Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 66 - Evidence - September 11 (Afternoon)
OTTAWA, Wednesday, September 11, 2002
The Standing Senate Committee on Social Affairs, Science and Technology met today at 2:07 p.m. to review the
document entitled ``Santé en français — Pour un meilleur accès à des services de santé en français.''
Senator Yves Morin (Acting Chairman) in the Chair.
The Acting Chairman: We are going to begin now and other senators will certainly be joining us. I want to thank the
witnesses for being with us this afternoon. They are Mr. Hubert Gauthier, Chief Executive Officer of St. Boniface
Hospital, who was Joint Chair of the Advisory Committee. In addition to occupying the position of President of the
Federation, you were also President of the Fédération des communautés francophones et acadiennes, did you not? Am
Mr. Hubert Gauthier, Chief Executive Officer, St. Boniface Hospital: Initially, yes, Mr. Chairman.
The Acting Chairman: I believe you received an award in that capacity. Your expert qualifications are undeniable.
We also welcome Mr. Jacques Labelle, who was the Chief Executive Officer of the Ottawa General Hospital, and Mr.
Edmond LaBossière, Coordinator of Intergovernmental Francophone Affairs.
As I understand it — and correct me if I am wrong — this is a group of provincial governments who have formed a
consortium with a view to examining a certain number of issues affecting
francophones. Is that an accurate
Mr. Edmond LaBossière, Coordinator/Facilitator, Intergovernmental Francophone Affairs: Yes, that is essentially
correct. The position involves coordinating intergovernmental cooperation on francophone affairs for the provinces
The Acting Chairman: That includes all the provinces and territories, does it?
Mr. LaBossière: Yes.
The Acting Chairman: As you know, this Committee was struck for the specific purpose of studying these two
reports and subsequently reporting to the Senate. This was done in response to a motion by Senator Gauthier that was
passed unanimously by the Senate. We will be reviewing these two documents — in other words, ``La santé en
français,'' and the report to the federal government minister. So we are proceeding with this study. This afternoon's
discussion is very important because ultimately, that is the purpose of our Committee. It was put in place specifically to
review these two documents.
Mr. Jacques Labelle, former Chief Executive Officer, Ottawa General Hospital: I am here not because it was my
intention to get involved, but because I was asked to provide input. Perhaps some background information is in order:
I have held the position of Chief Executive Officer in institutions throughout Ontario, and specifically in Sudbury,
Ottawa, Brockville, Smith Falls, Toronto, and Montreal for five years. So, having lived there, I am quite familiar with
the Ontario environment. I am not as familiar with the Maritimes, and even less so, Western Canada, even though I
have travelled extensively in that part of the country.
I believe the issue of health services in French has to be examined based on groupings of provinces. In my opinion,
Ontario and New Brunswick are a special case because of the large number of francophones there. With the other
provinces, such as the Western provinces, I believe the dynamic is completely different because Francophones are
scattered over the area and relatively few in number.
The same applies to the Maritime provinces, with the exception of New Brunswick, which seems to take the needs of
the francophone population very much to heart.
My comments will probably give people the impression I am playing the devil's advocate. What I say will not be
seen as ``politically correct.'' I have to say I had problems with the report and with the connection made between the
health status of francophones outside Quebec and the quality French-language services. There is no connection
between the two. If francophones are experiencing health problems, the causes are socio-economic. If, one day,
francophones have a status similar to that of anglophones in their province, I believe they will have the same health
problems — no more, no less. If we had services in French for those who are socio-economically disadvantaged, the
health problems would be the same. So, I challenge the connection the report makes between these two elements.
The term ``community'' that is used in the report also raises questions. The term ``community'' refers to a group of
people who have something in common — more than just language, a society, or an ability to exchange views on a
daily basis in one language. That has been the case in certain communities where there was a concentration of
At the time I was born raised in Ottawa, I could walk from the cathedral on Sussex Drive down to Notre-Dame de
Lourdes cemetery, which was a two-hour walk. I would not have met a single anglophone during my walk. Every
activity was carried out in French — be it a trip to the garage, the hairdresser, the pharmacist or the cashier in the
convenience store. If I were to take the same route today, I would consider myself lucky if I met even one francophone.
Similarly, if someone were to serve me in French in a store, I'd also consider myself pretty lucky.
To a certain extent, existing communities have been eliminated because non-francophones have become integrated
into those communities and the francophones have become dispersed. Now there are francophones in Kanata,
Rockliffe, everywhere; when I was young, that was not the way it was. And that causes serious problems in terms of
providing services in French. Francophones who live in those communities certainly have less control over language
than I did, when I was young.
If I look at my sisters, cousins and people living in the community nowadays, I see that their children are certainly a
lot more comfortable in English than in French, which was not the case with people of my generation. The same
phenomenon has occurred in Western Canada, such as in St. Boniface, Gravelbourg and other communities.
The report struck me as bureaucratic. I got the impression that people had been forced to present findings, and not
knowing how to tackle the problem, they suggested bureaucratic structures, the way people do when they do not really
have a clear idea of what should be done. It reminds me of the health councils that were set up. We had a list of issues
but we didn't know what to do to resolve them. So, it was suggested that health councils be established; they meet on
an irregular basis, conduct studies and draft reports. But what impact does that have on the quality of services
provided to those communities? I have my doubts as to how effective they are.
The problem is that francophones in certain areas have not attained the socio-economic status they should have.
That is the fundamental problem. And in every province in Canada, there is a shortage of francophones working in the
health care sector. We need to focus here on two types of professionals: nurses and physicians. The others are
important, but less so than nurses and physicians, who are at the very heart of the problem.
As I said earlier, the communities are becoming scattered across the country, and up to a point, you could say that
the communities are rapidly shrinking; thus the possibility of finding health care professionals within these
communities is also diminishing, because their numbers are decreasing. These people are disadvantaged. And their
becoming professionals is still problematic.
It is important to recognize that the provinces, with the exception of New Brunswick, are not interested in this issue.
This is their responsibility, because health care is an area of provincial jurisdiction. As long as we cannot ensure that
the provinces will take the needs of their population seriously, it will be difficult to get around these issues.
As for networking, my concern is that we will create a bureaucratic structure. If we hire people to conduct studies
and write papers, that will generate a great deal of bureaucratic activity. What effect will that have on the number of
francophone nurses or physicians? That is the key point. We need francophone physicians and nurses in strategic
As for training, there is discussion of a consortium. I am in favour of using existing training facilities where there are
francophones. That would certainly include the University of Ottawa, and Laurentian University in Ontario. There are
bilingual community colleges in Ontario as well; in Western Canada, there are francophone colleges. I favour
concentrating training activities in existing colleges to see whether they can develop programs for francophones.
As regards medical training programs, that would be quite complex. It would be easier in the case of nursing. There
are some possibilities there. Once again, the training could be provided in existing hospitals where, west of the Ottawa
River — except for Montfort — all available training is given in English. These francophone students would be
required to go to anglophone facilities to be trained.
With its Bill 8, Ontario has tried to make francophones feel more welcome. They designated certain hospitals as
bilingual, and these hospitals were asked to prepare action plans setting out what had to be done to meet the needs of
their francophone population. However, this seems to have had no effect on the daily lives of francophones who live in
these areas. With the exception of Ottawa, which has a larger population, the hospitals haven't taken this seriously.
Where francophones are in a minority position, very little has been done. Action plans were put together and there has
been a lot of activity at the bureaucratic level, but the actual situation in these hospitals has not changed.
Another fundamental point is that the majority of francophones themselves do not demand services in French.
Many are comfortable speaking English where complex and technical matters are concerned.
When I was Chief Executive Officer of the Ottawa General Hospital, a third of the correspondence I would receive
from Franco-Ontarians was addressed to me in English: ``Dear Mr. Jacques Labelle.'' They would write to me in
English and I would answer in English. That is the reality, and there is nothing I can do about it.
