Answers to questions tabled at the Board of Directors Public Meeting

1)

 

Has an investigation been undertaken into the issuing of other contracts (beyond the construction contract) which were awarded under the tenure of Dr. Porter and the previous Board, in particular a large contract for imaging equipment?

We have reviewed a number of contracts, and in each case have determined that government policies and procedures have been followed.  In the area of imaging equipment we have reviewed our acquisition of linear accelerators for the Glen and confirmed that the process was appropriate. If, however, you have evidence of wrong-doing in the area of contracting, please share it with us so we can have the matter investigated. 

   

2)

 

Has an inquiry or review into the Board or committee structures and practices which were in place to supervise and control Dr. Porter (Nomination and Governance Committee for example)? Has the possibility of an action for culpable negligence been considered? Is not the pretence that the previous Board was some kind of an alien entity for which you are not answerable hard to maintain as your current Chairman and Vice-Chairman were key decision makers on the former Board?

Dr. Porter periodically submitted a list of outside interests in writing that were reviewed by the Chair and the Nominating and Governance Committee. The previous Board was duly advised, and appropriate feedback was provided to Dr. Porter both verbally and in writing. To our knowledge we have no grounds to justify an action for culpable negligence in the circumstances.

Having said that, the current Board of Directors has taken steps to enhance governance at the MUHC. This, in fact, has been one of its primary foci since it came into office in February 2012

Board Committees and Councils have been set up in accordance with new provisions of the law enacted in February 2012 and the particular needs of the MUHC and are fully operational.  At the recent public Board meeting, for example, we received in-depth reports from the Chairs of our Audit, Ethics and Governance, Real Estate and Quality Control Committees. For ease of reference, we are enclosing  the report of Glenn Rourke, the Chair of the Ethics and Governance Committee, which includes the chart outlining the various committees. (See Appendix 1).

Steps that we have taken include the following:

  • The Chair of the Board is no longer Chair of the Ethics and Governance Committee;
  • Our Code of Conduct and Conflict of Interest policies have been updated and are being promoted;
  • Our Audit Committee is assessing the merits of setting up an internal audit function and is reviewing our signing authority policies.

Please note that much of this information along with the mandates of the various committees is now posted on the MUHC Board section of our website at:

http://muhc.ca/homepage/page/board-directors

   

 3)

 

Why have you not explained the purported budget overrun of the MUHC? Why have you allowed the government and the press to depict the hospital as the most inefficient and corrupt manager of public funds in the whole Quebec healthcare sector? Are you capable of making a convincing argument in defence of your management practices? These problems do not all date back to the former Board and Dr. Porter. Why have you shut the public and the MUHC community out of your process of negotiations with the government?

Our commitment is to live within our financial means while fulfilling our academic health care mandate. With the input of our internal community we have developed a plan that will bring us back to fiscal equilibrium by March 31, 2015. In developing the plan, management of the MUHC has consulted broadly, meeting with the leadership of our various councils and committees  as well as our unions and hosting town hall meetings. The current Board of Directors and management team have been forthcoming about our financial results. With regards to the Baron Report we made the strategic decision not to dispute factual errors when it was first released and to buckle down and address our financial challenges while remaining committed to fulfilling our academic health centre mission. We have subsequently advised stakeholders during face-to-face meetings with the internal community (we have, for example met with the various Councils, managers and Foundation Boards and held town hall meetings), through a message from the DG and CEO, at the public Board meeting and through media interviews of clarifications related to the Baron Report. We have, for example, explained that the deficit projection is inaccurate and the characterization of our remunerated hours of work is not fully accurate. Finally, even before the Baron Committee the MUHC had advised the Agence and the MSSS repeatedly that the MUHC was underfunded in relation to the care it provided, the complexity of patient cases it handled and the scope of its catchment area.

We should also point out that we are pleased with the positive evolution of our relationship with the current government in recent weeks. The announcement of the decision to keep the Lachine Hospital in the MUHC family, the Minister’s news release about our submitting information related to the Baron Report on January 18, Dr. Bureau’s comment that he has noticed a phenomenal change at the MUHC since December 17” and the government’s press release of March 25 endorsing our budget plan are proof of this. In the coming months and years we will jointly face the challenge of implementing our clinical plan. Although we anticipate that we will in the future have differences with the Agence and the MSSS on how best to proceed and remain committed to defending our academic health centre mission, particularly access to quality patient care, we are now in a better position to address these challenges in a collaborative manner.

