Health and social services centre - Refusal to provide the rehabilitation treatments required after a road accident

A road accident victim still suffering from after-effects did not receive the services she felt she was entitled to from her health and social services centre (CSSS).

For a certain time, the Société de l’assurance automobile (SAAQ) paid for the citizen’s private rehabilitation treatments, after which the agency closed her file. She is challenging this decision using the proper legal recourse. Meanwhile, her physician referred her to her regional CSSS for further physiotherapy and occupational therapy treatments, but it refused her request on the grounds that it did not provide the medium- and long-term services required following a head injury.

The citizen’s complaint concerned:

• the CSSS’s refusal to provide the physiotherapy and occupational therapy services needed in order to maintain her functional gains.

The Québec Ombudsman’s investigation revealed that:

• although the physician’s prescription specified the services required (physiotherapy and occupational therapy), it was short and lacked detail;
• in accordance with a collaboration agreement, the CSSS had referred the citizen to a rehabilitation centre, which had also refused to provide the prescribed treatments;
• the CSSS should have made more of an effort to provide background information for the request for treatment;
• the CSSS did not seem to have a program that could respond to the needs of an  "ambulatory" adult population for rehabilitation and the maintenance of functional gains;
• the agreement between the two partners stipulates that "priority is given to focusing services on users’ needs and on ensuring there is no breakdown in services for this clientele;"
• the CSSS had made a commitment to take charge of, assist and support users, especially those with special and more complex needs, by ensuring, within the local health and social services network, the continuity of the services their condition requires;
• when the rehabilitation centre refused services, the CSSS should have notified the joint monitoring committee to have the dispute settlement mechanisms provided for in the agreement applied.

The Québec Ombudsman recommended that the CSSS:

• review its screening, assessment and referral procedures for front-line rehabilitation service (physiotherapy and occupational therapy) requests to include bio-psycho-social aspects within a comprehensive approach;
• review its rehabilitation (physiotherapy and occupational therapy) service offers to include a response to the needs of an "ambulatory" adult clientele for services that are not short-term and to inform this clientele of the measures it will take regarding these services;
• take the appropriate measures to ensure that the follow-up mechanisms provided for in the CSSS-rehabilitation centre agreement are applied;
• remind those appointed under the agreement of the application of follow-up mechanisms provided for in the agreement and their responsibility in this regard;
• appoint a case manager to be responsible for the user’s record;
• conduct a comprehensive assessment of the user’s needs;
• establish an individualized service plan (ISP) in collaboration with the user.

The CSSS agreed to act on the Québec Ombudsman’s recommendations.