Sherbrooke, September 3, 2023
Minister Christian Dubé
Ministry of Health and Social Services
Catherine-De Longpré building
1075 Sainte-Foy Road
Quebec (Quebec) G1S 2M1
Subject: Law 15, Health Insurance Law, Law 32, protection of whistleblowers and rules of inclusion in Health
In light of recent articles published in The Guardian concerning the protection of whistleblowers in the British public health sector, it would be appropriate for your Bill 15 to take into account the critical issues of whistleblower protection in the public health system as well as academic freedom in the university medical training setting. These articles highlight problems similar to those afflicting our Quebec health care system (our underlining):
NHS whistleblowers need stronger legal protection to prevent hospitals using unfair disciplinary procedures to force out doctors who flag problems, the British Medical Association has said. Doctors are being “actively vilified” for speaking out, which has resulted in threats to patient safety, including unnecessary deaths, according to the council chair of the doctors’ union, Phil Banfield. Despite a series of scandals in recent years, it is becoming more common for hospitals to use legal tactics and “phoney investigations” to undermine or force out whistleblowers rather than address their concerns, he warned. Banfield said: “Someone who raises concerns is automatically labelled a troublemaker. We have an NHS that operates in a culture of fear and blame." That has to stop because we should be welcoming concerns, we should be investigating when things are not right. “Whistleblowers are pilloried because some NHS organisations believe the reputational hit is more dangerous than unsafe care,” he added. “Whereas the safety culture in aviation took off after some high-profile airplane crashes in the 70s, the difference is that the aviation industry embraced the need to put things right and understand the systems that led to the disaster – the NHS has not invested in solving the system, it’s been bogged down in blaming the individual instead of the mistake”. Whistleblowers could be afforded greater protection through changes to the law as well as through cultural change in hospitals, including putting an end to many hospitals’ hierarchical “command and control” management style, which prevent more junior staff from airing concerns, he said.
The calls were echoed (…) by the hospital doctors’ union (HCSA), which is asking for an independent national statutory body to be established outside the health service to protect whistleblowers and those who report safety concerns. “The intolerable cover-up culture by managers that we still see in corners of the NHS is bad for patients and bad for doctors,” said the HCSA president, Dr Naru Narayanan. “For too many doctors, the brave, professionally obligated and morally correct step of reporting safety concerns is rewarded with attempts to silence and force out the individual who reports problems by managers focused on protecting reputations.” The union, which said it had dealt with “a string of cases affecting members” – with some reporting being left on the verge of suicide after raising safety alarms – has also called for a law to be created making it a criminal offence to cause detriment to people who have made protected disclosures.
In Quebec, the prevention of harassment is governed by section V2 of the Act respecting labor standards. However, this law does not apply to health professionals, as provided for in article 19 of the Health Insurance Act:
The provisions of the Labour Code (chapter C‐27) and of the Act respecting labour standards (chapter N‐1.1) do not apply to a health professional to whom an agreement made pursuant to this section applies who provides insured services in a facility maintained by or on behalf of an institution.
Only the Quebec code of ethics of physicians in the section Relations with colleagues and other professionals prohibits harassment as follows:
110. A physician must not, in his relations with whomever in the practice of his profession, notably a colleague or member of another professional order, denigrate him, abuse his confidence, willingly mislead him, betray his good faith or use disloyal tactics.
111. A physician must not harass, intimidate or threaten a person with whom he is connected in the practice of his profession.
However, its ultimate application falls to the College investigators who too often only consider such infringements as personality conflicts at the expense of the physician targeted by the harassment.
One another note, let us cite the recommendations contained in the report entitled Defending Medicine: Clinical Faculty and Academic Freedom produced by the Canadian Association of University Teachers (CAUT) Task Force on Academic Freedom for Faculty at University-Affiliated Health Care Institutions (our underlining):
The recommendations of this report—that universities and affiliated health care institutions make strong declarations of academic freedom rights, provide security of appointment and security of income, and allow access to dispute resolution systems characterized by natural justice; and that clinical faculty themselves form powerful representative organizations—will provide clinical faculty with the same academic freedom protections as other members of the professoriate.
