Download free PTCB practice questions with practice exam and dumps

killexams.com PTCB Free PDF contains a Complete Pool of PTCB Questions and Answers and Exam Questions checked and substantial including references and clarifications (where material). Our objective to rehearse the PTCB Questions and Answers is not just to breeze through the The Pharmacy Technician Certification Board (PTCE Exam) test at first endeavor yet Really Improve Your Knowledge about the PTCB test subjects.

Exam Code: PTCB Practice exam 2022 by Killexams.com team
PTCB The Pharmacy Technician Certification Board (PTCE Exam)

Medications (40%)
- Generic names, brand names, and classifications of medications
- Therapeutic equivalence
- Common and life-threatening drug interactions and contraindications (e.g., drug-disease, drug-drug, drug-dietary supplement, drug-laboratory, drug-nutrient)
- Strengths/dose, dosage forms, routes of administration, special handling and administration instructions, and duration of drug therapy
- Common and severe medication side effects, adverse effects, and allergies
- Indications of medications and dietary supplements
- Drug stability (e.g., oral suspensions, insulin, reconstitutables, injectables, vaccinations)
- Narrow therapeutic index (NTI) medications
- Physical and chemical incompatibilities related to non-sterile compounding and reconstitution
- Proper storage of medications (e.g., temperature ranges, light sensitivity, restricted access)

Federal Requirements (12.5%)
- Federal requirements for handling and disposal of non-hazardous, hazardous, and pharmaceutical substances and waste
- Federal requirements for controlled substance prescriptions (i.e., new, refill, transfer) and DEA controlled substance schedules
- Federal requirements (e.g., DEA, FDA) for controlled substances (i.e., receiving, storing, ordering, labeling, dispensing, reverse distribution, take-back programs, and loss or theft of)
- Federal requirements for restricted drug programs and related medication processing (e.g., pseudoephedrine, Risk Evaluation and Mitigation Strategies [REMS])
- FDA recall requirements (e.g., medications, devices, supplies, supplements, classifications)

Patient Safety and Quality Assurance (26.25%)
- High-alert/risk medications and look-alike/sound-alike [LASA] medications
- Error prevention strategies (e.g., prescription or medication order to correct patient, Tall Man lettering, separating inventory, leading and trailing zeros, bar code usage, limit use of error-prone abbreviations)
- Issues that require pharmacist intervention (e.g., drug utilization review [DUR], adverse drug event [ADE], OTC recommendation, therapeutic substitution, misuse, adherence, post-immunization follow-up, allergies, drug interactions)
- Event reporting procedures (e.g., medication errors, adverse effects, and product integrity, MedWatch, near miss, root-cause analysis [RCA])
- Types of prescription errors (e.g., abnormal doses, early refill, incorrect quantity, incorrect patient, incorrect drug)
- Hygiene and cleaning standards (e.g., handwashing, personal protective equipment [PPE], cleaning counting trays, countertop, and equipment)

Order Entry and Processing (21.25%)
- Procedures to compound non-sterile products (e.g., ointments, mixtures, liquids, emulsions, suppositories, enemas)
- Formulas, calculations, ratios, proportions, alligations, conversions, Sig codes (e.g., b.i.d.k, t.i.d., Roman numerals), abbreviations, medical terminology, and symbols for days supply, quantity, dose, concentration, dilutions
- Equipment/supplies required for drug administration (e.g., package size, unit dose, diabetic supplies, spacers, oral and injectable syringes)
- Lot numbers, expiration dates, and National Drug Code (NDC) numbers
- Procedures for identifying and returning dispensable, non-dispensable, and expired medications and supplies (e.g., credit return, return to stock, reverse distribution)

The Pharmacy Technician Certification Board (PTCE Exam)
PTCB candidate
Killexams : PTCB candidate - BingNews http://www.bing.com:80/news/search?q=PTCB+candidate&cc=us&format=RSS Search results Killexams : PTCB candidate - BingNews http://www.bing.com:80/news/search?q=PTCB+candidate&cc=us&format=RSS https://killexams.com/exam_list/PTCB Killexams : Democrats Grim, Ortiz hope to represent Toledo in Ohio House No result found, try new keyword!Michele Grim is challenging Daniel Ortiz in the Democratic primary in Ohio's 43rd House District, which features Ottawa Hills and parts of Toledo. Fri, 29 Jul 2022 13:06:10 -0500 en-us text/html https://www.msn.com/en-us/news/politics/democrats-grim-ortiz-hope-to-represent-toledo-in-ohio-house/ar-AA107qGP Killexams : Embattled KS Rep. Aaron Coleman faces 2 election opponents. Could that help him win?

