Quebec Healthcare/Bill 15 August 2024-

Written by Diana Thebaud Nicholson // November 4, 2024 // Health & Health care, Québec // No comments

Quebec Healthcare/Bill 15 October 2022-July 2024

2 August
Quebec health-care language directive open to constitutional challenge: Frédéric Bérard
“You are dividing people who do not need to be divided. It makes me sad,” Montreal law professor says.
One of Quebec’s leading constitutional scholars has come out against a controversial linguistic directive regulating the province’s health care in English and other languages apart from French, warning the new rules are divisive and open to legal challenges before the courts.
Frédéric Bérard, co-founder of the Observatoire national en matière de droits linguistiques and a professor of law at the Université de Montréal, said the July 18 directive issued by Quebec’s Health Ministry likely violates both the Canadian and Quebec charters of rights and freedoms.
“There’s no doubt that French is the official language in Quebec, but we tend to forget that the anglophones have had constitutional rights, too, since 1867,” Bérard said, alluding to the Constitution Act of that year. “It’s not just that French is the official language, it’s minority rights as well.”
In that context, Bérard suggested, the language directive could be struck down in court, even though the Coalition Avenir Québec government invoked the notwithstanding clause preemptively in the Canadian Constitution to shield Bill 96 from anticipated judicial challenges. Although Bill 96 overhauled the Charter of the French Language, Bérard maintained what is at stake is not Bill 96 itself, but a linguistic directive.
9 December 2023
Quebec adopts sweeping health-care reform bill [15]*
* Bill 15, Act to make the health and social services system more effective
(CBC) The bill contained nearly 1,200 articles, making it one of the most imposing bills in Quebec history.
It will make way for the creation of provincial agency, Santé Québec, which will oversee all activities related to the public health-care system, including providing services and facilitating access. The Health Ministry will provide the agency’s guidelines.
Santé Québec will become the sole employer, integrating the CISSS and CIUSSS networks. Union accreditations will be merged and a single seniority list will be established, allowing staff to move from one region to another.

4 November
Quebec College of Physicians wants expanded private medical care halted
The group warns that accessibility to health care and services, guaranteed by law, is being compromised.
(Montreal Gazette) The request is one of six guiding principles established by the College during a regular meeting of its board of directors Oct. 25. The principle aim is to rethink the role of the private sector in health care to ensure the sustainability of an accessible and universal public system.
Quebec wants to force new doctors to work in public system after graduating
Training a physician costs Quebec taxpayers between $435,000 and $790,000, Health Ministry says
Quebec plans to force new doctors to stay in province and work in public health care system
(Canadian Press via Globe & Mail) The provincial government says it will force new doctors trained in Quebec to work in the province’s public health care system for the first years of their practice.
Health Minister Christian Dubé told a Montreal radio station this morning that those who want to leave Quebec or work in the private system will face “consequences.”
The minister announced Sunday evening he plans to table a new bill to force new family physicians and specialist doctors to start their careers in Quebec.
The government estimates it costs between $435,000 and $790,000 to train a doctor, including during their residency.
It says there has been a 70 per cent increase in the number of doctors working exclusively in the private system since 2020, adding that the trend is especially notable among new doctors.
Dubé has not said how long new doctors would have to remain in Quebec, or what consequences they could face if they leave.

10-17 October
Allison Hanes: We should all be outraged by the latest idea for solving Quebec’s family-doctor crisis
Taking away people’s GPs and reassigning them to the most vulnerable patients would only worsen the health of all Quebecers.
… It is estimated the province is lacking 1,500 family doctors, while more than two million Quebecers are orphans, dependent for all their health needs on walk-in clinics, emergency rooms or a new triaging hotline that will find you a one-time appointment with a random physician.
Losing your GP is stressful and the long wait to find a new care provider is frustratingly long. But all Quebecers should be extremely worried about the plan in the works to resolve the scarcity of family physicians once and for all: cutting loose all the people in decent health and assigning only vulnerable patients with chronic conditions to dedicated doctors.
The news trickled out last week with the release of a study by the Institut national d’excellence en santé et services sociaux, which suggested that 1.5 million medical appointments a year used up by Quebecers in decent shape visiting their physicians could be reallocated to some 500,000 stray patients with moderate to serious health problems. Everybody else would just book an exam as needed through the Guichet d’accès à la première ligne (GAP), the new central booking service that matches unattached patients with vacant appointments.
… Whether you have a family doctor or are hoping to find one, all Quebecers should be outraged.
The abrupt severing of the relationship between six million Quebecers and their trusted physicians will not help those on waiting lists. The inconvenience of having to see a different primary care provider at a different clinic each time you have a medical problem will not improve anyone’s health — just ask those stuck in limbo right now. The complete abandonment of preventive medicine will lead to more sick people in the long run. …

