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Cheryl Stadnichuk

Health Canada hasn't fined Quebec in past decade for medicare violations | Montreal Gaz... - 0 views

montrealgazette.com/...decade-for-medicare-violations

CHA user fees Quebec

shared by Cheryl Stadnichuk on 11 May 16 - No Cached
  • Despite raising concerns about the prevalence of user fees in Quebec, among other violations of the Canada Health Act, Health Canada hasn’t penalized the province for more than a decade while other provinces have been fined repeatedly. A Montreal Gazette review of Health Canada’s annual reports since 2002-2003 has found that the federal agency has warned Quebec more often than not about a wide range of contraventions against medicare — most recently, last year about user charges — but has not deducted penalties from funding transfers to the province. By comparison, Health Canada has penalized British Columbia, Alberta, Manitoba, Nova Scotia, as well as Newfoundland and Labrador for a total of $10.1 million in that time period. In its latest available report last year, Health Canada noted that it “wrote to the Quebec Ministry of Health concerning patient charges by physicians, when they provide certain publicly insured health services in their offices or private clinics. Health Canada’s consultation with Quebec on this issue is ongoing.”
  • The Montreal Gazette’s review has found that, unlike most other provinces, Quebec routinely declines to provide Health Canada with relevant statistical information about its private for-profit clinics. The issue of enforcing the Canada Health Act (CHA) arose last week after patient-rights groups across Quebec filed a lawsuit against the federal government to compel Health Canada to put an end to illegal extra billing and user charges in the province. Dr. Isabelle Leblanc, president of the pro-medicare group Médecins québécois pour le régime public, said she was taken aback over the fact that Quebec hasn’t been fined in more than a decade despite the proliferation of two-tier medicine in the province and the growth of so-called accessory fees, such as $200 eye drops. “The principles of the Canada Health Act should be the same throughout Canada,” Leblanc added. “If the federal government acts on non-compliance in one province, they should do it for all other provinces.” The CHA, adopted in 1984, gives the federal government the power to assign financial penalties over medicare violations. The penalties are deducted from federal funding transfers to the provinces.
  • British Columbia and Alberta have been fined the most of all provinces since 2002-2003, but Leblanc argued that queue-jumping, extra billing and user charges — all violations under the CHA — are just as widespread in Quebec, perhaps more so in recent years. Leblanc suggested that Health Canada might be more reluctant to crack down on medicare violations in Quebec for political reasons. “It’s probably different for the federal government to do something in Quebec than the other provinces,” she said. “Quebec has a different perception of what is a provincial duty and what is a federal duty.”
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  • Health Canada’s annual reports show that Quebec has sometimes complied with its concerns. But in its 2003-2004 report, the agency observed that the Quebec government was “not at liberty to reveal the status of the province’s investigation” into user charges imposed by a private surgical clinic. A year earlier, Health Canada expressed concern “about private surgical clinics that allow individuals to privately pay for medically insured services and thus jump the queue. … Health Canada asked Quebec to confirm that the matter had been resolved.” A long-standing complaint of Quebec by Health Canada is that it allows patients to be charged for MRIs and CT scans if they are done in private clinics. In its 2004-2005 report, Health Canada held discussions with British Columbia, Alberta and Nova Scotia about charging for medical imaging in private clinics, but Quebec refused to participate. 
  • Health Canada officials did not respond to requests for an interview since last Thursday. Reacting to the Quebec lawsuit last week, federal Health Minister Jane Philpott said she’s a strong supporter of the CHA, and did not rule out reducing transfer payments to provinces that flout the law.
Govind Rao

Health care under attack in Quebec; Why the Trudeau government must act now to save hea... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|shrc|20151116|233774979

from heather quebec privatization private clinics

shared by Govind Rao on 16 Nov 15 - No Cached
  • The Record (Sherbrooke) Mon Nov 16 2015
  • The people of Quebec will only benefit from a universal, free and comprehensive health-care system if there is strong and swift intervention by the federal government. Otherwise, Quebec will likely be the first province to slip out of the Canadian health care scheme. In fact, Quebec's current health care laws and practices do not respect the principles set out in the Canada Health Act. During the past decade, the core principle of health care - that medically necessary care should be universally covered and paid through public funds - has gradually eroded in Quebec. The process has been a slow but steady sum of small legislative changes that have benefited practitioners over patients. The result has been governmental tolerance for grey-zone billing practices and impressive fee-charging creativity from medical entrepreneurs.
  • The turning point was probably the Supreme Court of Canada Chaoulli ruling in 2005. The decision said that prohibiting private medical insurance was a violation of the Quebec Charter of Human Rights and Freedoms, particularly in light of long wait times for some health services. The ruling has fed steady development and acceptance of a two-tier health care system in Quebec. The expectation that medically necessary care will be free in Quebec is less and less warranted. Some specialists in public hospitals propose faster access to their patients - for a fee - or less invasive interventions through their for-profit clinics. In such clinics, doctors are still paid by Quebec's public health insurance, but patients are often billed for the rental of the surgery room, for local anesthetics or for access to more advanced technologies. hile officially illegal, such practices are widespread. Stories abound about W eye drops or anesthetics that cost the clinics cents being billed to patients for hundreds of dollars.
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  • This clearly puts the doctors involved in a conflict of interest. In a health system experiencing a significant shortage of practitioners, medical resources are drained from public hospital-based "free" care and into private purses. It also ties health care quality and accessibility to a patient's wealth - precisely what the Canada Health Act tries to prevent. For example, Montreal Children's Hospital - one of Montreal's two pediatric university hospitals - has decided to stop offering many medically necessary services. Instead, it will direct some patients to a new outpatient clinic. There, parents may be billed for such services as dermatology, endocrinology, general pediatrics and other important specialized care.
  • This steady disintegration of the principles of health care could soon be irreversible. Premier Philippe Couillard's new Bill 20 will legalize direct patient billing for medically necessary services provided outside of hospitals. The provincial government is confident that Ottawa won't intervene to enforce the Canada Health Act in Quebec (the federal government hasn't intervened in the past decade). Bill 20 makes legal practices that were grey-zone breaches in the universal public health system. This is creates a parallel, legal private health-care system subsidized by public health insurance. This could be the final blow to health care in Quebec. An unhealthy coalition - the Couillard government, private clinic owners, medical federations, private insurers and even some hospital administrators - is irresistibly pushing to decrease the care offered in public institutions and to increase the market share of direct payment and privately insured services. The only chance to save health care in Quebec is direct intervention by the federal government. Prime Minister Justin Trudeau and federal Health Minister Jane Philpott must enforce the Canadian Health Act in Quebec, even cutting federal health transfers until the province conforms.
  • Doing anything less will mean access to care according to a Quebec patient's wealth, rather than their needs. Astrid Brousselle is a professor in the Community Health Department, and researcher at the Centre de recherche de l'Hopital Charles-LeMoyne, Universite de Sherbrooke and Canada Research Chair in Evaluation and Health System Improvement. Damien Contandriopoulos is a professor in Nursing and a researcher at the Public Health Research Institute at University of Montreal (IRSPUM). CIHR Research Chair in Applied Public Health.
Govind Rao

