This article was originally published in Maclean's Magazine on July 12, 1999
Nurses Defy Quebec Government
Under a hazy sky, Helen Beath clutched a placard on the picket line outside Montreal General Hospital. Even though she retired in May after 43 years of nursing, Beath returned to the hospital last week to support her former colleagues. After launching an illegal strike on June 26, the province's 47,500 nurses spent the week locked in a standoff with the Quebec government over pay and deteriorating working conditions. "The frustration level is at an all-time high," said Beath. Nearby, Nathalie Comtois scrawled slogans on placards while passing cars, buses and trucks blared their horns in an encouraging, almost nonstop show of support. "We are all exhausted, we're on the edge of burnout," said Comtois, a union representative and nurse in the General's neurological intensive care unit. "You have a patient who gets bad news and the only thing you have time to do is say, 'Well, I'm very sorry, sir - but I have to go.' "
Nurses in other parts of the country share their Quebec colleagues' militancy. Alberta and Newfoundland came to the brink of serious work stoppages. In April, Saskatchewan nurses defied back-to-work legislation and went on a 10-day illegal strike leading to a long standoff with the province that was only tentatively settled on Friday, the same day Premier Lucien Bouchard was legislating his nurses back to their posts. Bouchard gave the striking nurses until Saturday afternoon to return to work. But the mood on the picket line was defiant and Quebec's back-to-work law, while imposing fines and restrictions on union leaders, pulled its punches: the bill contained no measure to strip nurses of seniority or send leaders to jail.
The dispute with the nurses is just one of several problems - some more recent, others longstanding - gnawing at Quebec's beleaguered health-care system. In mid-June, partly due to a shortage of specialists, especially radio-oncologists, the province began sending cancer patients to the United States for radiation treatment after waiting lists became too bloated (Ontario and British Columbia have also been forced to send patients south of the border). Then, on Thursday, ambulance technicians, seeking premiums for weekend work, voted overwhelmingly in favour of a general strike for later in the month. And nearly 1,000 hospital pharmacists renewed an earlier threat to resign en masse in September over stalled contract talks. Hoping to nip that revolt in the bud, the government has included them in a new bill governing essential services.
The disputes follow years of belt-tightening. The Parti Québécois government slashed more than $1.4 billion from the health-care system during its first mandate and, though pledging to reinvest similar amounts, has imposed strict limits on public sector salaries. The result: "You've got all of the provider groups fed up," observes Lee Soderstrom, a health economist at McGill University. "They see their workloads have increased substantially. And at the same time, they see their incomes have, at best, remained constant in real terms."
For nurses, their union's rallying cry "enough is enough" captured the mood of many on the picket line. In 1996, when the government offered early retirement packages to public workers as part of its deficit-slashing efforts, 3,200 nurses took the buyout - and those who remained have since complained they are being run off their feet. According to Michèle Boisclair, vice-president of the Quebec Federation of Nurses, the union's membership hasn't had a decent pay increase in five years. In fact, nurses have had only a one-half-per-cent increase in 10 years. "We have been holding the health-care system on our shoulders," declared Boisclair. "Families and patients know that."
Among the lowest paid in Canada - the most senior nurses earn $44,000 - Quebec nurses were demanding a six-per-cent raise over two years, plus an immediate 10 per cent as catch-up pay. But Bouchard refused to budge on the government's uniform offer to all public servants: a five-per-cent raise over three years and an offer to consider some sort of catch-up if an independent commission agrees it is necessary. By week's end, his government claimed that 11,500 operations had been cancelled as a result of the dispute. But a strong current of public sympathy clearly backed the nurses. Just before they walked off the job, one poll showed 71.3 per cent of Quebecers thought their salary demands were reasonable.
Nicole Laverdière experienced firsthand some of the problems afflicting Quebec's health-care system. In mid-March, following a routine mammogram, an abnormal mass in her breast was determined to be malignant. But the 52-year-old clerk from Pintendre, near Quebec City, did not begin radiation treatment at a Montreal hospital until late June after being bounced around from one possible treatment site to another. "It's frustrating," the soft-spoken Laverdière told Maclean's . "I think it's playing with people's lives."
Laverdière is not alone. In his cramped hotel room overlooking a bustling road in Plattsburgh, N.Y., Hervé Brin, 60, was relaxing hours after his first treatment for prostate cancer. Like many Quebecers, Brin used to equate this small upstate city, 100 km from Montreal, with cross-border shopping. But now, he and a dozen other cancer patients are being treated at Plattsburgh's FitzPatrick Cancer Center, a gleaming institution with carpeted floors and pale pink walls.
While some Quebec patients refused the Plattsburgh option, Brin pushed to get on the list - even though he speaks little English. Staying in Montreal would have meant waiting until the fall for an appointment. A retired foreman, Brin is relieved to be treated - but his assessment of Quebec's health-care system is not glowing. "I'm not a grand strategist," says Brin, "but I don't understand how it deteriorated like that."
In late May, Quebec announced its intention to send patients to the United States. The reason: of the 1,200 patients in the province needing radiation therapy, nearly 300 had been waiting more than eight weeks for treatment, some as long as 19 weeks. "It's never been this bad," says Dr. Carolyn Freeman, chief of radiation-oncology at Montreal's McGill University Health Centre and the head of a government advisory committee on cancer treatment. "It is a crisis now."
Freeman is encouraged by the recent response from Quebec's health minister, Pauline Marois. Among the new measures announced to deal with the problem are a special cancer task force and plans to recruit more oncologists and buy new radiation machines. But many critics contend the predicament was a foreseeable one. Quebec oncologists warned the government in the 1980s about a shortage of doctors. Still, the province established a limit on the number of openings for cancer specialists. "It's definitively a flagrant lack of planning," argues Dr. Michel Gélinas, vice-president of Quebec's Association of Radio-oncologists.
The problems in the health-care system may also come at a political cost for the Bouchard government. The militancy among the nurses and other health-care workers may presage even larger troubles to come when negotiations with the rest of Quebec's 400,000 public sector workers kick into high gear this fall. Bouchard has pledged to create "winning conditions" for a sovereignty referendum - which some observers say may be held next year. But widespread labour unrest may deal the PQ's aspirations a blow. "It's rare that a government emerges stronger from those kinds of confrontations," says Louis Massicotte, a professor of political science at the Université de Montréal. For the Bouchard government, last week's standoff with the nurses may be just the first of many headaches.
Maclean's July 12, 1999