Affidavit of Diane Peckham

Court File No.
CV-20-639605-0000
ONTARIO
SUPERIOR COURT OF JUSTICE
B E T W E E N:
ONTARIO NURSES' ASSOCIATION, VICKI MCKENNA, RN and BEVERLY

MATHERS, RN
Applicants
and
HENLEY PLACE LIMITED AND PRIMACARE LIVING SOLUTIONS INC.

Respondents
AFFIDAVIT OF DIANE PECKHAM

(Sworn , 2020)
I, DIANE PECKHAM, of the City of London, in the Province of Ontario, MAKE
OATH AND SAY as follows:
1. I am a Labour Relations Officer with the Ontario Nurses’ Association (“ONA”). I
have been in this role since 2003. In my capacity as a Labour Relations Officer for ONA,
I engage in discussions, labour relations, and support for litigation as necessary with
various employers that are assigned to me, on behalf of all ONA members at each
particular facility. I also complete all long-term disability (“LTD”) appeals for ONA
members that fall under the purview of ONA’s West District Service Team.
2. In addition to my LTD work, I also currently act as Labour Relations Officer for
ONA at seven long-term care facilities, including Henley Place in London, Ontario. In this
role, I liaise with the Employer regarding, inter alia, the health and safety of all ONA
members who work at each such facility.

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3. Since the COVID-19 pandemic was announced, I have been flooded with concerns
from ONA members, who fear for their health and safety when arriving at work each day.
4. These experiences remind me of the SARS outbreak in the mid-2000s, wherein
many of ONA’s members died and/or became seriously ill as a result of the failure of
many Ontario employers to provide nurses with appropriate access to all forms of
personal protective equipment, up to and including N95 respirators. That being said, the
threat posed by COVID-19 is extraordinary given the severity of the illness that can result
from transmission and how easily this virus is passed from one individual to another.
5. I have grave concerns that a serious and devastating outcome will very soon take
place at Henley Place in London, Ontario.
I. General Background on Henley Place
6. On March 29, 2020, Henley Place experienced an outbreak of COVID-19 when a
resident on the Medway Unit tested positive for the disease. It is my understanding that
the source of this resident’s transmission has not yet been identified.
7. As of April 13, 2020, two residents with confirmed COVID-19 have died. There are
also seven confirmed COVID-19 positive residents in the home, one confirmed COVID-
19 positive resident in the Hospital, and many others with symptoms consistent with the
virus.
8. The residents at Henley Place are increasingly acute in their condition and require
constant supervision. They typically rely on registered nursing staff for their medications,
daily care, monitoring, and intervention in the event of a critical or urgent situation.
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9. The residents at Henley Place often have a number of co-morbidities as well, and
nearly every resident, at any given time throughout a shift, could require close contact
care. During such care, these residents often engage in aerosol generating behaviours
such as coughing, spitting, heavy breathing, and sneezing.
10. In light of these realities of the COVID 19 outbreak and the grave threat it poses,
as well as the likelihood that COVID-19 may be transmitted by airborne particles, on
March 31, 2020 I contacted the Administrator for Henley Place, Kelly Kummerfield, and
requested that all ONA members providing care to known or suspected cases of COVID-
19 be provided with access to an N95 respirator. I noted at that time that the science on
COVID-19 does support transmission by airborne particles, and urged the Employer to
provide N95 respirators to any ONA member caring for a suspected or confirmed case of
the disease.
11. After this conversation, I sent an email to Ms. Kummerfield noting the following:
“Just want to add as per our conversation that the Occupational

Health and Safety Act legislates that Employers must take all
reasonable precautions to protect the safety of their workers. The
science on the coronavirus does state the virus could be born of
air and therefore I am urging you to please provide N95 masks
to any ONA member who is caring for a suspected or confirmed
case of coronavirus. This would include any ONA member who
is screening”.
12. A copy of this email is attached as Exhibit “A”.
13. I did not receive a response from Ms. Kummerfield to this communication.
14. Later that day, I became aware that an ONA member was required to provide care
to a COVID-19 positive resident without access to an N95 respirator. This member was
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terrified for her safety, and the Employer did not allow this member to use her clinical
judgment to ascertain the appropriate level of personal protective equipment that was
required for this resident. Instead, they determined on her behalf that a surgical mask
would suffice.
15. As the Chief Medical Officer of Health has stated that the precautionary principle
should be applied to all such interactions with suspected or confirmed cases of COVID-
19 – and that Employers should not await full scientific certainty on transmission before
taking all reasonable precautions in the circumstances to protect the health and safety of
healthcare workers – I wrote to the Employer again on April 1, 2020 to advise of this
member’s experience, and reiterate that ONA’s members in long-term care deserve our
utmost respect and the most appropriate personal protective equipment available –
namely, an N95 respirator.
16. I also advised that it was my understanding that the Employer had a sufficient stock
of N95 respirators on hand, and questioned why the Employer was not taking all
necessary precautions to protect its employees. A copy of this email is attached as
Exhibit “B”.
17. Later that day, I sent a follow-up communication to Elvie Hall, the Facility’s counsel,
reiterating my request that ONA members be given access to N95 respirators when caring
for known or suspected cases of COVID-19. I noted at that time that “Henley Place have
the N95 masks in their supply and it astounds me that the employer is not providing
access to the masks”. A copy of this email is attached as Exhibit “C”.
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18. Shortly after this communication, I became aware from
at Henley Place, that the Employer had removed all N95
respirators from the storage room and relocated them to Ms. Kummerfield’s office. Ms.
Kummerfield’s office is locked at all times and is only accessible by key.
19. Moreover, only three individuals have access to the key to Ms. Kummerfield’s
office: Ms. Kummerfield, the Administrator; Ameena Mujeeb, the Associate Director of
Care; and Bridgette Woods, the Financial Manager.
20. These three individuals only work on the day shift. Accordingly, in the event that
an N95 respirator is required during the night shift, or any other time they are not at work,
I am told by that the key to the office will be hidden in the Facility, and its
location will only be shared if the Nurse or Manager on shift can reach Ms. Kummerfield,
Ms. Mujeeb, or Ms. Woods at home by telephone.
21. As ONA’s Labour Relations Officer for this Facility, I am gravely concerned that
this practice places ONA’s members at a risk of imminent harm, up to and including death.
This is because, in the event that a resident with suspected or confirmed COVID-19 had
an emergency during a time when these individuals are not on site, the assigned nurse
may be placed in a situation where she or he is unable to access an N95 respirator and
must provide direct care, up to and including Aerosol Generating Medical Procedures,
without access to appropriate personal protective equipment.
22. Moreover, in the amount of time that it would take to call the above-noted
individuals, locate the key to Ms. Kummerfield’s office, travel to the office to obtain an
N95 Respirator, and return to the resident to provide care, the resident could die.
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Alternatively, nursing staff could be putting their lives at risk in order to care for residents
in urgent circumstances. This is an untenable situation.
II. Attempts to Resolve the Issue Have Been Unsuccessful
23. As above, since first learning of the COVID-19 outbreak, I have been sending
frequent communications to the Employer requesting an expeditious resolution of ONA’s
concerns. The Employer has frequently either ignored these concerns or brushed them
off as inconsequential.
24. Indeed, on or around April 2, 2020, counsel for the Employer suggested to me that
the Facility had more urgent priorities than responding to ONA’s concerns.
25. Accordingly, I wrote to Ms. Hall on April 3, 2020, and advised that communication
regarding the health and safety of ONA members is an urgent priority and requested
again that N95 respirators be provided to ONA members caring for known or suspected
cases of COVID-19. I further advised that the Union would be filing a grievance in light of
these issues. A copy of this email is attached as Exhibit “D”.
26. A copy of the grievance filed later that day is attached as Exhibit “E”.
27. Among other things, ONA grieved that the Employer had failed to take adequate
measures to ensure the safety of ONA’s members, failed to provide adequate personal
protective equipment, failed to follow the precautionary principle, and failed to take every
precaution reasonable in the circumstances arising as a result of the extraordinary threat
posed by the COVID-19 pandemic. In remedy, the Union requested that ONA members
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be provided with appropriate personal protective equipment, including but not limited to
N95 respirators, to guard against all forms of transmission.
28. Despite ONA’s insistence, this grievance has not yet advanced to arbitration.
29. I continue to receive communications from and about ONA members advising that
they are terrified that they will become infected with the virus, become extremely ill, and
possibly die. Residents are likewise placed at risk of harm up to and including death, yet
the Employer continues to resist providing appropriate access to N95 respirators for staff
caring for known or suspected cases of COVID-19.
30. In the context of this pandemic, where the number of resident deaths and
confirmed and suspected cases at Henley Place continues to climb, this delay in
addressing the grievance can and will cause irreparable harm.
III. The Employer Does Not Have an N95 Shortage
31. On April 8, 2020, I wrote to the Employer and requested information regarding its
supply of N95 respirators and surgical masks. A copy of this email is attached as Exhibit
“F”.
32. I received an email from the Employer’s counsel later that day. I was advised that
the Employer had sufficient supplies of personal protective equipment, including surgical
masks and N95 respirators. A copy of this email is attached as Exhibit “G”.
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33. As Henley Place does not have a supply shortage of this life-saving personal
protective equipment, I remain puzzled and concerned why this Employer is limiting
access to N95 respirators for nurses treating known or suspected cases of COVID-19.
34. As detailed below, this practice places the lives of staff and residents at an
imminent risk of harm, up to and including death.
IV. Emergency of April 10, 2020
35. Though a very limited supply of N95 respirators has started to be made available
on medication carts for staff treating known or suspected cases of COVID-19, there
continues to be an insufficient supply of such respirators readily available, and indeed
they are or were all of only one size.
36. Unlike surgical masks, N95 respirators are not a one-size-fits-all form of
equipment. An N95 respirator that does not appropriately fit the wearer will not provide
protection. Therefore, the N95 needs to be fit tested in order for the respirator to function
properly.
37. Due to the above-noted practices, however, when the three individuals with access
to Ms. Kummerfield’s office are not in the building, staff are left without access to the
Facility’s supply of N95 respirators. To obtain a respirator in such circumstances, staff are
expected to do the following:
(a) Attempt to contact by telephone the Manager who is on-call at the time, and
inform him or her of the situation;
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(b) The on-call Manager will then attempt to speak with one of Ms. Kummerfield
(the Administrator), Ms. Mujeeb (the Associate Director of Care), or Ms.
Woods (the Financial Manager), who will provide the location of the key to
Ms. Kummerfield’s office;
(c) The on-call Manager will then call the member back and provide the location
of the key to Ms. Kummerfield’s office; and
(d) The member will then be required to obtain the key, attend at Ms.
Kummerfield’s office, locate an appropriate N95 respirator, ensure that this
equipment is obtained as quickly as possible, and return to the resident to
provide care.
38. All the while, the resident would be placed at a risk of harm, up to and including
death, while she or he awaits care.
39. Alternatively, the treating health care professional would be required to intervene
without access to appropriate life-saving personal protective equipment. This would
likewise place the worker at an imminent risk of harm, up to and including death.
40. The issues with the Employer’s approach crystalized in an incident that occurred
on April 10, 2020, at which time I was informed by
that the Employer’s practice with respect to personal protective equipment had
directly placed the health and safety of staff and residents at risk.
41. In a report he filed the next day, he described the incident as follows:
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“I would like to inform you about an incident that happened on