Family doctors weighing their options; Changes to Bill 20 are welcome, but the buzz amo... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|mtgz|20150530|221592846

from heather Quebec doctors cuts privatization

shared by Govind Rao on 01 Jun 15 - No Cached
  • Montreal Gazette Sat May 30 2015
  • Montreal family physician Fahimy Saoud hated leaving her sick 5-year-old in someone else's care this week, but it was her turn to staffa walk-in clinic and she didn't want to let those patients down. But as the day wore on, Saoud kept hearing her daughter's plea when she left the house: "Who will take care of me?" So on Monday, after seeing everyone in the waiting room, Saoud left the clinic early; her daughter needed her as much as her patients did.
  • She went home thinking of her game plan as the provincial government prepares to pass Bill 20, the controversial carrot-and-stick health reform that Health Minister Gaétan Barrette would soften after alienating many of Quebec's doctors with the threat of clawing back 30 per cent of their salary if they failed meet a patient quota. Barrette announced this week that Bill 20's sanctions would not apply to family physicians for two years - taking the immediate sting out of the bill while keeping the onus on doctors to improve patient access. Which is small comfort to busy family doctors like Saoud.
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  • "I go help mothers with their sick children while I leave mine at home," Saoud said. "I can't see how I can do more." Saoud has three young children. She devotes 60 per cent of her workweek to a Montreal hospital's emergency department - irregular hours that include evening and weekend shifts - while the rest of her schedule is split between a walk-in clinic and what's known as "dépannage," replacing doctors in Quebec's more remote regions at least once a month. What she wants is more time for her job as a mother - helping with their homework and sharing meals - and not have to meet "an impossible" quota of following 1,500 patients, as the original Bill 20 would have required of each family doctor.
  • I am already at my maximum," said Saoud. And so, she has applied for a licence to practise outside Quebec. Nearly 24 per cent of Quebecers are on a waiting list or desperately searching for a family doctor. The crisis is rooted in a 1990s provincial government plan to save money by encouraging doctors to retire early. Staffing shortages ensued, and family doctors were obliged to fill the gaps by working outside their clinics in hospitals and far-flung regions. Quebec has attempted, with little success, to improve primary care over the last two decades by expanding community health clinics (CLSCs) and creating pools of doctors known as Groupes de médecine de famille (GMF) but both limped along under budget constraints and heavy bureaucracy. Barrette contends that the province has more than enough physicians to meet its needs, but that a profound structural change is needed.
  • He presented Bill 20 last fall as his road map to ensure that every Quebecer has a regular doctor. But the bill's punitive measures sparked widespread discontent among doctors against what they called a one-size-fits all, state-controlled, conveyor-belt approach to medicine. Doctors were further incensed at Barrette's assertion that doctors are not productive enough - which they saw as being accused of laziness - and frustrated at being blamed for a broken health system.
  • Like Saoud, many doctors prepared exit plans - from retiring to leaving the province. Some med students, many of whom were actively recruited to shore up Quebec's supply of family doctors, began reconsidering family medicine - or simply leaving to do their residency out-of-province, according to the Fédération des médecins résidents du Québec. Saoud was heading home to her sick daughter on Monday when Barrette announced he had cut a deal with the provincial federation of family physicians to exempt them from Bill 20 - temporarily. There would be no quotas and no penalties, Barrette said, as long as family physicians were able to collectively ensure that 85 per cent of Quebecers had a family doctor by the end of 2017. But Saoud says the change will not keep her here. And she's not alone.
  • The buzz among disillusioned physicians is that "everyone has a Plan B." And while the bill's delay has eased tensions a notch, some doctors are saying the two-year delay simply means they now have until 2017 to prepare a better exit. Bill 20 remains a guillotine above the heads of doctors. "Most definitely, there are physicians investing in Ontario licences and poised to leave if Bill 20 passes. I myself may have to leave," family physician Maggie O'Dell, who works at the Wakefield Family Medical Centre near the Ontario border, said before the bill was modified. And after Barrette backtracked, she had this to say: "It's nice to have reprieve, so it's a relief - for now ... a reason for many to hold back on pulling up stakes in the short term."
  • Doctors are willing to do their part to improve access, O'Dell said, but the Health Department must make participation in the Groupes de médecine de famille (GMF) more attractive by funding electronic records and support staff, and boosting mental health services and long-term beds in nursing homes. Dr. Catherine Duong, president of a collective of 550 general practitioners known by the French acronym ROME, said that the biggest threat of exodus is among doctors who live near the Ontario border. Physicians in that neighbouring province earn, on average, 15 per cent more than those in Quebec, and pay lower income taxes.
  • The group's recent survey - 204 of its members responded - indicated that Bill 20's sanctions would backfire. While the survey was taken three days before Barrette modified Bill 20, Duong said the results reveal that doctors, in particular those whose mother tongue is English, are at risk of leaving the province. Among the 134 francophone doctors polled about their intentions if Bill 20 were applied, 32 per cent said they would resign from hospitals, 12 per cent said they would leave Quebec and another nine per cent would go into private care.
  • Among the 70 anglophone respondents, seven said they already sent letters of resignations to their hospitals (it's not clear whether they are keeping their office family practice) and among the remaining 63 doctors, 34 - more than half - said they planned to leave Quebec. Another seven said they would retire early, seven would move to the private system and three would stop working as family doctors. It's a small sample, Duong conceded, but the study is nonetheless alarming.
  • We are worried that doctors will leave," Duong said, noting that every year, more doctors are opting out of the provincial insurance board (RAMQ), meaning they are no longer on the public payroll, though it's not clear whether they went to private practice or left Quebec. RAMQ representative Marc Lortie confirmed this week that 246 family physicians dropped out of RAMQ between May 2014 and May 2015, up from 204 the previous year and 187 in 2012-2013.
  • In the wake of Monday's announcement to put offBill 20's sanctions, many doctors remain skeptical of Barrette's 85-per-cent target, Duong says, "because it's far too ambitious a goal." Whatever doctors' efforts, Duong says, the reform will fail if the government doesn't help them do their jobs - for example, by abolishing mandatory hospital work. Others suggest the crisis between the province's doctors and Quebec's health minister is over. Bill 20 was heavy-handed, they argue, but if it leads to doctors taking on more patients it will have been a successful negotiating tool. Dr. Yoanna Skrobik, a critical care researcher and adjunct professor at McGill University's department of medicine, is among those who wholeheartedly support the Barrette reform.
  • It's the most dramatic change in the history of Quebec's health system, and the best thing that's ever happened to patients," said Skrobik, who worked side by side with Barrette at Maisonneuve-Rosemont Hospital in the early 2000s, when Barrette was chief of radiology and she was an intensivecare physician. She said that if 85 per cent of Quebecers have a family doctor, the quality of health care in the province will be much improved. Doctors may be offended by Barrette's manner, and by what they see as an attack on their autonomy, Skrobik said, "but it's also true that he puts patient care in the forefront."
  • But Saoud also has priorities. She earned her first medical degree in Haiti, then had to obtain it again after emigrating to Montreal. There's a saying among those who work in the ER, she said: "We know when we go in, but we don't know when we will leave." Saoud, who won the Nadine St-Pierre Award for her research as a resident in family medicine in 2009, still loves being a doctor. "It can be frustrating, but it's really gratifying work. Helping someone is really the cherry on the sundae. But my priority is not that." She would rather not force the children to uproot, but she's skeptical doctors can meet the demands of the health reform. And possible sanctions in two years could force her to to make a tough choice.
  • "My male colleagues don't have that issue. The bill is discriminatory. I'm just asking for the right to be a mother and not simply a doctor." With her permit application process in motion, Saoud says she will go wherever her licence takes her. cfidelman@montrealgazette.com twitter.com/HealthIssues
  • Medical students from four major Quebec universities demonstrate against Bill 20 in March near the legislature in Quebec City. • VINCENZO D'ALTO, MONTREAL GAZETTE / Dr. Fanny Hersson-Edery, left, at a diabetes clinic she runs with nurse Jen Reoch. Hersson has a full schedule, from research to teaching and seeing patients.
Cheryl Stadnichuk

