Evidence of meeting #26 for Health in the 43rd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was covid-19.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Joanne Liu  Physician and Former International President of Doctors Without Borders, As an Individual
Michael Barry  President, Canadian Association of Radiologists
Gilles Soulez  Vice-President, Canadian Association of Radiologists
Arden Krystal  President and Chief Executive Officer, Southlake Regional Health Centre
Jim Armstrong  President, Canadian Dental Association
Jason Nickerson  Humanitarian Affairs Advisor, Doctors Without Borders
Dave Neilipovitz  Head of the Department of Critical Care, The Ottawa Hospital
Aaron Burry  Associate Director, Professional Affairs, Canadian Dental Association

4 p.m.

President, Canadian Association of Radiologists

Dr. Michael Barry

Gilles, go ahead.

4 p.m.

Vice-President, Canadian Association of Radiologists

Dr. Gilles Soulez

If I may comment, with the task force we really have reviewed all the recommendations worldwide—so from the U.S., Europe, China—and basically tried to adapt those recommendations to the Canadian realities: how to place our equipment, etc. It's very difficult to say.... Let's use air exchange as an example. Air exchange is very important for COVID prevention. So those that are based on good science.... We know the cycle of ventilation we need between patients, if you have a patient with COVID. So—

4:05 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

I take it that PHAC has not been in contact with your organization at all. Am I correct in understanding that?

4:05 p.m.

Vice-President, Canadian Association of Radiologists

Dr. Gilles Soulez

Basically, it's based on recommendations from all radiological societies across the country.

4:05 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

Okay, but they haven't reached out to you to provide information that might pertain to radiological services, etc., across the country.

4:05 p.m.

Vice-President, Canadian Association of Radiologists

Dr. Gilles Soulez

We have very close collaboration with the American College of Radiology and with the French Society of Radiology, so we really have [Inaudible—Editor] on exchange, so this is a close relationship.

4:05 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

Thank you. I take it then that—

4:05 p.m.

President, Canadian Association of Radiologists

Dr. Michael Barry

According to my office, we did have coordination with PHAC, which I'm not familiar with, and with CADTH. We had federal agencies on our task force on re-entry. That's the answer to your question.

4:05 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

Thank you very much.

Ms. Krystal, I appreciate your presentation. I had to look up Southlake Regional Health Centre. I knew it as York County. I spent a lot of time there when I was at St. Andrew's College. In fact, York County was where my life was saved when I was the victim of a hit and run. It was the first hospital I went to before they sent me to SickKids, at 16 years of age. So I have great admiration for that hospital, and it will always have a place in my heart.

You—and I think all three organizations—talked a lot about the lack of preparedness we've had for this COVID virus. That's interesting to hear. When I hear you talk about a lack of preparedness, I think I hear you talking about the need of being proactive instead of reactive and having testing procedures, protocols, procedures, simulation tests, etc. Would you agree with that?

4:05 p.m.

President and Chief Executive Officer, Southlake Regional Health Centre

Arden Krystal

Well, partly yes and partly no, Mr. Chair. I would say that certainly from the point of view of personal protective equipment and pandemic preparedness, I think there is some room for improvement, for sure. I mentioned that in my opening comments, around pandemic supplies that were put in with SARS and expired, etc.

However, remember that this is a unique virus. To try to develop some of the testing protocols, we had to do it on the fly, because it was something new and we didn't even know how we would be able to test for it.

The test is actually not an easy test. I think people think they can do something simple and go in for a test. When they come in, they get that nasal swab and it goes very, very deep. It is not a pleasant activity. We have a lot of availability of testing. We don't always have people who want to come and get tested, so there is sometimes a—

4:05 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

I'm sorry for interrupting you, but—

4:05 p.m.

Liberal

The Chair Liberal Ron McKinnon

Thank you, Dr. Kitchen.

We go now to Ms. Sidhu.

Ms. Sidhu, go ahead. You have five minutes.

June 10th, 2020 / 4:05 p.m.

Liberal

Sonia Sidhu Liberal Brampton South, ON

Thank you, Chair, and thank you to all the witnesses for joining us today.

My questions are for Ms. Krystal. I want to talk about long-term care facilities even though this comes under provincial jurisdiction.

At the 24th meeting of the health committee, Region of Peel CAO Nancy Polsinelli testified about the long-term care homes that the region manages. She discussed how the region has approached managing its homes during the COVID-19 pandemic.

In your opinion, as someone whose hospital has taken over the management of a private long-term care facility, is there a difference in the quality of care in private long-term care homes compared to the public option?

4:05 p.m.

President and Chief Executive Officer, Southlake Regional Health Centre

Arden Krystal

I've had experience both in the B.C. sector for many years and here in Ontario. One of the things I did notice, which I think made some improvements in the B.C. sector, was the fact that all private and public homes were still connected to the regional health authority and were directly contracted, if you will, with specific contractual obligations around quality standards, staffing ratios and those kinds of things. That clearly helps.

I think there is some evidence to suggest that here in Ontario, and in other provinces, private homes do have a tendency to have lower staffing levels, particularly the smaller private homes that do not have the large infrastructure that some of the larger cross-Canada companies have. Certainly, our experience has been that there has been a lack of infrastructure in teaching, in training, in the purchase of personal protective equipment and in infection control practices, which really did put them in a one-down situation going into this pandemic.

