N.B.'s top doctor at bottom of COVID-19 decision-making hierarchy, auditor general finds

The Office of the Chief Medical Officer of Health was at the bottom of New Brunswick's COVID-19 pandemic decision-making hierarchy, a new report by the auditor general shows, while third from the top, after cabinet and the cabinet committee on COVID-19, was a group that several MLAs say they knew nothing about.

The roles and responsibilities of executive committees were not always clearly defined or documented, and no records were maintained to support meetings of the "COVID core," Paul Martin said in his performance audit, presented Thursday to the legislature's standing committee on public accounts.

He described the COVID core as "the group of senior officials who supported the cabinet committee on COVID-19."

Tory MLA Trevor Holder said he didn't recall any such group and questioned what its purpose was.

Martin said, "a process was created whereby the Department of Health would bring forward advice to COVID core who would then review, challenge and provide strategic thought around the information."

Department of Health advice would then proceed to the cabinet committee on COVID-19 and on to cabinet, he said. The minister of Justice and Public Safety would then issue mandatory orders under the Emergency Measures Act "informed by advice from the Department of Health."

The provincial government made "difficult decisions, which significantly impacted the lives of New Brunswickers," such as restrictions on gatherings, mask mandates and closures of schools and business, Martin noted in his 99-page report.

Overall, the government reacted quickly to the COVID-19 pandemic with unprecedented measures aimed at saving lives, including the province's first state of emergency, he said.

But he criticized the government's level of preparedness. For example, New Brunswick did not have an updated pandemic plan, based on lessons learned from the H1N1 flu experience, he said.

He also found problems with the government's decision-making process, record keeping and communications.

"We found six instances out of 14 sampled restrictions in mandatory orders where public health measures were supported by verbal updates only," the report says.

One mandatory order from June 2020, that everyone who enters any building open to the general public must wear a face mask covering their mouth and nose, was reversed the next day, "after decision-makers asserted that it did not reflect the intended decision."

Holder said this "pointed out a significant gap."

"That wasn't leaving out a comma or a colon somewhere. That was a pretty significant oversight that changes what cabinet actually decided. That's a pretty big breakdown."

'Face' of COVID response missing from report

Tory MLA Andrea Anderson-Mason questioned the lack of reference to "what one would arguably say was the face of COVID [response] for us," Dr. Jennifer Russell, the province's chief medical officer of health.

"From my own recollection, she was very involved in the decision-making process and the advice that came from her department," Anderson-Mason said, adding she was surprised to see Russell's office at the bottom of the organizational chart.

Martin said the chief medical officer of health, assistant deputy minister of public health and deputy minister of health were among those with authority to attend cabinet committee on COVID-19. "So these people were in the room at these cabinet committee meetings," he said.

Like Holder, Anderson-Mason zeroed in on the COVID core. "Even though I was a member of cabinet at the beginning of the pandemic, this is the first that I have ever heard of COVID core."

She consulted with a few of her colleagues, she said, and they're "in a very similar situation."

"And yet we have a whole chapter dedicated to this elusive cabinet core. How do you actually know that it exists?"

Martin said he got his information from the Department of Health.

Anderson-Mason said she found some of the information in his report "quite concerning," citing as examples the lack of terms of reference and lack of records, such as meeting minutes, agendas, discussion notes or actions.

She also found it "bizarre" that Martin's report describes the COVID core as a subcommittee of the security and emergency committee, yet it's listed above that committee in the organizational chart.

Martin acknowledged she has a "great question there for the executive council office when they come in."

5 recommendations

Overall, the structures and processes established by the province for the COVID-19 response "set a framework for effective oversight," but there are opportunities to improve oversight to be better prepared for a future pandemic, Martin said.

Among other steps, he recommended the province:

• Prepare and keep emergency response plans up to date for all hazards, including pandemics.
• Test and update plans on a regular basis according to a pre-defined schedule.

In addition, he said, the executive council office should ensure the roles, responsibilities and expectations of all executive committees involved in provincial emergency response are clearly defined and documented; records are maintained for all committee meetings during an emergency response; and that recommendations and decision support be documented for any similar future emergencies, "as emergency situations become more stable with the passage of time."

The executive council office, in collaboration with New Brunswick Emergency Measures Organization, should undertake a post-operation review and incorporate communication lessons learned into an updated New Brunswick Emergency Public Information Plan, said Martin.

The executive council office should also ensure the Department of Justice and Public Safety, in collaboration the Department of Health:

• Undertake an after action review to evaluate the provincial response to the COVID-19 pandemic.
• Incorporate lessons learned into an updated provincial pandemic emergency plan.
• Create and implement a schedule to regularly test and update the provincial pandemic emergency plan.

The government agreed with all five recommendations, according to the report.

The legislature unanimously requested the performance audit on March 31, 2022.

Another volume is expected in December.