Long Term Care Covid-19 Commission Mtg.

Meeting with MS. Hartley and Ms. Bauman on Thursday, January 7, 2021

77 King Street West, Suite 2020 Toronto, Ontario M5K 1A1

neesonsreporting.com | 416.413.7755 Long Term Care Covid-19 Commission Mtg. Meeting with MS. Hartley and Ms. Bauman on 1/7/2021 1

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7 MEETING OF THE LONG-TERM CARE COVID-19 COMMISSION 8

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13 ------14 --- Held via Zoom Videoconferencing, with all 15 participants attending remotely, on the 7th day of 16 January, 2021, 10:00 a.m. to 11:30 a.m. 17 ------18

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neesonsreporting.com 416.413.7755 Long Term Care Covid-19 Commission Mtg. Meeting with MS. Hartley and Ms. Bauman on 1/7/2021 2

1 BEFORE: 2

3 The Honourable Frank N. Marrocco, Lead Commissioner 4 Angela Coke, Commissioner 5 Dr. Jack Kitts, Commissioner 6

7 PRESENTERS: 8

9 MINISTRY OF HEALTH: 10 Justine Hartley, Acting Director, Health System 11 Emergency Management Branch 12 Jessica Bauman, Senior Program Management Lead in 13 SOC - Special Projects, Cabinet Office 14

15 PARTICIPANTS: 16

17 Alison Drummond, Assistant Deputy Minister, 18 Long-Term Care Commission Secretariat 19 Ida Bianchi, Counsel, Long-Term Care Commission 20 Secretariat 21 Kate McGrann, Counsel, Long-Term Care Commission 22 Secretariat 23 John Callaghan, Counsel, Long-Term Care Commission 24 Secretariat 25 Lynn Mahoney, Counsel, Long-Term Care Commission

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1 Secretariat 2 Michael Finley, Counsel, Long-Term Care Commission 3 Secretariat 4 Derek Lett, Policy Director, Long-Term Care 5 Commission Secretariat 6 Dawn Palin Rokosh, Director, Operations, Long-Term 7 Care Commission Secretariat 8 Jessica Franklin, Policy Lead, Long-Term Care 9 Commission Secretariat 10 Adriana Diaz Choconta, Senior Policy Analyst, 11 Long-Term Care Commission Secretariat 12

13 ALSO PRESENT: 14 Amy Leamen, Legal Counsel, Ministry of 15 Health/Ministry of Long-Term Care 16 Kristin Smith, Legal Counsel, Ministry of 17 Health/Ministry of Long-Term Care 18 Sunil Mathai, Legal Counsel, Ministry of the 19 Attorney General 20 Roopa Mann, Legal Counsel, Ministry of the Attorney 21 General 22 Eric Wagner, Counsel for Ontario 23 Deana Santedicola, Stenographer/Transcriptionist 24

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neesonsreporting.com 416.413.7755 Long Term Care Covid-19 Commission Mtg. Meeting with MS. Hartley and Ms. Bauman on 1/7/2021 4

1 -- Upon commencing at 10:00 a.m. 2

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4 COMMISSIONER FRANK MARROCCO (CHAIR): 5 I think most of you understand the 6 procedure. We changed it a bit. We are attempting 7 to expedite the questioning of the witnesses, so 8 the procedure we'll follow is that Mr. Callaghan 9 will ask questions to try to make sure we have 10 covered everything, and we'll give you an 11 opportunity to make your presentation, of course. 12 And then if there are matters that require 13 clarification after, then Mr. Mathai will arrange 14 somebody to let Mr. Callaghan know what matters 15 need to be clarified and what the clarification is, 16 and he'll make sure that the Commissioners see 17 that. 18 And so that that's the procedure we are 19 going to follow. And with that, we are ready to 20 proceed. 21 JOHN CALLAGHAN: So let me just start 22 by telling the Commissioners the process that has 23 been followed up to now. With Mr. Mathai's 24 assistance, we had asked to hear about the 25 provincial stockpile issue, and he had arranged for

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1 us to meet Ms. Hartley and Ms. Bauman, and we have 2 received some documents. The documents are 3 obviously still coming, so there may be additional 4 documents that are relevant to this issue and it is 5 not suggested that the documents we might see today 6 are all the documents. 7 And Commission Counsel provided a list 8 of questions that we thought might focus the 9 investigation today on issues that might assist the 10 Commission. 11 The issue of the stockpile and the 12 documents you may review will go back I think as 13 early as 2006. To be absolutely clear, and we'll 14 get the clarity from Ms. Hartley and Ms. Bauman, 15 they weren't necessarily there in 2006. These are 16 documents that will assist the Commission in its 17 investigation to understand it. They have seen the 18 documents. We gave them documents in advance, and 19 in many respects these are documents that they 20 worked with in their current capacity. But I don't 21 want it suggested that they necessarily were 22 involved other than when they tell you they were 23 involved, so just to make that clarification. 24 MICHAEL FINLEY: And I apologize for 25 interrupting, but before you begin, I see that Ms.

