Subcommittee on Food Safety Committee on May 27th, 2009

[Dr. David Williams]

To answer the question, yes, I did receive the letter. I would also indicate that in the letter from the three officials, they did comment in the first paragraph, “We welcome the report's intended purpose of demonstrating the accountabilities and the opportunities that exist...”. So there were positives as well as their concerns.

During the whole outbreak, I did not receive any call from the federal Minister of Health or his office. We dealt mostly or totally with the representatives of the agencies, those being the Public Health Agency of Canada, Health Canada, and the Canadian Food Inspection Agency in that, and of course some of their counterparts, the national medical laboratory and the laboratory in Ottawa, on that perspective in that. But no, I did not hear any inquiries from the federal minister to my office.

[André Bellavance, Bloc, Richmond—Arthabaska, QC]

Do you find that normal? In your comments, you say that, when there is a national crisis, there should be someone responsible at the national level. In my opinion, the person ultimately responsible in this kind of issue... Obviously, we were talking about agri-food, but we're also talking a lot about public health: some people were sick, others died.

Do you think the federal Minister of Health should have been in the picture and should have had a say when the crisis occurred?

[Dr. David Williams]

Most of the time when we're operating, even at the provincial level, I expect that the public health officials will be speaking and leading on the issues, the same as in our province. If our minister chooses to speak on the matter, he has the full privilege to do so. We keep him informed on the matter. If he feels that he wishes to speak, he does speak on the matter. They usually expect us in the public health leadership to carry out our duties and responsibilities and give leadership to a point of their satisfaction. If there's some level at which they feel they should be engaged, they have that privilege, and it's their role if they wish to do so.

I don't really have a control from my side to say when I expect a minister to engage in activities, yes or no. My task is to keep him or her—these are both hims in this case—informed on the matter, such that they can deal with it as they feel fit.

[André Bellavance, Bloc, Richmond—Arthabaska, QC]

I understand, and my intention isn't to embarrass you with this kind of question, but these are questions that people ask us.

I also want to go back to the fact that the impression we get on this entire matter—and that's why I'm drawing a parallel—is that the Canadian Food Inspection Agency had control over management of the entire crisis when, in my view and that of the people who have spoken with us since this subcommittee was struck, Health Canada should have carried the greatest weight in the decisions made and in the coordination of this entire affair. I'm also intrigued by the fact that the agency wrote to you and told you that samples taken by Toronto Public Health were sent to Health Canada's Listeria Reference Service Laboratory, but should have been sent to the Canadian Food Inspection Agency's Scarborough lab. In response to a question from me during his appearance, Dr. Butler-Jones said that you had acted correctly. And yet he signed the letter in which you are blamed for having done that. It states that it was because of that that the chance to reduce the time it took to confirm the source of contamination was lost. Mr. Jeff Farber, from Health Canada, also said that it was normal for the samples to be sent to the Health Canada lab.

How is it that, in 2009, we are still trying, after the fact, to toss the ball into our neighbour's backyard and say that he's the one who didn't do his job. I understand that we're trying to improve things, but when you talked about the lack of coordination earlier, here's a concrete example in which, after the crisis, the agencies figured they would quickly wash their hands of the whole affair and say that others hadn't done things properly. And yet when we question their representatives during their testimony—

[The Chair, Conservative, Larry Miller]

Mr. Bellavance--

[André Bellavance, Bloc, Richmond—Arthabaska, QC]

—they say that ultimately what was done was correct.

[The Chair, Conservative, Larry Miller]

Do you have a question?

[André Bellavance, Bloc, Richmond—Arthabaska, QC]

Yes, it's on this subject.

[The Chair, Conservative, Larry Miller]

You're way over time. Thank you.

Do you want to comment?

[Dr. David Williams]

The overall purpose of my report is more of the other side of what you're speaking to. I don't think there's any benefit in saying that if something was on one day or that day and necessarily in small details.... We can talk about those at different times. I like to focus more on the higher level of seeking system solutions to the coordination, not wanting to pass the buck in that sense. We all want to be engaged and do our part.

