Quebec Healthcare October 2022-

Dr. Mark Roper (posted on Facebook)
The RLS sub-region of Faubourgs – Plateau-Mont-Royal – St-Louis-du-Parc (632) is a unique medical region in Quebec. The worst rate of registration with a family doctor in the province is 60%. This is far from the Quebecois average of 79% and the best sub-region, Charlevoix has 92%. With a total population of 166,866 inhabitants, 67,012 citizens are orphans. Despite this serious situation, the MSSS calculates that there is a surplus of front-line family doctors in the territory of 21 full-time doctors.
Their calculations are simplistic. One family doctor on the front line for every 1,500 inhabitants translates needs 111 doctors, with is 132 is in place. But absent from the calculation is the effect of portability. Doctors in the territory have registered 67,004 Quebecers who do not live in the territory
It is surprising that businessmen like Mr. Legault and Mr. Dubé chose to follow the simplistic calculations of his MSSS. Mr. Legault considers that the doctors of the region do not work hard. His minister Mr Dubé follow the same logic and transfer the doctors to the 450 regions. For us, portability is a measure of water quality.
Speaking of the large regions, the population of Montreal has the worst registration rate with a family doctor in Quebec at 68%, far from the best region, Lac St Jean at 92%. There are more than 600,000 orphan Montrealers. Despite this situation, 382,954 patients from other regions are registered with family doctors in Montreal. If Montreal’s family doctors only saw its own residents, there would be an 86% enrolment rate.
At present the percentage of orphans in Montreal and several sub-regions is increasing. Montrealers without a family doctor (and doctors about to retire) are stuck with three options:
• Do without a family doctor and see an occasional walk-in clinic,
o It does little to address the complex needs of primary care and has poorer outcomes
• Go into the rapidly growing private sector
o The current rate is $3,000-5,000 per year for three visits and a blood test.
o It’s hard to swallow when your tax dollars are spent to provide health care to your fellow citizens in the 22 regions where enrollment rates are over 90%.
• Stop healthcare portability.
o It won’t be long before people in the regions insist that doctors in their area prioritize locals and send other patients back to their local areas where there is less shortage.
o This is a challenge because it is a core tenet of our health care system that encroaches on the doctor-patient relationship.
o There is no effort made by the government or surrounding areas to repatriate these patients despite the allocation of doctors for them in their areas.
To find the situation in your territory go to Where are the Family Doctors? (where-is-my-doctor.com)

23 May
Quebec has lost nearly 21,000 health workers in less than two years
Aaron Derfel
Quebec Health Minister Christian Dubé’s spokesperson said the government hopes that with its proposed reform of the health system, known as Bill 15, it will be able to hire and retain more workers
The departure of so many workers in so short a period of time is placing Quebec’s health-care system under tremendous pressure, forcing hospitals to close 2,000 beds across the province and leading to record emergency-room overcrowding, as well as a growing backlog in year-long elective surgeries at the McGill University Health Centre.
On July 3, 2021, the government employed a total of 349,582 workers in the health and social services system. By April 22, that number had dropped by 20,823, or about six per cent. Most of the workers who quit the system were nurses. Their ranks plummeted from 68,078 to 62,821 — a net loss of 5,257 nurses.

19 May
After dreams crushed by Quebec’s controversial nursing exam, this candidate is ready to quit
An investigation by Quebec’s commissioner of professions, André Gariépy, concluded that there were major problems with the September exam.
“The reliability level of the questions in the exam is pretty minimal, and for a high-stakes exam like this one, it should be much higher,” he said
The report also concluded that the passing grade had been raised — from 50 to 55 per cent — without justification.
Gariépy said if the order had maintained the previous mark, more than 500 nursing students who failed would have passed.
Last week, OIIQ announced it is revising the exam in light of Gariépy’s report. The OIIQ said it will now rely on the National Council Licensure Examination for Registered Nurses (NCLEX-RN) as an assessment tool starting early next year.
Nearly all regulatory agencies in the United States and Canada use the NCLEX-RN, and it has been around since 1994, the OIIQ notes. It has tested over six million people, making it a proven measurement tool, the order said.