   

4) 

 

Have all senior members of the governance and supervisory regime under the last Board clearly, formally and publicly recused themselves or been excluded from all participation, deliberative administrative, executive and representative, in the management of any process arising from alleged corruption related matter (members of the former) nomination and Governance Committee including the Chairman and Vice-Chairman as well as the current Executive Director)?

As we have repeatedly stated we are collaborating with the authorities in relation to allegations of corruption. We believe that they are in the best position to investigate such matters. At the same time we have established a hot line, asked an independent third party to look into allegations that Yanaï Elbaz and Dany Journo, former employees of the MUHC, may have illegally obtained services and materials from a small number of suppliers of the MUHC for the construction of their private homes and are in the process of reviewing our contracting and procurement policies and procedures.

   

5)

 

Have measures been taken to ensure that information records and evidence in paper or electronic form are not mishandled or destroyed?

In responding to your question, we wish to point out the following:

  1. The MUHC has policies in place pertaining to information management that are on the MUHC intranet and are accessible to MUHC staff and professionals. Staff and professionals are expected to follow these policies and procedures;
  2. The MUHC backs-up its information systems;
  3. Relevant correspondence related to ongoing investigations have been shared with the authorities and have been secured to ensure that the material can neither be modified nor destroyed. 
   

6)

 Can an explanation be provided of the cause and nature of former HR Director Stella Lopreste’s departure from employment at the MUHC? Were there any circumstances which have not been made public? Was any severance paid and if so how much?

This matter is under police investigation, and it is therefore inappropriate to comment. An investigation by an independent third party was conducted, which has been shared with the authorities.

   

7)

 

What was the rationale behind Dr. Porter’s receiving a salary and loan from McGill? Did the MUHC Board approve this arrangement? Was it even aware of it? Was any consideration given to the possible conflicts of interest which this type of arrangement could give rise to? What was the actual source of the funds that McGill provided to Dr. Porter? Was any hospital or hospital related entity involved (Foundations?)?

Questions pertaining to benefits provided by McGill University to Dr. Porter should be addressed to the University.

   

8)

 

What is the role of Dr. Bureau in the budget process? Does he function as a de facto trustee? Is the Board capable of standing up to the government? Why have you not sought community support? Why has everything been done in secret?

Dr. Bureau’s role is explained in the news release announcing his appointment. (http://communiques.gouv.qc.ca/gouvqc/communiques/GPQF/Decembre2012/18/c2...). Since January we have been in regular consultation with Dr. Bureau who has provided useful advice and support. His in-depth knowledge of the Quebec health care system has been helpful in providing us with an understanding of how others in the network have addressed similar challenges. He has been particularly beneficial in strengthening our dialogue and collaboration with both the MSSS and the Agence.

Having said that, the MUHC is leading the budget process, which benefits from the active involvement of MUHC leadership, from healthcare professionals to managers, as well as the full support of the Board. Our commitment is to move towards a performance culture and to involve all elements of our community in this process. In fact, our goal is to “work smarter together” and to emerge as a model academic health centre.

   

9)

 

Did Dr. Porter’s other business activities, and his sponsorship of tours of his Caribbean clinics by medical staff of the MUHC, create any conflicts of interest or compromises which require review?

To our knowledge, no sponsored tours of Dr. Porter’s Caribbean clinic have ever been arranged for medical staff of the MUHC. If you have knowledge to the contrary, please let us know so we can investigate.

Dr. Porter periodically submitted a list of outside interests in writing that were reviewed by the Chair and the Nominating and Governance Committee. The previous Board was advised, and feedback was provided to Dr. Porter both verbally and in writing.

   

10)

 

You have said on several occasions that no current member of the MUHC is under investigation. How can you be sure of this? Is it because the authorities have told you so? If so, do you think it shows good judgement to believe them?

