Safety problems persist in Ontario: SARS report

Last Updated: Tuesday, January 9, 2007 | 10:18 AM ET

CBC News

Toronto's outbreaks of SARS were likely not preventable, the final report of a provincially appointed commission said Tuesday, but more could have been done to protect the safety of health-care workers.

Justice Archie Campbell's report found systemic problems with the health-care system, says Doug Hunt, chief counsel for the SARS commission.
(CBC)

The Ontario Ministry of Labour was sidelined during the outbreaks that killed 44 people in the Toronto area, the 1,204-page report called Spring of Fear said, calling for the ministry to play a lead role in future infectious disease outbreaks.

Having occupational health experts involved in containing the outbreaks would have helped protect hospital workers, said the report by Justice Archie Campbell, who was ill Tuesday and unable to attend a news conference.

"Justice Campbell found that systemic problems ran through every hospital and every government agency," said Doug Hunt, chief counsel for the commission.

Hospitals, the report said, are as dangerous for workers as mines and factories, and the courage of front-line health workers saved the province from a worse disaster.

Among Ontario's 375 SARS cases, 45 of those afflicted were health-care workers. Two nurses and a doctor died from SARS.

The province's emergency infrastructure is in a state of decay and the health system's capacity to protect workers was neglected by parties of all political stripes, Campbell's report said.

Systemic problems identified in the report include:

• Poor internal and external communications.
• Problems with preparation and planning for an outbreak of a virulent disease.
• Accountability issues: who is in charge and who does what.
• Problems with worker and patient safety.
• Infection control, surveillance and lack of independent safety inspections.
• Resource problems including people, money, laboratories and infrastructure.
• Most importantly, a lack of the application of the precautionary principle that action to reduce risk should not wait for scientific certainty.

Changes at labour ministry

Ontario Labour Minister Steve Peters said his ministry won't be shut out in a future health care crisis, and that both the occupational health and safety committees and pandemic advisory working groups now include labour representatives, which wasn't the case during SARS.

Health-care workers will also be trained on the use of N95 respirators, and more will be available in hospitals as Campbell recommended, Peters added.

Paramedic Alicia Butler, 26, contracted SARS while transporting an infected patient to hospital. Butler was wearing an N95 mask when she got sick, but it wasn't properly fitted.

"No one knew any better before," Butler told CBC News Online. "Thank goodness we've learned now."

Paramedics now use machines to test the masks before wearing them, said Butler, who is still coping with the effects of her illness. The Toronto woman has been put on modified duty at work because she still has trouble breathing, must take daily steroid medication, and has sleeping problems, muscle pains and fatigue.

Comparing Toronto, Vancouver

The report concluded that no system was in place in 2003 to prevent or stop SARS, but Vancouver did a better job of dealing with cases there than Toronto did, Hunt said, crediting a combination of better preparedness and systemic strength, as well as good fortune.

Campbell's report said changes made throughout the health-care and the public-health sectors in the wake of SARS mean that the people of Ontario are safer than they were before the disease hit.

However, the province is not as safe as it should be, said the report, which recommends dozens of changes to hospital practices, disease surveillance and provincial public health and emergency legislation.

Campbell found no evidence that political or economic pressure was put on the public health systems or hospitals to minimize the outbreak or hide cases of SARS, or to declare prematurely that the outbreak was over.

Wake-up call

Hunt said Ontarians need to demand that the government implement the report's recommendations and not let it gather dust on a shelf.

"I think Justice Campbell really wants to give the citizens of Ontario a wake-up call that we all have to … put pressure on the government to make sure that it takes steps in order to rectify the problems," Hunt said.

Health authorities misjudged the threat posed by SARS, Dr. Richard Schabas says.
(CBC)

But the report is wrong about the threat posed by SARS, said Dr. Richard Schabas, a former chief medical officer of health for the province who is now chief of staff of York Central Hospital, north of Toronto.

Schabas told CBC Newsworld the report wrongly follows the conventional view that SARS was a grave threat to the world that required draconian measures such as travel advisories and quarantines.

"The bottom line really came down to how big a threat SARS was," Schabas said. "It was not a highly infectious disease. It was capable of very limited spread in very limited circumstances, and the disease itself died out within a matter of months.

"We have to come to grips with how could we have got it so badly wrong."

Campbell's commission cost $4.5 million.

With files from the Canadian Press