- Health Services
On March 18, 2015, in Quebec City, the Cree Board of Health and Social Services of James Bay was among the groups testifying at public hearings before the Parliamentary Commission on Bill 20: “An Act to enact the Act to promote access to family medicine and specialized medicine services and to amend various legislative provisions relating to assisted procreation”.
The Chair, Bella Moses Petawabano, along with Dr Darlene Kitty, President of the Council of Physicians, Dentists and Pharmacists (CPDP), presented a Brief summarizing the CBHSSJB concerns about Bill 20 to the Parliamentary Commission, which included the Minister of Health and Social Services, Dr. Gaëtan Barrette. Geoffrey Kelly, Minister responsible for Native Affairs, was also present at the hearings. All the members of the Board of Directors and several senior managers of the CBHSSJB attended the presentation to show their support.
The Brief (mémoire) prepared by the Cree Health Board explains the difficulties of recruiting physicians to work in the Cree communities of Eeyou Istchee, and the reasons why the organization decided to take the significant step of coming to Quebec to express opposition to Bill 20 as it is currently formulated.
In her remarks to the Committee, Bella Moses Petawabano pointed out that the proposed requirements of Bill 20, which include quotas and minimum case-loads for doctors practicing in Quebec, will have a negative impact on the Board’s parttime and replacement (dépanneur) doctors. These doctors, who do not maintain a full-time practice in the south, are the cornerstone of medical staffing in many small, remote, aboriginal communities throughout Quebec and across Canada’s north.
The Cree Health Board Chair stated that the implementation of Bill 20 in its current form would lead to a massive exodus of physicians from Region 18. She indicated that any measures having such effects would be contrary to Québec’s treaty obligations toward the Cree of Eeyou Istchee set out in Section 14 of the James Bay and Northern Québec Agreement (JBNQA). They would also be inconsistent with Québec’s undertakings in the Cree-Québec Health Agreement of 2012.
The Cree Health Board has made strenuous efforts to recruit and retain physicians in order to improve access to family medicine and increase the quality of care in the Cree communities. But all these efforts would be compromised by the requirements that Bill 20 would impose on family physicians working in Region 18.
The President of CPDP, Dr. Darlene Kitty, stated in her remarks to the Commission that the loss of stable part-time and dépanneur family physicians would have far reaching consequences on the quality of care in Eeyou Istchee. The remaining physicians would have much increased workload, as would nurses and other staff. The impacts would undermine recent efforts in recruitment and retention, reduce the organization’s ability to contribute to research and understanding of indigenous health and remote medicine, and limit the organization’s ability to provide training opportunities for medical students.
In a region where nearly 25% of the adult population has Type-Two diabetes, and where the needs are complex, the Bill will have the effect of forcing the Cree Health Board to send more patients outside the Territory for complex care, and to reduce community health programs, chronic disease management and preventive care, all of which which will lead to a decline in health status.
For these reasons, the Chair and the President of the CPDP requested that Region 18 be exempted from Bill 20 or that the Bill and its By-laws include specific considerations to prevent these negative impacts from taking place.
In reaction to the presentation, the Health and Social Services minister, Dr Gaëtan Barrette fully acknowledged all the work that has been done by the CBHSSJB to attract and retain family doctors. Dr Barrette stated explicitly that Bill 20 will not be applied in its current form to Region 18, and that considerations and adjustments will be made in the Bill 20 and the By-Laws to avoid any negative impacts on the Cree Region.
Mr. Geoffrey Kelly, Minister responsible for Native Affairs, reiterated the commitment of the Quebec Government to support the Cree Health Board in the implementation of the Health Agreements signed in 2014 and 2012.