Quebec Healthcare 2018-June 2020

coronavirus COVID-19

Montreal ERs are near capacity with delayed health problems, a worrying sign as second wave looms
The people flocking to the city’s emergency rooms don’t have COVID-19, for the most part, but they have an accumulation of months’ worth of other problems—while staff is still short.
The MUHC, the Lakeshore and the Royal Victoria are all running at or close to capacity today. … Another big problem are the 5,000 workers who are still off the job, either because they are recovering from COVID-19 or as a preventative measure.

25 June
Canada Among Worst Countries For Care Home COVID-19 Deaths: Study
Long-term care residents made up 81% of all reported coronavirus fatalities.
(HuffPost) The analysis released Thursday by the Canadian Institute for Health Information (CIHI) provides a damning snapshot of senior care as of May 25, when LTC residents made up 81 per cent of all reported COVID-19 deaths in the country compared to an average of 42 per cent among all countries studied. The data compares Canada’s record to that of 16 other countries in the Organisation for Economic Co-operation and Development (OECD). The proportion of LTC deaths ranged from less than 10 per cent in Slovenia and Hungary to 31 per cent in the United States to 66 per cent in Spain.

10 June
Feds will continue to help Quebec manage long-term care facilities through end of summer
The federal government says it will continue helping Quebec manage COVID-19 outbreaks in the province’s long-term care homes until the end of the summer, but what that help will look like remains unclear.
Quebec Premier Francois Legault had asked Ottawa to keep hundreds of soldiers deployed in the hard-hit seniors’ residences until mid-September, when 10,000 newly trained orderlies are expected to begin working in the facilities.
Public Security Minister Bill Blair told the House of Commons Wednesday that federal assistance could take various forms, including the involvement of the Canadian Red Cross.

5 June
Quebec is facing a ‘disaster’ in cancer care, experts warn
Aaron Derfel
Three months into the COVID-19 pandemic, Quebec is facing an unprecedented crisis in cancer care, with thousands of people walking around with malignancies that have gone undiagnosed and a potential backlog of about 24,000 oncology surgeries can no longer be delayed, experts in the field warn.
The latest figures released by the Quebec Health Ministry paint a disturbing portrait of the situation, with 30 per cent of chemotherapy and radiotherapy sessions still not available. What’s more, the overall backlog in elective surgeries has grown from 68,000 — a figure Health Minister Danielle McCann cited last month — to more than 72,000 as of this week.
The decision to postpone cancer diagnoses and surgeries means Quebec faces a monumental challenge in ramping back up those activities in the context of the highly contagious coronavirus and with many hospital nurses already exhausted from having to care for patients in CHSLDs while on temporary reassignment.

15 May
Premier mulls complete overhaul of Quebec’s long-term care institutions
Short-staffing at CHSLDs still an issue as COVID-19 cases continue to rise, says François Legault
Of the 3,401 people who have died of COVID-19 in Quebec to date, more than 2,000 were residents of long-term care homes.
There have been calamitous outbreaks at both public and private CHSLDs, but some of the worst have been at privately operated facilities, including four long-term care homes run by Vigi Santé.
Quebec’s new contact-tracing system panned by expert as ‘very outdated’
The new system, developed by Quebec company, relies on email chain to investigate virus spread
(CBC) Contact tracing, a public health practice to help stop the spread of infectious diseases, involves identifying every individual who has come into contact with an infected person. Canada’s chief public health officer has called it an “absolutely critical” tool to contain the spread of COVID-19.
A new digital platform to automate the tracing process was supposed to be delivered to the province three weeks ago, Quebec Public Health Director Dr. Horacio Arruda said earlier this month.
That platform, designed by the Quebec company Akinox, is now set to arrive later this week, but it’s not clear even once it is up and running how well it will help track and curb the spread of the disease.

13 May
Quebec does not have enough masks to provide for everyone, says Legault
Even if Quebec wanted to render the wearing of masks obligatory, it’s not clear the province could actually come up with enough of them to make it happen, Premier François Legault said Wednesday.
But Quebec is actively seeking supplies and will try and help Montreal get the masks it needs for the public transit system.
“Quality masks have to be available before we can even think of making them obligatory,” Legault said at his pandemic briefing. “We have a team on this. We’re working hard.