Quebec auditor general's report: User fees in clinics uncontrolled | Montreal Gazette - 0 views

montrealgazette.com/...s-uncontrolled-auditor-general

user fees private clinics Quebec

shared by Cheryl Stadnichuk on 11 May 16 - No Cached
  • May 10, 2016
  • QUEBEC — Extra fees charged in private clinics for procedures covered by medicare are not being controlled and may be abusive, the province’s auditor general said in a report Tuesday. Extra billing has been in dispute ever since the government of Quebec adopted Bill 20 in November. The bill aimed, among other things, to regulate add-on fees by creating a standardized price list. The situation remains ambiguous, confusing and misunderstood, auditor general Guylaine Leclerc wrote in her report.
  • QUEBEC — Extra fees charged in private clinics for procedures covered by medicare are not being controlled and may be abusive, the province’s auditor general said in a report Tuesday. Extra billing has been in dispute ever since the government of Quebec adopted Bill 20 in November. The bill aimed, among other things, to regulate add-on fees by creating a standardized price list. The situation remains ambiguous, confusing and misunderstood, auditor general Guylaine Leclerc wrote in her report. Neither the health department nor Quebec’s health insurance board (RAMQ) has a firm grip on these add-on fees, which are estimated at $50 million a year, she noted. For example, the report said, Quebecers are charged between $300 and $400 for a colonoscopy, $125 to $225 for a vasectomy, $51 to $100 for a biopsy and $5 to $50 for an excision, depending on the clinic. 
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  • Doctors have argued in the past that they need the extra money to pay their operating costs, but the report recommended the health department take time to really “assess the operating costs of clinics, determine the funding to be granted and consider the funding already paid.”
  • Lawyer Jean-Pierre Ménard insisted last week Quebec is the worst offender when it comes to over-billing patients, and that the fees are creating a two-tier health-care system that may violate the Canada Health Act. With Ménard’s help, various patients’-rights groups have come together to launch legal action against the federal government to make sure the Canada Health Act is applied in Quebec and other provinces. Reacting to the report Tuesday, Health Minister Gaétan Barrette reiterated his recent promise to abolish add-on fees by possibly rolling them into doctors’ salaries. “For care that is medically required, there won’t be any fees,” he told reporters.
  • Parti Québécois MNA Diane Lamarre said Barrette’s “about-face” is the result of relentless criticisms by her and the PQ. “When we started studying Bill 20, we were fighting the fact that the minister introduced an amendment that authorized accessory fees,” Lamarre said. “It was a new opportunity to charge, legally, new medical fees. … We asked the minister many times to (scrap) his amendment and he refused. “(It) was a way to introduce accessory fees and make some patients with no money unable to have access to medical services, which is completely against the law. Now we’re proud that he changed his mind,” she said. Both Lamarre and Coalition Avenir Québec MNA François Paradis said they are concerned Barrette will not be able to convince doctors’ associations to include the fees in their remuneration. If doctors’ salaries are boosted by an additional $50 million in the next contract agreement, for example, it will mean that collectively we will all be paying the fees indirectly, Paradis said.
Govind Rao

Quebec unions call government wage offer 'insulting' | Montreal Gazette - 0 views

montrealgazette.com/...ts-wage-offer-to-public-sector

from heather Quebec bargaining cupe

shared by Govind Rao on 16 Dec 14 - No Cached
  • December 15, 2014
  • “What we have here are five pages of contempt,” added Sylvain Mallette, president of the Fédération autonome de l’enseignement. “Quebec is saying to its employees, you are not worth the rate of inflation.
  • “This is a government that wants to drive its employees out of the public sector.” It was the part of Quebec’s package designed to discourage workers from retiring by increasing the retirement age from 60 to 62 that appears to have caught the unions off guard.
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  • “This is a government that does not like its employees,” said Régine Laurent, president of the Fédération interprofessionnelle de la santé du Québec, representing 65,000 nurses and health care workers.
  • Right now, a worker can retire at 60 with no penalty.
  • Not only does the retirement age increase, Quebec is proposing to increase the pension penalty for early retirement and calculate retirement income on the eight best years of income instead of the current five.
  • As for the rest, Quebec — in the name of austerity — is proposing a five-year contract that would kick off with a two-year wage freeze.
  • Over the remaining three, Quebec would increase wages by 1 per cent per year.
  • That’s a long way from the union demands for a 13.5 per cent increase over the next three years.
  • The unions argued Quebec could slash funding for private schools, crack down on tax havens used by the rich and slap corporate Quebec with higher taxes to raise money.
  • But Serge Cadieux, secretary-general of the Quebec Federation of Labour, questioned why Quebec is going after pensioners when public sector pensions are solvent with the cost split 50-50 by the government and workers. “What they tabled this morning is worse than we imagined in our worst nightmares,” Cadieux said.
Govind Rao

