The emergency rooms at Verdun hospital require a mandatory deposit of $500 for patients without an up-to-date health insurance card and those who resist have been regularly ignored by emergency workers who wanted to ensure they were paid.
These doctors – at least one of whom carried an Interac terminal in his doctor’s coat – simply ignored the patients in question in the waiting room and postponed their consultation until their shift was over. At night, only one doctor works in these emergency rooms.
This is according to an arbitration decision dated last week, which describes the situation that prevailed in 2019. The requirement for a $500 deposit, however, is still in force, it was indicated to The Press when we called directly to the emergency room at Verdun hospital on Thursday.
The arbitrator looked into the suspension and dismissal imposed that year on nurse Yves Goulet. He had tried to convince a man who arrived in an ambulance with an expired card to pay the deposit or go to the CLSC to obtain a temporary card. Otherwise he risked not being seen by a doctor.
The patient involved in Mr. Goulet’s case, unable to pay, ultimately left the emergency room before seeing a doctor. He returned a few hours later by ambulance, his condition ultimately requiring urgent surgery.
The Verdun hospital then strongly criticized Mr. Goulet for his intervention. He was suspended for 20 days, then fired following evaluations of his work.
“Nurses forced to collect”
In a long decision, grievance arbitrator Dominique-Anne Roy canceled Mr. Goulet’s dismissal, reduced his suspension and criticized the Hospital’s “incomprehensible” decision.
When [l’infirmier] explains to the user that he must pay a deposit of $500 to access care, he is not lying: he is only stating the applicable rule.
Extract from the decision of the grievance arbitrator Dominique-Anne Roy
The nurse “did not make false statements when he explained to the user that it was possible that he would not be seen by the emergency doctor present without paying the deposit”, is it it also emphasized in the decision.
“Doctors manage not to treat users without a card, leaving them in the waiting room to be seen by their colleagues on the next shift. The triage nurses also suffer indirectly, they who remain stuck with the problem. The complainant explains that he witnessed this situation every month when a user without an up-to-date card did not present a really urgent case, such as a cardiac arrest. The nurse “also witnessed situations where nurses were forced to collect money directly from users and then give it to doctors”.
Internal turmoil
The Verdun hospital is part of the CIUSSS du Centre-Sud-de-l’Île-de-Montréal (CCSMTL).
“The 2019 incident reported in the arbitration decision is regrettable, but is not representative of the way we welcome our users at Verdun Hospital or in other CCSMTL establishments. Our mission is to offer quality care to our users, and to ensure a fair assessment of their condition when they arrive at the emergency room,” indicated CIUSSS media relations advisor Marianne Paquette, in an email.
“All patients will receive the care required according to the severity of their condition, without discrimination based on their means of payment. Patients receive the required health care, even if they do not give a deposit upon arrival at the emergency room. If the patient is unable to pay the deposit and their consultation fee, the financial resources department will send a bill to the user’s home, she added. Health professionals prioritize responding to the most urgent situations at all times. »
The decision reports that the directive regarding mandatory filing caused internal turmoil.
Head nurse Rinda Hartner “reproaches” the fact that her team had to serve as collectors for the doctors and “reminds that the oath taken [par les médecins] to care is real, must speak, and targets the beggar as much as the Prime Minister,” noted arbitrator Dominique-Anne Roy.
One of the doctors involved, contacted by The Press, argued that he had “never refused to treat a patient,” but confirmed that he had “insisted on having patients’ information.”
I am convinced that neither I nor any of my colleagues have refused to see a patient who did not have RAMQ.
One of the doctors involved, contacted by The Press
He confirmed that he had carried a payment terminal in his blouse at one time, in order to charge the tourists he was treating. The Press decided not to publish the name of this doctor, because he was not heard by the grievance arbitrator.
Mr. Goulet’s union, the FIQ, did not want to react.
“It is clear that the doctor must prioritize the patient and always come to their aid and provide them with the best possible care,” responded the College of Physicians, through its media advisor Leslie Labranche. “We would like to remind you that from the point of view of the ethical obligations of the doctor, the latter must always, in an emergency situation, ensure that the interests of the patient are prioritized above any financial consideration on their part. »
A mistake, all the same
Grievance arbitrator Dominique-Anne Roy reduced the suspension imposed on Yves Goulet from 20 to 2 days without pay, in addition to canceling his dismissal.
Because the nurse still made a mistake, according to his decision. “The plaintiff’s years of experience in the emergency room should have led him not to try so hard to convince the user of the importance of having an up-to-date health insurance card,” ruled the arbitrator. . To the point that he “failed to sort the user and adequately evaluate [la] condition” of the patient, contenting himself with transcribing the observations of the paramedics rather than carrying out his own assessment.
Following this episode, the nurse was subjected to an intensive assessment of his skills, following which he was dismissed. “The conduct under attack is for the most part consistent with the emergency practices of the Verdun Hospital,” wrote arbitrator Dominique-Anne Roy, canceling the decision.