The authorities have advised us on several occasions that they are not investigating current MUHC employees or the MUHC itself. Once again, if you have specific allegations to make, please bring them to our attention so that we can take appropriate action.

   

11)

 

As a public entity, you have a responsibility to the community to act properly and to account for your decisions. Given that the acquisition of 1750 Cedar Avenue was clearly illegal, why have you not undertaken any investigation into the wrong doing? Please do not tell us that are you leaving it all to the Police as though this were something done by third parties to the institution and not undertaken by the MUHC itself. Why has there not been an application to the courts to have the unauthorized transaction reversed via an action in nullity? Why should the MUHC operating budget be on the hook for the cost of malfeasance by parties unidentified and unpunished?

The MUHC sought legal advice throughout the negotiations with the owner of the 1750 Cedar Avenue property and as such, all agreements were concluded with the benefit of said legal advice.

After holding public hearings, the City of Montreal announced that it was referring to the Government of Quebec a decision on amending the by-law to allow 1750 Cedar to be used for institutional purposes, or more precisely as a healthcare facility. In the ensuing months, Quebec’s Ministry of Health and Social Services made it clear that it did not support the zoning change.

In order to respect the government’s wishes and after an in-depth analysis by management and the Real Estate Committee of the Board, we decided to move forward with the winding up of the 1750 Cedar project, which we believe will culminate with the sale of the property in its current state. The negotiations with the various parties to the transaction are ongoing and progressing. We estimate that the cost of our withdrawal from this project will be significantly lower than projected by the Baron Report.

As you know, this file has been referred to the authorities, and we maintain that they are in the best position to investigate potential wrong-doing related to this transaction.

   

12)

 

What cuts to what services are contemplated in the current budget negotiations? Particularly, can you assure us as of today that no cuts in professional staff or time of professional staff have been undertaken or will be undertaken until they have been fully disclosed, their consequences in respect of service delivery reviewed by the medical staff, and explain to the public?

Thanks to the hard work since January of hundreds of people across the MUHC, we submitted to the Ministry of Health and Social Services (MSSS) our “Plan complémentaire de retour à l’équilibre budgétaire”. This plan, which the MSSS has approved, included our:

  1. Budget-reduction plan cutting at least $50M in expenses, $40M of which in 2013-2014, the breakdown of the plan by mission/directorate, the nature of the expenses and a summary of the return to fiscal balance by March 31, 2015;
  2. List of measures totalling $28.8M, service by service, that are underway and will be completed in 2013-2014, annualized to 2014-2015, and a list of 6 major optimization projects where another $21.4M in savings, 40% of which in 2013-2014, are to be identified;
  3. Charters for the 6 optimization projects and related documentation for ambulatory care, medical  laboratories, operating rooms, adult clinical imaging, staff mix on inpatient units and the Lachine Hospital;

In short, we defined over 287 measures and six major optimization projects whose measures and implementation plans will be defined between now and May 1.

  • 65% of these measures pertain to reductions in manpower hours (many positions being cut have been vacant for over a year while others are in anticipation of the move to the Glen and improvements to match practice standards);
  • 16.4% are contract and other non-salary expense reductions (ex.: renegotiation with suppliers);
  • 7% stem from standardization of practices;
  • 5.6% are related to team consolidation/work redesign;
  • 3.5% result from capping clinical volumes based on budget;
  • 2.5% come from the application of MSSS policies 

The changes will clearly have an impact on our personnel including changes to team structures, shifts in workloads, job losses and closures as well as the reorganization of job functions. These changes may also require training to learn new skills or become familiar with policies, procedures and protocols.

To be more specific in terms of workforce impact, the cost-reductions measures will amount to 151 job closures for people in full-time or part-time positions with job security. In accordance with our collective agreements, unionized employees will have the right to supplant someone with less seniority or apply to fill another job posting, as we have 296 vacant positions. Another 113 vacant positions have also been closed. In these cases, incumbents chose to retire or positions have simply been vacant for some time. In addition, occasional employees will have fewer remunerated hours than before, but we are centralizing our call list to give them the maximum possible. As for new recruitment, it has been frozen for the time being in favour of using our existing human resources. Finally, 13 managers’ positions have been closed.

