Rarely has there been a standoff between so many influential, rich and powerful people in Quebec. Some with their faces uncovered, others in the shadows. And in this debate, which has only just come to light but has been going on behind the scenes for months, everyone believes that they are defending the public interest in order to improve the healthcare system for the benefit of patients.
In Corner A sit six former Quebec premiers who released a letter Tuesday afternoon calling on Minister Christian Dubé to amend his Bill 15. This aims to reform the health system, in particular by creating the new Agency Santé Québec, which will be responsible for the day-to-day operation of the network, entrusting the Ministry of Health with the task of developing the main directions.
This is an extremely rare event. At the end of the document, all living prime ministers without exception signed: Philippe Couillard, Pauline Marois, Jean Charest, Lucien Bouchard, Daniel Johnson and Pierre Marc Johnson. Because they come from Liberal and PQ political families, they have experience at the highest levels of government and benefit from a huge network of contacts.
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Former Liberal Prime Ministers Philippe Couillard and Jean Charest. (archive photo)
Photo: The Canadian Press / Jacques Boissinot
However, they are not alone in this revolt. They are not even the most active. In reality, they act as spokespeople for institutions and people who have not spoken publicly but have been working behind the scenes since last spring to try to influence Minister Dubé: the members of the administrative boards of the University Hospitals (CHU), specialized university institutes such as the Montreal Heart Institute and its important foundations, which raise millions of dollars each year for cutting-edge health research and equipment purchases.
And on these boards, where management, philanthropy, networking and even the identity of certain communities are intertwined, sit some of Quebec’s richest and most influential people, from families with sometimes well-known names – Desmarais, Pomerleau, Bédard, Lamarre… – or less well-known , but just as important within Quebec Inc. : Chiara, Edwards, Parent, Des Groseillers, Della Posta, Palladitcheff… We’ll come back to that.
The leaders of this group are Éric Bédard, CEO of the Montreal Heart Institute and senior partner at the law firm Fasken, and Lucien Bouchard, the only former prime minister who has spoken in person and by telephone with Minister Dubé in recent weeks.
These two men, who have been part of the PQ family for a long time, share the same network of friends and acquaintances as well as a love of classical music. Éric Bédard is one of the administrators on the board of the Orchester Métropolitain, while Lucien Bouchard chairs the board of the Montreal Symphony Orchestra. Both usually also have the ear of Prime Minister François Legault. He considers Lucien Bouchard his political mentor.
Opposite, in corner B, are the Minister of Health, Christian Dubé, as well as the majority of the 34 CEOs of Quebec’s Integrated Health and Social Service Centers (CISSS) and Integrated University Health and Social Service Centers (CIUSSS), who want the minister to hold out, those who already have always been a little jealous of the autonomy of their colleagues in the CHU and want to get them to contribute more. Also present are the Deputy Minister of Health, Daniel Paré, the Secretary General of the Government (the highest official in the state), Dominique Savoie, and the Prime Minister of Quebec, François Legault.
If Quebec society were a pyramid, the protagonists in corners A and B would face each other at the top, at the very top.
The power of war
At the heart of this dispute is a small element of Bill 15 that is attracting a lot of attention: the autonomy of the province’s seven university hospitals and specialty institutes.
Christian Dubé is trying to achieve what several health ministers before him have tried unsuccessfully: to further integrate the four university clinical centers (CHUM, MUHC, CHUQ, CHU Sainte-Justine) and the three specialized institutes (the Cardiology Institute of Montreal), the Philippe-Pinel -Institute and the University Institute of Cardiology and Pulmonology of Quebec) under the Ministry of Health (and now Santé Québec). He wants to get these seven organizations to work more closely with the government to coordinate, deliver and plan care, even if it means limiting their autonomy.
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The University Institute of Cardiology and Pulmonology of Quebec (IUCPQ)
Photo: Radio-Canada / Sébastien Vachon
Everyone works in silos. The status quo must end. The creation of Santé Québec will improve the network’s efficiency for patients. But there is resistance to change, argued Christian Dubé in an interview with Midiinfo on Wednesday.
