Investigation underway into military notes on deaths from neglect in long-term care homes: Minister

An investigation is now underway into allegations from the Canadian Armed Forces that residents of two Toronto long-term care homes died of neglect at those homes last spring, Ontario's minister of long-term care said Friday.

It marks the first time any government official has confirmed an investigation into the disturbing allegations by the military, including that 26 people had died from dehydration at one of the homes when all they needed was "water and a wipe down."

Excerpts of those military reports were first publicly released on April 30 in the final report of Ontario's independent commission into the COVID-19 crisis in long-term care. QP Briefing published the full notes May 10.

Merrilee Fullerton said Friday, in response to media questions after a press conference about funding for nursing programs, that multiple inspectors from her ministry are currently at both of the long-term care homes and should be there for weeks. The province has officially reported that 65 residents of the Downsview Long-Term Care Centre died with COVID-19, as did 51 residents of Hawthorne Place.

Fullerton said her ministry is working with the Office of the Chief Coroner, as well as the long-term care inspectors that were involved with the homes earlier in the pandemic, to understand the source of the military notes and verify what happened, she said. That involves interviews with staff, the homes' medical directors and others who were "on the ground" at the time.

"So we're trying to piece this together, as to what really happened," Fullerton said.

"We are reviewing where this information came from. What is the basis, and what is the source, and verifying," she said. "And I think that that is a very important understanding because there's a lot of information, a lot of discussion, and people say certain things, and we have to understand what the basis for that is so, so we must verify."

The source of the allegations are notes created by the CAF on meetings held in May and June of 2020 and initially circulated within Joint Task Force Central in Toronto. Excerpts of those notes were included in the long-term care commission's final report, along with criticism of the Ontario government for being too slow to bring in the military to help the province's hardest-hit homes.

Fullerton said her office first received copies of the full notes on May 6, 2021.

Notes on a May 18, 2020 CAF meeting about the Hawthorne Place long-term care facility said: "The ACCT [augmented civilian care team] described that when they first arrived at the [long-term care facility] there was 'feces and vomit on floors and on the walls.' One ACCT member discovered that two of the residents had dried feces under their fingernails for a prolonged period of time. The ACCT Team reported that there had been resident deaths due to dehydration and malnourishment."

A meeting about the CAF operation to assist Downsview Long-Term Care Centre, held on June 4, 2020, described deaths from neglect under the heading: "Was there any issue you feel should be raised to higher?"

"Large concern with the timing of arrival. It was noted by ACCT that 26 residents died due to dehydration prior to the arrival of the CAF team due to the lack of staff to care for them. They died when all they [needed] was 'water and a wipe down,'" the notes said.

The owners of both homes deny their residents died of neglect.

These notes are part of a package of some 14,000 pages of documentation on the CAF mission that has been requested by members of parliament on the federal health committee and may soon be publicly released.

But they are separate from the infamous CAF report on long-term care that was released to the public and the province of Ontario last May to widespread outrage. That report also contained disturbing allegations and prompted the Ford government to launch the long-term care commission.

However, that initial report did not contain the allegations about deaths from neglect nor the specific reference to 26 fatalities at Downsview. A CAF spokesperson told QP Briefing that the initial report was the only documentation given to the province last spring.

At the time, Premier Doug Ford promised an investigation would take place.

However, opposition MPPs have questioned whether or not that really occurred, in part due to comments from Solicitor General Sylvia Jones earlier this month that there was no ministry-led investigation, nor would there ever be one.

Fullerton said Friday that investigation did occur last year, with involvement from inspectors from her ministry as well as the Office of the Chief Coroner. She said it was up to the coroner's office to alert police.

That investigation did not result in police involvement concerning the two Toronto homes that are now under investigation once again. However, the Durham Regional Police Service has launched an investigation into a death at a third home, Orchard Villa in Pickering, where the military alleged in its initial report that a resident had died from choking after being improperly fed.

However, the ministry of long-term care inspectors made no findings concerning that choking death.