Quebec studying reassigning family doctors based on person’s health
(CTV) The François Legault government could withdraw no fewer than 1.5 million medical appointments from people who have family doctors and redistribute them to people who do not.
This is one of the options proposed by the Institut national d’excellence en santé et en services sociaux (INESSS) in a study on primary care published this week.
Under this option, only the most vulnerable people with health problems would be assigned to a family doctor, to the disadvantage of healthy people. The Coalition avenir Québec (CAQ) had originally promised access to a family doctor for every patient(opens in a new tab).
During question period on Thursday, Health Minister Christian Dubé referred to new “vulnerability criteria” for care that had been defined by INESSS.
“Doctors have asked us to revise the criteria for patient vulnerability. It’s not done like that, by shouting with scissors,” he said.
“We will present this list of new criteria to my colleague [Treasury Board President Sonia LeBel] who is negotiating with the doctors, and we will be able to find solutions so that doctors … are obliged to take on vulnerable patients.”
These scenarios are part of the negotiations to renew the agreement with the Fédération des médecins omnipraticiens (FMOQ).
Quebec mulls scrapping family doctors for healthy patients
Scenario would have only those deemed more vulnerable assigned a family doctor
(CBC) … A report by the Institut national d’excellence en santé et en services sociaux (INESSS), commissioned by the government and made public on Wednesday morning, lays the foundations for such a model.
This INESSS report indicates that 500,000 sick Quebecers do not have a family doctor, and suggests transferring up to 1.5 million annual appointments from patients who have a doctor to those who do not.
Of the 2.1 million Quebecers who were not registered with a family doctor in 2022-23, INESSS estimates that nearly half a million have major or moderate health problems. These patients are classified in the red and orange categories by INESSS.
These categories include, among others, people with depressive disorders, anxiety disorders, cancer, dementia, eating disorders and acute palliative conditions.

26 September – 1 October
Allison Hanes: MUHC blood-test restrictions are another obstacle for doctors and patients
Starting Tuesday, the McGill University Health Centre’s blood-testing services are not only inaccessible for people who don’t live on the island of Montreal, but also for the patients of family doctors in the city, including those working in the neighbourhoods close to the hospital.
The move is intended to unclog the busy testing centre for those seeking specialized care or receiving emergency treatment at the MUHC. However, some fear the policy will erect new barriers for patients and further complicate the work of family physicians.
…as of Oct. 1, 2024, the blood collection centres at the Royal Victoria Hospital (Glen site — adults) and the Montreal General Hospital will mainly serve patients with requisitions prescribed by an MUHC prescriber.”
The change will not affect the blood testing services offered at the Montreal Children’s Hospital and Lachine Hospital. And it does not cover tests like X-rays, obstetric ultrasounds, mammograms, or more complex diagnostics like cardiac MRIs.
MUHC requesting off-island patients go elsewhere for some services
The MUHC is asking off-island physicians to refer their patients to centres in their region rather than to MUHC centres.
(CTV) The McGill University Health Centre (MUHC) is trying to reduce congestion at its major hospitals by not accepting off-island requests for blood tests and imaging examinations.
MUHC spokesperson Gilda Salomone said that the blood collection centres at the Royal Victoria Hospital and Montreal General Hospital will “mainly serve patients with requisitions prescribed by an MUHC prescriber,” as of Oct. 1.
“At present, people have to wait about three to four months to get an appointment for a blood test at one of Quebec’s blood collection centres,” she said. “Many local service points within CISSSS and CIUSSS are open and available, offering the Quebec population the possibility of having an additional blood sampling service.”
Salomone said that the change would not affect the Montreal Children’s Hospital or the Lachine Hospital.