Wait times for medical scans surge in Quebec: report; Radiologists can earn more chargi... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|mtgz|20151209|235447975

from heather waits private clinics quebec privatization

shared by Govind Rao on 09 Dec 15 - No Cached
  • Montreal Gazette Wed Dec 9 2015 Page: A2
  • Quebec reported the steepest increase this year of any province in wait times for medical imaging scans in Canada - a finding which suggests that the public system is being stretched to the limit, a national survey reveals. The 25th annual survey by the Fraser Institute found that the median wait time in hospital for a magnetic resonance imaging (MRI) scan in Quebec jumped to 12 weeks this year from eight in 2014. By comparison, the median wait time for an MRI is five weeks in Ontario, unchanged from last year.
  • Wait times increased slightly for other medical imaging in Quebec, going up from four to five weeks for both ultrasounds and CT (computerized tomography) scans. (Although Prince Edward Island reported a considerably longer wait for ultrasounds, its survey sample size was much smaller than Quebec's and so its results are probably skewed, a Fraser Institute spokesperson said. In any case, P.E.I.'s wait times for MRIs decreased to 12 weeks from 16.) Unlike all other provinces, Quebec allows radiologists to work in both the public and private systems. Doctors are permitted by law to bill medicare for scans performed in hospital, and to bill patients for those same scans if conducted in a private clinic. This has proved to be a sore point for Health Canada, which has argued repeatedly that Quebec is flouting the accessibility principle of the Canada Health Act.
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  • Dr. Isabelle Leblanc, president of the pro-medicare group Médecins québécois pour le régime public, said the survey results show that radiologists in Quebec are increasingly choosing to work in the private sector to the detriment of the public system. "For us, this is the best example of how mixing the public and private systems can lead to decreased accessibility for most patients and increased accessibility for those who have the money to pay," Leblanc said. "Radiologists have no incentive to increase access in the public system, and in fact, they're draining resources from the public system." Leblanc explained that radiologists can earn more money charging patients for scans in private clinics than they would if they worked exclusively in hospital and billed the Régie de l'assurance maladie du Québec. Leblanc's group warned in a report three years ago that wait times for MRIs in hospital would increase.
  • "We're the province that has the highest number of MRI and CT scan machines per capita in the country - with a third of the machines in the private sector - and yet our public wait times are going up," Leblanc added. Health Minister Gaétan Barrette, a radiologist by profession who had worked in a private clinic before entering politics, was unavailable for comment. Officials with the Association des radiologistes du Québec could not be reached for comment, either. The Fraser Institute report observed little progress in cutting wait times for medically necessary surgery or treatments. The median wait time in Canada for treatment inched up to 18.3 weeks from 18.2 weeks last year. In Quebec, the median wait time for treatment by a specialist rose to 16.4 weeks from 7.3 weeks in 1993, when the Fraser Institute first started compiling such data. The median wait time denotes the midpoint for those waiting, as opposed to an average. In Quebec, the median wait time to see a medical specialist following referral from a general practitioner rose to 7.3 weeks from 7.1 weeks last year. The survey found that the longest median waits in Canada were for orthopedic surgery at 35.7 weeks, or almost nine months.
  • "These protracted wait times are not the result of insufficient spending but because of poor policy," Bacchus Barua, the author of the Fraser survey, said in a statement. "In fact, it's possible to reduce wait times without higher spending or abandoning universality. The key is to better understand the health policy experiences of other more successful universal healthcare systems around the developed world." aderfel@montrealgazette.com Twitter.com/Aaron_Derfel
  • The median wait time in hospital for a magnetic resonance imaging (MRI) scan in Quebec jumped to 12 weeks this year from eight in 2014, a survey has revealed. Wait times also increased slightly for other medical imaging. ALLEN McINNIS-MONTREAL GAZETTE FILES • MONTREAL GAZETTE / Source: Fraser Institute
Govind Rao

Non to austerity in Quebec: Demonstrations scheduled for Saturday | rabble.ca - 0 views

rabble.ca/...onstrations-scheduled-saturday

from heather Quebec cuts campaign union ally

shared by Govind Rao on 23 Mar 15 - No Cached
  • March 19, 2015
  • Spring is being welcomed in Quebec with a Popular Protest (Manifestation populaire) against austerity and the petro-economy this Saturday, March 21, called by Printemps 2015 organizers. Saturday's event in Montreal will be the biggest of the day, though others are planned around Quebec. 
  • The schedule of events for the spring in Quebec is packed. Highlights include a National Protest (Manifestation nationale) on April 2, the Act On Climate March in Quebec City April 11, and a wide-ranging Social Strike (Grève sociale) on May 1. 
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  • This builds off active fall and winter seasons which saw, among other events, a massive Halloween demonstration in Montreal dubbed "Austerity: A Horror Story", and at the end of February a week over 100 educational and mobilization actions throughout Quebec including banner drops, lectures, singing in bank lobbies, and occupying ministers' offices.
  • Unlike the spring of 2012 in Quebec, the core of this mobilization is much broader than students and includes community groups, professors, day-care workers, parents, unions and more. 
  • Quebec's public-sector unions are currently in contract negotiations with the government and some may be in a position to strike legally as early as April 1. There is mobilization happening at local union levels, especially in those focused on health and education, where the cuts and legal changes  will be strongly felt. 
  • Organizers in the rest of Canada are hoping the movement in Quebec can inspire action in their English-speaking communities. And it may be starting. 
  • David Gray-Donald
Heather Farrow

Billing crackdown is long overdue - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|tost|20160923|256771653