CAUT's Executive Director can confirm that the Canadian academic medical community has not implemented the recommendations of this report published in 2004 in the wake of the Olivieri scandal.
Finally, a concern for inclusion should prevail within our health system. Indeed, ‘(…) autistic employees may be less susceptible to the bystander effect (social inhibition) than non-autistic employees. As a result, autistic employees may contribute to improvements in organizational performance because they are more likely to identify and report inefficient processes and dysfunctional practices when they witness them. These preliminary findings suggest (…) potential benefits of neurodiversity in the workplace (…)’ Hartman et al. (2023). Organizational benefits of neurodiversity: Preliminary findings on autism and the bystander effect. Autism Research, 1–13. These remarks certainly apply to autistic doctors who work in the health sector. Thus, it was noticed that: ‘Difficulties faced by autistic doctors, in our experience, rarely relate to patient care. Indeed, patient contact is usually task-focused or structured around a well-defined role. Rather, trouble arises in the unstructured, unpredictable, or in some other way confusing interactions with colleagues or organisational hierarchy. Here, social conventions and nuances of neurotypical norms may seem opaque, illogical, or otherwise bewildering. This may mean that interactions with management, training, or regulatory bodies become fraught with misunderstanding, though the issue is entirely understandable when viewed through an autistic lens.’ Doherty M, Johnson M, Buckley C. Supporting autistic doctors in primary care: challenging the myths and misconceptions. The British Journal of General Practice. 2021 Jul;71(708):294.
By virtue of the foregoing, I inform you that I have personally send alerts to which I alluded in a letter addressed on December 16, 2011, to Dr. Jean Rodrigue, then Assistant Deputy Minister, Department of Health and Social Services, Ministère de la Santé et des Services sociaux (MSSS). In order to preserve the objectivity of the process, I invited the Deputy Minister to himself question my Director of professional services (DPS) about the dysfunctions of my department. Since then, the hierarchy of the Centre Hospitalier Universitaire De Sherbrooke (CHUS) and the Faculté de médecine et des sciences de la santé (FMSS) have caused me great harm by resorting to legal tactics and phoney investigations, even though the CHUS granted me twice monetary compensations drawn from public funds in 2015 and 2021, an implicit recognition of reparation of harm done, if any. These compensations are attached to a non-disclosure clause, which means that the system cannot self-correct. In addition, the CHUS signed with me a Dispute resolution and dispute prevention plan (DPR) in 2021, a first in the medical academic community in Canada. The CHUS is not respecting its commitments to the DPR by maintaining presence of its lawyers in the dispute process, and by refusing to carry out an investigation into the Academic mobbing which targets me since 2003, as recommended by the mediator approved by both parties. Worse, the CHUS is asking the mediator to modify the conclusions of his report, thereby demonstrating the CHUS’ disrespect of the moral and professional integrity of the mediator accepted by both parties.
Mobbing can be summarized in four stages: 1) the future target presents a threat to the interests of certain people and becomes the subject of slander, attacks, pettiness or bullying; then occurs 2) contamination at the group level and 3) at the level of the entire organization, including in particular Human resources and senior management, with denial of the rights of the target; then comes 4) exclusion from the labor market. A successful mobbing terminates with a dismissal, a transfer, a resignation, an extended sick leave, a disability, an authoritarian decision of psychiatric internment or a suicide. The defense of a legitimate right or belonging to a minority have been identified as risk factors for mobbing. The mobbing target has no recourse within his organization, and exposes himself to an escalation of the mobbing if he/she defends himself.
