The lack of personnel, but especially of doctors, in CHSLDs during the first wave of COVID-19 adversely affected the quality of care offered to seniors at the end of their life, according to Dr Serge Brazeau, who was president of the Association des médecins gériatres du Québec at the time of the first wave.
“Comfort care: it means offering support and the presence of loved ones. And that was lacking, ”says Serge Brazeau. The latter testified Tuesday at the coroner’s public inquiry which is examining the national aspect of the COVID pandemic in the province’s CHSLDs in the spring of 2020.
While the cases of COVID-19 multiplied in CHSLDs at the start of the pandemic, doctors were asked not to attend and to use telemedicine. Doctors who were too old should particularly avoid going there. “There was no ban, but there was a suggestion,” says Dr Brazeau. For him, this instruction “to avoid being physically present” sent to CHSLD doctors “lasted a long time”. And “in a context of respiratory distress and palliative care, it is not necessarily elegant”, according to the specialist. The Dr Brazeau says “understands” that the objective was to limit contagion, but for him “to avoid the presence of doctors, it is a bad symbol”.
Coroner Géhane Kamel did not hide her annoyance at the absence of a doctor in a CHSLD during the first wave. “This is the subject I want to tear off my shirt,” she said. […] It is not telemedicine that is the problem. The fact is that in some centers, the fire was caught and there was no doctor who came ”.
An “impression of killing”
While the cases multiplied in CHSLDs, the DD Marjorie Tremblay of the CISSS de Laval has designed a “Respiratory Protocol” for patients at the end of their life. Several of the COVID-19 patients “showed symptoms of suffocation,” said Dr.D Tremblay. The objective of this protocol was, among other things, to reduce their discomfort. According to her, “although many did not get through, most were fine,” she said.
Lawyer Patrick Martin-Ménard, who represents families of seniors who have died in CHSLDs, mentioned that several of his clients are worried about the fact that their loved one “was placed on respiratory protocols when there was other treatment options ”. Monday, the Dr Vinh-Kim Nguyen from the Jewish General Hospital who helped in CHSLDs in the spring of 2020 spoke of “euthanasia” and argued that some patients had been placed under a respiratory distress protocol when they “did not have to surrender until there “. “They could have been treated. I stay on it, ”he said. The DD Tremblay said he had never heard of such cases.
The Dr Jacques Ramsay, who supports Coroner Kamel, stressed that the Respiratory Distress Protocol involves a constant review of the patient’s condition. And that since the doctors were not very present in CHSLDs, these evaluations were done by telemedicine “on the basis of evaluations of nurses who are often overwhelmed”. “Your protocol involves a medical and nursing presence which was not necessarily always in place according to what we saw in our investigation,” he said. Coroner Géhane Kamel added, mentioning that if the Dr Nguyen used the term “euthanasia”, “I think it’s reasonable that there are families who feel […] that it was killings ”.
The Dr Brazeau mentioned that around March 20, 2020, when he saw that there was no screening in CHSLDs and that CHSLDs were asked to avoid transferring their patients to the hospital and to promote telemedicine: “In my head, it was a recipe. It was clear it wasn’t going to work, ”he said.
Increase ratios
The Dr Brazeau, just like the professor at the Faculty of Nursing Sciences of the University of Montreal, Francine Ducharme, affirmed that it will quickly be necessary “to settle the question of the ratios of personnel in CHSLDs” in Quebec. The Dr Brazeau mentions that this subject is currently “taboo”. “Over time, nurse-patient ratios have been reduced significantly to lower system costs. We can be worried about the safety and quality of care ”, says Mme Some charm.
The Dr Brazeau points out that Quebec has around 100 geriatricians. According to him, international standards would like there to be one geriatrician for 4,000 seniors aged 75 and over and therefore that Quebec should have at least 235, explained Dr.r Brazeau. Consequence: geriatricians essentially play a consultant role in CHSLDs, he said.