On almost every shift Paul Parks has an encounter that would have been unthinkable when he started practising emergency medicine 26 years ago. Here’s one that was weighing on him when we spoke: a woman in her mid-twenties, actively miscarrying, distressed, and with nowhere to talk to Parks but a small space right beside the waiting room. There’s no privacy. He knows it. She knows it. But there’s no place else.
“That’s become a common thing,” Parks says.
Parks is an emergency physician at Medicine Hat Regional Hospital and the former president of the Alberta Medical Association (AMA). Again and again over the last two decades he’s spoken out about what’s happening in Alberta’s emergency departments. But what he’s seeing now in the province’s health system is different from anything he’s seen before—not just in volume, but in kind. Beginning in early 2024, Alberta Health Services (AHS), long under pressure from a growing population and lack of resources, was split into four parts and is now organized in a way that’s difficult to navigate, both for patients and for the people caring for them. “The system has never been more unfocused,” Parks says. “It’s never been more chaotic. It’s never been more disorganized.”
And he adds one more superlative: it’s never felt so risky for people to speak out.
Parks finished his training at the University of Alberta in 2005, specializing in emergency medicine. He spent four years working in Edmonton before moving to Medicine Hat, where he’s practised ever since. Emergency medicine offers an up-close view of the entire health system, he says. When there’s a shortage of hospital beds, patients get stuck in the emergency department. When patients don’t have a family doctor, they end up in emergency for treatment that should’ve been done outside the hospital. When people fall behind on vaccinations, they’re more likely to get sick and end up in emergency.
“We own the sins of the system,” says Parks. “Wherever the system’s not working, it all ends up in the emerg.”
In 2010 Parks, then president of the AMA’s section of emergency medicine, publicly called out health minister Gene Zwozdesky for overcrowding in the ER. Parks said four out of every five emergency room beds were occupied by admitted patients waiting for ward space elsewhere in the hospital. Lives were at risk. Those were early turbulent years for AHS. Under premier Ed Stelmach the provincial government consolidated nine regional health authorities and three provincial boards into a single province-wide “superboard.” AHS was unlike anything else in Canada, with one executive chain and one organization to coordinate healthcare delivery across the province. Leadership in the first years turned over repeatedly.
But the organization stabilized. In 2018 AHS was named by the International Congress on Integrated Care as one of the world’s top five health systems. It developed standardized pathways that sped up cancer diagnoses and stroke treatment. It implemented Canada’s first province-wide hospital electronic medical record, allowing physicians across Alberta to view a patient’s history. In 2022–2023, the most recent year with national data, Alberta had the lowest administrative costs—2.8 per cent of health spending on corporate services, compared to the national average of 4.4 per cent.
“Many looked to AHS as a model of a high-performing healthcare system,” says Lorian Hardcastle, an associate professor of law and medicine at the University of Calgary. “That’s where everyone else is: moving more towards the AHS model, not abandoning it.”
It wasn’t a perfect system. Parks and others spoke out about AHS’s problems over its first two decades. Decision-making was very centralized, with little ability for healthcare workers in a single hospital to adopt solutions for their local problems. Grande Prairie and Fort McMurray—which have distinct populations and concerns—were lumped together in a single zone. AHS drifted into functions it was never designed to manage, including long-term care and primary care recruitment, with varying degrees of success.
Even so, it was a system that worked well. “I don’t know very many people who would have said ‘Blow this system up,’ ” Parks says. “ ‘Totally disintegrate it. Break it up into a bunch of pieces.’ Nobody was advising that.”
“The system has never been more unfocused,” says Paul Parks. “It’s never been more chaotic. It’s never been more disorganized.”
Enter Danielle Smith. In 2009 she was named leader of the far-right Wildrose Party and with the 2012 provincial election she became leader of the Official Opposition. During that campaign she offered a wait-time “guarantee” that would let Albertans use private clinics outside the province on the public dime if they couldn’t get surgery in Alberta within a set time period. The public healthcare system “will be strengthened by introducing choice and competition,” Smith said. At the time she claimed she wasn’t opposed to AHS per se so much as to the single-payer model of public health.
