A “root cause” of the tragedy that led to 50 resident deaths at St Basil’s aged care home was an eight-day delay between the reporting of its first Covid case to Victoria’s health department and the testing of all residents, a coronial inquest has heard.
New evidence of failures at the home was obtained in recent months, counsel assisting Peter Rozen QC said in his opening address to the inquest, which began on Monday with the names of those who died being read as the court stood in silence.
Rozen referred to an independent expert report dated 11 November 2021 from a specialist emergency physician, Dr Ian Norton.
Norton’s report said the delay between the first case at the home being reported on 9 July 2020 and subsequent testing was “the root cause of a serious outbreak not being contained and the subsequent issues at St Basil’s”. At the time, federal government protocols stated testing should occur within four to six hours of a case being identified in aged care.
The report also said the decision by the state government to furlough the St Basil’s workforce, the repercussions of managing this falling to the federal government, and failures in coordination between both levels of government, was another “root cause” of the disaster.
“A successful response to an outbreak of this very infectious virus necessitated a high degree of cooperation and coordination among the various government and non-government agencies involved,” Rozen told the court.
On 21 July the Victorian chief health officer, Prof Brett Sutton – who will give evidence to the inquest on 24 November – decided that all staff who worked at the home between 1 and 15 July 2020 would be deemed a close contact and furloughed in the interest of the health of both residents and staff. Rozen said the commonwealth had “great difficulty” in finding a suitable number of experienced staff to replace them, and this had a “devastating” consequence for the residents.
Rozen told the inquest that a number of senior members of the original staff, including doctors from the medical team, warned senior state and federal government officials that furloughing the entire workforce would lead to neglect of residents.
One doctor told government officials on 21 July that furloughing the entire staff was a “shocking idea”, using his recent experience at Estia Heidelberg – where a replacement workforce resulted in medications being lost, meals not being provided, residents not receiving fluids, and other neglect of care – to stress his concern.
A senior geriatrician told the meeting that continuity of some regular staff was needed or “disaster” would occur. The facility manager at St Basil’s told the meeting that it would be “dangerous” to furlough all the staff, Rozen told the court.
“Despite the concerns of the doctors and the operator of St Basil’s, the 3pm meeting on 21 July 2020 concluded with a decision to press on with the replacement of the entire staff at St Basil’s” the following day, Rozen said.
Separately the secretary of the federal department of health, Dr Brendan Murphy, and the then aged care minister, Richard Colbeck, asked chief nursing and midwifery officer, Prof Alison McMillan, to go to St Basil’s on 22 July to assess the situation. Murphy wanted to move the residents out of the home and was concerned about the situation, the court heard, but wanted someone to assess the home to help make a decision.
McMillan assessed the home alongside a senior officer from the Victorian department of health.
“It appears that they spoke to the senior managers but did not assess the quality of the replacement workforce,” Rozen said. “They saw no residents, they did not tour the facility.”
McMillan emailed Murphy to say she thought St Basil’s was a “fit for purpose facility’ and there was “no need for a significant evacuation of positive residents to hospital”.
“On that basis, the question of transferring a significant number of Covid-19 positive residents out of St Basil’s was deferred, only to be revived in the form of a partial evacuation of the residents from late on the 24th of July as the true extent of the neglect became apparent to those at the highest levels of the commonwealth and Victorian governments,” Rozen said.
Senior commonwealth public servants in Canberra were making decisions about a home they never set foot in, he added. Rozen stressed that the replacement workforce at the home were not to blame, and that a number had gone above and beyond in trying circumstances, working 17-hour shifts for more than a week straight trying to help the residents.
“There were far too few of these workers at St Basil’s for them to have provided care at the level the residents deserved and the law required,” Rozen said.
Christine Golding, whose mother Efraxia, 84, died in the facility after contracting Covid, was the first witness to give evidence. She described her mother’s experience as “extremely dehumanising, sad, and inhumane”.
She remembered a call she received from a staff member before her mother’s death, when she was told that if all the staff were sent home, people would die from neglect rather than Covid.
“It sent a shiver down my spine,” Golding said.
While 45 residents died from Covid-19, five died from neglect, Rozen told the inquest.
“I want the true story to be told and documented Australians deserve to know why our aged care Covid-19 preparedness was so poor, and contributed to premature death,” she told the court.
The inquest continues.