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1 Smith is sharing her screen. We had discussed in 2 advance that it might be more fluid for the 3 purposes of this interview for me to share my 4 screen and I can control both the presentation - 5 and I have it up now - and any documents that 6 Mr. Callaghan would like to refer to, just so that 7 we are not passing the ball back and forth and 8 slowing things down, if that works. 9 JOHN CALLAGHAN: Yes, that works. 10 COMMISSIONER FRANK MARROCCO (CHAIR): 11 That is fine. Ms. Smith, let us know 12 if there is a problem and we'll try something 13 different. 14 KRISTIN SMITH: That is fine. 15 MICHAEL FINLEY: All right, so I'll 16 begin sharing my screen now, and I will pull up the 17 presentation first and we can go from there. 18 JOHN CALLAGHAN: Good. I wonder 19 because -- and I should have noticed that we 20 haven't actually put your names and titles on the 21 cover sheet. I wonder if Ms. Hartley and Ms. 22 Bauman might tell us their role and when they first 23 became involved in the stockpile issue so that 24 there is some clarity right from the outset. 25 So if I could ask Ms. Hartley and Ms.

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1 Bauman, and perhaps Ms. Hartley could go first, 2 their involvement and their titles. 3 JUSTINE HARTLEY: Absolutely. My 4 current title -- sorry, I'm getting a bit of 5 feedback. I don't know if anyone else is hearing 6 that as well. 7 COMMISSIONER FRANK MARROCCO (CHAIR): 8 Yes, I was. I was. I'll put myself on 9 mute. 10 JUSTINE HARTLEY: Great, so I am 11 currently the Acting Director of the Health System 12 Emergency Management Branch, and one of the 13 operations that we have is overseeing the stockpile 14 in the Ministry's Emergency Operations Centre. 15 I have been the Acting Director since 16 July of 2020. Prior to that, I was the Manager of 17 Policy and Programs, and my role in that position 18 as well was overseeing the operation and the policy 19 work that went into informing the stockpile. 20 So my first involvement with the 21 stockpile was approximately 2011 and 2012. During 22 that time period and until now, I was off on 23 maternity leave for about three years, but 24 certainly I started being involved in the stockpile 25 work in 2011.

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1 JESSICA BAUMAN: My name is Jessica 2 Bauman, and my current role is Senior Program 3 Management Lead with Cabinet Office. However, at 4 the time that we were discussing, I was a Senior 5 Consultant with the Health System Emergency 6 Management Branch, mainly in the Policy and 7 Programs Unit. I started with the Health System 8 Emergency Management Branch in 2015 and became 9 involved supporting the stockpile work around 2018, 10 until I transitioned my roles at the end of 11 November last year. 12 JOHN CALLAGHAN: And so just so I am 13 clear, who is then responsible for the 14 modernization of the stockpile issue which we are 15 going to hear about? Is that you, Ms. Hartley? 16 JUSTINE HARTLEY: Yes. Yes, so Jessica 17 was the senior policy consultant that supported 18 that work and certainly drafted quite a few of the 19 materials that we are going to look at today, and 20 she reported to me as the Manager at that time. 21 JOHN CALLAGHAN: All right, so it is 22 still under your portfolio though? 23 JUSTINE HARTLEY: Uhm-hmm, yes. 24 JOHN CALLAGHAN: All right, so why 25 don't we just take you to the first slide and tell