medicare fees CHT

shared by Heather Farrow on 23 Sep 16 - No Cached
  • Toronto Star Fri Sep 23 2016
  • Federal Health Minister Jane Philpott has served notice that she will enforce the Canada Health Act in Quebec. Good for her. It's about time. The Canada Health Act is the federal statute governing medicare. It lists the standards that provinces must meet if they are to receive money from Ottawa for health care. And it gives the federal government the right to cut transfers to any province that doesn't meet these standards. In particular, it imposes a duty on the federal health minister to financially penalize any province that allows physicians operating within medicare to bill patients for extra, out-of-pocket fees. Successive federal governments have been reluctant to use this power. They have usually done so only when the offence is so obvious that it cannot be ignored.
  • From the Canada Health Act's inception in 1984 until 2015, Ottawa clawed back a net total of $10 million from five provinces that permitted extra-billing. Alberta, British Columbia and Manitoba were the biggest offenders although Newfoundland and Nova Scotia also got nicked. Compared to the billions the federal government spent on health transfers over the period, these penalties were pittances. But they did make the point that medicare is indeed a national program. And in every province except B.C., where the issue has morphed into a constitutional court case, the extra-billing problem was apparently resolved.
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  • However, until now no federal government has had the nerve to take on serial offender Quebec. Quebec has been allowing its doctors and clinics to charge extra user fees since 1979. The province's current health minister, Gaetan Barrette, freely acknowledges this. In some cases, these fees were truly exorbitant. The Montreal Gazette reported last year that some colonoscopy clinics were charging patients an extra $600 for medications - on top of the publicly paid medicare fee. Many Quebecers were outraged. The provincial Liberal government's somewhat peculiar response was to pass a bill codifying the practice of extra-billing but giving itself the authority to regulate it. In March 2015, the then-Conservative government in Ottawa formally notified Quebec that it would be looking into the issue. This March, Liberal Philpott sat down with Barrette to discuss the practice. On Sept. 6, she sent her provincial counterpart a letter threatening cutbacks to Quebec's health transfer. A few days later, Barrette announced that extra billing will end as of next January.
  • It is hard to gauge the importance of Philpott's threat. User fees have become widely unpopular in Quebec. That alone may have been enough to drive the provincial government to disavow them. Still, it was bracing to see a federal health minister publicly standing up for the principles of medicare. It is not an everyday occurrence. It is particularly interesting that she targeted a province that is notoriously touchy about what it sees as federal interference. Perhaps she will do more. Certainly, more needs to be done. The latest annual report on the Canada Health Act filed with Parliament notes that private MRI clinics in British Columbia, Alberta, Quebec, New Brunswick and Nova Scotia are charging user fees to patients. It says some hospitals are avoiding the ban on charging for drugs by routing the sick through outpatient clinics - which do charge. It also notes that the portability requirement of medicare, which allows Canadians to receive care outside their home provinces, is routinely ignored.
  • Quebec routinely refuses to fully reimburse other provinces that provide health services to Quebec residents. Yet it has never been penalized by Ottawa for this. Nor have an unspecified number of other provinces that, at one time or another, did the same. Except for Prince Edward Island, the report says, no province appropriately reimburses residents who obtain medical care outside Canada. Such patients aren't necessarily entitled to the full cost of their out-of-country care. But they are entitled to be reimbursed for the amount it would have cost them to be treated in their home province. To work as a national program, Canadian medicare needs two things. First, the federal government must put up enough money to give it a real financial role in the system. The 2002 Romanow royal commission suggested that Ottawa provide at least 25 per cent of medicare funding. That figure still makes sense. Second, Ottawa has to use its financial clout to enforce those few national standards that do exist. A former Liberal health minister, Diane Marleau, tried to do this back in the 1990s. She was sandbagged by Jean Chrétien, the prime minister of the day. Let's hope Philpott has better luck.
  • It was bracing to see a federal health minister stand up for medicare principles, writes Thomas Walkom.
Heather Farrow

Quebec government abolishes independent health watchdog - Montreal | Globalnews.ca - 0 views

globalnews.ca/...es-independent-health-watchdog

Quebec regulation cuts

shared by Heather Farrow on 30 May 16 - No Cached
  • May 20, 2016
  • QUEBEC CITY – The province has decided to get rid of the body in charge of evaluating how well Quebec’s health care system is working.The Liberals call it a cost-saving measure, but the opposition insists the government doesn’t want its decisions being questioned.
  • Heather Farrow on 30 May 16
     
    Quebec plans to close the office of its health care commissioner, an independent body tasked with evaluating the province's health care system. The government said it was a cost-savings move, but opposition members claimed the decision was made to shield the health minister from criticism.
Heather Farrow

Poor wait times in Quebec - 0 views

www.thestar.com/...western-world-report-says.html

Quebec waits privatization

shared by Heather Farrow on 06 Jun 16 - No Cached
  • Heather Farrow on 06 Jun 16
     
    35 per cent of patients in Quebec must wait five hours or more for care, a report released today has found. Quebec has the worst emergency department wait times in the western world, according to a report by the province's health and welfare commissioner. The percentage of patients waiting five hours or more is 35%, compared to 15% in Ontario and 5% in the United States.
  • Heather Farrow on 06 Jun 16
     
    35 per cent of patients in Quebec must wait five hours or more for care, a report released today has found.
Heather Farrow

QC Auditor General misses point: extra-billing is illegal | Press Releases | Newsroom - 1 views

canadiandoctorsformedicare.ca/...-extra-billing-is-illegal.html

cdm Quebec audit privatization private clinics legislation court

shared by Heather Farrow on 12 May 16 - No Cached
  • TORONTO (May 12, 2016) – Extra-billing in Quebec medical clinics are “excessive” says Auditor General Guylaine Leclerc, but Federal Health Minister Jane Philpott has yet to act on calls to enforce the Canada Health Act and bring them under control. Leclerc tabled her Spring 2016 report yesterday in the National Assembly, which focused on the billing practices of medical clinics patients for services already covered by provincial insurance, or extra billing. According to the audit’s findings, neither the Ministry of Health (MSSS) nor Quebec’s health insurance board (RAMQ) are providing sufficient guidance and oversight with clinics and their billing practices.
  • Leclerc failed to recognize extra-billing prohibits equitable access to health care as well as violates sections 18 to 21 of the Canada Health Act. “Charging fees to patients for services covered by Quebec’s provincial insurance hurts everyone,” said Dr. Monika Dutt, Chair of Canadian Doctors for Medicare. “They deter people from seeking care, make health outcomes worse and in the end, drive up the costs as people get sicker before seeking treatment. Extra-billing is also not allowed under the Canada Health Act.” In March, Canadian Doctors for Medicare (CDM) asked the Honourable Jane Philpott, Canada’s Minister of Health, to defend and enforce the Canada Health Act against contraventions in British Columbia, Saskatchewan, Ontario as well as Quebec. CDM reiterated their concerns at May 3 press conference in Montreal hosted by FADOQ, a leading seniors’ organization in Quebec, that is seeking a writ of mandamus from the Federal Court to compel the Minister of Health to enforce the Act in the province.
  • “As physicians, our organization’s goal is to improve Medicare, which will not happen if the provincial and federal governments continue to ignore the problem of extra-billing,” Dutt continued. “CDM calls on the federal government to protect public Medicare in Quebec and across Canada by applying the penalties prescribed in the Act against extra billing.” Canadian Doctors for Medicare provides a voice for Canadian doctors who want to strengthen and improve Canada's universal publicly-funded health care system. We advocate for innovations in treatment and prevention services that are evidence-based and improve access, quality, equity and sustainability.
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  • Auditor Calls Quebec Extra Billing Out of Control Doctors Call on Health Minister Jane Philpott to Illegal Billing Practices in Quebec TORONTO (May 12, 2016) – Extra-billing in Quebec medical clinics are “excessive” says Auditor General Guylaine Leclerc, but Federal Health Minister Jane Philpott has yet to act on calls to enforce the Canada Health Act and bring them under control.
Govind Rao