   

13)

 

Is it true that laboratory services have already been cut? What further cuts are contemplated? Will you undertake not to make cuts without full public review of the consequences

Laboratory services are one of our optimization projects, and the task force will be formalizing its plans in the weeks ahead

   

14)

 

In the current budget negotiations what other MUHC services are on the table? Family Medicine seems to have been jettisoned without consultation. What further concessions will be made without open discussion, Labs? Neuro? Lachine? Children’s?

All Missions, Directorates, Departments have been provided with a budget reduction target.  Every unit is contributing to the return to budget equilibrium.  In total we have identified $28.8 million of savings over our $1 billion budget. Proportionally the budget reductions will affect clinical missions and professional services by approximately 2.6%, financial and clinical support by close to 8%, other support services by 7% and interest and other corporate expenses by more than 3%.

We should point out that recent measures in administrative and support services shaved $3.5M in fiscal 2012-2013 through changes in Technical Services and supplies. Within the Budget Plan, we have since identified another $10.7M of the $28.8 million mentioned above in cost-reduction measures from this area: in round numbers, roughly $3M in IS through Syscor; $2.8M from renegotiating supplier contracts; $0.8M by optimizing drug utilization for patient treatments without affecting clinical care or manpower; $0.6M and $0.4M, respectively, in infrastructure and parking expenses; $0.8M through the Executive budget envelope; and $2.3M from other administrative and support services.

As part of our improvement plan, as stated above, we are setting up task forces to look into the following six areas: ambulatory care, Lachine Hospital, the operating rooms, labs, adult clinical imaging and the staff mix on inpatient units.

We should point out that the Family Medicine clinic at the Queen Elizabeth Health Complex is not closing. We are working with the clinic’s leaders to ensure a smooth transition and that the same level of care is delivered to patients... More details will be shared shortly.

   

15)

 

Does your mention of “walk in clinics” as a service to be eliminated mean that the MUHC will not be providing ambulatory care? If not, where will it be available? What other institution(s) have you transferred it to? Or, are you taking the position that the public can fend for itself?

Ambulatory care is one of the areas that will be reviewed by a task force. We will continue to provide ambulatory care services, but our goal is deliver these services more efficiently. We will also work increasingly with the McGill RUIS and other network partners to ensure the right care is provided at the right place and the right time.

   

16)

 

Dr. Porter has been accused of participating in a fraudulent consulting contract designed to divert funds from the construction project.  Similarly, the MUHC as represented by Dr. Porter is accused of entering into (by way of guarantor) a fraudulent consulting contract designed to divert $425,000.00 of MUHC funds to Yanai Elbaz.  According to Mr. Elbaz’s Court filing, Mr. Rinfret requested that MMI cooperate in this fraudulent scheme.  Quoting from Mr. Elbaz’s Nov. 27th 2012 Statement of Claim in Quebec Superior court, page 2, para. 6 b. ‘Messers Poulis and Rinfret made the representations to the Plaintiff, during the period of October 2011 and May 2012, ...6d. Mr. Rinfret advised Plaintiff/Mr. Elbaz not to involve Dr. Churchill-Smith and that he (Mr. Rinfret) will handle everything on behalf of Defendant MMI, dealing with MMI paying the sums owing; 6e. Mr. Rinfret instructed Plaintiff on how and where the invoices (Exhibit P-2 ‘en liasse’) should be addressed to.  Mr. Rinfret was the architect of Exhibit P-1. Mr. Rinfret was the architect of the transaction (Exhibit P-1 and P-2).  Mister Rinfret negotiated Exhibit P-1 on behalf of the Defendants’.  Considering that Mr. Rinfret claimed publicly to have had no knowledge of the matter prior to hearing about Mr. Elbaz’s lawsuit late in 2012 and even allowing that Mr. Elbaz’s Statement of Claim may not, in the end, be found to be completely truthful, do you not think it is incumbent on the MUHC to make some effort to understand and explain what role Mr. Rinfret may have played in the matter?  Have you, in fact, investigated this matter and reviewed Mr. Rinfret’s role as an agent or a principal in attempting to manage the execution of this apparently fraudulent consulting contract?

