Quebec Healthcare 2018-19

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Can’t find a doctor? Civil rights lawyer set to take on ‘unfair’ permit system penalizing Montrealers
Julius Grey going to court to challenge how Health Ministry decides where doctors can hang up their shingle
(CBC) Civil rights lawyer Julius Grey is going to court to challenge the way Quebec’s Health Ministry decides where family doctors in the province can hang up their shingle.
Grey says the system the government uses to allocate doctors to work across the province discriminates against patients in Quebec’s largest city.
“The system is regionally unfair,” said Grey. “It produces [an] egregious effect especially unfavourable to Montreal — and to all the population, really — and that is open to challenge.”
[Dr. Mark] Roper says there are regions outside of Montreal where most people are registered with a family doctor, but they’re still being allocated new PREMS — and gaining new doctors. In Montreal, he says, it’s the opposite scenario. Four out of ten Montrealers have no family doctor.
… Grey said he has not yet determined on whose behalf he will file the legal challenge. But Roper says it will be on behalf of “a group of patients and clinics in the Montreal area.”

29 June
Medical clinic in Milton Park closes after more than 40 years of service
Clinique Médicale de la Cité closed on Friday due to problems recruiting doctors
One of the busiest medical clinics in Montreal closed its doors for good on Friday, after more than 40 years of service and leaving behind 40,000 active files.
Clinique Médicale de la Cité, located at the corner of Park Avenue and Léo Pariseau Street, had to close because it was unable to replace retiring doctors.
The clinic opened in 1976, and its closure leaves 12,000 patients without a family doctor.
Radio-Canada reports that five of the 10 family doctors working at la Cité retired, and that they can’t operate without replacing them.
Dr. Mark Roper, head of the primary care division at the McGill University Health Centre, told CBC News that the provincial Health Ministry is not allocating enough permits for doctors to practise on the island of Montreal.

23 February
Long overdue, but still, excellent news
Quebec College of Physicians announces new powers for nurse practitioners
On Friday, the college adopted a resolution that would give nurse practitioners the power to treat common illnesses such as otitis, urinary tract infections as well as the following chronic diseases: diabetes, hypertension, asthma, hypothyroidism, high cholesterol and chronic obstructive pulmonary disease.
The decision comes after Quebec health minister Danielle McCann announced she wanted to give more autonomy to Quebec’s nearly 550 nurse practitioners, also nicknamed “super nurses.”
McCann says the goal is to make it easier for Quebecers to have access to healthcare. The move, she says, will provide more access to people because physicians and nurses will no longer duplicate their efforts.

Who will take care of the caregivers? Cadotte trial brought that question into sharp focus
Experts say details of Cadotte’s case demonstrate the deep cracks in the support system for caregivers in Quebec.
(Montreal Gazette) A 2015 report by the province’s ombudsman detailed how years of government cutbacks have led to a “growing, crying need” to improve the province’s health care system in the face of an aging population. The report described a system plagued by reduced services and home support, the effects of which all trickle down to caregivers.
François Legault’s Coalition Avenir Québec government, elected last year, has promised it is working on the first-ever “national caregiver policy” in the province’s history.
In a 31-page memoir prepared in 2018, the RANQ stressed the “urgent need to act” and called for the policy to provide, among other measures, more support, care services, employment incentives and financial compensation.
“Without caregivers,” the document concluded, “offering quality and accessible care to Quebec’s population is a utopian task.”
The government’s policy is expected to be presented next fall.