Freshman Kansas state Rep. Aaron Coleman has been embroiled in controversy, with a history of abusive behavior, and, more recently, two arrests. Now two Wyandotte County women are vying to bring him down in the Aug. 2 Democratic primary.

Yet though they have the funding and prominent support, some observers worry the challengers could split the vote in the district, helping the embattled incumbent eke out a win in the three-way race. Many are encouraging voters to pay attention and turn out to vote.

Faith Rivera, a longtime community activist, has been campaigning for the 37th District seat for roughly two years after calling for Coleman to be ousted for the abuse allegations against him. She is the more progressive candidate in the race, who admits she does not have the backing of the establishment, and has been known to ruffle feathers among government leaders in Kansas City, Kansas.

Melissa Oropeza is a health care professional with a doctorate in nursing who has secured the support of more traditional and establishment Democrats, and has won endorsements from several prominent unions. She also has raised the most money, more than $7,300 during the campaign, compared to Rivera’s $1,500.

Coleman has run an almost entirely self-funded campaign, according to a July campaign finance filing.

“I was shocked that (Aaron Coleman) was going to run again. He’s been an embarrassment to Wyandotte County and to the whole Kansas Legislature,” said longtime lobbyist and retired Unified Government public relations director Mike Taylor. “One of the bad things is he didn’t get assigned to any committees, so we in effect lost a state representative because he wasn’t there. He can vote on the floor, but not serving on any committees, he had no input there.”

The primary winner will go on to face Diana Whittington, the lone Republican candidate, in the general election.

The recently redrawn 37th House District lies in eastern Wyandotte County, generally bordered by Parallel Parkway on the north, Kansas Avenue on the south, 94th Street on the west and the county line on the east.

Aaron Coleman’s controversies

Coleman, now 21, has been arrested twice during his first term in office. He was also banned from the Kansas Department of Labor offices in Topeka after he berated a security guard. And he has been accused of a pattern of abusive behavior toward women, including physical abuse of an ex-girlfriend, as well as blackmail and revenge porn.

Lawmakers formed an investigative committee last year and found the abuse allegations against Coleman credible, but they took no action because the behavior occurred before he took office.

Earlier this year, Coleman received diversion after being charged with misdemeanor domestic battery for allegedly kicking and pushing his brother during an argument. And he was found guilty of one of two traffic infractions in Douglas County after he allegedly led state troopers on a brief pursuit on Interstate 70 and acted in an “erratic” manner when he was pulled over.

Coleman did not respond to The Star’s requests for an interview.

“I think it’ll be a good race between Faith and Melissa,” Taylor said. “Faith has been out campaigning and is well known in the community. She’s somebody who would go to Topeka and try to stir things up. Melissa is a more traditional candidate. It will be interesting to see what folks in the area do. But I don’t think Aaron will play enough of a role to cause a plurality or something. I will be shocked if he does.”

Some like Taylor think that Coleman is a long shot to win the primary. But others do worry that votes could be split between Rivera and Oropeza, possibly opening the door for Coleman to have a chance at reelection.

“It is a concern,” said state Sen. Pat Pettey, a Kansas City, Kansas, Democrat. “I am supporting Dr. Melissa Oropeza, and I’m very optimistic for her being successful. However, it is a three-way primary with two Hispanic women running against the incumbent.”

Taylor said the outcome of the primary will likely be partly determined by turnout, and whether more young, progressive voters show up to have a say on whether to remove abortion rights from the state constitution.

Activist Faith Rivera

Rivera, 43, is a lifelong Wyandotte County resident and pharmacy technician. She has been open about her personal experience escaping domestic abuse, which also has fueled her efforts to get Coleman out of office.

“I want to be an inspiration, not just for these women who are victims, but also for the community,” Rivera said. “I’ve been homeless. I’ve lived in a hotel, lived in my car. I’ve had food stamps. I know what it’s like. But I’m working my way to becoming more. Despite what we’ve been through, we’re worth something.”

Rivera has worked as a voting rights activist, fighting for polling places to be fairly located, for example. She has advocated for several local issues, and was among the residents who sued to block the state’s new congressional map, alleging that its redrawn district boundaries are a racial and partisan gerrymander.

“Faith is very well known for speaking truth to power, and doing so doesn’t always make her the most popular person in the room,” Kansas state Rep. Susan Ruiz, a Shawnee Democrat, said. “However, this does not stop her from carrying the voice of the people in the community. … Faith’s reputation of listening and taking action has led her to also help organize rallies to speak out against injustices to women, especially women of color.”

If elected, Rivera said that she would push for redistricting reform, raising the state’s minimum wage from $7.25 to $15 an hour, legalizing marijuana, reinforcing women’s reproductive rights and expanding access to health care and Medicaid.