April 10 at 0700 with resident H.H. positive for COVID-19. She
required suctioning as her lungs were full of fluid and she was
struggling to breath. was doing the med pass on Medway
and she called me saying she needed an N95 mask as the one
in the med cart was not the size that fit her. Thankfully, she knew
there was one that was her proper fit in the DOC officer that was
her size and she told me where it was, and I was able to run and
grab it for her in order to suction her.
This is a health and safety issue to not have access to proper

equipment on a moment’s notice and we were lucky that there
was one mask in the DOC office. I would like to ask that the RNs
have access to the PPE/N95 so that we can respond quicker and
as needed for situations like this. I would like to mention that if
we do grab PPE/N95 equipment we would continue to inform a
manager on-call or manager in the building that we did take a
piece of equipment so that you can keep track of ordering.”
42. A copy of this incident report is attached as Exhibit “H”.
43. As above, given that the Employer had advised me that they had sufficient supplies
of N95 respirators, I remain confused as to why the Employer was not providing
appropriate access to this life-saving personal protective equipment.
V. Further Attempts to Address the Issue Have Been Unsuccessful
44. In light of the foregoing, I wrote to the Employer on April 12, 2020, to again raise
my concerns. At that time, I advised that I was asking for immediate resolution of these
issues and noted that it is absolutely imperative that N95 respirators be readily available
at a moment’s notice, given the urgency of care that might have to be provided. I further
noted that nurses are required to use their clinical judgment when assessing what
personal protective equipment is appropriate for any patient encounter, and that the
failure to provide immediate access to all forms of personal protective equipment puts
staff and residents at an imminent risk of harm.
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45. The Facility’s Administrator, Ms. Kummerfield, responded by advising that it was
her belief that an appropriate number of N95 respirators was made available to staff. She
further implied that it was the fault of the staff member treating the COVID-19 positive
resident on April 10, 2020 for not requesting the appropriate fit-tested N95 respirator in
advance of the incident. Attached to her email was a document from Ontario Health, dated
March 30, 2020. A copy of this email communication and its enclosure is attached as
Exhibit “I”.
46. As above, it is ONA’s view that fit-tested N95 respirators should be readily
available at all times, particularly in a health care environment where the health of the
patient, care needs and risk to the nurse may change rapidly. I do not think it is
appropriate that this individual was blamed for making a reasonable assumption that the
Employer would have all necessary personal protective equipment readily available.
47. Moreover, on April 10, 2020, the Chief Medical Officer of Health released Directive
#5, which applies to all long-term care facilities and public hospitals in Ontario. While the
Directive does contemplate the use of surgical masks as a minimum precaution, it is also
clear that the judgment of registered staff reigns supreme, and that where a nurse
determines an N95 respirator is appropriate, it must be provided by the Employer.
48. The Directive states the following in this regard:
“If a health care worker determines, based on the [Point of Care

Risk Assessment], and based on their professional and clinical
judgement, that health and safety measures may be required in
the delivery of care to the patient or resident, then the public
hospital or long-term care home must provide that health care
worker with access to the appropriate health and safety control
measures, including an N95 respirator. The public hospital or
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long-term care home will not unreasonably deny access to the

appropriate PPE.”
49. A copy of this Directive is attached as Exhibit “J”.
50. With this in mind, I responded to the Employer’s communication by requesting that
the Employer make all necessarily personal protective equipment readily available in the
event of a further emergency like the one on April 10, 2020. A copy of this email
communication is attached as Exhibit “I”.
51. Counsel for the Employer responded by advising that the Employer was tracking
the supply of personal protective equipment and providing access as noted in Ms.
Kummerfield’s email (attached at Exhibit “I”). A copy of this email communication is
attached at Exhibit “K”.
52. I responded by requesting confirmation that an adequate supply of all personal
protective equipment will be made readily available on an as-needed basis, including on
evenings, nights, weekends, and statutory holidays. A copy of this email communication
is attached at Exhibit “L”.
53. In a separate communication, I requested further confirmation that appropriate
personal protective equipment would be made available to all staff who determine, in
accordance with a Point of Care Risk Assessment, that such personal protective
equipment is necessary. A copy of this email communication is found at Exhibit “M”.
54. The Employer’s counsel responded to this communication by advising that they
would leave a “couple” N95 respirators in the Director of Care’s office, but the supply
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would be limited as “6-N95s were used inappropriately over the weekend”. A copy of this
email communication is attached at Exhibit “N”.
55. I immediately requested clarification regarding what “inappropriate” use had
allegedly taken place.
56. In response, counsel for the Employer advised me that “appropriate PPE is made
available and RNs are aware of how to access additional PPE if required”. Counsel further
advised that the N95 respirators had been used “inappropriately,” because they “were not
being used during a [Point of Care Risk] assessment”.
57. In a follow-up email, counsel for the Employer further advised that such usage was
“inappropriate” because “N95 masks were being used in situations where the [health care
worker] was not performing any [Point of Care Risk] assessment”.
58. A copy of these email communications is attached at Exhibit “O”.
59. As above, the procedure for accessing additional personal protective equipment
would require a series of calls and delays, as well as running throughout the Facility. It is
not safe for either staff or residents.
60. Moreover, these responses demonstrate an alarming misunderstanding of the
applicable Directive issued by the Chief Medical Officer of Health for Ontario. N95
respirators are not to be limited to use “during” a Point of Care Risk Assessment. Instead,
as is explicitly stated in Exhibit “J”: if a health care worker determines, based on the
Point of Care Risk Assessment and based on their professional and clinical judgement,
that health and safety measures may be required in the delivery of care to the patient or
4835-2973-8938, v. 1
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resident, then the public hospital or long-term care home must provide that health care
worker with access to the appropriate health and safety control measures, including an
N95 respirator.
61. Accordingly, if a nurse exercises his or her clinical judgment and determines that
an N95 respirator is required for care, it must be provided and cannot be unreasonably
denied. To suggest that a nurse’s clinical judgment is “inappropriate” is contrary to the
Chief Medical Officer of Health’s Directive #5.
62. The Employer’s practice of providing a “couple” N95 respirators is likewise
troubling and problematic, because emergencies can, do, and will occur throughout this
facility. Leaving a “couple” N95 respirators in the office of a Director of Care does not
ensure that staff will have access to this life-saving personal protective equipment on an
as-needed basis, as determined in accordance with their clinical judgment. This, too,
places staff and residents at a risk of imminent harm, up to and including death.
VI. The Employer Has Refused ONA’s Attempt to Expedite the Grievance
63. In light of these issues and the risk of imminent harm, up to and including death,
facing both staff and residents, on April 14, 2020, I wrote to the Employer requesting that
the Employer agree to expedite the hearing of the grievance found at Exhibit “E”.
64. I noted in this letter that “in order to avoid irreparable harm to our members, we
are seeking the Employer’s agreement to have the grievance heard by an arbitrator
mutually appointed by the parties on an expedited basis, with agreement to a video
4835-2973-8938, v. 1
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conference hearing date scheduled by no later than April 16, 2020”. A copy of this
correspondence is attached as Exhibit “P”.
65. Later that day, the Employer denied ONA’s request for an expedited hearing. A
copy of this correspondence is attached at Exhibit “Q”.
66. As a result, ONA’s members are left without access to a meaningful remedy for
the foreseeable future.
67. Indeed, despite the fact that the Employer’s practice as described above is
contrary to the Collective Agreement, as well as various other statutes, we have no means
of obtaining any interim relief in light of the statutory confines of a labour arbitrator’s
jurisdiction. All the while, ONA’s members are at an imminent risk of harm, up to and
including death, as they are forced to provide care to known or suspected cases of
COVID-19 without appropriate access to life-saving personal protective equipment, such
as N95 respirators.
68. As a long-time Labour Relations Officer for ONA, I am reminded today of our
experiences in SARS, wherein our members died and/or became seriously ill as a result
of similar practices. However, the threat of COVID-19 is unique and extraordinary, given
the grave severity and likelihood of serious injury and possible death that can result from
transmission of this deadly disease. This situation is quite simply unprecedented. ONA’s
members and Henley Place’s residents therefore need urgent help to ensure that they
will not face a similar fate.
4835-2973-8938, v. 1
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69. Finally, as of April 15, 2020, it is my understanding and I verily believe it to be true
that an ONA member at the Facility, who works full-time nights on the outbreak unit, has
developed symptoms that are consistent with COVID-19. She is currently off work in self
isolation for 14 days and awaiting testing. I fear that many more at this Facility will find
themselves in a similar position soon if intervention does not occur in the form of ensuring
appropriate access to all forms of personal protective equipment, including N95
respirators.
70. I further understand and verily believe it to be true that residents outside of the
outbreak unit have also recently developed symptoms that are consistent with a diagnosis
of COVID-19. Urgent intervention is required to ensure that this situation does not go from
bad to worse.
71. I make this affidavit for no improper purpose.
SWORN BEFORE ME at the City of

in the Province of Ontario,
this ___ day of ________________.
DIANE PECKHAM
A Commissioner for taking Affidavits
4835-2973-8938, v. 1
ONTARIO NURSES' ASSOCIATION et al -and- HENLEY PLACE LIMITED et al
Applicants Respondents
Court File No. CV-20-639605-0000
ONTARIO
SUPERIOR COURT OF JUSTICE
PROCEEDING COMMENCED AT
TORONTO
AFFIDAVIT OF DIANE PECKHAM
CAVALLUZZO LLP
474 Bathurst Street, Suite 300
Toronto, ON M5T 2S6
Kate Hughes, LSO# 27345R

Philip Abbink, LSO# 50945Q
Janet Borowy, LSO# 56710C
Danielle Bisnar, LSO# 60363K
Tyler Boggs, LSO# 72139H
Tel: 416-964-1115
Fax: 416-964-5895
ONTARIO NURSES’ ASSOCIATION

85 Grenville St. Suite 400
Toronto, ON M5S 3A2
Marcia Barry, LSO# 52763I

Nicole Butt, LSO# 50983A
Tel: 416-964-8833
Fax: 416-964-8864
Lawyers for the Plaintiffs,

Ontario Nurses’ Association,
Vicki McKenna, RN and Beverly Mathers, RN
4835-2973-8938, v. 1
This is Exhibit “A” referred to in the Affidavit of Diane Peckham
sworn April .........., 2020.
Commissioner for Taking Affidavits (or as may be)

(4/2/2020) Diane Peckham - Re: cell # Page 1
From: Diane Peckham

To: kkummerfield@primacareliving.com;
Date: Tuesday, March 31, 2020 6:57 PM
Subject: Re: cell #
Hi Kelly
Just want to add as per our conversation that the Occupational Health and Safety Act legislates that
Employer's must take all reasonable precautions to protect the safety of their workers. The science on
the coronavirus does state the virus could be born of air and therefore I am urging you to please provide
N95 masks to any ONA member who is caring for a suspected or confirmed case of coronavirus. This
would include any ONA member who is screening. Kelly thank you for calling me and I am hopeful that
you will do whatever you can to advocate on behalf of your employees during this very difficult time as I
am advocating on behalf of my members. I know you have reviewed the Hospital directives on N95
masks and ask that you take the same precautions for employees working in Long Term Care.
Sincerely,
Diane Peckham dianep@ona.org

Labour Relations Officer
Ontario Nurses' Association
1069 Wellington Road South, Suite B109
London, ON N6E 2H6
519 438-2153 ext 5126
Toll Free: 1-877-839-6245 ext 5126
Fax: (519) 433-2050
This (e-mail or fax) communication and accompanying documents are intended
only for the individual or entity to which it is addressed and may contain
information that is confidential, privileged or exempt from disclosure under
applicable law. Any use of this information by individuals or entities other than
the intended recipient is strictly prohibited. If you have received this
communication in error, please notify the sender immediately and delete all the
copies (electronic or otherwise) immediately. Thank you for your co-operation.
>>> Kelly Kummerfield <KKummerfield@primacareliving.com> Tuesday, March 31, 2020 6:12 PM >>>
Diane,
What is your cell number ‑ I was provided 519‑494‑7084
Call my BB 226‑974‑9327
Kelly Kummerfield | Administrator

henley place long term care residence
1961 Cedarhollow Blvd, London, ON, N5X 0K2
Tel | 519.951.0220 ext 5130
Fax | 519.951.0212
kkummerfield@primacareliving.com<mailto:kkummerfield@primacareliving.com>
www.primacareliving.com<http://www.primacareliving.com/>
[Image result for facebook
icon]www.facebook.com/PrimacareLiving/<http://www.facebook.com/PrimacareLiving/>
primacare Living Solutions Inc.(tm) people focused. quality care
This is Exhibit “B” referred to in the Affidavit of Diane Peckham
sworn April .........., 2020.

(4/2/2020) Diane Peckham - RN caring for confirmed COVID19 case Page 1
From: Diane Peckham

To: , KKummerfield@primacareliving.com
Date: Wednesday, April 01, 2020 11:23 AM
Subject: RN caring for confirmed COVID19 case
Kelly after our discussion yesterday an ONA member was providing care to a resident with a confirmed
case of COVID19 Last night and did not have access to a N95 mask. The CMOH has stated in his
orders that the precautionary principle should be used. I don’t know why long term care have not been
given the same directive as the hospitals it does not make any sense to me at all. Our members in long
term care absolutely deserve the same respect and right to the most appropriate protective personal
equipment. Kelly I know you were getting back to me in 24 hours but our members need the most
appropriate protection now and not just for their safety but For the safety of your residents. Kelly you
have a supply of the N95 masks why is the employer not taking all necessary precautions to protect their
employees and their residents.

