I believe that our Government has failed to uphold its pledged commitment, has violated our right to health care as publicly promised, and has endangered our already fragile health and welfare, to the point of causing some premature deaths.   – Lt Wolf William Solkin, 96 years old

Ste. Anne’s Hospital (SAH), the last hospital wholly owned and operated by Veterans Affairs Canada (VAC) on the West Island of Montreal, was transferred to the province of Québec on 1 April 2016. This transfer, which could have been carried out efficiently for the benefit of the Veterans of World War II and Korea who lived in the hospital, was a completely failed mission by the federal and provincial govern­ments and the West Island Health Centre. 

BACKGROUND
Canada’s support to the defence of Europe during the Second World War is well known. At the end of the conflict, our country of 11 million had contributed more than a million sailors, soldiers and air personnel to defend our freedoms. Some statistics: 45,000 Canadians were killed; 48,000 were married – to Dutch, French and British women; 54,000 were wounded, 29,000 of whom required long-term care. From 1950 to 1953, during the United Nations’ operation in Korea, 26,000 served, 516 died, and more than 1000 were wounded. These heroic men and women have since, and always will be, known as “the greatest generation.”

As our fighters returned from these conflicts, the Government of Canada built or acquired hospitals across the entire country to house the wounded and sick with long term care needs. 

Later, as health care is a provincial responsibility, Veterans Affairs Canada began transferring these hospitals to the provinces, and provided a monetary allowance to the Quebec government for each Veteran living in the hospitals. 

By 1 April 2016, only one hospital remained to be transferred, and that was Ste. Anne’s Hospital in Montréal. This 450-bed hospital still housed more than 300 Veterans of the second World War and the Korean war with an average age of 92. 

The services and care these Veterans were receiving from VAC personnel were second to none: bilingual personnel, efficient and caring nurses and Personal Support Workers (PSWs), and on-site medical services 24/7. Personnel turnover was rare and most had served at the hospital for many years – they and the Veterans had become like family. 

Because of their advancing age, the hospital was losing one or two Veterans per week, and incoming admissions were not enough to fill the empty beds. The province of Québec was therefore anxious to take over the hospital and its increasingly empty beds for its own civilian elderly population.

HOW TO “MANAGE” A TRANSITION THAT HAS ALREADY HAPPENED
After many years of negotiations, the two levels of government had reached an agreement to transfer the hospital to provincial authority on 1 April 2016. 

During negotiations, the parties had agreed to ensure the continuity of care for the Veterans that existed before the transfer. The Ministers had also promised publicly and privately to Veterans that the level of services and care to Veterans would not be reduced. 

The transfer agreement included a commitment on the creation of a Transition Committee to “oversee” the transfer for three years. This committee would be composed of representatives of the governments of Canada and Québec, the SAH, the Montréal West Island Integrated Uni­versity Health and Social Services Centre (CIUSSS), and one representative of the Veterans at Ste. Anne. 

Inexplicably, the Transition Com­mit­tee met for the first time several months after 1 April. It did not therefore have a chance to review the transition plan, to ask questions, or, most importantly, to ensure any departure of personnel would be mitigated in order to maintain the level of service provided. A mass departure was anticipated because the provincial staffing plans included cutting hours, cutting pay rates, and cutting benefits of staff who had formerly been on the federal payroll.

As expected, on the date of the transfer, between 31 March and 1 April, 40% of the staff departed with retirement packages. The others agreed to remain under provincial management at the hospital. 

Since that time, the hospital has been unable to return to the staffing levels required to provide the agreed level of services. Management has hired temporary agency personnel whose training is considered by residents and advocates to be woefully inadequate. Most of these temps do not know what a Veteran is, many are unable to speak English (half the Veterans are English-speaking), and often do not understand what these men and women have sacrificed for Canada. 

A mere few weeks after the transfer, in the middle of this chaos, the provincial authorities forced the hospital to admit a large number of civilian patients from the region who had experienced a loss of autonomy. This put additional pressure on already overworked, under-trained and under-manned staff. 