Rural ERs better in Quebec than Ontario - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246200|ntnp|20150506|219898181

from heather rural emerg Ontario Quebec hospital cuts

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  • National Post Wed May 6 2015
  • Rural emergency departments in Ontario have dramatically fewer CT scans, specialists and nearby intensive-care units than those in Quebec, suggests a new study that adds to evidence of wide quality gaps in Canada's emergency health care. The findings parallel a similar disparity the researchers discovered earlier between rural ERs in British Columbia and Quebec.
  • They are now studying whether that lack of specialists and equipment affects the number of non-urban Canadians who die from trauma, stroke, heart attack and severe infection. The early results are "concerning," said Richard Fleet, a Laval University emergency-medicine professor who co-authored the newest research. "In a rural emergency department, people actually save lives by working as teams," said Dr. Fleet, who practised in a small-town B.C. emergency department before heading to Quebec. "For emergencies ... it's really good to have these backup systems in house."
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  • One prominent rural ER physician in Ontario rejected the notion that his province's departments are inferior, saying the focus is more on sending the sickest patients to big trauma centres. Across the country, however, wide variations in emergencydepartment standards definitely do exit, said Alan Drummond, a spokesman for the Canadian Association of Emergency Physicians. "It's a crapshoot, when you go to any hospital in this country, in terms of what you're going to get in the type and quality of care," he said. "We have national variability and for 23 per cent of Canadians (who live outside cities), that's unacceptable." About 6 million Canadians live in rural areas, tend to be older on average, have greater health needs, and are more likely to suffer traumatic injury, partly due to the prominence of dangerous professions like farming and logging.
  • Fleet became interested in the relative quality of emergency service after cutbacks meant his former hospital in Nelson, B.C., could offer only "bare-bones services to a high-risk population." He lobbied for additional funding, but realized there were no published data comparing different Canadian emergency departments. In the most recent study, just published in the journal PlosOne, he and colleagues looked at rural departments with 24/7 service and an ability to admit patients to acute-care beds in their hospitals - 26 facilities in Quebec and 62 in Ontario. If anything, the Ontario ERs appeared more isolated on average, with a greater percentage of them being at least 300 kilometres from a trauma centre.
  • Yet 92 per cent of the Quebec emergency departments had a local intensive-care unit, compared to 31 per cent of the Ontario ones. Just over 80 per cent of the Quebec ERs had a general surgeon available on call, versus a third of the Ontario emergency departments. Fleet said he is not sure why Quebec's rural ERs are better equipped, given the provinces' spending on health care is similar per capita. It may relate to the fact its rural hospitals have fewer foreign-trained doctors, who may feel less empowered to demand better facilities. But Drummond said Ontario has a different protocol that ensures rural ER physicians are well-trained to provide basic emergency services - such as treating shock and blocked airways - and emphasizes funnelling critically ill patients to trauma centres in larger cities. The province's CritiCall system helps rural hospitals find facilities that can take their patients.
  • However, he agreed that having a CT scanner is now crucial to emergency departments anywhere making accurate diagnoses; the one his hospital in Perth, Ont., acquired five years ago "changed the way we practice." Just nine of 62 full-time rural Ontario departments had a CT scanner, according to the new study.
Govind Rao

National pharmacare plan not the answer; Quebec model is the one to follow writes, Yani... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|otct|20150819|227385877

from heather pharmacare

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  • Ottawa Citizen Wed Aug 19 2015
  • Many of those calling for a pan-Canadian pharmacare monopoly undoubtedly have the best of intentions. They want all Canadians to have access to the drugs they need, regardless of ability to pay, and they want to control costs. But good intentions do not guarantee good results - and in this particular case, international experience has much to teach us about the dangers of monopolistic drug insurance plans. Under Canada's current mixed public-private system, administered by the provinces, 42 per cent of prescription drug spending in the country is paid for by public insurance plans. The rest is funded privately, either out-of-pocket by patients themselves (22 per cent), or through private insurance plans (36 per cent). In every province, low-income seniors and children, welfare recipients, and people suffering from certain serious illnesses enjoy complete or nearly complete coverage. In all, about 98 per cent of the Canadian population has private or public drug insurance coverage.
  • It's true that some people report having to forgo requesting a prescription or skip a dose for reasons of cost. In a recent Commonwealth Fund study, 8 per cent of Canadians with belowaverage incomes said they had not taken a drug because of cost. But this phenomenon is hardly unique to Canada. Indeed, the same study found that this percentage was 11 per cent in France, 14 per cent in Australia, and 18 per cent in New Zealand. What explains these findings is the fact that the public insurance plans in place in other OECD countries, even those that are universal, don't cover pharmaceutical expenses in their entirety. A sensible portion of costs are paid by the insured - and generally a larger portion than in Canada.
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  • Rather than moving toward a countrywide public monopoly, Canada's provinces should follow the lead of Quebec, which in 1997 implemented a reform that made drug insurance coverage in the province universal, but that relies on a range of insurers, public and private. The costs of the Quebec system have risen since its implementation, but this is largely because Quebec has resisted the temptation to ration access to innovative drugs. Indeed, among Canadian provinces, Quebec provides the most generous coverage by far. Whereas on average 23 per cent of all drugs approved by Health Canada between 2004 and 2012 were reimbursable by Canada's provincial public plans as of December 2013, the proportion in Quebec was 38 per cent.
  • A national plan, it is argued, would provide the public insurer with greater negotiating power, allowing it to obtain price concessions from pharmaceutical companies. But the savings would largely come from increased rationing rather than from greater efficiency. In the United Kingdom, there has been one policy after another since the 1990s aimed at controlling spending. Patients continue to suffer the consequences of a lack of access to many proven drugs. Likely as a result of such restrictions, despite screening rates that are among the highest in the world, English patients have lower survival rates for various cancers than most other industrialized countries. In New Zealand, another country frequently held up as a model, patients' access to innovative drugs is just as restricted, if not more so. Of all the drugs approved in the country from 2009 to 2014, barely 13 per cent were reimbursable by the public insurance plan, the worst result among 20 countries evaluated.
  • It is also important to note that while Quebec spends more on drugs, this goes hand in hand with lower overall costs in the public health care system compared to other provinces, as more accessible pharmaceutical therapies have likely replaced other kinds of more expensive medical care, like hospital surgeries. Quebec's mixed universal plan is not perfect, but it does provide coverage to all residents. And only 4.4 per cent of Quebecers say they had to forgo taking their medicines or skip a dose for financial reasons - less than the residents of all other Canadian provinces, and less than the residents of many other countries, too. If one is concerned with universal access to the latest drugs, that's a far better model to follow. Yanick Labrie is an economist at the Montreal Economic Institute (www.iedm.org)
Govind Rao