Challenger Melissa Oropeza

Oropeza, 45, was born and raised in Wyandotte County and has 23 years of experience in health care. In 2020, she graduated with a doctorate in nursing practice from the University of Missouri-Kansas City, and for the past 11 years, she has worked as a nurse practitioner. Oropeza previously ran for the Board of Public Utilities.

“Watching everything during the pandemic, listening to everything going on, I knew that things can be done better,” Oropeza said. “Having that nursing and health care perspective in Topeka would be helpful. I want to bring that data- and research-driven mindset to Topeka.”

Oropeza supports expanding Medicaid and access to health care, as well as improving opportunities for students to gain education and training after graduation. She also believes she could offer a unique perspective to the debate on women’s reproductive rights, and worries that removing abortion rights from the constitution would drive residents and health care workers from the state.

“What are they going to push our health care providers into? Will you have people that say, ‘this is too much stress for me. I just had a pandemic. Now I could be prosecuted or go to jail for helping with care’?” Oropeza said. “It’s not even about abortion. It’s more about restricting access to care. It’s more about putting undue pressure on our health care workers. And I can see it snowballing into something that could be really detrimental for the state of Kansas.”

Pettey, the Democratic state senator, is supporting Oropeza in the race, arguing that she is the most qualified and would offer a needed perspective and expertise in the statehouse.

She encouraged Wyandotte County residents to pay attention and vote, saying that, “we don’t deserve to have someone that’s repeatedly breaking the law, that has no respect for authority and does not want to work through the legislative process.”

In 2020, Coleman, then 19, defeated incumbent Stan Frownfelter in the Democratic primary by 14 votes.

“I’m hopeful that those that live in the 37th District are looking at all of the issues that are on the ballot,” Pettey said. “Because we only get what we vote for. And if we don’t go out and vote, then we have no one to blame but ourselves for the representation we have.”

Voters can cast ballots in the Aug. 2 primary early or on Election Day, with polls open from 7 a.m. to 7 p.m.

Thu, 28 Jul 2022 22:00:00 -0500 en-US text/html https://www.aol.com/news/embattled-ks-rep-aaron-coleman-100000095.html
Killexams : Ohio voters head to polls Tuesday in primary for state legislature contests No result found, try new keyword!Redistricting fights led Ohio voters to an Aug. 2 primary for state House and Senate candidates on maps that were struck down by the state’s supreme court as unconstitutional. Sun, 31 Jul 2022 08:01:02 -0500 en-us text/html https://www.msn.com/en-us/news/politics/ohio-voters-head-to-polls-tuesday-in-primary-for-state-legislature-contests/ar-AA109RS7 Killexams : Kansas lawmaker faces abuse allegations and 2 arrests. And now: 2 election opponents No result found, try new keyword!Freshman Kansas state Rep. Aaron Coleman has been embroiled in controversy, with a history of abusive behavior, and, more recently, two arrests. Now two Wyandotte County women are vying to bring him ... Sat, 30 Jul 2022 03:33:00 -0500 text/html https://www.kansas.com/news/politics-government/article263894727.html Killexams : Three run for Democratic primary in 37th District

Three candidates are running in the Democratic primary for the 37th District, Kansas House.

Incumbent Rep. Aaron Coleman, a Democrat, faces primary opposition from Melissa Oropeza and Faith Rivera.

There is also one Republican running for the district, Diana Whittington.

The primary is Tuesday, Aug. 2, with advance voting currently taking place.

Rep. Aaron Coleman (File photo from 2020)

Rep. Coleman, age 21, faced opposition from his own party in the state Legislature after he won the last election over former Rep. Stan Frownfelter. Past alleged actions such as a revenge porn incident while he was a student, along with his words about a “hit” on the governor, which he said was misinterpreted, resulted in opposition from his party and not being assigned to committees. Coleman also had an alleged incident reported to police involving a dispute with his brother, and a trooper’s stop of him on I-70, where he allegedly did not pull over fast enough, also made the news.

Rep. Coleman could not be reached for this story.

According to information provided in the past by Rep. Coleman, he is a progressive who is a native of the Turner area. He was 19 years old when he won election as state representative. He had served as a Democratic precinct committeeman and in the Wyandotte County Young Democrats.

Coleman stated in 2020 that he wanted to bring a fresh view to the Legislature and to the issues that it considered. He stated he admired Sen. Bernie Sanders, and he wanted the state to work for all citizens.

In 2021, Rep. Coleman introduced a bill to reduce the penalties for drug possession.

