Speaking notes for Catherine Smitka
Walkerton Inquiry Town Hall in Toronto
October 29, 2001
Mr. Commissioner,
If I may, I would like to mention a few brief points of orientation about the Ministry laboratories. In 1975 when I joined the Public Health Laboratories of the Ontario Ministry of Health, the laboratory was a vibrant organization involved in the identification and detection of infectious diseases. It was also a reference laboratory for
hospital and private laboratories in the province, occasionally for other provinces and international laboratories, including the US.
Approximately 35 scientists worked in the laboratory. Each scientist supervised technologists working in a unit in their area of specialty, and in addition to diagnostic work carried out relevant research and teaching at universities. The laboratory was a leader in clinical microbiology and public health. I worked in six different
laboratories in this organization in the capacity of technologist and scientist.
· Erosion of research, development and scientific expertise in Ontario Public Health laboratories over the last quarter century leading to inadequate staffing
When an outbreak occurs through water or other vehicles, the Public Health Laboratory (PHL) provides the first line of response to these public health threats. In contrast, hospitals or doctors look after individuals, the federal laboratory coordinates national response.
The laboratory response to infectious diseases was and should continue to be a team effort starting from the reception and registration of specimens by entry staff, to screening and testing to technologists, implementation of specialized procedures and expertise from individual scientific staff for the samples which are unusual and
atypical. This is to be followed by reporting to proper authorities and provision of meaningful interpretation of test results by specialized staff.
The educational background of staff varies widely in respective categories. The scientists have completed anywhere from 8-13 years of university education, followed by years of laboratory experience in specialized research. Technologists typically have two years of community college after high school and general laboratory experience.
Today, following the deletion of mine and the four remaining scientists' positions in the Standards and Methods department, the laboratory testing is provided by technologists only. As the educational background of this group is at about the same level, the response is at the same level. The depth of expertise has been lost and the
balance of the team approach to the detection and identification of infectious diseases eroded. The ability to respond to new emerging diseases is compromised.
We witness a case of a system which wasn't initially broken but somebody decided to fix it anyway.
It became apparent perhaps even as far back as 15 years ago that scientists were not promoted, within or outside this category, or allowed to participate in secondment assignments, even though the technical staff advanced consistently. The scientific positions were not replaced.
The developmental work towards new laboratory methods was a slow process due to lack of technical support, office support, provision of funds for conferences to promote our work and setup collaborations or partnerships. In contrast, financial support was generally provided to technologists to attend local and national meetings or
conferences.
The microbiologists who left the Laboratories Branch previously, departed dissatisfied and expressed their dismay by writing to various levels of government - with no effect. All indicated their concern for the erosion of scientific expertise in the PHL, management's disrespect for knowledge and lack of support for public health.
The biggest challenge for us then became not research but self motivation to provide new ideas.
· Scientists replaced with kits fold by commercial companies
On October 19, 2001 we learned from the PHL spokesperson (Dr. Fearon) on CFRB radio that 99% of testing in the PHL is done by kits.
A kit is a set of pre-measured materials needed for a test. Kits test for known, routine infections. Most have backing of the company's technological support. But they are non-adjustable, patent protected and expensive.
They are appropriate for routine and private laboratories which recover their costs from the patient. The PHL testing is free of charge. Increases in the kit prices (particularly when the company finds out that the laboratory has no alternate methods) expands the budget. Meaningful evaluation and selection of kits should be based on
scientific expertise. Without scientific presence in the PHL, this "research" is run by the commercial company sales representatives who provide a few free kits as advertising.
New infections do not come with a kit.
Kits are not available for specialty testing - unusual, emerging and esoteric diseases not seen in large numbers.
The reference function of the laboratory cannot be continued by using kits.
The response time to unusual organisms which will not be detected by a kit will be unnecessarily prolonged without scientific support.
· Tests for new and emerging threats - Amethyst Award Winner 1998
I have developed over 15 new diagnostic methods and described a new pathogenic fungus. In 1998, I was a winner of the Provincial Amethyst Award for innovative research. I am very proud of it. I wonder why my work is all of a sudden not considered useful for the province for which it was done.
One example is a rapid test for yeast infection often afflicting infants. The identification time was shortened from three weeks to 30 minutes.
To bring the parallel closer to Walkerton:
In 1999, Northern Ontario experienced a different fungal environmental outbreak in man and dogs - blastomycosis. There were 61 documented cases and three deaths. During that time the scientific unit was excluded from routine communications in the PHL. I became aware of the situation quite late in the outbreak and realized that only one
of the three available tests being used. I alerted my supervisor and contacted the Health unit. I recommend further testing which helped in early identification and treatment of patients, and helped with epidemiological tracking mechanism. One summer student was employed by the health unit to complete this work. I was asked to prepare a presentation for my manager who
delivered it to the Kenora health units, but I was not allowed to go.
This is an example of dysfunctional system - tests were performed well but there was not connection and provision of expertise to the community. This clearly demonstrates the need for specialists in laboratory support.
· Lack of clarity regarding staff's roles
The management, scientific and technical categories became seriously disconnected in the provision of laboratory support.
Several layers of management were added to the administration during the past four years. Most positions seemed to be tracking money, not advancements in testing. The roles of the staff were still not clearly defined.
For example, supervisors claimed to be managers in some situations, scientists, specialists or only administrators in others. This presented problems in our daily operation, particularly creating difficulties in the delivery of our research. Many of our proposals or submissions were rejected simply for the fear of setting precedence.
Similarly, the scientists were at times asked to undertake technologists' duties, even though outside consultants were brought in to aid with the scientific work. Following our dismissal we learned last week from the Minister of Health that technologists do out research.
Scientific expertise will be provided by the Federal government laboratory in Winnipeg, Manitoba and the Center for Disease Control and Prevention in the US. This staff is not routinely accessible to Ontario physicians and technologists.
In view of last month's events, any potential temporary de-commission of the federal laboratory would leave the Province without expert support.
Interestingly, in addition to our surplus notices we were provided with the Federal Government Human Resource's office number as a potential job opportunity in Winnipeg.
US protocols were circulated for Ontario Laboratory response to bioterrorism threats last monthas none were available in the province.
· No transition plan in place to continue the work
With my recent surplus notice the province lost five years of applied research. Two main projects were nearing completion. One of these was new prognostic test for Lyme disease. This test has gone beyond rapid testing, it actually got ahead of the patient. The person would not have yet developed symptoms when the test is applied. They
could be treated and prevented from developing Lyme disease.
In terms of money - my colleague calculated that one case of misdiagnosed Lyme disease may cost the province up to $600,000 in health costs. This new test is about $5.
Ontario strives to promote technological development. By diminishing scientific positions? We need to be in our laboratories working and applying our knowledge and experience to protect the health of Ontario citizens, not be looking for jobs elsewhere. For me, the surplus notice came several months prior to potential retirement date. It
makes no sense.
Inopportune time for surplus, namely several months prior to potential retirement. I thank the Union for their interest in support of PH, and I hope that the primary common sense response will be restored by the laboratories.
Scientists provide inexpensive insurance and intelligence network for the health protection of Ontario citizens.
Thank you.
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