8 May
Quebec gets a pandemic reality check as confusion reigns
It’s important to understand the scale of what’s happening in Quebec, especially the Montreal region. It’s a completely different pandemic than in the rest of the country. In fact, it’s no stretch to say that Quebec’s COVID-19 problem is now solidly world class.
By Alan Freeman and Samuel Freeman.
(iPolitics) As Quebec struggles to control an expanding epidemic that is sweeping through Montreal neighbourhoods and threatens to overwhelm the city’s hospitals, the Legault government has embarked on an aggressive reopening of shops, schools, daycare centres and the economy, combined with a major relaxation of measures designed to stop the spread of the virus among the elderly in care homes.
This dual strategy, a dangerous venture to begin with, has been executed with a frightening lack of scientific justification and advanced planning. The government has backtracked on some measures several times over the last week, and ministers have given to saying one thing one day and the opposite the next. On May 7, Premier François Legault was forced to postpone plans to open stores, schools and daycare centres in Montreal until May 25. He had earlier delayed store openings by a week.
… In other provinces, some of them reporting zero or a couple of new cases a day, authorities are treading very carefully when it comes to reopening the economy and schools, fearful of any misstep. In Quebec, the government has voiced no such fears of moving boldly, as Legault’s team demonstrates a willingness to overlook inconvenient facts.

6 May
Coronavirus: 12 children, four employees infected at Mascouche daycare
The daycare centre — an emergency childcare service for essential workers in Mascouche — was closed on Monday, Dr. Richard Lessard said in a virtual news conference on Wednesday. The first case was confirmed on April 30. The children have been in quarantine at home since then. “We can expect more outbreaks in other daycares,” Lessard warned.

5 May
There must be a long-term overhaul of the CHLSDs and private seniors residences
Mysterious inflammatory syndrome in children potentially linked to COVID-19 reported in Montreal
As Quebec prepares to reopen schools, doctors are poring over 15-20 cases of children with what seems to be the same illnesses reported in U.S. and Europe
It began in Europe about two months ago, has spread to cities along the U.S. east coast and is now being reported in Montreal: clusters of a rare and mysterious illness in children that may be linked to COVID-19.
The latest alert comes from New York City’s health department, which, on Monday, reported 15 cases of children ages two to 15 arriving in city hospitals with “multi-system inflammatory syndrome.”

3 May
Le déclin de l’empire québécois
Alexandre Poulin, Jérôme Blanchet-Gravel et Claude Simard Respectivement auteur, journaliste et essayiste, et professeur retraité de l’Université Laval
(La Presse) Avec la pandémie et la mise sur pause du Québec qui s’en est suivie, la société québécoise croyait avoir conservé la solidarité qui l’avait souvent servie à travers son histoire. La maladie et le ralentissement de l’économie devaient faire ressurgir les vertus de l’altruisme dans un monde rongé par l’individualisme.
Malgré les beaux gestes d’entraide et de solidarité observés ici et là tous les jours, force est de constater que le Québec n’aura pas été à la hauteur de sa bonté légendaire. S’est plutôt révélée une société aussi socialement et moralement abîmée que les autres sociétés occidentales.

13 April
COVID-19 in Quebec: Province to send inspectors to check every long-term care home
Quebec will inspect every long-term care residence in the province, public and private, to ensure conditions are acceptable, Premier François Legault said at his daily briefing Monday.
With Quebec’s minister responsible for seniors, Marguerite Blais, at his side, Legault softened the tough stand he took over the weekend toward private seniors’ residences, noting that Health Ministry inspectors have found that most are well-run.
He acknowledged that even before the crisis, there was a shortage of health-care support workers in chronic-care institutions.
Legault said inspections have been completed at all 40 private, independent CHSLDs — the French acronym for residential institutions for people in need of a high level of care. He said residents are well-treated at the majority of them, but four or five of those 40 residences will be monitored more closely.