Melissa Oropeza

Oropeza said she has been campaigning door-to-door, listening to constituents, and she would bring a new health care perspective to the district, along with being an advocate for the district.

Oropeza, 45, is a nurse practitioner in gastroenterology, and has been in the health care field for 23 years.

She attended Turner High School, received an associate degree from Kansas City Kansas Community College, graduated with a bachelor’s degree from the University of Kansas School of Nursing, received a master’s degree in nursing from KU, and received a Doctor of Nursing Practice from the University of Missouri at Kansas City.

“I am confident that with my educational background and professional insights, I can be a reliable and committed advocate for our 37th District and all of Kansas,” Oropeza stated.

Her top issues include health care and the expansion of Medicaid; giving every student the access to opportunity to advance their education or access to trade training; and support for the Kansas Promise scholarship, education at no cost to the student.

Oropeza also said she noticed in going door-to-door that constituents were talking about reducing gun violence, as well as the constitutional amendment on the ballot Aug. 2. She said she has encouraged people to educate themselves on the facts and make sure they are informed on the constitutional amendment.

She has continued her professional work and her advocacy in the field of nursing. She was appointed to the Kansas Board of Nursing in July 2021. Oropeza was recognized as the Nursing Advocate for Kansas in 2017 by the American Association of Nurse Practitioners.

Oropeza ran unsuccessfully for the Board of Public Utilities in 2019. She said this campaign is different, as it is very focused on one district instead of the county at large, and it has been more labor intensive, going door-to-door.

She has been an at-large member of the Johnson County Democratic Women of Kansas, and a member of the Wyandotte County Third Saturday Democratic Breakfast. She also has been a T-ball coach for more than 20 years at a park in the Armourdale area.

Oropeza stated she would like to preserve the diversity and cultural values that make Wyandotte County unique and prosperous.

“Solidifying and expanding these core values at the heart of Wyandotte County will help us to ensure safety and awareness within the community,” she stated.

“If elected, I will provide accountability and reliability for District 37 constituents as well as all of Kansas,” she stated.

According to campaign finance reports, Oropeza has received much of the financial support that is normally given to a Democratic incumbent for the state Legislature.

Faith Rivera

Faith Rivera, 43, said she has been knocking on doors and making phone calls, and her campaign has received some assistance from other officeholders in the area.

She said her top issues are defending women’s reproductive rights for all women; expanding Medicaid and health care access; raising the minimum wage to $15 an hour; and legalizing medical and recreational marijuana.

Rivera, a pharmacy technician, noted that there is a serious drug problem in the community. It has resulted in safety concerns for some employees.

She is well known as one of the persons who filed suit over the redistricting maps that split Wyandotte County into two parts.

“It was an eye-opening experience,” she said about the suit. She won in Wyandotte County and thought they would win at the state level, “but we learned so much,” she said.

“The biggest thing I learned is that there should be a nonpartisan third party that should be in charge of our redistricting,” Rivera said.

No one should be in charge of redistricting who has any ties or leadership role that would benefit from it, she said.

If elected, she will fight for redistricting reform in Kansas, she stated in her campaign information.

Rivera attended Bishop Miege High School and received her certification as an electrician at Kansas City Kansas Community College. She also studied at Johnson County Community College, in general studies, and has not yet completed that degree.

She ran unsuccessfully for the BPU in 2019, the same time that Oropeza ran for the BPU.

She also has volunteered with the Safe and Welcoming Coalition, and served on the parks and recreation board. She fought to keep Parkwood Pool open and also helped move the polling location from the South Patrol back to the Argentine Community Center. She also fought against the 24-hour Fitness center locating in the community center.

Rivera said that years ago, she was homeless for a while, living in her car, and she understands the challenges that single women face.

Rivera, who held rallies on the “vote no” position on the constitutional amendment, said she has been endorsed by Planned Parenthood. She supports the current Kansas abortion laws, and said she wants women to have a choice.

Rivera was instrumental in bringing to the limelight Rep. Coleman’s alleged involvement in revenge porn in his student years. She said that her kids were friends of some of the alleged victims.

“We need better representation here in Wyandotte County,” she said.

Rivera filed first for the 37th District, with other candidates filing months later.

Diana Whittington

The Republican candidate, Diana Whittington, does not have opposition in the primary election.

A retired teacher, Whittington stated in her questionnaire responses that she was the conservative, pro-life choice for like-minded people in District 37.

“I hope to bring life experience and common sense to the state house,” she stated.

Her three top issues included being more fiscally responsible during a time of high inflation and looking at how Kansans’ money is being spent in order to be efficient and effective, including lowering taxes if possible; parents having the right to decide upon the best education for their children; and support of law enforcement and first responders, looking at ways to lower the crime rate and investing in them, she stated in her questionnaire response.

