Quebec's worst-hit long-term care home woefully unprepared for COVID crisis, inquest hears

As the COVID-19 pandemic approached its first peak in the spring of 2020, the health board overseeing the worst-hit long-term care home in the province, CHSLD Sainte-Dorothée in Laval, scrambled to digitize its paper records. 

"It was like building a plane in mid-air," said Dr. Jean-Pierre Trépanier in his testimony at coroner Géhane Kamel's inquiry.

The Sainte-Dorothée residence had Quebec's highest death toll among long-term care homes — known in the province as CHSLDs — during the pandemic.

Trépanier is the public health director for Laval, one of the epicentres of COVID-19 cases during the first and second waves.

His testimony unveiled a number of issues at the beginning of the pandemic that slowed the response in long-term care homes. The challenges included converting paper records and making work practices more efficient. 

The facility on Samson Boulevard saw 100 residents die over the course of the pandemic and 211 become infected. A total of 173 staff members also tested positive for COVID-19.

The coroner's inquiry into deaths in seniors' facilities during the pandemic has already heard what happened in other homes in Lévis, Longueuil, Shawinigan and Montreal.

The hearings into the Sainte-Dorothée residence began Tuesday, the same day Quebec announced that there are no more active cases in long-term care homes.

Trépanier said the health board — the Centre intégré de santé et de services sociaux (CISSS) de Laval — was, at first, relying on a pandemic plan that had not been updated since 2006.

He said it had been hard to predict the crisis in long-term care homes, given how focused the government was on protecting hospitals. 

Trépanier said the government's plan came only three days after emergency measures were put in place across the province and made little mention of long-term care homes.

Fragmented information and lack of plan for long-term care

Trépanier testified that his team quickly realized it would need more resources and personal protective equipment to handle the outbreaks that were cropping up in March and April of last year, but supplies were limited.

He defended his health board's handling of the crisis, noting Laval was the first region to push for more testing, but that the government was rationing swabs at the time and test results had to be sent to a lab in Winnipeg.

Kamel was at times pointed in her questions to Trépanier, asking him why, if the risks of the novel coronavirus were made public in February, his team was not prepared for an onslaught of cases.

Trépanier replied that information from provincial public health officials was fragmented and that a lot remained unknown about the impact of the virus at the time.

Police investigation into deaths was dropped

Trépanier was the second witness to testify, after Sgt.-Det. Jules Briand of the Laval police force. 

Briand's testimony was short, compared to Trépanier's which lasted a couple of hours. Briand was asked in October 2020 to investigate the deaths that had taken place at Sainte-Dorothée during the first wave. 

He said he conducted 25 interviews, which uncovered several issues at the home, including a lack of staff and equipment, as well as the improvisation of a hot zone for infected residents in the home's lobby, with some transferred to other floors despite being sick. 

The home also lacked washrooms and wash stations and had hired staff from outside the home, allowing infection to spread. But he and other investigators determined no criminal charges could be laid because of the structural issues. 

Later in the day, testimony from infection prevention and control staff pointed to staff shortages and a lack of testing.

The inquiry heard the first resident tested positive on March 26, 2020, but that it took the Health Ministry until April 11 to implement mass testing, according to Christian Gagné, the CEO of CISSS de Laval.

Gagné acknowledged some kinds of equipment, such as masks, were locked up so people wouldn't steal them. He admitted that, at times, there were not enough employees on hand to unlock cabinets and hand them out.

The head of infection prevention and control at the health board, Julie Huard, told the coroner she had to scramble to find and train people.

For the entire month of April, the person in charge of infection prevention and control assigned to Sainte-Dorothée was home sick and could only answer questions or analyze measures in place remotely. 

Huard said that, on April 9, she saw an employee on site who seemed unwell, and asked one of the managers to speak with her and have her sent home.

She said it was that as far as she knew, it was the first time an employee was sent home by a person in authority because they were exhibiting symptoms, despite the first wave being well underway.

The inquiry continues Wednesday, when several nurses are expected to testify.

The son of one of the COVID-19 victims at the home will be testifying on Thursday. 

Jean-Pierre Daubois alleged in a class-action lawsuit, filed in April 2020, that employees were forced to work even if they were showing signs of a COVID-19 infection.

His mother, Anna José Maquet, died at the age of 94 on April 3, after she contracted the disease while she was a resident of the CHSLD.