The mobbing campaign which targets me was initiated in 2003 as I was finalizing a three-year Fellowship (2000-2003) in Cellular Therapy in Montreal while attempting to defend the right to scientific objection and the right to enforce the code of medical ethics in the Quebec university medical environment. In particular, at the cost of my entire scientific and professional reputation as well as my entire career, I refused to subscribe to the aberrant and scientifically untenable thesis that cancer cells could be considered as transplantable (manuscript ultimately refused by the referees). Forty years of schooling, completion of four university degrees (BSc Physics, M.A.Sc Aeronautics, PhD Mathematical Physics, MD), a list of original publications in the fields of mathematical physics, medicine and bioinformatics, as well as experience as a reviewer for scientific journals with peer review committees should more than amply justify my demands for the respect of the right to scientific objection in the Quebec university medical setting, and the creation of a scientific review committee. Moreover, we find in a recent Collège des Médecins du Québec (CMQ) report entitled The physician and clinical research the following affirmations:
Societal expectations and the current context of clinical research demand that any physician conducting or collaborating on research assess their own integrity and exercise caution in their actions. When problematic behavior in research is observed, it brings up the highly delicate issue of reporting misconduct, which seldom occurs if previously published statistics are to be trusted. While exemplary research is a virtue that all researchers adhere to in theory, it is more complex to apply in practice. When researchers witness a potentially reportable situation, they are likely to feel conflicted (not wanting to cause harm to colleagues, not wanting to rock the boat, fear of reprisals, fear of causing harm to the research centre’s reputation and, consequently, fear of indirectly damaging their own reputation, etc.). Researchers may be tempted to stay quiet, procrastinate, or even hope someone else reports the situation. Maintaining public trust and exemplary conduct in research requires courage.
Several of these affirmations may appear to the reader as incoherent and may foster an in-depth questioning about their ethical groundings. These questionable utterances by our professional watchdog demonstrate the absolute necessity of a law protecting whistleblowers in the health sector and the medical university setting.
As for the professional alerts that I have communicated to my hierarchies since 2003, they remain relevant to this day.
It would therefore be essential, Minister, that your Bill 15 would include:
- Protection of the right of scientific objection in the university medical setting.
- Protection of academic freedom in the university medical setting.
- Explicit rules for inclusion of neurodivergent doctors who care about the quality of care offered to our patients.
- Legislation making it a criminal offense to cause harm to persons who have made protected disclosures.
Hoping that you will be able to take into consideration the important professional, ethical, and scientific issues described herein, please accept, Minister, the expression of my most distinguished feelings.
Richard Le Blanc MD PhD
Cc : Sous-ministre adjoint Stéphane Bergeron, DGAUMIP, MSSS
Ministre Pascale Déry, Ministre de l’Enseignement supérieur
Dr Brian Hodges, Président du CRMCC
Dr Mauril Gaudreault, Président du CMQ
Dre Marie-Josée Dupuis, syndique et directrice des enquêtes du CMQ
Dr Jean-Hugues Brossard, Président de l’ACPM
Recteurs des universités québécoises
Doyens des facultés de médecine du Québec
Gille Bélanger, député d’Orford, CAQ, adjoint parlementaire du ministre des Finances
André Fortin, député de Pontiac, PLQ, porte-parole de l’opposition officielle en matière de santé
Vincent Marissal, Député de Rosemont, QS,
Porte-parole du deuxième groupe d’opposition en matière d’éthique et de santé
Joël Arseneau, député des Îles-de-la-Madeleine, PQ, porte-parole du troisième groupe d’opposition en matière de santé, de services sociaux et de soins à domicile
L'Honorable Pascale St-Onge, députée, circonscription de Brome-Missisquoi, Ministre du Patrimoine canadien
Élisabeth Brière, députée, PCL, circonscription de Sherbrooke
John D. Stefaniuk, Président, Conseil d'administration du l'Association du Barreau Canadien
Mme la bâtonnière Catherine Claveau, Conseil d’administration du Barreau du Québec
Me Catherine Ouimet, Directrice générale, Barreau du Québec
Pamela Forward, President, Whistleblowing Canada Research Society
Les médias québécois et canadiens