Quebec Health Ministry issued directive that kept seniors in long-term care out of hospitals during 1st wave

A doctor in charge of more than 30 patients during the first wave of COVID-19 at Quebec's worst-hit long-term care home says there was a Ministry of Health directive to avoid sending residents to hospitals. 

Coroner's inquiry hears that only a handful of patients at worst-hit home received top-level care

A funeral home worker removes a body from the CHSLD Sainte-Dorothée in Laval in April 2020. More than 100 residents died of COVID-19 at the home. (Ryan Remiorz/The Canadian Press)

A doctor in charge of more than 30 patients during the first wave of COVID-19 at Quebec's worst-hit long-term care home says there was a Health Ministry directive to avoid sending residents to hospital.

As a result, Dr. Tu Anh Nguyen told an inquest Wednesday that she called the families of her patients to discuss what level of care they should receive in case of distress. 

Nguyen was testifying at the last day of the inquest into the death of 94-year-old Anna José Maquet, who was a resident at CHSLD Sainte-Dorothée in Laval. The inquest is part of a larger public inquiry examining deaths in seniors' homes in the province led by coroner Géhane Kamel. 

When Kamel asked if there was a ministry order to lower the level of care of elderly patients, Nguyen said there wasn't.

But she admitted that only three of the roughly 30 patients were to get top-level care, after she spoke with the families.

Nguyen says she told Maquet's family it would be better to keep her in the home in case she got sick, instead of transferring her to Laval's Cité-de-la-Santé Hospital. 

"I explained to them that given Madame Maquet's general state of health we will treat her on site and prioritize her comfort, that it would be better with staff that knows her, rather than the emergency room where she doesn't know anyone and can get bed sores and catch COVID," Nguyen told the inquest.

"In retrospect, we know it was the opposite."

Last week, Maquet's son, Jean-Pierre Daubois, testified that his family wouldn't have consented to comfort measures if they had known it meant that she wouldn't receive the level of care she needed.

Over the past week, the inquest has heard how ill-prepared Sainte-Dorothée and the health board (the CISSS de Laval) overseeing it were, leading up to the first wave. 

It also heard how the provincial government had focused resources on equipping hospitals, even transferring personal protective equipment to them from long-term care homes, where the pandemic eventually hit hardest. 

"The enemy came through the back door and we were unarmed," one witness, a nurse, told Kamel last week. 

Maquet died April 3, 2020 after she was given a mix of painkillers and sedatives, prescribed by Nguyen because she had choked on some water. 

Coroner Géhane Kamel is presiding over the inquest into long-term care deaths in the province. (Ivanoh Demers/Radio-Canada)

Six CHSLDs — the French acronym for publicly run long-term care homes in the province — and one private residence have been selected to be examined by Kamel. One death per establishment is being looked into.

Sainte-Dorothée is one of them. In all, 102 patients died at the residence, the highest death toll for a long-term care home in the province; 211 residents and 173 employees were infected with COVID-19. 

Kamel has said the inquiry's goal is not to determine guilt, but to come up with recommendations to prevent future crises.

Oxygen levels reduced

Another doctor testifying Wednesday, Dr. Thérèse Nguyen — who was on call at the time of Maquet's death — confirmed that she had allowed nurses to reduce the amount of oxygen in the ventilators of some COVID patients to avoid producing aerosols that could infect staff, who were not equipped with N95 masks.

On April 3, 2020, nurses had used their "right of refusal," to demand N95 masks if they were to approach residents whose devices produced aerosols. No such masks were sent to Sainte-Dorothée.

"This decision was taken without patients' interest in mind," Patrick Martin-Ménard, the lawyer for Maquet's son, told CBC in an interview from the Laval courthouse. 

"If a patient needs oxygen, the patient will end up in respiratory distress and will pass away in horrific circumstances [if they aren't given enough]."

The coroner's inquest is revisiting what happened in seniors' residences in Quebec in the spring of 2020, where more than 60 per cent of the province's COVID-19 deaths occurred.

Other residents died of dehydration and neglect brought on by the chaos of infection and staff shortages. Almost half of Quebec seniors' residences experienced an outbreak.

With files from Lauren McCallum