2 February
Jonathan Montpetit: How ‘wilful blindness’ was the undoing of engineering giant SNC-Lavalin’s ex-CEO
Pierre Duhaime admits to bit role in ‘biggest case of corruption fraud in Canadian history’
(CBC) …a chastened Duhaime, now 64, leaves a Quebec provincial courtroom, having pleaded guilty to helping a public servant commit a breach of trust.
Fourteen other charges against him were dropped. He was sentenced on the spot to 20 months’ house arrest and 240 hours of community service, and he handed over a $200,000 cheque — a donation to a fund to compensate victims of crime.
With that guilty plea, Duhaime has avoided a much-anticipated courtroom drama — allowing the storied corporation he once led to escape further embarrassment as its new management team continues efforts to clean up its image and win back investors’ confidence.
Yves Boisvert: Il vaut mieux être idiot que bandit
On fera beaucoup de bruit autour de la toute petite peine de Pierre Duhaime, et on n’aura pas tort. Vingt mois d’assignation à domicile pour avoir trempé dans une aussi grosse affaire de corruption, c’est une sorte de blague.
D’autant qu’après 13 mois, il pourra sortir à peu près comme bon lui semble, sauf pour effectuer 240 heures de travaux communautaires.
Oui, il s’en tire bien, question sentence. Mais ce qui est vraiment répugnant dans cet arrangement, c’est qu’il prétend réécrire l’histoire. L’homme, voyez-vous, n’a presque rien fait. Une indiscrétion, une éthique douteuse et un simple aveuglement volontaire…
C’est ainsi que 15 des 16 chefs d’accusation sont passés à la trappe.

2018

17 December
Former MUHC exec to serve 39 months in prison, won’t have to pay back $10M bribe
Arther Porter‘s former right-hand man, Yanaï Elbaz, will not have to pay damages for having received a $10-million bribe when they awarded the contract for the McGill University Health Centre’s so-called superhospital to SNC-Lavalin.
Quebec Court Judge Claude Leblond made his decision on the damages Monday morning. He ruled that a civil court, and not criminal court, is the more appropriate forum for such a matter
In November, Elbaz pleaded guilty to receiving a bribe, breach of trust, conspiring to launder money with Porter and transporting or transferring the proceeds of a crime. He admitted to accepting the bribe from SNC-Lavalin executives to award the contract to build and maintain the MUHC’s so-called superhospital. Over the course of 20 years, the contract, which is still valid, is worth more than $4.6 billion. The figure the MUHC sought was 20 per cent of the contract. A few years ago, the provincial government adopted legislation allowing the victims of such crime to seek 20 per cent of the value of a contract tainted by fraud or bribery.
The $10 million Elbaz received was part of a $30-million bribe arranged by Elbaz with Porter. More than $22 million was paid out before some executives at SNC-Lavalin began to ask questions about a contract through which SNC-Lavalin was paying Sierra Asset Management Inc., a company set up by Porter to launder the money.
10 December
MUHC to run up $8.8-million deficit in 2019: Gfeller
Dr. Pierre Gfeller confirmed that parking losses are contributing to the MUHC’s budget deficit, projected to reach $8.8 million.
Gfeller, who was appointed head of the public hospital network in May, attributed part of the projected deficit to the high cost of certain cancer drugs. However, he also acknowledged for the first time that the MUHC superhospital’s indoor parking lot — which at one point charged the highest parking rates of any hospital in the province — is a financial bust and is contributing to the deficit as well.
Compounding matters is the CAQ’s election promise to cap hospital parking rates to $10 a day. The Glen site parking lot in Notre-Dame-de-Grâce charges $24 after four hours of parking. That’s the same as the Centre hospitalier de l’université de Montréal charges. Those rates are not only the highest in the province, but arguably the highest in Canada.

28 November
MUHC bribery scandal: A timeline of ‘the biggest fraud in Canadian history’
Here is a breakdown of how the conspiracy began and what has happened in Project Lauréat since.

22 October
‘No cuts to health-care system,’ Health Minister Danielle McCann vows
(CBC) After saying she would only cut “to better organize” the health care system, Quebec’s new health minister, Danielle McCann, now says that was a slip of the tongue, and there will be no cuts.
“I know very well that in the system there is a lot of competence. People are ready to give really more efficient services. We have to help them, create the conditions for them to be more efficient,” McCann told Debra Arbec, host of CBC News at 6, in an interview Friday.
“And I’m not talking about cutting services to patients, I’m cutting to better organize, in many ways, the administration … to improve the volume of services to patients.”
Elsewhere in the same interview, McCann told Arbec, “I want to say also for everybody in the network that we will continue, and increase even, our work in terms of efficiency: no cuts in services to patients, but efficiency.”