London, ON N6E 2H6
519 438-2153 ext 5126

Toll Free: 1-877-839-6245 ext 5126
Fax: (519) 433-2050

This is Exhibit “C” referred to in the Affidavit of Diane Peckham
sworn April .........., 2020.

(4/2/2020) Diane Peckham - Re: RE: RN caring for confirmed COVID19 case Page 1
From: Diane Peckham

To: elvie@hall-labour.ca
CC: ABanks@primacareliving.com, KKummerfield@primacareliving.com
BC DianeP@ona.org
Date: Wednesday, April 01, 2020 2:45 PM
Subject: Re: RE: RN caring for confirmed COVID19 case
Good Afternoon Elvie
I assume you have read the directive for the hospitals which states that the virus could be in the air and
as such they are stating the precautionary principle should be applied. Under the Occupational Health
and Safety ACT employers must take all reasonable precautions to protect the health and safety of their
employees. It is reasonable to supply those caring for suspected or confirmed cases with the N95 masks
as confirmed in the directive sent to hospitals. An RN providing care to a resident with a confirmed case
of COVID19 should absolutely be provided protection that is the safest to prevent exposure to this virus.
Henley Place have the N95 masks in their supply and it astounds me that the employer are not providing
access to the masks.

London, ON N6E 2H6
519 438-2153 ext 5126

Toll Free: 1-877-839-6245 ext 5126
Fax: (519) 433-2050

>>> Elvie Hall <elvie@hall-labour.ca> 04/01/20 12:55 PM >>>
Good Afternoon Diane, I offered to reach out to you on behalf of Kelly. As you can imagine this is a very
trying and busy time for everyone. Henley Place has the Resident, Staff and Public safety as a priority.
I left a voice message for you, but thought I would send you an email, rather than play telephone tag.
Henley Place is following protocols required and is providing the appropriate PPE’s as per MOH and
PHO.
Regards,
Elvie A. Hall
Hall Labour Relations Services Professional Corporation
(4/2/2020) Diane Peckham - Re: RE: RN caring for confirmed COVID19 case Page 2
781 Main Street East, Unit 17, Milton, On L9T 5A9

phone 905-878-7227 fax 905-878-7873 cell 647-200-8232
"SERVICE AND SUPPORT DESIGNED FOR YOU."

IMPORTANT NOTICE: This message and the information contained therein is intended only for the use
of the individual or entity to which it is addressed. If the reader of this message is not the intended
recipient, or the employee or agent responsible for delivering the message to the intended recipient, you
are notified that any dissemination, distribution or copying of this communication is strictly prohibited.
If you have received this communication in error, please notify Hall Labour immediately by contacting
(905) 878-7227 and delete this electronic message from your computer system and that of your Internet
Service Provider. Please note that any information provided via electronic messaging will be collected in
accordance with Hall Labour Privacy Policy (the "Policy"). This Policy is available upon request from Hall
Labour Relations Services Professional Corporation.
From: Diane Peckham <dianep@ona.org<mailto:dianep@ona.org>>

Sent: April 1, 2020 11:23 AM
To: >; Kelly Kummerfield
<KKummerfield@primacareliving.com<mailto:KKummerfield@primacareliving.com>>
Subject: RN caring for confirmed COVID19 case
Kelly after our discussion yesterday an ONA member was providing care to a resident with a confirmed
case of COVID19 Last night and did not have access to a N95 mask. The CMOH has stated in his orders
that the precautionary principle should be used. I don’t know why long term care have not been given the
same directive as the hospitals it does not make any sense to me at all. Our members in long term care
absolutely deserve the same respect and right to the most appropriate protective personal equipment.
Kelly I know you were getting back to me in 24 hours but our members need the most appropriate
protection now and not just for their safety but For the safety of your residents. Kelly you have a supply of
the N95 masks why is the employer not taking all necessary precautions to protect their employees and
their residents.
Diane Peckham dianep@ona.org<mailto:dianep@ona.org>
London, ON N6E 2H6
519 438-2153 ext 5126
Toll Free: 1-877-839-6245 ext 5126
Fax: (519) 433-2050
This e-mail communication and accompanying documents are intended only for the individual or entity to
which it is addressed and may contain information that is confidential, privileged or exempt from
disclosure under applicable law. Any use of this information by individuals or entities other than the
intended recipient is strictly prohibited. If you have received this communication in error, please notify the
sender immediately and delete all the copies (electronic or otherwise) immediately. Thank you for your co-
operation. Avis de confidentialité Ce message, transmis par courriel, est confidentiel, peut être protégé
par le secret professionnel et est à l'usage exclusif du destinataire ci-dessus. Toute autre personne est
par les présentes avisée qu'il lui est strictement interdit de le diffuser, le distribuer ou le reproduire. Si le
destinataire ne peut être joint ou vous est inconnu, veuillez informer l'expéditeur par courrier électronique
This is Exhibit “D” referred to in the Affidavit of Diane Peckham
sworn April .........., 2020.

From: Diane Peckham
To: Elvie Hall; Kylie McCoy
CC: ; andrew@hall-labour.ca; kkummerfield@primacareliving.com
Date: 4/3/2020 8:21 AM
Subject: RE: More suspected cases
Attachments: 20200403_grievanceformPPE.pdf
Good morning
With all due respect Elvie, email communication on issues regarding the safety of our ONA members is of an urgent nature. Currently there are
three confirmed cases of COVID19 at Henley Place. One resident is currently at the Hospital and two are at the Home. N95 masks provide better
protection than surgical masks and given that this virus does produce coughing in residents the virus could become bourne by air. Our registered
staff care for those residents and are in close proximity when providing the care. Our members, I assure you, have the residents safety and well
being as their number one priority. Elvie, there is a supply of N95 masks at the home and I urge the Employer to allow our members who are
putting their own health at risk to be provided access to those masks in this unprecedented time. Also, can you please confirm how swabs for
suspected/confirmed cases are being gathered and what personal protection equipment is being provided while collecting those swabs. If a
resident with a suspected or confirmed case of COVID19 is exhibiting symptoms such as a cough are the employer allowing access to the N95
masks in those situations? I am trying to determine if N95 masks are being provided at all to any employees, such as RPNs, PSWs, etc. at the Home
At this time the Union is filing a grievance, which I have attached. I request that all communications related to this grievance and this ongoing
situation be addressed to me directly and that you copy on any and all communications.
I am also copying Kylie McCoy, my Labour Relations Assistant, and request you copy her on all communications.
Sincerely,

London, ON N6E 2H6
519 438-2153 ext 5126
Toll Free: 1-877-839-6245 ext 5126
Fax: (519) 433-2050
>>> Elvie Hall <elvie@hall-labour.ca> Thursday, April 02, 2020 10:41 AM >>>
Good Morning Diane:
There is nothing more important to us at this time than the safety of our residents and staff. Our client(s) has the most up to date information on
Covid-19, all directives, emergency orders and updates from PHO; MOH & LTC and OLTCA othe COO of primacare is also a board member of
OLTCA.
On the whole, long term care providers know how to manage outbreaks and have done so extremely well throughout the years. Yes, Covid 19 is
unprecedented and we will get through this together. Our staff is committed to providing care and services to our residents and each other and
we are committed to doing everything in our power to keep them safe and stop the spread.
N95s are available to the reg staff based on a point of care risk assessment. This is IPAC guidelines as well as Directive 1 re issued March 30.
Please understand, we are not trying to diminish your role with our employees, your members, we are simply asking you to understand that these
are unprecedented times and we will make every effort to be transparent but, our priority is our home, residents and staff not responding to emails
that are not going to immediately impact the safety and security of our residents and staff.
Kind regards;
Elvie A. Hall
phone 905-878-7227 fax 905-878-7873 cell 647-200-8232
IMPORTANT NOTICE: This message and the information contained therein is intended only for the use of the individual or entity to which it is
addressed. If the reader of this message is not the intended recipient, or the employee or agent responsible for delivering the message to the
intended recipient, you are notified that any dissemination, distribution or copying of this communication is strictly prohibited.
If you have received this communication in error, please notify Hall Labour immediately by contacting (905) 878-7227 and delete this electronic
message from your computer system and that of your Internet Service Provider. Please note that any information provided via electronic messaging
will be collected in accordance with Hall Labour Privacy Policy (the "Policy"). This Policy is available upon request from Hall Labour Relations
Services Professional Corporation.
From: Diane Peckham <dianep@ona.org>

Sent: April 1, 2020 8:04 PM
To: ; Elvie Hall <elvie@hall-labour.ca>; KKummerfield@primacareliving.com
Subject: More suspected cases
I understand three more residents have been tested for COVID19 and RNs are assessing and providing direct care to those residents. As you know
from the directives the virus could become borne of air by coughing for example and N95 masks provide better protection than surgical masks.
Since the employer is not taking all necessary precautions to protect the ONA members grievances will be filed tomorrow. I was hoping to have a
more satisfactory response considering you actually have the masks on site.
Elvie I was not able to get back to you by phone today. If you still wish to talk let me know and I can call you tomorrow.
Diane Peckham dianep@ona.org<mailto:dianep@ona.org>
London, ON N6E 2H6
519 438-2153 ext 5126
Toll Free: 1-877-839-6245 ext 5126
Fax: (519) 433-2050
This e-mail communication and accompanying documents are intended only for the individual or entity to which it is addressed and may contain
information that is confidential, privileged or exempt from disclosure under applicable law. Any use of this information by individuals or entities
other than the intended recipient is strictly prohibited. If you have received this communication in error, please notify the sender immediately and
delete all the copies (electronic or otherwise) immediately. Thank you for your co-operation. Avis de confidentialité Ce message, transmis par
courriel, est confidentiel, peut être protégé par le secret professionnel et est à l'usage exclusif du destinataire ci-dessus. Toute autre personne est
par les présentes avisée qu'il lui est strictement interdit de le diffuser, le distribuer ou le reproduire. Si le destinataire ne peut être joint ou vous est
inconnu, veuillez informer l'expéditeur par courrier électronique immédiatement et détruire ce message et toute copie de celui-ci. Merci.
This is Exhibit “E” referred to in the Affidavit of Diane Peckham
sworn April .........., 2020.

This is Exhibit “F” referred to in the Affidavit of Diane Peckham
sworn April .........., 2020.

From: Diane Peckham
To: kkummerfield@primacareliving.com
CC:
Date: 4/8/2020 12:57 PM
Subject: URGENT REQUEST REGARDING SUPPLY OF PERSONAL PROTECTIVE EQUIPMENT
Dear Kelly
URGENT REQUEST FOR INFORMATION
Please advise by the end of the day tomorrow, April 9, 2020, how many days supply of masks you currently have both surgical and N95. I am also
requesting information as to how the Employer intents to deal with any shortage of the needed personal protective protection should you exhaust your
supply. ONA’s position is if the masks run out the employer would be required to have higher rated protection available. It is also ONA’s position that
cleaning masks and reusing them at a later date is not safe in the event this is something the employer is currently doing or may plan to do in the
future, please advise.

London, ON N6E 2H6
519 438-2153 ext 5126
Toll Free: 1-877-839-6245 ext 5126
Fax: (519) 433-2050
This is Exhibit “G” referred to in the Affidavit of Diane
Peckham sworn April .........., 2020.

From: Andrew Hall
To: Diane Peckham
Cc: Carrie Pasco; Adam Banks; Kelly Kummerfield
Subject: HP and ONA - Information Request RE PPE
Date: April 8, 2020 4:52:05 PM
Hi Diane,

Your email was forwarded to me for response. As I am sure your aware, the home and the staff are
working tirelessly to protect the health and safety of all involved.

We believe that we have sufficient Personal Protective Equipment, including surgical and N95 masks,
based on the latest directives from the Ministry of Health and Public Health Ontario. We have plans
in place if there is a shortage and we are working with the Ministry of Health regarding supply if
there ends up being a provincial or regional shortage. This is a evolving conversation, however, we
believe at this time we have an adequate supply based on the current directives.

Regarding the reuse of masks, we appreciate you conveying the Union’s position. At this time we
are collecting used masks but we are not reusing them. The practice guidelines at this time do not
support this practice, however, we are monitoring this situation very closely. If the practice of
cleaning, sanitizing and/or sterilizing masks is approved by Health Canada and/or Public Health
Ontario, we will investigate the matter and make our determination based on the requirements of
the home.

Our staff and residents health and safety is our top priority, something we both share.

Should you have any questions or concerns, please do not hesitate to contact me directly.

