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Suburban Exclusive: Quebec Health Ministry report raises spectre of health-care “prioritization”

The Suburban has obtained a copy of a protocol issued in the name of the assistant deputy Minister of Health of Quebec Dr. Lucie Opatrny on Nov. 2 concerning the “prioritization” of access to intensive care for adults in the context of an “extreme pandemic.” Both it’s assumptions and recommendations are dramatic and troubling as they raise the spectre of selection and rationing of health care.

The Protocol is entitled “Priorisation pour l’accès aux soins intensifs (adultes) en contexte extrême de pandémie.” The Suburban has sent e-mailed a series of written questions on what you will read below to appropriate government officials. No answer has been received by press time.

Among the more disturbing aspects of this report are the following : 1. some 41 medical and academic personnel were involved in its authorship yet as far as we have been able to find none were from Montreal; 2. it implies that rationing of ICU admittance, medicine and care is coming based on assumptions of “150-200%” surges in hospitalizations — a number that is four times greater than any previous surge — leading to a near total collapse of hospital capacities. Yet as of this writing Quebec has over 7300 empty hospital beds and hospitalizations and deaths continue at low levels with some 95% of Covid tests coming back negative every week; 3. It calls for three-person committees in hospitals to approve the access to care and particularly ICU admittance; 4. perhaps most incomprehensible is that though it cautions against any discrimination based on any of the aspects protected by the Quebec Charter of Rights and Freedoms such as colour, creed, religion, gender and even physical handicaps, it leaves open the possibility — written in parentheses — that as far as age is concerned this may not be protected “if laws permit it.” No such exemptive laws permitting ageism currently exist. ; 5. in lightly coded language it even leaves open the door to terminating ICU care without anyone’s consent and the discharge of patients from hospitals prior to the completion of their course of treatment or term of recovery. Implied throughout, is that these three-person committees would be the determinators.

The questions we sent to the government are the following: 1. under what legal rubrique was this protocol permitted to be put forward? 2. why is there no appeal mechanism to any ombudsperson or anyone in the event of the withdrawal or rationing of care? 3. why has this not been publicized to the population as is required in the event of an increase or decrease in medical care as required by Quebec’s own health legislation? 4. is this publicity not also part of the responsibilities of a “moral contract?” 5. finally, were there individuals involved in this who were also involved in formulating the disgraceful “Do Not Resuscitate” order to Urgences Santé in April that The Suburban front-paged two weeks ago?

This is a developing story and we will be publishing updates online amd in had copy in the days ahead.

CDN/NDG anti-corruption audit winds down

The anti-corruption management audit ordered by Côte des Neiges–Notre Dame de Grâce Borough Mayor Sue Montgomery is complete.

Meant to articulate what the borough needs to meet the ISO 37001 international anti-bribery management standards, the 55-page report by Gestion Jean Bourdeau acknowledges changes have been implemented to clean up the city’s contracting and acquisitions processes since the Charbonneau Commission, but there are lapses, and measures only partially present or missing.

For example, there is no dedicated person or anti-corruption training in place, only internal audits by the city centre, nor is there an actual clear anti-corruption policy per se, she told The Suburban. “That sort of piqued my interest in the audit.” There are conflict of interest, ethics and other measures, but no single articulated anti-corruption policy, or specific management review, other than normal yearly reviews and in the event that a specific complaint is made.

“At the end of the day I am responsible for $70 million of taxpayers’ money,” says Montgomery, “and part of that responsibility is making sure that it’s spent properly and responsibly.”

The diagnostic maps out the path to meeting the standard, which mostly deals with bribery, but can be appended to address bid-rigging, collusion and more. The process could take 18-24 months if the borough was exclusively in charge of its affairs, but a more accurate calendar is not possible given that the centre city figures heavily, and the current, less-than-optimal work environment between Montgomery and the borough’s administration.

Montreal Opposition leader and Darlington councillor Lionel Perez first proposed it to city council in 2018 to no avail, and then part of Projet Montréal, Montgomery opposed the idea, but as an independent now wants to press forward. City council also blocked consideration by the Inspector-General’s committee and steered it towards finance and administration, which leaned heavily on the city Comptroller-General’s office in their work. That raised eyebrows by some observers who viewed asking those in charge to determine if they are doing a sufficient job as problematic.

“This is why I asked for the audit. I wanted someone from the outside to come in and do this analysis” she says, insisting that city employees “were very cooperative. They did a very thorough job, our auditors told us that our bureaucrats gave them their full cooperation, provided all the documents they asked for and followed up.”

The finance committee report released last summer was unimpressed with ISO 37001, deemed more about corruption than fraud and collusion, and signaled high costs to maintain certification due to requirements like “strong political engagement, leadership and administration at every level,” concluding that the Controller-General Inspector-General and Auditor-General offices could sufficiently address the concerns.

To meet the standards the borough requires a dedicated employee at half-duty – less moving forward – and up to $20,000 for external consultants during the process, along with re-certification every three years. Recommendations also include measures for supplier compliance where the borough is concerned. “For example, we see construction materials of lower quality than what’s in the contract, so in that case if a company employee wants to denounce that, there is a mechanism for them to do so.”

Despite CDN-NDG’s recent legacy involving influence peddling, UPAC investigations, bribery allegations and other scandals, Montgomery doesn’t believe that corruption is present today, “but there is longstanding distrust by the public. Let’s get a mechanism in there that will instill some confidence. It would entail some expense, but I think it’s money well spent and worth helping gain the public trust.”

The report, to be tabled Monday night, will soon be accompanied by a more detailed look at the finance committee conclusions. Whatever happens with them, recommendations are now on record says Montgomery. “Whoever is in power next year, and I hope it will be me, this can’t be dismissed. And I will continue this exercise. I think we can set an example here.” “We can be the first borough to do this.”

Legault cancels Christmas gatherings

Christmas gatherings with people from other households will not be allowed in Quebec’s red zones, including the Montreal area, Premier François Legault announced Thursday.

“This is a governmental decision, not one made by Public Health, but Public Health is in agreement,” he said. “It’s not a good idea to get together, the virus present in every region of Quebec....This year, it will be a very quiet Christmas.”

This is a reversal of the Premier’s previous announcement that gatherings of up to 10 people would be allowed on two days between Dec. 24 and 27, and that Quebecers would be expected to honour a moral contract to isolate themselves a week before and after those dates.

Legault told Thursday’s press conference that the situation in hospitals is “fragile” and they they are “almost at the limit of what they can do.

“Regardless of how many beds we have, we don’t have enough staff,” he added. “The pandemic has been around nine months, and the hospital staff are tired, 6,600 are on sick or preventive leave.”

Legault did say that while the death toll is 30 per day, it is at least 80 percent less than during the peak of the first wave this past spring.

“It’s not realistic that this will be reduced by Christmas,” he added, then announcing that the previously allotted two days of Christmas gatherings are cancelled in red zones, and only members of the same household can be present in a home. “We can’t have police in every home, but there will be fines.”

However, one person can still visit another person living alone, and Legault encouraged such visits as long as masks are worn and those involved stay two metres apart.