It’s been over a year since Bill 10, the Quebec government’s complex reform of health and social services, came into effect. But what about its implementation?

Lawyer Eric Maldoff, who worked tirelessly for 40 years to protect the rights of Quebec’s English-speaking community, is the man to ask. He was a key player in lobbying for changes on behalf of the Quebec Community Groups Network (QCGN), considered the voice of English Quebecers, linking 48 English-language community organizations across the province. He discussed the changes with Health and Social Services Minister Gaétan Barrette and his staff, and monitored their implementation.

Maldoff reviewed the status of community institutions under the new law in an interview at the Montreal offices of Lapointe, Rosenstein, Marchand, Melançon, where he is a corporate lawyer.

Most prominently, the law guarantees the bilingual status of the consolidated agencies on Montreal island that govern participating institutions, known by the French acronym as CIUSSS, Centre intégré universitaire de santé et de services sociaux.

The CIUSSS Centre Ouest-de-Île-de-Montréal covers 30 institutions, including the Jewish General, five CLSCs, Miriam Home, Constance-Lethbridge Rehabilitation Centre, Maimonides Geriatric Centre, MAB-Mackay Rehabilitation Centre, Richardson Hospital, Jewish Eldercare, Mount Sinai Hospital, and some seniors residences.
The CIUSSS Ouest-de-l’Île-de-Montréal includes Lakeshore General and St. Mary’s Hospitals, Batshaw Youth and Family Centre, Douglas Mental Health University Institute, West Montreal Re-adaptation Centre, and Lac St. Louis and Pierrefonds CLSCs. The other three CIUSSS on the island are required by law to ensure that some service in English is provided at some of the institutions they govern.

Equally important, Maldoff’s team negotiated the presence of at least one English-speaking representative to sit on the boards of all integrated health and social services centres in Quebec, as well as un-amalgamated institutions, including the MUHC and CHUM super hospitals, Ste. Justine’s Hospital, and the Pinel Institute.

“It was a bit of a bumpy road,” Maldoff recalled.

The access committees created under previous legislation had ceased to exist. Goodwill triumphed, however, and the ministry “did its best” to appoint names to the boards that were recommended. In fact, some boards now have more than one English-speaking representative.

Having members from the English-speaking community on these boards is important because the boards, according to Maldoff, are in their formative period when practices and precedents will be established. “If you can get it right at the beginning, you have a system that is functioning well,” he said.

English-speaking representation throughout the system at the board level is necessary to counterbalance the centralizing effect of Bill 10. The legislation was designed “to create a nice, Cartesian centralized system where everything is identical,” he noted. “On a broader scale, you have to think of the impact that it has on the ability of the health and social service system to be responsive to local particularities, on a timely and sensitive basis.”

Maldoff believes Dr. Barrette is sensitive to the needs of institutions that cater to English-speakers. “The system has to be open to innovation, to allow those on the ground to make decisions that are appropriate to circumstances they are facing at the time.

“You can’t run a healthcare system by some sort of operating manual … The health and social services system is full of highly trained professionals who have the necessary judgment to care for the wellbeing of those under their care, and they have to have latitude to make those kinds of judgments, and not wait for permission.”

In recognition of the historic roots of the institutions that became part of groups, or are amalgamated into integrated centres, each can have a seven-member advisory committee.

Maldoff says this is an opportunity for grassroots participation in governance. The advisory committees are expected to make recommendations to the boards of the integrated centres on ways to preserve the cultural, linguistic, and/or historic character of the group or amalgamated institution.

The foundations that support these bilingual institutions can also continue to carry on fundraising independent of the integrated centre, he noted.

“We have maintained some of our legal status, maintained and enhanced some of our bilingual status, and got advisory committees that enable the community to have some meaningful engagement with the integrated centre,” Maldoff said. “The right to services in English has actually been strengthened under Bill 10.”

Of course, institutions built over the years have lost a lot of their autonomy. They no longer have their own governing boards, and the chief executive officers of the integrated centres report directly to the deputy minister of health, to whom they are responsible, and less directly to their boards. To make the new system work, engaged and informed members of the public are needed to volunteer for advisory committees and to use influence there to protect and enhance patient rights.

“The reality of the health care system here is to know enough to be able to speak up,” Maldoff said.