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A nurse with COVID-19 symptoms worked up to five days at a Montreal seniors home where at least 30 residents have died since March 27, according to documents shared by the owner of the long-term care facility with Global News.

Public health officials believe the disease started spreading at the Résidence Herron private nursing home, located near Montreal’s Trudeau airport, in mid-March, according to the recently released documents.

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The files consist of correspondence and legal letters sent between officials from government, public health and Katasa, the company that owns the residence.

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The tragedy has prompted new investigations by the coroner, public health officials and the major crimes unit of the Montreal police.

The nurse in question started showing symptoms on March 23 and worked on two out of the three floors of the building until March 27, according to a chart that was shared among local public health officials and the Herron residence’s administration.

A Montreal public health official had emailed the document and other spreadsheets to the owner of the long-term care facility as part of regional efforts to investigate and confirm which staff members were infected with the virus.

READ MORE: Quebec premier calls for help to staff nursing homes as coronavirus death toll climbs

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The correspondence also includes a mobile text message, sent early in the morning on March 29, in which a local public health official told the home’s manager that she wanted the seniors home to stop sending its residents to a nearby hospital, the Lakeshore General.

“There has [sic] been COVID-19 positive cases and… you have a very sick nurse working in your environment,” wrote the official, Brigitte Auger, who would later be placed in charge of managing the facility.

“The ambulance workers made a [complaint] to Santé Publique [Public Health]… Positive cases unless [they are] severe respiratory problems need to be kept in the establishment. The staff need to be wearing the proper equipment.”

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Later that evening, after officials had assessed the state of the home and said they found many residents lying hungry and dehydrated on soiled beds with few remaining staff, Auger’s boss, Lynne McVey, emailed the home’s manager after 9 p.m. to say that the facility would be placed under trusteeship.

Katasa released the documents to media outlets at a time when its Herron facility and other long-term care homes are becoming hot spots of COVID-19 cases, making up a large proportion of the hundreds of deaths in Canada that have been linked to the virus in recent weeks.

At least five of the residents who died had confirmed cases of COVID-19 at the Montreal nursing home, which has been on the receiving end of multiple allegations of health, safety or sanitary problems, interviews and documents reveal.

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Relatives of residents at the Herron home have alleged neglect and understaffing, while one Quebec legal document pointed to a cost-cutting campaign launched by Katasa after it bought the 154-bed facility in 2015.

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“It’s like the elderly are completely forgotten,” said Leane Conti, whose 79-year-old mother had lived in Herron for nearly two years and was moved to a hospital after being diagnosed with COVID-19.

“There needs to be more control; there needs to be a higher standard of care.” Tweet This

Conti is among several families who are searching for answers after 31 residents died near the end of March. Five deaths were confirmed COVID-19 cases, while the other causes of death are still undetermined.

Katasa chief executive Samir Chowieri and his three daughters, Katherine, Tanya and Samantha, own and manage Herron and a group of other retirement homes and residential buildings in Quebec and Ontario. The company charges several thousand dollars per month for each resident at Herron, which it describes in its marketing as a place that provides “Luxury. Comfort. Convenience. Security.”

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In the correspondence shared by the company, Samantha Chowieri blamed the regional health officials at Montreal West Island Integrated University Health and Social Services Centre (IUHSSC) for creating a “catastrophic” situation once they took control on March 29.

This includes allegations that staff, under the supervision of local public health officials, did not consult clinical charts prior to treating and medicating patients and that they failed to isolate patients with COVID-19.

Although Quebec Premier François Legault has alleged that someone was trying to hide the deaths from the government, Katasa has alleged that most of the deaths occurred after local public health officials arrived to offer assistance and take over management of the facility.

Katherine Chowieri told Global News in an interview that staff at the Herron residence, like other health-care facilities, struggled to contain the virus and keep its employees on the job in March because it was facing a shortage of personal protective equipment for staff, despite asking the government for help procuring supplies.

“It’s not easy to be faced with these allegations that we were responsible for 31 deaths,” she told Global News, adding that the company has fully co-operated with the province.

“As soon as they came in on the 29th, they told us that they were taking charge of our building, and we were happy for that. And we wanted help.

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“We needed help to manage the situation,” she said in a Skype interview from Gatineau, Que., where Katasa’s head office is located. “And as of that day, we stayed in constant communication either by text messages and emails on a daily basis to help them find staff.”