In the other camp, we don’t see things that way. CHUs and institutes risk losing their soul with this integration, even partial, under the umbrella of Santé Québec, affirms Lucien Bouchard, who speaks of a dangerous risk for innovation, research and the loss of influence of foundations. of these facilities.
Why undo what’s going well? Isn’t there a war for power, a desire for control?
Former Prime Minister Daniel Johnson, still on Midi-Info on Wednesday, added that we must at all costs protect the identity of every establishment and avoid the leaden screed and one-size-fits-all of Santé Québec.
Bing! Bang!
Usually all these beautiful people get along pretty well. But in this case there is a pause.
In public, but especially in private, we have not spared blows on both sides for several days. It is ironic to see Daniel Paré, Dominique Savoie and Christian Dubé pushing through reform [dont] They will not face the consequences because they are leaving political life or retiring in three years, claims a member of the council of a university hospital, who did not want to be named so as not to worsen his relations with the government .
Several within the Legault government are convinced that the questioning of the power of the boards of CHUs and institutes, which are guarantors of the autonomy of these institutions, has contributed to the rebellion of recent months. In the House of Representatives, François Legault said: There is resistance because some on the boards of hospitals and institutes want to keep their small powers!
That same evening, on the 24/60 program, Lucien Bouchard appeared dismayed by the words of his friend who had become prime minister. It’s a bit small to talk about small forces! We’re talking about volunteers who want to help. It is not right to turn this into a class struggle. If Pierre Karl Péladeau gives the CHUM 15 million, as in 2018, it is not to buy a room! It’s about doing good.
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Former PQ Prime Minister Lucien Bouchard (archive photo)
Photo: Radio-Canada / Ivanoh Demers
However, it is true that the boards of CHUs and their foundations, as well as the charitable activities they organize, also serve as networking venues for CEOs, lawyers and other senior executives of Quebec Inc.
The overview of the board members of these institutions and their foundations is dizzying, as the big names of the business world go hand in hand there. From Mitch Garber to Joseph Broccolini via Daniel Lamarre (Cirque du Soleil), Vince Chiara (Groupe Mach), Ian L. Edwards (President of AtkinsRéalis, ex-SNC-Lavalin), Marc Parent (CEO of CAE), Nadine Renaud-Tinker (CEO Quebec of RBC), Maria Della Posta (CEO of Pratt and Whitney Canada), Nathalie Palladitcheff (Ivanhoé Cambridge), Harley Finkelstein (Shopify), André Beaulieu (Bell)… The list of Quebec Inc. heavyweights seems endless .
Some are there for the right reasons, they say in Quebec, but others are mostly interested in the prestige of being on a board or a large foundation with their friends, says a Legault government strategist.
“That’s ridiculous,” Daniel Johnson replies. People have a stake in the success of their businesses.
A member of one of these boards that I spoke to said he believes – on condition of anonymity – that the Legault government is being a little forceful with its accusations in defense of its health care reform. It is a voluntary activity. I could do something else! At the same time, however, he agreed that less influential CAs could demotivate certain people to get involved in the management of university hospitals and institutes.
But despite the hostility, in my conversations with supporters of both camps this week, I found that they all seem well-intentioned and care about the health of Quebecers.
But if it blows, it’s because the shock of the visions is very real. And it’s public now.
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The battle has been raging since March
Behind the scenes, the fight began when Bill 15 was introduced last March. Inside the Ministry of Health and within the government, the phone quickly began to ring. The allies of the university hospitals and institutes have begun to make their presence known. And they have several allies! testified a source in the Ministry of Health who requested anonymity because he is not authorized to speak to the media.
For officials, deputy ministers and deputy deputy ministers, it was a return… to 2015, during the previous battle involving the same actors from Corner A. Before them, however, was not not Christian Dubé, but Gaétan Barrette and his Bill 10, which would create the CISSS and CIUSSS in all regions of Quebec. The seven university hospitals and institutes did not want to report to the managers of these new ministry units. Due to their special mission in research, innovation and teaching, the management, their boards and their foundations wanted to retain their complete autonomy.
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The University of Montreal Hospital Center. (archive photo)
Photo: Getty Images / Sébastien St-Jean
The storm was powerful. I didn’t succeed [à les intégrer] : The headwind was too strong, confirms Gaétan Barrette. The lobby is powerful.
