Lessons to learn from an investigation at MUHC: the Québec Ombudsman calls for fair and rigorous oversight of the admission of foreign patients to Québec
Québec City, June 9, 2014 - In an intervention report released today, the Québec Ombudsman concludes that MUHC's admission of a Kuwaiti foreign national for healthcare in December 2011 occurred outside normal channels and without government supervision. The Québec Ombudsman fears that as foreign admissions become common practice, waiting lists will be unfairly affected in a network already bursting at the seams.
"At a time when health institutions in Québec are under considerable pressure in attempting to meet Quebecers' needs, it is imperative to ensure above all that healthcare network users have the best possible access to care and services within the appropriate timeframe," cautioned Ombudsperson Raymonde Saint-Germain.
The events behind the Québec Ombudsman's intervention
In December 2011, a Kuwaiti foreign national was admitted for healthcare and services to the Royal Victoria Hospital of McGill University Health Centre (MUHC). The Québec Ombudsman decided to conduct an investigation into various aspects of the situation and, more particularly, the public interest issues raised.
The purpose of the Québec Ombudsman's intervention was not to second-guess why the foreign national came to MUHC. Rather, the circumstances of her stay in Québec and the services she received were starting points for examining the different medical, material, financial, administrative and regulatory dimensions of her admission. This examination brought to light several lapses regarding:
- the leeway that MUHC gave itself in admitting the foreign national;
- compliance with the procedure for obtaining the Québec Acceptance Certificate required for an entry visa to Canada;
- compliance with applicable rules while this person was hospitalized at Royal Victoria Hospital;
- billing of the fees related to the hospitalization and MUHC's use of the amounts paid.
Admission of the foreign national occurred within the framework of an expertise-sharing contract between MUHC and the Ministry of Health of the State of Kuwait. MUHC assigned to a private company the rights and responsibilities incumbent on it under the contract. The company, MMI Montreal Medical International Inc., has as its single shareholder the Optimal Health Care Foundation, a charity dedicated to supporting health research and public health institutions. Both these organizations are not subject to the Act respecting health services and social services and its prescriptions with regard to transparency and accountability. In the opinion of the Québec Ombudsman, a business model of this kind, which involves the use of public infrastructure and resources, is unacceptable. It raises questions of ethics, fairness and sound management.
This is why the Québec Ombudsman recommends that the Ministère de la Santé et des Services sociaux ensure that, from now on, public institutions be prohibited from offloading their rights and responsibilities on a private company, as MUHC did with MMI. It also recommends that it examine in depth MUHC's ties with this company and require MUHC to fully account for the amounts received from Kuwait in connection with expertise sharing.
The Québec Ombudsman recommends that henceforth the Minister of Health and Social Services be the only person empowered to authorize the planned admission of foreign nationals for non-urgent healthcare and that he work with the Minister of International Relations and La Francophonie to define health admission policy.
It also calls for the Ministère de la Santé et des Services sociaux to lay down rules for international expertise-sharing exchanges for all network institutions. Another recommendation is that there be an arrangement with the Ministère de l'Immigration, de la Diversité et de l'Inclusion so that the Québec Acceptance Certificate is not issued until the Minister of Health and Social Services has approved admission of a foreign national, designated the host institution and set the conditions of hospitalization.
The investigation by the Québec Ombudsman also showed that several media statements in February 2013 by a spokesperson for MUHC were incomplete or inaccurate, for example, the one to the effect that the Minister of Health and Social Services had authorized the Kuwaiti woman's admission before her arrival. The investigation revealed that, instead, the Minister's Assistant Chief of Staff was informed of the woman's admission to Royal Victoria Hospital after the fact.
The intervention report, entitled Admission of a foreign national to Royal Victoria Hospital of McGill University Health Centre (PDF, 45 KB) details these events and highlights questions of public interest. Its recommendations are aimed at preventing the recurrence of similar lapses and at ensuring decisions that are fair to all public healthcare users in Québec.
Carole-Anne Huot, 418 646-7143/418 925-7994