'we tolerated the intolerable’: coroner blasts quebec pandemic response in chslds
géhane kamel also criticizes doctors for relying heavily on telemedicine “despite the need for support and the very large number of deaths.”
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frail seniors living in long-term care homes were tragically abandoned during the covid-19 pandemic’s first wave as quebec opted to protect its hospital network even though flaws in the chsld network were well documented, a coroner says.
“the covid-19 crisis illustrates decades of failing public policies concerning chslds that were already known,” coroner géhane kamel said in a report published monday on care homes (known as chslds), where about 4,000 people died in the spring of 2020.
in a 200-page document that focused on 53 chsld deaths, kamel was highly critical of how the province responded to the crisis among its most vulnerable citizens. describing it as a “dark period in quebec history,” she noted the province had the highest proportion of deaths in care homes and seniors’ residences.
“we tolerated the intolerable,” she wrote in the report.
many of the dead were left in their rooms for 24 hours before being taken by a funeral home. “this image alone is unworthy of a civilized society,” she wrote.
the virus was able to quickly spread from one room to another in chslds because of lax hygiene rules. meanwhile, quebec instituted very strict infection-control rules at public covid-19 testing centres, where the virus was much less prevalent.
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in addition, “while hospitals had almost no covid-19, they were well organized and had all the necessary equipment,” the report said.
at the same time, in chslds, “where soon the majority of cases of covid-19 were to be found, they continued to argue about what equipment was necessary. managers, often without specific instructions, tried to ration personal protective equipment (ppe). at the provincial level, tight management of (ppe) was practiced because the never-proven shortage remained nonetheless always imminent.”
noting chslds have struggled to maintain their workforce for at least a decade due to “historical budgetary considerations,” the coroner concluded: if that issue had been dealt with before the pandemic, “the train that was going to hit chslds … would undoubtedly have been less violent.”
quebec health officials testified they knew “the elderly are among those at risk and among the most vulnerable,” yet the province “nevertheless chose to keep seniors, specifically people living in chslds, in a pandemic planning blind spot.”
kamel, who heard more than 200 witnesses during her inquiry:
* was highly critical of lynne mcvey, chief executive of the regional health authority that covers western montreal, including the herron chsld in dorval.
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she describes as “disgraceful” mcvey’s criticism of the herron’s owners for transferring residents to hospitals, “even though in an emergency, this move was the most sensible one if these residents were to have a fighting chance.”
on april 11, 2020, mcvey called 911 about the herron situation, hours after the montreal gazette broke the story, reporting authorities had found bodies, and unfed and soiled elderly residents.
kamel said she does not understand why mcvey made the call since information gathered by the inquiry found that authorities knew the situation was “alarming” on march 29 — almost two weeks earlier.
* recommended quebec’s public health director be independent of politics.
under the current setup, the top doctor is a deputy health minister. kamel said that should change and the person’s “functions (should be) exercised in complete independence and without political constraint.”
she noted that early in the pandemic, dr. horacio arruda, the public health director at the time, did not make the wearing of a mask compulsory in chslds.
“would his opinion have been the same if he had not had to worry about a possible shortage of (masks)? i tend to think not,” kamel wrote. “hence, in my humble opinion, the danger of wearing two hats.”
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kamel also criticized what she calls a “grey zone” in arruda’s testimony at the inquiry: his “vagueness” on what was done between january and mid-march 2020 to protect chslds.
she wrote: “how can we believe we will be able to face the next crisis if the leading players aren’t ready to recognize where their preparation failed?”
* was critical of doctors for relying too heavily on telemedicine in chslds.
kamel noted that in mid-march, quebec doctors were encouraged to consult with patients by telephone to avoid becoming infected, but also told to use their own judgment about whether a physical examination was necessary.
despite the dire herron situation, only one of its three doctors visited the home on march 29 and 30, the coroner found. in a conference call a week later, the three doctors said they weren’t allowed to visit the herron even though no such directive was in place, the report said.
kamel recommended the college of physicians of quebec “review the individual medical practices of attending physicians at chsld herron, les moulins and sainte-dorothée, in particular with regard to their decision to continue teleconsultation care despite the need for support and the very large number of deaths.”
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* says seniors’ minister marguerite blais, who some critics have zeroed in on for blame, tried her best.
kamel says there was confusion within multiple government departments as they tried to deal with the crisis.
“the non-involvement of (blais) at the start of the crisis is therefore not surprising,” kamel said. “i believe she tried to make herself heard, but the emphasis on (protecting) hospital settings was so great that her voice… was not heard until later.”
in the report, kamel offered praise to:
* health workers who acted as whistleblowers, quoted anonymously in the first montreal gazette story about the herron.
“we can only welcome this initiative,” kamel said. “some described the state of the herron and its residents as a concentration camp. although the term is certainly exaggerated, it denotes all the horror of letting human beings die in inhumane conditions, alone, malnourished and in their excrement.”
* the montreal chinese hospital’s long-term care home, where not a single covid-19 case was reported during the first wave.
in the early days of the pandemic, workers at the hospital decided on their own to wear masks, avoid contact with their families and gatherings, and steer clear of public transit, kamel noted.
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“the emphasis was on protecting residents against an invisible enemy that was believed to be dangerous.”
she added: “ironically, at the time, employees were being discriminated against in the public sphere because of their background, which some associated with the source of the virus. today, each of them can be proud of having been pioneers in the fight against covid-19.”
kamel offered 23 recommendations, including that quebec:
- study the possibility of setting up a “voluntary civic emergency service” overseen by the public security department
- increase home support for seniors
- implement a “safe” ratio of healthcare professionals to residents in chslds
- increase, when required, the number of managers in chslds to ensure all shifts are covered
- discuss with unions contract clauses that would allow for increased availability during health emergencies
- plan new infrastructure or renovations to congregate living settings, ensuring that the settings can meet health care requirements, particularly in health crises
- ensure that accommodation facilities can offer residents individual rooms
- enforce greater accountability of regional health authority and health department managers for the care provided to seniors with loss of autonomy
- maintain the necessary supply of protective equipment at all times in addition to planning reserves to meet needs in the event of a crisis
- ensure in chslds a presence of nurses specialized in prevention control
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