11 April
André Picard: Seniors’ care shouldn’t be a horror show, even when the pandemic is over
The challenge – no, the moral imperative – now is not just get through the pandemic without much more carnage, but to deal with these issues permanently.
How is it possible that, in 2020, in Canada, that elders entrusted to a licensed care home can be treated worse than dogs at the city pound?
How is it conceivable that vulnerable seniors – some with dementia and severe mobility issues – could be left to fend for themselves?
And how can the managers of a corporation that boasts about offering its clients “luxury, comfort, convenience, security” be so crass that they would try to cover up the debacle?
Hundreds of nursing homes and seniors’ residences across Canada have been hit by outbreaks of coronavirus, often with deadly consequences.
There is no lack of work in nursing homes and long-term care. In fact, there are dire personnel shortages. But many employers refuse to offer full-time work so they can avoid paying benefits. This forces staff, especially low-wage ones like personal support workers, to juggle shifts at various locations.
COVID-19 is a disaster in seniors’ residences. But, more than anything else, it has exposed a crisis that already existed – a crisis of neglect for our elders.

Legault said he’s focused on getting through the coronavirus crisis for now, but said when it’s done, the province will review every aspect of its seniors’ residences, whether they be private or public.
La bataille s’intensifie dans les CHSLD
(Le Devoir) L’épidémiologiste spécialisé en vieillissement a plus d’une idée pour stopper la progression du coronavirus dans les CHLSD et les RPA : « recruter, intégrer des gens qui ont fourni leurs candidatures jusqu’à maintenant, généreusement », « réorganiser le travail et les procédures de soins pour diminuer le nombre de contacts », « interdire le travail sur plus d’une unité ou plus d’un établissement », « [accroître] le nombre de dépistages de la COVID auprès des usagers et du personnel », « mettre en place une équipe d’experts en épidémiologie pour faire des investigations ciblées dans les milieux de vie touchés par le virus et augmenter le soutien à la formation du personnel en prévention et contrôle des infections »…
« Ce sont là le début d’une série de mesures », a prévenu le Dr Nguyen, aux côtés des ministres McCann et Blais.
Quebec takes charge of seniors’ home after reports of death, unhygienic conditions
(CTV) With COVID-19 outbreaks present in over 150 of Quebec’s long-term care facilities, the provincial government rolled out a new prevention plan for seniors’ residences on Friday.
[Quebec Health Minister Danielle] McCann and [Minister Responsible for Seniors and Caregivers Marguerite] Blais introduced a new team of experts, which will be led by physician Quoc Dinh Nguyen, a geriatric internist who specializes in the epidemiology of aging.
The trio described an action plan that they said will be aggressively deployed in long-term care centres and private seniors’ residences.
The team will be tasked with monitoring the situation in those facilities in real time, in order to react more quickly in environments where COVID-19 has spread.
In a statement, the government described several measures that will be taken to keep seniors in long-term care safe.
The new measures include reallocating staff to facilities that need them, with a goal of limiting the number of people coming into contact with individual seniors. The plan also calls for increasing COVID-19 tests for both residents and staff, suspending new admissions and transfers between facilities and providing more protective equipment to all staff members.
COVID-19: One-third of Quebec deaths concentrated in six long-term care and seniors’ residences
Public health, police find bodies, feces at Dorval seniors’ residence: sources
By Aaron Derfel
A privately run seniors’ residence in Dorval that is grappling with an outbreak of COVID-19 has been described as a “concentration camp” — with unfed and soiled elderly residents inside — by health professionals who came to those residents’ rescue, a Montreal Gazette investigation has found.
Although the official COVID-19 death toll at Résidence Herron stood at two on Thursday, a worker said 27 residents have died in the past two weeks. This is highly unusual, as the facility reports an average of four deaths a month, the worker noted.
In addition to the Herron, the West Island — which at first was not a government focus in the COVID-19 pandemic — is now beset with at least 117 confirmed cases of the respiratory illness and more than 460 suspected ones in 14 other public and private seniors’ facilities.