Philippe Couillard, who was inclined towards university hospitals and institutes, finally asked his minister to let go.
The arguments and concerns were exactly the same as today: protecting the ability of these hospital foundations to raise money from private donors who prefer to give to a specific cause or institution – with the recognition that comes with it – rather than being diluted a bigger picture like a CIUSSS or now Santé Québec. They also want to ensure that cutting-edge research quickly reaches hospitals, patients and medical students. This is an innovation capability that university hospitals and institutes fear losing in a larger and less agile structure.
And in 2015 it was the Cardiology Institute that made the accusation and mobilized the other university hospitals for the cause.
The influential Heart Institute of Montreal
Back then, it was France Chrétien Desmarais – daughter of former Prime Minister Jean Chrétien and wife of André Desmarais, deputy chief executive of the Power Corporation of Canada – who helped amend Bill 10 at the last minute. She served as chair of the Heart Institute Foundation (HIM) from 2001 to 2008 and still serves on the board as vice president. Cirque du Soleil CEO Daniel Lamarre is now chairman of the ICM Foundation.
The ICM has been the philanthropic protégé of the Desmarais family for years. In addition, a few months after the amendments to Bill 10 that guaranteed the ICM’s full autonomy, France Chrétien Desmarais and André Desmarais donated three million dollars to the ICM Foundation to accelerate the creation of a genetic biobank. In addition, the cohort of patients cared for over several years is now called the André and France Desmarais Hospital Cohort.
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The Montreal Heart Institute.
Photo: Radio-Canada / Ivanoh Demers
In 2015, France Chrétien Desmarais’ request was forwarded to Daniel Desharnais, then chief of staff to Health Minister Gaétan Barrette. Daniel Desharnais is now Deputy Minister of Health. The then deputy health minister Michel Fontaine was also contacted by members of the institute’s board.
Without wanting to reveal details, the general director of the ICM, cardiologist emeritus Denis Roy, told me in an interview in 2015 (New Window) that the operation was successful. People from our board and our foundation spoke. Influential people have joined our cause. Let’s just say I didn’t slow anyone down! he said laughing.
Given the exemption obtained by the ICM, the other CHUs and the University Institute of Cardiology and Pulmonology of Quebec jumped into the breach and were able to evade Bill 10, thanks in particular to the support of Philippe Couillard… to the great dismay of his minister Gaétan Barrette. “I have always been committed to protecting foundations, clinical research and teaching,” the former health minister said today. Anyone who claims otherwise is dishonest! But I still believe that university hospitals and institutes need to become more involved in clinical care. They must be part of the network and have greater accountability to the government and the people. Dubé takes the step that I couldn’t take back then.
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Gaétan Barrette, former Liberal health minister. (archive photo)
Photo: Radio-Canada
But what do we mean by the fact that we are more committed to clinical services at university hospitals and institutes? According to my information, Minister Christian Dubé is having difficulty digesting the lack of cooperation between institutions in certain critical phases.
For example, during the crisis that rocked the emergency room of the Maisonneuve-Rosemont hospital in January last year, the Ministry of Health reportedly asked the ICM to admit more ambulances and patients and even send nurses as reinforcements to the Maisonneuve-Rosemont hospital, just 1 km away a few streets away, in the east of Montreal. We were told that they would come back to us, that we had to ask the board for permission first! Well then! thunders a government source who did not wish to be named.
Requests for interviews with the presidents of the boards of directors and various foundations for this story were ignored or rejected. But a source familiar with deliberations on the Heart Institute board is skeptical. This is not the type of decision that comes back to the CA. The ICM has always helped us when asked, assures this person, citing the example of the COVID-19 pandemic, when ICM nurses visited two CHSLDs at the height of the crisis, in 2020.
In an interview, Christian Dubé bluntly states that university hospitals and institutes sometimes reject patients who are not registered in the correct zip code and therefore see their situation worsening. My hands are tied and I can’t accept this anymore! he says.
Daniel Johnson, who has served on the board of the CHUM and the ICM, has a different opinion. I have served on several boards and have never heard of patients being turned away based on their zip code. Never!