At least one other nurse who tested positive for COVID-19 worked in the facility after developing symptoms, according to the charts with the employee test results included in the correspondence. The charts also indicated that there were staff with the disease who were working on all three floors of the building.

Katasa did not immediately respond to questions about how or why a nurse with symptoms may have been allowed to continue to work in the facilities.

Katherine Chowieri also said there was an industry-wide labour shortage affecting long-term care facilities and that her own facility had offered bonuses to staff as a result of the COVID-19 pandemic. She also said that salaries were negotiated collectively with the union.

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“We’re not the only retirement home that’s living through this situation right now,” she said.

The correspondence released by the Herron facility includes letters and emails sent between March 29 and April 12 after the government officials had moved into the building.

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In one of the first messages, the email sent to the Herron manager on the evening of March 29, McVey, the top regional health administrator, wrote that the local health authority was taking over management of the building after its residents “had been abandoned” by staff and “sent in large numbers toward the emergency room of the Lakeshore General Hospital.”

The responses show that the company had asked the government for help, that it was happy to get assistance and that it repeatedly asked for more clarity while criticizing health officials for making negative comments about the facility.

The back-and-forth messages continued as both sides appeared to make frantic efforts to find nurses and orderlies to fill in for quarantined staff members who started calling in sick after the virus spread among dozens of health-care workers and residents at the building.

Samantha Chowieri, who had been working out of the Montreal facility, noted that the quarantine measures recommended by the government were the main issue that forced the core staff to stay away and that even her manager was forced to stay home after showing symptoms of COVID-19.

She also said in a March 30 email that physicians of the residents were the ones who decided to send some patients to the hospital.

The government responded by asking the owners to be more co-operative, including through formal legal warnings that instructed Katasa to comply and turn over the keys to every room in the building.

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In one of the letters, sent on April 8, the government’s lawyer accused the company of telling a job agency that it wouldn’t pay the wages of new personnel, leading that agency to not assign any health-care workers to the embattled facility.

Katasa did not respond to a question from Global News about this allegation.

Samantha Chowieri wrote in an April 8 email that the tone taken by the health officials was leading some employees to lose faith in the company management.

She also questioned why at least one employee was sent by local public health officials to work at another facility.

In a separate response, dated April 9 and addressed to the Quebec health minister, Katherine Chowieri alleged that local health officials weren’t taking adequate steps to separate residents who had tested positive for COVID-19 from other residents in the building. She also warned in this letter that a “catastrophic” situation was unfolding.

In the interview, Katherine Chowieri told Global News that she doesn’t understand why local health officials issued an order to access clinical files, saying that they were available but that the newly assigned staff were treating and medicating patients without consulting the information.

“I would like to ask them to prove that they tried to communicate with us before sending us a lawyer’s letter,” said Katherine Chowieri. “Why did we have to escalate from us being on the floor with them and in contact on a daily basis, and then escalate that directly to sending us a lawyer letter — an order to send them information?”

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Katasa did not share all of its correspondence with Global News, and it declined to share at least one formal letter it received from McVey, the local health authority’s top administrator, on March 30.

Meanwhile, Conti, the daughter of Carole Stewart, who has lived in Herron for nearly two years, noted that she had numerous concerns that her mother was allegedly neglected inside the residence.

Conti described one incident earlier this year in which she claims she had to cut the vomit from her mother’s hair after it had been left for so long it became caked to her head.

“It’s almost unbelievable, honestly,” Conti said, adding the family was paying nearly $6,000 a month for a room at Herron. “I used to send them pictures and say, ‘Look, it’s been two weeks, and the same dirt is in her room’… spoiled milk and just dirt.”

Katasa declined to comment about this specific incident.

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In another instance, Conti alleged her mother’s feet became infected after she wasn’t bathed properly.

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“Her toes got infected a few times, and because of her paralysis, she doesn’t feel it,” Conti said. “It’s shocking.”

Stewart, who is partially paralyzed after several strokes, didn’t want to leave the home because it would be too much “emotionally and physically,” Conti said.

Patrizia Di Biase-Leone’s 97-year-old mother lives at Herron. She and her husband Franco Leone are hoping for some “truth” to come out of the investigation into the home.

“The transparency that we never got, that would be great. A bit of light at the end of the tunnel,” Leone said. “It would clarify what really went on in there.”

They are concerned Patrizia’s mother, who has dementia, isn’t being cared for properly with limited staff at the home and concerns of the new coronavirus spreading.