31 August
Opinion: Needed, a healthier climate in Quebec health institutions
Not enough attention has been paid to the human impact of the Bill 10 administration reform, which has brought enormous stress and malaise.
Dr. Brian Gore
Why have so many of my patients working in health care in the Montreal area experienced a disturbing level of emotional distress? Their stories are compelling and illustrate how deeply our health-care professionals and non-professionals have been affected by outgoing Health Minister Gaétan Barrette’s Bill 10 administrative reform.
A centralized ministerial approach is essential for public health, distribution of medical manpower and services, provincial technological and IT directives and global budgets. However, the attempt to micromanage all aspects of local and regional care has demotivated far too many of our care providers.
It’s up to the next health minister to make amends: Foster the development of local and regional expertise, adapt care to community demographics, allow and encourage local and regional initiatives to address the health and social realities on the ground. Restore in whole, or in part, local governance that rewards the more innovative and productive institutions. Provide them with the resources to serve as advisors to those needing help. Permit our best practices to be seeded across the province.
Ending this atmosphere of malaise that the Barrette reform created must be a priority. We need to re-establish a healthier and more collaborative climate in our health-care institutions. Our care providers deserve better. The time is now to convey this message to whoever the next minister of health in Quebec may be.

24 August
Quebec election: CAQ would replace ‘dreaded’ CHSLDs with senior homes
The CAQ says the new homes would be “warm, peaceful and comfortable” and be adequately staffed to “take good care” of residents.
A Coalition Avenir Québec government would overhaul Quebec’s entire CHSLD nursing home network and replace it with a new series of senior homes.
The CAQ is describing the idea, called the “Maisons des Aînés,” as a “project of a generation.” It estimates the first phase of the project would cost $1 billion, followed by $245 million a year in operating expenses.
The party says the idea is “destined to replace the CHSLDs that everyone dreads,” calling the current model “obsolete, out-of-date and poorly adapted to users’ needs.”
Quebec’s CHSLDs, the government network of nursing homes known as Centres d’hébergement de soins de longue durée, has been criticized by some for poor care and lengthy waits.

9 August
Liberals quietly killed Montreal General expansion in 2014: document
The project was to include a helipad for the Montreal General’s Level 1 trauma centre as well as major renovations to its decrepit ER.
By Aaron Derfel
Health Minister Gaétan Barrette was all smiles when he announced a $300-million expansion of the Montreal General Hospital more than a week ago. … some fear that the latest announcement might be nothing more than a shallow pre-electoral promise, given that a feasibility study must first be conducted before approving the expansion yet again.
Barrette made the announcement two months before the upcoming Oct. 1 provincial election. But two months after winning the last election in 2014, the Liberal government quietly killed a $380-million expansion of the same hospital that had already been approved years earlier, according to a government document obtained by the Montreal Gazette.

6 August
Québec va de l’avant avec l’agrandissement de l’hôpital de Verdun
Cet agrandissement permettra d’« accroître l’espace disponible [à l’hôpital], d’augmenter le nombre de chambres individuelles et de regrouper les soins ambulatoires dans de nouveaux locaux distincts ».
Outre l’ajout d’un nouveau pavillon, au sud des édifices existants, on prévoit rénover certains espaces déjà utilisés pour « constituer des axes de circulation structurants ».
Si le nombre de lits d’hospitalisation demeurera le même, à 244, le nouvel hôpital comptera une proportion de 72 % de chambres individuelles, comparativement à 11 % actuellement.

3 August
Editorial: Protecting the right to English-language health care
There are opportunities for the community to exert leverage within the system. Let’s make the most of them
The outrage heard this week over the downgrading of English on signage at St. Mary’s Hospital is about much more than whether it makes life harder for some patients, though it does. Making the English words smaller than the French — not even required under Bill 101 — struck a nerve at least partly because it seems symptomatic of a broader threat to the community’s rightful acceso s tEnglish-language health and social services.
The provincial government’s Bill 10 administrative reorganization three years ago, which eliminated hospitals’ boards and shifted power to regional umbrella bodies, raised no shortage of red flags as to the possible effects on bilingual institutions, including those founded by and dear to specific communities. Would the new administrators be sensitive to the institutions’ identities and clienteles?
In response to the cry of alarm, a provision was added to Bill 10 allowing the creation of advisory committees to “preserve the cultural, historic, linguistic or local character” of those institutions. But it seems the existence of such a committee for St. Mary’s was a well-kept secret. Not even patient-activists were aware they could take their concerns to it — perhaps because it seems to have existed only on paper.
Such committees are active at institutions grouped under the West Central CIUSSS in Montreal, but are less evident at those in the West Island CIUSSS (which oddly includes St. Mary’s, in Côte-des-Neiges). While the committees do not wield power, the boards of the integrated health centres are obligated to address their recommendations and respond in writing; this at least gets issues on the table and affords some accountability.

