Megahospitals could lead to mega mess


Friday, November 07, 2003
All this talk about megacities and megahospitals is starting to feel like a mega mess. To address the mess that's been piling up on the hospital front, Jean Charest did what every premier does to play for time: he formed a special committee.
To hand in a final report in four months from now, he chose two mega names: former prime minister Brian Mulroney and former premier Daniel Johnson, respectively his former boss in Ottawa and his predecessor at the head of the Quebec Liberal Party. Friends in need are friends, indeed.
Their mandate is to analyze the two superhospital projects, the French-language CHUM and the English-language MUHC, which were announced but never built by the previous government. The committee's two mega co-chairpersons might be "well versed in the administration of public resources," as the premier's press release says, but they have no expertise in actual medical care or hospital administration.
So why name two men who know so little about what will be one of the most expensive public projects of the next few years, one that concerns the No. 1 priority of the population and allegedly of the Charest government?
Since the premier makes it sound like the building of the superhospitals is a fait accompli, the lack of expertise of these two men is neither here nor there. If anything, they stand to serve as prestigious rubber stamps on the final report.
Like most government reports, this one will be mostly written by senior civil servants.
More importantly, the naming of these two heavyweights, who are also close allies and friends of Charest, will help him keep his own health minister in check. It feels as if the premier went to great lengths to sideline Philippe Couillard by taking this crucial dossier out of his hands to give it to Mulroney and Johnson.
The reason might be Couillard wasn't nearly as enthusiastic about the superhospitals as Charest. Last spring, while the premier was making the television rounds and expressing his full support for the superhospitals, Couillard was much more reserved, even alluding to the possible creation of a committee headed by real experts, including some from other countries where similar projects were undertaken.
Surely, the health minister must have known a number of these experiences have proven to be extremely expensive and not as effective as expected. But now that he's faced with Mulroney and Johnson, two of the most influential men around, Couillard stands to have little to say on the outcome of these hospitals. So it's Charest: 1. Couillard: 0.
This fait accompli isn't all that is disturbing on this issue. One is the number of beds. The plan now is to have 1,000 beds at the CHUM and more than 800 beds at the MUHC.
But the press release from the premier's office states these numbers must now include the beds of one complementary hospital that each side will have to keep open in the downtown area.
Given, for example, the Royal Victoria has 750 beds, what would that leave to the superhospitals? Unless, of course, the press release was wrong.
Also disturbing is what will happen to the buildings that will be closed. Will luxurious condos take their place in many sites that are now prime real estate? Who would benefit from this?
Another major problem is the premier is demanding both superhospitals must be "fully complementary." But the reality is these two linguistically defined university hospital networks, in most cases, have been functioning like parallel systems with a number of similar specialties and departments.
Are we supposed to believe these parallel systems would go gently into an integrated system with all the power struggles that would entail?
Given such power struggles have already been going on within each hospital network ever since Lucien Bouchard announced the creation of the superhospitals, one can bet they would be even more fierce between the two networks.
If it were to be fully complementary, the government would create one hospital network, instead of keeping the two. A system that is probably the only health-care system divided on linguistic lines in the world - a remnant of what Montreal was in the 18th, 19th and first part of the 20th century.
But what is most worrisome is the main focus of the Mulroney-Johnson committee is on budgets, infrastuctures, transport and urban landscape, not on patient care.
With an aging population and ever-growing needs in health care, that kind of attitude is the true mega mess that stands at our doorstep.

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