The loss of staff, the inability to hire permanent trained replacements, the rush to admit new civilian patients, and a lack of understanding of Veterans by new personnel had an enormous impact on both the quality and quantity of care received by Veterans. The impact was felt in many ways: long wait times for meals, ablutions or baths; long wait times for diaper and urine bag change; poor and often late response to emergencies; mistakes in medicines; negative attitude of personnel; inability to communicate the simplest need; long wait times for specialist medical support now outside SAH; and so on. Temporary staff were poorly trained and did not understand the Veteran population; evenings and weekends were especially difficult for Veterans. 

Dealing with the 'fait accompli" of the transfer, the Transition Committee was never able to redress the situation and the Veterans suffered greatly. Although the question was posed several times, statistics comparing monthly deaths before the transfer to those after the transfer were never provided. It is possible to speculate that deaths increased when the Veterans’ routine changed and they lost their usual caretakers; some nurses are convinced that the reduction in care from the loss of personnel actually resulted in the death of a number of Veterans.

Several solutions were proposed to both levels of government and the CIUSSS to alleviate the situation. For example, a special team from VAC or the province could have reinforced the hospital until the staff situation could have stabilized; or the transfer of civilian patients could have been slowed or delayed until sufficient staff was hired. All these solutions were deemed too difficult or would have required increased efforts and so were not applied. Presentations to explain to the staff “what is a Veteran” were organized for new personnel but temporary worker employment continued.

MORE LOSS OF VETERANS AND CLASS ACTION
To provide an idea of the impact of the transfer on Veterans, 305 of them lived at SAH on 1 April 2016. At the end of September 2018, two and a half years later, there had been 160 admissions of Veterans, yet there were only 166 Veterans left in residence. Their age on average was 95 years old, with six over 100. As of today, there are less than 90 of them. 

Unsurprisingly for this “Greatest Gen­eration”, the Veterans themselves took action. On 29 February 2019, the Québec Superior Court authorized a Class Action by one of the SAH residents, Veteran Lieutenant Wolf William Solkin (then 96) on behalf of all those having lived in SAH or their families. Lieutenant Solkin was the most vocal of the Veterans decrying the reduction in care standards. This courageous man, prisoner of his adapted wheelchair or his hospital bed, was still in full possession of his faculties. With his iPad, he was keeping all informed of the situation and providing details of daily incidents. He had a network of dozens of employees who would confide in him as they witnessed the negative impact of the transfer on Veterans and their services. Lieutenant Solkin became their voice and that of many Veterans unable or unwilling to speak out. He managed to convince an indomitable team of lawyers to take on the Class Action. 

The suit against the governments of Québec and Canada and the CIUSSS was to demonstrate that the reduction in care and services for Veterans was a breach of contract of the promises made to them. The Class Action also requested that the matter be dealt with swiftly given the advanced age of the Veterans. 

Lieutenant Solkin’s perseverance ultimately led to an out of Court settlement. He happily signed the agreement on behalf of all members of the Class on 1 February 2021, two days before he passed. 

The agreement was formally approved by the Court on 29 April, and the three defending parties agreed to pay a total of $19 million to any Veterans having lived at SAH between 1 April 2016 and 31 October 2020 or to their heirs. Solkin had won his last battle for his fellow Veterans. 

The fact is, that these brothers and sisters in arms have sacrificed much for us and they deserve not only our gratitude, but also the care, services and attention they were promised, allowing them to live out their last years and ultimately dying with dignity. 

The failed mission of the transfer of Ste. Anne’s Hospital from federal to provincial authority removed this possibility for many of them. It is still uncertain if the situation at SAH will eventually be resolved so we can honour them appropriately. Shame on all of us if it is not. 

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Lieutenant-General (ret’d) J.O.Michel Maisonneuve is a Veteran of 35 years’ service in the Canadian Armed Forces. He was appointed Representative of the Veterans of SAH on the federal-provincial Transition Committee that was to oversee the transfer of the hospital.