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1 us about it. 2 JUSTINE HARTLEY: Yes, absolutely. So 3 the stockpile was originally created for the 4 purpose of preparing for an influenza pandemic. 5 At the time of its creation in 2006, 6 SARS had just ended and the focus had shifted to 7 the threat at the time which was H1N1, which is the 8 avian flu. The threat of avian flu was the main 9 impetus for the stockpile planning, and then later 10 H1N1, which was the swine flu it was called at the 11 time, and the H1N1 pandemic in 2009 continued to 12 influence the purchases that were made for the 13 stockpile and the stockpile purchases focussed on 14 certainly the PPE needed to support a response for 15 an influenza pandemic, immunization supplies and 16 equipment, antivirals, and then later it included 17 ventilators. 18 Next slide. 19 JOHN CALLAGHAN: So could I just ask 20 for clarification, prior to SARS and I guess prior 21 to 2006, there was not a stockpile for pandemic 22 purposes; correct? 23 JUSTINE HARTLEY: That's right, 24 correct. 25 The stockpile was intended to be an

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1 emergency supply, so a top-up if needed to 2 complement local preparedness activities if those 3 local stockpiling activities were unable to meet 4 the demands during a surge or certainly global 5 competition, which we saw during the pandemic. 6 As part of the system of writing this, 7 local organizations were expected to take every 8 precaution reasonable in circumstances for the 9 protection of their health workers, including 10 insuring that the appropriate PPE was available for 11 their workers. 12 COMMISSIONER FRANK MARROCCO (CHAIR): 13 Can I just interrupt for a second, Ms. 14 Hartley. So the idea behind the stockpile is that 15 it is a backstop? Each long-term care home or 16 group of homes is expected to have acquired, on its 17 own, its own stockpile of personal protective 18 equipment? 19 JUSTINE HARTLEY: That is right. 20 COMMISSIONER FRANK MARROCCO (CHAIR): 21 And the stockpile is there in case they 22 run out and can't continue to replenish their 23 inventory? 24 JUSTINE HARTLEY: That is correct, yes, 25 if they are unable to replenish through their

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1 normal supply chain mechanisms. 2 JOHN CALLAGHAN: So, well, it is 3 probably easier to do it now. Why don't we look at 4 document 1, just because it is the first in the 5 sequence. 6 So this is a Management Board of 7 Cabinet submission, and it is dated January 12, 8 2006. And I appreciate that this will be old hat 9 to Commissioner Coke, but just to be clear that 10 everyone here understands, this is a confidential 11 document. This is advice to Cabinet; correct? 12 JUSTINE HARTLEY: Yes. 13 JOHN CALLAGHAN: And I take it the 14 reason why it is confidential is that it is 15 intended to be candid advice for government to act 16 upon; correct? 17 JUSTINE HARTLEY: That's right. It is 18 for government at the time, that particular 19 government at the time. 20 JOHN CALLAGHAN: All right, so let's 21 just take a look at it. Let's go to page 1 then. 22 So the request is in preparation for a 23 potential influenza pandemic; do you see that? 24 JUSTINE HARTLEY: Yes. 25 JOHN CALLAGHAN: Okay, and we are going

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1 to talk about this perhaps a little later. In 2 SARS, Justice Campbell said, you know, we have got 3 to worry about more than an influenza pandemic. Is 4 this the only stockpile in respect of other types 5 of diseases, for example, a Coronavirus disease 6 such as COVID? 7 JUSTINE HARTLEY: Yes, so the main 8 impetus for the stockpile in 2006 was to prepare 9 for an influenza pandemic because the monitoring of 10 the threats that were currently going on globally 11 was to do with influenza pandemics, so particularly 12 the H5N1 was thought to be the biggest threat to 13 the health system within Canada, internationally 14 and Ontario, so therefore we would need the 15 appropriate PPE to prepare for that particular 16 event. 17 JOHN CALLAGHAN: Right, and even though 18 SARS came out of a Coronavirus pandemic and not an 19 influenza pandemic, the government only did 20 influenza, is that the idea? 21 JUSTINE HARTLEY: Yes, that was the 22 government's decision at the time based on what was 23 circulating and what was thought to be the next 24 threat for Ontario. 25 JOHN CALLAGHAN: So let's read the

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1 project requirement: 2 "Approve the Ministry 3 proceeding with development and 4 implementation of a widespread 5 pandemic preparedness strategy 6 including formal consultation with 7 vendors to acquire and manage, over 8 the next four years, a stockpile of 9 emergency supplies and equipment to 10 protect healthcare workers and their 11 patients." 12 So I take it the impetus here was to 13 ensure that health care workers and patients were 14 protected in the event of a pandemic? 15 JUSTINE HARTLEY: Yes. 16 JOHN CALLAGHAN: And that remains to be 17 the focus of the stockpile? 18 JUSTINE HARTLEY: It does, and it also 19 includes residents, what we would consider 20 long-term care home residents. 21 JOHN CALLAGHAN: Okay, over to page 3. 22 So this defines the issue that was being discussed 23 in 2006, and it says: 24 "The province has developed and 25 released the Ontario Health Plan for