16 May
Must be on waiting list for GP
Primary Care Access Point offers relief for ‘orphan’ patients, says Dr. Roper
Roper said the provincial health ministry has set up a new program, the Primary Care Access Point, to help people without a family doctor obtain a medical consultation or a health service.
Westmount Independent
In order to benefit from the program, a person must be on the waiting list for a family doctor, or be currently under the care of a group of doctors. Roper said the Primary Care Access Point makes it possible for those without a family doctor to have a single visit with a doctor just to regulate an immediate medical issue or to renew a prescription.
He said doctors in the community were asked by the health ministry to pitch in and help with the program.
“It’s a stopgap measure until the system changes and we’re able to freely recruit family doctors,” he said.
Regarding the provincial government’s latest reform of the public health care system, which proposes to place the existing
network of regional CISSS and CIUSSS agencies under a single agency known as Santé Québec, he said he was not optimistic.
The Primary Care Access Point can be found on the web at the following address: https://gap.soinsvirtuels.gouv.qc.ca/en

9 May
Quebec health-network reform an ‘undeniable risk’ to care, union says
Increasing the mobility of health-care staff to work anywhere in the network could leave some regions understaffed, the union warns.
A proposed reform of Quebec’s health-care system tabled by provincial Health Minister Christian Dubé poses an “undeniable risk” to the maintenance of care, according to the Fédération interprofessionnelle de la santé
The FIQ, which represents 80,000 nurses and other health-care workers, has concerns about the maintenance of health care, partially based on the mobility offered in Bill 15.

1-3 May
Analysis: The unspoken crisis for ‘nos bâtisseurs’ in Quebec’s ERs
“Nobody wants to talk about the way the elderly are treated in ERs,” said a veteran Montreal nurse. “Absolutely, they’re suffering. And nothing is being done about it.”
Aaron Derfel
Far more than any other demographic group in Quebec, it’s the elderly — specifically those over the age of 75 — who are bearing the brunt of the province’s emergency-room crisis. And newly compiled Health Ministry statistics reveal the situation is getting worse for “nos bâtisseurs” — the endearment given in Quebec to our elders.
On Monday, the government announced a “home hospitalization program” … Those pilot projects are an expanded form of home care designed to cut down on the number of ER visits.
Such initiatives are no doubt helpful. But given the fact that Quebec hospitals have had to close 2,000 beds because of a shortage of nurses and that some doctors are quitting ERs, there is no short-term fix for the province’s ER crisis.
Home hospitalization program announced for Montreal, Quebec City areas
The initiative is part of the province’s effort to free up hospital beds.
The eight targeted regions are expected to be able to provide the service to patients by 2024, said Sonia Bélanger, the junior health minister responsible for seniors. If their condition allows it, patients who wish to do so can continue their treatment at home under the supervision of a medical team.
Thanks to remote connections, medical personnel can follow the condition of an at-home patient from a distance. Generally, a patient will be given an iPad linked wirelessly to sensors measuring blood pressure, heart rate, blood sugar and other indicators.

18 April
Ethics case dropped against Lachine Hospital physician: ‘It’s a big relief’
A Montreal leading physician is feeling relieved that he can continue speaking his mind about shortcomings in the health care system. The Quebec college of physicians has vindicated Dr. Paul Saba after complaints were brought against him by the McGill University Health Centre. The family doctor says he hopes the decision will encourage others to act as whistleblowers.
Dr. Saba has steadfastly defended his position and continues to vehemently defend community hospitals and local access to health care services.
“I have nothing but positive things to speak about the MUHC. I believe it was a bad decision on their part to have brought these allegations,” Dr. Saba said.
He says the decision by the College of Physicians should help other doctors or front-line health care workers to publicly speak out when they feel bad decisions are being made by health care administrators.