The military reports are not the first warning the province has had that seniors were dying from neglect in long-term care. Interviews conducted with the long-term care commission made public months ago included concerns that the collapse of staffing led to increased resident deaths when seniors didn't receive enough help with eating and drinking.

Families have shared similar concerns with the media.

Neil Shukla, whose grandfather Nemai Mallick died at Hawthorne Place on April 27, 2020, is doing so now.

"We know for sure that he didn't have COVID when he died," said Shukla. "And when he did die, it was very all of a sudden."

He said his family struggled to get clear information about how his grandfather had died in his bed but felt the explanations they were given "didn't fully add up, or make sense."

"When this report came out, and they said that residents had died of like dehydration and stuff? Just connecting the dots, our family is now wondering, did he die because he wasn't being given water?" he said. "And it just feels like a very realistic possibility that that's the way he died."

"And we want answers," he said. "And we want justice. And we want some people to answer for this."

Shukla said his family pursued answers a year ago, asking both the long-term care home and the coroner's office for an investigation and autopsy to be performed. They were told that the determination of the home's physician would be relied on — and that was a concern for the family because that doctor hadn't actually been in the home during the pandemic.

While the Office of the Chief Coroner has not confirmed if it investigated any deaths at Hawthorne Place during the pandemic, the home itself has said none were.

QP Briefing has reached out to Hawthorne Place about Shukla's concerns.

In an earlier statement, the home denied residents died of neglect.

"Every death certificate issued in Ontario must include a cause of death and be signed by the attending physician," said communications director Nicola Major. "None of the death certificates issued for Hawthorne Place residents cite neglect, dehydration or malnutrition as a cause of death. There have been no investigations into any deaths at Hawthorne Place."

Shukla said he and his family had complaints about the home over the seven years his grandfather lived there, both about its cleanliness and the level of care his grandfather was provided at the for-profit home. He added that he hopes what has happened convinces the government to review the profit model.

He said his grandfather was a "kind and humble" man who grew up in India and emigrated to Germany before coming to Canada and leading a "long middle-class life." He died at 90, with dementia, and wasn't generally one to complain, and wouldn't have demanded the care he required, said Shukla.

"The vulnerability, the trust he had, it was just betrayed," he said. "And then to just go like that, and those conditions. Just a travesty."

The news of the provincial government investigation isn't enough for Shukla, he said. "I'm not going to be happy until I see some measurable results, see some accountability."

At her press conference, Fullerton said her "heart goes out to all of the families who have been devastated by this."

"It's important to understand, not only what happened, but the devastation that all of these deaths have been for families and loved ones in this terrible, terrible time," she said.

Asked if she believes the CAF members who said that residents died of neglect, and the similar concerns from family members and health-care providers and experts over the past months, she did not say so.

"We have to understand what happened," she said, "and verify the information that we are receiving."

Editor's note: After publication of this article the owners of Hawthorne Place, Responsive Management Group, released a statement to QP Briefing.

"To protect our residents’ privacy, we are unable to comment on a specific case or incident.

"All long-term care homes across Ontario follow the same process when a resident passes.

"Residents are under the care of the home’s attending physician who is intimately involved in the residents’ medical history treatment. When a resident passes, the attending physician completes a death certificate and provides a cause of death based on their medical knowledge of the resident's health and any pre-existing conditions. In most cases, the physician communicates directly with the family about the cause of death and answers any questions they may have. The death record of anyone who passes in a long-term care home is filed with the Coroner’s Office. However, if any concerns are brought forward with respect to the resident, their care or the cause of death, the case is shared directly with the coroner to review.

"The decision to conduct an autopsy is made by the coroner based on their knowledge of the case and their expertise. The home and its management do not have the authority to decide if and when an autopsy is conducted. Our residents and their families are at the forefront of everything we do, and all resident deaths are responded to with the deepest of respect. The family and loved ones of the resident are in our thoughts and, in addition to expressing our condolences, our team and the attending physician will connect with the family to address their concerns directly."