Thanks AH

Andrew M. Hall
781 Main Street East, Unit 17, Milton, ON L9T 5A9
phone 905-878-7227 fax 905-878-7873 cell 416-569-1904

"SUPPORT DESIGNED FOR YOU"
IMPORTANT NOTICE: This message and the information contained therein is intended only for the use of the individual or entity to which
it is addressed. If the reader of this message is not the intended recipient, or the employee or agent responsible for delivering the
message to the intended recipient, you are notified that any dissemination, distribution or copying of this communication is strictly
prohibited.
If you have received this communication in error, please notify Hall Labour immediately by contacting (905) 878-7227 and delete this
electronic message from your computer system and that of your Internet Service Provider. Please note that any information provided via
electronic messaging will be collected in accordance with Hall Labour Privacy Policy (the "Policy"). This Policy is available upon request
from Hall Labour Relations Services Professional Corporation.

This is Exhibit “H” referred to in the Affidavit of Diane Peckham
sworn April .........., 2020.

From:
To: Kelly Kummerfield
Cc: Diane Peckham
Subject: April 10/20
Date: April 11, 2020 6:45:19 PM
Hi Kelly
I would like to inform you about an incident that happened on April 10 at 0700 with resident
H.H positive for Covid 19. She required suctioning as her lungs were full of fluid and she was
struggling to breath. was doing the med pass on Medway and she called me saying she
needed an N95 mask as the one in the med cart was not the size that fit her. Thankfully, she
knew there was one that was her proper fit in the DOC office that was her size and she told me
where it was and I was able to run and grab it for her in order to suction her.
This is a health and safety issue to not have access to proper equipment on a moments notice
and we were lucky that there was one mask in the DOC office. I would like to ask that the
RN's have access to the PPE/ N95 masks so that we can respond quicker and as needed for
situations like this. I would like to mention that if we do grab PPE/N95 equipment we would
continue to inform a manager on-call or manager in the building that we did take a piece of
equipment so that you can keep track of ordering.
Thank you
This is Exhibit “I” referred to in the Affidavit of Diane Peckham
sworn April .........., 2020.

From: Diane Peckham
To: ; kkummerfield@primacareliving.com
Cc: elvie@hall-labour.ca; ABanks@primacareliving.com
Subject: RE: URGENT Response for resolution
Good Evening Kelly
Thank you for your quick response. I would like to suggest that an
adequate supply of PPE including N95 masks, gloves and gowns be
available in the DOC office in the event the supply becomes limited on a
unit. The RN in charge would then be able to access the appropriate PPE
if required. Also wondering if it would be possible that an inventory
be done at the start of each shift on each unit to ensure that those
staff working on that shift on that unit have appropriate supplies in
the medication room or on the carts should they have to use them based
on a Point of Care Risk Assessment as per Directive 5. They may not
require for example the N95s on a particular shift or unit but they will
know that they have them if needed.

London, ON N6E 2H6
519 438-2153 ext 5126
Toll Free: 1-877-839-6245 ext 5126
Fax: (519) 433-2050
This (e-mail or fax) communication and accompanying documents are
intended
only for the individual or entity to which it is addressed and may
contain
information that is confidential, privileged or exempt from disclosure
under
applicable law. Any use of this information by individuals or entities
other than
the intended recipient is strictly prohibited. If you have received
this
communication in error, please notify the sender immediately and delete
all the
copies (electronic or otherwise) immediately. Thank you for your
co-operation.
>>> Kelly Kummerfield <KKummerfield@primacareliving.com> Sunday, April

12, 2020 2:45 PM >>>
Good afternoon Diane ,
I can assure you that each med room as N95s in both sizes for all
registered staff to access based on the mask fit result list I have.
These are stored in the medication room accessible to all registered
staff for point of care risk assessments.
is a covering manager and was very aware that her mask (that is
unique) is in the DOC office. It is her responsibility to prepare for
her shift and check for her PPE (example her unique N95). We keep a
daily inventory check and I agree if a mask is used they should alert
the manager on‑call. I am open to considering providing additional
replacements in the DOC office.
The resident in question was palliative and required oral suctioning

which performed. is an RPN manager and it would be out of
her scope to have performed "deep suctioning" (and further inappropriate
for this palliative resident). She was wearing a level 3 mask which was
adequate for this procedure; I have reviewed this again with her (see
attached).
Our JHSC has been updated regularly on the IPAC Standards for PPE use
in our setting and the documents are posted for all.
Thank you,
Kelly
‑‑‑‑‑Original Message‑‑‑‑‑
Sent: April 12, 2020 2:02 PM
To: elvie@hall‑labour.ca; Kelly
Kummerfield <KKummerfield@primacareliving.com>
Subject: URGENT Response for resolution
Dear Elvie and Kelly
As per email sent from , sent

yesterday, I am asking for immediate resolution to this issue. I
understand that N95 masks are now available in the medication carts
however as per the situation that happened on Friday morning not all
sizes are available. Fortunately, on Friday, there was a manager in the
building, who was covering the outbreak unit for the RPN, I believe.
The manager did have a key for the office where the N95 masks are being
stored and was able to obtain the appropriate N95 mask and provide the
urgent care to the resident. It is imperative that N95 masks, in all
sizes, be readily available at a moments notice given the urgency of
care that might have to be provided in a moments notice.
As you are no doubt aware, Directive # 5 now applies to Long Term Care
homes. The decision regarding appropriate Personal Protection Equipment
is a clinical decision based on a Point of Care assessment by the health
care worker administering the care to the resident. This is a clinical
decision and should be respected and not be a decision left up to the
Employer, as per Directive # 5. Not having immediate access to the
appropriate PPE not only puts our ONA members at risk but also other
health care workers providing care and also your residents who are very
ill and vulnerable who's care at any given moment is unpredictable.
Please respond by 1700 hours today with an appropriate response to this

issue and what process is being put in place to ensure ONA members have
access to the appropriate PPE, including N95 masks, when in their
clinical assessment certain precautions must be taking in relation to
providing care.
This could have been a disastrous situation that fortunately was

resolved due to the quick response from and the manager
working on the unit who happened to have the key thus allowing access to
the mask that was required. The manager providing the care was covering
for an RPN and if that manager was not in the building several calls
would have to have been made to gain access to the N95 masks. I do not
think the Employer wants to be in the position of having one of their
staff either exposed to the virus as a result of providing care without
the appropriate PPE and/or be in a situation where a staff member
exercises their right under the Occupational health and Safety Act to
Refuse work. ONA members are Registered Nurses and their first priority
is to the residents of Henley Place and I have no doubt that they would
put their own safety at risk to care for one of their residents, which
is very concerning to me as this should not have to be choice or a
decision that they should have to make.
I understand that all ONA members were fit tested for the N95 masks in
February. The N95 masks are not a one size fits all, which is why fit
testing is required, therefore, all sizes must be available at a moments
notice considering the unpredictablility of the care that must be
provided to the residents of Henley Place.
If an appropriate resolution is not put in place by 1700 hours today

the Union will have no recourse but to involve the Ministry of Labour
and lodge a complaint.
I would greatly appreciate your immediate response to the Union's

concerns and while I appreciate how busy and difficult this time is for
all involved I am also aware that this situation can be resolved in a
timely manner by providing access to the appropriate PPE immediately
when needed.
Sincerely,

London, ON N6E 2H6
519 438‑2153 ext 5126
Toll Free: 1‑877‑839‑6245 ext 5126
Fax: (519) 433‑2050
This (e‑mail or fax) communication and accompanying documents are
intended only for the individual or entity to which it is addressed and
may contain information that is confidential, privileged or exempt from
disclosure under applicable law. Any use of this information by
individuals or entities other than the intended recipient is strictly
prohibited. If you have received this communication in error, please
notify the sender immediately and delete all the copies (electronic or
otherwise) immediately. Thank you for your co‑operation.
This e‑mail communication and accompanying documents are intended only

for the individual or entity to which it is addressed and may contain
under applicable law. Any use of this information by individuals or
entities other than the intended recipient is strictly prohibited. If
you have received this communication in error, please notify the sender
immediately and delete all the copies (electronic or otherwise)
immediately. Thank you for your co‑operation. Avis de confidentialité Ce
message, transmis par courriel, est confidentiel, peut être protégé par
le secret professionnel et est à l'usage exclusif du destinataire
ci‑dessus. Toute autre personne est par les présentes avisée qu'il
lui est strictement interdit de le diffuser, le distribuer ou le
reproduire.
Si le destinataire ne peut être joint ou vous est inconnu, veuillez
informer l'expéditeur par courrier électronique immédiatement et
détruire ce message et toute copie de celui‑ci. Merci.
This is Exhibit “J” referred to in the Affidavit of Diane Peckham
sworn April .........., 2020.

Personal Protective Equipment
(PPE) use during the COVID-19
Pandemic
Recommendations on the use and conservation of PPE from
Ontario Health
Release date: March 30, 2020
Version History
Release Date Source Change Detail
March 25, 2020 COVID-19 Response: Personal Initial release.
Protective Equipment (PPE)
Committee
March 30, 2020 COVID-19 Response: Personal • List of aerosol-generating medical procedures updated
Protective Equipment (PPE) (appendix A)
Committee • Guidelines for use of Powered Air Purifying Respirators
(PAPRs) added
• Extended-use guidelines for surgical masks in all care
settings added
• New guidance on when to begin droplet/contact
precautions in Long Term Care Facilities added
• New guidance on the use of nebulization for medications for
Long Term Care residents provided
2
Personal Protective Equipment (PPE) use during
the COVID-19 Pandemic
Included are three evidence-based documents produced to support health care organizations and
providers be stewards of personal protective equipment.
1. Guidelines for Use of N95 Respirators versus Facemasks for Care of Individuals with
Suspected or Confirmed COVID-19
2. Guidelines for use of Powered Air Purifying Respirators (PAPRs)
3. Guidelines on the Allocation and Use of Procedural / Surgical Masks
4. General Strategies for Conserving Personal Protective Equipment (PPE)
Acknowledging the fear and anxiety associated with providing healthcare to persons with suspected or
confirmed COVID-19, as well as the need to ensure effective personal protective equipment is available
for healthcare providers, we encourage you to familiarize yourself with the evidence and
recommendations provided here and communicate to your staff on the appropriate and responsible use
of PPE. We also acknowledge the important relationship we have with our stakeholders, associations,
organized labour and workers in working together to achieve the sustained safety of our workforce.
It is recognized that as community spread increases, this guidance will need to be updated to ensure
both that the best available evidence is applied and that we continue to think about longer-term
sustainability of PPE.
It is also recognized that PPE has been used and continues to be used in health care delivery across all
sectors, independent of COVID-19-related use. The first step in conservation of PPE in these situations
has been cancellation or postponement of all elective activity. For activity that is urgent or emergent (or
otherwise must continue), all are encouraged to collaborate with their local clinical and IPAC expertise
to devise strategies to further maximize PPE conservation.
3
Guidelines for use of N95 Respirators Versus Facemasks for Care of
Individuals with Suspected or Confirmed COVID-19
The appropriate stewardship of our provincial supply of PPE requires consideration of the safety of
health care workers combined with strategies to both reduce inappropriate use and conserve supply. In
order to best protect our health care workforce and to ensure the longer-term sustainability of
appropriate PPE for all healthcare workers in Ontario who need them, a set of recommendations –
based on the best available evidence – is provided here.
While we work with health care providers at the front lines on PPE stewardship, we are also working
quickly to stabilize the supply chain for all PPE. We will continue to communicate with you on a regular
basis as more information becomes available.
Acknowledging the fear and anxiety associated with providing healthcare to persons with suspected or
confirmed COVID-19, and the need to ensure effective personal protective equipment is available for
healthcare providers, we encourage you to familiarize yourself with the evidence and recommendations
provided here and communicate to your staff on responsible use of appropriate PPE for the specific
circumstances.
Inpatient Facilities (acute care hospital and complex continuing care)