14 April
Group demanding action on reduction of services at Lachine hospital
The Save the Lachine Hospital Committee, a group formed by Dr. Paul Saba, is demanding action to address concerns about the Lachine Community Hospital.
“We need to reopen our emergency room 24/7, we will save lives by doing that,” Dr. Saba said. “The MUHC has a responsibility to save and secure the population on the West Island.”
The reduction of services at the hospital have been ongoing since October 2021, and in February of this year, the McGill University Health Centre (MUHC), announced ambulances in Lachine would be redirected to other health centres and ER operations would be reduced to 14 hours a day.

22 March
Quebec budget highlights
Cash for health care and seniors
Quebec will get an additional $4.7 billion in federal health funding over the next five years…. Of that, $3 billion will be used to improve health care, with almost half of that being used to expand new approaches developed amid the pandemic.
The government said it will make permanent the vaccination and testing clinics developed for COVID-19, extending their scope in a bid to relieve the hospital system. They will, for example, offer other types of vaccines and draw blood for testing.
In addition, $2 billion will be used to improve the lives of seniors and caregivers, increasing home-support services and access to adapted housing.
Another $565 million will go to support vulnerable Quebecers, with just over one-third of it going to increase mental health, homelessness, and addiction services.

25 February
MUHC mulls refocusing care at Lachine Hospital
Dr. Paul Saba, who practices family medicine at the hospital, worries the hospital will no longer serve the community.
Saba says there is enough medical personnel to keep the hospital a fully functioning community hospital, and that scaling back services would hurt people in need of care — whether in Lachine, the West Island or other parts of Montreal.

Aaron Derfel: Pandemic caused extra surgical backlog of at least 46,000 cases in Quebec
As of Jan. 28, nearly 162,000 patients were waiting for elective surgery, according to the latest Health Ministry figures.
Last March, [Health minister Christian] Dubé announced what he called a “refondation” or major reform of the health system, allowing for the private sector to play a greater role in the delivery of medical services. He noted at the time that more than 100,000 day surgeries had been carried out in private clinics in the previous two years. Those operations were all covered under medicare.
But Radio-Canada reported on Tuesday that the government refused to grant 15 permits in the past 18 months to private surgical clinics in the Laurentians, raising concerns the backlog may grow even bigger.

Hanes: Doctor has job offers in Montreal, but is blocked by ‘rigid’ permit system
Quebec’s PREM process not only undermines efforts to recruit doctors, it is actively driving some away from the province.
If a doctor were to work in Montreal without a PREM, he would take a 30 per cent hit when he bills RAMQ. He would also be barred from reapplying for a PREM for five years and be denied hospital privileges.
Short for Plans régionaux d’effectifs médicaux, these are permits that dictate where physicians can practise in Quebec, not to be confused with the medical licences granted by the Collège des médecins authorizing them to work.
Getting one is an extra hoop to jump through for new medical school graduates and physicians who want to come here from outside Quebec. Without one, doctors face penalties and restrictions — although they are allowed to work in the private system.

14 February
‘A bad decision that’s going to cost lives’: Health-care workers protest cutbacks at Lachine Hospital
As of Tuesday night, the Lachine Hospital in Montreal will no longer accept ambulances, instead redirecting them to other facilities. Walk-in patients will have access to an ER doctor until 10 p.m., and only for the next two weeks – as of March 1, the hospital with have no more emergency room doctors.
“We need hospitals that are close to the community. Is this a question of, ‘Is this to take our resources and transfer them downtown? Let them fix their own problems,'” [Dr. Paul Saba] said.

9 February
Opinion: This isn’t how to solve Quebec’s nursing shortage
We are sounding the alarm regarding a recent measure that will severely affect the future of nursing in our province.
Sydney Wasserman and Enora Ledieu
The Ministry of Health and Social Services negotiated in the latest contract that all new nurses who received their licences after Dec. 12, 2022, regardless of education level, will start at the lowest pay scale, echelon 1. For decades, new nurses who graduated with university degrees started their careers at a minimum of echelon 7, reflective of their higher education. This is a $6.44/hr difference, which adds up to $515.20 over a two week pay period, close to a 20-per-cent decrease in pay.
Nurses will leave Quebec. Since this announcement, many of our graduating nurse colleagues have expressed their intent to leave Quebec for jurisdictions where salaries, working conditions and government support are significantly better. Increasingly, nurses are already being driven out of the health-care system into private agencies, other provinces, or out of the profession of nursing completely. This salary decrease exacerbates an already dire situation.

