QUEEN'S PARK -- Ontario’s chief medical officer of health “did not lead” the province’s response to COVID-19, Ontario’s auditor general has concluded in a scathing review of the Progressive Conservative government’s handling of the months-long health care crisis.
Bonnie Lysyk’s special report into the pandemic determined that Dr. David Williams “did not fully exercise his powers” under the Health Protections and Promotions Act, did not issue directives to local medical officers of health to ensure a consistent response, and did not issue directives on their behalf to Ontarians.
“For instance, it was the province, not the chief medical officer, that finally issued an emergency order in early October 2020 to require masking for the general public,” the auditor’s report states.
Lysyk’s report also concluded that Ontario was “slower and more reactive” compared to other provinces largely because the province “failed to act” on key lessons highlighted after the 2003 SARS outbreak – contributing to “fragmentation and inconsistencies” across the province.
“The SARS Commission’s final report identified taking preventative measures to protect the public’s health even in the absence of complete information and scientific certainty,” the report states. “Instead, we found systemic issues and delays in decision-making.”
Initial response
During the initial stages of the pandemic response, Emergency Management Ontario was undergoing a “significant changeover” in leadership and was dealing with outdated emergency plans and a lack of sufficient staff – prompting the hiring of an external consultant, at a cost of $1.6 million, to create a new COVID-19 structure.
The result was the COVID-19 Central Command Table, which convened its first meeting on April 11, weeks after Ontario Premier Doug Ford declared a state of emergency, shut down schools and imposed a lockdown across the province.
The auditor also discovered that pandemic command structure became “overly cumbersome,” growing from 21 people to 500 members and was not led by public health experts.
“Public Health Ontario played a diminished role in the province’s pandemic response,” the report states.
Involvement of chief medical officer of health
Despite playing a prominent public role in the pandemic response, including bi-weekly news conferences and appearances at Ford’s daily news conference, the auditor concluded Ontario’s chief medical officer of health did not lead the province’s response to COVID-19.
Williams, according to the auditor, did not chair meetings of the Health Command Table and saw his role “further reduced” in August, when the government branch responsible for COVID-19 response and co-ordination was transferred from his portfolio to another provincial bureaucrat.
During an interview with the auditor, Williams also said he “would not” issue directives to local public health units without first consulting with the Health Command Table and the Deputy Minister of Health.
The auditor also discovered several delays in decision-making:
- Williams issued a memo on June 21“strongly recommending” that local medical officers of health issue their own directives to decrease the risk of transmission among migrant workers in the agri-food sector. The memo was issued eight weeks after the first farm outbreak, the report stated.
- Williams and the ministry of health “did not acknowledge” community spread of COVID-19 until March 26, “despite strong evidence of community transmission” as early as Mar. 15.
- An associate medical officer of health emailed Williams on Mar. 18 recommending mandatory masking of all long-term care workers but “no immediate province-wide action was taken.”
The auditor concluded that Williams “neither played a leadership role nor fully exercised his powers to ensure timely and consistent responses by local public health units and health care providers.”
Speaking on Wednesday afternoon, Lysyk said that it was clear Williams played "an advisory" role and that the decisions were being made by government officials.
"The command table was chaired by the Deputy Minister of Health, and sometimes when she wasn't there, it would have been chaired by Ontario Health. The recommendations from that would have went up to the coordination table, and that was chaired by the secretary of cabinet and the chief of staff to the premier.
"And then those recommendations would have gone to the cabinet and the premier."
Government’s involvement
The auditor’s report repeatedly highlights the role of the premier and his cabinet as the chief decision makers during the pandemic and noted that all COVID-19 command tables lacked “any decision making authority.”
The premier took a hands-on approach, even attending some of the command table video conferences, and took charge on the issue of universal masking to reduce community transmission.
“In some cases actions, such as requiring a mask mandate to be followed in each public health unit, were eventually executed by the premier and the cabinet,” the report stated.
Lysyk also said the Ford government’s “choice” of not giving Williams the lead role in the pandemic response was “unusual” and said the premier became the “key media spokesperson for COVID-19 in Ontario.”