The situation in terms orientation/service facilities for francophones in the other provinces, where the population is
even more scattered, is difficult to understand. I was a member of the Association canadienne-française de Kingston
for many years. There are 5,000 francophones in the region, and yet no services are provided to francophones. There
are French-speaking nurses and physicians, but there is nothing structured. Rectifying the situation could be difficult
because francophones are scattered over a large area, are well-off financially and already have a physician. Getting
these people to focus on providing services in French, rather than English, could well prove impossible.
The technological aspect of the report completely escapes me. It is claimed that using computers will allow us to
revolutionize the world. A doctor has to stay in touch with colleagues and social agencies in his/her community. If the
technology being used is in English, it could be a problem if someone is using a different system.
When I need to be referred, even though my doctor is a francophone, I want to be referred to a physician in
Kingston. That is where I want to receive services — not in Ottawa or Quebec City. My doctor has to have contacts
with other professionals in and around the City of Kingston. In that sense, having communication links with Ottawa
or Sudbury may not be viable for the people who live in those areas.
In conclusion, the real problem we have to tackle is the assimilation of francophones. The fewer francophones there
are, the more difficult it will be to justify services in French for them, because as the percentage of francophones goes
down, the numbers of other groups are going up.
Second, because we need to find health care professionals within this francophone population, we don't want to see
its numbers decrease, because the more they decrease, the less likely we are to find physicians and nurses within that
population. I believe we need to convince the provinces with significant francophone populations to take action. If we
go around the provinces, we may end up being the big losers.
At one time, Ontario had the two largest hospitals in Canada outside of Quebec. They were administered by
francophones. The majority of their employees were francophone, as well as the members of their boards of directors,
their senior managers and middle managers. Over the last five years, these two hospitals have been merged with
English-speaking hospitals. Their boards of directors as well as their administration have been abolished. Middle
managers from these hospitals have been transferred elsewhere. If you go to the Ottawa General Hospital, there is not
one manager left. All of them have been transferred to the Civic Hospital. They will tell you that everybody is bilingual,
but in fact there is no francophone representation.
Francophones used to play a role that contributed to the health status of Franco-Ontarians and Ontarians. That
role has been taken away from them, although the same is not true for other minorities that also had independent
hospitals. They were allowed to keep their hospitals — for example, Mount Sinai Hospital and St. Michael's Hospital
in Toronto. However, there was no hesitation about abolishing French-speaking hospitals.
No one can redress the wrong that was done when the Ottawa General Hospital and the Sudbury Regional Hospital
were dismantled. Having administered both of these facilities, I know whereof I speak.
The Acting Chairman: That is a different side of the story from what we have heard thus far. Mr. Edmond
LaBossière, please proceed.
Mr. LaBossière: When I was in Quebec City several years ago taking a course, I was asked how long ago I had left
Quebec to take up residence in Manitoba. I answered that it had been 111 years. Today, I could say that it has been 124
years, because it was in fact my ancestors who left Quebec to settle in Manitoba. My children are francophone. Our
home is francophone and we live in the community of St-Pierre-Jolys, which is primarily French-speaking.
I could speak at length about this issue, but before I begin, perhaps I could tell you something about my background
so that you can understand where I am coming from. I worked for the Government of Manitoba for ten and a half
years as a special advisor on French-language services. Last December, I took up a new position created by the
provinces and territories as a whole. That position is Coordinator of Intergovernmental Francophone Affairs.
I have provided you with a brief. It presents the ideas that I would like to address in our discussions this afternoon.
Access to health services in French varies tremendously from one region of Canada to the next. Indeed, the FCFA
report describes the current situation with respect to health care services in French.
Why this significant difference? Well, one might be tempted to believe that demographic and geographical factors
(small numbers of francophones and the fact that they are scattered over different areas) are the main reason for a lack
of services in French. However, these same factors did not prevent the establishment of French-speaking schools in
practically every region of the country.
One must not believe that smaller populations and the dispersal of the communities prevent us from providing
health care services in French. We have done so in the educational field. Why can we not do the same for health care?
Political and legislative realities for minority francophone and Acadian communities are very different from one
province or territory to the next. Some governments, like those of New Brunswick and Manitoba, have constitutional
obligations where linguistic matters are concerned. Manitoba and Quebec, although their circumstances are special,
have the same constitutional obligations both from a legislative and legal standpoint.
Other provinces, such as Ontario and Prince Edward Island, have passed laws dealing with services in French.
Manitoba also has a policy statement that is extremely clear and favourable to services in French — I could tell you a
great deal about it, since I worked on the policy for ten and a half years in Manitoba.
Given that situation, it is also worth noting that those are the regions in Canada where health care services in French
are currently evolving.
Other examples of that would be Georges-Dumont and Montfort Hospitals, health care centres in the Évangéline
area, in St. Boniface, Sudbury and a number of other places. In Manitoba, with its policy of providing services in
French, centres have been designated, some of which are partly bilingual, others, fully bilingual, but the fact is that
their staff is still not completely bilingual. Some favourable changes have occurred, though, thanks to legislation or
policies that are now in place.
When it comes to services in French, political leadership is absolutely critical. Action and support from governments
can greatly contribute to the vitality of francophone communities and foster their development. The Official
Languages Act and its implementation is an example of that. Political will and government commitment are absolutely
key in implementing initiatives aimed at developing and acting on action plans for health care services in French.
However, community participation is also critical. Based on my own experience, I can confirm that where government
action was involved, it was very helpful to plan services in French by working directly with the community. That is an
absolute prerequisite — otherwise, there is a risk that the solutions identified will not be the most appropriate — in
other words, those that best address the needs of francophones.
The active offer of services in French can be accomplished by a variety of means and infrastructures that reflect the
different demographic and geographical realities of Canada's francophone communities. However, there are two
principles that must be adhered to. Even if we find different ways of providing services in French, the services must be
offered in those areas where francophones live. That may seem a rather trivial point, but sometimes hospitals or centres
are designated that are actually outside of the area where francophones are concentrated. If we want to provide
services, let's provide them right where francophones reside.
To the greatest extent possible, the offer should be made by having francophone or fully bilingual units — it could
be small units — or centres. There will be some exceptions. Sometimes you have to designate a certain number of
positions in a large centre. I can tell you, based on my own experience, that having a few positions designated in a large
centre does not guarantee quality services in French, because you can easily end up in a situation where people will say:
``I'm sorry, I don't speak French. Can you speak English?,'' or worse yet: ``Can you not speak English?'' or other turns
of phrase that are even worse.
On the other hand, the language of communication between employees can be French, when you create units or
entities that are entirely francophone or entirely bilingual. The St. Boniface Health Care Centre is a good example of
that: it has 25 employees, all francophone, who communicate with each other in French. All the documentation is
prepared in French. That is also the case in other regions of the country. So, I repeat: it is important to create separate
entities — francophone or fully bilingual units — and francophones must be completely in control of these units.
Intergovernmental cooperation in the area of francophone affairs, particularly the matter of health care services in
French, is not something that should be neglected. Critical masses can be attained where borders are not taken into
account. It is perfectly true that there are not many francophones in Saskatchewan. There may be 50,000 in Manitoba,
almost 60,000 in Alberta, about the same number in British Columbia, and very few in Yukon or the Northwest
Territories. However, if you look at the francophone population as a whole in the West or in Northern Canada, the
fact is their numbers are close to 200,000.
A call centre set up to provide services in French throughout the region would have an attractive critical mass to
work with. This would also make it possible to group together a goodly number of service providers. Fortunately, we
are starting to see initiatives such as this. In British Columbia, the Ministry of Health has just sent out a memo to
ministries of health in the Western provinces — that was done this summer — to see whether they would be interested
in setting up a phone line to provide information to citizens in English. The ministry has also said that there needs to be
a francophone component. Indeed, the St. Boniface Health Care Centre is currently examining the possibility of setting
up a health care information line for francophones. We have reached an agreement with the Western provinces and will
be engaging in discussions to review the options in terms of creating a francophone health care information line.