What system adjustments should we make so it is clear that in the case of an outbreak where the public's health is at risk there's the right leadership at that stage? In Ontario the public health system, under the Minister of Health, takes that leadership for the protection of the public in an outbreak. We're looking for a similar structure at the federal level that would comply or work synergistically with ours at the provincial level. Rather than who does what, when, and where, it is how do we all work better together to give a better response. I think that's what the public of Canada and Ontario expect in this situation. Jurisdictional issues, I think, are not a concern to them, but the type and timeliness of response is of paramount importance.

[The Chair, Conservative, Larry Miller]

Thank you.

Mr. Shipley, for five minutes.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Thank you.

Mr. Williams, I appreciate so much the dialogue that's happening today in terms of what needs to be done about the systems by everyone: the communications, what we need to do to move ahead to seek system solutions and not pass the buck. I think that's really it.

When did it become a national event? When it moved outside one region, is that correct?

[Dr. David Williams]

When we had our cases and we did our notification through CIOSC, that meant my fellow CMOHs across the country would be checking their cases as well to see if they had an increased number of listeriosis cases. That's one aspect. When we identify that through the hypothesis generation and agreement around that period of August 18 and August 19, they said they had closed packages from the plant. Therefore a product had gone out that we understood went to our institutions in Ontario. Of course we didn't know whether it went to institutions beyond Ontario, and certainly it was confirmed to us that this was the case. Therefore, on the federal level the Public Health Agency of Canada added that to the alerts, and so did the health hazard alert, which is a national one, along with the company that would alert them to that effect.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

So basically, it became sort of unclear at the national level, where there were actually issues outside of Ontario, in and around that time? I mean, you'd send out the alerts, but the recognition of it, that--yes, we have that issue here too--was some time in that area.

[Dr. David Williams]

The other provinces became aware that they were exposed to whatever we were dealing with in Ontario. At first you'd wonder if it was an Ontario-only issue, because of the determination of where the source was. Since that source had more than an Ontario-only distribution, that moved it from the side of being, I would assume, in one of the provinces of interest and from you just checking to see if you have anything from there, to saying that this has now landed in your jurisdiction and you're going to have to investigate it further.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

I keep looking at this, and it talks about “all open packages”. It was determined that only two of 13 samples submitted had similar molecular typing. There was a concern, I would think, because of these one-kilogram open packages of cold meat--and now we're into August 11. Does that create an issue when you have open packages in terms of trying to pinpoint the issue and the intensity, in terms of the seriousness of the listeria effect that it's going to have on people?

[Dr. David Williams]

One of the points in my recommendation is around the facilitation and efficiency of food sampling processes. It was frustrating to some of us in Ontario that when our trained staff, who know how to do sampling with a sterile and careful technique...instead of 36 health units sending in 10 to 20 one-kilogram bags to a centre to get assessed, they could take some samples and send them in. To say that because your staff opened them or your lab staff opened them up, that's not as good as our lab staff opening them is a little bit frustrating in that sense, because they use the same care and technique to undertake that. Shipping large packages of products over long distances in a timely manner can become overwhelming, and one has to look at what is a more efficient and effective way of sampling.

Also, confidence and trust that if you train people out on the periphery to do the proper sampling and give them clear instructions, even on how you might want to augment or change that in the process...I've experienced that before, where an experienced medical microbiologist doing that will say, “Now we want to sample this portion and do it this way”, and you needed an iterative process to make it more timely to go through pounds and pounds, up to a quarter of a tonne, of stuff. Testing is a huge task.

So I think the open packages were of concern to the agency, but I thought, in my sense, that some of our staff who are well trained in that can sample products quite well and keep them in the proper process that would still be valuable and meaningful in that investigation. So we wanted to make sure we clarify that.

[The Chair, Conservative, Larry Miller]

Thank you, Mr. Shipley. You have six seconds left, so that's it.

Mr. Allen, I apologize. I bypassed you, and it wasn't deliberate.

[Malcolm Allen, NDP, Welland, ON]

You said he had six seconds, but he actually took four minutes and 54 seconds of my five minutes.

[Some hon. members]

Oh, oh!