• When caring for individuals with suspected or confirmed COVID-19, healthcare workers should
follow droplet/contact precautions (surgical/procedure mask, isolation gown, gloves and eye
protection).
o A surgical mask can be used over the course of many patients. Conserve your mask for
as long as possible, but once wet, damaged, soiled, or removed (e.g., to eat or drink),
you should immediately dispose of the mask. Take extra care when removing this mask
as this is when self-contamination may occur. Don a new mask for your next set of
patient encounters, extending its use for as long as possible. It is safe to wear your mask
for multiple patient encounters; in fact, you may reduce the risk of self-contamination
by reducing the number of mask changes. Take care not to touch your facemask, and if
you do, immediately perform hand hygiene.
• Use an N95 respirator during aerosol-generating medical procedures (AGMP) performed on

suspected or confirmed COVID-19 patients. For an evidence-based list of AGMPs, see Appendix
A adapted from the Toronto Region Hospital Operations Committee IPAC Consensus List of
Aerosol-Generating Medical Procedures (AGMP).
• The following aerosol-generating medical procedures should be avoided in suspected or

confirmed COVID-19 patients. Where these procedures must occur based on clinical judgment,
an N95 respirator should be used:
o Cardio-pulmonary resuscitation (this is considered a high-risk procedure and should only

be embarked upon where there is a reasonable prospect of success)
o Tracheotomy
o High frequency oscillating ventilation
4
o Bronchoscopy (Diagnostic or Therapeutic)
o Sputum induction (Diagnostic or Therapeutic)
o Open suctioning (e.g. “deep” insertion for nasopharyngeal or tracheal suctioning, not
inclusive of oral suction)
o Non-invasive positive pressure ventilation (CPAP, BiPAP)
o CPAP/BiPAP for obstructive sleep apnea
o Large volume nebulizers for humidity
o High flow oxygen therapy
• For all other situations, including screening, entering a patient’s room, or providing direct care
to patients suspected or confirmed to have COVID-19, a surgical mask, isolation gown, gloves
and eye protection is sufficient. N95 respirators SHOULD NOT be used by providers caring for
COVID-19 or suspected COVID-19 patients unless the patient is undergoing an aerosol-
generating medical procedure as described above.
• Visitor restriction should be in effect to reduce the need for PPE. Visitors that are permitted
entry to an inpatient unit under an exception, after screening for symptoms of COVID-19 and
ensuring there are none (including travel in the last 14 days), may receive allocation of one (1)
procedure mask and only if the hospital’s PPE supply allows. Hand hygiene must be performed
prior to donning the procedure mask and the visitor instructed that the mask must remain fully
in place for the duration of the visit.
Primary Care (including walk-in clinics), Outpatient and Ambulatory Settings

• When caring for individuals with suspected or confirmed COVID-19 healthcare workers should
protection).
for multiple patient encounters. In fact, you may reduce your risk of self-contamination
• Patients suspected of, or confirmed to have COVID-19, who are waiting to be seen should don
surgical masks and maintain a 2-metre special distance from others.
• Refer to appendix A for a list of evidence-based aerosol generating medical procedures

(AGMPs).
5
COVID-19 Assessment Centres
• Patients who are waiting to be assessed should don surgical masks and maintain a 2-metre
special distance from others.
• Screeners are advised to don a surgical mask if they are less than 2 metres away from those
being screened and not behind a partition.
• Workers who are assessing (+/- obtaining nasopharyngeal swabs from) staff and patients with
COVID-19 symptoms do not require N-95 respirators.
for multiple patient encounters. In fact, you may reduce your risk of self-contamination
• Refer to appendix A for a list of evidence-based aerosol generating medical procedures

(AGMPs).
Long-term Care Facilities

• Once a long-term care facility has confirmed a COVID-19 case, all residents should be cared for
using droplet/contact precautions (surgical/procedure mask, isolation gown, gloves and eye
protection).
patient encounters, extending its use for as long as possible. In fact, you may reduce
your risk of self-contamination by reducing the number of mask changes. It is safe to
wear your mask for multiple patient encounters. Take care not to touch your facemask,
and if you do, immediately perform hand hygiene.
• Use an N95 respirator during aerosol-generating medical procedures performed on suspected or

confirmed COVID-19 patients. For an evidence-based list of aerosol-generating medical
procedures, see Appendix A adapted from the Toronto Region Hospital Operations Committee
IPAC Consensus List of Aerosol-Generating Medical Procedures (AGMP).
• Note: CPAP and BiPAP (for obstructive sleep apnea) for residents with suspected or confirmed
COVID-19 should be avoided if possible. Where these procedures must occur based on clinical
judgment, an N95 respirator should be used and patients should be in a private room with the
door closed.
6
• Note: Nebulization for medications for residents with suspected or confirmed COVID-19 should
be avoided if possible. Where these procedures must occur based on clinical judgement, an N95
respirator should be used and patients should be in a private room with the door closed.
• Visitor restriction should be in effect to reduce the need for PPE. Visitors that are permitted
entry to an inpatient unit under an exception, after screening for symptoms of COVID-19 and
ensuring there are none, may receive allocation of one (1) procedure mask and only if the
facility’s PPE supply allows. Hand hygiene must be performed prior to donning the procedure
mask and the visitor instructed that it must remain fully in place for the duration of the visit.
Home and Community Care

• When caring for individuals with suspected or confirmed COVID-19 healthcare workers should
protection).
o A surgical mask can be used over the course of many patients including while driving
between homes. Conserve your mask for as long as possible, but once wet, damaged,
soiled, or removed (e.g., to eat or drink), you should immediately dispose of the mask.
Take extra care when removing this mask as this is when self-contamination may occur.
Don a new mask for your next set of patient encounters, extending its use for as long as
possible. It is safe to wear your mask for multiple patient encounters. In fact, you may
reduce your risk of self-contamination by reducing the number of mask changes. Take
care not to touch your facemask, and if you do, immediately perform hand hygiene.
• Use an N95 respirator during aerosol-generating medical procedures performed on suspected or

confirmed COVID-19 patients. For an evidence-based list of aerosol-generating medical
procedures, see Appendix A adapted from the Toronto Region Hospital Operations Committee
IPAC Consensus List of Aerosol-Generating Medical Procedures (AGMP).
• For all other situations, including screening, entering a patient’s home, or providing direct care
to patients suspected or confirmed to have COVID-19, a surgical mask, isolation gown, gloves
and eye protection is sufficient. N95 respirators are not required.
7
Guidelines for use of Powered Air Purifying Respirators (PAPRs)
PAPRs are meant protect the wearer against airborne hazards. Because they are positive pressure
devices, they are generally more comfortable for long-term use than N95 respirators. When donned,
the user’s head and neck are also well protected against ballistic (non-airborne) droplets. When used in
a setting where there is a high number of air exchanges (i.e., an operating room, an airborne isolation
room), the relative benefit of using a PAPR versus an N95 respirator in protecting against airborne
hazards is negligible because airborne particles are rapidly removed by the ventilation and N95
respirators are efficient at preventing the inhalation of airborne-sized particles.
The challenge with using PAPRs for primarily droplet/contact spread pathogens such as SARS CoV-2 is
contamination of the PAPR hood and the possible risk of user hands and mucous membrane
contamination upon removal. As a predominantly droplet-contact transmitted disease, the use of
PAPRs may paradoxically increase the risk of healthcare worker transmission. This is not a concern for
the airborne hazards for which the PAPR was created. Similarly, while contamination of the tubing and
HEPA-filtration unit warn with the PAPR hood is typically not a concern with airborne hazards,
contamination will occur with droplet/contact transmitted pathogens.
Concerns related to possible user contamination upon removal relate to:

• Bulkiness of the hood.
• Lack of formal training and practice in removing the hood.
• Lack of validated procedures to attempt hood decontamination prior to removal.
• Requirement for repeated donning and doffing of the hood if these are meant to replace an N95
respirator.
• Requirement to handle and decontaminate the accompanying hood and HEPA filtration unit.
For these reasons PAPRs are not generally recommended for the care of COVID-19 patients. In settings
where the equipment is donned and doffed once per shift i.e. worn for an entire shift, PAPRs may play a
role, provided that the concerns listed above are appropriately addressed.
8
Guidelines on the Allocation and Use of Procedural / Surgical masks by
Healthcare Providers
Mask use for COVID-19 and suspected COVID-19 patients
• Health care providers who are caring for COVID-19 and suspected COVID-19 patients should don
a surgical/procedural mask, an isolation gown, protective eyewear and gloves. Masks should be
substituted for N-95 respirators for the specific indications listed in the previous section.
When should we escalate mask use for other or all patient encounters?
• The assessment of risk posed to health care workers who are caring for the general public who
have not been diagnosed with COVID-19 or suspected COVID-19 can be challenging as the risk
varies based on care setting, type of care being provided, prevalence of asymptomatic infection
in the population presenting for care and the extent to which the virus sheds from
asymptomatic individuals. In addition, there are increasing reports of COVID-19 patients
presenting with atypical symptoms, allowing them to pass through screening undetected.
• In some areas of the province where community spread is felt to be likely, some organizations,
particularly hospitals, have taken the decision to provide two (2) masks per shift to all health
care workers who are patient-facing. This action has been taken to show an abundance of
caution in areas where the risk to health care workers posed by the general patient population is
felt to be elevated. Conserve your mask for as long as possible, but once wet, damaged, soiled,
or removed (e.g., to eat or drink), you should immediately dispose of the mask. In some
circumstances more than more than 2 masks/shift may be necessary.
• Other areas have not yet seen community spread and are comfortable maintaining a
recommendation for health care workers to only use masks when treating COVID-19 or
suspected COVID-19 patients. It is acknowledged that not all communities have implemented
broad testing.
• This kind of risk stratification is necessary and appropriate if we are to protect our health care
workforce while at the same time conserving the supply of masks. Using masks injudiciously in
low-risk environments could contribute to an undersupply later when risk everywhere is higher.
• Accordingly, a thoughtful, risk-based approach to mask allocation is recommended. It is

recognized that, at any given moment in time, this will result in different mask allocation
protocols across organizations in all sectors in health care. It is also recognized that individual
organizations will need to change or escalate their allocation policies as risks change.
o All surgical masks in the organization should be immediately secured (treated like
narcotic supply)
o All organizations (including acute care, COVID-19 assessment centres, primary care,
outpatient and ambulatory care, long-term care and home and community care) should
establish a defined, phased approach to mask allocation based on risk assessment with
Phase 1 representing mask use for the highest risk scenarios, and Phase 4 representing
the lowest risk scenarios.
9
▪ One potential risk stratification scheme (from acute care, to serve as an
example):
• PHASE 1: Unplanned urgent and emergent care (e.g. EDs staff)
• PHASE 2: Planned urgent or emergent care (e.g. dialysis, endoscopy,

labour and delivery)
• PHASE 3: All remaining clinical areas and inpatient units
• PHASE 4: Non-clinical spaces
o Organizations in all care sectors should escalate through phases of mask allocation as
risk escalates. As the pandemic begins to recede, early de-escalation through the phases
should be considered.
o Estimates of risk should be made on an organization-by-organization basis, depending

on local prevalence of disease, evidence of community spread, and advice from local
IPAC experts.
o Importantly, in a future scenario of restricted masks, these risk categories allow

organizations to roll back mask allocation in a rational fashion.
General guidelines when using surgical/procedural masks:

• A surgical mask can be used over the course of many patients. Conserve your mask for as long as
possible, but once wet, damaged, soiled, or removed, you should immediately dispose of the
mask. Take extra care when removing this mask as this is when self-contamination may occur.
Don a new mask for your next set of patient encounters, extending its use for as long as
possible. It is safe to wear your mask for multiple patient encounters. In fact, you may reduce
your risk of self-contamination by reducing the number of mask changes. Take care not to touch
your facemask, and if you do, immediately perform hand hygiene.
• Leave the patient care area to remove the facemask and perform hand hygiene afterwards.
• Take care not to touch your facemask, and if you do perform hand hygiene.
This guidance is current as of the release date noted. It will be updated from time to time. In
regions where there is no community spread, this guidance will be most applicable. Regions
that are currently experiencing large scale community spread may alter this approach to meet
their current needs based on local epidemiology and infection control advice.
10
Strategies for Conserving Personal Protective Equipment (PPE)
1. Assess your existing supply of N95 respirators and other PPE
a) Gather and secure supplies from across your organization, including:
i. From visitor and public areas.
ii. Clinics or surgical areas not in use.
2. Centralize distribution of N95 respirators, manage them as you would narcotics

a) Take stock of supplies, steward judiciously and track usage. Distribute only according to
guidelines issued by Ontario Health.
3. Where appropriate, limit number of patients going to hospital, outpatient and homecare settings
for non-urgent care
a) Maximize virtual consults. Any patient who does not require a physical presence in a health
care institution should not be there.
a) Use drive-thru or virtual COVID-19 screening as much as possible.
4. Minimize contact with patients suspected or confirmed to have COVID-19

a) Restrict healthcare workers entering rooms to only those involved in direct care (e.g. no
learners).
b) Assess what other staff/allied health professionals could be restricted. Minimize inpatient
consults. Consider virtual inpatient consult options.
c) Maximize trans-disciplinary (e.g. caregiver who has to enter the room anyway for other
reason can deliver a food tray).
d) Caregivers should cluster their tasks to reduce the number of times they need to enter the
room.
e) Consider other changes to minimize use of PPE, e.g. moving infusion pumps outside patient
rooms so alarms can be addressed without donning PPE or going to a dial flow non pump
system to reduce the number of alarms.
5. Alter care processes to minimize possible COVID-19 patient contact to as few providers as
possible, with as little time in the hospital as possible.
a) For example, for low risk patients arriving to the emergency room, consider taking vitals at
triage and history, then sending patients back to their cars to have a phone consult with the
doctor, with re-entry only if diagnosis is not clear or more investigation is needed.
6. Cohort patients with confirmed COVID-19 in the same room and on the same unit.
7. Assign a specialized team to care for a cohort of patients with suspect or confirmed COVID-19
8. Severely limit visitors to rooms/areas with patients suspected or confirmed to have COVID-19
9. Remove droplet/contact precautions as quickly as appropriately possible

a) COVID-19 results may be available on Connecting Ontario or OLIS prior to our laboratories
receiving notification.
b) Contact infection control in a timely manner and prior to discontinuing precautions.