There are also other interesting initiatives in the works. Last year, in Edmonton, the FCFA report and the Advisory
Committee report were presented to the Ministerial Conference on Francophone Affairs. Indeed, Hubert Gauthier
came to the conference to make a presentation. Following his presentation, the delegates passed a certain number of
recommendations. They also wrote to Mrs. McLellan to make her aware of issues of interest to ministers of
Francophone Affairs and to begin acting on the Advisory Committee's report. That question will be addressed and
examined again at the Ministerial Conference on Francophone Affairs that will take place in St. John's,
Newfoundland, in early October.
The provinces and territories are starting to hold discussions on these matters. Federal/provincial/territorial
agreements and bilateral agreements may also be useful. At the present time, there are no specific federal-provincial
agreements on health care. There are agreements on official languages promotion that are used to a very limited extent
in the health care field.
There are some cooperative intergovernmental initiatives. We need to look at how resources can be used to ensure
health care services can be provided in French.
Having national incentives makes for more equal access to services in French in the different regions of the country.
Section 23 of the Canadian Charter of Rights and Freedoms, Section 41 of the Official Languages Act, and the federal
funding envelope for school management by Franco-Manitobans are all examples of national incentives that greatly
contributed to positive change as regards education in French. Is it not now time to consider similar measures in the
health care field? That would be a way of making progress in this area as well.
To conclude, for many members of the francophone and Acadian communities, access to health care services in
French depends on an appropriate mix of government leadership, intergovernmental cooperation — either through
agreements or other projects or initiatives — and community participation.
The Acting Chairman: Mr. Gauthier, please proceed.
Mr. Gauthier: I want to begin by thanking you for taking the initiative of reviewing the matter of health care services
in French for the 1 million francophones who live outside of Quebec. First of all, although there are a lot of things that
could be said about me, the important thing is that I come from the land of Riel. In Manitoba, in Riel's time, the
province was officially bilingual. The francophone community suffered every possible kind of attack from 1916 until
the 1950s, and since then, it has been possible to turn the situation around somewhat.
If I am talking that way to you today, it is because I still remember my grandfather, who was a real fighter in
Manitoba, and I know that were he still alive, he would be saying to me: ``Hubert, we should have done that 40 years
ago!.'' I am a member of that race of Franco-Manitoban Gauls who refuse to give up and who firmly believe that they
bring added value to the debate, and that they shouldn't have to beg for things that could be interpreted as gifts being
bestowed on a small group of citizens.
Today's initiative is particularly appropriate, coming as it does just before the tabling of important reports, such as
the Senate Committee Report, and financial decisions that will be made over the course of the next few months and will
affect Canada's health care system for years to come. Of course, I refer to the Romanow Commission and to what is
now called the ``Kirby'' Senate Committee. There is also the Dion Plan on Official Languages which is expected
The position we are taking is that we will be part of both debates, not just one. We want the circumstances of
minority francophone communities to be taken into consideration in both debates and the decision-making. Concrete,
aggressive measures are required to correct the current situation — namely that more than half of the francophones
who have minority status in their area have little or no access to services in their own language, when they live in
provinces where the majority speaks English. That is a fact.
Instead of theories, I prefer to talk about concrete cases involving services in French. I think it is worth taking the
time to see what this means on the ground, and to that end, I will use examples from my own family.
First of all, my mother is 78 years old and requires home support services — specifically 22 interventions per week.
Four are in French. People come to her home and prepare meals for her, and my poor mother has said to me: ``I have
to tell them what I want to eat, but I'm not going to talk till I'm blue in the face to explain. They don't understand a
thing I say, and the same goes for me.'' Result: my mother does not eat properly. What is the effect of that on an
elderly person? This is just one example of people being unable to understand each other. Draw your own conclusions.
I have an elderly aunt who is 66 years old and has suffered a stroke. She was having trouble speaking and is now
experiencing problems with the speech therapy she is receiving to learn how to talk again. This example is cited in a
video we made. That aunt came to my hospital to receive care, and when it came time to give her therapy, it just did not
work. They were trying to give her speech therapy in English. In her file they wrote: ``Does not respond to treatment.''
They sent her back home and then a miracle occurred. Her environment was a French-speaking one. In St. Adolphe,
Manitoba, some individuals providing home support were able to give services in French, and all of a sudden, her
language skills began to improve, without the assistance of experts in the field. The doctors were nonplussed. Draw
your own conclusions.
My wife has liver disease. She is receiving treatment in Winnipeg, but they do not perform liver transplants there.
They wanted to transfer her to an English-speaking environment, but she refused. Fortunately, she has been referred to
Hôpital Saint-Luc in Montreal. I can assure you, since I experienced this myself over the summer, that it was an
absolute pleasure to be able to explain our problems in our own language, our own culture. My wife told me there are a
lot of things she had not understood, even though she is completely bilingual. She is only 52 years old, so she is young.
Now she says: ``I'm back in my own environment and I feel well despite my illness.'' Draw your own conclusions.
The committee I chair jointly with Marcel Nouvet, Assistant Deputy Minister with Health Canada, was established
in April of 2000 by the Department of Health to advise it on ways of maximizing its contribution to the development of
minority francophone communities, pursuant to Section 41 of the Official Languages Act. Some people may be
wondering what the federal government is doing acting in an area of provincial responsibility.
Our committee immediately wanted to get the provinces involved in our process because we knew we could not
carry out this kind of work without involving the provinces. My colleague, Edmond LaBossière, mentioned that some
provinces are already making provision for services to be provided in French in their communities. Others have already
expressed, in a variety of ways, their interest in implementing such measures, albeit — and there I agree with Mr.
Labelle — after ten years of health care system reorganization where francophones were completely ignored. Mr.
Labelle made that point when he talked about the Civic Hospital and the Ottawa General Hospital; he told me it
would be more accurate to refer to it as a ``take-over'' than a merger.
I want to emphasize that our approach is based on cooperation with the provinces and territories. Indeed, the
provinces and territories have primary responsibility for providing health care services. In addition to community and
federal government representatives, our committee also includes representation from three provinces — New
Brunswick, Manitoba and Alberta. Curiously enough, we initially had only New Brunswick and Manitoba, but
received a request for representation from Alberta. We have received requests from no other provinces or territories to
date. Our work convinced us that with the support of the federal government, it would be possible to get a significant
number of provinces and territories involved in the action plan that we have now developed.
I would remind you that the issue is that half of the francophones living outside Quebec have little or no access to
services in their language. We based our arguments on health- and health care quality-related considerations, rather
than on purely constitutional ones. Mr. Chairman, this issue concerns health, and health alone.
When we talk about language in Canada, we often make reference to the official languages question, but this issue
goes well beyond the challenge presented by official languages. This challenge is health related. It's something we carry
deep within us and that needs to be examined.
I want to come back to the fact that the international literature has shown — these are not our studies but
international ones — that the connection between the inability of a user to communicate adequately in his or her
language leads to consequences — consequences that I address in my brief about service delivery. I would say that my
examples — I have twenty more I could cite — explain these kinds of consequences, which create problems for both the
individuals and the health care system.
From our very first meeting, our committee chose to focus on front-line health care services: not on hospitals, but on
front-line health care services. I am Chief Executive Officer of a hospital, so I could have made the argument that there
is a need to talk about hospitals. I am convinced that primary health care services, family medicine services and front-
line services in general have to be the priority, and that is also the view of members of our committee. I believe that the
witnesses you heard from yesterday and this morning also made that point. The committee believes that is the best
strategy for improving access to services by minority francophone communities. Our views are therefore consistent
with those laid out in your report, and I quoted it in my brief.
