Without even assessing its labor needs in a “rigorous” manner, the CIUSSS de l’Estrie awarded private health agencies direct contracts whose value exploded up to 922%.
On January 27, 2023, the CIUSSS awarded a $118,000 contract, without a call for tenders, to an agency to provide nurses and beneficiary attendants to lend a hand in the network. The contract ended up costing $1.2 million.
In a decision rendered Wednesday, the Public Procurement Authority (AMP) calls the CIUSSS de l’Estrie to order. By avoiding public calls for tenders, he contravened a directive in force in the network. The establishment also did not carry out an “adequate and rigorous assessment of its needs” before awarding three direct contracts.
The CIUSSS also chose to meet its needs for nurses and beneficiary attendants through three separate contracts, the value of which was just below the call for tender threshold, established at that time at 121,200 $, notes the AMP.
A $115,000 contract awarded on January 17, 2023 ended up costing the CIUSSS $409,895. Another, initially valued at $110,000, ended up being worth $688,078. That leaves the third contract, which went from $118,000 to $1.2 million. The AMP, we read in the decision, “notes that the additional expenses result from greater use of the services of nurses and beneficiary attendants than what was provided for in the contracts”.
In a response to Duty, the CIUSSS explains that “the gap comes from issues in the monitoring mechanisms rather than from non-compliance with instructions”. He adds that he had already noted the problems raised in the AMP report and is therefore carrying out corrective work.
No vision of needs
To justify the separation of its contracts, the CIUSSS “indicated to the AMP that purchase requests for independent labor needs were processed individually” and not “globally”. It was therefore “difficult for the CIUSSS-Estrie to have a clear, transversal vision” of its needs, we read in the decision.
The AMP also says it notes that “these shortcomings in determining the extent of the needs” in independent labor “were such that the CIUSSS-Estrie contravened its obligation to carry out an adequate and rigorous evaluation of its needs” before awarding three contracts from private agencies.
Once the contracts were awarded, the CIUSSS admitted to being unable to “quickly have the information to adequately monitor the amounts committed” to agencies providing independent labor.
In addition, the two agencies selected for the contracts were not among the service providers identified by the government as part of a large public call for tenders. The CIUSSS thus had the obligation to request the services of these agencies selected by Quebec, which it did not do.
No emergency
The AMP also looked into the awarding of two direct contracts, on June 7 and 15, 2023, for respective values of $971,465 and $535,430. To justify them, the CIUSSS pleaded an “emergency situation where the safety of people or property was in question”.
However, a manager had informed his colleagues of a “significant shortage of human resources” as early as January, notes the AMP. In April, the CIUSSS de l’Estrie had also estimated its needs for external services for beneficiary attendants and nurses at $6.8 million.
“The AMP notes that the event at the origin of the situation described as urgent by the CIUSSS-Estrie, namely the shortage of personnel, was known and thus predictable since January 25, 2023, i.e. more than four months before the “award of the two contracts”, it is written in the decision.
She adds that emergency contracts should be limited in time and of short duration, and not provide for renewal options, as was seen at the CIUSSS de l’Estrie.
The AMP recommends in particular that the establishment submit a recovery plan to it within 45 days of its decision. In particular, the CIUSSS is required to review its contractual management procedures and improve its contract monitoring. “We will comply with all of the recommendations made in this report,” assured the CIUSSS in its email to Duty.