14 July
Inégalités dans l’accès à un médecin de famille
(Le Devoir) Près de la moitié des réseaux locaux de service (RLS) du Québec, soit 43 sur 93, atteignent l’objectif de donner un médecin de famille à 85 % de leurs citoyens. Ils n’étaient que 9 en 2014.
La promesse phare du gouvernement libéral en début de mandat rencontre des écueils dans plusieurs RLS où le taux d’inscription a pu reculer ou s’améliorer timidement, comme le montre une cartographie de l’évolution de la situation depuis quatre ans, réalisée par Le Devoir.
Plus de 107 000 Montréalais attendent toujours sur le GAMF qu’on leur attribue un médecin de famille. Les plus bas taux d’inscription au Québec peuvent être observés dans plusieurs RLS montréalais, comme Parc-Extension–Métro–Côte-des-Neiges et Saint-Michel–Saint-Léonard. La RLS faisant meilleure figure, Dorval–Lachine–Lasalle, à tout près de 73 %, reste loin de la cible.
Le président de l’Association des médecins omnipraticiens de Montréal, le Dr Michel Vachon, s’oppose à l’idée de forcer les jeunes médecins à s’installer dans un sous-territoire précis. « C’est précisément la coercition qui a nui à l’attractivité de la médecine de famille ces dernières années », selon lui. En témoignent les 65 postes de résidents en médecine familiale restés vacants cette année.

22 June
Trauma response: Quebec launches helicopter ambulance pilot project
Trauma specialists have long decried the fact Quebec is the only province in Canada without such a program, and Montreal the only urban centre not to have one.
Quebec is using Montreal’s Sacré-Coeur Hospital, which has a heliport and a Level 1 trauma centre, as its receiving centre. The helicopter ambulances will be based at the St-Hubert Airport south of Montreal, and travel to six hospitals in three regions: the Laurentians (Mont-Laurier Hospital, the Rivière-Rouge medical centre and the Laurentians Hospital), Lanaudière (Lanaudière Regional Hospital) and in the central Quebec-Mauricie region (Haut-Saint-Maurice medical centre and the Central Mauricie Hospital). The helicopters will only transport patients between hospitals, and will not be used at the scene of accidents, although that could change if the government decides to use helicopter transport as part of its medical services, following its evaluation of its pilot project.

Jewish General Hospital ER ‘victim of its own success’
Emergency room saw record 85,000 patients last year
Unveiled in 2014, the ER was billed as the largest and most sophisticated of any hospital in Quebec.
Jewish General Hospital unveils new ER
That reputation, and the results it’s getting, are leading patients from around Montreal and beyond to opt for the Jewish General’s emergency services over hospitals closer to home, making it the busiest ER in Quebec. (May 2016)
Not-so-super clinics in Quebec?
Wait times in the province’s emergency rooms have been called the worst in the western world. Because doctors need to sign off on so much, and most clinics aren’t open evenings or weekends, patients often have few other options than to go to the ER for care.
The perpetual clog of Quebec’s emergency rooms might be due to red tape, says the Parti Quebecois. “I will give you a very simple example: audiologists, you know, they have a master’s degree — five years, and they are not allowed to wash ears,” said PQ Health Critic Diane Lamarre. (3 May 2017)

