For the family of Nemai Mallick, waiting for justice is starting to feel a little hopeless.
Mallick died on April 27, 2020 at the Hawthorne Place long-term care home, one of the homes assisted by the Canadian Armed Forces during the first wave of the pandemic. A year after his death, a report from the military was made public that detailed neglect and horrific conditions at the home, alleging that there had been "resident deaths due to dehydration and malnourishment."
(A Toronto paramedic rolls a stretcher into the main entrance at Hawthorne Place Care Centre in northwest Toronto, May 20, 2020. Andrew Francis Wallace/Toronto Star)
Mallick's loved ones fear he was among them.
Inspectors with the Ministry of Long-Term Care are currently at that home and at the Downsview Place Long-Term Care Centre, where military notes alleged 26 residents had died from neglect and dehydration, "when all they [needed] was 'water and a wipe down."
And QP Briefing has learned that while a number of police services have been alerted to deaths within their jurisdictions that may warrant criminal investigations, none have yet been launched.
According to one detective assigned to the file, "the Durham Regional Police, the Ontario Provincial Police, the Peel Regional Police and the Toronto Police Service to name a few," were "notified of deaths attributed to or related to COVID-19 at long-term care homes within their respective jurisdictions."
A Durham Regional Police Service (DRPS) detective disclosed that in an email to Cathy Parkes, who lost her father at Orchard Villa and went to the DRPS on behalf of herself and other family members of deceased residents, seeking a criminal investigation into their suspicions of neglect at the home.
Parkes told QP Briefing she doesn't understand why families are still being told they have to wait. "We've been asking for this for over a year but you know, it seems to be, 'Wait a bit longer.'"
A spokesperson for the DRPS confirmed the service is working with other agencies and the provincial government and said that while issues involving long-term care are being investigated, it's not accurate to say a criminal investigation has been launched.
“I can tell you that this is going to be a lengthy process,” said A/Sgt. George Tudos.
The detective who emailed Parkes in May said that the police services were reviewing reports from the military, the ministry, and the long-term care commission and consulting with each other, as well as with the Office of the Chief Coroner, to determine what the next steps will be, but so far no determination has been made.
The Office of the Chief Coroner would not confirm to what extent it is involved in this work.
In an interview with QP Briefing, Deputy Chief Coroner Dr. Reuven Jhirad, who is overseeing matters related to long-term care, said he could not confirm what involvement coroners are currently undertaking related to deaths from neglect in long-term care generally, or in relation to the military reports in particular. He would not confirm any details regarding any investigations, nor give specifics on how his office may be involved in reviewing the military reports.
While the minister of long-term care has said the Office of the Chief Coroner is reviewing the military reports on the Downsview and Hawthorne Place homes, Jhirad would only say his office is open to pursuing anything that the ministry brings forward that falls within the coroners' mandate.
"Certainly, I can say that if there are any concerns from their reviews and whatever they're doing and their procedures, they're best to speak to it, because I honestly can't speak to that, I don't have that knowledge," he said.
Jhirad said coroners have a legal mandate to investigate deaths in long-term care that involve neglect, whether or not that neglect is related to another cause of death or an underlying illness. However, he qualified that that will only occur, "as long as the issues are raised, as long as they're brought to us."
Investigations are a crucial step that can prompt police investigations, if they turn up evidence of potential criminality, or can lead to inquests.
Jhirad also acknowledged concerns raised by the Long-Term Care Homes Public Inquiry that not all deaths in long-term care that should be investigated are investigated because the process mainly relies on self-reporting from long-term care homes.
Coroners determine whether on not to launch an investigation primarily based on a form filled out by the home after a resident's death. The inquiry had recommended that those forms be revised to capture more information and that they be shared with a broader group of people involved in the deceased's care, in order to ensure that coroners get all of the information they need to determine whether or not an investigation is warranted.
Jhirad said those recommendations have not yet been implemented but coroners will act based on concerns raised by other parties, including health-care workers and residents' families.
However, those concerns didn't prompt an investigation into Mallick's death, according to family members, who asked both the long-term care homes' administration and the coroner's office to pursue an investigation and an autopsy, but were denied.
Hawthorne Place, the home where Mallick died, has stridently maintained the coroner has investigated no deaths at its facility, and adamantly denied any residents died from neglect.
Another possibility is a coroner's inquest into one or more deaths from neglect in long-term care. Jhirad said decisions haven't been made yet as to whether that will occur. There may be requests for inquests in different jurisdictions and there is a possibility that an inquest could include multiple deaths at multiple homes.
Without offering specifics, Jhirad tried to give assurances to family members that their concerns are being acted on.