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1 an influenza pandemic but needs to 2 acquire the necessary resources to 3 implement the plan in order to 4 respond to an influenza pandemic. 5 The Ministry seeks appropriate 6 procurement approvals to begin 7 strengthening the province's 8 preparedness for an influenza 9 pandemic immediately. A brief 10 synopsis of OHPIP and key pandemic 11 preparedness initiatives has been 12 included as Appendix 2." 13 I am going to take you in a moment to a 14 2013 OHPIP plan, but there was a 2006 plan, was 15 there? 16 JUSTINE HARTLEY: There was, yes. 17 JOHN CALLAGHAN: And the 2013 plan is 18 the last plan that was done; correct? 19 JUSTINE HARTLEY: Yes. 20 JOHN CALLAGHAN: And then if you could 21 go to the next page, Michael, and it says: 22 "The supplies it contains", and 23 they are talking about the 24 stockpile, "are designed to respond 25 to a range of events, and are not

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1 always the most appropriate items 2 for influenza specifically, and the 3 amounts it contains represent only a 4 small percentage of what will be 5 needed. The supplies and equipment 6 included in the Treasury Board 7 submission are designed to bring the 8 provincial stockpile up to the level 9 needed to ensure a rapid and 10 effective pandemic response. 11 Concern regarding a potential 12 pandemic is global, and 13 international demand for pandemic 14 supplies will dictate availability 15 of these supplies. If the process 16 is delayed, Ontario risks being 17 unprepared for an influenza pandemic 18 due to this unprecedented 19 international demand and queueing 20 for delivery." 21 Do you see that? 22 JUSTINE HARTLEY: I do. 23 JOHN CALLAGHAN: So just so I am clear, 24 when you break this down, the submission refers to 25 the province having a rapid and effective pandemic

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1 response, and just going back to what Commissioner 2 Marrocco said, I don't read this as a stopgap, as 3 your presentation says. I read it as a rapid and 4 effective response that the province is obligating 5 themselves to be ready for; am I correct in that? 6 JUSTINE HARTLEY: For this particular 7 Treasury Board, but if we refer back to Chapter 5 8 of the OHPIP, there was an expectation that local 9 organizations also stockpile for four weeks of the 10 supply. 11 JOHN CALLAGHAN: And we'll get to that, 12 but I think what I am trying to get at is that it 13 wouldn't be fair to say it is all on the local 14 health unit or long-term care home. The province 15 itself wanted to have at least in 2006 a need and 16 an ability to provide a rapid and effective 17 pandemic response; correct? 18 JUSTINE HARTLEY: Yes, which 19 complemented the local stockpiling. 20 JOHN CALLAGHAN: Right, okay, we'll get 21 there. 22 And then if we could go down to under 23 "Substantiation", and we have highlighted bits to 24 make it easier on everybody, it says: 25 "Public Health experts around

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1 the world are forecasting that an 2 influenza pandemic is statistically 3 overdue, and that if the source is 4 not the avian influenza virus 5 currently circulating, which has the 6 potential to evolve into a strain 7 that could cause a pandemic in 8 humans, it will be another as yet 9 unknown virus." 10 Do you see that? 11 JUSTINE HARTLEY: Uhm-hmm. 12 JOHN CALLAGHAN: So I take it that at 13 that time, akin with what Justice Campbell said, 14 there was the concern of influenza and a yet 15 unknown virus; correct? 16 JUSTINE HARTLEY: Yes, other viruses. 17 JOHN CALLAGHAN: And that continues to 18 be the concern; correct? 19 JUSTINE HARTLEY: Yes. 20 JOHN CALLAGHAN: And were you aware 21 that in the fall of 2019 the World Health 22 Organization issued a report that said that a lot 23 of industrial countries, or a lot of countries in 24 the world, I guess, weren't actually taking it 25 seriously and weren't prepared? Were you aware of

