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Quebec’s Court of Appeal has ruled its system of regionally restricting family doctors and the method used by the minister are valid.
Dr. Mark Roper and his lawyer, Julius Grey, did not convince the judges the Plans régionaux d’effectifs médicaux (PREM) created a real injustice toward the population of Montreal.
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In a reaction sent by email, Grey said he was disappointed and mentioned he was considering turning to the Supreme Court.
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In the judgment signed by judges Stephen W. Hamilton, Martin Vauclair and Frédéric Bachand, the court upholds the Superior Court decision rendered by judge Dominique Poulin, noting how “careful” it reached its conclusion.
Grey and Roper alleged Montreal is at a disadvantage compared to the majority of regions of Quebec. According to Dr. Roper’s figures, Montreal has the worst rate of registration with a family doctor, with 68 per cent, and from one year to the next, the minister uses his discretionary power to deprive the metropolis of new doctors in favour of other regions. Quebec’s target is 85 per cent. For comparison, Montérégie has the second worst rate at 75 per cent. The regions best served are Saguenay—Lac-St-Jean at 91 per cent and Gaspésie-Îles-de-la-Madeleine with 89 per cent.
The applicants maintained the system used was “unreasonable” and it even violated the Canadian Charter of Human Rights and Freedoms.
However, the judges of the Court of Appeal reached the same conclusions as Judge Poulin, that the insufficient number of front-line family doctors “does not result from the distribution of staff carried out by the minister, but rather the insufficient number of doctors to meet the needs at the provincial level.”
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In defence, Amélie Bellerose, who represents the Attorney General of Quebec, argued family doctors do not only provide front-line consultation, which is even more of a striking reality in remote areas. This is what forces the minister to deploy more resources in these regions, even if the rate of patients registered with a family doctor is higher.
“Nothing is lost, nothing is created,” she said at the opening of her presentation to the Court of Appeal on Thursday morning. “We also need doctors in CHSLDs, in emergency rooms, in the short term,” she added.
Bellerose recognized the method was not perfect and could be improved. She even described the appellant’s approach as “noble” since it comes from a desire to improve health-care coverage. But the reality remains the inability to offer more general practitioners in Montreal is explained by the lack of doctors.
“We make do with what we have. What we have are family doctors who do CHSLD, obstetrics, emergency,” she insisted, concluding there was a gap between supply and needs throughout the territory.
In his request, Roper also denounced the fact the calculation used for the distribution of staff did not take into account the rate of registration with a family doctor. In addition, he criticized the Ministry of Health for not taking into account the real pool of patients served by Montreal and for only sticking to the number of inhabitants.
The judges, however, said it was not the role of the courts to replace the legislative, executive or administrative powers in this situation.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
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