At the start of the pandemic Smith was out of politics, busy as president of the Alberta Enterprise Group and as a libertarian talk show host for whom no idea about freedom was bad. Many of her suggestions indicated that, for her, scientific evidence carried as much weight as fairy dust. She claimed that getting cancer was entirely in a person’s control. In March 2020 she tweeted, then deleted, that a cure for COVID had been found (none had). As waves of COVID came and went, Smith’s attacks on AHS grew. The organization was bearing the weight of a public health crisis under a government that was reluctant to impose restrictions. Its own staff shared the hashtag #weareAHS to boost morale and honour the efforts of healthcare workers. Smith put AHS, along with COVID restrictions and vaccines, in her crosshairs, turning opposition to all three into her political brand.
By July 2022, while campaigning for the leadership of the UCP, she told supporters in Airdrie that the health system had failed Albertans: “AHS… is either completely incompetent or they actively sabotaged our government,” she said. She was skeptical about reports from physicians, scientists and AHS leadership. She questioned whether the capacity issues in AHS facilities were as bad as officials claimed, and said she’d carry out an audit to factcheck those numbers.
The UCP unveiled a plan to divide Canada’s most integrated health system into four pillars. Parks told them: “This will be disastrous.”
After becoming premier, Smith and her government “scapegoated AHS for what went on during COVID,” says Hardcastle. Smith had promised quick action on healthcare once elected. Give her 90 days, she’d said, and she’d fix the system. She wanted to be seen as doing something drastic about problems in the health system—long ER waits, surgical backlogs, a shortage of family doctors. “The Smith government could have done the hard work and figured out the solutions,” Hardcastle says. “Instead, they chose the more dramatic.”
The reorganization that followed was neither targeted nor evidence-based. “If we look at the scholarship on this issue, it doesn’t support siloing the system into different parts,” Hardcastle says. “It’s difficult to justify based on [Smith’s] own ‘red-tape reduction’ ideology. It’s difficult to justify based on any of the literature, which tends to support greater integration. It’s difficult to justify based on other jurisdictions.”
Braden Manns, a nephrologist and health policy researcher at the U of C, is equally direct. He says Smith’s plan to dismantle AHS “was done for all the wrong reasons”: revenge against a health authority that tried to reduce the spread of COVID, ideological control over addictions care, and structural changes that make it easier for private health operators to function with less oversight.
Parks was one of the first people outside the UCP government and its consultants to see the plan to reorganize AHS. In fall 2023 he was invited to a meeting with minister of health Adriana LaGrange and government officials. With him was Athana Mentzelopoulos, then interim executive director of the AMA. The pair were told that the meeting was covered by a non-disclosure agreement that would be in place until the government announced publicly what they were about to tell Parks and Mentzelopoulos privately.
LaGrange and team unveiled their plan to divide one of Canada’s most integrated health systems into four separate pillars: acute care, primary care, continuing care and mental health and addiction. Each would become its own organization with its own leadership structure. “They were like ‘Ta da! And what do you think?’” Parks recalls.
He wasn’t impressed. The four pillars appeared to function separately from one another. There was no mechanism for day-to-day decision-making across them, no single authority to resolve conflicts, no one to turn to who could make calls on patients or resources when the pillars overlapped—which, in a health system that looks after real-life people with real-life needs, happens constantly.
Parks spoke up. He gave the example of a patient admitted to hospital who needs to move to continuing care, but there’s no bed available. Under the new model, acute care (hospital care) and continuing care are two separate organizations. It wasn’t clear who would be in charge.
“I said to them, ‘You’ve described four pillars, but you didn’t describe what the pillars are holding up or what would be over top of them,” Parks says. “I said, ‘If you don’t figure out operational control on a day-to-day basis, we’ll be doomed. This will be disastrous.’” The officials took notes but didn’t change the plan, Parks says.
In December 2023 Mentzelopoulos was named as president and CEO of AHS. Just one year into her tenure, however, she was fired. She had planned to meet with the Auditor General to discuss her concerns about procurement, including government contracts with privately run chartered surgical facilities. Mentzelopoulos has since filed a wrongful dismissal suit against AHS and the province, alleging she was terminated because she investigated contracts with links to government officials.
