Families of residents at Ontario’s hardest hit long-term care home are calling for an investigation into all death certificates and records issued during the pandemic, alleging the proper process was not always followed and the home’s real death toll due to COVID-19 could be higher than what has been reported.
Cathy Parkes, whose father Paul was one of 71 residents who died at Orchard Villa in Pickering, Ont. during the pandemic’s first wave, said she knows of five to 10 family members, including herself, who have concerns about their loved one’s death certificates.
“It has happened quite a bit, and there’s been a lot of struggle getting information, getting death certificates,” she told HuffPost Canada.
“In history, when we look back at what happened, there needs to be an accurate snapshot of what happened in there,” she said. “In some cases, I’m concerned that they put other causes of death, so that we wouldn’t truly know how bad the amount of deaths were, due to COVID there.”
There is a difference between a statement of death, a legal document provided by a funeral home, a medical certificate of death, which is filled out by an attending doctor or coroner and includes the cause of death, and a death certificate, issued by the province of Ontario when a family applies with those two documents, according to Service Ontario.
Orchard Villa family members did not specify the type of document they want reviewed, but said they want an investigation of all certificates and records relating to deaths at the home.
Ongoing investigations: lawyer
Melissa Miller, a partner at Howie, Sacks & Henry LLP, who is currently representing around 80 families engaged in civil actions against Canadian long-term care homes, told HuffPost she has a number of clients involved in ongoing coroner investigations because of issues with medical cause of death certificates.
The issue goes both ways, she said. In some cases, a resident’s cause of death is listed as COVID-19 but a family might believe or have records to suggest they actually died of dehydration or starvation, while in others, the home has listed a different cause of death, like pneumonia, when the true cause of death was COVID-19.
“If a coroner who’s investigating a death believes there’s been foul play, or some reason other than a natural cause of death, the coroner will do an investigation and police will then decide whether charges may be appropriate in the circumstances,” Miller said.
She said the number of residents who died from COVID-19 or neglect from not being properly cared for once testing positive needs to be questioned.
A spokesperson for Ontario’s Chief Coroner’s office said she couldn’t comment on any cases that may be occurring. The coroner’s office wouldn’t investigate death certificates, the spokesperson said, but could be asked to review a death, which could result in a change in the cause or manner of death.
Long-term care homes submit an Institutional Patient Death Record (IPDR) to the coroner to report deaths, which acts as a screening tool to identify deaths in a home that would require a coroner’s investigation, the spokesperson said. If the coroner doesn’t investigate, a physician at the home would sign the death certificate.
The spokesperson said if families have questions about the cause or manner of a loved one’s death, they should contact the attending coroner for information.
WATCH: Ontario promises new standard in long-term care. Story continues below.
A spokesperson for the Registrar General, which holds death certificates in Ontario, said its office “is not aware of any allegation or investigation into incorrectly completed medical certificates of death.”
Candace Chartier, Chief Seniors’ Advocate and Strategic Partnerships Officer at Southbridge Care Homes, the company that operates Orchard Villa, said in a statement to HuffPost the company can’t discuss individual residents for privacy reasons. Orchard Villa’s protocols for resident deaths during the pandemic are in accordance with directives from the Ontario government and Office of the Chief Coroner of Ontario (OCC), she said.
That process includes either a registered nurse or registered practical nurse working with a physician to complete the documentation required by the OCC — the Managing Resident Deaths Report and the IPDR. That documentation is then sent to the OCC, the authority responsible for signing the death certificate.
‘Lie after lie after lie’
Pamela Bendell, whose mother June died in May after living at Orchard Villa for over a decade, told Ontario’s long-term care commission in October that a coroner told her that her mother’s death was accidental — but has since changed the report to say she died of COVID-19.
“My mother didn’t have COVID. So there’s an investigation into that,” Bendell told the commission, according to a transcript posted online. “It’s been lie after lie after lie after lie.”
Marie Tripp, whose mother Mary Walsh died at Orchard Villa in April from COVID-19, told the commission families want all death certificates issued from the beginning of the pandemic to the present to be reviewed and revised to include COVID-19 as the cause of death where necessary.
“We are aware that some certificates have other causes of death even though the resident was COVID-19 positive,” Tripp told the commission.
Tripp also said families believe that from March to today, staff at Orchard Villa pronounced multiple deaths despite not holding the required medical licence to do so. Families want action taken if it’s found that a registered physician or registered nurse did not fill out a death certificate, she said.
Parkes said she heard personal support workers at the home called deaths.
She is also concerned for funeral home staff who have been impacted by a family not knowing a loved one died of COVID-19.
Parkes said her family told the funeral home to treat her father’s body as a COVID-19 positive, which would signal to staff to follow infection prevention and control measures despite the low risk of transmission, according to the Ontario Ministry of Health’s funeral services guidance.
But she said other families who didn’t have confirmation of a loved one’s COVID-19 diagnosis or an accurate cause of death might not have known to flag anything to funeral home staff — potentially putting funeral and crematorium staff at risk if the deceased did have COVID-19.
Police holding off investigation: family member
Durham police have not responded to HuffPost’s requests for comment on potential investigations at Orchard Villa, first sent Oct. 29.
But Parkes said a detective on the case told her that police will be waiting until after the province’s long-term care commission releases its final report in April — despite commission lawyers telling families there’s no reason to wait.
John Callaghan, one of the commission’s lawyers, told HuffPost the commission has no authority over police, “including what or when it investigates.”
Parkes said it’s “frustrating” to have heard from police that they won’t investigate until April. As cases climb in Ontario the province’s long-term care homes appear to be repeating the same mistakes as the spring, she said.
Lawyer Matthew Friedberg previously told HuffPost there’s no reason why charges couldn’t be laid at long-term care homes now if police are investigating and have enough evidence to lay charges.
‘Substandard care’ at the home
Parkes and other family members have raised concerns about Orchard Villa’s handling of the pandemic for months. It was one of several homes that the Canadian Armed Forces was called into and part of the military report Ontario Premier Doug Ford called “appalling.”
Orchard Villa’s executive director Jason Gay previously told HuffPost the issues the military raised were being investigated and the home “appreciate[d] their willingness and commitment to assist us in caring for our residents during this pandemic.”
There are currently several claims and proposed class actions against Orchard Villa.
In their meeting with Ontario’s long-term care commission, family members said there was “substandard care” provided particularly during the pandemic. They alleged some dying residents did not receive oxygen, and others were left in soiled garments, were not fed properly before or during the pandemic and that there was a lack of communication while the home was experiencing an outbreak.
“We feel that almost every death could have had a different outcome if the families and [powers of attorney] were informed and allowed to send the residents to hospital, which many of us weren’t,” Parkes told the commission.
Chartier, from Southbridge Care, said the company takes all concerns about its homes seriously. Southbridge hired a new infection control lead and a recruiter to bolster hiring efforts. Staff are tested for COVID-19 every two weeks and continue to follow government and public health directives, she said.
Under a new management model at Orchard Villa, Southbridge is now directly responsible for overseeing front-line care and services, Chartier said. Lakeridge Health is also helping in an advisory role.
Family members are also calling for several more investigations at the home, including one into their allegations of a rise in urinary tract infections and bedsores during the pandemic and another into how for-profit homes allocate provincial funding.
In their exit report issued at the end of July, The Canadian Armed Forces, who were called into Orchard Villa in April, said members observed “inaccurate documentation” on several occasions, and management at the home had advised they would complete an investigation and action report.