncovered.

Mr. Ralph did not respond to requests for comment. Two weeks after the meeting, Mr. Georgiou suddenly resigned. A few days later, the CEO of Infrastructure Ontario, David Livingston, announced in a company-wide e-mail that Mr. Georgiou was "leaving." The departure e-mail made reference to "various personal and family matters" Mr. Georgiou needed to address. "I know it was a tough decision for him, but I admire him for making it." Mr. Livingston did not respond to repeated requests for comment e-mailed to him and to his lawyer. After leaving IO, Mr. Livingston was appointed chief of staff in May, 2012, to Dalton McGuinty, then premier of Ontario. Mr. Livingston has been accused by Ontario Provincial Police of orchestrating a plan to purge government records after the controversial cancellation of two power plants. He has denied through his lawyer that he did anything wrong.

Employment lawyer Natalie MacDonald said a chief risk officer should give the board of directors any information that could damage the organization's reputation. A risk officer has a "duty to inform the board so it can make an informed decision," Ms. MacDonald said, speaking generally. But according to Infrastructure Ontario's organization chart, the chief risk officer reports directly to the CEO rather than to the board. In an interview last Wednesday, Ms. Robinson, the board vicechair, said the news that Mr. Georgiou had, at one time, been named a defendant in the lawsuit and admitted writing false invoices never made its way to the agency's board.

In April of 2012, Mr. Georgiou and Mr. Lato signed a settlement agreement with York that required them to pay restitution - the amount has not been disclosed in public documents - which Mr. Georgiou said in his statement to The Globe was covered by the "party" who requested the invoices. One of the conditions of the settlement is that York "shall not make any statements to the media" about the agreement or about allegations levelled in York's claim, except to say that Mr. Georgiou co-operated.

Seven months later, St. Michael's board meeting minutes show that it had identified a preferred candidate to replace its chief administrative officer, and in the New Year, Mr. Georgiou officially started his new job. In its statement, St. Michael's said an external search firm was enlisted to identify Mr. Georgiou, and a separate firm conducted reference interviews. The issues at York were "never disclosed by Mr. Georgiou," St. Michael's statement said.

In his statement to The Globe, Mr. Georgiou said he has led the hospital in securing government funding, as well as capital redevelopment funding. "During my tenure at St. Michael's we have achieved tremendous results for the hospital both in the excellence of our hospital's performance as well in the success of our redevelopment project."