Whittington previously ran unsuccessfully for state Senate in 2020 against Sen. Pat Pettey in the 6th District, and for 8th District Unified Government commissioner in 2021, which was won by Andrew Davis.

Campaign finance information

According to campaign finance reports, Oropeza received donations from several political action committees, including the KNEA, Building and Construction Trades Council PAC, Carpenters PAC, KC Bizpac and the International Association of Fire Fighters PAC.

She also received donations from three state legislators currently serving from Wyandotte County, and also a donation from former Rep. Stan Frownfelter, who held the 37th District seat before Rep. Coleman was elected. Oropeza reported receiving contributions of $7,381.26 during the latest reporting period, with cash on hand of $3,547.62 at the close of the period, July 21.

Rivera received mostly smaller donations from individuals, according to campaign finance reports. She did not receive larger PAC contributions. She reported contributions of $1,557 for the latest reporting period, with $3,107.32 cash on hand at the close of the period, July 21.

Rep. Coleman’s main contributions were a loan from himself of $6,000, according to campaign finance reports. He reported total contributions of $8,749.14 during the latest reporting period, with cash on hand of $856.88 at the close of the period, July 21.

Whittington reported receiving a contribution from Kevin Braun, a former state senator, of $500, according to campaign finance reports. She reported contributions of $1,450 during the reporting period, and cash on hand of $1,149.25 at the close of the period, July 21.

Voting details

Early voting in person is currently taking place in Wyandotte County, starting last Saturday.


Voting on Election Day, Aug. 2, is open from 7 a.m. to 7 p.m. at assigned polling places.


For more information about voting, see http://www.wyandottedaily.com/early-voting-in-person-starts-saturday/.

Visit the Wyandotte County Election Office website at wycovotes.org or call 913-573-8500 for more details on times and places to vote.

To see an updated map of Kansas House seat boundaries in Wyandotte County, and determine what district you are in, visit https://www.wycokck.org/files/assets/public/election-office/kshouseofrep24x36clip.pdf. Some boundaries recently changed.

Registered voters also can learn their district number and see what will be on their ballot at Voter View, https://myvoteinfo.voteks.org/VoterView.

Election stories in the Wyandotte Daily can be found by clicking on the Election 2022 tab or visiting http://www.wyandottedaily.com/category/election-2022/.

To reach Mary Rupert, editor, email maryr@wyandottedaily.com.

Fri, 29 Jul 2022 23:45:00 -0500 Mary Rupert en-US text/html http://www.wyandottedaily.com/three-run-for-democratic-primary-in-37th-district/
Killexams : Rising retail, restaurant, fast-food wages make hiring tougher for manufacturing, construction, health care

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Killexams : On Bill 96 and Quebec health-care

Editor’s note: This article has been written by a group of McGill students involved in health care in Quebec. An accompanying open letter to politicians and petition can be found here.

Links to download translations of the petition can be found at the end of the article.

As a group of multilingual Quebec residents and first-, second- and third-generation immigrants passionately studying and/or actively involved in the health-care field, we are concerned by the potential impacts of Bill 96, An act respecting French, the official and common language of Québec, on health-care delivery to all Quebecers and, in particular, vulnerable immigrant and indigenous populations.

The COVID-19 pandemic has exposed systemic flaws in our health-care system that require fundamental changes. Bill 96 will further stress and complicate health-care delivery by introducing language barriers.

Bill 96 was adopted in May to halt the steady decline of French. However, according to political journalist Michel C. Auger’s book, Debunking 25 Political Myths in Quebec, this fear is based on the relative decline of French as a maternal language from 79.7 per cent (2011) to 79.1 per cent (2016), though the absolute number during this time grew. However, a record 94.5 per cent (2016) of Quebecers were able to speak/sustain a conversation in French and the rate of using French at home is increasing. Auger attributes these changes to immigration, which decreases the maternal French rate since most immigrants’ first language is not French, but increases the overall percentage of individuals who speak French due to obligations from Bill 101/Charter of the French Language.

Immigration has impacted English in the same way, decreasing its relative share of non-French/English mother tongues. As put by the journalist Francine Pelletier at the end of her Canadian Broadcasting Corporation (CBC) French documentary Fight for the soul of Quebec: “Little by little, Quebec is opening up to the world again. Change is in the air. Diversity, too. The soul of Quebec is far from disappearing, it’s expanding.”

Multilingualism is an asset. Martin Braun, who holds a doctorate in languages, states: “Numerous studies have shown that speaking multiple languages provides many advantages that go far beyond the knowledge of the languages themselves. Multilingual speakers can concentrate better, resolve conflicts easier and empathize better with others.” 99.1 per cent of Quebec parents agree, believing that it is either very or fairly important for their child to learn English as a second language.

