MONTREAL – After Quebec announced a ban on medical accessory fees this month, gastroenterologists said they would stop performing colonoscopies in their private practices and radiologists said they’d cancel appointments for ultrasounds in their private clinics.

Commercial pharmacists are now saying they will stop vaccinating for the flu and will halt certain blood tests because they can no longer charge a fee.

Meanwhile, hospitals have not been given additional resources, the Montreal Gazette reported. “Patients are falling through the cracks,” said Paul Brunet, executive director of the Conseil pour la protection des malades. “It’s urgent. Something must be done. Can you imagine all the patients who now have no choice but to go to the emergency room because they don’t have access to these services?”

Brunet’s group has threatened to launch a class action against radiologists for discontinuing ultrasounds in their clinics.

For its part, the Association québécoise des pharmaciens propriétaires (AQPP) announced that its members will likely discontinue services for which they were able to charge patients in the past. Those services include vaccinations and blood tests for those who take anticoagulant medication (blood thinners).

Pharmacists used to charge patients about $20 for the test, which is used to evaluate the ideal dose for a patient. Jean Bourcier, executive director of the AQPP, estimated that the province’s pharmacists carry out 135,000 such blood tests each year.

“Now that they risk losing money on each and every test, the pharmacists are going to refer patients to hospitals and CLSC clinics,” Bourcier told the Gazette. “This is a major problem. We don’t see how the public sector, how the CLSCs, can absorb this overflow of patients.”

Brunet agreed, criticizing Health Minister Gaétan Barrette (pictured) for banning accessory fees without allocating additional resources to hospitals and reaching agreements with doctors and pharmacists. In fact, the government has cut funding to Montreal-area hospitals like the McGill University Health Centre and the Jewish General.

Barrette has dismissed the potential impact, saying that his government is actually improving access to healthcare by banning the fees.

Barrette pledged that next month the anticoagulant tests in pharmacies will be added to the province’s medicare formulary, allowing pharmacists to be paid for them by the Régie de l’assurance-maladie du Québec.

Barrette’s pledge was news to Bourcier, who accused the minister of negotiating in bad faith with the pharmacists. “We’re a bit skeptical of what Barrette is promising,” he added. “The minister is improvising as he goes along.”

Indeed, Barrette initially proposed to legalize accessory fees. But his position changed dramatically last year after meetings with federal Health Minister Jane Philpott. Ottawa has repeatedly reprimanded Quebec for allowing accessory fees to flourish in the province, arguing that they constitute user fees in violation of the Canada Health Act.

Patient-rights groups in Quebec were also gearing up to file class actions against the provincial government, and some cases are already pending in the courts.

“The minister seems to be stuck between Mrs. Philpott, who advised him of the illegality of the fees charged to patients, and the province’s health professionals, who have been charging fees since 1970 as medicine and techniques have evolved,” Brunet said.

Brunet criticized Barrette for rushing through the ban and for a lack of clarity on the subject. Unlike for some public-awareness campaigns, the health ministry has chosen not to take out advertisements spelling out what fees can still be charged and what services are now covered under medicare.

A list is available on the ministry’s website, informing the public that doctors in private practice can no longer charge fees for eye drops, vasectomies, colonoscopies, mammography and childhood vaccinations, among other services. Doctors, however, can still charge for MRIs, cosmetic surgery and laser eye surgery, among a smaller list of exceptions.