Quebec LTC inquest hears sickened residents were refused transfers to hospitals

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The provincial health minister at the time COVID-19 devastated Quebec nursing homes is laying blame on local administrators, saying they should have made sure preparedness plans were ready and facilities properly equipped.

Danielle McCann testified Thursday before coroner Géhane Kamel’s inquest into the massive death toll in Quebec nursing homes during the first wave of the pandemic.

Ms. McCann held the health portfolio when the disease emerged in early 2020. Her remarks mirrored testimonies by senior civil servants this week, who said local officials misunderstood directives or applied them in a misguided, detrimental way.

The contentious directives included:

- a ban on visits to nursing homes, which locked out family caregivers;

- a March 19 letter telling nursing homes that ailing residents shouldn’t be sent to hospital unless as in exceptional circumstances;

- clinical directives that residents with care levels C and D (comfort and palliative care) should be kept in nursing homes.

Ms. McCann said those directives should have never prevented people who needed acute care from getting taken to a hospital. However, the inquest has heard that, in fact, sickened residents were refused transfers to hospitals and remained in poorly equipped nursing homes without intravenous rehydration or supplemental oxygen.

“It was the responsibility of the CEOs of the facilities to make sure that there was equipment,” Ms. McCann said.

Quebec’s health network is divided into local authorities. Ms. McCann said it was up to the chief executives of those local units to implement preparedness plans and reallocate resources for their hospitals and nursing homes.

“The CEOs had to put the plan in motion, starting in January and picking up speed after, and provide for all the components in the plan – having the equipment in nursing homes, the staff.”

She said CEOs of local health authorities were told during a Jan. 22 conference call to update pandemic plans. However, Patrick Martin-Ménard, a lawyer representing families of deceased nursing-home residents, pointed out that there was no mention of those plans in the minutes of that telephone meeting.

A former health administrator, Ms. McCann said it was important to have strong local managers. “Unfortunately, that wasn’t the case in nursing homes,” she said. She added that this shortcoming was a result of the 2015 health reform by the previous Liberal government, which removed hundreds of management positions.

Ms. McCann, who was health minister until June, 2020, is the only politician called to testify at the inquest. She replaced Marguerite Blais, the Minister Responsible for Seniors, who had been scheduled as a witness but withdrew for health reasons.

Ms. McCann recalled that, on March 9, the Quebec national institute for public health unveiled alarming forecasts that hospitals would be overrun unless the spread of the coronavirus was contained.

“It was shocking news ... we had seen what happened in Italy and we feared it would happen in Quebec.”

The Health Department responded by freeing up hospital beds. Ms. McCann said this was achieved mainly by postponing non-urgent surgeries rather than just discharging patients to nursing homes. Only a few hundred people were transferred to nursing homes, she said.

Jacques Ramsay, a physician assisting Ms. Kamel in the inquest, was skeptical, noting that once outbreaks started in a nursing home, it was very hard to relocate infected residents to a hot zone since those facilities were filled to capacity.

Even a few transfers added to the strain, Dr. Ramsay said. “I know it was a small number, but it was a significant number.”

Documents filed at the inquest show, for example, that at the Sainte-Dorothée nursing home north of Montreal, transfers continued for five days after a resident tested positive. Of the 11 additional transfers, four died of COVID-19.

Ms. Kamel also noted the cases of a man transferred from hospital to the Herron nursing home, just as an outbreak started at the Montreal facility. He was found dead two days later and the family believes he was forgotten in the chaos.

“It’s that part that bothers me … I understand that at some point admissions to nursing homes were suspended. It might have happened too late,” Ms. Kamel said.

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