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Legal Ease: Vulnerable citizens in need of white knight

A directive has been issued as part of Program 68 by the Agence de la santé et des services sociaux de Montréal that will affect some of our most vulnerable citizens—those recovering in hospital.

Once stabilized—that is, no longer in need of hospital care—a patient is to be discharged within eight days without regard to his needs or the availability of persons or services to tend to those needs. This is meant to be preferable to switching residences until a permanent placement is found. How will this affect those—many of whom are seniors—with limited mobility and/or capacity but without anyone to help them bathe, use the bathroom, cook a meal or pay the bills? The government must balance health services and funding without violating human rights.

The Quebec health system was created by the Health and Social Services Act. Its goal is to maintain and improve the physical, psychological and social capacity of people to function within society.

There are three levels of organization. First is the minister responsible for health and social care services. He is to maintain, improve and restore the health and well-being of the population by providing a range of services, improving access and quality of services and ensuring efficient management of financial and human resources. He must develop plans to monitor the health and social issues of the population to identify major problems and gather information for the promotion of health and the adoption of public social policies.

The next level consists of 18 regional agencies of which the Health and Social Services Agency of Montreal is one. The third level consists of local service providers. Each level has its own complex organizational structure and its own set of priorities.

The primary objectives of the regional agencies are to assess the needs of the population, establish and coordinate health and social services and arrange for financing, human resources and special services. The agency must develop methods to protect users and promote and defend their rights. Each agency must develop a multi-year strategic plan to improve the health and well being of the population. This must be approved by the minister and serve as a basis for developing a National Public Health Program, which is to include decreasing the risk factors affecting, in particular, the most vulnerable groups of the population.

Before implementing a regional health program, the agency must consult the People’s Forum respecting health and social services.

This “People’s Forum” is created by the agency to establish ways of consulting with the population on matters of health and well-being, to make recommendations to improve public satisfaction with health and social services and to better respond to the needs of the public.

In February 2013 the Canadian Foundation for Health Care Improvement Issues produced A Report on Funding Health and Social Care in Montreal (link opens a PDF), in which it analyzes the health care system in Montreal and discusses different funding possibilities. It points out several failings in the system, including a tendency for community health services to focus on budgetary considerations rather than quality of care or user needs.

Most disturbing for seniors was the finding of a lack of any process to assess the accuracy of data regarding long-term care patients. Consequently there is little known regarding the clinical characteristics of these patients, making the nature and extent of their care needs “challenging to evaluate.” Also disturbing was the finding that there are few data to support the effectiveness of funding provided for social care.

The goals set out in the act are commendable. But the methods created to fulfill these goals must respect and abide by the provisions of our laws and rights. An agency must respect a person’s right to life, his personal security, the integrity of his person and his dignity and treat the user of the health system “with courtesy, fairness and understanding, with respect for his dignity, autonomy, his needs and his security.”

It must acknowledge that every user has the right to choose the professional or the establishment from which he wishes to receive health or social services and to participate in every decision affecting his state of health or well being. The right of choice may depend on availability of such resources as money and manpower and where users have gone to court on these issues some cases have been won, and some lost.

An example of a winning case is found in a judgment of the Quebec Superior Court rendered in 1992. The patient had been in the hospital for two years, as a bed in the residence of his choice was not available. His family visited him regularly. The hospital decided to move him to a temporary residence far from his home. The patient and his family objected and went to court to stop the move. The judge granted their request and the patient was permitted to remain in the hospital until a bed became available.

The judge discussed our health system, the rights it provides to users and the problems of funding. He concluded that the dilemma created between the limitations of funding and the needs and rights of the individual user must be resolved politically and declared that a right to a health service is illusory if that service is not available.

The head of the Montreal Health and Social Services Agency has stated that the objective of the new directive is the best care for the elderly. That may be, but let us make sure that in implementing that objective, no one is abused and that the rights of all users are respected.

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