11
10. N95 Respirator Testing
a) Use N95 respirators beyond the manufacturer-designated shelf life for fit testing if
necessary in the context of inadequate supply of non-expired product.
b) Limit the use of N95 respirators during mask fit testing to key staff.
c) Use your testing mask for patient care.
11. N95 Respirator Education

a) Offer education on the indications for use of N95 respirators in the care of patients with
suspect or confirmed COVID-19 (see Guidelines for Use of N95 Respirators for Care of
Individuals with Suspected or Confirmed COVID-19 in the previous section).
12. Audit the use of PPE in your organization

a) Either conduct leadership rounds to deliver key messages and address variability observed
in practice, or charge managers and directors with enforcing and reporting on appropriate
PPE use on each unit.
13. Extend use of facemasks by wearing the same facemask for repeated close contact encounters
with several patients without removing in between
a) The facemask should be removed and discarded if soiled, damaged or hard to breathe
through.
b) Take care not to touch your facemask, and if you do perform hand hygiene.
c) Leave the patient care area to remove the facemask and perform hand hygiene afterwards.
d) Once the facemask has been removed dispose of in a bin for possible reprocessing.
14. Extended use of eye protection by wearing the same eye protection for repeated encounters with
different patients without removing in between.
15. Extend the use of isolation gowns (disposable or cloth) by wearing the same gown for repeated
encounters with different patients with COVID-19 without removing in between. Re-use of cloth
isolation gowns (without washing in between). Remove after last patient encounter and do not
reuse without reprocessing.
16. Reprocess PPE

a) Collect used masks for potential future reprocessing; early work suggests N95 masks could
be irradiated and potentially used weeks later (current thought is that virus can survive on
surfaces for 3 days) (Note: not recommended by 3M).
b) Consider moving from visors to goggles which can be cleaned.
c) Strongly consider moving to washable gowns. One hospital tested washing blue isolation
gowns in-house and reported they laundered well.
12
17. Prepare for last-resort scenario:
a) Use of respirators approved under standards used in other countries that are similar to
NIOSH-approved respirators (e.g.: N100, P100, R100, N99, P99, R99, N95, P95, R95).
b) Limited re-use of N95 respirators for patients with COVID-19 (implemented according the
CDC guidance).
c) Use of N95 respirators beyond the manufacturer-designated shelf life for delivering patient
care – it is important to ensure a seal check is completed prior to providing patient care.
d) Save expired N95 masks for last resort back-up or low-risk settings.
e) Consider use of non-approved NIOSH masks for low-risk settings; Use of respirators from
other countries (that are similar to NIOSH approved N95 respirators).
13
Appendix A:
Aerosol-Generating Medical Procedures, adapted from the Toronto Region Hospital Operations
Committee IPAC Consensus List of Aerosol-Generating Medical Procedures (AGMP)
Aerosol-Generating Medical Procedures

• Intubation
• Extubation
• Cardio Pulmonary Resuscitation (NB - chest compressions and cardioversion/defibrillation are
not considered AGMP; however, procedures associated with CPR, such as emergent intubation
and manual ventilation are AGMP)
• Non-invasive ventilation (e.g., CPAP, BiPAP) (suggest avoid where possible)
• Manual ventilation
• High-flow oxygen (i.e., AIRVO, Optiflow, not 5L oxygen by nasal prongs) (suggest avoid where
possible)
• Open suctioning (e.g. “deep” insertion for naso-pharyngeal or tracheal suctioning, not inclusive
of oral suction) (suggest avoid where possible)
• Bronchoscopy (suggest avoid where possible)
• Induced sputum (e.g. inhalation of nebulized saline solution to liquify and produce airway
secretions, not natural coughing to bring up sputum) (suggest avoid where possible)
• Large volume nebulizers for humidity (suggest avoid where possible)
• Autopsy
• Nasopharyngoscopy
• Oral, pharyngeal, transphenoidal and airway surgeries (including thoracic surgery and
tracheostomy insertion) (tracheostomy should be avoided if possible).
• High frequency oscillation ventilation (suggest avoid where possible)
• Needle thoracostomy
Not Considered Aerosol-Generating Medical Procedures

• Collection of nasopharyngeal or throat swab
• Ventilator circuit disconnect
• Chest tube removal
• Coughing
• Oral suctioning
• Oral hygiene
• Gastroscopy
• ERCP
• Colonoscopy
• Cardiac stress tests
• Caesarian section or vaginal delivery of baby done with epidural
• Any procedure done with regional anesthesia
• Electroconvulsive Therapy (ECT)
• Transesophageal Echocardiogram (TEE)
• NG tube insertion
• Chest physiotherapy
14
References:
Health Protection Scotland. Aerosol Generating Procedures (AGPs).

https://hpspubsrepo.blob.core.windows.net/hps-website/nss/2893/documents/1_tbp-lr-agp-v1.pdf.
(November 2019). Accessed March 24, 2020.
Public Health Ontario. Updated IPAC Recommendations for Use of Personal Protective Equipment for
Care of Individuals with Suspected or Confirmed COVID19 (March 12, 2020).
https://www.publichealthontario.ca/-/media/documents/ncov/updated-ipac-measures-covid-
19.pdf?la=en. Accessed March 23, 2020.
Release of Stockpiled N95 Filtering Facepiece Respirators Beyond the Manufacturer-Designated Shelf
Life: Considerations for the COVID-19 Response (February 28, 2020).
https://www.cdc.gov/coronavirus/2019-ncov/release-stockpiled-N95.html. Accessed March 23, 2020.
Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in
Healthcare Settings (March 28, 2018):
https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html. Accessed March
23, 2020.
Strategies for Optimizing the Supply of PPE (March 17, 2020). https://www.cdc.gov/coronavirus/2019-
ncov/hcp/ppe-strategy/index.html. Accessed March 23, 2020.
Toronto Region Hospital Operations Committee IPAC Consensus List of Aerosol-Generating Medical
Procedures (AGMP) (version date: March 25, 2020).
15
COVID-19 Response: Personal Protective Equipment (PPE) Committee
Name Title(s) and Institutions(s)

Dr Zain Chagla, MSc MD Co-Medical Director of Infection Control, St. Joseph's Healthcare Hamilton and
FRCPC Niagara Health System
Associate Professor, Department of Medicine, McMaster University
Connie Clerici, RN Executive Chair, Closing the Gap Healthcare
BHsc(N) Adjunct Lecturer, IHPME, University of Toronto
Dr Jennifer Everson, Vice-President, Clinical, Ontario Health (West)
BscN MD CCFP FCFP Associate Professor McMaster University, Faculty of Medicine, Department of
Family Medicine
Dr Michael Gardam, Chief of Staff, Humber River Hospital
MSc, MD, CM, FRCPC Associate Professor, Department of Medicine, University of Toronto
Derek McNally, RN MM Executive VP Clinical Services & Chief Nursing Executive, Niagara Health
Adjunct Professor, Department of Nursing, Brock University
Dr Howard Ovens, MD, Chief Medical Strategy Officer, Sinai Health System
FCFP(EM) Professor, Dept. of Family and Comm. Med., University of Toronto and Sr.
Fellow, IHPME
Ontario Provincial Lead for Emergency Medicine
Dr Paul Preston, MD Vice President, Clinical, Ontario Health (North)
CCFP CCPE CHE
Dr. Amit Shah, MD Emergency Department Lead, South West Region
CCFP(EM) FCFP Emergency Physician, London Health Sciences Centre/St. Thomas-Elgin General
Hospital
Associate Professor, Division of Emergency Medicine, Western University
Dr Chris Simpson (chair), Vice-Dean (Clinical), School of Medicine, Queen’s University
BSc, MD, FRCPC, FACC, Medical Director, Southeastern Ontario Academic Medical Organization
FHRS, FCCS, FCAHS Professor, Division of Cardiology, Queen’s University
Affiliate Scientist, Institute for Clinical Evaluative Sciences
Dr Tamara Wallington, Program Chief and Medical Director, Trillium Health Partners
MD FRCPC Academic Lead, Family Medicine Teaching Unit FMTU
16
COVID-19
Directive #5 for Hospitals within the meaning of the Public Hospitals
Act and Long-Term Care Homes within the meaning of the Long-Term
Care Homes Act, 2007
Issued under Section 77.7 of the Health Protection and Promotion Act
(HPPA), R.S.O. 1990, c. H.7
THIS DIRECTIVE REPLACESTHE DIRECTIVE #5 ISSUED ON MARCH 31, 2020. THE
DIRECTIVE #5 ISSUED ON MARCH 31, 2020 IS REVOKED AND THE FOLLOWING
SUBSTITUTED:
WHEREAS under section 77.7(1) of the HPPA, if the Chief Medical Officer of Health (CMOH)
is of the opinion that there exists or there may exist an immediate risk to the health of persons
anywhere in Ontario, he or she may issue a directive to any health care provider or health care
entity respecting precautions and procedures to be followed to protect the health of persons
anywhere in Ontario;
AND WHEREAS pursuant to O. Reg 68/20 made under the Retirement Homes Act, as part of the
prescribed infection prevention and control program, all reasonable steps are required to be taken
in a retirement home, to follow any directive pertaining to COVID-19 that is issued to long-term
care homes under section 77.7 of the HPPA;
AND WHEREAS, under section 77.7(2) of the HPPA, for the purposes of section 77.7(1), the
CMOH must consider the precautionary principle where in the opinion of the CMOH there
exists or there may exist an outbreak of an infectious or communicable disease and the
proposed directive relates to worker health and safety in the use of any protective clothing,
equipment or device;
AND HAVING REGARD TO the emerging evidence about the ways this virus transmits
between people as well as the potential severity of illness it causes in addition to the
declaration by the World Health Organization (WHO) on March 11, 2020 that COVID-19 is a
pandemic virus and the spread of COVID-19 in Ontario, and the technical guidance provided
by Public Health Ontario on scientific recommendations by the WHO regarding infection
prevention and control measures for COVID-19 which is required to be followed by health care
providers and health care entities, including hospitals and long-term care homes, in Directive
#1, dated March 12, 2020 and revised on March 30, 2020;
AND HAVING REGARD TO the precautionary principle, which in my opinion has been met, in
that this directive will protect health care workers' health and safety in the use of any protective
clothing, equipment and device in public hospitals and long-term care homes and the failure to
adhere to this directive may put worker health and safety at risk;
I AM THEREFORE OF THE OPINION that there exists or may exist an immediate risk to the
health of persons anywhere in Ontario from COVID-19;
AND DIRECT pursuant to the provisions of section 77.7 of the HPPA that:
Directive #5 for Public Hospitals within the meaning of the Public