“Local medical officers of health informed us that they were confused by provincial politicians delivering critical public health advice in place of the chief medical officer of health,” Lysyk said in her report.
The auditor noted that was in sharp contrast to other jurisdictions such as Alberta, British Columbia, and Manitoba where their chief medical officers of health were tasked with being the key spokesperson for the pandemic response.
Critics of the government have frequently asked whether the premier or the public health experts have been the driving force behind the pandemic response – even as they debate whether to extend Williams’s contract until September 2021.
“The question is not whether we want Dr. Williams as the chief medical officer or not. It is about how this government has mismanaged this pandemic and who is at the command table actually directing what’s going on in this province,” NDP MPP Doly Begum said.
Progressive Conservative MPP Robin Martin said Williams has been doing a “terrific job” during the pandemic and stressed the important of his recommendations.
“He does not let us tell him what to do. He gives his professional opinion and frankly, we’re stuck with it, because that’s his opinion. He’s a professional,” Martin said on Tuesday evening in the legislature.
Recommendations
The auditor general recommended giving the chief medical officer of health and Public Health Ontario a more prominent role in the pandemic response, including the power to chair key decision making meetings and leading the province’s public health surveillance.
In a response to the auditor, the Ministry of Health said Williams will continue to attend planning meetings “when agenda items require the expertise of the chief medical officer of health.”
The ministry it will consider the auditor’s recommendation to strengthen the role of the chief medical officer of heath when it resumes its overhaul of the health care system “once the COVID-19 pandemic is contained.”
‘Stick with the number crunching,’ government says
Ford defended Williams in his daily afternoon briefing on Wednesday and went as far as to say that the auditor general report “does nothing but undermine” the province’s health team.
“I have some serious, serious problems with this report. To say that Dr. Williams wasn't leading this response, it just isn't right,” he said. “I'll tell you, I won't stand for this. My friends, ultimately, as your elected premier, the buck stops with me. But Dr. Williams has been riding shotgun with me from day one.”
Ford went on to say that the independent officer of the legislature should “stick with the number crunching” and should not be offering recommendations on medical advice.
“To sit in the office and throw hand grenades at Dr. Williams and his team and the minister of health is totally unacceptable, totally unacceptable. Stick with looking for value for money, stick with the job that we hired you for,” the premier said.
“Don't start pretending you're a doctor or health professional, because I can tell you, you aren't. Stick with the numbers, stick with the number crunching.”
Speaking to reporters prior to the news conference, Health Minister Christine Elliott called the auditor general’s report disappointing and said there was a “mischaracterization of the province’s pandemic response.”
“The reality is that over the course of the pandemic there have been different views—different views among public health officials amongst the medical community amongst policymakers and of course the public,” she said.
“While we welcome certain other recommendations from the auditor general, many in areas where we were continuing to make improvements, we have different views on various aspects of her report. No jurisdiction is perfect.”
Elliott said there were a number of issues she tried to get Lysyk to alter before publishing the report, but “no changes were made.”
“We had an agreement to disagree about certain aspects of the report,” she said. “I would say one big area of where there was a disagreement on the facts was with respect to our initial response to the pandemic.”
Lysyk later told reporters that all items in her report were "vetted for factual accuracy" and signed off by various departments. She said that the pushback by the government was "unexpected" andreiterated that her report isn't a criticism, rather it is meant to help guide future decision-making.
"The intent is to make sure that the issues that have been highlighted get finally get addressed."
The health minister said that Williams did attend the command table meetings and offer recommendations, saying that she has “complete confidence” in his ability.
“I know that he has been a leader throughout,” she said.
Liberal leader Steven Del Duca said the report indicates that the premier “just can’t be trusted” and that his government did not listen to public health advice.
“(The report) was a complete indictment of Doug Ford’s incompetence in terms of completely dropping the ball with respect to Ontario’s COVID-19 response,” he told CTV News Channel.
“Doug Ford owes the people of Ontario an apology.”
Del Duca said the “scathing” report is not about Williams, but rather about the premier who has been the decision-maker throughout the pandemic.
In a news release issued Wednesday, the Liberals went on to say that the Progressive Conservative government has been “steadfast” in its support of the auditor general's findings for years and questioned why there is a disconnect now.
