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TA B L I N G O F T H E QU É B E C OM B U D S M A N’S 2 0 0 8‐2 0 0 9 AN N U A L RE P O R T
‐ A number of deficiencies for which urgent action is required ‐
Québec City, May 26 2009 – The Québec Ombudsperson, Raymonde Saint‐Germain, is critical of many instances in which the public service has failed to uphold citizens’ rights. In tabling her 2008‐2009 Annual Report, she noted a number of worrying situations and unsatisfactory follow‐up to the recommendations made in last year’s report. She also emphasized problems affecting the general public as a whole, particularly in the health and social services sector, and paid particular attention to the situation of vulnerable people, including seniors and the mentally ill.
Residential care for seniors: The Québec Ombudsman notes many unacceptable situations The grounds for complaints received by the Québec Ombudsman in 2008‐2009 include user transfer conditions, the capacity of certain private residences to care for their users, poor care quality and mixed client groups. Accordingly, the Québec Ombudsman has recommended that the MSSS should intensify its quality assessment visits and take steps to ensure that certified private residential facilities are included. In addition, it has recommended that quality indicators be included in management agreements between agencies and institutions, and suggests that contracts with private resources should indicate expected quality levels and quality control methods. It also recommended that resources should have the capacity to meet the special needs of their residents. In response to these recommendations, the MSSS confirmed that it has set a target of visiting 12% of all facilities by June 2009, and has undertaken to draw up a separate profile for each region, showing the current state of residential resources that have purchase agreements for places or services. It will also analyze the conditions of agreements between health and social services agencies, health and social services centres and private promoters. (Page 64)
Certification of private seniors’ residences: the MSSS must speeds up the rate of inspection visits
Roughly 99.7% of all private seniors’ residence owners applied for certification within the time allowed. However, as of April 7, 2009, only 686 out of a total of 2,199 residences had actually obtained certification. (Page 68)
Unreasonable delays before seeing a physician in some hospital emergency rooms
Many of the complaints received by the Québec Ombudsman concerned the long wait before seeing an emergency room physician. This situation is a reflection of the problems many citizens experience when they need primary medical services. The Ministère de la Santé et des Services sociaux (MSSS) must find alternative solutions to ensure that users whose condition is assessed as being level 4 (less urgent) or level 5 (not urgent) have access to primary care services outside hospital emergency rooms. The MSSS has already acknowledged that the solution to emergency room wait times lies in providing access to primary care services. In the meantime, however, it has proposed four steps that it hopes will improve the situation, at least in part. They are: agreements between emergency rooms and the existing primary care network to redirect less urgent cases during triage, support for innovative work organization projects, application of collective prescriptions during triage, and development of mechanisms that will allow family physicians to direct their patients to the right place (page 75).
Even more complaints about access to home support services
The Québec Ombudsman continued to receive complaints about wait times and failure to provide the required number of hours of care and services. The gap between needs and supply continues to grow, and the Québec Ombudsman has therefore recommended that the MSSS should specify the prioritization criteria for access to services, and instruct institutions to apply these criteria with timelines and specific accountability. (Page 78)
Launching of protective supervision programs for incapacitated individuals: Average time of 111 days for processing by the Curateur public
Despite the Curateur public’s efforts over the last year, the Québec Ombudsman has once again observed significant delays in the opening of protective supervision programs. The average time required to obtain the necessary court ruling is estimated at 154 days, plus an average period of 111 days for processing of the file by the Curateur public. The Québec Ombudsman has therefore recommended that the Curateur public should report to it on the outcome of the steps taken to reduce processing times. The Curateur public has undertaken to do this by the end of 2009. (Page 94)
The Curateur public must visit more of its wards
For the last ten years, the Québec Ombudsman has reminded the Curateur public of the importance of understanding its client base. However, the Curateur public is finding it difficult to meet its targets as the number of wards continues to grow steadily and the workload of its personnel continues to increase. The Québec Ombudsman has
recommended that the Curateur public should submit a review of the steps taken to understand its clientele, no later than January 2010. (Page 97)
Still no optimization of the Curateur public’s reassessment processes for protective supervision programs
The Curateur public failed to meet its own deadline of December 31, 2008, for completion of its reassessment of protective supervision programs. It has, however, undertaken to report to the Québec Ombudsman on the results of its actions in May 2010. (Page 98)
Curateur public: Documentation that is difficult to understand
Following a number of complaints during the year, the Québec Ombudsman has recommended that the Curateur public should use the principles set out in the Act respecting administrative justice as a basis for producing explanatory documents with a generalized version of its final report and accounts that will be more easily understood.
(Page 100)
SAAQ: Unacceptable delays for obtaining medical opinions
For the fourth consecutive year, the Québec Ombudsman has criticized the time taken by the SAAQ to obtain medical opinions. This situation causes significant prejudice to road accident victims, who must wait several months before receiving the money they are owed.
