Shameful Bill 96 healthcare directives on language restrictions creating chaos in Quebec

The new Bill 96 directives for the Quebec healthcare system — 31 pages detailing exceptions for language restrictions that require healthcare providers to communicate with patients in French only — have prompted confusion and even panic among the public and staff alike.

Have you ever had to explain to someone whose first language isn’t French how to complete a medical form in their second or third language? I have.

Have you ever had to make a medical appointment for an allophone senior who’s worried they didn’t quite understand the rapid-fire message left by the clinic’s front desk staff or the mile-long CISSS email address they said you should fax your medical referral to? I have. 

Have you ever had someone hand you a bank statement, a Hydro- Québec bill, a government notice from Revenu Québec for you to go over and translate for them because the recipient is worried there’s something they didn’t understand and was worried they might get it wrong? I have. 

I grew up doing all of these things for my Greek immigrant parents who, of course, spoke basic French and English for their daily interactions, but were not as comfortable with complex medical, legal or financial terms in French. Many first-generation immigrants like my parents routinely rely on their more educated trilingual kids to clarify complicated bureaucratic communication and legalese they couldn’t possibly decipher on their own. In my book We, the Others, I write about us, the second generation. “We’re bill readers, doctor’s appointment-makers,  bank-statement decryptors, de-facto translators for all things major or minor.” 

As a journalist, I’ve interviewed countless new immigrants and refugees who also rely on grassroots organizations, volunteers and staff at places like the Welcome Collective. These Quebecers help confused newcomers with no current knowledge of French (and sometimes no knowledge of English, either) decode their new world and what is needed of them. Filling out online forms for French language classes is not as easy as you think when you’re unfamiliar with Canada’s two official languages, or, sometimes, not even familiar with a computer. A quarter of Canada’s population speaks neither English nor French as a first language.

Government employees and healthcare workers confused

Bill 96’s new language directives for Quebec’s healthcare system have added even more confusion to the mix. In some cases, it’s become even harder to access help when you try to communicate with public employees, who, because of the legislation’s new convoluted language rules, are themselves often confused and unsure of whether they can even help you in a language other than French. Many of the current legal challenges against Bill 96 involve cases like these.  

Parents of children with disabilities were denied an English presentation by Quebec Education Ministry staff last year because the people giving the presentation were simply confused about whether they could. By the time it was clarified, these parents, who are already dealing with hurdles and challenges, had been forced to deal with the unnecessary frustration of unclear directives. They don’t need this. 

In response to a series of articles by health reporter Aaron Derfel, detailing how Quebec’s anglophone and allophone minorities are worried by directives they say are dangerous and could hamper access to healthcare services in English, French Language Minister Jean-Francois Roberge has fired back with a lengthy, convoluted reply of his own. I’m starting to see where the problem may reside. 

Roberge says it’s simply not true and people can access care. His reply said, among many other things, that the “MISS directive and the Charter of the French Language clearly expresses that an organization may deviate from the obligation to use French exclusively when health, public safety or the principle of justice demands it,” and “with the exception of members of the historic English-speaking community, the directive stipulates that communications of an administrative nature or that do not compromise the health of the user, must be in French.”

If that wildly confusing reply was meant to be reassuring, I’m not sure that it worked. It reads more like the fine print of a complicated contract where a surprise clause will have you suddenly losing your house or dealing with a 29% interest rate. No wonder people are worried. 

It’s worth nothing that “nowhere in the 31-page directive are there the words ‘communications of an administrative nature’ even mentioned,” according to Derfel. 

In addition, “communications of an administrative nature” may not be considered part of healthcare to Minister Roberge, and therefore may not be required to access in English, but they are most definitely part of healthcare. Are people trying to book a medical appointment, trying to access a GP on the GAP system, or inquiring on behalf of a loved one’s health at the nurse’s station considered “communications of an administrative nature” or part of essential healthcare? And who gets to decide? 

When a 75-year-old English speaker recently called the Régie de l’assurance maladie du Québec (RAMQ) to inquire about her husband’s medical coverage, she was refused service in English and eventually hung up on by a RAMQ employee. Minister Roberge, once again, said that the provincial health insurance board is required to serve certain users in English. But if government employees can’t figure out what they’re allowed or not allowed to do, what makes Minister Roberge think that a 75-year-old stressed senior worried about her husband’s health will solve that riddle? 

Directives attempt to clean up a mess created by the government itself

When I recently read some examples from the 31-page directive created by a team of bureaucrats in Quebec’s Health Ministry, spelling out the “exceptional” circumstances in which English is allowed to be spoken in hospitals and other medical facilities, it read a little like a bad joke. 

Exception after exception after exception of medical emergencies were outlined in which I, an allophone Quebecer whose education was in English, would be technically allowed to access health services in that language. Faced with the confusion and concerns of many — healthcare employees included — health ministry staff listed examples of dire health emergencies where the use of English would be acceptable. Suicidal thoughts, providing medical information to someone’s legal guardian after an abortion, a psychotic episode, etc. And the list apparently goes on and on for 31 entire pages. 

The recent changes implemented by Bill 96 have created such confusion and have so many (mostly seniors) in a tizzy about what that means for their access to healthcare that Quebec’s Health Ministry was essentially forced to write up that complex and ridiculously long list of directives explaining where access to healthcare in English is indeed allowed.

The directives are actually meant to help clarify things. Only they don’t. They’ve created even more unease and concern because they read like layers of bureaucracy and fine print that scare most people and create uncertainty. And when it comes to your medical record, a medical diagnosis, a course of treatment, giving consent for a medical procedure, a referral to a specialist (assuming you can even see one these days), for you or a loved one, the last thing people need is uncertainty. 

With these directives, the government is basically now trying to rectify a mess they themselves created. None of it was necessary. Quebec’s healthcare didn’t need added layers of bureaucracy or pages and pages of exceptions or silly certificates of eligibility. Quebecers just want to know that they can access quality care quickly and efficiently. That’s it! And making those who don’t speak perfect French and would prefer to be treated in English jump through hoops doesn’t improve the French majority’s chances of better healthcare or protect the French language in any possible way. 

Everyone — regardless of language — deserves prompt care

Insensitive comments dismissing people’s fears and asking why some Quebecers “don’t just learn to speak French” are unkind. People don’t acquire a second or a third language for many reasons. Alzheimer’s, dementia, learning disabilities, cognitive conditions like dyslexia, trauma to the brain, and even autism are some of the many reasons preventing people from learning another language efficiently. Who’s so language-obsessed that they’ve convinced themselves that fellow Quebecers who don’t speak French are second-class citizens and don’t deserve proper healthcare geared to their needs?

In a similar vein, people pointing to the lack of French services for francophone minorities in the rest of Canada are engaging in pointless whataboutism. While I truly recognize the challenges in providing proper care in French in the ROC, how does depriving English speakers of their right to healthcare in their language improve conditions for the latter? Quebec’s English community isn’t responsible for other provincial government’s unwillingness to provide better services and it’s simplistic and petty to act like they are. 

I truly believe that most healthcare workers try hard to provide care in the language that best serves the patient. I find it incredibly disheartening that they’re not supported by a government able to understand how important that is. ■

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Read more weekly editorial columns by Toula Drimonis.