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1 that when you were doing your work in the fall of 2 2019? 3 JUSTINE HARTLEY: I was not aware of 4 the report, no. 5 JOHN CALLAGHAN: So if we go down to 6 the next bullet, they are planning this out. And 7 we are going to take you to a planning document. 8 You have got some material in your slide deck about 9 it, so we'll wait until we get there, but just so 10 we can frame this for the Commissioners, just above 11 the highlight, it says: 12 "Modelling indicates that there 13 could be up to 73,000 additional 14 hospitalizations annually, well over 15 2 million additional hospital 16 visits, and as many 18,000 17 additional deaths [...]" 18 They increased that a little bit in 19 their note. And we'll get there. This is all 20 modelled out. But so am I to understand that the 21 plan at least in 2006 is to prepare for something 22 that might kill as many as 18,000 Ontarians? Is 23 that how -- 24 JUSTINE HARTLEY: Yes, if that is in 25 the Treasury Board, the request would meet with the

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1 modelling that we were basing -- the request would 2 be placed based on the modelling. 3 JOHN CALLAGHAN: Okay, so can we just 4 go to the next page then, and we'll just read the 5 line just above the highlighted: 6 "A recent report from the World 7 Bank predicted that a pandemic flu 8 could cost the global economy up to 9 $800 billion. As in SARS, the 10 report warned that the most 11 immediate economic impact would come 12 not from actual death or sickness, 13 but from the uncoordinated efforts 14 of citizens to avoid becoming 15 infected, and from public policy 16 inaction to help prevent fear, 17 illness, and death. 18 The key issue that all 19 jurisdictions will face as they 20 begin to prepare for an influenza 21 pandemic is the lack of surge 22 capacity for essential supplies and 23 equipment to protect healthcare 24 workers and their patients. This is 25 a serious problem during a pandemic,

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1 but also well before one begins as 2 countries initiate stockpiling 3 campaigns and are forced to compete 4 for scarce supplies. Further, many 5 key items are produced in, or 6 require components produced in, 7 Asian countries which, according to 8 experts, may be among the first hit 9 by an influenza pandemic. 10 International experts have 11 already identified that essential 12 supplies such as surgical masks are 13 likely to be scarce and highly 14 sought-after during a pandemic." 15 So just to break this down a little 16 bit, this note suggests that it was predictable 17 that an influenza type virus could emanate from 18 Asia which could affect supplies. Was that your 19 understanding when you were working on the 20 stockpiling from 2012 to 2019, that that was a 21 risk? 22 JUSTINE HARTLEY: Those were the 23 original assumptions that informed 2006. We did 24 see with H1N1 did not originate from Asia, so our 25 planning principles evolved to understanding that

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1 the pandemic could start at any place, any country 2 within the world. 3 JOHN CALLAGHAN: Well, I don't think 4 this is trying to say that it couldn't. I think 5 this is trying to say, as I understand it, that 6 because Asia has such a manufacturing capability, 7 that one has to worry that influenza has a strong 8 likelihood, or another such disease coming from 9 Asia, which will affect supplies, and was that an 10 understanding while you were doing your job in the 11 later years and even up to 2019 that that's a risk? 12 JUSTINE HARTLEY: Yes, that there would 13 be certainly global restraints in our reliance on 14 products coming from other countries other than 15 country. 16 JOHN CALLAGHAN: Right, but 17 particularly Asia; correct? 18 JUSTINE HARTLEY: Yes. 19 JOHN CALLAGHAN: All right. So if we 20 could just go to the bottom of the page, because 21 this becomes the issue, and I know we are going to 22 hear there was a response by the Premier to some of 23 this, but at the bottom it says: 24 "With most suppliers and 25 distributors of emergency medical

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1 supplies based outside of Canada, 2 minimal manufacturing capacity in 3 North America, and no domestic 4 manufacturing capacity within the 5 province, Ontario will find itself 6 in competition with other 7 jurisdictions for the necessary 8 supplies and equipment." 9 And I take it that situation did not 10 change? That situation exists, that it existed as 11 of January 2020? And I know you are making headway 12 to change it now, but as of January 2020, we did 13 not have the domestic capacity; correct? 14 JUSTINE HARTLEY: Yes, we had limited 15 domestic capacity. There are some manufacturers 16 that exist in Canada, but certainly it was limited. 17 JOHN CALLAGHAN: Okay. And so if we 18 can just go over to page 8, and let's try to get 19 through this document first, and it says: 20 "This Treasury Board submission 21 request makes provisions for 22 essential preparedness items for the 23 healthcare sector with a focus on 24 centralized stockpiles and 25 equipment. As local planning for