Another example circulating is the treatment of cerebrovascular accidents (CVA) at the CHUM in Montreal, where it is one of their specialties. The exchange and monitoring of patients with other hospitals in the Montreal region would be facilitated by the integration of clinical services in a structure such as Santé Québec, says the Ministry of Health.
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The Minister of Health Christian Dubé (archive photo)
Photo: Radio-Canada / Sylvain Roy Roussel
The last chance meeting
On the morning of October 13, a final meeting was organized at the Health Ministry’s offices on Union Street in Montreal to bring the two camps together. Minister Christian Dubé and some representatives of the CAs affected by his reform plan were present.
In addition to Éric Bédard, CEO of the Heart Institute, other business leaders were present in the room. Ann MacDonald, chief operating officer at BONE Structure and long-time executive at Bombardier Transportation, led the discussions with Éric Bédard. She is now chairwoman of the board of Loto-Québec (appointed in 2021) and chairwoman of the board of directors of the CHU Sainte-Justine children’s hospital, which explains her presence.
Ann MacDonald was accompanied by the CEO of the Sainte Justine Foundation, Pierre Pomerleau, whose name may sound familiar. He is the outgoing CEO and chairman of the Pomerleau construction empire, founded in 1964 by his Beauceron father, Hervé Pomerleau. From the REM to the Romaine dam, including the construction of the CHUM, the reorganization of the Saint-Joseph Oratory or the renovation of the Grand Théâtre de Québec, Pomerleau is involved in most of the major construction projects in Quebec.
Also on hand was Peter Kruyt, CEO of McGill University Health Center, who spent his career as an executive at the Power Corporation of Canada.
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The McGill University Health Center. (archive photo)
Photo: McGill University Health Center
Peter Kruyt, Pierre Pomerleau, Ann MacDonald and Éric Bédard reiterated their arguments to the minister, namely that the seven CHUs and specialized institutes should not be placed under the new public body Santé Québec in order to preserve their full autonomy to facilitate research. Teaching, Innovation, and Major Donor Fundraising.
Minister Dubé had already met with them in June to listen to their complaints. He had good news for her this time, he thought. The amendments he wanted to table in the parliamentary committee would allow the full autonomy of CHUs and institutes to be maintained in terms of research, innovation, teaching and foundations. The board members remained in place. It will be belt and suspenders, that will be clearly shown in the bill, he told them.
Last Wednesday, Mr. Dubé made the following clear on Midi-Info: It is important to keep donors happy. I’m not crazy, I need the money on the network! I won’t shoot in the boat!
However, there is no question of going backwards when it comes to clinical services. When it comes to direct patient care, the CEOs of these facilities will have to report to the new agency, Santé Québec, rather than to their boards of directors.
This decision was poorly received on the other side of the table.
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Brothers Daniel and Pierre Marc Johnson, both former premiers of Quebec, Liberal and PQ respectively. (archive photo)
Photo: The Canadian Press / JACQUES BOISSINOT
The application of research is the clinical aspect, we cannot separate the two, claims Daniel Johnson, who considers the amendments presented by the minister to be insufficient.
It was only at that moment, faced with the impasse, that Lucien Bouchard and the former prime ministers were called in for reinforcements. The following week, on Friday October 20th, Lucien Bouchard met Christian Dubé. The two spoke again earlier this week.
Lucien Bouchard is a man I respect very much, but I have no intention of giving in. And I have the support of my Prime Minister.
In a press briefing before the National Assembly on Wednesday, François Legault actually expressed his confidence in his minister. Research is important. The Desmarais family donates a lot of money. We don’t want to touch that. On the other hand, when we talk about clinical care, there must be coordination between all hospitals. Santé Québec must have the final say. It cannot be a board that meets once a month that decides on this.
And what now? Behind the scenes it is said that the former prime ministers did what they had to do and would no longer intervene in the public sphere. The members of the concerned CAs, who prefer the shadow over the light, are hesitant to speak publicly as they know that the government does not seem to want to give in on all issues. Senior researchers and doctors are wondering whether they should speak out, but the determination of the Dubé-Legault tandem and the guarantees received from the minister to preserve research have led them to remain silent for now.
Christian Dubé seems to have won the battle. But that bitterness will leave its mark at the top of the Quebec pyramid.