The Quebec Health Department didn’t keep written records of thousands of surveillance visits that it conducted to check if medical directives were followed in elder-care facilities during the pandemic, a coroner’s inquest heard Tuesday.
The revelation came from Natalie Rosebush, the assistant deputy minister responsible for elder care, who testified at coroner Géhane Kamel’s inquest into the pandemic death toll at seven Quebec long-term care facilities.
The testimonies given Tuesday by Ms. Rosebush and another senior civil servant, Luc Desbiens, underlined how Quebec nursing homes, despite their vulnerable residents, had not been given priority when health officials crafted their preparedness plans ahead of the arrival of COVID-19.
Ms. Rosebush testified that she hadn’t been involved in a directive that was misunderstood by nursing homes and made it harder to hospitalize ailing long-term care home residents.
Mr. Desbiens recounted that the province didn’t have significant stocks of personal protection equipment and that nursing homes didn’t have precedence in the distribution of medical supplies.
After the impact of the crisis became clear on April 10, when the dire conditions at the Herron nursing home became public, Premier François Legault announced that the government would send inspectors to check conditions in other congregate-living settings for the elderly.
Ms. Rosebush testified that between April 11, 2020, and Sept. 30 of this year, 1,593 surveillance visits took place at nursing homes, along with 6,279 visits at private seniors’ homes and 3,640 visits at other assisted-living facilities.
However, when Ms. Kamel asked to see the findings for some of the facilities that her inquest is investigating, such as the Manoir Liverpool retirement home, Ms. Rosebush explained that the ministry hadn’t kept written records.
“We wanted to be as much as possible present at the scene – not necessarily to prepare a report, to put it on paper, that would take up the time of people who went in the field,” Ms. Rosebush said.
The information was recorded in files that were overwritten after each new visit, she said. There might be some evaluation grids left, she added, but it is unclear if they still hold any information.
“There was no directive to keep what was observed during the visit,” Ms. Rosebush said.
Ms. Kamel noted that the inquest had heard too often that medical information was not recorded properly, depriving the relatives of deceased residents of clarity about what went wrong in nursing homes during the first wave of the pandemic.
“Put yourself in the shoes of the families,” she said. “Several times we’ve heard that information was given verbally. So we have no answers to give them about what really happened.”
Answering questions from Patrick Martin-Ménard, a lawyer representing the families of six deceased nursing-home residents, Ms. Rosebush said she was not consulted on a letter that told nursing homes to avoid hospitalizing sick residents.
The March 19 letter by Health Department deputy minister Yvan Gendron said transfers from nursing homes to hospitals should only be done in exceptional circumstances.
In practice, it meant that long-term care homes were unwilling to send sickened residents to hospitals even though the elder-care facilities were unable to provide enough intravenous rehydration and supplemental oxygen to COVID-19 patients.
The inquest heard, for example, that at the Sainte-Dorothée nursing home, where 102 people died during the first wave, residents struggling to breathe were given morphine rather than getting the chance to recover in hospital.
Ms. Rosebush said she had no signs that the directive created problems, with the exception of one region not in the Laval area, where Sainte-Dorothée is located. She said she first heard about problems in Laval at the inquest.
In his testimony, Mr. Desbiens, the senior Health Department bureaucrat in charge of procurement, said that before the pandemic, personal protective equipment supplies were distributed in a “just-in-time” system. So when COVID-19 hit, health officials were caught between skyrocketing needs and plummeting supplies.
Answering questions from Mr. Martin-Ménard, Mr. Desbiens said he was not aware of a past pandemic plan from 2006 that outlined the need for a reserve of essential gear.
The inquest also looked at a memo from March 20, 2020, listing nursing homes third in priority to get medical supplies, behind hospitals designated as COVID-19 centres and local health authorities. Three days later, the priority was amended, moving nursing homes to second in line.
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