I would like to draw your attention to some of the main aspects of the approach we are recommending to
government — and you have copies of the documents we have prepared. We have identified five levers that should be
used. No single lever, taken alone, will be adequate to make progress in this area. Those who think we can score a
home run with this issue are mistaken. It is too huge for anyone to believe that a single lever will allow us to be
victorious all along the line. Following discussion, we also concluded that our five levers should be in the three areas we
will be working on over the course of the next few months, because the decisions will be made during that period.
First, development of a network — what we have termed ``networking.'' A lot of people have trouble understanding
this. However, networking should make it possible to consult and spur the community to action, and to plan and
develop health care services in French.
Second, roll-out of training activities. If we want an action plan that provides for more services, it is clear that if
there are no physicians or nurses — and I completely agree with Mr. Labelle on that point — we will not get very far.
Third, we must have a service organization and infrastructure model for delivering services in French that
francophones can relate to. Both the committee and our partners have done this work, and that work has prompted us
to make a connection between research and training. In our brief, we make reference to trainer-related research.
Research is an integral part of training for those of us who work in this sector.
As you probably know, the technology issue is very current. We are not talking only about computers on desks.
Current technologies allows us to interact with each other. We believe telephone lines should be set up for
francophones requiring services. I'm talking about a 1-800 line. That is a technological tool. When we talk about
technologies, we are referring to these kinds of technologies, and innovations such as telemedicine, which didn't exist
25 years ago. Recent technologies can be used to improve access to services in the health care sector. That has been the
single focus of all of our work.
The Honourable Stéphane Dion recently announced, on behalf of the Minister of Health, Mrs. McLellan, initial
transitional funding of $1.9 million. Mr. Chairman, as I have already said, $1.9 million is not the be-all-and-end-all
solution to this issue; it is a small chunk of money to help us make the transition between now and implementation of
the plan we're expecting from government in the next few months.
Let me come back to the question of networking, which is the cornerstone of the strategy we are proposing. The idea
is to establish partners' forums in each province that include health care professionals, community organizations,
service facilities, training institutions and policy and decision-makers, and to sit them all down at the same table to
draft plans, clearly identify needs, develop strategies and then implement them.
As director of a hospital, I have occasion to engage in discussions with members of English-speaking hospitals. My
francophone doctors are members of the English-speaking associations. My 150 francophone nurses at the hospital tell
us they never have an opportunity to get together and talk among themselves. The unions are English-speaking, as are
the professional associations. Not being able to speak one's mother tongue leads to isolation. For these associations,
services in French are not high on their agenda. In order to break down that isolation, we have to bring all the
stakeholders together. Concrete examples show that bringing people together to prepare an action plan, for example,
results in renewed energy. If there is no dialogue or consultation and no action plan, no matter how many people we
train, our efforts will lead us nowhere! Networking goes hand in hand with one of the three basic realities you identify
in your own documents.
It is important that that be said. You say there is a need to find mechanisms that will encourage all the parties —
health care providers, facilities, governments and patients — to provide, manage or use health care services more
efficiently. That is what networking is all about. We can show the way, and, when we bring the partners to the table in
small groups, we realize that it does work.
People looking at this say to themselves that this could well be a solution. So, let's do more of that — not through
structures that are superbureaucratic, but rather ones where you rely on people of action, such as Suzanne Nicolas,
Élise Arsenault and other people working in our health care network.
The second lever has to do with training of personnel, and as your report points out, human resources — and we all
know this — is one of the areas of the health care system where we can legitimately talk about a crisis. The situation is
made worse by the fact that for 20 years, francophones paid so much attention to education that they forgot to train
health care professionals. There is a tremendous amount of catch-up to do now, and I agree that as our communities
shrink in size, it will be even more of a challenge to find francophone applicants.
St. Boniface College introduced a nursing program last year. The objective set was a total of 20 enrolments, and
ultimately there were 18. This year — the second year of the program — the objective was 20 enrollments, and there
were 33. If courses are offered and they're funded, we will achieve results.
Human resources are the primary focus of our strategy. We believe that it is possible, as part of a national effort, to
respond both to the shortage of health care professionals and the needs of francophones. We have forcefully told the
federal government: ``Our francophone professionals will, of course, provide care not only to francophones but to
anglophones as well.'' We kill two birds with one stone.
People have told you about the consortium, which essentially is a partnership between colleges and universities that
want to tackle this problem head on. The consortium is a new element of the approach we are suggesting, and has
resulted in close cooperation with training institutions with a view to defining and implementing common strategies
and avoiding duplication.
Also, we are seeing that close cooperation is developing with other health care partners, such as facilities,
communities and political decision-makers. These universities and colleges are agreeing to accept the challenge of
identifying their needs and priorities. That is resulting in our building a solid case which is supported by the
population. Young francophones will want to receive their training in the health sciences in French if they see that it
will be possible for them to work in French in that sector.
I had to go on site to convince nurses to register at St. Boniface by telling them that I had work for them and that I
was making a commitment to them. That is very important. If we give them opportunities and environments in which
to practice their profession for the benefit of their community, they will need settings in which to complete their
apprenticeship. Even Ottawa, with l'Hôpital Montfort, is seeking other good training and apprenticeship environments
all across Canada, because available resources are inadequate. That is an important aspect. You don't only learn things
in school. In the health care sector, practical training in an actual facility is a necessity, and if that is not available, we
will also be neglecting part of the equation.
That being the case, environments where health care can be delivered in French are urgently needed. We're not
talking about creating hospitals. I am not a hospital administrator. I am part of the university hospital network, and I
am not afraid to say so. We have to emphasize primary health if we want to create settings in which care can be
provided in French. We need to organize and reorganize those health care settings, possibly by targeting small
communities first, so that people feel at home. However, there is no doubt that health care delivery must move in that
direction. The big problem in Canada, as you state in your report, is that if we do not reorganize medicine and basic
services, we will not resolve much.
I would like to draw your attention to a central feature of the approach we have developed — the active offer of
services. It simply is not enough to greet callers as follows:
Bonjour, this is the Ottawa General Hospital or the St. Boniface General Hospital. How may I direct your
... for people to feel that they can request services in French and receive them. What we need to do now is create places
or centres where francophones, when they come through the door — whether physical or virtual — will feel that life
unfolds in French and that they will not be bothering people if they ask for services in their language. When someone is
ill, and therefore vulnerable, we should not be asking him to fight to receive services in French. People don't even have
the energy to do it with Air Canada when they end up in the wrong line, so why should they have to do it at the
My mother has had to go to the emergency at my hospital several times over the last two years. When I told her I
was going to find services for her in French, her answer was: ``Hubert, don't make problems for me here.'' There simply
is no active offer. When I find services for her in French, she is happy about it, but when she is ill, she has no desire to
wage that battle. When there is no proactive offer of services because it simply isn't available, then it's just not going to
happen. When we talk about the majority, that says:
Services are offered and advertised, but this is not good enough.
Yet the Évangéline Community Centre, francophone health centres in Ontario and the St. Boniface Health Care
Centre clearly demonstrate that when services are offered in their language, francophones use them to such an extent
that the institutions themselves find their waiting lists becoming impossibly long. We have to broaden our platform.
When the offer of services is there, it is clear, people talk about it and it has a ripple effect.
That active offer of services, even with a small number, can be structured and tied into education, early childhood
education and the work of other community organizations. We should be looking at what francophone and Acadian
communities are doing across the country for innovative examples such as those, and the majority should use them as a
It is important and urgent to put responsive services in place based on the needs and means of each of the
communities. We have never said that clinics should be set up in Saskatchewan all across the province. People are more
realistic than one may think. My wife is originally from Saskatchewan, and when we go back there, we are struck by
the fact that everything has come apart, become shrunken, the institutional bases are simply non-existent. We have to
find other ways to provide health care services in their own language to those people who deem this to be important.