"What can we say? Our goal is to ensure that every investigation that needs to be done is done," he said, adding that his office recognizes that the investigative process can be intrusive for grieving families when it occurs.
But for Neil Shukla, Mallick's grandson, it's not enough. His hope is for justice, as well as systemic improvements to long-term care in Ontario. He and his family want to see a criminal investigation into Mallick's death and others like it. Legal experts have said death from neglect in long-term care could lead to criminal charges of failing to provide the necessaries of life against the homes' management or corporate ownership for their failures during the worst of the pandemic.
But a year later, little progress has been.
"The push for accountability can't just dwindle away," Shukla told QP Briefing. "There has to be answers or solutions, or concrete action."
There may never be justice for resident #001.
When the Canadian Armed Forces released a report on their deployment in five Ontario long-term care homes over a year ago, the province was shocked by its description of resident neglect and the decrepit conditions of the homes. When further reports on two Toronto homes were publicly released in late April of this year, containing allegations that dozens of residents had died of neglect, dehydration and malnutrition at two of those homes, the province was shocked anew.
The province promised investigations both times and responded by sending Ministry of Long-Term Care inspectors into the homes. While inspectors are currently at Hawthorne Place and Downsview Care Centre, there are no such inspections at other sites where similar allegations have been made but no new damning military reports have made the news.
Resident #001 lived at one of those other homes. Inspectors visited Altamont Care Community in Scarborough after a devastating COVID-19 outbreak, after the home was included in the original military report last year. The report has been sitting in the government database among thousands of others ever since.
(The entrance to Altamont Care Community in Scarborough. Andrew Francis Wallace/Toronto Star)
It describes "resident #001," who was hospitalized after their family contacted emergency services of their own accord, concerned about dehydration.
"The resident would complain they were often thirsty, as it would take extended periods of time for staff members to respond to the call bell when they would request a drink. According to the [family member who complained], they would also call into the home to attempt to get a staff member to bring resident #001 a drink," the report said.
"Resident #001 was admitted to the hospital, where they passed away."
The report notes the resident was unwell and that the hospital's diagnosis was "consistent with poor fluid status" and the inspectors found, in a review of records, that the resident had consumed less than half of their required fluids prior to hospitalization.
The homes' staff agreed with the family's assessment that the resident would often complain of thirst — they noted there was a water jug kept at the bedside, which staff tried to keep full, but said, "due to staffing concerns around that time ... it was difficult to ensure small tasks like that were being done when we were just trying to make sure everyone was clean and fed."
The inability to help resident #001 drink is explained by the staffing crisis at the home during the COVID-19 outbreak. The report quoted one nurse saying staffing levels were "horrible" and as a result residents didn't get the care they need. It found that, on one shift, a single personal support worker was "responsible for the provision of care and safety monitoring of 97 residents over three home areas."
"The PSW identified that they were concerned that residents would fall while no one was present on the wings, that as soon as they heard a bell that they would run, having to change PPEs between wings, to prevent a resident from trying to self-transfer when they needed toileting assistance," it said.
Geriatrician Nathan Stall said staffing levels described in the report mean it "would be impossible to meet any basic level of care" for the residents, adding that higher staffing levels would have been required because of the demands of caring for residents with COVID-19.
He said the report shows other consequences of the breakdown of care, including increased pressure ulcers — sores that resulted from staff being unavailable to turn over bed-bound residents — and one resident in particular who suffered the contracture, or locking, of their joints for being left in one place for too long. It details hydration and nutrition problems with many residents other than #001 and noted that 86 per cent of the residents lost weight between March 2020 and May 2020.
"What you're reading here is direct signs of the lack of ability to provide basic necessities of care, and to provide to the basic necessities of life," Stall said. "It's through no fault of the staff who are working there. They were put in absolutely impossible situations. It would be impossible to care for this many sick and dying residents with levels of staffing that they cite there."
While the report on Altamont is particularly clear and disturbing, a review of other reports on long-term care homes that suffered devastating outbreaks, some that received military assistance and others that did not, include inspectors' observations of problems with hydration and nutrition, resident weight loss, and critical staff shortages.
In a statement, Sienna Senior Living said that it has since changed the leadership at Altamont and taken action to ensure that residents are properly hydrated.
"There is a daily recording and monitoring process for food and fluid intake in place for every single resident. Team members flag any variations to registered staff, who provide additional assessments and interventions. There is an additional process whereby every day, team members review the intake of fluid and nutrition for residents over the past three days. Residents with reduced food and fluid intake are flagged for further assessment by registered staff, and increased support is added to their care plan," the statement said.
Based on those changes, the orders the ministry made as a result of this inspection were lifted, the company said.