4:10 p.m.

Liberal

Sonia Sidhu Liberal Brampton South, ON

In regard to your statement on lack of staff, we had the CEO of the William Osler hospital in Peel, Dr. Naveed Mohammad, testify to the success of our local temporary program to allow foreign-trained medical experts to work in the health system on the front lines to mitigate the shortage. On top of preventing burnout among permanent medical staff, the program allowed foreign-trained specialists to get the necessary experience in our health care system.

What is your perspective on this solution?

4:10 p.m.

President and Chief Executive Officer, Southlake Regional Health Centre

Arden Krystal

Well, I think it's a solution to potentially another problem. I can speak from my experience and our local experience. Our experience is that we can actually hire people, but the structure for their hiring.... The people exist, but right now the job market is such that many of the private homes don't offer full-time positions. Some of the home health agencies don't offer full-time positions for personal support workers, and that creates a situation where they job-hop. They work at multiple organizations. As we saw during this pandemic, PSWs working at multiple organizations were a definite vector for the spread of COVID-19.

In some cases, it isn't necessarily about a need to go outside to hire. It's that we have to improve the conditions for our own people, who are ready to be hired but simply can't work properly within the structures we have provided them.

4:10 p.m.

Liberal

Sonia Sidhu Liberal Brampton South, ON

Thank you.

Mr. Chair, do I have more time?

4:10 p.m.

Liberal

The Chair Liberal Ron McKinnon

You have a minute and a half.

4:10 p.m.

Liberal

Sonia Sidhu Liberal Brampton South, ON

Okay.

You also talked about virtual care. How do you think it's beneficial for all the residents of Ontario?

4:10 p.m.

President and Chief Executive Officer, Southlake Regional Health Centre

Arden Krystal

I think in the long-term care sector, it can be very beneficial to connect some of those patients to some of the specialists that otherwise would not have the bandwidth to visit in person, people in palliative care, geriatricians and, in many cases, mental health professionals. In the hospital sector, we've found that a fairly large number of people can be seen at home.

For example, we used to bring in people to do pre-op assessments. There's no reason why we can't do that virtually with someone in their home. In many cases, a lot of post-operative assessments don't necessarily have to require the patient to come into the hospital. We can use the available virtual care, and many platforms are available. COVID-19 and the pressure from that allowed for some very rapid trials and testing of some of these solutions, which worked. So we essentially cut the bureaucracy, if you will, and jumped right to the solution, into trials, and found out that they worked.

4:10 p.m.

Liberal

The Chair Liberal Ron McKinnon

Thank you, Ms. Sidhu.

We'll go now to Mrs. McLeod for five minutes, please.

4:10 p.m.

Conservative

Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC

Thank you, Mr. Chair.

It's certainly a pleasure to join you. I know the committee has been working very hard for quite a while now.

I think we have a bit of a window right now to prepare for what was said to be either a microburst or a second wave, especially as it relates to the long-term care homes. I know many people talk about national standards, but I would suspect that if you look at the community care facility licensing acts in every province and territory, the standards are there and they would be remarkably similar, so I'm more concerned with what we are doing right now.

Ms. Krystal, does every facility in Ontario have both a health and safety inspection and an infection control inspection? To me, every facility across the country should. It would make sense to have a complete and thorough assessment as step one. Is that happening?

4:15 p.m.

President and Chief Executive Officer, Southlake Regional Health Centre

Arden Krystal

The question is a hard one for me to answer about everywhere in the province, but in our experience, we believe there were some inspections of the particular home we took over. There were some violations of the standards, and there wasn't always a rapid follow-up to ensure a rapid improvement cycle to address the inadequacies. I think that's probably the case across the province.

I think we have some lack of integration in the system in Ontario, where Public Health is charged to look at some of the community structures, some of the quality standards that need to be inspected. The Ministry of Long-Term Care is responsible for inspecting others, so I think there has been a disconnect and a lack of integration in rapidly detecting problems and in rapidly addressing them.

4:15 p.m.

Conservative

Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC

Perhaps that would be a good first step. An important second step is the dollars being allocated for some of the capital issues that might be identified.

You talked about the real challenges with the PPE issues. Do you have a sense that the whole flow is getting better? Do the people who work in these facilities have adequate and proper training? Is that something that needs a focus right now in terms of PPE?

4:15 p.m.

President and Chief Executive Officer, Southlake Regional Health Centre

Arden Krystal

We have had a better flow of PPE over the last month or so, for sure. I think it is still somewhat tenuous, especially as we ramp up or start to try to ramp up some of our elective and scheduled procedures throughout this system. That will put a drain on some of the PPE.

With regard to PPE in the homes themselves, I can speak from my experience and probably that of some of my colleagues, and say that in some cases they actually did have PPE, but they didn't have the right PPE. They were not using it properly. They were not trained to use it. In some cases, they were using two masks, thinking that would help protect them when all it did was waste a mask. They didn't always have face shields, and they didn't always change their gowns. There was, and remains, a lot of work to be done around education and training. That can't just happen in a one-time shot. Even in a hospital that is very prepared, we set up a PPE headquarters, and we had people working around the clock as what we call “PPE observers”. These are people who would watch you put on and take off—“don and doff”, as we call it—your PPE. That's really important because many of the staff who tested positive were infected from taking off their personal protective equipment improperly and contaminating themselves. I believe that's a factor.