12 September
MNAs unanimously adopt motion saying Quebecers don’t need certificates for English health care
The Liberal motion in the National Assembly came in response to fear and confusion caused by a July government directive.
“This is a significant step,” said Eva Ludvig, president of the Quebec Community Groups Network (QCGN). “It may have little force in law and I’m told the minister could theoretically choose to largely ignore it, but this full expression of the assembly’s view is an important statement.”

12-17 August

Aaron Rand and Bill Brownstein chat with Eric Maldoff, lawyer and political advisor and Sylvia Martin-Laforge, Director General of the Quebec Community Groups Network (QCGN) on The Corner Booth at the Snowdon Deli on Friday, August 16, 2024

‘Every 4 to 6 months, they pick an issue and attack the English-speaking community’
Quebec’s directive on language in the health care system is just another example of political pandering, says lawyer Eric Maldoff.
(The Corner Booth) Earlier this week, Quebec French Language Minister Jean-François Roberge said there were “huge misunderstandings” surrounding his directive on the use of languages other than French in the health care system. …Eric Maldoff doesn’t buy it.
“This is not a friendly, good-faith, accidental matter. This is deliberate, conscientious — they do wanna wipe English off the map as a public, as a legitimate language in Quebec,” he told Aaron Rand and Bill Brownstein in this latest episode of The Corner Booth.
Maldoff was joined by Sylvia Martin-Laforge, director general of the Quebec Community Groups Network, who said the messaging she’s received from Quebec officials has not assuaged her concerns.
“Either the left hand doesn’t know what the right hand is doing or there’s serious obfuscation here about their intentions around the English-speaking community,” she said.

Some anglophone groups refused to meet with Quebec’s language minister. Here’s why
The QCGN and Director General Sylvia Martin-Laforge showed “a lot of chutzpah” by turning down a meeting with Quebec French Language Minister Jean-François Roberge to discuss directives around language in health services, says Andrew Caddell, president of the Task Force on Linguistic Policy. “Why sit down,” he asks, “when it’s going to be another one of those consultations like Concordia and McGill, where basically they (the government) are telling them what the conditions will be rather than holding a genuine consultation?”
Roberge pledges new health-care language directive after meeting anglo groups
But he said the existing directive will be in force until the updated version is ready. The QCGN, which was not invited to the meeting until the last minute, countered that it “must be suspended immediately.”
(Mtl Gazette) “Health care and social services are accessible for the English-speaking community, no questions asked. They don’t have to show any documents, any certificates at all,” says Quebec French Language Minister Jean-François Roberge.
“We are coming with a new way to formulate it, with new wording, which will be more clear that you don’t have to have your life at risk” to receive services in English, he said, adding that people can receive care in English for any health concern.
Roberge said he met Tuesday with a provincial committee on social services and health care; Seniors Action Quebec; 211 Montreal; the Cummings Centre, a community centre for adults over 50 in Montreal; as well as committees from Jeffery Hale — Saint Brigid’s, a Quebec City health-care institution serving the English community, to discuss the directive. …
Quebec to replace directive on language in health care after original sparked confusion
(CBC) Roberge isn’t reassuring anxious English-speaking community, says Townshippers’ Association director
Minister of the French Language Jean-François Roberge met with some groups of Quebec’s English-speaking community to clarify the directive on the use of English in hospitals
Roberge met with stakeholders of Quebec’s English-speaking community on Tuesday to hear concerns about how the province’s language law would be applied in a health-care setting.
The meeting comes days after Liberal MP Anna Gainey called for detailed explanations on the Health Ministry directive, saying constituents worry it will interfere with their ability to get care in English.
Following what Roberge called a “pretty cordial” meeting with six health and social services groups, he told CBC News that the government started clarifying the directive a few days ago. He would not provide a time frame for when the revised instructions would be published.
Key anglo leaders excluded from meeting with Roberge on Tuesday about health-care rules
Health Minister Christian Dubé and Eric Girard, in charge of anglophone relations, will not attend the meeting on the directive that appears to limit the use of English in health care.
Several anglophone leaders have expressed disappointment that Tuesday’s meeting will only be with French Language Minister Jean-François Roberge. “It is vital that (Health Minister Christian) Dubé be present. This concerns his ministry,” said the Quebec Community Groups Network
Anglophone leaders are outraged that French Language Minister Jean-François Roberge has decided not to invite several prominent community representatives to a meeting Tuesday, and two other government ministers will not attend as promised to address concerns about a new directive that appears to limit the use of English in health care.
“We were not surprised to be left off the list of hand-picked invitees for a meeting about language directives in the health-care system by … Roberge’s office,” the Quebec Community Groups Network (QCGN) declared in a statement Monday afternoon.
Andrew Caddell, president of the Task Force on Linguistic Policy and a councillor in the town of Kamouraska, said he had contacted Roberge’s office last week but was not invited either.