1 April
Quebec’s super clinics and their side-effects
A 2014 election promise touted a solution to ER overcrowding: the creation of 50 super clinics. But the 31 inaugurated so far are ‘all smoke and mirrors,’ critics say
“For the first time in history — and it’s never been seen before — there is a reduction in the number of patients presenting to the ER,” Barrette said on Feb. 23 in Côte-des-Neiges without providing any figures to back up that assertion.
Less than two weeks later in Pointe-Claire, Barrette predicted that the Stillview super clinic will attract 40,000 walk-in patients per year. “This is a very, very significant milestone,” he added in what sounded like a pre-electoral speech.
But a close examination of the super clinics raises questions about many of Barrette’s claims, chief among them, that the minister is fulfilling a 2014 election promise to “create” 50 super clinics by the end of this year. In fact, the Montreal Gazette has confirmed that every one of the 31 super clinics announced to date was long-established as a family medicine group, and all were already open seven days a week before Barrette rechristened them.
Dr. Mark Roper, chief physician of the Queen Elizabeth super clinic in Notre-Dame-de-Grâce, acknowledged the difficulties in being able to treat all walk-ins despite hiring two more nurses. The clinic extended its weekend hours on Sept. 11, 2017.
“Some mornings we have 100 patients registered by noon,” he said. “We try to avoid closing early but when you have 80 people waiting, it’s a dangerous situation.”

15 March
It’s Time to End Med School Quotas
Viewpoint explaining how government control over access to medical training hurts patients
(Montreal Economic Institute) Quebec’s Health Minister announced a reduction in the number of medical school admissions last year in order to keep doctors from ending up unemployed in the future. And yet, one in five Quebecers still does not have a family doctor, and proportionally, Quebec has fewer doctors than most industrialized countries. Is this government control over access to medical training the best way to meet Quebecers’ health care needs?

7 March
American readers of Newsweek must think this is a satirical piece:
500 Canadian Doctors Protest Pay Raises Because They Already Make Too Much Money

26 February
More than 200 Quebec doctors come out against proposed pay increases
(Global) At least 200 doctors and residents in Quebec are asking the provincial government to backtrack on plans to give them and other physicians substantial pay hikes.
In an open letter with the Médecins québécois pour le régime public (MQRP), they say the increases are particularly shocking given that other health-care workers such as nurses and clerks face difficult working conditions.
The letter, which was signed by general practitioners, specialists and residents, comes at a time when many nurses are complaining about excessive workloads.
Isabelle Leblanc, president of the group behind the letter, said nurses, orderlies and other employees in the health-care system are working under awful conditions.
“There’s only a specific amount of money and not more, and the more you give to the physicians, the less you give to workers or to improve access (to the system).”

17 February
Doctors need to play a bigger role in improving medical system: QMA president
In an open letter published on Friday, the president of of the Québec Medical Association said he’s now embarrassed to tell people he’s a doctor.
(Montreal Gazette) [Dr. Hugo] Viens said doctors need to be more involved in improving the health-care system and he worries the associations that represent doctors in their negotiations with the government have become too focused on winning bigger salaries.
“We’ve not been doing what we should have been doing,” he said in an interview. “We should work at curing the system, helping the system get better and not just keep using the system to make our money.”
With health-care costs rising, Viens said he’s worried about how much of the provincial budget will be “left for education and what kind of (health care) system we’re going to be left with in 10 years, 15 years, if we continue spending and asking and not trying to see how we can do things better.”
Part of the problem, he said, is in other provinces the provincial medical association negotiates with the government on behalf of doctors. In Quebec, the QMA, which has 10,000 members, is a voluntary organization and two unions — one representing general practitioners, the other representing specialists — negotiate with the government.
This situation has made it harder for doctors to work with the government to “try and find strategies that would solve many of the issues and control expenses.”
The recent announcements medical specialists, who are already highly paid, are getting further increases could also damage the relationship between doctors and nurses, many of whom have to work mandatory double shifts.

16 February
Quebec says deal with medical specialists will allow it to save $3B by 2023
Treasury Board President Pierre Arcand calls 8-year deal ‘reasonable, under the circumstances’
The Quebec government is defending the confidential deal it struck with medical specialists earlier this week, saying the province will save billions over the next five years even as it pays out money owed to specialists.
Quebec revealed the details of its agreement with the federation of specialists Friday.
Under the eight-year deal, which is retroactive to 2015, Quebec medical specialists get an annual salary increase of 1.4 per cent until 2023.
Quebec specialists earn $36K more than those in Ontario, with another raise on the way
The agreement also honours a contract that was signed in 2007 between the province and the federation, which was meant to close the gap between specialists’ salaries and those of their counterparts in Ontario.
The Quebec government has been withholding some of the money the 10,000 specialists are still owed under that deal.
Under the agreement, a pay equity clause under which specialists were entitled to the same annual increase as other public sector workers has been abolished, for savings of $1.4 billion

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