Santa Cabrini pilot project to be extended to all Quebec hospitals
Staffed kiosks in entryway reduce pressure on ER by redirecting non-urgent cases to other services.
Quebecers have the right to be seen at the hospital of their choice, and emergency departments will not refuse to see a patient if their needs are not urgent. But the waits can be long, and non-urgent patients do slow down the functioning of emergency rooms, so the Health Ministry mandated the CIUSSS de l’Est-de-l’Île-de-Montréal — the health authority responsible for Santa Cabrini and Maisonneuve-Rosemont hospitals — to explore the concept of an onsite ER kiosk for referrals to other points of service.

20 January
Quebec health minister apologizes for end-of-life care for Robert Bourassa’s widow at St. Mary’s Hospital
Regional health board vows to investigate Andrée Simard’s treatment after family goes public with complaint
The family’s description of Andrée Simard’s treatment prompted Quebec Health Minister Christian Dubé to offer them his apologies “in my name and that of the network,” while the minister responsible for end-of-life care, Sonia Bélanger, said the responsible health board must “review practices at St. Mary’s Hospital so that a situation like this one never happens again.”
Simard, the widow of former premier Robert Bourassa, died last November, several days after being admitted to the hospital in Montreal’s west end.
Soon after Simard was admitted, it became clear she was going to die, Bourassa said in a lengthy letter to the hospital administration which she shared with the French newspaper, La Presse.
Denied a transfer to the palliative care unit, every request by the family to get appropriate care for Simard in her final hours turned into a pitched battle, Bourassa said.

2022

29 December
With viruses overwhelming Montreal ERs, ‘we’ve had to virtually create space’
The associate chief of the emergency departments at the Royal Victoria and Montreal General hospitals said he thinks it’s the worst December he has seen.
A combination of three viruses and a shortage of staff have conspired to make this one of the most difficult Decembers in memory at hospital emergency rooms across Quebec.

5 December
What’s gone wrong: More than 800,000 Quebecers wait for family doctor
Four years ago, the CAQ promised a family doctor for every Quebecer, but in the last election campaign, it had to admit that wouldn’t be possible, which has left many people feeling lost in the system.
The head of the Primary Care Division at the MUHC, Dr. Mark Roper, says a full-time family doctor will make more than 2,000 diagnoses per year, everything from high cholesterol, to hypertension, to diabetes. By catching conditions and illnesses early, family doctors can prevent life-threatening complications such as stroke and heart attack, he said.
“For every 100,000 people who do not have a family doctor, we observe an increased mortality of 60 per year,” he said, adding that would mean 360 Montrealers die each year because of lack of access to a family physician.

1 December
Quebec health minister asks nurses to come back to help struggling health-care system
He is calling on nurses to come and help out at busy Info-Santé 811 phone line, which received around 10,000 calls on Wednesday.
Quebec needs more nurses to help answer 811 calls, health minister says
As pediatric emergency rooms continue to deal with unprecedented levels of sick children, family doctors and clinics are also overcrowded and overwhelmed. Many parents are exhausted just looking for someone to call and a place to bring their sick child.
During question period, Liberal health critic André Fortin criticized Dubé for his poor results and said emergency rooms are overflowing.
“In Repentigny this morning, Madame Speaker, it’s 181-per cent occupancy in the emergency room,” he said. “In Sorel, 194 per cent. In Buckingham, 208 per cent and in Mont-Laurier, 300-per cent occupancy in the emergency room.”
Fortin said that every day, up to 1,500 Quebecers leave a hospital emergency room without seeing a doctor.

