MONTREAL — It was viewed by many as the darkest day in the history of the McGill University Health Centre.
On a snowy afternoon on Dec. 17, nearly one year ago, Health Minister Réjean Hébert announced that a government “accompagnateur” — or special monitor — would be appointed to oversee the MUHC on a daily basis. It was one step short of placing the hospital network under trusteeship.
“There is an urgency to act,” Hébert declared after a government report released that day uncovered extensive mismanagement at the MUHC going back at least three years. Among the report’s revelations were that the MUHC paid its employees for more than 600,000 hours of work that was never authorized and that could not be explained, and that “hazardous” real-estate ventures were distracting senior managers from their key mission of health care.
Dr. Michel Baron, a former dean of medicine at the Université de Sherbrooke and author of the report, said the MUHC “did not follow the law” in a number of money-losing real-estate projects, and he made a series of far-reaching recommendations.
Nearly a year later, how is the MUHC faring? On some issues, it has made undeniable progress, while on others it has struggled. With the MUHC’s annual public meeting on Tuesday afternoon, here’s an overview of some of those critical issues:
Public accountability
The Baron report accused the MUHC of a flagrant lack of accountability, noting that the top managers often neglected their duty to share with the board of directors “complete and pertinent information.”
On that score, Baron singled out one individual for much of the blame: the smooth-talking Arthur Porter, the former chief executive officer of the MUHC, who had been hired in 2004 to win approval for a stalled superhospital project. Porter did succeed in securing funding for the $1.3-billion superhospital, but he has since been accused by provincial police of taking bribes and money laundering arising from that same project.
But Baron also chastised the current MUHC administration, headed by Normand Rinfret, saying it was “was slow to react” to a financial “hemorrhaging” of its budget, among other problems.
When Porter was at the helm of the MUHC, the board of directors had to abide by a “professional conduct” policy set out over barely three pages. That policy stipulated that the CEO of the MUHC had to disclose any potential conflicts of interest to the chairman and vice-chairman of the board, but not to the board as a whole.
At the time, David Angus, a retired Conservative senator, served as chairman of the board, and he said that Porter declared to him all his private outside interests. However, several board members told The Gazette that they were never made aware of Porter’s numerous private business dealings.
In January, the MUHC’s legal department overhauled the conflict-of-interest guidelines, which now require that every board member, including the head of the hospital network, submit annual written declarations of personal interests to a newly-formed “governance and ethics” committee that meets four times a year. One of the members of that committee is Jill Hugessen, a lawyer who specializes in corporate governance and who was elected by the public to the MUHC board.
What’s more, the MUHC this year became the first hospital network in the province to proactively disclose to the public the expenses of all its senior managers. For example, the MUHC on its website reports that Rinfret was reimbursed for $1,015 in travel, parking and meal expenses for the first three months of this year.
“The transparency has improved considerably,” said Dr. David Morris, an endocrinologist and self-described “member of the unofficial opposition” at the MUHC.
“I have to give them credit where it’s due. Discussions have been open. If we have problems, the administration has come back rapidly to address them.”
However, Morris did criticize MUHC management for a lack of transparency regarding some ill-fated real-estate projects, notably one to build a complex of outpatient clinics at 1750 Cedar Ave.
Rinfret, who started his career at the MUHC more than 30 years ago, was not available for an interview this week.
Real estate
Much of the Baron report scrutinizes the MUHC’s real-estate ventures, including properties at 1750 Cedar, 5100 de Maisonneuve Blvd. W. and 5252 de Maisonneuve — the latter two of which are located next to the superhospital in Notre-Dame-de-Grâce. Baron warned that the MUHC could lose tens of millions of dollars on those properties.
In the case of 1750 Cedar, one of the MUHC’s subsidiaries signed a long-term land lease with businessman Vincent Chiara to construct outpatient clinics next to the Montreal General Hospital. The MUHC never sought government approval for that project and started building the clinics before it could even obtain a zoning change from the city. Quebec ultimately refused to fund the project and the city refused to rezone the land from residential to institutional.
Today, the concrete structure of 1750 Cedar stands abandoned, and for the last year-and-a-half the MUHC has been negotiating with Chiara on how to extricate itself from what has become a tangled legal mess. The Baron report’s auditors calculated that the MUHC could lose as much as $42 million on Cedar.
The Baron report also observed that the MUHC has run up deficits of more than $1 million as landlord of 5100 de Maisonneuve, an office building that is to be part of the superhospital facilities but which now has commercial vacancies. The Royal Victoria Hospital Foundation purchased that property from Air Canada in 2006 for $40 million. Eight years earlier, Air Canada had acquired the building for $9.3 million.
The year that Air Canada concluded the property deal with the MUHC, Porter was serving on two boards: Air Canada and the MUHC.
Porter, who is incarcerated in a Panamanian jail fighting extradition to Canada, could not be reached for comment. Air Canada officials have not responded to a number of Gazette emails since June about Porter’s appointment to the Air Canada board. And MUHC officials have not given any updates about that building.