Putting aside the question of whether French is truly in decline, we wholeheartedly take pride in being French speakers and believe it is an important aspect of Quebec identity. At the same time, Bill 96 has wide-ranging implications on the economy, business, judicial system, education and other public and private sectors, services and domains. As a result, this would impact Quebecers’ social determinants of health (“the non-medical factors that influence health outcomes”), including education, working life conditions and social inclusion and non-discrimination.

Legal experts contend that the bill itself does not explicitly exclude health services.

Premier Francois Legault has stated that Bill 96 will not impact health-care delivery in languages outside of French, but legal experts contend that the bill itself does not explicitly exclude health services. The bill states: An agency of the civil administration may depart from [the French requirement] by using another language in addition to French in its written documents … where health, public safety or the principles of natural justice so require.” This clause is ambiguous and up to interpretation. Therefore, this bill warrants further discussion given that there have been accusations of language discrimination in health-care pre-Bill 96. We believe multilingualism is crucial in the context of delivering health care to the general population during an emotional, stressful and painful moment of their lives.

Bill 96 is an update to Bill 101 with the Quebec government preemptively using the Canadian constitution’s notwithstanding clause to prevent legal challenges. Bill 96 mandates that businesses and public-sector workers communicate with their clients exclusively in French, with the following exceptions:

  1. Recognized bilingual institutions and municipalities, which retain the right to provide services in English but cannot provide services in languages other than English or French (apart from situations outlined below).
  2. Interactions with individuals who are:

a) Historical anglophones and attended elementary school in English in Canada or previously communicated with this institution solely in English.

b) Indigenous peoples.

c) Tourists.

d) An immigrant who arrived in Quebec less than six months ago.

The application of these exceptions may prove difficult, as 2a) would likely require an official letter from the school board as proof; for 2d), arrival dates aren’t always present on immigration documentation.

Bill 96’s impact on health-care professionals

Despite each health-care profession having its own licensing guidelines, they are all bound and guided by the same four fundamental pillars of ethical medicine: (1) autonomy; (2) beneficence; (3) non-maleficence; (4) justice. Bill 96 places health-care professionals in conflict with these tenets, and therefore with their certifying bodies. The following examples are just a few, among many, of how the bill will obstruct patient care and prevent health-care professionals from achieving the ethical standards necessary to maintain a professional license:

  • Autonomy means that “every human being of adult years and of sound mind has the right to determine what shall be done with [their] own body.” Patients must provide informed consent, meaning they are given “an adequate explanation about the nature of the proposed investigation or treatment and its anticipated outcome as well as the significant risks involved and alternatives available.” Since Bill 96 prevents health-care practitioners from communicating with patients in their primary language, it is likely that information will not be provided “in a manner that [they] understand and can apply.” This would breach health-care directives, leading to negligence or assault charges against the health-care worker.
  • Beneficence and non-maleficence mean that medical practitioners must provide the best available care by acting in the patient’s best interest and allowing no harm through neglect. Bill 96 would prevent medical professionals from using a professional translator/interpreter; transferring patients to a multilingual facility; and/or transferring to a colleague fluent in a patient’s native language. This would also include transferring a native French patient from an employee with elementary French to a colleague who is more fluent. Here are specific conflicts that different health-care professionals would have between Bill 96 and their professional associations:
  1. a)         Physicians: Not being able to transfer patients due to a language barrier conflicts with the Canadian Medical Association (CMA) Code of Ethics, which states that physicians must be “cautious not to overstep the limits of their knowledge and skills … [and] seek advice and support from colleagues in challenging circumstances.”
  2. b)         Critical Care Nurses: Bill 96 would violate the communication standards set by the Canadian Association of Critical Care Nurses (CACCN) by handicapping nurses’ ability to “gather data concerning patients’/families’ needs and responses to the critical care experience” and “advocate[s] with patients/families to address their expectations and needs.” Any misinformation due to miscommunication would be passed on to the multidisciplinary team and negatively impact the treatment plan prescribed.
  3. c)         Psychologists: Psychologists are responsible for assessing and helping patients overcome problems in thinking, feeling and behaviour and must operate in accordance with scientific principles. However, studies on mental health assessment in a second language demonstrate that providing care in a non-primary language interfere[s] with clinician and patient knowledge and rapport, leading to qualitative as well as quantitative differences in… treatment.” As such, language barriers impair a psychologist’s ability to diagnose and treat, while placing undue stress on patients.
  • Justice requires that medical professionals uphold existing legislation and the equitable treatment of persons. Bill 96 would force health-care practitioners into making an impossible choice: Abide by Bill 96, but provide substandard care due to miscommunications issues introduced by a language barrier and suffer professional consequences from their governing body, including a potential loss of license; or violate Bill 96 to communicate effectively with patients in their native language but be subject to punitive government fines.

