22 out-of-province doctors for Vitalité did not fully self-isolate after travel

Twenty-two doctors from outside New Brunswick have worked for the Vitalité Health Network since the COVID-19 pandemic began without fully self-isolating for 14 days after travelling, says president and CEO Gilles Lanteigne.

Almost all of the doctors, known as locums, who fill in on a temporary basis, have worked in the northern part of the province, he said, including nine in the Campbellton region, where there is an outbreak of 28 active COVID-19 cases and where, last week, the province recorded its first death related to the respiratory disease.

The locums, who came from Quebec (16), Ontario (four), Nova Scotia (one) and B.C. (one), had contact with patients and other health-care workers because of the nature of their work, said Lanteigne.

But they were tested and monitored regularly and followed several "rigorous" conditions to limit the risk of transmission. For example, they did not use the same washrooms as other people or eat in shared spaces and had to self-isolate when they were not at work.

"I think we managed it well," said Lanteigne. "We were able to maintain some of the services that we deemed essential," despite a shortage of New Brunswick physicians, he said, noting about a quarter of emergency room shifts in the northern part of the province are filled by locums.

"And there was no situation which led to propagation of the COVID" from the locums used between March 15 and June 1, based on the contact tracing conducted by Public Health.

Provincial officials have linked the Campbellton outbreak, which started May 21, to a medical professional who travelled to Quebec for personal reasons and returned to work at the Campbellton Regional Hospital without self-isolating.

Dr. Jean Robert Ngola, who has had a family practice in the region since 2013, has been suspended by Vitalité, and the province has asked the RCMP to investigate whether charges are warranted.

Four new cases in the Campbellton region were announced Wednesday, including two people in their 80s and two people in their 50s.

Two are residents and two are staff at the Manoir de la Vallée, a long-term care home in Atholville, where 13 other elderly residents and four employees in the Alzheimer's unit have also tested positive. Resident Daniel Ouellette, 84, died last Thursday.

At least one of the new cases is outside the Alzheimer's unit, where all the previous cases had been contained, Dr. Jennifer Russell, the province's chief medical officer of health, told reporters.

A lone confirmed case of COVID-19 in the Moncton region — a temporary foreign worker in their 20s — is unrelated to the outbreak in the Campbellton region.

The individual, ​​​who brings the province's total number of active cases to 29, was following the mandatory 14-day isolation and has had minimal contact with others, Russell said.

New policy triggered by 'concerns'

Vitalité did not obtain isolation exemptions from WorkSafeNB for any of the 22 locums, who fill in during an illness, absence or staffing shortage, said Lanteigne. "At that time, it was not required," he said.

Of the 22 locums:

• Nine have worked in the Restigouche, Campbellton region (Zone 5).

• Eight have worked in the Acadian Peninsula, Chaleur region (Zone 6).

• Four have worked in Edmundston, Saint-Quentin region (Zone 4).

• One has worked in Moncton, Beauséjour region (Zone 1).

It was May 19 that the province's pandemic task force decided that "locums, short-term residents who are unable to self-isolate for 14 days prior to starting work, would be subject to WorkSafeNB's work-isolation policy," said Department of Health spokesperson Bruce Macfarlane.

The four-person task force created in April and given authority over all aspects of the health-care system's response, including health authorities, "had concerns" about the number of locums coming in from outside the province, he said in an emailed statement.

It discussed the issue on May 14 and decided it needed to "understand the volume of locums, the volumes of the different categories of residents, where they're coming from and for how long as well as the risks and impacts of bringing them into the province and their self-isolation requirements."

It also wanted a consistent policy for locums applied by the two regional health authorities — Vitalité and the Horizon Health Network, said Macfarlane.

Under the WorkSafeNB work-isolation policy, the requests for exemptions must be submitted to WorkSafeNB two weeks in advance for approval and be accompanied by a plan explaining the measures that will be taken to reduce the risks, he said.

Vitalité and Horizon are responsible to have "an operational plan to support/manage" the locums while they are in the province, he added.

Horizon follows full isolation

The "small number" of locums Horizon has brought in from outside New Brunswick since the pandemic began have all been subject to 14 days of mandatory self-isolation, said Dr. Edouard Hendriks, vice-president, medical, academic and research affairs.

Out-of-province locums were not eligible for the isolation exemption during the red and orange phases of the province's COVID-19 recovery plan, according to Horizon spokesperson Kris McDavid, "only since the implementation of the yellow phase."

Horizon currently has four locums from Ontario working within the organization — two in Moncton, one in the Miramichi region and one in the Fredericton/Upper River Valley region.

"Each of them have completed the required 14-day isolation period prior to beginning work," Hendriks said in an emailed statement.

Horizon anticipates the need for more locums this summer, he said.

If they have to be brought in from other provinces and "should the need be such where a 14-day self-isolation period isn't possible," Horizon will apply to WorkSafeNB for "work-isolation," Hendriks said.

Under this policy, locums would be authorized to go directly to and from work but required to self-isolate when not in the workplace for the first 14 days of their employment.

In addition, any locums coming into the province from so-called hot zones, where there are a significant number of COVID-19 cases would be tested for the coronavirus, and must remain in isolation until the test result is known.

No contact allowed

Asked to clarify what the isolation requirements for locums were before the task force's May 19 directive, Macfarlane replied, "This question should be addressed to the RHAs."

WorkSafeNB also would not clarify the isolation requirements and exemptions for locums and other health-care workers.