27 March
How to make sense of the number of COVID-19 cases in Quebec
Earlier this week, the total number of confirmed cases jumped significantly in Quebec, from 219 on Sunday to 2,021 on Friday.
The province now has the highest number of confirmed cases in the country. So, cause for alarm?
Not necessarily.
First, other provinces count cases differently, aka, the apples-to-oranges problem.
Before Monday, Quebec was keeping a separate tally of probable and confirmed cases.
In the early days of the outbreak, swabs were tested at the hospital where they were taken (a probable result) and then sent to a provincial laboratory for confirmation.
But public health officials are now confident in the quality of the results available in hospital labs, making that second step unnecessary.
A whole bunch of cases that were previously considered ‘probable’ were then moved into the confirmed column. Result, a big spike in numbers on Monday.
Given the roughly two week lag between infection and symptoms, the current cohort of test results in Quebec is thought to include thousands who travelled abroad during the first week of March, the province’s spring break.
That was just before the province introduced isolation guidelines for travellers, and as many have pointed out, popular holiday locations for Quebecers — such as Europe, Caribbean cruises or Florida — have since become disease hot spots.

23 March
Philippe Couillard réclame une cellule de sortie de crise
(La Presse) « Il faut quelqu’un quelque part, ou un petit groupe de personnes, qui regarde au périscope, qui regarde bien ce qui se passe ailleurs, ce qui s’en vient, ce qui est devant nous, et peut-être guider le gouvernement dans les choix qui sont à faire, les choix de sortie de crise », propose l’ancien premier ministre, qui s’apprête à donner un nouveau tournant à sa carrière.
M. Couillard est d’avis que la crise actuelle va changer beaucoup de choses dans nos vies et qu’il faudra savoir tirer les leçons qui s’imposent.
Sur le plan de la fiscalité, par exemple, les gouvernements devraient, selon lui, songer à offrir à tous les citoyens un revenu minimum garanti, pour éviter que certains d’entre eux se retrouvent sans emploi et sans revenu en temps de crise.
Les pratiques médicales sont aussi appelées à se transformer. La télémédecine, soit les consultations à distance par téléphone, « il faut conserver ça », même une fois l’épidémie passée.

19 March
Legault takes lead on coronavirus as former foes rally behind him
“You have to give credit where credit is due … Even with respect to a government that, in general, I’ve had a lot of trouble with.”

15-17 March
COVID-19 in Quebec: Tax deadline pushed back until June as cases rise
Quebec will be extending tax filing season beyond April 30 to ease pressure on residents coping with the fallout of the COVID-19 outbreak, the province’s finance minister announced Tuesday. … The announcement comes a week after Girard tabled the provincial budget. At the time, he said Quebec was “well-equipped” to weather the crisis. His budget speech made all of one reference to coronavirus, and the budget itself contained no specific measures to deal with the outbreak or its economic consequences.
The CAQ passed additional budget appropriations on Tuesday before it adjourned until April, giving the government access to $500 million to pay for things like the emergency daycare that will serve essential workers.
74 confirmed cases in Quebec as of Tuesday, up from 50 a day earlier and 39 on Sunday. More than 3,700 people are under investigation.
Starting today, Quebec will be able to conduct 6,000 COVID-19 tests a day, up from 1,600.
Two encouraging news items:
Retired doctors, nurses willing to help fight pandemic
More than 5,000 people with experience in healthcare have offered to help out battling the pandemic, TVA news reports
Many of the curriculum vitaes are from retired doctors and nurses.
Daycare for children of emergency workers
Health-care workers who are vital in fight against the coronavirus can send their children to free daycare centres that are being opened across the province.
The daycare centres and babysitting services are also available to ambulance technicians, police officers, firefighters and other essential service employees.
Scientists welcome Quebec’s aggressive coronavirus measures. Here’s why
The critical number in Quebec isn’t how many people have the new coronavirus but how many other people they’ll infect, scientists say.
COVID-19: Quebec orders bars and theatres to close, restaurants to limit customers
With the number of confirmed cases on the rise and the province grinding to a halt, Quebec continues to plan for the worst.
Life in Quebec slowed even further Sunday with the Legault government ordering the closing of bars, theatres, gyms, ski hills, sugar shacks, arcades, and pools to impede the spread of COVID-19 in the province.
Restaurants are also being asked to limit the capacity of their business to 50 per cent to maintain a distance between customers. That means keeping only one of two tables open, for example. Fast food restaurants are being allowed to remain open.
And with the number of confirmed cases rising again — the total rose by 18 to hit 39 — health officials are urging citizens to keep at least a metre of distance — two metres if someone has symptoms — between themselves and other people.
But the government wants people to keep working so businesses and office towers remain open, as will public transit.
“We are not surprised (the number of cases is up),” Premier François Legault said at his daily news briefing at the legislature on the evolution of the virus.
“This week we acted fast and decisively. What we are in the process of doing, together, is save lives.”
With his government on high alert and Quebec operating under the rules of a public health emergency, Legault ran down the list of reasons for leaving home: going to work, to buy groceries, to go for a walk, to go to the pharmacy, seek medical help or to help people aged 70 or over.
The steeped up measures follow orders issued Saturday where Legault asked people aged 70 and over to stay at home. Quebec also stopped visits to hospitals, seniors’ residences and long-term care centres.

