RAMQ — Born without a social safety net

The daughter of Ridwan and Durowoju Sulaimon was born on February 4 at the Sacré-Coeur-de-Montréal Hospital. Like all young Quebecers born that day, she received Canadian citizenship. His parents, two holders of temporary residence permits from Nigeria, believed that this gave him the right to health care paid for by the Régie de l'assurance Maladie du Québec (RAMQ). They would quickly discover that this was not the case. Children born in Quebec to parents who hold a temporary work or study permit, or who are undocumented, are not eligible for RAMQ. When these children need health care, their parents have to pay for it out of pocket. The bill sometimes amounts to tens of thousands of dollars, with serious consequences for families.

In the case of the Sulaimons, not only was the baby not entitled to RAMQ, but the mother and child did not have access to private insurance due to a misunderstanding. This misunderstanding cost the family over $20,000. “When I came to study at Concordia, I thought my family would have access to university insurance just like me,” says Ridwan Sulaimon, the girl's father.

However, they changed their policy so that their insurance no longer covers dependants. They say they tried to let us know by email, but I didn't get anything. Having known, I would not have come with my family.” The Sulaimons only understood the gravity of their situation after the birth of their daughter.

Knowing that the bill kept rising, they left the hospital the day after the birth of their child. However, they received three invoices totalling approximately $9,000. A few days after coming home from the hospital, they discovered that their daughter had a mass on her back. “I tried to get care for the baby, but everywhere we were asked if we had the health insurance card,” continues Mr. Sulaimon. In Sacré-Coeur, the doctors sent us to Sainte-Justine, where we waited several hours in the emergency room.

We were told that without a card, you had to pay $721 to see a doctor. We couldn't pay, so we went home without a doctor seeing my daughter. A pediatrician from Sacré-Coeur told me that, if I did not get my child treated, I could be arrested for negligence; but without money, I could do nothing...” Fortunately, with the help of a social worker, the Sulaimons were able to establish a payment agreement and have their daughter treated.

“We finally learned that the mass on his back was not cancerous, but we had to talk to several specialists before considering having it removed — which is expensive.” In addition to the $9,000 bill payable to the Sacré-Coeur-de-Montréal Hospital, they currently owe nearly $13,000 to Sainte-Justine Hospital, they currently owe nearly $13,000 to Sainte-Justine Hospital, Mr. Sulaimon tells us. Three months after the birth of his daughter, he received a letter confirming that, due to the status of her parents, the girl was not eligible for the RAMQ, despite her Canadian citizenship. Through his social worker, Mr. Sulaimon was put in contact with the Montreal law firm Trudel Johnston & Lesperance. He is now the main plaintiff in a class action lawsuit filed against the Government of Quebec.

Me Marianne Dagenais-Lesperance, who is involved in the class action, considers that the RAMQ's practice violates the Canadian Charter of Rights and Freedoms. She is seeking $5,000 in damages for each child who was denied access to care and $2,000 in additional compensation for each family, in addition to reimbursement of expenses. “This is a violation of the fundamental rights of children who are Canadian citizens and residents of Quebec,” she explains.

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Crowdfunding to fight

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Sandra Escalera, a Quebec resident, has been campaigning for children's health rights for several years. In 2014, while her husband was studying at Laval University and was applying for a work permit, their son Bruno, then aged five, was diagnosed with cancer. “Without access to the RAMQ, you have to pay hundreds of dollars just to talk to a doctor, you have to pay hundreds of dollars just to talk to a doctor,” she says sorry. The first time I went to the doctor with my son, he was crying in pain. I told them it was an emergency and they asked me to pay. They later saw how urgent his situation was and they reimbursed me, but it was very stressful.”

Shortly after, Bruno had to undergo surgery that required a stay in intensive care. When her insurance company stopped paying, Sandra turned to her friends and the local media. The family organized a crowdfunding campaign and several fundraisers to pay for Bruno's care. Some of his doctors also stopped billing the family. The child died in 2019, at the age of 10, shortly before his parents received their permanent residence.

“I can talk about it today because, despite everything, I am very lucky,” says Ms. Escalera, now a CEGEP teacher. We have always managed to work things out, we have never gone into debt. I know a family whose daughter had leukemia and they had to declare bankruptcy.”

With the Association des Parents-Étudiants de l'Université Laval, she campaigns for the children of foreign students and undocumented children to have access to health care. “Two years ago, we decided that all children in Quebec had the right to go to school, regardless of their status,” she says. “If school is a right, why is health not so? ” she asks.

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Life against a credit score

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Rodrigue Barbe lives in Quebec City. Her daughter, Elizabeth, who is five years old, was born at the Centre Hospitalier de l'Université Laval (CHUL). He had access to the RAMQ at the time of the birth of his child, but his spouse was not eligible. As the pregnancy was at high risk, the family now owes more than $97,000 to the CHUL. In 2014, Ms. Barbe had a miscarriage.

The following year, when she lost her water at 24 weeks pregnant, the couple went to the Lévis hospital center. The doctors quickly stabilized the mother, before transferring her to the CHUL, where she stayed for 30 days.