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1 outbreaks of this magnitude 2 intensify in future years, other 3 opportunities to support the 4 healthcare sector will emerge. An 5 example of one consideration for 6 future implementation is included 7 below, but is not part a part of the 8 current request." 9 And it goes on and says: 10 "In addition to the provincial 11 stockpile, the Ontario Health Plan 12 for an Influenza Pandemic contains 13 the expectation that health care 14 facilities will develop their own 15 four-week stockpile. At present no 16 ministry funds are being provided to 17 facilities for their own stockpiles. 18 While some facilities have begun 19 stockpiling, this is not being done 20 in a systemic way, and with a major 21 MOHLTC stockpile purchase, the 22 ministry may be perceived to be in 23 competition with its own 24 stakeholders for limited supplies." 25 So just to deal with that for a second,

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1 so just when you said stopgap, I mean, does it 2 remain the government's position - and perhaps it 3 may be just your understanding and I don't want to 4 put the whole government on your shoulders - but 5 that the stockpile was essential for preparedness, 6 which is what is implied in the first paragraph? 7 JUSTINE HARTLEY: Yes, it was an 8 important piece of the emergency preparedness 9 program. 10 JOHN CALLAGHAN: Right, and it remains 11 so. 12 JUSTINE HARTLEY: Yes. 13 JOHN CALLAGHAN: And then this is the 14 four-week provision you referred to; correct? 15 JUSTINE HARTLEY: Yes. 16 JOHN CALLAGHAN: All right, and there 17 was no funds given by government to the health 18 sector to assist with that; correct? 19 JUSTINE HARTLEY: That is my 20 understanding, yes. 21 JOHN CALLAGHAN: Right, and I just -- 22 well, let's just finish this document and we'll 23 come back. Let's just get rid of this document 24 first. 25 If we could go over to page 13. And I

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1 know you have a planning slide, so I'll leave the 2 planning or more of the detailed planning questions 3 to that. So let's just take a look here, and it 4 says, and this is in item 3, this is the 5 "Supplies": 6 "The ministry will procure 7 essential PPE material (over and 8 above, not including, the usual 9 operating amounts) estimated to be 10 necessary to handle the anticipated 11 surge in illness and infection from 12 an influenza pandemic for a period 13 of 4 weeks." 14 So was the Ministry supply supposed to 15 be four weeks, or was that the calculation to be 16 four weeks in the field, as it were, and four weeks 17 in the provincial stockpile? 18 JUSTINE HARTLEY: That's correct. 19 JOHN CALLAGHAN: And what about the 20 federal stockpile? Was there any reliance put on 21 the federal stockpile? 22 JUSTINE HARTLEY: No, other than there 23 was -- we had an awareness that there was a federal 24 stockpile. I am not quite sure what their planning 25 principles are.

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1 JOHN CALLAGHAN: But just to be clear, 2 and this was 2006, so was that consistent with the 3 position that you were aware of when you had this 4 responsibility, that there wasn't -- like you 5 planned independent of the federal stockpile; 6 correct? 7 JUSTINE HARTLEY: Correct. 8 JOHN CALLAGHAN: All right, and it 9 says: 10 "(This stockpile is intended to 11 augment facility-level stockpiles to 12 ensure the entire system has 13 adequate surge capacity to respond 14 to a pandemic.) 15 - Stockpile estimates currently 16 include approximately 1 [million] 1 17 litre bottles of hand sanitizer, 94 18 [million] surgical masks, 42 19 [million] exam gloves, 25 [million] 20 disposable gowns, 13 [million] pairs 21 of safety glasses, 134 [million] 22 disinfecting wipes, and supplies for 23 mass vaccination/prophylaxis clinics 24 including 2 [million] thermometer 25 covers, and 25 [million] needles and

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1 syringes." 2 So to be clear, you have a slide - so 3 let's just cover the document - that talks about 4 how that is estimated, but these aren't guesses. 5 These are calculated estimates on the expectation 6 of I think your slide says a moderate pandemic? 7 JUSTINE HARTLEY: Correct, there was a 8 work group that was brought together under OHPIP 9 for supplies and equipment that informed these 10 calculations. 11 JOHN CALLAGHAN: Okay, so let's just 12 continue with the document. If we go to page 14, 13 it is talking about "Risk Assessment". 14 The first highlight deals with the 15 numbers on the modelling which we have talked 16 about, and that is the 73,000 hospitalizations, 2 17 million additional hospital visits and 18,000 18 deaths, and it says: 19 "This rate of infection will 20 have an impact on every aspect of 21 society. Those populations with 22 underlying health issues that make 23 them vulnerable to respiratory 24 illness will be particularly 25 affected."