[The Chair, Conservative, Larry Miller]

You're saying your time is over?

[Some hon. members]

Oh, oh!

[The Chair, Conservative, Larry Miller]

Go ahead, for five minutes, please.

[Malcolm Allen, NDP, Welland, ON]

As you can see, we sometimes get out of sync here.

My colleague across the way, the parliamentary secretary, talked about shared responsibilities between numerous agencies. Dr. McKeown and Dr. Williams have both articulated relatively well the sense of local public health officials, provincial health officials, and of course Canadian public health officials.

In your opening remarks you talked about all of these groups and agencies having jurisdictional issues, in the sense that you have this jurisdiction and they have that jurisdiction, and how do we somehow find the synergy to make them all work together. As you said, “the committee's overarching priority needs to be to protect the public's health”. Forgive me for being overly simplistic, but I think that's why we call you public health officials. That's your only mandate, from the perspective of what we believe. There are other things you do, but protecting public health is really your mandate, as it should be.

If we had followed the model you outlined for us in general terms and had that seamless operation among the local, provincial, and federal jurisdictions, could we have decided at an earlier time than the timeline we see here that we did have a crisis of some proportion and that we ought to have taken steps then? Those steps would have been earlier perhaps. I'm asking for your professional opinion around that, either one of you or both. If we had reacted earlier and made the same decision as we made in August on July 29 or even July 21 and had all the folks working together, could we have averted some of the deaths?

I recognize that the second part is an extremely difficult question. There is some conjecture involved in that, but you are professional public health officials. You are tasked with the sense of public health, what to do to minimize the risk to the public and avoid deaths from occurring, and ultimately taking it from that level to avoid health issues from arising, including food-borne illnesses. We've heard Dr. McKeown talk about the numbers.

Could you respond to that?

[Dr. David Williams]

First, if the seamless system is working and we have open disclosure, and everybody is at the table--the way I imagine the model I'm proposing--with a sense of confidence and sharing, it would have allowed us to respond by declaring the outbreak a number of days earlier. Part of that aspect is like the issue the previous member asked about--the discussion around the laboratory testing and the poor quality of the samples. We'd say, “There's enough for us to take action right now, so can we do it?” There are questions about what was happening at the plant that I wasn't aware of that would have given me concerns about confidence or concerns about doubt that we should move more expeditiously to handle that.

I wasn't sure why those one-kilogram packages happened to be from one line and were the only ones that were contaminated in the process system. I was not versed on totally understanding how this was happening, but those ones weren't exposed. Were they the only ones producing that or not producing that? Why was it done in that packaging and they only went to these institutions and not to public ones? It's that kind of thing used to assess who in the public are at risk. Either it's known clearly or it's found out very early, and even one federal agency says:

We don't know, and we're not very confident that we can get that information. We can't confidently tell you that it isn't. Therefore while we can't say what it is, we think that as a public health official you should react now on a precautionary basis and take the steps to do so. So while there aren't enough grounds to say we can land on something solidly, I can't tell you enough from our mandate and perspective that would persuade you that it's contained only here, therefore you should probably take action further.

It's not only the amount of the information; it's the opinion and evaluation of the quality of that information from those people as they're going through the process that will help to expedite the decision-making aspect in there.

It's the same with the sampling packages being opened or not. With some of our public health officials, if the PFGE type is the same, what if some inspector happened to brush it with his finger and contaminate it with the same one? That was highly unlikely. Why could we not move expeditiously? That frank discussion should happen in a command-type thing with people at the table where they're held to be there, who share what they know, with a common respect for each other's mandate and what you have to do in your job. But the final task is the public's protection, and let's get on and do the job.

On the question of how far back, if you go back to the 21st, we talked with Toronto Public Health about their two cases. They said they had investigated them. We can't respond to an outbreak before we know it has occurred. It would be nice if we had certain powers that we don't have. We're only public health officials. We'd like to dream of that and be preventative rather than reactive, and that's the idea.

On the number of deaths, it's tough to say how that would have been affected, because the incubation period is so long. When the person actually ingested the product is tough to say.