Public Health Ontario's IPAC experts held back from helping long-term care homes over bureaucratic concerns, LTC commission told

When the pandemic first began to tear through Ontario long-term care homes, infection prevention and control experts that work at Public Health Ontario were sidelined over concerns about the agency's standing and funding amid the province's reorganization of the health-care system.

That's the concerning message from Dr. Gary Garber's testimony to the province's independent commission into long-term care.

Garber is the former medical director of infection prevention and control at Public Health Ontario. He told the long-term care commission that the agency had significant infection prevention and control (IPAC) expertise on staff — including 25 to 30 IPAC experts who were accustomed to going into hospitals and long-term care homes during outbreaks to do investigations and issue recommendations.

But he said they did not go to long-term care homes suffering from the earliest outbreaks in the province — some of which became among the deadliest — over bureaucratic concerns.

Prior to the pandemic, Health Minister Christine Elliott began a reorganization of the province's health-care system, which has included amalgamating former standalone agencies such as Cancer Care Ontario, Health Quality Ontario, eHealth Ontario into the new super agency Ontario Health.

Garber said PHO's IPAC experts wanted to go and help the long-term care homes that needed it in March and April but were told not to. He attributed that decision to the agency's concern that PHO could be amalgamated as well.

"And part of that difficulty is that there was — because of the formation of Ontario Health — there was this real concern within Public Health Ontario that if the organization looked too much like health care, that Public Health Ontario would be subsumed with the other organizations and agencies into Ontario Health," he said.

Garber said that PHO didn't want its IPAC staff to have "a big visibility," a concern he specifically attributed to the former CEO. "My editorializing is his approach to, you know, budgetary structures, things like that, was keep your head down so, you know, no one chops it off. And so I think that was why we're sort of being put below the radar."

The former CEO, Peter Donnelly, went on medical leave in April before leaving permanently. QP Briefing has reached out to seek his comment on the allegations.

Garber said the decision not to send the IPAC experts into long-term care homes changed in late April, but even then they weren't going into homes when things were at their worst, only when they were "either coming out of outbreak or were considered at risk of future outbreak."

The IPAC experts have been frustrated about what they weren't allowed to do and some have since left, he said.

"There was a real frustration of the fact that these people with expertise were not able to basically help out to scope," said Garber. He likened it to highly trained experts "sitting on the bench" when the pandemic is essentially the "IPAC Olympics" that they had been training for, for years.

According to Garber, the tension arose because of Public Health Ontario's role in the health-care system. The agency is mostly geared toward providing scientific advice and only two of its groups have more clinical roles — the laboratory, which performs testing, and the IPAC experts, which prior to the pandemic had been working directly with the health-care system, including in hospitals and long-term care homes.

When the pandemic hit, the decision was made that the local public health units should be in charge of handling outbreaks and PHO would only assist if requested, even though public health units generally have less IPAC experience, according to Garber.

He recalled being on the phone with a long-term care home in early March that only had a few cases — they told him they couldn't cohort the sick residents from the well.

"And it was the one time – maybe one of the few times in my career that I just felt helpless because I just knew what was going to happen," he said.

The home would go on to have an extremely high infection rate and more should have been done to teach them how to use their recreational and dining spaces to isolate sick residents, he said. "It was very clear that on the ground, they didn't know what to do about it, and we weren't in a position to help."

In a statement to QP Briefing, Public Health Ontario pushed back against some of Garber's testimony, saying it has not "prohibited infection prevention and control (IPAC) specialists from going into long-term care homes."

"In fact, PHO IPAC specialists have been deployed into these homes to provide support and assistance when requested," it said. "In April, Public Health Ontario worked with public health units, Ontario Health, the Ministry of Health and the Ministry of Long-Term Care to identify and support homes in outbreak that may require on-site visits versus virtual consultation and other online resources."

"Local public health units and the Ministry of Long-Term Care are responsible for managing outbreaks in long-term homes and ensuring safety in the homes. PHO has worked throughout the pandemic to support public health units as needed. With a small team at PHO, it was not possible to meet every request," the statement continued.

The agency went on to say that public health units were doing outreach with local long-term care homes in their communities and "when there were complex situations, or if the health unit had several outbreaks or at-risk homes to manage, these were prioritized for on-site assessments or virtual consultations by PHO."

That work continues today, it said.

According to Garber the agency's concerns over the bureaucratic concerns about the role of the IPAC specialists predated the pandemic. Just prior to COVID-19 reaching Ontario, the IPAC division of PHO was de-emphasized for the same bureaucratic concerns about the health-care reorganization, according to Garber. The structure was changed in January 2020 so that it was amalgamated with another department, a move he said "has significantly reduced the robustness of infection control within Public Health Ontario."

After the transition, Garber departed PHO and joined the Canadian Medical Protection Association in December and there were other significant departures — at least 10 senior staff, he said.

Prior to the pandemic, some of their work involved educating long-term care homes on best practices — but he noted PHO's work was only with homes that were interested in participating, and many were not. Even in those that were, staff turnover was generally so high that as soon as they were trained, they'd end up in another position and new staff would need to be trained. "So it was very difficult to be able to maintain the level of basic IPAC expertise within the homes."

Editor's note: The Ministry of Health released a statement to QP Briefing after the initial publication of this story:

"The ministry did not prohibit PHO’s IPAC experts from going to help LTC homes," it says, in part.

"The ministry connected PHO with the Ministry of Long Term Care (LTC) in order to seek and utilize PHO’s IPAC expertise, including creation of [an] IPAC checklist, multiple webinars for LTC staff and on-site visits by IPAC specialists to conduct IPAC audits and make recommendations."

"The government values the important service that Public Health Ontario provides to Ontarians, and the ministry will continue to work with Public Health Ontario to ensure the best possible use of our health care resources to support the important work of public health."