Hospitals Act and Long-Term Care Homes within the meaning of the
Long-Term Care Homes Act, 2007
Date of Issuance: April 10, 2020
Effective Date of Implementation: April 10, 2020
Issued To: Public hospitals within the meaning of the Public Hospitals Act and long-term care
homes within the meaning of the Long-Term Care Homes Act, 2007 referenced in section
77.7(6), paragraphs 4 and 10 of the Health Protection and Promotion Act.
Introduction:
Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common
cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV), Severe
Acute Respiratory Syndrome (SARS-CoV), and COVID-19. A novel coronavirus is a new strain
that has not been previously identified in humans.
On December 31, 2019, the World Health Organization (WHO) was informed of cases of
pneumonia of unknown etiology in Wuhan City, Hubei Province in China. A novel coronavirus
(COVID-19) was identified as the causative agent by Chinese authorities on January 7, 2020.
On March 11, 2020 the WHO announced that COVID-19 is classified as a pandemic virus.
This is the first pandemic caused by a coronavirus.
Related Directive
On March 12, 2020 I issued a Directive on Personal Protective Equipment (PPE) (Directive #1)
which directed the use of droplet and contact precautions for the routine care of patients or
residents with suspected or confirmed COVID-19, and airborne precautions when aerosol
generating medical procedures (AGMPs) are planned or anticipated on patients or residents
with suspected or confirmed COVID-19. That Directive was revoked and replaced with
Directive #1 dated March 30, 2020.
To the extent that anything in this Directive conflicts with Directive #1, this Directive prevails.
On March 17, 2020 the Premier and Cabinet declared an emergency in Ontario under the
Emergency Management and Civil Protection Act due to the outbreak of COVID-19 in Ontario
and Cabinet made emergency orders to implement my recommendations of March 16, 2020.
On March 30th 2020, the emergency declaration was extended.
Symptoms of COVID-19
For signs and symptoms of COVID-19 please refer to the update on guidance for testing
issued on April 8, 2020.
Complications from COVID-19 can include serious conditions, like pneumonia or kidney failure,
and in some cases, death. Complications from COVID-19 can include serious conditions, like
pneumonia or kidney failure, and in some cases, death.
Required Precautions and Procedures

All public hospitals and long-term care homes must immediately implement the following
precautions and procedures, as applicable to regulated health professionals as defined under
the Regulated Health Professions Act, 1991 (“health care worker”) employed by or in public
hospitals and long-term care homes and, where specified, other employees employed by or in
public hospitals and long-term care homes (“other employees”) dealing with suspected,
presumed, or confirmed COVID-19 patients or residents:
• Public hospitals and long-term care homes, health care workers and other employees
must engage on the conservation and stewardship of personal protective equipment
(PPE). Public hospitals and long-term care homes must provide all health care workers
and other employees with information on the safe utilization of all PPE and all health care
workers and other employees must be appropriately trained to safely don and doff all
PPE.
• Hospitals and long-term care homes must assess the available supply of PPE on an
ongoing basis. Public hospitals and long-term care homes must explore all available
avenues to obtain and maintain a sufficient supply of PPE.
• In the event that the supply of PPE reaches a point where utilization rates indicate that a
shortage will occur, the government and employers, as appropriate, will be responsible
for developing contingency plans, in consultation with affected labour unions, to ensure
the safety of health care workers and other employees.
• The public hospital’s or long-term care home’s Organizational Risk Assessment must be
continuously updated to ensure that it assesses the appropriate health and safety control
measures to mitigate the transmission of infections, including engineering, administrative
and PPE measures. This must be communicated to the Joint Health and Safety
Committee including the review of the hospital or long-term care environment when a
material change occurs.
• A point-of-care risk assessment (PCRA) must be performed by every health care worker
before every patient or resident interaction in a public hospital or long-term care home.
• If a health care worker determines, based on the PCRA, and based on their professional
and clinical judgement, that health and safety measures may be required in the delivery
of care to the patient or resident, then the public hospital or long-term care home must
provide that health care worker with access to the appropriate health and safety control
measures, including an N95 respirator. The public hospital or long-term care home will
not unreasonably deny access to the appropriate PPE.
• At a minimum, for health care workers and other employees in a hospital or a long-term
care home, contact and droplet precautions must be used by health care workers and
other employees for all interactions with suspected, presumed or confirmed COVID-19
patients or residents. Contact and droplet precautions includes gloves, face shields or
goggles, gowns, and surgical/procedure masks.
• For long term care homes only, all staff and essential visitors must wear
surgical/procedure masks at all times for the duration of full shifts or visits in the long-term
care home. For further clarity this is required regardless of whether the home is in
outbreak or not. During breaks, staff may remove their surgical/procedure mask but must
remain two metres away from other staff to prevent staff to staff transmission of COVID-
19. This is to be implemented in conjunction with all other requirements contained in
Directive #3 dated April 8th 2020 or as amended.
• All health care workers or other employees who are within two metres of suspected,
presumed or confirmed COVID-19 patients or residents shall have access to appropriate
PPE. This will include access to: surgical/procedure masks, fit tested NIOSH-approved
N-95 respirators or approved equivalent or better protection, gloves, face shields with side
protection (or goggles) and appropriate isolation gowns.
• The PCRA by the health care worker should include the frequency and probability of
routine or emergent Aerosol Generating Medical Procedures (AGMPs) being required.
N95 respirators, or approved equivalent or better protection, must be used by all health
care workers in the room where AGMPs are being performed, are frequent or probable.
AGMPs include but are not limited to; Intubation and related procedures (e.g. manual
ventilation, open endotracheal suctioning), cardio pulmonary resuscitation during airway
management, bronchoscopy, sputum induction, non-invasive ventilation (i.e. BiPAP),
open respiratory/airway suctioning, high frequency oscillatory ventilation, tracheostomy
care, nebulized therapy/aerosolized medication administration, high flow heated oxygen
therapy devices (e.g. ARVO, optiflow) and autopsy. Any change to this list is to be based
on the Technical Brief "Updated IPAC Recommendations for Use of Personal Protective
Equipment for Care of Individuals with Suspect or Confirmed COVID-19" dated March 25,
2020 as amended from time to time which has been prepared by Public Health Ontario
In accordance with O. Reg 68/20 made under the Retirement Homes Act, retirement homes
must take all reasonable steps to follow the required precautions and procedures outlined in
this Directive.
Note: As this outbreak evolves, there will be continual review of emerging evidence to
understand the most appropriate measures to take. This will continue to be done in
collaboration with health system partners and technical experts from Public Health Ontario and
with the health system.
Questions
Hospitals, Long-term care homes and HCWs may contact the ministry’s Health Care Provider
Hotline at 1-866-212-2272 or by email at emergencymanagement.moh@ontario.ca with
questions or concerns about this Directive.
Hospitals, long-term care homesand HCWs are also required to comply with applicable
provisions of the Occupational Health and Safety Act and its Regulations.
David C. Williams, MD, MHSc, FRCPC

Chief Medical Officer of Health
This is Exhibit “K” referred to in the Affidavit of Diane Peckham
sworn April .........., 2020.

From: Elvie Hall
To:
Adam Banks; Kelly Kummerfield
Subject: FW: URGENT Response for resolution
Date: April 13, 2020 11:44:54 AM

Good Morning Diane, thank you for your suggestions, we do track our supply of PPE and make it
available to our staff as per Kelly’s email below. . Our staff and resident safety is our priority.

Elvie A. Hall
phone 905-878-7227 fax 905-878-7873 cell 647-200-8232

IMPORTANT NOTICE: This message and the information contained therein is intended only for the use of the individual or entity to which it is addressed. If the reader of this message is not
the intended recipient, or the employee or agent responsible for delivering the message to the intended recipient, you are notified that any dissemination, distribution or copying of this
communication is strictly prohibited.
If you have received this communication in error, please notify Hall Labour immediately by contacting (905) 878-7227 and delete this electronic message from your computer system and
that of your Internet Service Provider. Please note that any information provided via electronic messaging will be collected in accordance with Hall Labour Privacy Policy (the "Policy"). This
Policy is available upon request from Hall Labour Relations Services Professional Corporation.

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Sent: Sunday, April 12, 2020 9:30 PM
Cc: Elvie Hall; ABanks@primacareliving.com

Good Evening Kelly

London, ON N6E 2H6
519 438-2153 ext 5126
Toll Free: 1-877-839-6245 ext 5126
Fax: (519) 433-2050
intended
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co-operation.
This e-mail communication and accompanying documents are intended only

immediately. Thank you for your co-operation. Avis de confidentialité Ce
ci-dessus. Toute autre personne est par les présentes avisée qu'il lui
est strictement interdit de le diffuser, le distribuer ou le reproduire.
détruire ce message et toute copie de celui-ci. Merci.

12, 2020 2:45 PM >>>
Good afternoon Diane and Jamie,



attached).
Thank you,
Kelly
Sent: April 12, 2020 2:02 PM
To: >; elvie@hall‑labour.ca; Kelly


providing care.



when needed.
Sincerely,

London, ON N6E 2H6
519 438‑2153 ext 5126
Toll Free: 1‑877‑839‑6245 ext 5126
Fax: (519) 433‑2050

reproduire.
This is Exhibit “L” referred to in the Affidavit of Diane Peckham
sworn April .........., 2020.

From: Diane Peckham
To: ; elvie@hall-labour.ca
Cc: ABanks@primacareliving.com; KKummerfield@primacareliving.com
Subject: Re: FW: URGENT Response for resolution
Can you please confirm, as per Kelly’s email response stating that she is “open to considering providing
additional
replacements in the DOC office”, that supplies will then be available in the DOCs office for access by the
RN in charge should the medication rooms or carts require replenishing. This would be the case for
example on evenings, nights, weekends and statutory holidays.

London, ON N6E 2H6
519 438-2153 ext 5126
Toll Free: 1-877-839-6245 ext 5126
Fax: (519) 433-2050
>>> Elvie Hall 04/13/20 11:45 AM >>>

Elvie A. Hall
phone 905-878-7227 fax 905-878-7873 cell 647-200-8232

Get Outlook for iOS

________________________________
From: Diane Peckham >
Good Evening Kelly

London, ON N6E 2H6
519 438-2153 ext 5126
Toll Free: 1-877-839-6245 ext 5126
Fax: (519) 433-2050
intended
contain
under
other than
this
all the
co-operation.

>>> Kelly Kummerfield > Sunday, April

12, 2020 2:45 PM >>>
Good afternoon Diane and ,

attached).
Thank you,
Kelly
Sent: April 12, 2020 2:02 PM
Kummerfield >


providing care.



when needed.
Sincerely,

London, ON N6E 2H6
519 438‑2153 ext 5126
Toll Free: 1‑877‑839‑6245 ext 5126
Fax: (519) 433‑2050

reproduire.
This is Exhibit “M” referred to in the Affidavit of Diane

From: Diane Peckham
To: ; elvie@hall-labour.ca
Please confirm now that PPEs including N95s and nitrile gloves are available in the DOC office.
Managers may be leaving the building soon and the evening and night staff may require access to
additional PPEs. I appreciate some supplies are available in the med rooms however as a precautionary
process there needs to be access to additional PPEs if a POC assessment determines the need. I am
hoping to avoid a call to the MOL and I appreciate some additional PPEs have been added to the med
rooms but situations arise and having access to all PPEs is essential.
————————————————————-
additional

London, ON N6E 2H6
519 438-2153 ext 5126

Toll Free: 1-877-839-6245 ext 5126
Fax: (519) 433-2050

>>> Elvie Hall 04/13/20 11:45 AM >>>
Elvie A. Hall
phone 905-878-7227 fax 905-878-7873 cell 647-200-8232

Get Outlook for iOS

________________________________
Good Evening Kelly

London, ON N6E 2H6
519 438-2153 ext 5126
Toll Free: 1-877-839-6245 ext 5126
Fax: (519) 433-2050
intended
contain
under
other than
this
all the
co-operation.
>>> Kelly Kummerfield > Sunday, April

12, 2020 2:45 PM >>>
Good afternoon Diane and ,

attached).
Thank you,
Kelly
Sent: April 12, 2020 2:02 PM
To: ; elvie@hall‑labour.ca; Kelly
Kummerfield >


providing care.

resolved due to the quick response from the manager


when needed.
Sincerely,

London, ON N6E 2H6
519 438‑2153 ext 5126
Toll Free: 1‑877‑839‑6245 ext 5126
Fax: (519) 433‑2050

reproduire.
This is Exhibit “N” referred to in the Affidavit of Diane Peckham
sworn April .........., 2020.

From: Elvie Hall
To: ; Diane Peckham
Subject: RE: FW: URGENT Response for resolution
Date: April 13, 2020 2:59:13 PM
Diane, they will leave a couple of extra N95’s in the DOC’s office, however, I understand that 6 -
N95’s were used inappropriately over the weekend.

Elvie A. Hall
phone 905-878-7227 fax 905-878-7873 cell 647-200-8232

IMPORTANT NOTICE: This message and the information contained therein is intended only for the use of the individual or entity to which it is addressed. If the reader of this message is not
the intended recipient, or the employee or agent responsible for delivering the message to the intended recipient, you are notified that any dissemination, distribution or copying of this
communication is strictly prohibited.
If you have received this communication in error, please notify Hall Labour immediately by contacting (905) 878-7227 and delete this electronic message from your computer system and
that of your Internet Service Provider. Please note that any information provided via electronic messaging will be collected in accordance with Hall Labour Privacy Policy (the "Policy"). This
Policy is available upon request from Hall Labour Relations Services Professional Corporation.