28 February
Veterans claim victory at Ste. Anne’s Hospital, continue fight for better health care in Quebec
(Global) “There was an entente arrived at between the federal and provincial government to permit eligible long term care to those categories,” wrote Wolf Solkin, a Second World War veteran and the acting president of the Veteran’s Committee at Ste. Anne’s Hospital.
The categories Solkin refers to include post-Second World War vets who did not serve overseas, as well as vets who served with the allied forces, peacekeepers, those who participated in Cold War deployments and also fought in Afghanistan.
Veteran complains care at Ste. Anne hospital still not adequate
Solkin began fighting for better treatment for vets not long after the federal government transferred management of the veterans’ hospital to Quebec in 2016. After complaining about the province’s standards of care, Solkin finally launched a class action lawsuit in February 2019.
Quebec Superior Court judge authorizes veteran’s class action lawsuit over deteriorating care at Ste-Anne’s Hospital

14 February
Despite overcrowding issues, many beds at Montreal’s university superhospitals are empty
Quebec’s health minister says labour shortages are the cause
An MUHC spokesperson said that when the hospital opened in 2015, funding existed to make 471 beds available out of 500. Since then, new funds allowed the opening of seven additional beds: two in palliative care in early 2018 and five critical care beds in 2019-2020.
“Either they’re amateurs, or they’re really cheap,” said Jean-Lesage MNA Sol Zanetti, Québec Solidaire’s spokesperson for health and social services.
“We paid billions to get beds. We’ve got overflowing emergency rooms, specifically because of a lack of beds. And here we have unused beds, which we’re not funding although there’s a $4-billion surplus. It makes no sense.”

7 January
Health professionals calling for long-term solutions with ERs running at double capacity across Quebec
Winter clinics not helping overburdened emergency rooms, says Sainte-Agathe ER doctor
For most of the holidays, the emergency room in the Laurentians hospital where Dr. Simon-Pierre Landry works has been operating at nearly twice its capacity.
The problem is not just in the Laurentians. Emergency rooms are running beyond capacity across Quebec, and health care professionals and patient advocates say the government needs to come up with long-term solutions.

2019

23 November
UdeM researchers find molecule to block multiple sclerosis progression
“If we can mitigate (the side effects) of the treatments we have, we’ll be finally close to a cure,” Dr. Alexandre Prat said.
A team of researchers at the Université de Montréal has identified a potential drug target that could safely slow down the progression of multiple sclerosis, a debilitating disease of the central nervous system that has afflicted more than 77,000 Canadians.
“In the field of MS, we’re getting very close to reaching a cure,” he added. “Several of the medications that we use currently for the treatment of MS are extremely efficient and they do control the disease quite well. The problem we’re facing is all the side effects that these medications have in terms of infection and cancer. If we can mitigate this aspect of the treatments we have, we’ll be finally close to a cure.”
Canada has one of the highest rates of MS in the world, with an estimated one in every 385 Canadians living with the disease. Symptoms can include fatigue, lack of coordination, vision problems, cognitive impairment and mood changes.

4 October
Will the MUHC woes never cease?
MUHC computer crash caused by two successive malfunctions
A preliminary investigation indicates the failure was not caused by the kind of cyber ransomware attack that has been seen elsewhere.
The massive computer crash at the McGill University Health Centre on Monday was caused by two malfunctions in quick succession, rendering the back-up system powerless and resulting in the cancellation of a dozen surgeries as well as medical procedures involving nearly 40 other patients, the Montreal Gazette has learned.
Alan Grnja, president of Healthcare IT Specialists, a company based in Florida with no ties to the MUHC, suggested the failure of the back-up system points to a deeper problem with the MUHC’s computer network.
“It raises in my mind one single point of failure,” Grnja explained. “You usually see that in smaller-scale organizations. It is very fishy that an organization that large … can run everything from a single area. In other words, the hospital said, ‘Let’s build up our own data centre. We’re going to make our own in-house data centre and we’re going to house all our equipment in the basement.’ But that truly does not give you any redundancy.”

