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Government & policy

Dispute over delivery of hospital services in Montreal

MONTREAL – Quebec Health Minister Philippe Couillard (pictured at left) announced the creation of a task force to re-examine the concept of “clinical complementarity” between the Montreal Children’s Hospital and St. Justine Hospital. The announcement was made after a dispute arose over the proposed sharing of clinical services.

The task force will also evaluate complementarity between Montreal’s two university teaching hospital networks – the McGill University Health Centre (MUHC) and the Centre hospitalier de l’Universite de Montreal (CHUM).

The task force is to be presided over by Dr. Michel Baron, former dean of medicine at the Universite de Sherbrooke.

The creation of a task force comes on the heels of a dispute over the proposed transfer of of complex cardiac surgerty and other specializations from the Children’s Hospital to Ste. Justine.

The task force will include four representatives from the MUHC, four from the CHUM, two from Ste. Justine and two from the Children’s. In addition to the chairperson, there will be an observer from the Health Department. The task force is expected to report back to the government in the next few months. Dr. Baron will act as a mediator or “facilitator” between McGill and the U de M.

The Health Ministry hopes to optimize the delivery of services as it creates two new “super-hospitals” over the next few years, one for the McGill organization and other for the CHUM. It is also expanding the St. Justine Hospital. The three projects are expected to cost on the order of $2.5 billion.

For its part, the Quebec government would rather create centres of excellence for various procedures, concentrating expertise in one location, rather than spread capabilities across sites which experience low volumes of surgeries.

Health Minister Couillard told the Montreal Gazette he was “struck by the intensity of the reaction” over proposals to transfer the services.”

He added that, “It’s obvious that it raised some deep sensitivity in the anglophone community, and I recognize that. Maybe we should have done things differently. But still, I’m very committed to the fact that because we are building these hospitals ... we’re trying to reach a new level of excellence.”

Couillard, who was trained as a brain surgeon, gave as an example surgery to remove tumors from the eyes of children. Doctors perform an average of 10 such operations a year in Quebec. “What is best,” he told the Gazette, “to have three done at one hospital and four at the other? “Or is it better to have all the cases treated by the same team all the time? That wouldn’t threaten the general mission of the hospital.”

The Montreal Children’s Hospital is affiliated with McGill University’s medical school, and Ste. Justine with the Universite de Montreal. The two medical schools have maintained positive relations in the past, but the complementarity proposals have sparked a bitter rivalry.

Another government appointee, Clermont Gignac, is overseeing the estimated costs and construction details of the hospital projects.

The first phase of MUHC’s $1.1-billion redevelopment will involve the construction of the Montreal Children’s at the Glen Yard site in Notre Dame de Grace. It’s scheduled to start in fall 2006.

Complementarity proposals for adult medical services have also been controversial, but did not come under as much fire as the plans for children’s services. For example, the government had recommended transferring organ transplant services from the MUHC to the CHUM, as well as concentrating all adult complex cardiac surgery at the Montreal Heart Institute.