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“We need the situation to be stabilized and prove to all family members that their loved ones are actually being cared for properly,” Leone said. “As much as they’re painting the picture that everything is under control, everybody else out here is not getting that feeling.”

When asked about claims of unsanitary conditions at the residence, Katherine Chowieri said that the facility “properly evaluated” how much care each patient needed.

“The way the care is charged is based on an evaluation of each patient and the care each patient needs on a daily basis — the hours of care needed on a daily basis,” she said.

Quebec’s premier said over the weekend that Katasa had refused to comply with health authorities after they stepped in on March 29 and called it a case of “gross negligence.”

“Herron is charging something between $3,000 and $10,000 a month to residents. So they must be able to pay well their people with this kind of money,” Legault told reporters on Monday.

“So there’s no excuse for me.” Tweet This

Katasa blamed public health officials for making mistakes that may have led to the virus spreading within the building.

“They were roaming around,” said Katherine Chowieri in the interview. “There was no confinement or isolation done of patients that were supposedly COVID positive.”

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Legault was asked about claims that health-care officials made mistakes and declined to comment on the specifics.

“Listen, there are three investigations underway: one by public health, a police investigation and a coroner’s investigation,” Legault said on Monday.

“So we should be able to know who is to blame once we have the results of these investigations. For me, what I was told is that the problem really came from the [Herron] facility and its management, but we will shed light on this entire affair.”

However, the government is also facing questions over its response to the outbreak after several reports had raised concerns about the residence.

Quebec Health Minister Danielle McCann said over the weekend that because Herron’s owner was not co-operating, the government didn’t realize until Friday that 31 residents had died. ​

McCann announced Saturday that health officials would visit all of Quebec’s 40 private nursing homes, and following these inspections, the government identified a handful that it has placed under close surveillance.

Seniors home hit hard by COVID-19

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Before buying the Herron residence in 2015, Katasa hired a consultant who found that the facility was losing about $300,000 per year and having trouble maintaining quality services.

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According to a Quebec labour board ruling, the consultant instructed the manager of the facility to create a list of positions to abolish and proposals to increase fees charged to clients.

The ruling outlines how the new owners of Herron were looking to make a profit “immediately” by increasing the occupancy rate from 55 to 88 per cent. The ruling also said that the plan of the new owners included improving the quality of services in the building.

“At the start of 2016, [the Katasa consultant] noted that the situation was not improving,” the document said. “The occupancy rate was not increasing as desired, the reorganization of food services is not going as planned and the financial results for January and February 2016 were negative.”

The company later fired the manager, without cause, according to the labour ruling. He ultimately won the wrongful termination case and was awarded his salary and benefits, according to the ruling.

READ MORE: Nearly half of Canada’s COVID-19 deaths linked to long-term care facilities

Katasa said it did “some reorganization,” as the residence was managed by a different company before they purchased it.

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“We have our own way of managing our building,” Katherine Chowieri said. “And so we did have to reorganize the staffing structure of the building.”

The residence’s occupancy rate was about 80 per cent, according to the most recent provincial inspection report that was drafted following Health Ministry visits on March 5 and 6, 2019.

The report also concluded that Katasa was providing adequate care while making some recommendations, including a requirement that the company elaborate on policies to protect vulnerable residents.

Long-term care facilities across the country have been devastated by outbreaks of COVID-19 that have killed dozens of residents.

One nursing home in Ontario has seen almost 30 residents killed by COVID-19 infections, while another in Vancouver had 18 deaths.

Sharleen Stewart, president of Service Employees International Union, which represents 60,000 health-care workers, told Global News that what is happening at Herron is systemic at long-term care homes across the country.

“Those corporations have always and will always put profits before people,” Stewart told Global News. “They will cut everything including staff.

“There’s serious problems in there, but the shortage of staff, selling facilities like this and pinching pennies and redeploying people, that is a systemic problem across the country,” she said. “That is not unique to that home in Quebec.”

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Social worker Mandy Novak spent her Easter Sunday volunteering at Herron after government officials had spoken out about the lack of staff on each floor.

She painted a bleak picture inside the residence, now under the management of local public health authorities.

“There’s a smell in there, a smell of the deceased,” she told Global News. “There are wounds that need to be taken care of and were not taken care of for a long time.” She said there were clear signs of negligence.

Keira Whitehead spoke with Global News outside the Herron residence, where her 89-year-old father John Whitehead died last Friday.

“It’s just progressively gotten worse. It’s the staff, the management, the owner. They’ll have to pay,” she told Global News.

