The directive sent in mid-March 2020 by the Ministry of Health saying that transfers of residents from CHSLDs to hospitals should be “avoided” was interpreted strictly by field workers during the first wave. But that was not the government’s intention, the assistant deputy minister for academic medical, nursing and pharmaceutical affairs, the DD Lucie Opatrny.
She testified at the coroner’s inquest which examines the deaths that occurred in CHSLDs at the start of the pandemic. The DD Opatrny assured that there was “no ban on transferring patients from CHSLDs to hospitals”. She mentioned that patients with a supporting medical assessment could well be referred to the hospital.
However, “people received it as: we do not transfer people from CHSLDs to hospitals […] People have been forced to call journalists to be able to get their parents out to hospitals. This is not anecdotal, ”said coroner Géhane Kamel.
In a letter sent to the health network on March 18, 2020, the Deputy Minister for Health, Yvan Gendron, wrote that “the transfer of residents in CHSLDs to hospitals must be avoided and become an exceptional measure”. The DD Opatrny acknowledged “gaps” between the government’s intentions and interpretations on the ground. It ensures that the will was not to prohibit these transfers.
“You can’t blame the field for interpreting the directive the way they did […] They respected the very essence of what the directive was, ”said Dr.r Jacques Ramsay, who supports Coroner Kamel in her investigation.
The latter spoke of a “masterful gap” between the directive of the Ministry of Health and the field. “Looking back, when you look at the letter, I think […] that we can at the very least say that perhaps these are not the words which should have been used if it is this will that you wanted to transmit to the people at the base ”.
The DD Opatrny said that at this time she had “several meetings” with the network every day. Despite this, the DD Opatrny admitted that there was “not the same interpretation everywhere”.
1,200 seniors transferred to CHSLDs
The DD Opatrny mentioned that on March 9, 2020, the National Institute of Public Health of Quebec (INSPQ) presented three projection scenarios for the COVID-19 pandemic in Quebec. According to the worst-case scenario, if no measures were adopted, Quebec would have recorded up to 35,000 hospitalizations per week, while the total number of acute care beds in Quebec is 18,000. saw that ”, testified the DD Opatrny, which was mandated to “clear hospital capacity”. At the height of the crisis, the maximum number of people who will be hospitalized in Quebec because of COVID-19 will ultimately be less than 1,500.
But at the beginning of March, we expected more of a disaster. The DD Opatrny mentioned that the forecasts of the INSPQ, combined with what was observed in Italy, pushed Quebec to accelerate the pace in its preparation. Hospital beds have been freed. Mainly by reducing the volume of elective surgeries. About 1,200 hospitalized seniors were also referred to CHSLDs. A not so high number considering that during the same period of the previous year, 900 hospitalized seniors had been sent to CHSLDs.
The DD Opatrny explained that the government initially planned that the virus would enter the hospital through the emergency room, and threaten hospitalized elderly patients as seen during the SARS crisis. We therefore believed to protect them by sending them to CHSLDs.
In March 2020, doctors had the opportunity for the first time to bill for acts by telemedicine. “The idea was to offer more services,” explained DD Opatrny. She said that “it was not the will of the directives to prevent anyone from appearing in person.” Between March and June 2020, 45,000 teleconsultations were made across Quebec. But in CHSLD, teleconsultation was the exception rather than the rule, assured the DD Opatrny. From March 16 to April 10, 6.4% of services rendered in CHSLDs were billed for services rendered remotely out of the 5.7 million acts billed.
The feared impact on CHSLDs from February
Earlier Monday, Quebec’s national director of public health, Dr Horacio Arruda, came to say that as early as February, Quebec knew that residential homes for the elderly were at risk if COVID-19 spread in a community way in Quebec.
PHOTO JACQUES BOISSINOT, ARCHIVES THE CANADIAN PRESS
Quebec’s national director of public health, Dr Horacio Arruda.
“It was in the scenarios that it was going to strike in CHSLD”, said the Dr Arruda. For him, the ban on visits decided in mid-March was precisely to “protect” living environments for seniors.
Coroner Kamel said she was surprised to know that CHSLDs were expected to be affected as early as February. “In fact, the hospitals in mid-March, they are more than ready to receive people. Equipment is available. The teams were mobilized. When we look at what we’ve heard since February […] that’s not at all that in a CHSLD… The preparation is zero and one bar […] This is one of the first times that I realize that these discussions took place before March 13. It’s a bit disturbing… ”
The Dr Arruda explained that given what was happening in Italy, there was a “focus on reorganizing acute care systems”. Coroner Kamel expressed her “unease”, while acknowledging that it was all beyond the sole Dr Arruda.
The Dr Arruda trusted the experts
Asked about the fact that Quebec has been slow to recommend the wearing of a mask in healthcare settings and has long limited the wearing of the N-95 mask to procedures generating aerosols, Dr Arruda said: “We make our recommendations based on what our scientists recommend in Quebec.” The Dr Arruda mentioned that there is “no scientific consensus yet”, particularly on the superior effectiveness of the N-95 mask over the procedural mask in healthcare settings.
Last week the Dr Arruda had also explained that the availability of the material had been considered in his decisions.
The coroner’s inquest continued Monday afternoon and Tuesday with the testimony of the Assistant Deputy Minister at the Directorate General of Seniors and Caregivers, Nathalie Rosebush.