Health-care language directive fit for the shredder
Ministers have offered to “clarify” the new rules for when a language other than French may be use in medical settings. That won’t cut it.
André Pratte, chairperson of the Quebec Liberal Party’s policy committee
(Mtl Gazette) The government’s directive on the use of English in health care is a clear example of the fussy, dehumanizing approach feared when Bill 96 was adopted. However, a subliminal message emerges clearly: Even if it deals with Quebecers at a time in their life when they are most vulnerable, the health-care system is seeing francizing Quebec added to its primary mission.
In their open letter, the ministers say they are “open to clarifying the directive to make it clear that there will never be language requirements in Quebec to treat a patient.” That is not enough. The directive is a poorly conceived, poorly written document. The government should shred it.

9 August
Letter: ‘We are open to clarifying’ language directive, ministers say
“The government of Quebec’s intention has never been to restrict access to health care for English speakers in Quebec.”
Jean-François Roberge, Eric Girard, Christian Dubé
The government of Quebec imposes absolutely no linguistic conditions in health-care settings before providing health care in English to anyone who requests it. Every English-speaking individual in Quebec has the right to receive health and social services in English, as per Section 15 of the Act respecting health services and social services. This right is clear and in no way is being called into question.

7 August
Health-care language directive is immoral and dangerous
The CAQ government is prepared to sacrifice fundamental constitutional rights to life, liberty and security of the person to fulfil its language goals.
Julius Grey and Eric Maldoff
(Opinion Montreal Gazette) French Language Minister Jean-François Roberge has said he will meet with representatives of the English-speaking community to listen to their concerns about the government’s linguistic directive regulating the use of English and other mother tongues in health care.
Essentially, except in life-and-death emergencies, the government wants to restrict English health and social services to “historic anglophones,” now defined in the directive as “recognized English-speaking persons,” being those who are eligible for English education in Quebec and for whom an eligibility certificate has been issued, and to deny these services to francophones, “non-historic” anglophones and recent immigrants of all origins. Since there are major problems obtaining eligibility certificates because of additional overwhelming demand related to CEGEP admissions, the notion of English identity cards for those who qualify is both uncertain and very restrictive.
This is singularly inappropriate in the field of health and social services. There is considerable scientific evidence showing that the access to and outcome of care are seriously affected by the facility of communication with caregivers. Whether you are “historic” or not, whether you know how to speak French or not, it seems obvious that the choice of language belongs to the patient. It is not right for bureaucrats — who are not accountable for health and social service delivery and results — to intervene in the treatment and care of patients, to meddle in life-and-death situations or to decide to listen in as surgeons are operating.
New Quebec language directive undermines Canada Health Act: Gainey
Gainey’s invocation of the federal law sets up a potential clash between Ottawa and Quebec over linguistic matters that the Trudeau government has long sought to avoid.
Notre-Dame-de-Grâce—Westmount MP Anna Gainey has appealed to federal Health Minister Mark Holland to intervene under the Canada Health Act in a controversial new language directive in Quebec.
In an official statement posted on the X social media platform on Wednesday evening, the Liberal Member of Parliament said she had “serious concerns” about the directive issued on July 18 that restricts the use of languages other than French in the health sector to exceptional situations like emergencies. The 31-page directive by the Health Ministry also now requires of historic anglophones that they obtain an eligibility certificate from the Education Ministry to seek and receive medical services in English only.
Gainey suggested the directive may interfere with one of the five principles enshrined in the Canada Health Act (CHA) — that of accessibility, which guarantees that every Canadian “have reasonable access to insured hospital, medical and surgical-dental services on uniform terms and conditions, unprecluded or unimpeded, either directly or indirectly, by charges … or other means.”
Gainey has also been in contact “with a number of my caucus colleagues to ensure that the federal government, which is a major partner under the Canada Health Act, is aware of these concerns and prepared, if necessary, to step up and insist upon respect for its fundamental principles, in particular as it relates to universal access to care in both official languages.”