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Whitehead said last year she had seen clear signs of her father being neglected.

“I took him to the dentist last year, and his diaper had not been changed,” she explained. “His feces were seeping out through his pants in the dental chair.”

Katasa declined to comment on this case.

In a separate case, a family moved their 90-year-old relative into a new home in February after alleging they had observed cases in which he was found lying in a soiled bed for extended periods of time and not properly fed or dressed.

In an audio recording from February that was shared with Global News, the man’s granddaughter, Katia Di Biase, can be heard raising the issue with a facility manager, who tells her that he understands why she was frustrated.

“We’ll definitely have to take some measures and actions not to be in the same position with other families,” said the manager in the recording.

Katherine Chowieri told Global News that she couldn’t speak about this specific case but noted that Katasa has been trying hard to increase staffing levels at the Herron residence.

“We did have issues with staffing, and I think as [Premier] Legault said, it’s an industry-wide reality. Whether or not salary is the base of it, I don’t know,” she said.

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“We did everything in our power, and we did everything to offer all services to each of the patients that we had — or each of our residents and offer the services. We never ended a day without ensuring that services were rendered to each patient.”

The family of the 90-year-old man who was moved out of the Herron home in February has retained a lawyer, Umberto Macri, to seek compensation from Katasa over how the former resident had been treated.

“Given that there is an investigation that has started, we want to see what the results of that investigation are before we… finalize our strategy,” said Macri in an interview.

Investigations of allegations of inadequate care

While new investigations are underway into the recent deaths, this won’t be the first time that a coroner has reviewed an incident at the Herron home.

A coroner’s report into the 2017 choking death of a 94-year-old woman said it wasn’t clear whether the staff at the home were properly trained to assist the woman and took adequate steps to save her.

“No incident report was filed. An employee involved in the incident said that she didn’t know a report needed to be completed,” the 2019 report said.

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“In this context, Montreal police investigated and met with the personnel. We must note that some of the statements from various witnesses are not entirely consistent, regarding the sequence of events.”

According to the report, video footage of the incident taken from cameras in the cafeteria do not show whether anyone tried to perform the Heimlich manoeuvre, CPR or any other procedure to help the woman.

The coroner, Julie-Kim Godin, wrote in her report that most witnesses said that some of the people who were present had tried to tap the woman on the back, but none of them could agree whether anything else was done. Godin said that the medical file also doesn’t specify what happened after the woman started choking.

The report also noted that staff should have known that the woman was at risk of choking while being fed due to her medical condition. The coroner also said she tried to ask questions to the facility regarding the staff response to the women choking and they didn’t respond to her requests for information.

Katasa said that following the coroner’s report, “corrective action” was taken to address the issues.

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“[Our manager reached] out to the deceased to meet with them and to go over those recommendations and to see how we can best fix the issues that we’ve had that we wouldn’t have this type of situation up in again,” Katherine Chowieri said in an interview.

In 2017, the province’s ombudsman also launched an investigation into the Résidence Herron after it received several complaints of inadequate nursing care, issues caring for patients with cognitive difficulties and food.

The investigation found that the facility was providing adequate care, but the ombudsman cautioned in its report that management needed to ensure there was enough suitably trained staff, given its intention to increase its number of patients.

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Patients’ rights advocate Jean-Pierre Ménard said the CIUSSS de l’Ouest-de-l’Île-de-Montréal had failed in its oversight role of Herron.

“A public coroner’s inquest will be the only way to allow the public to understand what took place inside this residence,” he said in a statement.

“It is urgent for the authorities to immediately check on the condition of the residents in the older private nursing homes, including those owned by the owner of CHSLD Herron.”

Canada’s chief medical officer, Dr. Theresa Tam, said Monday that nearly half of all coronavirus-related deaths in Canada happen in long-term care homes.

She said public health officials were working on strengthening their response, and the federal government has released guidelines aimed at helping provinces, territories and vulnerable facilities prevent further spreading of the virus.

“The key observation is still that the severe outcomes are impacting those who are of the old age group, particularly those over 70, in terms of hospitalizations and death,” Tam said.

Meanwhile, Conti said her mother is in palliative care at a Montreal hospital and is not likely to survive the COVID-19 infection.

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“I’m shocked 31 people died but I’m not shocked that that happened there,” she said. “I feel horrible that that’s what everybody has to go through, but honestly I am not surprised.

— With files from Global News’ Dan Spector