We're not talking about having hospitals all over the place; we're talking about front-line services. Our paper includes
an appendix showing a gradation of the type of services that can be offered, depending on whether it is a very spread-
out community, or a geographically concentrated one in North-Eastern New Brunswick. We are talking here about
multi disciplinary teams, about floating staff or flying squads and professionals who can practice on their own, but
with assistance from other professionals, in the form of telemedicine or health services phone lines.
The means are varied and can be tailored to needs. We now have access to opportunities that did not exist
previously, all of which require close cooperation with partners. Without that cooperation, we will not move forward.
In order to consolidate that dialogue and cooperation, we are preparing a convention to found a national network of
French-language health care services that reflects local realities. These are local units that will form a federation at the
national level and will be meeting next November with partners from every region of the country, care facilities and
health care professionals. Whether people like it or not, this is a necessary step.
Since April of 2000, the advisory committee has produced the report that you now have and which sets out a plan of
action. We believe our committee has fulfilled its mandate. There has not been as comprehensive a report on health
care. There have been ad hoc reports. We took inspiration from them and they are the basis for the other important
study conducted prior to our report.
Our plan of action is not the work of only a committee of 15 or 20 people. We had it validated by about 250 people
at a forum in Moncton in November of 2001. It received unanimous support. This was a forum on health with people
who work in the health care system, nurses, physicians, representatives of health care institutions, government officials
— even Edmond was there.
Mr. Chairman, we brought together key stakeholders with a view to implementing this plan. The communities have
rallied and have started to take action. This was urgently needed. People are making progress, despite the fact that they
are not receiving a lot of support. Yes, St. Boniface College offers training programs for nurses, but it didn't wait to
receive the necessary funding. It now wants to enhance that program, so let's give it the assistance it requires.
Yesterday and this morning, you heard from people working in different regions of the country who are trying to
improve the situation — in many cases with a great deal of commitment and only limited means. The provinces have
expressed their desire to follow suit. In my view, the federal government has to play its rightful role. It cannot replace
the provinces, but it does have an important role to play in terms of providing support and showing leadership. Its
intervention should not be half-hearted, but aggressive and substantial. Half-measures, at this stage of the game, and in
light of the current situation, simply won't be enough. We are no longer groping in the dark. That's the beauty of this.
A new course has been clearly charted, with the approval and cooperation of the communities and all our partners.
We believe that your committee and the report it will soon release — if I could just digress for one moment to say
that you probably know that decisions will be made over the next few months — will emphasize the fact that there is an
urgent need for action so that we can move forward in this area and improve access to services in French in every
region of the country.
We have to include francophones in efforts to reform the health care system. We firmly believe that not only will
these efforts help to enhance the quality of health care services provided to francophones and minority francophone
communities, but also contribute, by being innovative, to health care reform all across Canada.
Help me to ensure that my mother has better access to home health care.
The Acting Chairman: I would like to recognize Senator Keon first, because he has to leave soon.
Senator Keon: Mr. Gauthier, your presentation was very clear, so I do not need to revisit it. You mentioned
technology links in particular, which have also been mentioned by other witnesses.
I believe we will eventually move to an electronic health record for every Canadian. I do not know how soon. It
would be interesting to know where you think an electronic health record would fit in the system that you just
described. For example, at St. Boniface Hospital, if a French language electronic medical record on the patient were to
come out of the network of francophone community clinics, translation of the language itself would not be very
complex. Translation of some of the technical data would be more difficult, I suppose. I should like to hear from you in
Mr. Gauthier: I'm very pleased that you asked me that question. I would like to touch on two specific points in my
answer. I cannot help putting on my hospital CEO hat. To begin with, we will have to create a real electronic health
record for patients. In my hospital, I am having problems obtaining core funding. Having said that, however, our goal
over the next two years is to obtain funding for just this kind of project.
We believe it is both possible and necessary for there to be a single patient health record, whether it be in the
community, at the doctor's office, a community organization or ultimately my hospital. That will save the patient
having to run around in circles every time. My hospital has reached an agreement with a certain number of
francophone doctors' offices. We are trying to develop a project together, because we believe that it could be used as a
According to what the experts have told me, translation technology is not a problem; it is certainly much less of a
problem than is access to information and issues associated with privacy, et cetera. Computer people tell me that if we
decide to do this, in terms of the technology — just as for 1-800 phone lines — the software and the programs will be
translated, which means that we could have a screen with French on one side and English on the other at all times; that
would help health care professionals use the appropriate terms, which can sometimes be difficult to translate. So, that
Of course, there could be significant translation costs attached to that, but these are not insurmountable obstacles.
A francophone patient health record could easily move around. We are already experiencing difficulties, because at the
St. Boniface Health Care Centre, the patient records are written in French. In my hospital, we have been asked whether
all the records should be written up in French. But there are tremendous concerns in that area.
My answer was:
No one said you would all have to be bilingual.
I have 4,000 employees. Ten per cent of them are bilingual. I am sure you understand that a whole group of them are
quite concerned. But no one has told them they should all be bilingual.
We have provincial budgets for translation. Our computer people tell me that this would not be a problem, and that
it would be easier to mechanize the process.
I am in favour of a single patient health record, that would not be only the hospital record. My clients consider it an
awful thing to have to provide the same background information over and over at their doctor's office, the medical
clinic, the social services centres and at the hospital, sometimes on three different floors. So, Dr. Keon, I am very much
in favour of an electronic patient record.
Our basic systems don't usually allow us to make those kinds of changes. We would therefore have to modify our
basic system. I imagine people in Ottawa don't even know that we do not possess the basic technology that would
allow us to create such systems. In terms of transferring patient records in Manitoba, we have some pilot projects
underway, and we are trying to achieve a cost effective record. We'll see what happens. Did I answer your question?
Senator Keon: Do you think in Ontario that we can get back to having some French hospitals in addition to the
Montfort Hospital, for example, in the Sudbury region?
Mr. Labelle: I don't think that's going to happen. The integrated health care structure implemented five years ago
will remain in place. Only the Liberal government could make changes, and I don't think it will. If we remove French-
speaking hospitals from the merged system, we will have to do the same for Catholic hospitals. That will lead to
There is no demand for this, and francophones are not complaining. A merger has occurred and they couldn't care
less. When they go to the General Hospital, things are really no different. The only thing that has changed is that
francophones no longer play a political role in health care service delivery in Ontario. Before, we were accomplishing
something. Francophones were proud to manage the hospital and achieve even greater success at it than most of the
other hospitals in the province. That is a role that we were unable to appreciate. People see things differently.
We always said that services needed to be maintained at the General Hospital. But with the merger, it was decided
that some services would be provided at the Civic Hospital, and others, at the General Hospital. Now they want to
make the entire hospital system bilingual. At the General Hospital, 75 per cent of staff members were bilingual. But if
that staff is split equally between the Civic Hospital and the General Hospital, that means that 35 per cent of the staff
will be bilingual in one location, and 35 per cent in the other. Francophones will lose their critical mass. That critical
mass will diminish and francophones will become a minority. That is what would happen if the entire system were to
become bilingual. The savings achieved through the merger are so significant that no one will ever dare dismantle it.
Senator Keon: What about the community clinics? Do you believe in having a network of francophone community
Mr. Labelle: Where numbers warrant, yes, certainly. Unless it's possible to have a clinic servicing 95 per cent of the
francophone population, we will end up with a clinic that serves half of the francophone population and half of the
anglophone population. It can be difficult for a clinic to operate in English with certain patients. People can
communicate in English or French, but the health records of francophone patients are in French, and vice versa.
Within a single clinic, that would complicate matters for me as an administrator, and probably as a physician as well.
Where there is a high percentage of anglophones in a specific program, the patient records end up being written in
I should point out, however, that at the General Hospital, that had the largest francophone patient population
outside of Quebec, everything was done in English, although the patients could speak to their nurse, social worker or
psychologist in French. If they wanted a report, we would offer to have the report translated for them. However, all the
records were in English because of transfers and exchanges between multiple hospitals.
