Dr. Lucie Opatrny, left, Horacio Arruda, Quebec Premier Francois Legault and Health Minister Christian Dube, right, speak to the media at a COVID-19 press briefing Monday Jan. 11, 2021 in Montreal.Ryan Remiorz/The Canadian Press
Quebec government directives to prevent the acute-care system from becoming swamped with COVID-19 cases were misunderstood as a ban on hospitalizing sick nursing-home residents, a coroner’s inquest heard Monday.
The testimony at a public hearing in Quebec City goes to the heart of coroner Géhane Kamel’s inquest, which looks at the deadly impact of the first wave of the pandemic on Quebec’s long-term care sector.
Witnesses this week, including former health minister Danielle McCann and high-ranking civil servants, are expected to face questions about policies that favoured hospitals at the expense of elder-care facilities during the spring of 2020. About 4,000 Quebec nursing-home residents died during the first wave, while hospitals were spared from mass deaths.
On Monday, National Director of Public Health Horacio Arruda and Lucie Opatrny, the assistant deputy minister responsible for hospitals, were asked whether government directives amplified the crisis.
Dr. Opatrny testified that modelling presented on March 9, 2020, by the provincial public-health institute, known by the abbreviation INSPQ, warned that Quebec hospitals could be overwhelmed by the new disease.
One of the three INSPQ projections that Dr. Opatrny shared with the inquest, labelled “Scenario 2,” forecast up to 35,000 weekly hospital admissions if no steps were taken to control the spread of the coronavirus.
Quebec only had 18,000 acute-care beds. In the end, Dr. Opatrny said the peak hospitalization that spring was under 1,500 admissions. However, the INSPQ forecasts led officials to strive to keep as many hospital beds available as possible.
In a March 19 letter, Health Department deputy minister Yvan Gendron told nursing-home administrators that “transfers of [long-term care] residents towards hospital centres have to be avoided and be an exceptional step.”
Furthermore, clinical guidelines issued March 23 said that nursing-home residents who contracted COVID-19 should only be sent to hospitals “on an exceptional basis and after consultation with the doctor on duty.”
The inquest previously heard that ailing long-term care residents died after being prevented from getting hospitalized to receive intravenous rehydration or oxygen masks, which were lacking in nursing homes.
Dr. Opatrny said the directives were intended “to make sure the right patient was treated in the right place.”
She testified that her department didn’t get any feedback that Mr. Gendron’s letter had been misunderstood.
However, Ms. Kamel told Dr. Opatrny that many within the long-term care sector took its message as, “‘We don’t transfer people to hospitals.’ That’s what we’ve been hearing since February.” The coroner recalled that some desperate families turned to the media to put pressure on nursing homes to get their loved ones to hospitals.
“What I see is that there was a gap between some things that were done and how people in the field interpreted it,” Dr. Opartny said.
Jacques Ramsay, the physician coroner assisting Ms. Kamel with the inquest, told Dr. Opartny that front-line health care workers couldn’t be faulted for misunderstanding the letter.
“The directive said [transfers to hospitals] were to be done in exceptional cases, as a last resort. That’s what people in the field did,” Dr. Ramsay said.
“You can’t blame the people who did the transfers. They followed the very spirit of the directive. Now you’re saying that’s not what you meant to say.”
In his appearance at the inquest, Dr. Arruda said he wasn’t involved with that letter because it dealt with organizing health services. “We issue general guidelines for prevention and [infection] control,” he said.
“When the decision was made, were you at the table at the time?” asked Patrick Martin-Ménard, a lawyer representing the families of six deceased nursing-home residents.
“No,” Dr. Arruda replied.
Nor was he present, he acknowledged, when the government decided in mid-March to suspend visits by family caregivers to nursing homes. The decision was aimed at curbing viral transmission, but it also deprived short-staffed facilities of extra hands and allowed neglect to occur without eyewitnesses.
“I was informed, but I was not at the table,” Dr. Arruda said.
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