As for 5252 de Maisonneuve, across from the Vendôme métro station, the Baron report warned that the MUHC could also lose money on that property. Again, no update has been provided by the MUHC on that corner office building.
Hours after the Baron report was released, Hébertordered the Unité permanante anticorruption police squad to investigate all of those real-estate deals.
Finances
The Quebec government appointed Baron to investigate the MUHC amid concerns of wasteful spending and a surging deficit. The auditors projected a “realistic” deficit in 2012-2013 of $115 million — a shortfall that would be greater than those of every other hospital on Montreal Island combined.
The government accompagnateur, Dr. Michel Bureau — a former deputy health minister — did not wait for the MUHC to make cuts to its budget. In March, he imposed $50 million in funding cuts to be spread out over two years.
In June, the MUHC announced that Baron’s projected deficit for the fiscal year ending in April had been whittled down to $72.5 million. That shortfall would be tacked onto the MUHC’s accumulated deficit, which stands at $140.6 million.
In September, the MUHC reported that its operating deficit for 2013-2014 is $32.3 million. The government has agreed to absorb $12.3 million of that shortfall, but the balance, $20 million, will likely be added to the MUHC’s accumulated deficit for which it must pay millions of dollars in interest.
To date, the MUHC has eliminated more than 270 jobs (including 40 nursing positions), with dozens more to come next year. No department has been spared, including a pilot project in housekeeping aimed at ridding patient rooms of germs like the deadly C. difficile spores.
Richard Fahey, director of public affairs at the MUHC, has insisted that the funding cuts would not affect the quality of patient care — an assertion which many demoralized staff have told The Gazette they find doubtful.
In July, Bureau reported that he is “generally positive” about the MUHC’s financial position.
But Geoffrey Chambers, an ex-member of the board of directors of the Montreal Children’s Hospital and the son of Gretta Chambers, former chancellor of McGill University, said that the MUHC has not done enough to “push back” against what he believes is government underfunding following the Baron report.
“The MUHC has a huge amount of potential community support and is not using it,” Chambers said. “This government is cutting back for reasons of financial necessity without taking into account the needs of the community.”
Chambers pointed out that the government had tried to cut funding to the Jewish General Hospital, but that institution fought back and is often adept at rallying community support for its causes. The Jewish General sought an independent audit of its books, and the report absolved the hospital of any blame for its deficit. The recently-appointed executive director of the Jewish General, Lawrence Rosenberg, has stated publicly that the government is underfunding his hospital.
Clinical planning
Baron’s mandate was to examine the MUHC’s financial predicament and governance oversights, but he found a lack of clinical planning grave enough to warrant a stark mention in his report.
In the move to the superhospital in the summer of 2015, Baron observed that there will not be room enough for the following clinical services: mental health (now concentrated at the Allan Memorial Institute next to the Royal Vic); such clinics as rheumatology, immunology, dermatology and ophthalmology; along with geriatrics and in vitro fertilization.
There are two reasons for this: first, there is not enough space at the superhospital, which will have only slightly more square footage for clinical use than the Royal Vic, which is to be closed eventually; and second, the Montreal Health and Social Services Agency decided unilaterally in 2007 to alter the medical vocation of the MUHC toward more specialized care.
“There is a very high level of anxiety about what the future will look like,” said Anne Usher, a former Royal Vic nurse who helped found the family advisory council, now the MUHC user’s committee.
“There’s been a lot of scurrying to forge relationships between the MUHC and other organizations in the community about how they’re going to unload these services.”
In response to a sudden demand in private clinical space, the city of Westmount is poised to adopt a bylaw limiting the number of clinics and doctors’ offices in the municipality that is close to the superhospital. Should the bylaw pass, that would put even more pressure on the MUHC.
What’s worse, Morris cautioned, is that the MUHC’s role as a university teaching hospital will be compromised, along with McGill’s faculty of medicine.
“There have been some improvements, but there are significant clinical areas which will sadly not be adequately represented in the new hospital,” he said.
“It’s my feeling that any reasonable university-affiliated hospital that’s teaching medical students should have clinics in those areas, but that’s a strategic decision that the MUHC administration made that they’re not going to have them.”
In July, the government announced that it would be extending Bureau’s mandate as accompagnateur until March 31 next year. Michel Fontaine, a deputy health minister, expressed concern about problems with clinical planning in the move to the superhospital.
As of the latest planning sessions, the MUHC intends to keep dermatology at the Montreal General, “with a minimal presence” at the superhospital. What that minimal presence would entail is not clear. Ophthalmology “is currently being considered” for the Montreal General, with a minimal presence at the Glen.
Meanwhile, the allergy and immunology clinics will now be moved to the superhospital and will have a minimal presence at the Montreal General.
In an emailed statement, Ariane Lareau, Hébert’s press attaché, said the minister is pleased that the MUHC board and senior management are co-operating with Bureau.
“The return toward a balanced budget has started,” Lareau quoted the minister as saying. “However, we must remain vigilant in pursuing the work with the same rigour.”