The media relations representative said no one was available for an interview and directed CBC News to the operational plan, Embracing the New Normal. "It will provide you with information that may answer your questions. Also, there are several FAQs," the unnamed person said in an email.

The online document says people entering New Brunswick for work for a fixed period must self-isolate for 14 days before starting work, "unless the worker is a person entering New Brunswick under an arrangement with an employer previously approved by WorkSafeNB."

An employer must, among other things, ensure that any workers from outside New Brunswick self-isolate within the province for 14 days, or submit a plan at least 15 business days before they arrive that ensures for 14 days after they arrive that they are:

• Isolated from any New Brunswicker while they travel to and from their accommodations and worksite.
• Required to remain at their accommodations and isolated from contact with any New Brunswicker during work hours and while off duty.

"Failing to comply with these requirements could result in significant fines plus a victim surcharge and administration fees," the 22-page document, dated May 8, states.

7 applications for exemptions

Vitalité has submitted seven requests for exemptions to WorkSafeNB, said Lanteigne.

Asked about Horizon's position that locums never qualified for exemptions before, he replied, "Well, it was different here."

Locums did qualify, he said, provided they went through a work-isolation. "Because otherwise, some services would have been closed."

Vitalité always tries first to find a New Brunswick doctor who can provide a required service, said Lanteigne.

If a New Brunswick doctor isn't available, Vitalité assesses whether the service in question is essential or could be temporarily suspended because of a lack of staff, he said.

"We are not in an easy situation, I think people understood this last winter," said Lanteigne, referring to the contentious emergency room reforms, which would have closed six rural hospital emergency departments overnight but were cancelled about public outcry.

Although Vitalité relies on locums largely to fill ER shifts, it has also called upon a gynecologist/obstetrician, a pediatrician, a psychiatrist, someone in medical imaging and a surgeon this year, he said.

Obviously, if we have a choice between a hotspot and not a hotspot, we're going to take physicians that is not from a hotspot.- Gilles Lanteigne, Vitalité president and CEO

If a service is deemed essential and must be maintained, Vitalité will then find a locum from outside the province. 

"Obviously, if we have a choice between a hotspot and not a hotspot, we're going to take physicians that is not from a hotspot," said Lanteigne.

But looking at the list of 16 locums from Quebec, he noted six were from Quebec City, four from Montreal, three from Bas-Saint-Laurent and three from the Gaspé region.

"So we're very careful, but you know, as I mentioned, risk-free is not … an option here," he said.

"I think that people have learned that any travel can have consequences," he added, referring to the case of the doctor at the centre of the Campbellton outbreak.

"What I can tell you is that we make sure that our policies and procedures related to work isolation are respected."

On May 28, New Brunswick's chief medical officer of health Dr. Jennifer Russell told reporters she wanted to "clarify the current policy around health- workers travelling outside the province.

"If any health-care worker living in New Brunswick and working in a New Brunswick health-care facility leaves the province for any reason — any reason whatsoever —  it is mandatory that they self-isolate for 14 days upon their return," before going back to work, she said.

The province's pandemic task force had issued a directive to health-care workers that same day "to provide clarity," Department of Health spokesperson Bruce Macfarlane confirmed to CBC News.

"There were anecdotal reports that reflected confusion between the federal government's exemptions for essential workers at the international border and the provincial requirement for all New Brunswickers to self-isolate upon their return to N.B.," he said in an emailed statement.

Some exceptions

Despite Russell's blanket statement, there are exceptions to the mandatory self-isolation for health-care workers who live and work in New Brunswick.

A health-care worker who crosses the border to provide care to a New Brunswick resident would be exempt, said Macfarlane, citing as an example a paramedic who transports a patient by ambulance to a hospital in another province.

Health-care workers who live outside New Brunswick but commute to the province regularly as an employee or medical staff member of a health-care facility would also be exempt.

"These individuals are reminded of the need to travel directly to and from their destination/work/accommodation, follow all guidelines for infection prevention and control and the use of personal protective equipment (PPE), self-monitor for symptoms, avoid close contact with vulnerable individuals (for whom they are not caring) and follow the guidance of the chief medical officer of health."

Stricter to protect most vulnerable

Asked why the isolation requirements are stricter for New Brunswick health-care workers who take a trip outside the province than for those who commute or for locums, he said the people most vulnerable to COVID-19 depend upon the services provided by New Brunswick's health-care workers on a regular basis.

"We need to ensure that patients and long-term care residents are protected as much as possible. With only a few exceptions, their work rarely takes them outside of the province.

"Non-essential travel has not been permitted under the mandatory order for some time, so there should be no other reason for them to leave."

Doctor speaks

Ngola, who is also known as Ngola Monzinga and as Jean Robert Ngola Monzinga, told Radio-Canada's La Matinale on June 2 that he made an overnight return trip to Quebec to pick up his four-year-old daughter because her mother had to travel to Africa for her own father's funeral.

He said he drove straight there and back with no stops and had no contact with anyone, and none of his family members had any COVID-19 symptoms at the time.

Ngola said he did not self-isolate upon returning. He went to work at the Campbellton Regional Hospital the next day.

"Maybe it was an error in judgment," said Ngola. But he pointed out that workers, including nurses who live in Quebec, cross the border each day with no 14-day isolation period required.

He said he's not sure whether he picked up the coronavirus during that trip to Quebec or from a patient he saw on May 19 who later tested positive for COVID-19.

At a news conference May 27, Premier Blaine Higgs did not identify Ngola, but described his actions as "irresponsible."