Course:Law3020/2014WT1/Group G

Facts
In Quebec in 2005 the provincial government was prohibiting Quebec residents from taking out insurance to obtain private sector health care services through regulations in the Quebec Health Insurance Act and the Hospital Insurance Act. Zeliotis [explain who he is] was experiencing a number of health problems that lead him to speak out against the waiting times he was experiencing in the public health care system in Quebec. A physician, Chaoulli, had also been attempting to have his home-delivered medical activities recognized, as well as to obtain a license to operate an independent hospital in his city, both of which were considered private medical care.

Both Zeliotis and Chaoulli took issue with the validity of the prohibition on private health insurance: s.15 of the  Health Insurance Act (HEIA) and s.11 of the  Hospital Insurance Act (HOIA). They claimed that these prohibitions deprived Quebec citizens of access to health care services that did not come with the extraneous waiting times that existed in the public system.



Issue(s)
The main question at hand in Chaoulli v. Quebec was whether Quebec had the constitutional authority to establish a single-tier health plan while discouraging a second private tier health sector through specific prohibitions, and whether these prohibitions infringed a person's section 7 right from the Canadian Charter of Rights and Freedoms?

If so, was this deprivation of a person's section 7 Charter right in accordance with the principles of fundamental justice?

Section 15 of the Health Insurance Act
15. An insurer or a person administering an employee benefit plan may enter into or maintain an insurance contract, or establish or maintain an employee benefit plan, as the case may be, that includes coverage for the cost of an insured service furnished to a resident or temporary resident of Québec, only if


 * (1) the insurance contract or employee benefit plan does not cover any insured service other than the insured services required for a total hip or knee replacement, a cataract extraction and intraocular lens implantation or any other specialized medical treatment determined under section 15.1, and those required for the provision of the preoperative, postoperative, rehabilitation and home care support services described in section 333.6 of the Act respecting health services and social services (chapter S-4.2);


 * (2) the insurance contract or employee benefit plan includes coverage for the cost of all insured services and all preoperative, postoperative, rehabilitation and home care support services referred to in subparagraph 1, subject to any applicable deductible amount; and


 * (3) the coverage applies only to surgery performed or any other specialized medical treatment provided in a specialized medical centre described in subparagraph 2 of the first paragraph of section 333.3 of the Act respecting health services and social services.


 * An insurance contract or employee benefit plan inconsistent with subparagraph 1 of the first paragraph that also covers other goods and services remains valid as regards those other goods and services, and the consideration provided for the contract or plan must be adjusted accordingly unless the beneficiary of the goods and services agrees to receive equivalent benefits in exchange.


 * Nothing in this section prevents an insurance contract or an employee benefit plan that covers the excess cost of insured services rendered outside Québec or the excess cost of any medication of which the Board assumes payment from being entered into or established. Nor does anything in this section prevent an insurance contract or an employee benefit plan that covers the contribution payable by an insured person under the Act respecting prescription drug insurance (chapter A-29.01) from being entered into or established.


 * “Insurer” means a legal person holding a licence issued by the Autorité des marchés financiers that authorizes it to transact insurance of persons in Québec.


 * “Employee benefit plan” means a funded or unfunded uninsured employee benefit plan that provides coverage which may otherwise be obtained under a contract of insurance of persons.


 * An insurer or a person administering an employee benefit plan that contravenes the first paragraph is guilty of an offence and is liable to a fine of $50,000 to $100,000 and, for a subsequent offence, to a fine of $100,000 to $200,000.

Source: http://www.canlii.org/en/qc/laws/stat/cqlr-c-a-29/latest/cqlr-c-a-29.html

Section 11 of the Hospital Insurance Act
11. No insurer may enter into or maintain an insurance contract that includes coverage for the cost of an insured service furnished to a resident.


 * No person may establish or maintain an employee benefit plan that includes coverage for the cost of an insured service furnished to a resident.


 * An insurance contract or employee benefit plan inconsistent with the first or the second paragraph, as the case may be, that also covers other goods and services remains valid as regards those other goods and services, and the consideration provided for the contract must be adjusted accordingly unless the beneficiary of the goods and services agrees to receive equivalent benefits in exchange.


 * Nothing in this section prevents an insurance contract or an employee benefit plan that covers the excess cost of insured services rendered outside Québec from being entered into or established.


 * “Insurer” means a legal person holding a licence issued by the Autorité des marchés financiers that authorizes it to transact insurance of persons in Québec.


 * “Employee benefit plan” means a funded or unfunded uninsured employee benefit plan that provides coverage which may otherwise be obtained under a contract of insurance of persons.


 * An insurer or a person administering an employee benefit plan that contravenes the first or second paragraph is guilty of an offence and is liable to a fine of $50,000 to $100,000 and, for a subsequent offence, to a fine of $100,000 to $200,000.

Source: http://www.canlii.org/en/qc/laws/stat/rsq-c-a-28/latest/rsq-c-a-28.html

Analysis
The court found that delays which are the necessary result of waiting lists increase a patient's risk of mortality or the possibility of their injury/condition becoming much worse. This waiting period is often filled with pain and a lack of enjoyment of patients life, due to their urgent need for medical treatment. These waiting times causing pain and lack of enjoyment of life affect the right to life and to personal inviolability [?]. The court found that this was a clear violation of an individual's section 7 Canadian Charter right.

[38-43]

When a Charter right is infringed upon, the provision that infringes upon the right can sometimes be protected under s.1. [can you lay out the steps of the Oakes test?] The objective of the HOIA and the HEIA is to promote health care in Quebec that is of high quality even if the citizen lacks the adequate funds. Therefore, the purpose of the provisions being examined are to prohibit private insurance in order to preserve the integrity of the public health care system in Quebec. There is no proportionality between the measure adopted to attain the objective and the objective itself.

In order to be justified under s.1 of the Charter there must be a rational connection and minimal impairment [these are two separate steps of the Oakes test], but there is no rational connection with the objective or preserving the public plan, as well Quebec was not able to prove that there was minimal impairment by the provisions being examined.

Hence, the evidence presented to the courts showed that delays in public health care were widespread, and in some cases had serious consequences, such as death, as patients wait for proper medical attention. This evidence showed that the prohibition against private health care insurance/systems could lead to physical and psychological suffering, which meets the threshold test of seriousness.[what threshold test?] [112][123]

Conclusion/Holding
According to the Supreme Court of Canada the appeal should be allowed. The Court decided that s.15 of the HEIA and s.11 of the HOIA are inconsistent with the Quebec Charter.

In order to learn about about how each of these theories can be applied to the case at hand, click the categories below.