If we doubted the usefulness and the additional lighting of yet another report on the carnage that occurred in CHSLDs in Quebec during the first wave of the pandemic, let us be clear. Yes, the long-awaited report by coroner Géhane Kamel adds concrete elements to the background, confirms or clarifies certain theories previously put forward, and above all offers very concrete avenues of correction. Aim: to prevent such a denial of civilized society from again bearing the signature of Quebec.
The main competence of a coroner is to judge the causes of death when these are violent, obscure or potentially caused by negligence. In his detailed analysis of each of the 47 deaths that occurred at the CHSLD Herron between March 12 and the 1er May 2020, Géhane Kamel tells the unprecedented story of heartbreaking end of life, whose impact on families is hard to imagine. Residents of Herron, many who arrived there in the days or weeks before their death, lived their last moments dehydrated, lonely, starving, poorly cared for, neglected and, sometimes, even forgotten.
To examine the tragedy of all these deaths in CHSLDs, where Quebec wins the prize for the highest rate in Canada, several previous reports had pointed to the same possible causes, paving the way for Ms.me Kamel calls here an “announced catastrophe”. The desertion of caregivers, the lack of protective equipment, the major gaps in the chain of communication, the absence of clear orders, the closing of doors to caregivers, the “living environment” approach in complete contrast to that of the “hospital centre”.
The coroner comes to color the portrait with details of a forensic nature, some of which are blood-curdling: in several files, there is an absence of medical notes, or in any case starving reports that have not been completed for weeks. Food tray service “omissions”. A man fell in the bathroom and was left there alone despite repeated calls for help. Accidents that have sometimes caused a deterioration in the general condition of the patient, leading to death. There have been dehydrated patients, that we know. A frequent absence of a real cause of death, due to a lack of adequate medical follow-up. An unavailability of COVID tests which often leads the coroner to conclude that COVID is suspected as the probable cause of death, without however being able to confirm it. In short, these people died in a context of neglect and abandonment. This is the terrible “truth” that the families have had to face.
Coroner Géhane Kamel’s report served several times as a screen for the Legault government when pressing requests for a public inquiry were made to it, as was the case in this column. Each time, the Prime Minister and his team said they wanted to wait for his conclusions and criticized the plaintiffs for trying at all costs to identify “culprits”. Tuesday, a first resignation fell in the wake of the report of Mme Kamel, in the person of Lynne McVey, CEO of the CIUSSS de l’Ouest-de-l’Île, who was responsible for the CHSLD Herron. This departure is not surprising considering the bad role she played in the scenario. It agrees with Prime Minister Legault’s desire to detect more accountability.
More than resignations, we must now hope for actions to reverse this sociological fabric that makes Quebec a place where it is not so good to grow old, after all. If it is sincere in its desire for change, the Legault government must honor the coroner’s recommendations.
One of the key ideas of the report concerns the transformation of private CHSLDs into private centers under agreement, which would make it possible to ensure both more sustainable funding and more effective management control. This would be closely followed by an imposing improvement to the home care system, an avenue that has been put forward many times in the past as a lifeline. The idea of an emergency civic service, as we see for natural disasters, is not bad. The need to protect the independence of the national director of public health has been eloquently demonstrated, and Horacio Arruda is one of the skinned people of the Kamel report, precisely for the confusion that enveloped him during certain recommendations, in particular related to the availability of equipment protection in the field.
One of the most painful shortcomings that led to the “hecatomb” will undoubtedly remain the prioritization of the hospital model to the detriment of the CHSLD formula, as well as the very clear impression of navigating in the “second zone” when it comes to of these long-term care centers. It is to be hoped that a new philosophy of respect and benevolence will dictate Quebec’s political choices. Demographic projections encourage us to do everything we can to ensure that Quebec is crazy about its seniors.