Senator Keon: If a francophone community clinic were built here, where you used to walk when you were young,
how heavily would it be utilized?
Mr. Labelle: If I live in Kanata and require services, I am not prepared to drive all the way into downtown Ottawa
to obtain them. Perhaps my father or mother would be, but my brother or myself will not want to; we will want to
access services as quickly as possible, just as an anglophone would want to obtain the services he needs across the
street. People are not about to spend a half hour on the road in order to obtain services in French, because they are so
comfortable in English that that simply is not necessary. If you need to consult a physician, you will consult one across
the street from where you live — at least for people of my generation. That certainly is my belief.
The Acting Chairman: I note that the Senator has to leave, and I want to thank him for his comments. We will give
everyone a chance to speak, as we usually do. Senator Gauthier, please.
Senator Gauthier: Mr. Gauthier said that networking is important; Mr. Labelle does not believe in networking,
though. Did I understand you both correctly?
Mr. Labelle: I don't believe it will change much. As I see it, that is not the answer; the answer involves having more
francophone, bilingual professionals in the communities. Whether there is networking or not, if we don't have a greater
number of physicians tomorrow to provide those services, it will have been pointless. Look at the shortage of
physicians across Quebec and elsewhere. If we don't recruit 200 or 300 additional French-speaking physicians every
year, even if we have the best network one can image, that won't change much.
Senator Gauthier: I am not talking about the physicians, but the patients. I'm talking about people who want to be
served in their own language. I saw a case recently. You are certainly familiar with the example of the mother who,
speaking in French, told a doctor at an Ottawa hospital that her son had an upset stomach (``mal au coeur'' in French,
or literally, ``heart pain''). She was sent off to a section to see heart disease specialists. If I come to a hospital and say in
French: ``Mon muscle adducteur me fait mal,'' they won't understand me. But if I say: ``My hamstrings are sore,'' they
probably will understand.
I was ill for more than two years. I had an interesting experience at the General Hospital. I had been told that it was
a bilingual hospital. That is not true; everyone worked in English there, Mr. Labelle — both the physicians and the
nurses. Once in a while, one would come along and explain to me what was going on. When I lost my hearing after
taking a certain medication — Amicasin, and I advise you never to take it, Mr. Labelle — I asked: ``What's going on?''
So, they sent a nurse to explain things to me. But I am not a blithering idiot.
We managed to hang on to the Montfort Hospital, after building and presenting a strong case. And we managed to
get French schools — not because numbers warranted, but because the right of parents to have their children receive
an education in their own language is a fundamental right. And a parent's right to have his children receive health care
in their mother tongue is just as fundamental.
I believe in networking. And I'll tell you why, Mr. Labelle. In this day and age, with telemedicine and satellite
communications, it is possible to set up centres with expertise in a certain number of fields — for example, infectious
diseases, or lung disease. That is not particularly difficult to do. Mr. Gauthier said that with a 1-800 line, we could
create information networks. I think that is certainly something we could do now.
I took a lot of notes, and I am going to read over everything you said. Why isn't Ontario part of the network, Mr.
LaBossière. Do you know? It includes Manitoba, New Brunswick and one other province, Alberta.
Mr. LaBossière: When you say the network, are you referring to participation in the advisory committee?
Senator Gauthier: I'm talking about Hubert's committee.
Mr. LaBossière: No, I don't know why. Some provinces were invited to take part, but only two or three decided to
do so. However, we did find ways of keeping all the provinces and territories informed of the committee's work.
Indeed, a presentation was made and several meetings were organized by the advisory committee with various directors
of Francophone Affairs. The committee also made a presentation to the Ministerial Conference on Francophone
Affairs. So, we did keep the provinces and territories informed of what we were doing, even though they were not all
taking part in the Committee's work.
Senator Gauthier: I find it rather strange that the province with the largest number of francophones — Ontario —
would not have been present for discussions about an issue as serious as health care.
Mr. Gauthier, you asked that the federal government take concrete actions — that it make a commitment, get
involved and provide support. What kind of action is most critical, in your view? Certainly, the federal government has
spending power. With respect to communications and research, you made reference to a pilot project. Who will be
funding that project?
Mr. Gauthier: I referred to the steps that need to be taken and three areas that should be emphasized. Our report
refers to very important supporting documents that set out the issues to be resolved by order of magnitude. I believe
you have a copy of those documents, Mr. Chairman, because we have been gradually sending them to you.
As far as the network is concerned, we're talking about $5 million annually. For training, we are talking about
between $18 and $20 million annually.
The Acting Chairman: I would ask you to be more precise, because the funding issue is very important to us. I would
also like to refer to what Minister Dion has said, because this is the official document being used as a basis for
Mr. Gauthier: Our report?
The Acting Chairman: The report where it talks about $5 million for the network and $15 million for training.
I also note the speech made by Minister Dion in Whitehorse, where he said that initial discussions and expectations
had been seen as rather unrealistic, which meant that the amounts being requested were too high. But instead of getting
discouraged, you continued your work, and the recommendations of the Advisory Committee are now being made on
the basis of a much more realistic financial framework.
Based on what I understood the minister to say, funding requests have been modified. Is that correct?
Mr. Gauthier: In terms of the proposal you now have, no, that is not correct. There was the perception within Mr.
Dion's Department that our funding requests were extravagant. After several meetings, they came to understand the
content of our report.
I attended meetings where they were trying to tell us that the government has limited means, and that we should be
more reasonable. Our response was to make specific proposals.
At Health Canada, discussions took place with Mr. Dion's Department, and the amounts we're talking about are
still the ones mentioned in our proposal. Mr. Dion's impression was that we were talking about something much more
massive. I met with Mr. Dion to discuss every element of that proposal.
The trickiest issue is how to develop orientation/service centres or facilities. That issue, more than any other,
certainly falls within the jurisdiction of the federal government and the provinces.
It seems the proposal concerning the network is now well understood. The $1.9 million is intended to help us get that
The Acting Chairman: That is my second question. However, I would like to stay with the figures set out in the
report, because what you are saying is something completely different. You talk about the primary health care
Mr. Gauthier: On the basic question, the proposal we are making is the one you have in the folder that has been
provided. The weakest component is the one dealing with front-line services, infrastructure and service/orientation
structures. That one worries me.
After giving this matter a great deal of thought, I have come to the conclusion that this part of it is somewhat soft.
What worries me is that it is possible to develop plans and train staff, without necessarily having places where services
can be adequately delivered. I am making everyone aware of that concern, because I believe that this particular
component has to be firmed up more. As planned, we placed three priorities on the table for which funding would be
required. The size of the budgets as set out in the document you've been provided has not changed.
The Acting Chairman: Just to clarify, the $5 million a year to operate community networks is still applicable, then?
Mr. Gauthier: Yes.
The Acting Chairman: And the amount of $15 million per year for training and recruitment of francophone
personnel is also still applicable?
Mr. Gauthier: Yes, at the very least, because the proposal presented by the consortium is for more than $15 million a
year over five years. It could be as much as $20 million.
The Acting Chairman: Let's stick with what this document says.
Mr. Gauthier: Yes, that would be the very minimum.
The Acting Chairman: And when you talk about establishing service/orientation facilities, is that for front-line care?
Mr. Gauthier: Yes.
The Acting Chairman: And you're saying that the figure of $25 million is possibly a little soft?
Mr. Gauthier: That amount is currently under review. We have examples of how this could be carried out, but what
is not so certain is how we can ensure that number is included in the proposals that are accepted and funded.
The Acting Chairman: We will have to study the report and make recommendations. In order to do that, we need to
have direct testimony from witnesses. We cannot do that over the telephone. We have to rely on what you are telling us
today; we have no choice. That is why I am asking you all these questions.
So, should the $25 million per year for patient service/orientation facilities remain in the final report we will be
drafting? Is this a request from your committee?
