Subcommittee on Food Safety committee  There are a number of questions there. One aspect is that as you're going through the food-borne outbreak and you're trying to follow it, one has a method of generating certain hypotheses as to what is the source of it, and one looks for evidence. One of the things we always try to do is make sure we don't focus too quickly.

Subcommittee on Food Safety committee  No, it wasn't just in Toronto.

Subcommittee on Food Safety committee  In Ontario. When we collect the data, we normally have about 40 cases a year of listeriosis. There are different amounts each month, ranging from two or three up to about five or six cases a month. The system then, with our team of people such as Ms. Badiani, does the recording.

Subcommittee on Food Safety committee  Yes, we average about 40 a year. Those numbers go up and down a little bit, but that's the average number per year that we've experienced over the last three to four years.

Subcommittee on Food Safety committee  There are some deaths. It wasn't deaths that drove us to look at the numbers; it was the number of cases, first of all. As we look at those significant cases, we see if there are any unusual patterns. And right off the bat, the one thing that became obvious was that the cases were all in long-term care facilities.

Subcommittee on Food Safety committee  The uniqueness of Ontario is that we have 36 autonomous public health units. A medical officer of health such as Dr. David McKeown has the full legal authority to look after his own jurisdiction and has responsibilities and legal rights to carry that out. As a chief medical officer myself, I don't have my own separate staff who do inspections and carry that out; I work through the local medical officers.

Subcommittee on Food Safety committee  The issue is an important one. In our public health legislation, when we have reasonable and probable grounds that a hazard may exist, it allows our medical officers to act. That means, then, that one has to have some evidence to move--you can't just go about and be casual--but one has the ability to say that you should take steps to curtail, as soon as you can, the exposure of the public, or a portion thereof, to a presumed hazard until you investigate that one adequately.

Subcommittee on Food Safety committee  No, not since the letter and our response back to them. In Ontario, we've been consumed with issues around H1N1, so that may be a reason there. But we haven't received any formal correspondence as a follow-up to our letter back.

Subcommittee on Food Safety committee  Prior to the letter, we did have a meeting with some officials, facilitated by our Ontario Ministry of Agriculture, Food and Rural Affairs. We talked on a high level about going forward with more coordination. That was prior to receiving the letter. Prior to the letter, I also had a phone conversation with CFIA officials on just some general questions they wanted to ask.

Subcommittee on Food Safety committee  Overall, I haven't had the opportunity, because the Public Health Agency of Canada is relatively new and the legislation, roles, and responsibilities are ones that we're interested to understand well from the chief public health officer of Canada. While we have been involved and we look at our public health legislation--it's been there for a long time and modified under the Ontario Health Protection and Promotion Act, which lays out the roles and responsibilities of my role as a chief medical officer of health in an acting capacity and that of local medical officers of health--we have that shared dynamic, the one between the chief public health officer and how his or her authority works with the other agencies.

Subcommittee on Food Safety committee  That's one of my concerns in my recommendations in the report. We should be seeking ever better levels to bring our key stakeholders and the key partners together--local, provincial, and federal--to respond quickly, with timeliness, effectively, and efficiently. That's correct.

Subcommittee on Food Safety committee  Thank you for that question. I think the point I emphasized at that press conference is that in the new reality of our food services, where we're having more products than ever before from ever larger organizations of international scope—products that are often made offshore and over which we have very little control—and a wider population with importation coming in, it behooves us to look at how we can survey that even more effectively and appropriately, or we will be left with further outbreaks, such as we experienced with listeriosis.

Subcommittee on Food Safety committee  Thank you. Speaking through the chair, we did respond to the letter, with my response on the 29th back to the group. There are two points to make. First of all, when Toronto Public Health was investigating two cases in a nursing home in Toronto, there was no outbreak at the time.

Subcommittee on Food Safety committee  I believe so.

Subcommittee on Food Safety committee  I'll start off with some general comments and my introductory part. Good afternoon, and thank you for the opportunity to address this committee on the management of the 2008 listeriosis outbreak in Ontario. Today l'd like to talk about my report on the outbreak, released publicly on April 17, 2009, basically on what we did right, on what we could do better, and the lessons learned for the future.