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1 And let's go to the next page: 2 "The financial impact of an 3 influenza pandemic will be extreme, 4 and will be exacerbated if the 5 province cannot respond 6 effectively." 7 And then below that, the World Bank 8 notes that it could be 800 billion dollars on the 9 global economy. 10 And then: 11 "Federal Finance Department 12 officials have estimated that a 13 pandemic could reduce Canada's gross 14 domestic product by up to $14 15 Billion dollars. Other studies have 16 estimated that a pandemic could cost 17 Canada from $8 to $24 Billion 18 dollars. Although no studies exist 19 for the economic impact on Ontario 20 alone, with 41% of Canada's GDP, the 21 province could conceivably face an 22 economic impact between $3 and $10 23 Billion dollars." 24 So just pausing there, I mean, this is 25 them discussing, and I don't think I took it to

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1 you, but I think we can agree that the request from 2 Cabinet for funding was 170 million dollars over 3 four years; is that correct? 4 JUSTINE HARTLEY: Yes. 5 JOHN CALLAGHAN: So they are 6 correlating the assessment of paying 170 million 7 dollars over four years in response to a 8 conceivable economic impact of 3 to 10 billion 9 dollars; is that how I am to read this as? That is 10 what they are telling Cabinet? 11 JUSTINE HARTLEY: Yes, and this 12 submission did include more than PPE, though. It 13 was also, as you can see, it was also referencing 14 antivirals. 15 JOHN CALLAGHAN: For sure. For sure. 16 It was the entirety of the stockpile. 17 JUSTINE HARTLEY: Yes. 18 JOHN CALLAGHAN: Yes, I agree with you. 19 Okay, so we know the stockpile has been 20 destroyed, or a large portion of it, anyway, and I 21 am not suggesting that in the middle of what you 22 have been doing you should have done it, but has 23 there been a calculation as to what it would have 24 cost to keep the stockpile as proposed, the 170 25 million? Have you ever done an estimate as to the

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1 cost projections of keeping a stockpile that would 2 protect Ontarians regarding a moderate influenza 3 pandemic? 4 JUSTINE HARTLEY: No, we didn't do a 5 direct calculation because of the importance of 6 doing the policy work first to inform what actually 7 should be kept in the stockpile because we 8 certainly didn't want to be in the same position 9 that we were in 2019 and having that amount of 10 expired stock. We wanted to ensure that the 11 assumptions and the principles reflected not the 12 2006 principles but that we reviewed them to insure 13 that they reflected the current state. 14 JOHN CALLAGHAN: Okay, and just so I am 15 clear, and again, I don't know and this may not be 16 your bailiwick and so please don't take it that you 17 have to know the answer to this question, but do we 18 know what the economic impact to the Province of 19 Ontario has been as a result of COVID? 20 JUSTINE HARTLEY: Not that I am aware, 21 and I am not sure that has been calculated yet. 22 JOHN CALLAGHAN: So if we can go down 23 to the second paragraph there at the end: 24 "Without appropriate personal 25 protective equipment, Ontario's

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1 health care workers may be placed 2 unnecessarily at risk. Health care 3 workers may refuse to work without 4 adequate personal protective 5 equipment. The level of care that 6 can be provided to citizens during a 7 pandemic could be compromised." 8 Do you see that? 9 JUSTINE HARTLEY: I do. 10 JOHN CALLAGHAN: And so I take it the 11 concern was that if you can't protect the workers, 12 you can't protect the patients or the residents; is 13 that the idea? 14 JUSTINE HARTLEY: Yes. 15 JOHN CALLAGHAN: And so I guess did 16 that continue to be the risk in your time? Like 17 that risk never went away, right, as we probably 18 saw in COVID; correct? 19 JUSTINE HARTLEY: No, it was 20 consistent. 21 JOHN CALLAGHAN: If we can just go up 22 to the next, the top of the next page, so it 23 says -- and again, remember, I mean, I don't want 24 to overstate this. This is the risk assessment, 25 and so you know, we are talking about worst case

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1 scenarios. It says: 2 "The unprecedented 3 international situation, in which 4 demand for pandemic supplies is 5 increasing and minimal manufacturing 6 surge capacity is in place, means 7 that a delay in the procurement 8 process could result in the 9 necessary supplies being unavailable 10 or available only at much higher 11 cost than is usual due to a 12 'seller's market'. 13 An ineffective provincial 14 response would not only increase the 15 health impacts of a pandemic, but 16 would have a significant impact on 17 the economy and on public trust in 18 government." 19 So just on the first paragraph, I guess 20 the concern was gouging in the face of a pandemic 21 from suppliers? 22 JUSTINE HARTLEY: It was, yes, and a 23 limited supply of product which would cause an 24 increase in the cost of that product. 25 JOHN CALLAGHAN: So you would have a