Her treatment reinforces how hard it is to be a public healthcare advocate in Alberta in 2026, says Parks. Physicians saw Mentzelopoulos get fired and be subjected to harassment and intimidation, with her reputation publicly questioned. They watched what happened to Deena Hinshaw, the province’s chief medical officer of health during the pandemic; right after becoming UCP leader, Smith fired her. Hinshaw was later hired into AHS’s Indigenous Wellness Core, only to have the appointment almost instantly revoked. Physicians in Alberta now describe what happened to Hinshaw using a cautionary verb—“getting Hinshawed.” Manns, who’d been an AHS interim vice-president, resigned in protest, saying he believed Hinshaw lost her job because of political interference, including from the premier and her chief of staff.
Physicians and healthcare workers regularly contact Parks with concerns that they won’t raise publicly themselves. They worry they could be the next target. “Very, very few people are willing to speak truth to power right now,” he says. “Even quite senior leaders will ask me to advocate on stuff because they don’t feel comfortable doing so internally on their own. They’re afraid for their job.”
He believes his own employment prospects have narrowed as a result of his advocacy. “Outside of working as an emerg physician in Medicine Hat, I don’t think I’m employable in a leadership position within AHS or Covenant Health.”
Those concerns haven’t stopped Parks. In November 2025 he started travelling around the province for a series of public healthcare town halls with Friends of Medicare, a non-profit that calls for strengthening universal public healthcare in Canada. So far he’s done 26 events.
He’d only done a few when tragedy struck. On December 22, 2025, Prashant Sreekumar, a 44-year-old father of three, died in the emergency department at Grey Nuns Community Hospital in Edmonton after waiting eight hours to be treated for chest pain. His death wasn’t an isolated event—two other patients died in the same emergency department that day.
In the weeks following Sreekumar’s death, Parks contacted emergency physicians across the province and asked them to send him cases of deaths and near-misses that they believed were linked to overcrowding and blocked access. The list, compiled in a little over two weeks, highlighted six preventable deaths and more than 30 near misses. The anonymized cases included stories of patients having cardiac arrests in hallways; others resuscitated in corridors and on triage stretchers; sick people not being seen for six, eight, 12, 18 hours. One doctor wrote: “Our hallways and waiting rooms have become DEATH ZONES, and we wonder how many ‘ticking time bombs’ will drop dead when they should be receiving life-saving care.”
Parks sent the list to the government. It was leaked to the press; Parks says he didn’t leak it. Hospital and Surgical Health Services minister Matt Jones said the cases weren’t representative of the system. Within two days 300 doctors in Alberta had signed an op-ed saying the province’s hospitals were facing a crisis. Individual physicians are responsible for more patients than they can safely manage, they pointed out. A safe ratio is one physician to 18 patients; Alberta doctors are often managing 25 or more. Patients are being cared for in non-medical spaces and even labour and delivery rooms because medical beds are full.
“To get that many busy docs to sign something in two days—that tells you the climate,” says Parks. “They were worried.”
The lack of a rationale for reorganizing AHS, the poor planning and consultation, and the dismissal of staff concerns has, inevitably, led to declining care. Parks says it’s being felt on every shift in every facility in the province.
Take what happens to the growing number of Albertans who receive a cancer diagnosis in the emergency department. A cancer diagnosis is devastating anywhere, but especially where a stranger delivers the news in a not-so-private setting. If a patient doesn’t have a family physician, under the old system Parks could have set a care path in motion right from the emergency department. He could have connected them with imaging and a physician to quarterback their care, perhaps even with a family doctor. Now he has to figure out a plan to get the patient access to diagnostic imaging. He’ll try to connect them with a cancer specialist, but cancer care falls under a new corporation, Cancer Care Alberta, which is overseen by Acute Care Alberta.