Mr. Rinfret refused to pay invoices submitted by Mr. Elbaz, and that is one of the primary reasons the matter is now before the courts. All allegations have been reviewed, and the MUHC will be disputing all of Mr. Elbaz’s claims. In the current context, however, it is inappropriate for the MUHC to comment more specifically at this time.

   

17)

 

Is the Board confident and has the Board taken steps to ascertain that Mr. Rinfret’s frequent public denials of having had any ‘real estate’ dealings on behalf of the MUHC prior to his being appointed acting Executive Director in early 2012 are in fact accurate and that he was not in fact heavily involved in real estate transactions on behalf of the MUHC and related entities throughout 2011?

Mr. Rinfret has said publicly that he was aware of real estate matters, but did not lead the process. We assume that your focus on 2011 refers to the MUHC’s involvement with 1750 Cedar. In this regard, Mr. Rinfret objected to the 1750 Cedar transaction on more than one occasion. At the request of the then CEO, Mr. Rinfret sought legal opinions from two leading Montreal law firms. In fact, the MUHC sought legal advice throughout the negotiations with the owner of the 1750 Cedar Avenue property and as such, all agreements were concluded with the benefit of said legal advice.

Please see 11) above for more on this matter.

   

18)

 

At the last two MUHC public board meetings questions were raised about why those meetings were not announced on the MUHC website and assurances were given that future meetings would be properly posted.  Given the fact that today’s meeting was not announced on your website is there any possible interpretation other than that you are unable or unwilling to take even the most basic measures to be accountable to your community?

We did encourage attendance at our last Annual General Meeting (AGM) on December 3, 2012. It was promoted in advance on our website and internal (staff) Intranet, and was also advertised in both Le Devoir and The Gazette. Letters of invitation were also sent to an extensive mailing list.

The most recent public Board meeting was advertised on our public plasma screens across each of the six hospitals and Guy Street, on the Intranet and to staff for two weeks prior to the meeting. We also sent email invitations to MUHC volunteers. In the future we will also ensure an announcement is placed on the MUHC public website.

   

19)

 

Does the MUHC still intend to name a street after Dr. Porter?  Have you ascertained that the agreement to end the employment of Dr. Porter at the MUHC in which you contracted to name the street after him does not contain other ill-advised provisions?

The Board of Directors of the McGill University Health Centre announced on March 20 that it is revoking the name of Chemin Arthur T. Porter/Arthur T. Porter Way at the Glen site.

   

20)

 

Why did the MUHC decide to take the initiative to undertake an investigation by an independent third party into the activities of Mr. Elbaz?  Why was such an investigation never undertaken into other parties who were suspected of fraud such as Mrs. Lopreste and Dr. Porter?

Regarding Mr Elbaz and Dr Porter, we now know they were under investigation in connection with the awarding of the PPP contract. Consequently an independent third party investigation is not required.

Specific allegations were made in the case of Mr. Elbaz and also Mr. Journo, former employees of the MUHC, who may have illegally obtained services and materials from a small number of suppliers of the MUHC for their personal use.  The latter matters are currently being investigated at our request by an independent third party.

The matter related to Ms Lopreste is under police investigation, and we are collaborating with the authorities. We should point out that an independent third party looked into allegations related to Ms. Lopreste and that we have shared the ensuing report with the authorities.

If it is discovered that funds have been misappropriated or illegal activities have occurred, rest assured that we will pursue the matter and seek restitution.  

   

21)

 

Les procès-verbaux des rencontres du conseil d’administration ainsi que les décisions prisent par différents groups décisionnels, ne devraient-ils pas être accessibles à tous?

Subject to the protection of personal information contained therein and to any applicable legislation, the documents submitted or transmitted to the Board of Directors and the information furnished at public meetings of the Board as well as the minutes of those meetings are public. The decisions made at meetings held in camera are also public.

   

22)

 

Pourquoi le CUSM a-t-il attendu le rapport de Dr. Baron pour agir sérieusement à propos du déficit budgétaire alors que le rapport Raymond Chabot, Grant & Thornton était déjà connu depuis novembre 2010?