How to increase Quebecers' access to family doctors - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|240525|mtgz|20140604|197532037

from heather privatization primary health care Quebec

shared by Govind Rao on 04 Jun 14 - No Cached
  • s a former Quebec health minister. His C.D. Howe Institute study, The Case of the Vanishing Physicians: How to Improve Access to Care, can be found at www.cdhowe.org. For years, Quebecers and Quebec doctors have documented poor access to health-care services in the province. This situation ought to change. Quebec must reform primary care and put in place stronger incentives for better access. In 2012 and 2013, roughly 15 per cent of Quebec patients surveyed by the Commonwealth Fund reported not having a family doctor, compared with about four per cent of Ontarians and five per cent of western Europeans. Further, 68 per cent of Quebecers reported having a "somewhat difficult" or "very difficult" time accessing after-hours care, versus 58 per cent of Ontarians and 46 per cent of western Europeans.
Govind Rao

Court allows Quebec law on assisted dying to go ahead - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20151210|235533245

from heather quebec legislation seniors

shared by Govind Rao on 10 Dec 15 - No Cached
  • The Globe and Mail Thu Dec 10 2015
  • Controversial Quebec legislation on assisted dying will become law on Thursday, says the province's Health Minister. Gaetan Barrette made the announcement Wednesday after Quebec's top tribunal gave the provincial government permission to appeal a lower-court decision that granted an injunction aimed at blocking adoption of the law. "That [Quebec Court of Appeal] ruling means that, as of tomorrow [Thursday], Bill 2 will be implemented fully," he told a news conference. "The ruling does not state anything for or against Bill 2 in any way. What it says is that, as of tomorrow, Bill 2 can be implemented until there is a definitive hearing and definitive decision on the actual grounds of the appeal."
  • Lawyers will be in court for that appeal on Dec. 18. Quebec Justice Minister Stephanie Vallee issued a statement later Wednesday and said the government will send guidelines to the Crown prosecutors' office in Quebec in a bid to reassure people in the medical community who may be worried about criminal proceedings. She said the guideline is aimed at "allowing people at the end of their lives to receive care that respects their dignity and their autonomy." The legislation, which was adopted by the National Assembly in June, 2014, outlines how terminally ill patients can end their lives with medical help.
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  • Quebec is the first province to pass such legislation, arguing it is an extension of end-of-life care and thus a health issue, which falls under provincial jurisdiction. The injunction sought by the Quebec-based Coalition of Physicians for Social Justice and Lisa D'Amico, a handicapped woman, was related to a Supreme Court ruling last February that struck down the prohibition on physician-assisted dying.
Govind Rao

Quebec promises more palliative care | Montreal Gazette - 0 views

montrealgazette.com/...-promises-more-palliative-care

from heather quebec palliative ltc

shared by Govind Rao on 24 Nov 15 - No Cached
  • November 16, 2015
  • November 16, 2015
  • QUEBEC — The Couillard government responded to critics on Monday and presented its 2015-2020 plan for more palliative care in the province. Health Minister Gaétan Barrette began by describing the level of service currently offered as inadequate. “Elements are dysfunctional,” he said. “The people who provide palliative care in Quebec, they’re involved and they give great quality services. But policies are random in Quebec, the implementation of policies is random … I would say, politely, that it’s not uniform.”
  • Govind Rao on 24 Nov 15
     
    Quebec Health Minister Gaétan Barrette unveiled a $10-million, five-year plan for palliative care in the province. The plan earmarks half a million dollars for training of orderlies, $4.5 million for lump-sum payments of $1000 to family caregivers, and provides for 48 new palliative care beds in the province.
Irene Jansen

Medecins Québécois pour un Regime Public. Two-Tier Radiology: Quebec's Creep... - 2 views

www.mqrp.qc.ca

doctors quebec coalition ally private clinics

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  • Irene Jansen on 19 Nov 12
     
    Our 2012 annual report is now available in English The report shows: "While it has more material and human resources, Quebec is less effective than Canada as a whole in providing accessible medical imaging services. The exclusion from public coverage of CAT scan, MRI and ultrasound tests performed outside a hospital leads to joint public-private practice that has the effect of draining resources from the public to the private sector. This damaging distortion leads to problems of access to medical imaging for most patients…"  The report documents the inequitable, inefficient, costly and potentially unsafe utilization of medical imaging technology in Quebec's unique and highly privatized system.  One aspect, the relatively effective use of technology in hospitals compared to private clinics (which would be better yet if the system were entirely public), is clearly not limited to Quebec: "According to a 2008 study by Bercovici and Bell of public hospitals and private clinics offering MRIs in several provinces, including Quebec, the rate of use of machines is about 50% higher in hospitals than in private clinics: an average of 14.7 hours of operation per day during the week and 11.8 hours per day on weekends for hospital machines, compared to 9.7 hours per day during the week and 8.2 hours per day on weekends for machines in clinics." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645224/ The recommendations are also valuable information. 
Govind Rao

Fees are a barrier to care; Federal politicians should be denouncing Quebec's recent mo... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|mtgz|20151014|231353438

from heather quebec user fees doctors legislation privatization private clinics

shared by Govind Rao on 14 Oct 15 - No Cached
  • Montreal Gazette Wed Oct 14 2015
  • With a federal campaign in full force grabbing the majority of the headlines, a significant threat to Canada's most treasured national program is going largely unnoticed. For many years, certain physicians and clinics have quietly been charging extra fees for health services. In some provinces, the frequency of such charges has been increasing. These include hidden charges for medications that are many times their actual cost or access fees of hundreds of dollars for examinations such as colonoscopies. Because these fees are for services that are covered by the health system, this is, in effect extra-billing, a practice that is against federal and provincial law.
  • In Quebec, Health Minister Gaétan Barrette has identified these fees as a problem, as have many others for many years. You might expect Barrette to clearly inform patients and practitioners that this practice is illegal and put an end to it. Instead, he is trying to regulate and "normalize" these fees, in direct contravention of the Canada Health Act.
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  • When the Canada Health Act passed in the House of Commons in 1984 with unanimous support from all political parties, its primary purpose was to put an end to extra billing like this. Charging patients at the point of care for medically necessary services strikes at the heart of the principle that access to health care should be based on need rather than ability to pay. It undermines equity, increases system costs and reduces commitment to the public health care system. It's also illegal.
  • Why are we not hearing resounding denunciations of Barrette's plan from our federal politicians? Research has consistently demonstrated that forcing people with less money to pay a fee to access care means they might not seek out medical attention until later in the course of their illness. This means patient outcomes are likely to be worse and treatment more complicated and costly. Given higher levels of illness among people in poverty, these fees also shift costs to those who use the system most but can least afford to pay.
  • Doctors in Quebec and across the country have expressed alarm at Barrette's amendment to Bill 20, which regulates extra billing rather than prohibiting it. The Canadian Medical Association, Quebec Medical Association, Canadian Doctors for Medicare, Médecins Québécois pour le Régime Publique, and the Quebec College of Family Physicians have all come out against this decision, joining patient groups, all of Quebec's opposition parties, and Raymonde Saint-Germain, the independent Quebec Ombudsman. The measure was passed on Oct. 7, with no public debate. Bill 20 is currently before the National Assembly and is expected to become law this fall.
  • Barrette is effectively bringing user fees in through the back door. Rather than introducing user fees charged by government, he would let clinics do so. This further fragments care and makes access even more inequitable.
  • In this federal election campaign, the talk has been around reducing barriers to access by improving coverage of prescription medicines, home care and mental health care. Yet at the same time that our federal parties are committing to such muchneeded expansion, they are silent on protecting the core of medicare: publicly funded doctor and hospital services.
  • Any party that claims to be committed to the Canada Health Act should immediately state its position on the amendments to Bill 20 in Quebec. To do less is to skirt the core federal responsibility for medicare in Canada. Ryan Meili is a family physician in Saskatoon and an expert adviser with the Evidence Network. Danielle Martin is a family physician and vice-president Medical Affairs and Health System Solutions at Women's College Hospital in Toronto. Both are members of the board of Canadian Doctors for Medicare.
  • JACQUES BOISSINOT, THE CANADIAN PRESS / Health Minister Gaétan Barrette has put forward a measure that would regulate extra billing rather than prohibit it. It will become law when Bill 20 is adopted.
Heather Farrow