In spring 2025 Smith shuffled her cabinet and announced a minister responsible for each pillar of the health system. This only added to the challenge of getting answers about how the system works now. Representatives from Hospital and Surgical Services (the ministry that oversees Acute Care Alberta) and Acute Care Alberta didn’t respond to my multiple queries, including about what happens after patients are diagnosed with cancer in the emergency department.
It’s not always clear where to send a patient to expedite the next steps in care, and it takes time for busy emergency doctors to investigate. Every time this complicated process is initiated, says Parks, there’s a risk the chain of care could break. “By the time someone figures out it didn’t work, maybe that mass that hadn’t spread is now metastatic,” he says. “Maybe now we can’t cure it. Maybe now it’s life threatening.”
Dismantling AHS “was done for all the wrong reasons,” including making it easier for private operators to function with less oversight.
Data also show Albertans now face longer waits for cancer surgery than they would have a few years ago. In January 2026 only 40 per cent of Albertans who underwent an operation for the five most common cancers did so within the recommended time. That’s down from 52 per cent in January 2022, achieved while hospitals were under tremendous strain from the Omicron wave of COVID. Anesthesiologists say the waits are getting longer because too many specialists from their ranks are being pulled to work in private facilities, where they focus on orthopedic surgeries and cataracts. Kaylene Duttchen, an anesthesiologist in Calgary, wrote in a recent Calgary Herald op-ed that AHS contracts compel her department “to provide staff to for-profit facilities while our quaternary referral centre, which handles the most-complex trauma and cancer cases, has underutilized operating rooms.” Meanwhile, cancer patients wait in a growing queue.
Wait times to see an oncologist or a radiation oncologist, which were previously reported publicly, are no longer being published. Hospital and Surgical Services again did not respond to repeated queries about why this is the case.
Parks says the government’s reorganization of AHS has added barriers in the continuity of care. “Things fall between cracks. There’s different access. It’s delays in care. It’s death by a thousand cuts, because every single step along the way now has breaks in the chain,” he says. “Nobody is taking charge over any of these big pieces right now.”
Similarly, psychiatric care in Alberta hospitals has worsened under the restructuring, Parks says. It’s been problematic for years—in 2024 it took an average of 25 hours to admit psychiatric patients to hospital after being seen in a Calgary emergency department. Recovery Alberta, which now oversees mental health care, says that from January 2025 to November 2025, across the province, it took a median of 20 hours to admit a psychiatric patient to an in-patient bed. But that figure is watered down by a mix of data from large cities and smaller centres. Parks says emergency waits for mental health concerns in cities haven’t improved since mental health care moved over to Recovery Alberta. Patients with severe mental illness who show up in emerg sometimes wait up to seven days for a bed. “They’re often secluded in a secure area where they don’t see daylight,” Parks says. “No one interacts with them. They’re there for days.” He says the waits reflect a shortage of psychiatrists, counsellors and hospital beds. “That’s been a challenge for a long time, but now this refocusing has made it infinitely worse because now there is no workforce plan.”
And mental health services are now split across multiple organizations. Acute Care Alberta oversees the hospitals, but Recovery Alberta operates the psychiatric units in 14 acute care hospitals and four stand-alone psychiatric hospital facilities. Primary Care Alberta handles some mental health care in the community. Assisted Living has taken over some grief-counselling services. Parks says that when a patient with mental health issues is ready to leave hospital but has no community placement or primary care physician, no single organization is responsible for solving that problem.
But care doesn’t happen in the first place if hospitals can’t even open. Emergency department closures in small towns have become routine. Parks says there are times when the ERs in both Hinton and Edson, for example, are closed, leaving a corridor of nearly 400 kilometres, from Jasper to Stony Plain, without emergency care. He knows of a case of a young person in severe asthma distress who arrived at a rural emergency department to find it closed. EMS was unavailable—all units were on long-distance transfers to the city. The patient survived but has permanent disability now.
In Medicine Hat, Parks’s own hospital lost obstetrical on-call coverage for an entire weekend. That’s a major regional centre, serving roughly 300,000 people, without emergency coverage for complex deliveries, twin births and emergency caesarean sections.
