Health- care transparency at risk under Bill 10: experts

Hospitals and other health- care institutions across Quebec are at risk of becoming less accountable to the public under sweeping management changes imposed by Health Minister Gaétan Barrette.

Following the adoption in February of Bill 10 — Barrette’s reform of the governance of health establishments — the government has proceeded to eliminate more than 1,300 managerial positions across the network.

One of the objectives of the reform is to save $ 220 million a year in administrative expenses. With the abolition of so many jobs, the government has been left with no choice but to create new mega- managerial positions. For example, Quebec is taking applications for a three- in- one position: director of human resources, legal affairs and communications.

But critics charge that no single manager should be assigned so many responsibilities, or handling portfolios that often work at cross purposes with each other: legal affairs ( usually involving the protec- tion of information) and communications ( involving the sharing of information with the public).

The director of communications of one hospital, who agreed to be interviewed on condition his or her name not be published, expressed concern that the public might be deprived of significant information that is in its best interest.

As it stands, journalists and the public have to file requests under Quebec’s Access to Information Law to obtain documents on everything from a hospital executive’s expenses to changes in clinical planning. Requests can take months, while others are denied and are sometimes challenged before Quebec’s Access to Information Commission.

“If the head of communications is also the head of legal affairs, will every media request now have to go through access- to- information?” asked the director of communications, whose position will be abolished on March 31.

A spokesperson for another Montreal hospital, who declined to have his name published for fear of reprisals, noted that public- relations staff often struggle to get information out to the public over the objections of the legal department. He warned that the public could be deprived of essential information with the creation of the managerial position.

A director of human resources, communications and l egal affairs ( in French, the title is abbreviated as DRHCAJ for Directrice des ressources humaines, des communications et des affairs juridiques) will be appointed to each umbrella health organization that is being created to oversee up to nine health institutions, including at least one hospital, in a given area. The umbrella organizations are known as either a Centre intégré de santé et de services sociaux ( CISSS), or a CIUSSS, to denote an affiliation with a university medical school.

The government posted 21 DRHCAJ positions on Feb. 22. The McGill University Health Centre and the Centre hospitalier de l’université de Montréal are exempt from this aspect of the reform, and thus will maintain their public- affairs staff.

But every other hospital in Montreal that is part of a CISSS or CIUSSS — including the Lakeshore General and the Jewish General, among others — will have its own DRHCAJ. Previously, each hospital had separate directors of human resources, legal affairs and communications.

The posting for the position suggests that candidates should probably have a legal background, in order to understand a “complex legal framework,” and that they have “obligations toward performance and transparency.” The posting also mentions support staff.

Many managers are still in the dark as to how all this will play out in the coming weeks and whether the directors of communications at some hospitals will simply have their titles changed but continue with their old jobs. However, that is doubtful given that the objective of Barrette’s reform is to peel a layer of middle management.

Lise Millette, president of the Fédération professionnelle des journalistes du Québec, noted that citizens and journalists struggle to get information about the system, and she raised fears that this could only grow worse with the “tightening of government communications.”

“We’re very far here from an open government,” Millette said.

Paul Brunet, president of the Conseil pour la protection des malades, argued that a director of human resources who is also head of communications is potentially in a conflict of interest.

“If some conflict occurs in the human resources department and by pure bad luck the director of human resources is involved, you will ask him to give a statement as head of communications,” Brunet said. "At the very least, this would constitute a challenge or a problem of conflict of interest.

“Things could become less transparent than before,” Brunet added.

Joanne Beauvais, Barrette’s press attaché, dismissed those concerns as unfounded.

“Providing information to journalists and the public does not mean that legal issues should be ignored,” Beauvais said in an email. “On the contrary, by making sure a statement or a communication tool will not raise legal issues, the HR, legal affairs and communications manager and his team will ensure proper communications with journalists and with the public.”