At the outset it is essential to put our financial situation in perspective. We have a government authorized recurrent annual deficit of $12.3 million which represents the redistribution of a network/province-wide deficit. In addition, the Agence has reduced our revenue streams by approximately $23 million over the last three years. This has reduced the financial impact of efficiencies that we have introduced.

With regards to Raymond Chabot Grant Thornton (RCGT) it first tabled its report two years ago. In 2011-12, we implemented some of the recommendations, particularly  in areas such as supplies and technical services.  

The MUHC requested the establishment of the Baron Committee before the election to review the complexity of care at our institutions and the associated financial pressures. Even before the Baron Committee, we advised the Agence and the MSSS repeatedly that the MUHC is underfunded in relation to the care we provide, the complexity of patient cases we handle and the scope of our catchment area.

Our new Board and management team have spoken frankly about the financial challenges that our organization is facing, and have prioritized them, for some time now. We have incorporated RCGT’s analysis in our budgetary targets.  

The current financial challenges have been compounded over the last few years by the organizational focus on the redevelopment program. We can be proud of the progress made on that front given that we were starting from a 22% design complete baseline.  We have an action plan that we are implementing and are confident that we will reach budget equilibrium by March 31st 2015.

   

23)

 

Outre les coupures de 50 M, qu’advient-il des revenus des stationnements et des concessions (par exemple, Jean Coutu ou Café Vienne)?

Revenue generating activities like parking and the cafeterias appear in the MUHC financial statements as complementary <<activités accessoires>> and main operating <<activités principales>> activities respectively. If either activity generates net revenue it is channelled back into patient care. Concessions, such as Jean Coutu and Café Vienne are arranged through the hospital auxiliaries, who also support patient care at the MUHC hospitals.

   

24)

 

Toujours dans le cadre des coupures de 50 M d’économie, de quelle manière procéderez-vous pour en faire le suivi et en mesurer les impacts?

The key to our success is transforming the MUHC to a performance culture. With this mind we will be providing staff with appropriate training and support. Each Mission, Directorate and Department now has a budget that has been adopted by the organization. We will also be closely monitoring our performance and our success in meeting our goals. Reporting tools and dashboard, including quality indicators, are being developed to support the accountability process. With this in mind, we are appointing leaders of the various initiatives with clear mandates and responsibilities. We will also be monitoring our progress on a regular basis at the management committee and the clinico-administrative committee. In addition the Board has set up a number of committees to monitor our progress. The full Board will also be provided with monthly updates. Through these processes we are confident that we will be able to monitor progress and take steps if necessary to anticipate and mitigate risks.

   

25)

 

Dans le rapport final du Dr. Baron, d’importants constats sont inquiétants :

Recommandations 2 et 7 : Comment ferez-vous pour vous assurer que les budgets alloués par l’agence seront respectés?

See answer to question 24.

 

Recommandation 16 : Le comité d’éthique du conseil d’administration a-t-il terminé ses révisions?

  • Avons-nous accès à ces documents?
  • Qu’est-ce que cela implique concrètement?
  • Le document contenant ces règles sera-t-il disponible pour tous?

The Board code of ethics and conflict of interest policies have also been redrafted. The changes are now reflected on the MUHC Board section of our website. http://muhc.ca/homepage/page/board-directors

In addition senior leaders of the MUHC have launched a review of our policies and procedures and are developing an action plan. With regards to signing authorities, our policy is being reviewed and updated, and a revised version will soon be presented to the Audit Committee of the Board.   

 

Recommandation 30 : Qui va s’occuper du suivi financier de l’institut de recherche?

The Board of Directors of the Research Institute will assess the financial performance while consulting regularly with both McGill and the MUHC. There will be a report submitted to the MUHC Board of Directors on a quarterly basis.

 

Recommandation 37 : Quel est le plan prévu en ce qui concerne le manque de financement pour le Glen?

The Glen project is a Public Private Partnership and, as such, the current construction is fully financed. The Glen project has a sealed envelope, and we are on track. We should also point out that the Glen project is overseen internally by our Audit and Real Estate Committees and that disbursements are authorized and made by the Directeur exécutif, Modernisation des CHU de Montréal.