Gordon Robinson | Tufton and Cornwall: end of the trilogy
Recently, I reviewed two professional reports delivered to Ministry of Health (MOH) in March 2017 on Cornwall Regional (CRH).
Today, I'll detail (edited for word count only) all 28 recommendations made by Jose Espino, the environmental hygienist who authored one of those reports, to see how they compare with the minister's words and actions, including his April 24 statement to Parliament:
The water-intrusion problem needs to be addressed before any refurbishing efforts/mould removal are attempted.
Why make this recommendation #1? Last Sunday, I explained that moisture is a mould growth accelerator. Extracting mould before cauterising the excess moisture source is worthless.
But, up to April 2018, Chris Tufton spoke only of awarding contracts to design and build a new ventilation system by the end of March 2018.
March 2018 came and went; CRH crisis remained. In April, Tufton told Parliament:
"In September 2016, there were again complaints of poor air quality affecting staff in the radiology department ... ."
RUBBISH! As I revealed last week, analysis of the September complaints exposed the following departmental prevalence rates: "Medical Records 80 per cent; Pharmacy 50 per cent; Physiotherapy 80 per cent; Radiotherapy 75 per cent; Radiology 100 per cent; Urology Clinic 100 per cent."
Tufton warbled on:
"Investigations revealed ... a chemical spill in the dark room and improper chemical storage ... which resulted in chemicals leaking into the flooring, ceiling and old HVAC system. This affected floors one to three of the hospital ... ."
But this was old hat. Espino's report chronicled that the September 2016 complaints led investigators to discover that the ENTIRE HOSPITAL was contaminated not by a chemical spill, but by TOXIC GASES.
Tufton: "[MOH] moved to take immediate action to correct the problem to secure and safeguard the safety of [CRH] employees and users ... . Steps were taken to DECONTAMINATE AND EFFECT DEEP CLEANING TO REMEDY THE CHEMICAL LEAK [my emphasis]."
MOH tried to "decontaminate" based on misidentified contamination sources WITHOUT FIRST ELIMINATING THE MOISTURE PROBLEM.
Back to Espino's recommendations:
A more thorough mould inspection is recommended to identify all sources of mould growth.
Mould removal should be done according to standard procedures.
Mould removal operations should be commissioned by a certified mould remediator. A detailed infection-control plan should be developed and implemented ... ."
Since March 23, 2017, what's been done? I can't trace Tufton publicly using the word 'mould' before April 24, 2018, after media/Opposition pressure. After finally admitting that the "PAHO report" had identified massive amounts of mould, he said:
"In two areas, levels internally were higher than external levels ... . These areas were either abandoned or comprehensive mould abatement carried out."
"... Comprehensive mould abatement"? Seriously? Holy Oxymoron, Batman! What about mould removal (not "abatement") AFTER water-intrusion elimination?
Tufton returned to the central issue, MOULD:
"Once the PAHO study was in-hand ... immediate steps were taken to engage a private firm to do mould remediation ... ."
Tufton didn't mention this contract in May 2017's address to staff or September 2017's update. "PAHO study" was dated March 23, 2017.
Considering hospital services cannot be suspended, we recommend renovation/cleaning works in phases. Areas should be isolated from the rest of CRH to prevent cross-contamination.
Two epidemiological studies (one for patients; another for staff) should be done to better understand the full extension of the problem.
Affected persons should be medically evaluated and an occupational medical programme implemented for them.
Instead, according to Tufton (April 24, 2018): "In May 2017, A/C and ventilation engineering consultants were contracted. This firm since completed the design for the new heating ventilation and A/C (HVAC) system. The contract for supply and installation ... was awarded in April 2018."
Chasing the wild goose
Jeez, Louise! These are the same contracts Tufton promised staff in May 2017. He's still chasing that wild goose in April 2018?
Espino's March 2017 recommendations continued:
All deteriorated ducts/linings should be replaced.
HVAC system should be evaluated by a mechanical engineer with experience in hospital settings ... .
HEPA filtration system should be corrected to comply with applicable standard.
All AC split units should be replaced and have a proper filtration system.
Sigh. Any progress, Minister? Does your recently contracted HVAC consultant have "experience in hospital settings"?
Espino listed some "should be" urgencies:
Handling chemicals done in an appropriate area with an extraction system to prevent cross-contamination.
A hazardous-communication programme implemented to make staff aware of hazards related to chemicals use.
A chemical hygiene plan implemented to inform staff of correct chemical handling techniques.