Quebec plans to introduce 50 superclinics by 2018 | Montreal Gazette - 0 views

montrealgazette.com/...-to-ease-pressure-on-hospitals

Quebec private clinics legislation cma

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  • April 25, 2016
  • Quebec Health Minister Gaétan Barrette has announced a plan to introduce 50 so-called superclinics in the province to offer front-line health services and ease the crush of cases in emergency rooms. “We are one step closer to strengthening and consolidating the organization of medical services for the entire population of Quebec,” Barrette said Monday. “Complementing services offered by family medicine groups, the superclinic model will reduce the waiting time for emergencies and provide faster access to primary care and specialized services.” Barrette, who is hoping to have the clinics operating by 2018, said those who’d benefit in particular are people still looking for a family doctor.
  • Heather Farrow on 02 May 16
     
    Quebec will open 50 "superclinics" by 2018 to reduce the pressure on emergency rooms from non-urgent medical cases and provide faster access to primary and specialty services. The clinics will be required to run at least 12 hours a day; offer blood-testing and diagnostic imaging; and provide 80% of services to people without a family doctor.
Govind Rao

Porter's missing millions; Police continue to seek alleged bribe money - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|wist|20150722|225361361

from heather p3 hospital Quebec fraud

shared by Govind Rao on 22 Jul 15 - No Cached
  • Windsor Star Wed Jul 22 2015
  • With the death last month of alleged hospital fraudster Arthur Porter, the mystery of where he might have stashed as much as $5 million in suspected bribe money continues to frustrate police investigators. Quebec authorities last year obtained court orders to freeze Porter's luxury properties in the Caribbean, along with multimillion-dollar bank accounts around the world. They also froze assets belonging to Porter's one-time right-hand man, Yanaï Elbaz, and his brother, Yohann. Porter, the former CEO of the McGill University Health Centre, was charged with accepting bribes, money-laundering, conspiracy and fraud, among other crimes, stemming from the awarding of the $1.3-billion MUHC superhospital construction contract. Engineering firm SNC-Lavalin won that contract in 2010, and two of its former senior executives are accused of funnelling $22.5 million in bribes to Porter.
  • In December, a lawyer representing the provincial agency that seizes the proceeds of crime said authorities were in the process of "confiscating" all the assets from the alleged MUHC plot. Paul Mercier of the Bureau de lutte aux products de la criminalité gave a precise total for the amount that was frozen: $17.5 million. As for the remaining $5 million that is alleged to have been paid in secret commissions, Mercier was at a loss to explain where it might have been laundered. Since Porter's death on June 30, investigators and officials with the provincial agency have been tight-lipped about the missing loot. One lawyer with the agency would speak only on condition the interview be conducted off the record and, even then, did not answer a reporter's questions about the missing $5 million.
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  • However, an examination of court documents by the Montreal Gazette suggests that most of the missing funds - $4 million - was likely transferred to the country where Porter was arrested by Interpol agents two years ago and where he died: Panama. Indeed, in the days after Porter's death, the Unité permanante anticorruption dispatched two investigators to Panama not only to identify his body but to search for the missing funds, according to La Presse. "I want to assure Quebecers that we are continuing to deploy the resources and energy to recover for Quebec large sums of money that was defrauded," UPAC commissioner Robert Lafrenière said in a July 7 statement.
  • Anne-Frédérick Laurence, a UPAC spokesperson, would respond only to one question from the Gazette: "The only question I can answer concerns the money that has been blocked: close to $18 million. The judicial process is underway in this file, and that's why we can't respond to any other questions." Lawyers for some of the accused, including Riadh Ben Aïssa, a former SNC-Lavalin vice-president in charge of its international construction division, petitioned a Quebec Court judge last year to impose a publication ban on all but one of the police affidavits in support of the asset freezes. But that one affidavit provides strong hints of where most of the missing $5 million might have been transferred. Even much of that affidavit is still sealed, but what isn't is an annexed diagram in fine print at the end of the document. (None of the allegations in the affidavit have been tested in court.)
  • The diagram alleges an intricate web of money-laundering transfers by Porter, his wife, Pamela Mattock Porter, and the Elbaz brothers. In December, Pamela Porter pleaded guilty to money-laundering and was sentenced to two years in jail. The diagram alleges that Ben Aïssa made $22.5 million in unauthorized payments on behalf of SNC-Lavalin in 2010 and 2011 to Sierra Asset Management, a shell company controlled by Porter in the Bahamas. Half of that money was wired to Pan Global Holdings, another Bahamian shell company, allegedly controlled by the Elbaz brothers. Pan Global, in turn, wired millions of dollars to a number of bank accounts held by Porter and the Elbaz brothers, according to the diagram. The company also wired $4 million to an obscure company called Dallano Holdings Inc., which the diagram alleges was controlled by Yanaï Elbaz. A $2-million payment to Dallano was allegedly made on June 4, 2010, just two months after the superhospital contract was awarded to SNCLavalin. A second $2-million payment was allegedly made on Dec. 22, 2010, more than two weeks after Porter abruptly quit the MUHC, as scrutiny by the MUHC's board of directors intensified about his private business activities.
  • Over time, the Porter-Panamanian connection would grow stronger - and more mysterious. On June 4 last year, while Porter was still in La Joya jail fighting extradition to Quebec, he set up a company in Panama with the help of his lawyer, Ricardo Bilonick Paredes.
  • • Jeff Todd, The Canadian Press Files / Since Arthur Porter's death in Panama on June 30, Quebec investigators have been unable to explain what happened to $5 million that is alleged to have been paid in secret commissions for contracts for a new Montreal hospital. One court document suggests the missing money may have been sent to Panama.
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