The SAAQ believes the delays will be shortened when its action plan is implemented in 2009. However, the Québec Ombudsman has recommended that it should set improvement targets so that it is able to assess the impacts of its restructuring on the time taken to obtain medical opinions. The SAAQ followed up on this recommendation on May 14, 2009, and has presented its improvement targets, to be implemented by January 1, 2011. The Ombudsman will be vigilant in monitoring the achievement of these targets. (Page 37)
SAAQ: A much‐needed overhaul of the computer system
Every year, citizens are adversely affected by the limitations of the SAAQ’s computer system. The Québec Ombudsman has therefore recommended that the SAAQ should treat the system overhaul as a priority. (Page 41)
Unacceptably long telephone wait times at the Crime Victims Compensation Directorate (CSST)
The Québec Ombudsman noted an average wait of seven minutes from pick‐up by the automatic answering machine to transfer of the call to an agent. This long wait can have serious consequences for a particularly vulnerable client group. The Québec Ombudsman has therefore recommended that the Crime Victims Compensation Directorate should submit a plan of action by June 30, 2009, aimed at bringing the average wait time as close as possible to the standard of 20 seconds for 80% of calls received, as recommended by the Centre d’expertise des grands organismes. (Page 47)
CARRA: Inadequate information given to participants and beneficiaries
The information provided by the CARRA, which citizens use as a basis for important decisions, can be inaccurate, incomplete and difficult to understand. Following a number of complaints about this issue, the Québec Ombudsman has recommended that the CARRA should inform it of the results of steps taken to improve information quality when it implements its 2009‐2010 action plan. (Page 48)
RRQ: Unfair impacts of combined benefits
After receiving a complaint, the Québec Ombudsman noted that situations involving a combination of benefits from the RRQ and the SAAQ can produce unfair outcomes. In practice, citizens who find themselves in these circumstances have no recourse since the authorities are simply applying the law as it currently stands. The Québec Ombudsman has therefore recommended that, as part of the pension plan review due to take place in the fall of 2009, steps should be taken to ensure that the rules applicable to benefit combinations do not have the effect of reducing the recipient’s income from its original level. (Page 50)
Child and youth protection centres
An investigation by the Québec Ombudsman revealed that people adopting children from abroad do not have access to the same services as those adopting children from Québec.
Some regional disparities were also observed. The Québec Ombudsman has therefore recommended that the Ministère de la Santé et des Services sociaux (MSSS) should harmonize these services and report to it on the progress made in January 2010. (Page 56)
Some major deficiencies in complaints handling systems of detention facilities
Many detention facilities do not make full use of the register of inmate complaints, and there is therefore insufficient information available to improve practices and manage risks.
The Ministère de la Sécurité publique has undertaken to make quarterly reports on this subject to the Québec Ombudsman, beginning in August 2009. (Page 24)
Medical escorts to hospital appointments: Reconciling security requirements and rights
The Québec Ombudsman has recommended that the Ministère de la Sécurité publique (MSP) should review the internal directives of detention facilities so that the use of physical restraints in hospitals is based on the level of risk and on the security context. (Page 25)
The Québec Ombudsman received a number of complaints, from physicians among others, concerning the lack of confidentiality in discussions between health professionals and inmates, due to the presence of correctional officers during consultations. (Page 26)
The MSP has undertaken to review both these practices as part of its review of the provincial instruction on custodial methods in hospitals. It will inform the Québec Ombudsman of developments by December 31, 2009. (Page 26)
Release on parole: Chronic postponement of hearings
The percentage of postponements for hearings by the Commission québécoise des libérations conditionnelles (CQLC) has increased steadily over the years. At the same time, the percentage of eligible inmates who gave up on parole increased from 13.8% in 2000‐
2001 to 35.6% in 2007‐2008. Given that the parole program is a fundamental element of the social reintegration process and a trial run for unconditional release, the Québec Ombudsman has recommended that the Ministère de la Justice, the Ministére de la Sécurité publique, the Director of Criminal and Penal Prosecutions and the Commission québécoise des libérations conditionnelles should work together to analyze bottlenecks in the current parole release system, in order to improve existing practices and simplify their operation.
The leaders of the four authorities have undertaken to report to the Québec Ombudsman on the changes made by January 31, 2010. (Page 27)
UNSATISFACTORY FOLLOW‐UP TO THE QUÉBEC OMBUDSMAN’S PREVIOUS RECOMMENDATIONS
The follow‐up to certain recommendations made in the Québec Ombudsman’s 2007‐2008 Annual Report has been unsatisfactory, as shown by the following examples: (follow‐up to all the recommendations on page 125 of the Annual Report)
Certification of private residences that house vulnerable people
The Québec Ombudsman reiterates the urgent need for mandatory certification of private residences for people with addictions, mental health disorders or intellectual deficiencies.
Without certification, there is no guarantee that residents will receive proper care and treatment in a safe and clean environment. (Pages 70 and 128)
Consent for care dispensed to incapacitated individuals
The Curateur public has not yet reviewed the steps taken to ensure that health and social services institutions request consent for care dispensed to incapacitated individuals. The Curateur public has assured the Québec Ombudsman that it has completed its analysis and will report on its conclusions by June 2009. (Pages 96 and 127)
Assessment of care quality and quality of life (Mental Health Action Plan, 2005‐2010) The Québec Ombudsman believes the effort made by the Ministère de la Santé et des Services sociaux to assess the quality of life of users with mental health disorders is insufficient. (Pages 86 and 131)
Social Reintegration Plan and contracts with local social reintegration support funds The Québec Ombudsman is worried about the negative impacts of the delays accumulated by the Ministère de la Sécurité publique (MSP), and notes a significant disparity between the MSP’s words and actions. It recommends that the MSP should treat this work as a priority, and that it should table the government’s Social Reintegration Plan by June 30, 2009. (Pages 18 and 126)
Mandatory register for isolation and seclusion cells
The Québec Ombudsman is dissatisfied with the delay in following up on its recommendation to introduce a mandatory register for the use of isolation and seclusion cells in detention facilities. (Page 128)
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Source: The Québec Ombudsman
Information:
Joanne Trudel, Communications Department 418 644‐0510