“She had private insurance with a limit of $10,000,” recalls Mr. Barbe. On the 10th day in the hospital, we learned that we would be charged $3,300 per day.” The day she was born, Elizabeth weighed barely one kilo. Two months of hospitalization were necessary. Mr. Barbe negotiated to have his care paid for by the RAMQ, but despite all his efforts, he was unable to get the care provided to his wife to save their daughter's life paid for.

“We received automated calls from the hospital every day for two years,” recalls Mr. Barbe. Finally, I blocked the number, but we agree that our credit score is shitty now.”

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1. Barbe is a refugee of Central African origin. He has a doctorate but works in a restaurant until he finds a job in his field. His wife, who is originally from Cameroon, is a student and a part-time hairdresser. They take care of Elizabeth, her younger brother and her two teenage half-brothers. According to Mr. Barbe, their monster debt has mortgaged their health and put pressure on their marriage.

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“I find it all difficult to understand,” Mr. Barbe continues. It's unfair not to take care of a newly born baby or a pregnant woman. I know that sometimes children are not entitled to RAMQ either. Why do they say you can't take care of a child born in Quebec? When parents are careless, custody of the child can be taken away from them, but when the baby is in the mother's womb, it is said that the parents should pay. It's also carelessness.”

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Solutions in the rest of Canada

If Quebec is criticized for its management of this issue, what are the other provinces doing? Ontario and British Columbia have provided access to health care for every child born on their territory for several decades. More recently, Nova Scotia (in 2015) and Alberta (in 2016) adopted the same approach, mainly through citizen engagement. Activists Syed Hussan and Marco Luciano were at the forefront of the fight to expand access to health care in Alberta.

“It took us several years before we could bring the problem to the attention of our legislators,” says Mr. Luciano, who is the director of the migrant rights organization Migrante Alberta. In 2013, an undocumented woman came to us with her sick child and we realized that she was not eligible for health care. We did a lot of lobbying, we distributed a petition with 2,500 signatures and we were able to get the regulations changed. All told, it went well, and now, all a mother needs to do is show her child's birth certificate for the baby to have access to care.”

He adds that the issue of newborn rights has been a “selling point” in Alberta. “Conservatives had concerns about costs, but everyone knew it was shameful to debate toddlers' rights,” he reports. Migrante Alberta also intends to ask the provincial government that pregnant women have access to antenatal care, regardless of their immigration status. “It is important to make the connection between children's rights and mothers' right to health, and to migration status,” said Mr. Luciano.

Everyone should have the right to health care regardless of status.” Syed Hussan, his colleague at the Toronto-based Migrant Workers Alliance for Change, agrees. “We shouldn't divide people into [immigration] categories and end up in a situation where the country's 10 provinces and 3 territories have 13 different policies,” he says. If the federal government granted permanent status to everyone, that's it.”

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Health for all children

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Quebec Health Minister Christian Dubé said in July that he wanted to change some practices so that children born in Canada to parents who are ineligible for the RAMQ have access to health care. In an email sent to La Converse, RAMQ did not wish to make any additional comments or provide a timetable in the wake of this announcement. This is neither the first time that the Government of Quebec has been questioned on this issue nor the first time that a government has promised to act.

Me Dagenais-Lesperance recalls that former Prime Minister Pauline Marois also promised to give these children access to RAMQ in 1999, when she was Minister of Health in Lucien Bouchard's government. Nothing had changed, despite numerous reports, in particular from the Office of the Ombudsman, the Office of the Ombudsman, the Observatoire des Tout-Petits and Médecins du Monde. “I have the impression that we have been fighting for this since the beginning of time,” exclaims psychiatrist Nicolas Bergeron, director of Médecins du Monde Canada (MDM). Since 2011, MDM has been running a free clinic in downtown Montreal, where several families without status, waiting for status or otherwise ineligible for the RAMQ have their children treated. The organization provides care to nearly 150 children, all Canadian citizens, per year.

The director of MDM — an organization involved in the class action brought against the Government of Quebec — does not want to claim victory following Minister Dubé's announcement. “We must see how [this statement] will be operationalized,” says the psychiatrist.

According to him, it is necessary to “decouple migratory status and access to health” in Quebec.

He denounces the fact that a child's eligibility for the RAMQ depends on the status of his parents, while this is not the case in other provinces. The doctor is also concerned that the minister's statement does not go far enough. “Why limit this announcement to babies when parents have other dependent minor children? ” he asks.

Mrs Escalera agrees. She would like the health system to be accessible to pregnant women, regardless of their status, so that their children can avoid certain complications. “Without perinatal care, a baby is likely to be born with complications for which the system will pay,” she illustrates. It doesn't make sense.”

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• Clinic for migrants with precarious status : Médecins du Monde opened a clinic for migrants with precarious status in 2011. It works thanks to numerous volunteers, including doctors and nurses.
• About half of migrants without health insurance in the Montreal region consider that their health is not good, according to a study led by Professor Patrick Cloos, of the University of Montreal.