23 November
Quebecers say it’s time for a mixed health care system. They’re right!
Beryl Wajsman
We’ll give the Premier this. During the campaign he made statements that the health care system would start looking at private sector assets to help the public sector. It’s now time to put the words into reality.
M. Legault, on almost any issue, makes clear that his decisions will be based on “social acceptability.” Well now he’s got it. And he needs it.
An Ipsos/MEI poll last week demonstrated that 73% of Quebecers support the adoption of a mixed health care system as exists in France and Sweden. Throughout Canada, 64% have come to that acceptance.
“If Canadians still worry about the excesses of the American system, they are ready to experiment with mixed models like those of France and Sweden,” says Emmanuelle B. Faubert, economist at the MEI. “In the Quebec context, this shows that there is a clear mandate for the CAQ’s independent mini-hospitals project.”
Events since the election have proven why. With the government still not being able to deliver on its goal of more health care at home, even paediatric emergency rooms have exceeded capacity. And this is not because of Covid. But a respiratory virus that happens often this time of year. It’s gotten so bad through the system generally that just this week Federal Health Minister Duclos announced the release of an emergency $270 million worth of health care transfers to Quebec.

20 November
Quebec parents struggle to get children’s antibiotics amid nationwide shortage
Respiratory illnesses in children are lasting longer than usual, says infectious disease specialist
Canada is seeing a nationwide shortage of antibiotics and children’s pain and fever medication as respiratory illnesses among young patients surge.
Amoxicillin — a first-line antibiotic used to treat bacterial infections in children — is on back-order in Quebec. It’s also used in Clavulin, which is in short supply.
Shortage of ‘first-line’ antibiotic hits as surge in children’s respiratory illnesses strains supply (7 Nov.)

14 November
Quebec’s college of physicians is urging people to wear masks in public as hospitals are battling a trio of respiratory viruses that are filling up emergency rooms.
The order is recommending masks be worn on a “voluntary and preventive basis” in public places, crowded private spaces and on public transit.
It says hospitals are facing a “triple threat” of viruses – COVID-19, influenza and respiratory syncytial virus, or RSV.
A report by the Canadian government for the week ending Nov. 5 found that levels of influenza and RSV across the country are higher than expected for this time of year.
Health Minister Christian Dube has formed a crisis group to try and reduce overcrowding at hospital emergency rooms across Quebec.

13 October
Allison Hanes: Montreal’s ER crisis is being made worse by new policy, doctor says
It’s intended to lessen pressure on ERs, but may be having the opposite effect in some cases, prolonging the stay of elderly patients in hospital wards.
A dearth of family doctors, a shortage of medical staff in hospitals, too few beds, an aging population with increasingly complex problems, a resurgence in contagious viruses besides COVID-19, and pent-up need from patients who were unable or unwilling to seek care for minor ailments due to the risks of the pandemic are all taking a serious toll on the fragile health-care system.
Noémie Vanheuverzwijn, a spokesperson for the Health Ministry, confirmed a new protocol was put in place last month aimed at freeing up hospital beds and helping clear emergency rooms, where patients line the corridors waiting to be admitted.
“Considering the progression of short-term bed occupancy by a clientele requiring an alternative level of care in the Montreal region, a specific accompaniment by a ministerial team has been in place since September to co-ordinate all the best practices required on the island of Montreal,” she said.
The change is part of a greater push to send patients home with support while they await openings in long-term care facilities or other transitional care.

Immigration regularization needed for the sake of public health
Status for all is an effective solution to the failures of immigration policy and the negative health impacts it has had on my neighbours.
(Montreal Gazette Opinion) As a public health nurse, I see every day how important access to health care is in stopping contagion and improving health equity. But as a resident of Parc-Extension, I see that many of my neighbours cannot access vital health care, simply because of their immigration status. That is why I am adding my voice to those of almost 1,000 health-care workers and health organizations from across Canada who have signed an open letter calling on Prime Minister Justin Trudeau to develop a comprehensive and inclusive immigration regularization program granting status to all migrants currently living in Canada. We are also calling on provinces to ensure universal access to health care for uninsured patients.
Sasha Dyck, RN, serves on the board of the local tenant advocacy group and is a cofounder of Park Extension Mutual Aid and a member of the Healthcare for All Network.