The lack of independence given to Quebec’s director of public health may have slowed the government’s response at the start of the pandemic, as hundreds were dying in long-term care homes across the province.
Dr. Ghane Kamel published a report Monday after months of investigating deaths in nursing homes, where the pandemic killed more than 5,000 in the spring of 2020.
After hearing testimonies from 220 government officials, long-term care home workers and loved ones who have died, Kameli issued 23 recommendations targeting the provincial government, its Ministry of Health, local health boards and the Quebec College of Physicians. .
One of the report’s first recommendations urges the government to reconsider its role as director of public health, so that anyone in this position can exercise his functions “without political restrictions”.
The director of public health in Quebec is also a deputy health minister, but Kamel wrote that the two roles “are distinct and may not be compatible.”
Kamel gave as an example that masks were not mandatory in CHSLD (Accommodation center for long-term care) at the beginning of the pandemic.
“Would it have been his same advice if he had not had to worry about possible stock shortages? I tend not to think. Therefore, in my humble opinion, the risk of wearing two hats,” Kamel wrote in report. which can be read online.
At that time, Dr. Horacio Arruda held this role. He resigned at the end of 2021 and was replaced by Dr. Luc Boileau as interim director. Prior to that, Boileau was head of the provincial public health institute (INSPQ).
In this report, Kamel notes that in the early days of the pandemic, infection control measures were much stricter in hospitals and testing clinics than in long-term care homes, where there were far more cases of COVID-19.
“We tolerated intolerance. It was a sad day for medicine in Quebec,” she wrote.
Marguerite Blais, the minister responsible for the elderly, was one of the few who provided a clear timeline for government decision-making, Kamel said.
Kameli asks why doctors were absent in some of the long-term care homes where large numbers of people died and why they relied on telephone consultations instead of providing personal care.
“For a doctor, that many residents died without being allowed to visit the doctor during their final illness is not only sad, but also disturbing,” writes Kamel.
“It can hardly be imagined that life or death decisions could have been made solely on the basis of a telephone broadcast.”
More responsibility is needed
Kamel was harsh in her account of the events that took place in one of the long-term care homes she examined in the investigation, CHSLD Herron Dorval, Que. Forty-seven of the 53 deaths analyzed in the investigation occurred in Herron in the spring of 2020.
The residence had long had short staff and had done little to rectify the situation although it became clear that the COVID-19 pandemic was spreading worldwide, according to the report. The doctors responsible for the occupants of the house did not show up, until a few weeks after the crisis had killed dozens of them.
The West Island Health Board took control of the long-term care home on March 29, 2020, after one of the owners called the province for help, but several other residents subsequently died as confusion reigned as to who was responsible for what.
Moreover, the health board seemed more focused on his image and blaming Herron than taking the root of the problems at home, Kamel said, noting that he had hired a communications consulting firm.
She wondered why Lynne McVey, head of CIUSSS de l’Ouest-de-l’le-de-Montral,tried to call 911 in the middle of the night of April 11, when her health board had been checking the apartment for more than a week already.
“Listening to the audio of the 911 call from Madame McVey, it is difficult to understand the purpose of the call as the situation had been alarming since March 29, 2020,” Kamel wrote.
Earlier that day, Montreal Gazette journalist Aaron Derfel had published an investigation revealing what was happening in Herron.
The head of the TACT firm employed by CIUSSS, Daniel Desharnais, is now deputy health minister and was questioned by Kamel during the investigation.
If CIUSSS and Herrona had agreed on each other’s roles in the crisis, some deaths could have been prevented in early April, the forensic doctor wrote.
The weekend of April 4 to 6, 2020, five days after CIUSSS took over, was particularly dire, Kamel said. Whoever was left behind by the staff, many were ill or abandoned out of fear and frustration, did not know who to refer to for decisions.
Residents were lying in the urine and feces. The bodies of those who died were left in their rooms for more than 24 hours before being taken to a funeral home.
“Only this image is unworthy of a civilized society,” wrote Kamel.
Every death gave data
In her analysis of every death at Herron, Kamel often highlighted the lack or serious lack of medical records, making it impossible to know if people were being cared for their medical condition. Many causes of death were difficult to determine due to lack of information or because their COVID-19 test result was missing or not on file.
In some cases, dehydration or starvation appear to have contributed to the rate at which residents died. This was the case for OlgaMaculavicous, about whom Kamel wrote that he died due to “lack of basic care” on April 1, 2020.
Days earlier, on March 29, another resident, Leon Barrette, was found dead shortly after being transferred from McGill University Health Center.
“The information in the file is so scarce, we have the impression that he was forgotten and died alone,” wrote Kamel.
In the case of Thomas Baur, who died on March 28, 2020, one of Herron’s physicians had a conversation about end-of-life care with a family member without consulting Baur himself, who was knowledgeable enough to give approval or not for the kind of treatment he wanted, the report said.
Thelma Jean Allodied for a “heart failure after failure to receive proper care” on April 8, 2020, wrote Kamel.
Hanna Piechuta died on April 4, 2020, after “the lack of basic equipment such as oxygen cylinders contributed to the acceleration of her death.”
Amid the health crisis on March 23, 2020, Patricia Gaudet was also transferred from a hospital in Herron, where she died barely two weeks later, “asking the question,” wrote Kamel, “why authorize a transfer to CHSLD Herron?”
Calling for safer reports
In the report, Kamel also discusses the need for more ways to monitor services in long-term care settings and create an obligation to intervene in the event of problems.
She recommended having safer reports on the number of professionals to residents in the CHSLD.
Kamel said the health board management team was disorganized and she called for greater accountability for managers on local health boards, which oversee long-term care homes.
She said private CHSLDs need to receive some subsidies from the government in order to ensure they can provide residents with proper care.
Kamel did not say whether the government should move forward with a public inquiry, as the Opposition has called for, but said it should “make a retrospective of the events in the way it sees fit.”
She said the hierarchy of decision-making, the versatility of the health system in times of crisis, and the understanding and execution of responsibilities between ministries of health and the elderly, as well as within local health boards, should be among the areas that require auditing.
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