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I happened to swing by the annual public meeting of the McGill University Health Centre board of directors last week.

I had some time to kill before another engagement at the hospital, so I took a seat in the auditorium of the MUHC Research Institute and listened to the opening remarks by board chair Peter Kruyt.

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MUHC president and executive director Lucie Opatrny highlighted some significant staff appointments and touted some exciting innovations. Associate President Martine Alfonso shared some data on clinical activities, including over 32 million diagnostic tests conducted, more than 28,000 surgeries performed and just shy of 3,000 babies born.

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There was mention of a report on diversity and inclusion. There was discussion of a recent Accreditation Canada inspection that cited privacy concerns for patients waiting on stretchers in the overcrowded Royal Victoria ER. Then there were a few questions from the audience.

All in all, typical AGM stuff. But it’s hard not to wonder what this exercise will be next year, once Bill 15 is likely to have been adopted.

Quebec’s latest effort at health care reform is intended to “shake” the pillars of the system. It proposes to curtail the authority of volunteer hospital boards and limit the clout of councils of physicians, dentists and pharmacists, the professionals who work in health institutions. Most of the power at Quebec’s 194 hospitals will instead be transferred to a new agency, Santé Québec, which will be the single employer for everyone from janitors to surgeons and own all the facilities.

Many in the health system have been raising concerns about what these earth-shattering structural changes to administration and governance will do to hospitals.

But Quebec’s last six living premiers warned in an open letter that Bill 15 goes too far. That Philippe Couillard, Pauline Marois, Jean Charest, Lucien Bouchard, Pierre Marc Johnson, and Daniel Johnson would speak out, however politely, against Premier François Legault is rare. That Liberal and Parti Québécois leaders would stand together is unprecedented.

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Anyone questioning the motives for their remarkable intervention fails understand how serious it is to strip health institutions of their essence.

Bouchard later went on 98.5 FM and said Bill 15 will suck the “soul” out of Quebec’s hospitals, each with their own identity, organizational culture, character, mission, and community. It’s a description as eloquent as it is accurate.

Instead of showing humility toward the collective wisdom of his predecessors, Legault dismissed their concerns as amplifying the complaint of disgruntled hospital board members trying to cling to their “little bit of power.” Aside from a concession offered by Health Minister Christian Dubé to give the nominal administrative councils that will replace boards more say over teaching, research and philanthropy (mostly so donations don’t dry up), it’s full steam ahead.

It’s sad for Quebec hospitals. But it’s also sad for many of Quebec’s once proud institutions, which are losing more and more of their souls under a government that has no respect for their importance and is determined to centralize power within government.

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Although the words are sometimes (mis)used interchangeably, there is a profound difference between bureaucracy and institutions. “The” bureaucracy is the permanent apparatus of the state. The elected branch of government gives the administrative side its marching orders.

Institutions, on the other hand, may be publicly funded, but are independent from the state. Or they’re supposed to be. Think schools, colleges, universities, hospitals, libraries, art galleries and museums. A wider definition might also include charities, non-governmental organizations, the media, or religious communities.

Together they form the web of civil society, which contributes to our collective knowledge, health, wealth, culture, and freedom. The independence of these civic institutions are a key indicator of the health of a democracy. Strong institutions make for a strong society and vice versa.

But Legault is either unable to distinguish between bureaucracy and institutions, or else he doesn’t care. He treats important institutions as widgets under the thumb of central planning.

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There are many examples outside health care.

Not content with abolishing elected school boards, the Legault government is now looking to usurp even more authority from the service centres it replaced them with under Bill 23. (Although the courts have so far kept English boards intact.)

There is an element of this contempt at play in the Legault government’s decision to double tuition for out-of-province Canadian students, a move that kneecaps Quebec’s three English-language universities.

And this government is not above publicly second-guessing the head of Hydro-Québec — whether it’s former CEO Sophie Brochu or her successor Michael Sabia — even thought the utility is supposed to be arm’s length.

But back to hospitals.

Legault certainly didn’t start the hollowing out of health care institutions. That began under Couillard and his bombastic health minister Gaétan Barrette. With Bill 10, the two doctors slashed more than a hundred institutional governing boards — of hospitals, research institutes, nursing homes, rehabilitation centres — merging them into a couple dozen CIUSSSes and CISSSes (now there’s an acronym that inspires confidence).

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This was a particular grievance at the time for the English-speaking and Jewish communities, which have built up and nurtured some of Quebec’s most renowned institutions, and is of great concern again with Bill 15 now.

In many respects, Dubé is finishing what Barrette started, so Couillard’s signature is a little hypocritical.

A cautionary tale to illustrate the grave consequences of the present levels of remote management and over-centralized governance can be found in a tragic chapter of recent Quebec history.

When the private Herron nursing home was put under the trusteeship of the West Island CIUSSS after residents were found living in squalor after the first deadly wave of the pandemic in 2020, the situation failed to improve — until the Montreal Gazette broke the story.

Emails and other communications later made public at a coroner’s inquest showed that senior bureaucrats and most CIUSSS managers were calling the shots from afar, while residents went unfed, stewed in soiled diapers, and bodies piled up.

Just imagine what could be in store once another layer of accountability is removed under Bill 15.

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Quebec’s health care institutions — from l’Institut de cardiologie de Montréal, the example the former premiers gave, to the Centre hospitalier universitaire Ste-Justine, to the Jewish General Hospital — are not going to be made better, stronger or more efficient by being placed under the governance of Santé Québec. World-class institutions will be diminished and excellence sacrificed by having to constantly kowtow to the whims of a distant, new, bureaucratic monstrosity.

Maybe it will matter less for small regional hospitals. Then again, maybe not.

Institutions, be they hospitals, schools or universities, are not playthings for the government to grab and smash. When they’re treated with deference and respect, we’re all better off.

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