26 September
The number of doctors in Quebec is growing more slowly than in every other province
Between 2014 and 2018, the number of physicians in Canada outpaced population increases and grew by 12.5%, but in Quebec it only went up by 5.9%.
The number of doctors in Canada is growing at a rate more than double that of the population, says a report by the Canadian Institute of Health Information.
Canada’s population increased by 4.6 per cent between 2014 and 2018, while the number of physicians grew by 12.5 per cent over the same time period, says the report released Thursday.
Manitoba and British Columbia registered the largest increases in doctors at more than 17 per cent each while Quebec had the lowest level of physician growth at 5.9 per cent, just below the 6.5 per cent growth in Nova Scotia.
The figures show Quebec, at 25.6 per cent, had the highest proportion of residents who were without a regular doctor, followed by Saskatchewan at 18.7 per cent and Alberta at 18 per cent.
Since 2014, the number of female doctors increased by 21 per cent, while male doctors rose seven per cent, Ballinger said.

9 September
Quebec nurses union back in court over mandatory overtime
The FIQ’s fight against mandatory overtime came to a head with a one-day overtime strike last April 8.
The FIQ’s fight came to a head with a one-day overtime strike April 8. The same day, the union went before the labour board asking it to order health care managers to stop managing their “professional resources” in a “negligent, mistaken and abusive manner” that was compromising services to the public.
The labour board refused to hear the arguments, saying it was not its role, but rather that of employers and the Quebec Health Ministry to determine what services the public should receive.
Monday’s court filing seeks a review of that decision

5 September
Opinion: Outrageous wait times in Emergency must be addressed
The staff at the Glen are wonderful; what is appalling is the lack of resources
By Suzanne Turcot
(Montreal Gazette) Twenty-three hours. That was how long my 73-year-old mother had to wait in the ER at the Glen recently before being seen by a doctor. It took 45 hours before she was released. Something is fundamentally wrong with our health-care system. Or at least, something is wrong at the Glen. The outrageous wait times must be addressed. I hope this story sparks conversation that will result in positive change.
After 45 hours in the ER, we leave without a definitive diagnosis. What we have learned is that the staff at the Glen are wonderful. They do the best they can with what they have. What is appalling is the lack of resources. Lack of beds. Lack of follow up. Lack of communication between health-care professionals. Most importantly: lack of onsite staff. You cannot rely on the system to take care of you. And if your life is not immediately at risk, you cannot expect immediate attention in Emergency

14 August
Quebec offering scholarships in bid to hire 30,000 patient care attendants
Quebec wants to find a way to hire up to 30,000 of the attendants in the next five years to meet the growing demand as the population ages.
The Legault government raised concerns Wednesday about an increasing lack of patient care attendants in residential and long-term care centres.
Quebec wants to find a way to hire up to 30,000 attendants in the next five years to meet the growing demand as the population ages. The shortage will probably increase further, because many attendants are set to retire soon.
In the meantime, the government has decided to adopt a short-term solution by creating scholarships to make the profession more desirable. To do so, it will allocate $15 million to offer 2,000 scholarships worth $7,500 each for those interested in training to become a patient care attendant. The job entails tending to elderly, chronically ill and otherwise impaired patients.
Scholarship recipients will have to commit to working in the institutions they learned at for two years once their training has been completed.