On the first day its “refocused AHS” was announced, the Smith government said it would create timely access to primary healthcare practitioners, shorter wait times for surgery and emergency care, consistent access to continuing care, and expanded access to mental health and addiction treatment. Two years in, the evidence isn’t encouraging.
Healthcare providers across Alberta are still trying to figure out how things work under the new system. Parks hears this at town halls and reads it in his inbox and text messages. Nurses who work across the emergency department and in community settings contact him to say they don’t know which organization employs them, or whom to call if they have a problem, or who’s responsible if they identify a patient safety issue. “That sounds insane,” he says. “How is that possible two years in?”
Alberta’s emergency rooms, particularly in Edmonton, are buckling under pressures that veterans of the system say they’ve never seen before. When Braden Manns was in leadership at AHS, an emergency room was considered in crisis when 60 per cent of its beds were occupied by admitted patients waiting for a ward bed. On the day Prashant Sreekumar died in the emerg waiting room at Grey Nuns last winter, 90 per cent of the beds in emergency were filled. Says Manns: “Imagine being that triage nurse, making impossible decisions.”
Following Sreekumar’s death, Acute Care Alberta conducted a speedy review and made 16 recommendations. It is not clear if any have been implemented. In May 2026 the father and the stepmother of 33-year-old Travis Smith came forward to say their son too had died in an Edmonton waiting room, at the Royal Alexandra Hospital.
Manns sees patients affected by delays at multiple points in the system. A workup for a kidney transplant—the process of evaluating donors and recipients—formerly could be completed within three to four months. In Alberta today, he says, it can take over a year. A kidney biopsy, which used to take a week or two, now takes a couple of months because of a lack of day medicine beds.
The public lacks information about what’s happening to their provincial health system, he adds. Many of the Alberta Health or AHS dashboards that used to post data about wait times have disappeared or changed. Parks says the publicly listed wait times for emergency departments do not reflect what emergency physicians are experiencing; one doctor messaged him to say they’d just seen a patient with CTAS 2 acuity, which is urgent, who’d waited 13 hours to be seen. The posted time was closer to five hours. Researchers in Alberta are struggling to access data and information. Spokespeople for the four health pillars typically aren’t forthcoming with answers to questions.
Then there’s the Integration Council, which is supposed to ensure coordination among pillars. It has no publicly available membership list and no public record of having met. A spokesperson for Primary and Preventative Health Services says the council meets “regularly” and includes representatives of the four health delivery pillars and ministry representatives, but wouldn’t provide further details.
The initial estimate for dismantling AHS was $85-million over two years. A government spokesperson said an additional $15-million in new funding was allocated, with the remaining costs to be managed within existing budgets. No revised estimate of costs associated with the reorganization has been released, despite the creation of new agencies and corporations and four separate health ministries.
“Integral to accountability is transparency,” says Lorian Hardcastle. “You can’t hold a government’s feet to the fire if you don’t have information. And we don’t. We don’t have a lot of information on how this reorganization is going.”
Parks has three requests of the people in charge of the four pillars of Alberta healthcare.
The first is transparency: public reporting of important data such as emergency department occupancy; numbers of admitted patients waiting for beds; patients stranded in hospital when they require an alternative level of care elsewhere; and surgical wait times. These data existed before and then disappeared or now appear to be measured differently. The second is accountability: a clear map of who “owns” which problems, with consequences attached when organizations fail to act. The third is a public conversation about the government’s priorities in healthcare, especially with regard to privatization. “This government didn’t run on a lot of what they’re doing in healthcare,” he says. “They said they were going to fix healthcare in 90 days. They were going to invest. It was all about publicly funded healthcare. And now they’re on a totally different trajectory.”
Parks finished five shifts in Medicine Hat the week we first spoke. On one of them, a man came in with chest pain and was seen within 10 minutes. He received clot-busting medication and was on a plane to Calgary for an angiogram within 90 minutes. “When you get into our system, I still believe you receive some of the best care in the world,” he says. “It’s the getting-in part that’s harder and harder.”
Christina Frangou is a Calgary-based freelance journalist with a long-time specialization in health coverage.
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