A new directive to hospitals may cost lives

Off-islanders may no longer be welcome here

There are few events as traumatic in someone’s life as the threat that they might lose it.

That’s a fear that thousands of Quebecers and their families face every day in medical waiting-rooms across the province. Health problems that initially begin to show themselves as small lumps or rashes or slight coughs or numbness could eventually reveal themselves as cancer or heart disease or stroke or any other of the myriad modern diseases.

Many of these illnesses are indiscriminate. They could hit anyone at any time. But others show a great deal of discrimination, only attacking people of a certain age or gender or genetic make-up.

But none of them discriminate based on where you live.

That’s what is so disturbing about the directive that the Agence de la santé et des services sociaux de Montréal has issued to hospitals like the Jewish General, telling them to redirect off-island patients to hospitals a little closer to home.

The policy is intended to reduce the drain on the budget of key Montreal hospitals, but it’s hard to imagine that it does anything but ADD to the costs of healthcare in general. A patient who is turned away from the Jewish General and told to seek medical care at the Barrie Memorial in Ormstown, for example, will be seeing doctors who usually won’t have a fraction of the specialized experience of physicians and surgeons at Montreal’s teaching hospitals and trauma centres. That will often mean delays in diagnosis and treatment that will likely lead to referrals that take them right back downtown — and could easily result in hundreds of preventable deaths.

All this in order to reduce costs in one administrative district — at the expense of another.

The agency told CBC that it was merely trying to inform patients (through their doctors) that it may be more convenient to get treatment closer to home.

Do they think we’re idiots?

You don’t drive to downtown Montreal from Ormstown just because you forgot there was a more convenient hospital a few blocks away.

No, you drive downtown because you know your local hospital is fine for many things, but cutting edge specialties are not on the cafeteria menu. It’s a conscious decision and a government agency has no right to tell you that it’s not yours to make.

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Globe and Mail health reporter André Picard wrote a heartbreaking column this week about a British Columbia nurse who — having seen many of her dementia patients suffer during lingering illnesses — wrote a living will that clearly, she thought, told healthcare workers not to use any extraordinary measure to keep her alive if there was no hope for recovery.

Yet Margot Bentley, now in a semi-vegetative state at the age of 82, is today being kept alive through autonomic feeding despite the clearly expressed wishes of herself and her family. (You can read the full story here.)

The reason for continuing to force-feed a woman who merely wanted to die with dignity? It’s the self-interest of the institution that is providing the care and the bureaucratic mindset of the local health administration. And that position has been upheld by a B.C. judge who thinks feeding Bentley is not health care — which she and her family have the right to refuse — but personal care, much like brushing her hair or clipping her toenails.

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These two stories are mere threads in a massive tapestry of red tape and bureaucracy that is blanketing the Canadian healthcare system. It’s a system that sees patients as numbers to be shifted from one balance sheet to the next, out of one department, hospital or region and into another. The main health concern of institutions like these is their own as they fight over budgets that, even in the best of times, are often stretched so thin that you expect them to snap at any moment.

But let’s not confuse the symptoms with the disease. Budget-reduction efforts on the part of the ASSSM don’t come from middle managers, they come from pressure exerted by the health minister and the premier.

As the average age of Quebecers continues to climb, the system will see greater and greater stresses that will force us to look much more closely at what care we provide and how we pay for it. It’s a crisis that we’ve known was coming for decades now, yet successive governments have done little or nothing to address it.

To give the Parti Québécois credit, it has made major progress on the issue of dying with dignity. But it has done little for those who’d like to stave off the Reaper for a few more years.

Imagine if the time and effort we’ve put into debating the Charter of Values had instead been spent looking at how Quebecers can live out their final years with confidence that they will be cared for by health professionals, not shuffled here and there by bureaucrats.

A search for real solutions to real problems. Now that’s a prescription we can live with. ■

Peter Wheeland is a Montreal journalist and stand-up comic. His sardonic observations about the city and province appear every Wednesday. Follow him on Twitter, or find out about his upcoming stand-up performances here.