The nation’s chief nursing and midwifery officer initially advised against a wholesale evacuation of a coronavirus-hit Victorian aged care home a week before it was shut down.
Ordered by health minister Greg Hunt and then-chief medical officer Brendan Murphy, Alison McMillan attended St Basil’s Home for the Aged on July 22 as regular workers were sent home and replaced by inexperienced agency staff.
There were at least 50 positive cases connected to the home when St Basil’s staff were declared close contacts.
Forty-five residents at the Fawkner facility eventually died from COVID-19, while a further five died of neglect, during the state’s second wave last year.
Professor McMillan’s job was to observe the staff transition and report back.
“There was concern that the replacement staff would not arrive in the morning,” McMillan told the Victorian Coroners Court on Tuesday.
Counsel assisting Peter Rozen said an email exchange between Hunt and Murphy as well as other officials, which McMillan was not privy to, showed they were “actively considering” moving infected residents out of the facility.
McMillan sent an email later that night to Murphy and his deputy Paul Kelly after spending about four-and-a-half hours on site watching the handover process.
In the joint report, based on consolidated notes with Victorian health department official Terry Symonds, she said all 117 existing staff had been informed of the need to isolate and there was a “good ratio” of registered nurses to personal care assistants.
But there were also several issues, including the need for interpreters as few of the replacement staff spoke Greek, additional cleaning staff and extra personal protective equipment for “reassurance”.
“My assessment is a fit for purpose facility has the systems and processes to manage the current situation, no need for a significant evacuation of positive residents to hospital but will need close ongoing management of residents who are unwell and in reach,” she concluded.
McMillan declared the facility “fit for purpose” despite not touring it, something she would have done in retrospect.
The handover was “orderly”, in her view, but both existing and surge staff suggest otherwise.
Although Victoria’s chief health officer Brett Sutton ordered the handover be completed by “close of business”, existing staff were only given until 11am before being told to go home and self-isolate.
Registered nurse Lubo Zhang, who worked at St Basil’s from 2015, was tasked with providing a handover to replacement staff and felt it was rushed.
There was also not enough surge staff to care for all residents, Zhang added.
Jacinta MacCormack, one of the new staff members, said existing staff became “hostile” when informed they would be stood down.
“They basically shut down. You could feel it in the air. It was not comfortable at all,” she said.
On her second day on the job, the Aspen clinical first responder said she saw dementia residents out of their rooms wandering around the facility.
Others were “malnourished” and “dehydrated” she said.
“There was a couple that actually looked quite emaciated. Their hip was sticking out,” MacCormack said.
One resident was so unwell they needed to be taken to hospital and assessed by a doctor.
The inquest continues before Victorian State Coroner John Cain.