Coroner's inquiry into deaths in long-term care homes resumes as coroner looks for 'missing puzzle pieces'

·4 min read
Plush toys and flowers are shown outside Residence Herron in the Montreal suburb of Dorval, Sunday, May 10, 2020.   Dozens of residents died at Herron during the first wave of the pandemic. (Graham Hughes/The Canadian Press - image credit)
Plush toys and flowers are shown outside Residence Herron in the Montreal suburb of Dorval, Sunday, May 10, 2020. Dozens of residents died at Herron during the first wave of the pandemic. (Graham Hughes/The Canadian Press - image credit)

The coroner's inquiry into the deaths of thousands of seniors during the first wave of the COVID-19 pandemic resumed Monday with coroner Géhane Kamel looking for what she called "the missing puzzle piece" about preparing long-term care homes for the pandemic in early 2020.

The lone witness Monday was Pierre Lafleur, a former high-ranking bureaucrat in Quebec's Health Ministry. He was responsible for convening meetings of one of several COVID-19 working groups in the ministry in the weeks leading up to the pandemic.

Kamel asked Lafleur if the ministry issued an alert to health-care institutions about the potential threat posed by the pandemic at the first meeting of this group on Jan. 28, 2020.

Quebec Health Ministry
Quebec Health Ministry

Lafleur testified that it was more of a "yellow flag" than a "red flag" and that the first real warning by the province didn't come until late February 2020, when the World Health Organization declared a global pandemic and cases started appearing in Quebec.

Kamel said she still feels that no witness from the province has clearly explained what happened in terms of preparing long-term care homes between January and March 2020.

Lafleur countered that at a Feb. 6, 2020 meeting, the ministry suggested 25 concrete measures health-care institutions could take to prepare. But he also said he wasn't sure if there had been any follow-up, to make sure the measures were implemented.

Kamel commented she was still concerned that specific warnings and guidelines for long-term care homes came much too late.

Witness testimony was supposed to be finished by now, but Kamel added extra witnesses this week to try to fill in some of the gaps.

Martin Simard, a bureacrat who worked with Lafleur, was also supposed to testify Monday but due to a scheduling conflict his testimony has been pushed back to Friday or possibly next Monday.

Cabinet minister to testify later this week

The inquiry won't reconvene now until Friday, when it's scheduled to hear from perhaps its most eagerly awaited witness: the minister responsible for seniors, Marguerite Blais.


Blais was originally scheduled to testify last fall, but her testimony was delayed because she was on sick leave.

It wasn't clear at the time if Blais would ever testify, so the former health minister, Danielle McCann, testified in her place.

During her testimony McCann largely deflected blame away from the CAQ government, suggesting that it was the individual CEOs of local health agencies who were ultimately responsible for preparing care homes for the pandemic, and that they were well-placed to do so.

McCann also blamed the previous Liberal government's health reforms for cutting important mid-level manager positions that weakened the chain of command in care homes.


Speaking with reporters after her testimony McCann said her government's actions "saved many lives" in long-term care homes.

Blais may strike a different tone.

In a surprisingly candid interview with Radio-Canada in 2020, Blais seemed ready to admit some of her government's failings in preparing care homes.

"Our perception was very hospital-centric. We had forgotten that CHSLDs are care settings in the same way as hospitals," Blais told Radio-Canada at the time.

She also lamented the fact that in March 2020 the Health Ministry created 11 sub-committees to deal with COVID-19 but there was no sub-committee dedicated to seniors.

"It was unacceptable that there wasn't a seniors committee. I can't explain to you why there wasn't. I don't have a good answer for you on this," Blais said.

And Blais gave an intriguing answer when asked if she thought she had enough power to act within the ministry, seeming to suggest that her efforts to protect seniors were limited by Premier Francois Legault.

"Power is extremely relative. Power is what the premier gives you. It's the premier who has the power. He is the one who decides the direction and what he wants to do with his government. So what does that mean, power?" Blais said.

"I wanted to make a difference. But we had COVID and we lost a lot of seniors. It's very difficult. I know I lost the battle for CHSLDs," she said.

After Blais and Simard's testimony, lawyers for various interested parties will make closing remarks to the inquiry. The closing remarks are scheduled to start next week.

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