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Quebec’s director of public health needs to be more independent, says coroner in report on first wave deaths Nation World News

The lack of independence granted 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.

Coroner Gehne Kamel published a report on Monday after months of investigation into deaths at senior citizens’ residences where the pandemic killed more than 5,000 people in the spring of 2020.

After hearing testimony from 220 government officials, long-term care home workers and loved ones of those who died, Kamel issued 23 recommendations targeting the provincial government, its health ministry, local health boards and the Quebec College of Physicians.

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One of the first recommendations of the report calls on the government to review the role of its director of public health so that whoever is in the position can exercise his functions “without political constraints”.

The director of public health in Quebec is also a deputy health minister, but Kamel wrote that the two roles are “different and may not be compatible.”

Kamel cited as an example that masks are not mandatory in CHSLD.Center d’Hébargement de Sons de Longue Durie) at the beginning of the pandemic.

“Would his advice have been the same if he hadn’t had to worry about potential stock shortages? I don’t think so. Hence, in my humble opinion, the danger of wearing two hats,” Kamel wrote in the report, which read Is. online.

In a report, Coroner Gehen Kamel said CHSLD Heron was taken over by the West Island Health Board at the start of the pandemic, but that the board’s management was disorganized. (Ivano Demers/Radio-Canada)

At that time, Dr. Horacio Aruda played the role. He resigned at the end of 2021, and was replaced by Dr. Luc Boileau as interim director. Prior to this, Boileau was the head of the province’s Institute of Public Health (INSPQ).

In his report, Kamel noted that in the early days of the pandemic, infection control measures were far stricter in hospitals and testing clinics than in long-term care homes, where there were far more COVID-19 cases.

“We endured the unbearable. It was a sad day for medicine in Quebec,” she wrote.

Kamel said Marguerite Blass, the minister responsible for the seniors, was one of the few who provided a clear timeline for the government’s decision-making.

Kamel questions why doctors were absent in some long-term care homes, where large numbers of people died, and why they relied on phone consultations rather than providing in-person care.

“For a coroner, that many residents died without permission for a doctor’s visit during the last illness is not only tragic, but disturbing,” Kamel wrote.

“It is hardly conceivable that decisions of life or death could have been made on the basis of telephone relay alone.”

need more accountability

Kamel was reluctant to describe the events that unfolded in one of the long-term care homes she investigated at the CHSLD Heron in Dorval, Ky. Forty-seven of the 53 deaths analyzed in the investigation occurred in the spring of 2020 in Heron.

According to the report, the residence had long been short of staff and did little to correct the situation, as it became clear that the COVID-19 pandemic was spreading across the world. The doctors responsible for the residents of the house did not appear until several weeks after the crisis, killing dozens of them.

The West Island Health Board took control of the long-term care home on March 29, 2020, when one of the owners called the province for help, but several more residents later died as confusion was ruled out. Who was responsible for what?

What’s more, the health board focuses more on its image and blames Heron rather than getting to the root of the problems at home, Kamel said, noting that it had hired a communications consulting firm.

She wondered why Lynn McVey, head of the CIUSSS de l’Ouest-de-l’le-de-Montréal, It took pains to call 911 at midnight on April 11, when her board of health already had control of the residence for more than a week.

Quebec's director of public health needs to be more independent, says coroner in report on first wave deaths Nation World News
Coroner Gehen Kamel’s report named Lynn McVey, the head of the West Island Health Board. (Nation World News)

“Listening to the audio of the 911 call by Madam McVey, it is difficult to understand the purpose of the call as the situation was alarming since March 29, 2020,” Kamel wrote.

Earlier that day, Montreal Gazette journalist Aaron Derfel published an investigation uncovering what was happening at Heron.

The head of the TACT firm, Daniel Desharnais, is now the associate deputy health minister and was questioned by Kamel during the interrogation.

If CIUSSS and Heron had agreed on each other’s role in the crisis, many of the deaths in early April could have been prevented, the coroner wrote.

Kamel reported that the weekend of April 4 to 6, 2020, five days after CIUSSS took office, was particularly grueling. Anyone who left the staff—many were sick or passed out out of fear and frustration—didn’t know who to refer for decisions.

Residents lay in urine and feces. The bodies of those who died were left in their rooms for more than 24 hours before being taken to the funeral home.

“That image alone is not worthy of a civilized society,” Kamel wrote.

Every death gave a clue

In his analysis of each death in Heron, Kamel often highlighted the absence or dire paucity of medical notes, which made it impossible to know whether people were taken care of for their medical conditions. Many causes of death were difficult to determine because of a lack of information, or because the result of his COVID-19 test was lost or not on file.

In some cases, dehydration or starvation has contributed to the speed at which residents died. That was the case for Olga Maculavicus, who Kamel wrote died on April 1, 2020 due to “lack of basic care”.

Quebec's director of public health needs to be more independent, says coroner in report on first wave deaths Nation World News
Olga Maculavikas died on April 1, 2020 at CHSLD Heron. Dehydration and ‘forced fasting’ contributed to his death, wrote coroner Gehen Kamel. (Submitted by Paul Carganello)

A few days earlier, on March 29, another resident, Leon Barrett, was found dead shortly after being transferred from McGill University Health Center.

“The information on file is so sparse, we are under the impression he was forgotten and died all alone,” Kamel wrote.

In the case of Thomas Bauer, who died on March 28, 2020, one of Heron’s doctors had a conversation with a family member about end-of-life care—without consulting Bauer himself, who is cognitively impaired. was able to give consent or not. The kind of treatment he wanted, the report said.

On April 8, 2020, Thelma Jeanne Allo died of “heart failure after failing to receive adequate care”, Kamel wrote.

Hannah Piechuta died on April 4, 2020 “due to a lack of basic equipment such as an oxygen cylinder … contributed to hasten her death.”

On March 23, 2020, amid the health crisis, Patricia Gaudette was also transferred from a hospital to Heron, where she died barely two weeks later, “begging questions,” Kamel wrote, “in CHSLD Heron Why has the transfer been authorized?”

Safe Ratio Demand

In the report, Kamel also discusses the need for more ways to monitor services in long-term care settings and to make it an obligation to intervene in the event of problems.

He recommended that there should be a safe ratio for the number of professionals and residents in the CHSLD.

Kamel said the health board’s management team was disorganized and called for greater accountability for managers in local health boards, who oversee long-term care homes.

He said that private CHSLDs should get some government subsidies to ensure that they can provide proper care to residents.

Kamel did not say whether the government should proceed with a public inquiry, as has been called by the opposition, but said it should “retrospectively conduct such incidents in the manner it deems appropriate.”

He said the hierarchy of decision-making, the agility of the health system in times of crisis and the understanding and execution of responsibilities between health ministries and seniors as well as local health boards, should be among the areas that warrant an audit. ,

Nation World News Desk
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