Quebec’s Institute of Public Health states “Every code of ethics that health and social service workers abide by stipulates they must do everything in their power to provide service of the highest possible quality. This means that they must ensure that the level of mutual understanding they have with users does not interfere with the quality of service. Health professionals should therefore not only make every possible effort to speak the language of users, but – and most importantly – use every means available to ensure mutual understanding in cases where they are not proficient in the users’ language.” As such, Bill 96 severely compromises the quality of medical care for all Québec residents regardless of language or origin while putting health-care workers in a compromising position both professionally and financially. As put by the editor of The Suburban newspaper, Beryl Wajsman, “Compassion should be the only language of health.” We couldn’t agree more.

Bill 96’s impact on patient care

Quebec’s Act respecting health services and social services states that health care must be adapted to support all patients regardless of language or culture. According to Quebec’s Institute of Public Health, patients who are provided care in their non-mother tongue are more likely to:

1)     Be prescribed medication, receive an inappropriate prescription or not understand or know how to take their medication.

2)     Not understand their diagnosis.

3)     Spend additional time in the emergency department and receive more medical tests.

4)     Be exposed to undesirable events, such as hospitalization, unintentional injuries or complications.

5)     Be discharged from hospital without a follow-up appointment.

And are less likely to:

1)             Use mental health services.

2)             Be satisfied with their care.

3)             Show up to future appointments.

All of these consequences increase the cost of care and medical burden on patients.

Even under seemingly ideal circumstances where a health-care professional speaks the patient’s language, mistakes are commonplace.

Even under seemingly ideal circumstances where a health-care professional speaks the patient’s language, mistakes are commonplace. One study demonstrated that nurses who interpreted for physicians made serious miscommunication mistakes 50 per cent of the time. These requests are made frequently. Between January 2018 and November 2020, the McGill University Health Centre (MUHC) made 1,349 overhead announcement requests for a volunteer interpreter. This does not include situations in which someone on the treating team or in the vicinity (accompanying family and/or friends) speaks the appropriate language.

Though it is indisputable that French is the majority language, there is precedent from other areas of the world to offer minority language services: Californian facilities are required by law to provide language assistance services 24 hours a day for language groups that represent a minimum of five per cent of the population it serves; Finnish municipalities are considered bilingual if at least eight per cent of its population speaks the minority language. For reference, the regions of Outaouais, Gaspesie–Iles-de-la-Madeleine and Monteregie all have at least eight per cent of their population whose mother tongue is English. Montreal and Laval have 32 per cent and 25 per cent of their population respectively where their mother tongue is neither English nor French.

For immigrants in their first six months in the province, Bill 96 will have a particularly profound impact. Though research is limited on the time needed to acquire a second language due to the numerous variables at play (age, educational level, motivation, language learning anxiety and the closeness of origins between the primary and the new language), this six-month requirement to learn and be able to communicate in French does not seem to be based in science or consider the numerous challenges and time-constraints this population experiences. Based on 70+ years of teaching foreign languages to English-speaking diplomats, the United States Department of State Foreign Service Institute estimates that learning French takes 600-750 hours. This estimate is for a highly educated population (diplomats) that speaks English, which is 27 per cent lexically similar to French. Based on this estimate, all newcomers would require 25-31 hours/week of instruction to become proficient in French in six months.

Though these 25-31 hours may include exposure to French in day-to-day life, there must be intersectional efforts by the Quebec government, employers and society to foster a positive and uncoerced learning environment. The first step would be to set realistic goals that respect different backgrounds and circumstances that impact their ability to acquire a new language. The Quebec government’s own report confirmed that this six-month period was not realistic and recommends giving immigrants time to settle before beginning French courses. Unfortunately, this report was kept hidden and disregarded. This report is backed by psychologist, University de Montreal professor and scientific director of the interdisciplinary research team on refugee- and asylum-seeking families (ERIFARDA) Garine Papazian-Zohrabian, who stated that her research indicates that immigrants do wish to learn French and that instituting a six-month period to learn French is detrimental to the learning process. The aforementioned Braun agrees: “I’m absolutely convinced French is important and I love the French language. But when … everybody is more or less forced to learn French, it will not be a solution for French-speaking people in Quebec.”