6 August
‘Uber for doctors’ means getting a diagnosis without going to a clinic
The seven-month-old firm offers the first “asynchronous” health-care service in the country, where a patient and a doctor don’t need to meet in person to discuss a diagnosis.
(Bloomberg via Montreal Gazette) Canada’s taxpayer-funded health-care system has many benefits, but painfully long wait times to see a doctor isn’t one of them. This is where innovators like Felix Health Inc. see the most potential for disruption.
Felix is the latest among a slew of startups looking to shake-up a single-payer system that some U.S. Democratic presidential candidates including Bernie Sanders are seeking to emulate. Many are taking a direct-to-consumer approach to health care to eliminate cumbersome wait times or offer medical support in remote areas with few doctors.
Some have received funding, with Felix raising $750,000. Montreal-based Dialogue Technologies Inc. received $40 million last month in a funding round led by Canadian pension fund Caisse de dépôt et placement du Québec, along with Munich-based Holtzbrinck Ventures.
Maple Corp., often considered the pioneer in the recent wave of telemedicine startups in Canada, raised $4 million in March 2018 from a group of investors including MaRS, a Toronto-based innovation hub.

2 August
MUHC “heading into major deficit,” finance director warns
“The simple fact is that we are less efficient than our peers,” said Dawn Singerman, who was appointed to the MUHC last November.
Less than two weeks after officials publicly declared a “remarkable turnaround” in the troubled finances of the McGill University Health Centre, the director of finance sent a memo to all senior managers warning that the hospital network is “heading into a major deficit and we need to put a plan together to stanch the bleeding ASAP.”
Asked on Thursday what major deficit Singerman was alluding to in her email, Gfeller responded that the budget shortfall risks growing to $31 million by the end of this fiscal year if nothing is done to curb spending.
[Dr. Pierre] Gfeller [President and Executive Director] dismissed the notion that his public pronouncements about the MUHC’s much-improved bottom line were being undercut by his director of finance, who joined the hospital network after working for embattled engineering firm SNC-Lavalin.
“The communiqué that you refer to was written after the annual board meeting” in June, he explained. “It concerns the period that ended on the 31st of March. I am telling you once again, we will not end (this fiscal year) with $31 million. We will be much closer to a balanced budget than that. We might run a small deficit. We’ll see what happens.”

27 July
Why the endless wait for a family doctor in Montreal?
The number of patients waiting for a GP in the city has soared by more than 35 per cent since 2016.
(Montreal Gazette) Since the government launched the GAMF system in April 2016, the number of people waiting for a family doctor in Montreal has jumped by more than 35 per cent. As of May this year (the latest month for which complete figures are available), almost 137,000 people in Montreal who registered online were still waiting for a general practitioner, according to the Régie de l’assurance-maladie du Québec, which manages the system.
Average wait times for a family doctor in Montreal vary from a low of 205 days on the West Island for so-called vulnerable patients (those with chronic conditions like heart disease) to a high of 499 days for non-vulnerable patients in the north end of the city. What’s startling about the Montreal figures is how far they lag behind those in regions outside the city. In Saguenay—Lac-St-Jean, the registration rate is 91.6 per cent, the highest in the province. Other outlying regions fare nearly as well, like Chaudière-Appalaches (89.3 per cent) and Mauricie—Centre-du-Québec (89.2 per cent). That means that in those regions, nearly nine out of 10 people who want a family doctor have one.
By comparison, the registration rate in the centre-west of Montreal is the lowest in the province at 65.8 per cent as of May 31. It gets worse when one drills down deeper to examine the rates of city districts like Parc-Extension (61 per cent). In effect, in a multi-ethnic district where more than 43 per cent of the population is considered poor, only one of two people who need a family doctor can get one.
Dr. Mark Roper, chief of the Queen Elizabeth super clinic in Notre-Dame-de-Grâce, attributed the flagrant disparity between Montreal and the regions to poor planning and politics.
“I have lobbied three health ministers over the last number of years, and I have come to the conclusion that no politician will change the present system because they’re worried about consequences politically from off-island ridings,” Roper said. “They may be perceived as favouring Montreal.” … As for the concept of the GAMF database, Roper welcomes online registration, which requires individuals to enter their medicare card number, home address and answer a few questions about their health. Although Roper has used the system to sign up a few patients, he cautioned it’s only as good as the number of available doctors in a given area.
“Let’s look at N.D.G. They need to register 18,000 patients to get to an 85-per-cent registration rate, which was the target of the previous government, and they’re actually going to lose doctors next year to retirement,” Roper explained. “The doctors who are going to retire, they won’t be replaced, and you’re going to have 20,000 patients next year who will need to be registered.”

5 July
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