Mr. Gauthier: Yes, absolutely.
The Acting Chairman: So, there has been no change there?
Mr. Gauthier: No.
The Acting Chairman: The last amount in this report is for the purposes of gradually putting in place a health care
infrastructure for a one-time and non-recurring amount of $20 million. Is that item staying?
Mr. Gauthier: No. The last amount of $25 million includes technology. Mr. Dion realized that we were being more
reasonable by saying that the $20 million could be included. Technology costs over five years would amount to several
million dollars per year and can in fact be included in the $25 million amount we have just discussed.
The Acting Chairman: Did you say there is documentation providing rationale for these amounts?
Mr. Gauthier: Yes.
The Acting Chairman: Would it be possible to get them?
Mr. Gauthier: Yes, absolutely.
The Acting Chairman: I'm sure you understand that if we use the figure of $25 million, we have to provide a
Mr. Gauthier: It's a little like the Treasury, which is asking us for the same thing.
The Acting Chairman: I want to move on now to the primary health care transition fund. As I understand it, Health
Canada has earmarked $8 million, which is still in the bank and remains unused after almost a year, and perhaps even
two years. When Mr. Nouvet appeared, I asked him what he was going to do with that money. He answered that it
would soon be spent and that this was simply a matter of days. He appeared several months ago. He also said that if
there were urgent requirements, an amount of $8 million — which is still a sizeable sum of money — had been
earmarked for you, and was intended to be used for the provision of health care services in French outside Quebec.
Minister Dion took $1.9 million of that money, which means that there is still $6 million left. Have you received any
information that would lead you to believe that this money is going to be allocated to you and by what mechanism that
Mr. Gauthier: As regards the $1.9 million, the discussions are well underway. As a hospital administrator, I am
always a little impatient and find that obtaining the necessary authorizations takes a great deal of time. They have all
our documentation. What we want from them are answers. I even brought this matter to the attention of the
incumbent deputy minister this morning, saying to him that Mr. Dion had made the announcement in June, and that
we were waiting to see some progress. I got the impression that Mr. Green would like to see things move forward rather
Secondly, we were told that work was underway to develop criteria that should be released shortly and that we will
have to meet those criteria. We decided to make a proposal to Health Canada without hearing about the criteria,
because we may have to wait. Two years have already gone by. On our side, there is certainly some impatience, as you
will have noticed, but we intend to do our homework. For the $1.9 million, for example, we put our proposals on the
table. We thing it is now time to go through the same process for the $6 million, in order to get things moving. The
question Health Canada is asking is who will take responsibility for what comes next. This is a transition fund. We are
saying that follow-up will occur through the Dion plan or whatever action is taken in response to the Kirby and
Romanow reports, et cetera. As far as they are concerned, this is not a solid enough answer.
The Acting Chairman: Yes, but the money is there all the same.
Mr. Gauthier: There doesn't seem to be any problem in that respect. The money is there and the situation is as I have
The Acting Chairman: Thank you very much, but I must insist that you send us your rationale for the amounts being
requested. It is absolutely critical in our view that we be able to justify these allocations if we request the funding.
Senator Gauthier: This morning I referred to the sixth principle. Perhaps we should set out or make reference to such
a principle in the Health Act. I would like to have the views of each of our witnesses on that. Do you think a sixth
principle would be helpful?
The Acting Chairman: The idea would be to incorporate a sixth principle into the Health Act that would include
universality. That is one of the conditions. The sixth principle would have to do with linguistic duality and the
requirement to provide services in one or the other of Canada's two official languages.
Mr. Labelle: In both official languages, or in one or the other of the official languages?
The Acting Chairman: One or the other, depending on the patient. We need to ensure that a patient is entitled to
receive care in one or the other of the two official languages, on request, whether he is an anglophone living in Quebec
or a francophone living outside Quebec. That would become a sixth principle. That is what Senator Gauthier is asking
you about. What is your view on that?
Mr. Labelle: It is certainly a principle one cannot disagree with. However, what actions will be taken to ensure that
the law is enforced across the country? I live in Kingston where we are about 5,000 francophones. What are you going
to do to ensure that tomorrow, I will be able to receive services? Also, do you mean all services will be provided in
French, or only primary health care? If I require very sophisticated surgery, are you going to guarantee me that the
surgeon who performs cardiac surgery will be able to communicate with me in French? But there is no doubt this is
Mr. Gauthier: The legislative base is always important. In that sense, I am in favour of what you suggest. However,
my mother would say: ``Will that help me access more home care services in French?'' I would be hesitant about
focussing all my energy on that. I think there are people such as Mauril Bélanger, Senator Gauthier and others, who
will do that. I will certainly support their actions, but I will also work very hard in the short term to see that
improvements are made. I believe that even without the principle, we can make progress in certain areas.
The Acting Chairman: This morning, Dr. Schofield told us that principles are fine, but action is even better!
Mr. LaBossière: I stated in the brief I presented, in the second last paragraph, that there are a certain number of
things that we have observed. In the education sector, national incentives have been extremely helpful. So, draw your
own conclusions. In the health care sector, maybe we need something. I am not saying we necessarily need to
incorporate a sixth principle in the document, either as part of a specific program or a federal funding envelope. In my
view, we need national measures because it could take a great deal of time, in certain regions of Canada, to make
progress on health care services in French.
The Acting Chairman: Do you have the answer to your question, Senator Gauthier?
Senator Gauthier: I would like to make an analogy. When I go to have my car fixed, I don't ask the mechanic who
trained him, do I? I ask him to do the job properly. Whether he learned his trade in German, French or English is
completely irrelevant, as long as he knows how to fix the car. I am not interested in knowing whether the surgeon
speaks my language; what concerns me is whether he knows how to perform surgery properly. I want the person whom
I first have contact with in a facility to be able to respond to my needs in my language. When I go to the Ottawa
General Hospital and the nurse says to me: ``I'm sorry, I don't speak French,'' I have to admit that kind of puts me on
the defensive. Yet I grew up here. Maybe that's the way it is in Kingston, Mr. Labelle, but this city has not been
designated bilingual by the Province of Ontario. Even so, the federal government has a lot of facilities in Kingston,
including the Military College. That was one of the conditions for designating Kingston a bilingual city. But they
didn't — even though there are students from Quebec and all across Canada who go to study there.
Senator Losier-Cool: The witnesses we heard from yesterday from the FCFA are recommending, in addition to the
sixth principle, that the federal government implement a program similar to the Official Languages in Education
Program, or OLEP. Could you comment on that recommendation?
Mr. Gauthier: We talked about quantums and the money that would be required to manage such a program, which
has to be a Health Canada program. Because there is shared jurisdiction, we would probably agree that a federal-
provincial social/health program be integrated, so as not to end up with piecemeal initiatives, and constantly have to be
chasing after funding. We have already said that this program should be with Health Canada. It has groups in place
and appropriate structures for consulting the provinces and that could be the right vehicle. The communities have an
important role to play in acting as a link between the provinces and the federal government. As silly as it may seem, we
don't want to be caught between the federal government and the provinces in major federal-provincial debates on these
issues. At the same time, when it comes to service delivery, we can act as a catalyst between the provincial government
and the federal government to resolve certain issues. We have already seen, as demonstrated by our own matrices, that
such alliances exist. So, I would say yes to developing a single program that could have both purely national
dimensions and federal-provincial dimensions.
The Acting Chairman: Do you have any other questions?
Senator Losier-Cool: Once the witnesses have finished, I would like to put a question to committee members.
Senator Léger: This is the first time we have heard from a devil's advocate. It has been a difficult process, but we
really have met a lot of people who are working hard in this area. In the end, we find ourselves wondering whether the
province of Ontario is the only one to be isolated like this.
