When Francine Durocher took her husband, Réjean Malette, to the regional hospital in Saint-Jérôme in mid-June to deal with sudden weakness in his legs, she did not know the hospital was in the midst of a series of coronavirus outbreaks that would make it the deadliest in Canada.
On July 1, Ms. Durocher got a call from a hospital nurse telling her Mr. Malette was infected with COVID-19 in the fifth-floor room he shared with at least one other patient. Two days later, he was dead from the virus. He was 67. Ms. Durocher never did find out what was wrong with his legs.
And just last week, Ms. Durocher learned the full toll of the outbreaks. Since the start of the pandemic, COVID-19 has infected at least 503 patients and staff and killed 83 people at the 403-bed Saint-Jérôme hospital. It is the largest known death toll from Canadian hospital outbreaks, by far.
“I was so angry. There we were, following the rules all spring because we knew my husband was weak, we knew my daughter has breathing issues,” Ms. Durocher said. “And the bottom line is if my husband hadn’t gone to the hospital he’d probably still be alive.”
An internal report by the Laurentides health district that manages the hospital, obtained by The Globe and Mail, shows the breathtaking scale of the outbreaks. The Saint-Jérôme hospital suffered its first outbreak on April 4 and by the end of the month it had six more, four of which lasted three months or longer and killed 44 people in total.
While the majority of Saint-Jérôme’s deaths took place during the first spring wave and the summertime aftermath, the hospital is still struggling to keep COVID-19 out. It has two continuing outbreaks and at least three people have died in November.
The hospital alone accounts for one-quarter of the 334 COVID-19 deaths in the Laurentian region, which covers bedroom communities and the mountain resort towns north of Montreal.
The hospital has had at least 19 outbreaks in 10 months, in cancer, general medicine, oncology and other departments. The orthopedic ward has had three separate outbreaks with at least 14 deaths.
The documents and Ms. Durocher’s experience tell a cautionary tale for other Canadian hospitals such as the Foothills Medical Centre in Calgary, the Misericordia Community Hospital in Edmonton, the St. Boniface Hospital in Winnipeg and St. Joseph’s Health Centre in Toronto. Those hospitals have struggled to contain second-wave outbreaks that have killed nine to 15 people at each location, so far.
A smaller Laurentides health district hospital in Saint-Eustache, where many overflow patients from Saint-Jérôme are sent, has had seven outbreaks and 18 deaths, making it the second-hardest-hit acute-care hospital in Canada.
The Saint-Jérôme hospital is nearly 80 years old and rundown, with missing ceiling tiles, leaks and cracked windows. Even a hospital press release described it as “dilapidated.” The population of the region has doubled since the 1980s to about 620,000, but the main hospital is still the one designed in the 1940s.
Plans are in the works for a new hospital in 2030. The province has spent $19-million building a temporary 57-bed hospital tent expected to be complete in January to lessen crowding and help with COVID-19.
For now, up to four patients often share a room, and emergency-room stretchers are bumper-to-bumper. The ER has two toilets for 30 patients.
“When you see these jaw-dropping outbreaks, it’s a reminder how difficult it is to manage infection in these kinds of settings,” said Dr. Susy Hota, the medical director of infection prevention and control at the University Health Network in Toronto.
“People like to believe hospitals are these beautiful facilities with this state of the art infrastructure with the best of everything. The reality is different.”
Dr. Hota said a host of measures are known to help: ventilation, protective equipment, solo rooms and bathrooms, and isolating patients. But in a long series of outbreaks “you need to stop accepting patients, and you need to take a deep look at what’s been going on and what can be done differently.
“You have to turn the tap off.”
Earlier this month Laurentides health district director Rosemonde Landry questioned whether she had made a mistake allowing staff to mix infected with uninfected patients in the same room when the hospital faced a crush of patients. The Nov. 11 conversation was captured in audio recordings obtained by Radio-Canada in a report on hospital deaths.
“This summer, I decided to increase occupancy per room to three and four again. It perhaps wasn’t the best decision and it has led to the outbreaks we have today,” Ms. Landry told her staff. “We are in a dead end. I need your help to find the least bad solutions, the one that will do the least harm to our clients.”
In a statement last week, Ms. Landry added “we have never hidden that our hospital desperately needs an investment.” She said community spread of the virus has complicated attempts to limit outbreaks in the hospital but that staff and managers have worked hard to bring the situation under control. The hospital is experiencing two current outbreaks involving four patients.
It is not clear why patients were not sent to nearby health districts and larger centres such as Laval and Montreal, which experienced a summer lull in cases, to give the Saint-Jérôme hospital a chance to reset. A health district spokesperson said the Saint-Jérôme facility is designated to handle the region’s COVID-19 patients.
Dr. Chloé Jamaty, the director of the hospital’s emergency department, which has had two outbreaks but no deaths, said the crowding situation in the hospital was “catastrophic.”
She is not sure whether it was misplaced regional pride or intransigence from the Ministry of Health, or both, that left Saint-Jérôme fending for itself. “Bottom line is we were left with our own problems,” Dr. Jamaty said in an interview. “We knew we were in a vicious circle with no exit, and we were abandoned by the ministry.”
The situation has been devastating to hospital staff, she added.
“Everybody knows it’s not right to park patients next to each other, mixing infected and uninfected patients. It’s just we had nowhere else to put them. It’s very discouraging, and honestly it’s hard on the morale of employees to know they aren’t doing the right things. People are off on burnout because we asked them to do impossible things.”
Last week, Quebec Health Minister Christian Dubé said he went to Saint-Jérôme in the summer because he knew of troubles there. “We made an investment in a modular hospital, which is being built right now,” he said, adding that the long-term renovation is “a priority.”
Back in July, Ms. Durocher was outraged to learn only after her husband’s death that nearly 200 patients were infected with coronavirus around the time of his stay. Her frustration is compounded now that she knows dozens of people died with him.
“I wouldn’t have taken him to that hospital had I known,” she said. “There’s a real lack of transparency.”
Ms. Durocher and her daughter both need non-urgent surgeries that were supposed to be performed in Saint-Jérôme since her husband died. “Not until a vaccine,” she said. “My knees hurt but they won’t kill me.”
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