CRH cleaning protocols revised to assure proper levels of cleanliness ... .
Have these recommendations been implemented? More 'should bes' from Espino:
Operating rooms' ventilation set-up redesigned.
Glass-fibre air ducts replaced with metal ducts and alternate linings that don't contain fibreglass.
That's "replaced", Minister, not "cleaned", which only spreads contaminants.
We recommend an asbestos survey of the boiler area. All deteriorated insulation in boilers and tubing should be replaced.
Relocation of boiler
Thirteen months after UTech reported boilers were corroded and a source of toxic gases, Tufton told Parliament:
"Relocation of boiler was undertaken March 2018. Works are under way to recommission the boiler ... ."
UNDER WAY? After toxic gases were allowed to affect staffers for ONE YEAR?
The presence of lead paint is a possibility. We recommend a complete assessment by a certified lead inspector or industrial hygienist before any paint removal. Proper de-leading procedures should follow.
Laboratory ventilation system should be evaluated and biological safety cabinets replaced. A chemical hygiene plan for the lab should be developed/implemented.
Was the lead assessment done? Where's the chemical hygiene plan?
More 'should bes' from Espino:
Industrial hygiene (IH) staff need training in IH methods/interpretation of results. An IH plan developed.
Methodology for IH sampling revised to meet CRH's needs.
CRH/MOH IH staff need proper instrumentation for long-term monitoring of IAQ parameters.
Silence on this from Tufton as CRH's IH protocols remain substandard and underequipped!
A thorough safety inspection is highly recommended. Many safety violations were observed.
We recommend assigning a competent full-time safety and health officer for CRH.
Have the safety violations been rectified? Who's the safety and health officer?
Tufton to Parliament on safety and health:
"The welfare of staff, [and] patients was at the forefront of our minds. As such, [MOH] implemented measures to detect, document, and treat all healthcare workers and clients [with] complaints relating to ... poor air quality at CRH ... [including]:
- The establishment of a staff clinic ... .
- A reporting procedure for all patients and visitors with symptoms ... , a mechanism for patients to be treated ... and reporting procedure for staff members who report to work with symptoms."
Staffers get "a reporting procedure"? C'mon, man!
Implementation of the following three-tier approach:
Immediate remediation plan: Since closing the facility for complete remediation isn't a realistic option, remediation should start immediately in a well-planned process that allows working in priority areas.
Instead, Tufton spent months rabbiting on about contracts for 'assessment' (including of 'process flow') and to design/build a new ventilation system, which he ought to have known wasn't the solution.
Midterm actions: More detailed workers' health assessment is needed and should include a continuous surveillance system to follow up on existing and detect new cases ... .
Over a year later, only lip service.
Long-term actions: A comprehensive action plan on occupational health and safety is needed. It should include: "Safe Patient; Safe Worker Programmes, chemical safety, radiation protection, housekeeping and cleaning programmes, medical occupational evaluations, etc, which aren't in place ... ."
Instead, Tufton announces that MOH established a "working group to develop a framework to identify and address the concerns of staff and stakeholders ... .
Develop WHAT? A framework? 'Scrise! MOH knew from March 2017 what staffers' health concerns were. Why still fiddling?
On April 24, Chris Tufton spent time on "relocation" efforts. He said:
"... Relocation of services, staff, and patients commenced in 2016 and were well advanced as at March 2017. Approximately 70 per cent of [CRH] services were relocated ... ."
DWL! So what's the fuss about? Why'd UTech recommend, ON MARCH 19, 2017: "... Staff should be evacuated and relocated ... EXCEPT FOR ESSENTIAL SERVICES [my emphasis]?"
What staff? Where'd 77 sick staffers originate in February 2017? How'd they get sick? Why was a meeting with Tufton needed? Why overrule this common-sense proposal? In Parliament, Tufton declared: "... Only essential services were in operation on the main hospital building in 2017." But these were specifically exempted from UTech's recommendation.
What's up, Doc?
Tufton's tragicomic list of "relocation" exercises included "container purchases"; "renting outpatients' facilities"; "temporary" assignment of staff; and my personal favourite, "Relocation of chemotherapy services to eighth floor ... ."
Dr Tufton, time's up! Six hundred million dollars available for local government election 'bullo' work; $200m for undelivered cars for JCF; $200m for delivered 'crissas' to transport ministers; $200m to continue the King's House illusion. It goes on and on. But, naturally, no money available to implement Espino's recommendations. Bah, humbug!
Peace and love.
- Gordon Robinson is an attorney-at-law.
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