We heard from two or three other Ontario witnesses and their testimony was less negative. As far as I'm concerned,
it was negative; we would not be here today if we had always just sat back and accepted assimilation and all the rest of
Mr. Labelle, you said that socio-economic status is a problem in Ontario. Is the entire picture negative for Franco-
Ontarians? I am familiar with the New Brunswick case, and I would say that we responded by getting involved and
being inventive. I imagine it's the same in Ontario, is it not?
Mr. Labelle: The report itself points out that there is a disparity of socio-economic status between francophones and
anglophones in Canada. The research shows that this is one of the main causes for fewer health services being made
available to young people. If francophones are less better off, less well educated and have less power, they probably will
not be as healthy as others. That is my view. Francophones have to get an education and turn things around so that
they play a more significant role. That is what we must focus on.
Senator Léger: My feeling is that that has already begun. You're not so sure?
Mr. Labelle: Well, yes. If you have $5 million to spend, do what it takes to obtain an additional 200 French-speaking
physicians here in Canada. Concentrate on that and then you will get exactly where you want to go.
Senator Léger: According to Dr. Schofield, that has already begun, and whatever is already in place must be in
Ontario as well, I imagine.
Senator Pépin: Mr. Labossière pointed out that services have to be provided in the areas where francophones reside,
and Mr. Gauthier said we need to develop our delivery mechanisms, and certainly, primary care is extremely
important. We know that if current trends continue, people will go to hospitals only when they need surgery or are
gravely ill; otherwise, they will stay home when they're ill. I think we need to develop home care with the available
technology and develop our human resources as well, whether we're talking about physicians or nurses, so that in
future, we have a lot more of them working in the regions and providing home care.
Mr. Labelle, you said that Franco-Ontarians are not all that involved and that in your case, you would just as soon
be treated by a physician who speaks English. But when we're talking about health care services, it is important they be
available in French. What if all francophones decided to receive treatment in English? Young people would study in
English as well. It would be easier; there would be more services and they would naturally decide to focus on what is
available in English and abandon services and programs for francophones.
Do you not think the fact that francophones are using services and programs in English is part of the problem?
Mr. Labelle: It isn't accurate to say that people go to the hospital to die. Hospital clinics, even university hospitals,
are all filled to capacity. People go there for tests or because they have long-term illnesses. Often people go there
throughout their lives. It is more important for these people to have regular contact with a medical specialist, because
their illness forces them to maintain this relationship for 10, 15 or even 20 years before they die. So it just isn't true to
say that hospitals don't have a role to play.
Senator Pépin: I am saying that medicine will increasingly be practised outside of hospitals.
Mr. Labelle: A francophone who does not live in an area where there are services available within a five-mile radius
but sees he can get what he needs across the street, and happens to be perfectly bilingual, will basically have two
choices: either he can spend 20 minutes driving to the facility where he can receive care in French, or he can walk across
the street to a clinic where he can receive care in English. What is he going to do? He'll go across the street! That's what
I am saying: once people are comfortable with English, health care becomes just another service, like buying a car or
going to the hairdresser.
Senator Pépin: If people asked for your assistance to set up a clinic with French-speaking physicians, would you
agree to get involved?
Mr. Labelle: Yes, no problem. If we could have ten extra physicians, we would be very happy.
The Acting Chairman: Mr. Labelle, you mentioned earlier that you and your wife were looking for a family doctor
but were unable to find either a French-speaking or English-speaking one, and that you would take anyone you could
find, whatever language he or she spoke. You pointed out that 40 per cent of those who were looking for a family
physician over the last year were unable to find one. So, there is a shortage of physicians.
Mr. Labelle: As far as I'm concerned, any effort that diminishes the possibility of obtaining more bilingual or
French-speaking physicians is misguided. Getting more bilingual or francophone physicians is really the only goal
worth working towards.
The Acting Chairman: The report ranks this as the No. 2 priority and in terms of funding, training health care
personnel is the top priority. That is what the report recommends.
Mr. Labelle: I'm saying we should not be spreading ourselves too thin, and that it is preferable to focus on
increasing the number of bilingual or French-speaking physicians.
Mr. Gauthier: My comment is about the connection between training and networking. We know that we need
networking partners so that training can be provided. Training institutions are starting to see those partners come
forward, asking for assistance in convincing people to study in their universities.
Universities are realizing they can no longer provide training in isolation, and that today's watchword is
partnership, because you have a better chance of being successful if you accept the fact that it is a necessity.
Mr. LaBossière: As regards services in French, as Hubert mentioned earlier, the term ``active offer'' means that
appropriate efforts will be made to find a way to reach francophones. I pointed out in my brief that we have to try to
offer services in areas where francophones reside. If we look at the French school system, for example, that already
gives us a very good indication of where the health services should be made available. We could offer them through the
school system or using public or mental health nurses. That would be an effective way of reaching much of our
We should also start to sit down with the community and set priorities, so that we know where it is important that
this be done and find appropriate methods of achieving those goals. I don't have the perfect answer, but having worked
in Manitoba, I discovered that as a general rule, it was more logical to provide government services in multidisciplinary
In Manitoba, six government services are about to be provided at the St. Boniface Hospital, in Notre-Dame-de-
Lourdes and in three other locations. Services of professionals in various departments are now available in some
centres, including about 30 types of professional services at the government services centre in St. Boniface. In my
opinion, this centre is a good example of what can be done when professionals are brought together under one roof.
Senator Pépin: Yesterday we heard a very positive presentation to the effect that educational models need to be
developed in order to recruit professionals. For my own personal edification, I would like to put one last question to
Among francophones, there are Catholics and non-Catholics, and the two seem to be at daggers drawn. Perhaps
you could explain why francophones are tearing each other apart over access to services in French, apparently because
some are Catholic and some aren't.
Mr. Labelle: Let's take the example of a community where there are two high schools: one English-speaking and one
French-speaking. Taken individually, these two schools might be considered mediocre, but if you put them together,
they would certainly benefit from better facilities, and better training programs.
Senator Pépin: Why can't the Catholics and non-Catholics work together?
Mr. Labelle: In Ontario, Catholics have always had their own school system, and the same applies to non-Catholics.
What happened is this: because the Catholic system did not provide education in French at the secondary level, the
public school system began setting up free secondary schools. A lot of francophones now attend those public schools,
as do their children.
Senator Pépin: So, why don't they merge them?
Mr. Labelle: Because the Catholics do not want to attend public sector schools.
The Acting Chairman: This was a most interesting afternoon and I want to thank each of you individually. Mr.
Labelle's comments seem to suggest there is a certain malaise.
On the other hand, I should point out that we received very enthusiastic testimony from witnesses representing the
Maritime provinces, New Brunswick and Manitoba. In the case of Ontario, there is an undeniable malaise and that is
what Mr. Labelle made clear in his comments.
Mr. LaBossière told us that Ontario is not part of the consortium. It's important to remember that half of the
francophones outside Quebec live in Ontario. This is clearly a serious problem and we don't sense the same enthusiasm
and dynamism that is evident in other communities. This may be a problem that Franco-Ontarians will have to look at
more closely, and it may be a special situation that has to do with the provincial government currently in power.
I would like to thank Mr. LaBossière for his excellent comments and the parallel he drew between the education
system and the health care system. I think he is absolutely right to say that if the education system is working well,
there is no reason why the health care system, within the same communities, should not work just as well.
Finally, Mr. Gauthier presented a very special viewpoint on this issue. He is Chief Executive Officer of a university
health care facility and we know that he is a very busy man. We know the kinds of problems he may be facing,
particularly in a climate of budget restrictions.
In addition to being a member of the Canada Health Research Institutes Council, Mr. Gauthier has demonstrated
remarkable determination and devotion through his involvement in the issue of French services outside Quebec.
He makes weekly pilgrimages to Ottawa, and so I want to commend him for all he has done and tell him that
committee members are well aware of the time and singular effort he has devoted to this cause.
Mr. Gauthier: Thank you.
The committee continued in camera.