Quebec public health director should be more independent, says coroner in report on 1st wave deaths

The lack of independence granted to Quebec's public health director may have slowed the government response at the beginning of the pandemic, as hundreds were dying in long-term care homes across the province.

Coroner Géhane Kamel published a report Monday following months of inquiry into deaths in seniors' residences, where the pandemic killed more than 5,000 in the spring of 2020. 

After hearing testimony from 220 government officials, long-term care home employees, and the loved ones of people who died, Kamel issued 23 recommendations targeting the provincial government, its Health Ministry, local health boards and the Quebec College of Physicians. 

One of the report's first recommendations calls on the government to review the role of its public health director so that whoever is in the position can exercise their functions "without political constraints."

The public health director in Quebec is also a deputy health minister, but Kamel wrote that the two roles "are distinct and may not be compatible."

Kamel provided as an example that masks were not mandatory in CHSLDs (Centre d'hébergement de soins de longue durée) at the beginning of the pandemic. 

"Would his advice have been the same had he not had to worry about potential stock shortages? I tend to think not. Hence, in my humble opinion, the danger of wearing two hats," Kamel wrote in the report, which can be read online.

At the time, Dr. Horacio Arruda held the role. He resigned at the end of 2021, and was replaced by Dr. Luc Boileau as interim director. Before that, Boileau was the head of the province's institute of public health (INSPQ). 

In her report, Kamel notes that in the early days of the pandemic, infection control measures were far more strict in hospitals and at testing clinics than in long-term care homes, where there were far more COVID-19 cases.

"We tolerated the intolerable. It was a sad day for medicine in Quebec," she wrote.

Marguerite Blais, the minister responsible for seniors, was one of the few that provided a clear timeline of the government's decision-making, Kamel said.

Kamel questions why doctors were absent in some of the long-term care homes where high numbers of people died, and why they relied on phone consultations instead of providing in-person care. 

"For a coroner, that many residents died without being allowed a doctor's visit during their final illness is not only sad, but disturbing," Kamel wrote. 

"It is hardly conceivable that decisions of life or death could have been made on the basis of a telephone relay alone."