Sent: April 13, 2020 1:18 PM
To: ; Elvie Hall <elvie@hall-labour.ca>

additional

London, ON N6E 2H6
519 438-2153 ext 5126
Toll Free: 1-877-839-6245 ext 5126
Fax: (519) 433-2050
This e-mail communication and accompanying documents are intended only for the individual or entity to
which it is addressed and may contain information that is confidential, privileged or exempt from
disclosure under applicable law. Any use of this information by individuals or entities other than the
intended recipient is strictly prohibited. If you have received this communication in error, please notify the
sender immediately and delete all the copies (electronic or otherwise) immediately. Thank you for your
co-operation. Avis de confidentialité Ce message, transmis par courriel, est confidentiel, peut être protégé
par le secret professionnel et est à l'usage exclusif du destinataire ci-dessus. Toute autre personne est
par les présentes avisée qu'il lui est strictement interdit de le diffuser, le distribuer ou le reproduire. Si le
destinataire ne peut être joint ou vous est inconnu, veuillez informer l'expéditeur par courrier électronique
immédiatement et détruire ce message et toute copie de celui-ci. Merci.
>>> Elvie Hall 04/13/20 11:45 AM >>>

Elvie A. Hall
phone 905-878-7227 fax 905-878-7873 cell 647-200-8232

Get Outlook for iOS

________________________________
Good Evening Kelly

London, ON N6E 2H6
519 438-2153 ext 5126
Toll Free: 1-877-839-6245 ext 5126
Fax: (519) 433-2050
intended
contain
under
other than
this
all the
co-operation.


12, 2020 2:45 PM >>>
Good afternoon Diane and Jamie,

attached).
Thank you,
Kelly
Sent: April 12, 2020 2:02 PM


providing care.



when needed.
Sincerely,

London, ON N6E 2H6
519 438‑2153 ext 5126
Toll Free: 1‑877‑839‑6245 ext 5126
Fax: (519) 433‑2050

reproduire.
This is Exhibit “O” referred to in the Affidavit of Diane

From: Andrew Hall
To: Diane Peckham
Cc: Carrie Pasco; Elvie Hall; Adam Banks; Kelly Kummerfield
Subject: RE: HP and ONA - Information Request RE PPE
Date: April 13, 2020 3:44:21 PM
My apologies – when I said “(specifically were not being used during a POC assessment)” it is to be
known that N95 masks were being used in situations where the HCW was not preforming any POC
assessment. I do not want it to be confused that there were RNs who did not have access to N95
masks during a POC assessment – as they do have access to them.

Thanks AH
Andrew M. Hall
phone 905-878-7227 fax 905-878-7873 cell 416-569-1904

prohibited.

From: Andrew Hall
Sent: April 13, 2020 15:40
To: Diane Peckham <DianeP@ona.org>
Cc: Carrie Pasco <carrie@hall-labour.ca>; Kelly Kummerfield <KKummerfield@primacareliving.com>;
Adam Banks <ABanks@primacareliving.com>; Elvie Hall <elvie@hall-labour.ca>
Subject: RE: HP and ONA - Information Request RE PPE
Importance: High

Good Afternoon Diane,

Your further correspondence on this matter has been forwarded to my attention. Specifically:

Please confirm now that PPEs including N95s and nitrile gloves are available in the DOC office.
Managers may be leaving the building soon and the evening and night staff may require access
to additional PPEs. I appreciate some supplies are available in the med rooms however as a
precautionary process there needs to be access to additional PPEs if a POC assessment
determines the need. I am hoping to avoid a call to the MOL and I appreciate some additional
PPEs have been added to the med rooms but situations arise and having access to all PPEs is
essential.

AND

Can you please provide details of the inappropriate use. Directive 5 which now applies to LTC is
clear that the use of PPEs is based on a POC assessment and the clinical judgment of the
Registered Staff as it relates to their safety when providing care and the risk of exposure while
providing such care including airborne exposure.

The Employer is following Ministry guidelines and appropriate IPAC Control. We have been in
contact with the Ministry of Labour who have already stated that they satisfied with our current
management of the situation. Although I am not a Infection Control professional, the current IPAC
standards do not suggest nitrile gloves.

Appropriate PPE is made available and RNs are aware of how to access additional PPE if required.
There are managers available for Henley Place 24 hours a day if there are further concerns.

Regarding inappropriate use – N95 masks to my understanding were not being used in accordance
with the IPAC protocols and were not required as set out in Directive 5 (specifically were not being
used during a POC assessment) and this was not limited to the ONA membership. To my
understanding, no RN has been refused an N95 mask when requested.

If there are further concerns that need to be addressed, RNs’ concerns must be taken to JHSC where
the worker and management co-chair will investigate.

Please direct all future correspondence for the time being to my attention directly. The
management team is currently working on various matters at the home level and are consistently
working to protect the health and safety of staff and residents.

Should you have any further questions or concerns, please do not hesitate to contact me directly.

Thanks AH

Andrew M. Hall
phone 905-878-7227 fax 905-878-7873 cell 416-569-1904

prohibited.

From: Andrew Hall
Sent: April 8, 2020 16:52
To: Diane Peckham <DianeP@ona.org>
Cc: Carrie Pasco <carrie@hall-labour.ca>; Kelly Kummerfield <KKummerfield@primacareliving.com>;
Adam Banks <ABanks@primacareliving.com>
Subject: HP and ONA - Information Request RE PPE

Hi Diane,

Your email was forwarded to me for response. As I am sure your aware, the home and the staff are
working tirelessly to protect the health and safety of all involved.

We believe that we have sufficient Personal Protective Equipment, including surgical and N95 masks,
based on the latest directives from the Ministry of Health and Public Health Ontario. We have plans
in place if there is a shortage and we are working with the Ministry of Health regarding supply if
there ends up being a provincial or regional shortage. This is a evolving conversation, however, we
believe at this time we have an adequate supply based on the current directives.

Regarding the reuse of masks, we appreciate you conveying the Union’s position. At this time we
are collecting used masks but we are not reusing them. The practice guidelines at this time do not
support this practice, however, we are monitoring this situation very closely. If the practice of
cleaning, sanitizing and/or sterilizing masks is approved by Health Canada and/or Public Health
Ontario, we will investigate the matter and make our determination based on the requirements of
the home.

Our staff and residents health and safety is our top priority, something we both share.

Should you have any questions or concerns, please do not hesitate to contact me directly.

Thanks AH

Andrew M. Hall
phone 905-878-7227 fax 905-878-7873 cell 416-569-1904

prohibited.

This is Exhibit “P” referred to in the Affidavit of Diane Peckham
sworn April .........., 2020.

April 14, 2020
VIA EMAIL: kkummerfield@primacareliving.com
Ms. Kelly Kummerfield, Administrator

Henley Place, London
1961 Cedarhollow Boulevard
London, ON N5X 0K2
Dear Ms. Kummerfield,
Re: Henley Place, London, Grievance # 202004579. Personal Protective Equipment.
As you are aware, the above noted grievance raises urgent issues regarding the health and safety of ONA
members during the unprecedented COVID19 pandemic.
On Saturday April 11, the Participating Nursing Homes declined ONA’s proposal dated April 9, 2020 to have
the issues raised by the grievance dealt with through an expedited central rights arbitration process. Given this
refusal, I am writing to inform you that ONA is removing the above noted grievance from abeyance and will be
referring to arbitration.
In order to avoid irreparable harm to our members, we are seeking the Employer’s agreement to have the
grievance heard by an arbitrator mutually appointed by the parties on an expedited basis, with agreement to a
video conference hearing date scheduled by no later than April 16, 2020. In particular, we are specifically
requesting your agreement to the following process, which was previously incorporated into the proposal for a
central rights arbitration between ONA and the Participating Nursing Homes:
The arbitrator shall have full powers to determine how the evidence shall be heard to expedite
the process and ensure a bottom line decision is issued by the agreed upon date and to ensure
safety of the participants in the process given the current pandemic in accordance with current
public health directives and guidelines in relation to social distancing, including but not limited to
receiving evidence by way of affidavits, will says, or statutory declarations, videoconferencing,
teleconferences, or other alternate means. The parties will not object and agree to such
alternate means of evidence being adduced before the arbitrator in light of the extraordinary
circumstances.
Video conferencing is required as a matter of safety to all participants, while at the same time permits the
expedited arbitration of this urgent grievance. The above-noted paragraph also proposes that the arbitration be
conducted with evidence entered by statutory declarations or other alternate means to minimize the hearing
time. We would also ask for agreement that the arbitrator issue a bottom line decision by April 24, 2020 with
reasons to follow.
I ask that you respond to this letter by no later than 10 am tomorrow, Wednesday April 15, 2020. If we do not
receive your response I will assume you are denying our request.
Sincerely,
ONTARIO NURSES’ ASSOCIATION
Diane Peckham
This is Exhibit “Q” referred to in the Affidavit of Diane

Affidavit of Diane Peckham - Henley Place

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Affidavit of Diane Peckham - Henley Place

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Court File No.

ONTARIO NURSES' ASSOCIATION, VICKI MCKENNA, RN and BEVERLY

HENLEY PLACE LIMITED AND PRIMACARE LIVING SOLUTIONS INC.

I, DIANE PECKHAM, of the City of London, in the Province of Ontario, MAKE

OATH AND SAY as follows:

1. I am a Labour Relations Officer with the Ontario Nurses’ Association (“ONA”). I

members who work at each such facility.

4. These experiences remind me of the SARS outbreak in the mid-2000s, wherein

place at Henley Place in London, Ontario.

I. General Background on Henley Place

6. On March 29, 2020, Henley Place experienced an outbreak of COVID-19 when a

such as coughing, spitting, heavy breathing, and sneezing.

as well as the likelihood that COVID-19 may be transmitted by airborne particles, on

“Just want to add as per our conversation that the Occupational

12. A copy of this email is attached as Exhibit “A”.

namely, an N95 respirator.

necessary precautions to protect its employees. A copy of this email is attached as

access to the masks”. A copy of this email is attached as Exhibit “C”.

18. Shortly after this communication, I became aware from

at Henley Place, that the Employer had removed all N95

Kummerfield’s office is locked at all times and is only accessible by key.

Care; and Bridgette Woods, the Financial Manager.

Ms. Mujeeb, or Ms. Woods at home by telephone.

without access to appropriate personal protective equipment.

in urgent circumstances. This is an untenable situation.

II. Attempts to Resolve the Issue Have Been Unsuccessful

frequent communications to the Employer requesting an expeditious resolution of ONA’s

these issues. A copy of this email is attached as Exhibit “D”.

precaution reasonable in the circumstances arising as a result of the extraordinary threat

N95 respirators, to guard against all forms of transmission.

caring for known or suspected cases of COVID-19.

addressing the grievance can and will cause irreparable harm.

III. The Employer Does Not Have an N95 Shortage

imminent risk of harm, up to and including death.

IV. Emergency of April 10, 2020

continues to be an insufficient supply of such respirators readily available, and indeed

they are or were all of only one size.

expected to do the following:

inform him or her of the situation;

(the Administrator), Ms. Mujeeb (the Associate Director of Care), or Ms.

Ms. Kummerfield’s office;

of the key to Ms. Kummerfield’s office; and

Kummerfield’s office, locate an appropriate N95 respirator, ensure that this

equipment is obtained as quickly as possible, and return to the resident to

death, while she or he awaits care.

without access to appropriate life-saving personal protective equipment. This would

on April 10, 2020, at which time I was informed by

“I would like to inform you about an incident that happened on

This is a health and safety issue to not have access to proper

42. A copy of this incident report is attached as Exhibit “H”.

appropriate access to this life-saving personal protective equipment.

V. Further Attempts to Address the Issue Have Been Unsuccessful

staff and residents at an imminent risk of harm.

determines an N95 respirator is appropriate, it must be provided by the Employer.

48. The Directive states the following in this regard:

“If a health care worker determines, based on the [Point of Care

long-term care home will not unreasonably deny access to the

49. A copy of this Directive is attached as Exhibit “J”.

communication is attached as Exhibit “I”.

Kummerfield’s email (attached at Exhibit “I”). A copy of this email communication is

attached at Exhibit “K”.

52. I responded by requesting confirmation that an adequate supply of all personal

protective equipment will be made readily available on an as-needed basis, including on