Given all this, we do not understand why a proposed amendment to bring this timeline from six to 24 months was rejected. This bill discourages immigration at a time when we require additional immigrants to support the second fastest aging population in the world. Already, Quebec struggles with retaining immigrants – 38 per cent of the 53,000 immigrants welcomed to Quebec in 2016 have left for other provinces or countries. Thus, Bill 96 will not only make it difficult to support our aging population through reduced immigration, but also will complicate the recruitment of top research talent, ultimately impacting patient care and Quebec’s international scientific standing.

Even without the complications that Bill 96 poses, linguistic barriers have long been viewed as a reason for immigrants’ suboptimal health and dissatisfaction with health-care services. Compared to the general Canadian resident, immigrants and refugees are less likely to seek and use mental health services due to cultural and linguistic barriers. COVID-19 has made this case clearer with low-income refugees developing more severe infections and having difficulties accessing the virtual care system. The pandemic also has shown the importance of adapting public health messaging to cater to multiple languages and cultures.

Our health-care system already is on the brink of collapse with numerous interconnected problems, including primary care shortages (1.5 million Quebecers don’t have a doctor, a nearly four-fold increase in four years) that increase visits to emergency departments, which lack employees and hospital beds. Quebec has one of the lowest population-based hospital capacities amongst G7 countries; as of this past June, 12.3 per cent of hospitalized patients requiring long-term care could not be transferred to those facilities since they already were at full capacity and had unsafe staff to resident ratios. Ultimately, this delays Quebec’s surgery backlog (which neared 150,000 in 2021) since it doesn’t have the needed hospital beds or staff to perform the surgeries and has experienced a nursing and respiratory therapist exodus and shortage.

Even under the most ideal of circumstances, it would be difficult to address these and numerous other issues in our medical system. We do not believe the Quebec health-care system’s staff or patients can handle the additional and undue burden of Bill 96. Quebecers themselves believe health and social services should be exempted, with 57 per cent contending Bill 96 should be amended to allow for the best communication possible and 88 per cent expecting to be accommodated regardless of language.

All of this is not to say that there aren’t positive aspects to the bill, which would permit anyone in Canada to pursue a French university program in Quebec and pay in-province fees if they possess the requisite French knowledge and if that program is not offered in French in their province. We believe that this spirit of encouraging the French language should be the foundation of Bill 96 and would offer more opportunities to all Canadians.

Though we believe the bill’s intentions were to promote and preserve the French language, the way it is constructed will further deepen language divisions within Quebec and Canada.

Though we believe the bill’s intentions were to promote and preserve the French language, the way it is constructed will further deepen language divisions within Quebec and Canada. In the CBC French documentary, The Quebecers of Bill 101, many Quebec-born and bilingual children of immigrants say they are often treated like outsiders and non-Quebecers and are dissatisfied with the francophone educational system’s teachings on Quebec culture. The latter demonstrates that we need to reform our education system to better teach our youth about Quebec society. The former exemplifies how Quebecers, regardless of language, have faced language discrimination.

We recommend that Bill 96 promote French via positive reinforcement and community support. We believe we should re-examine the bill’s potential impacts in all domains, but more specifically in the health and social services sector. The government has a responsibility to ensure that all Quebecers receive equal services regardless of their language. We believe Bill 96 would further complicate health communication, exacerbate pre-existing health inequities, setback a fragile system, and expose Quebec’s health care, its workers, and citizens to increasing financial and human costs.

We encourage you to go through the thought experiment outlined by La Presse’s Rima Elkouri: Quebec is at war, you are forced to uproot your life and family to immigrate to Germany, and now must learn German in six months. Though you are willing to learn German, would you be able to master it in six months? Would you have the capacity to adapt to a new country while reaching a linguistic level where you would feel comfortable having complex and emotionally intense discussions regarding your health or that of a loved one? Or would you rather be accommodated and be provided a welcoming environment that gives you the appropriate time and resources to get you and your family settled before learning a foreign language?

Land acknowledgment: The authors would like to respectfully acknowledge that we are situated on the traditional, ancestral, and unceded territories of the Kanien’kehá:ka (Mohawk) and the Ho-de-no-sau-nee-ga (Haudenosaunee) people. As settlers, it is our responsibility to recognize the past, present, and future Indigenous communities that have made it possible for us to live here today. We encourage everyone to learn more about the lands we occupy by visiting https://native-land.ca/.

Translations of the petition:

(French)_Sur_la_loi_96_et_les_soins_de_santé_au_Québec

(Arabic)_مشروع_القانون_٩٦_و_الرعاية_الصحية_في_كيبك

Wed, 27 Jul 2022 17:32:00 -0500 en-US text/html https://healthydebate.ca/2022/07/topic/bill-96-quebec-health-care/
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