Ballem completed her undergraduate studies at McGill University and her Masters in Immunology at the University of Western Ontario. She received her medical degree in 1978 from the University of British Columbia, and completed her specialist fellowship at the University of British Columbia as well.
Ballem was Vancouver Mayor Gregor Robertson's top choice to head Vancouver's civil administration, to provide a "fresh start" after coming to power. Vision Vancouver, Mayor Robertson's political party, had concerns that the previous city manager had too much power. Within one week of Gregor Robertson taking office, former Vancouver city manager Judy Rogers, a 25-year veteran of Vancouver City Hall, was replaced by Ballem. Ballem was selected without the government conducting a candidate search. Rogers received $572,000 severance in the transition.
Bylaw powers
In July 2009 Vancouver City Council passed several temporary bylaw changes which were controversial for some civil liberties advocates who argued that they "make it more difficult to exercise fundamental constitutional rights to free speech, peaceful assembly and free expression." As part of the changes Ballem was given special powers that were referred to by Coalition of Progressive Electors councillor Ellen Woodsworth as "wide open carte blanche." Vancouver Mayor Gregor Robertson defended the changes as necessary.
Staff transitions
Ballem was charged by Mayor Robertson with cutting costs at city hall and attempted to do so through a centralization of powers. When asked about senior city staff's concerns about her micromanagement style, Ballem responded, "Tough, eh." In her first 10 months as city manager there were a large number of departures and non-scheduled retirements of city staff. In one such departure Ballem stripped the retiring Vancouver Park Board general manager, Susan Mundick, of all routine transitional duties. Ballem then stated she would help the park board choose Mundick's replacement, a selection process city hall traditionally had not been involved in. In response, Vancouver city councilor Suzanne Anton urged Mayor Robertson and the city council to limit Ballem's control of the park board. On September 1, 2009 Ballem announced that Sadhu Aufochs Johnston would be hired as Deputy City Manager to lead the city's environmental efforts.
Conclusion
On September 15, 2015 Mayor Robertson announced that Ballem's service had "concluded" and Sadhu Aufochs Johnston would be her interim replacement.
eHealth Ontario Scandal
Ballem was paid $30,000 for 78 hours of consulting work for eHealth Ontario, over the objections of an eHealth Ontario employee who claimed there was no signed contract. Ballem stated she was unaware an eHealth Ontario staff member had questioned her invoice, and that she was hired directly by the CEO of eHealth Ontario without a contract. RPO Management Consultants, which Ballem served as a senior advisor, received an untendered $600,000 contract from eHealth Ontario. Sarah Kramer, former CEO of eHealth Ontario, was fired on June 7, 2009 over a scandal involving failing to open more than $5.5 million worth of contracts to competitive bids.