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1 double-whammy. You would have the difficulty 2 obtaining the product, and then you would have to 3 pay more, which I gather - and I mean, we are going 4 to hear some others - but I gather that is what 5 happened. You did end up paying considerably more 6 than market price in 2019 in the middle of the 7 pandemic in March of 2020; correct? 8 JUSTINE HARTLEY: Yes. 9 JOHN CALLAGHAN: Okay, and then I don't 10 think the next sentence needs a comment, but let's 11 just go to the next one: 12 "Within Ontario, the Campbell 13 and Walker reports cited a need for 14 increased attention to emergency 15 planning and public health. 16 Government plays a critical role in 17 developing and implementing 18 comprehensive strategies to protect 19 citizens and respond in a 20 coordinated, efficient fashion when 21 communities become overwhelmed in an 22 emergency. The province is not yet 23 equipped to respond to an event on 24 the scale of an influenza pandemic. 25 Doing this effectively will require

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1 commitments from government, a 2 significant investment in new 3 resources, and the flexibility to 4 respond to the unique challenges of 5 the current global situation." 6 And I take it that is a statement of a 7 general policy that this Cabinet was being told was 8 this requires a significant commitment to meet the 9 obligation to protect the citizenry in the face of 10 an influenza pandemic; is that right? 11 JUSTINE HARTLEY: Yes. 12 JOHN CALLAGHAN: So your next couple of 13 slides, and why don't we go to the next slide, and 14 this is an important point that I think that Ms. 15 Hartley was trying to explain to us. And this 16 deals with -- I am not sure, I think it is the next 17 one, is it not? 18 MICHAEL FINLEY: Sorry, slide 4, John. 19 JOHN CALLAGHAN: Slide 4, I think that 20 is where she is at next, and we are just going to 21 go in order. 22 MICHAEL FINLEY: Okay. 23 JOHN CALLAGHAN: We can take 4 or 5. 24 Ms. Hartley, can you just tell us about this slide. 25 JUSTINE HARTLEY: Of course. Of

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1 course. 2 So as the slide states, there is 3 currently no legislation, regulation or formal 4 policy that requires a provincial stockpile. There 5 is some limited mention of the need for PPE and 6 other infection prevention and control, and 7 certainly emergency planning that we do see in the 8 Long-Term Care Homes Act, as well as a reference on 9 the obligation of employers to ensure that they 10 have the appropriate PPE and the reasonable 11 precautions in place for their workers which we see 12 stated in the Occupational Health and Safety Act. 13 JOHN CALLAGHAN: Okay, and then the 14 next slide then. 15 JUSTINE HARTLEY: So for this slide, 16 and while there is no legislation, regulation or 17 formal policy requiring a stockpile, there is 18 certainly legislation that provides justification 19 for a stockpile, and we see that under the 20 Emergency Management and Civil Protection Act where 21 there is responsibility given to the Ministry of 22 Health for human health, disease and epidemics and 23 health services during emergencies. 24 That responsibility for planning for 25 that and establishing an emergency management

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1 program to support that is tasked to the Health 2 System Emergency Management Branch which does 3 manage that program which includes the stockpile 4 for the health sector, and that is done under the 5 direction of the Assistant Deputy Minister and 6 Deputy Minister which has changed over the years, 7 but certainly we have always been in the Public 8 Health Branch and Division -- 9 JOHN CALLAGHAN: So just -- 10 JUSTINE HARTLEY: Sorry, I was just 11 going to say we were created in 2003, and at that 12 time we were called the Emergency Management Unit. 13 JOHN CALLAGHAN: Okay, so just so I am 14 clear and just so it is clear to the Commissioners, 15 under the Act there is a provision that by Order in 16 Council certain Ministries can be assigned 17 responsibility for certain emergencies. And Health 18 is, as you know here, the Ministry of Health is 19 assigned the responsibility for emergencies dealing 20 with human health, disease, epidemics and health 21 services; correct? 22 JUSTINE HARTLEY: Yes. 23 JOHN CALLAGHAN: All right, and just 24 this sounds self-evident, but so if it is a forest 25 fire, the Ministry of Natural Resources probably

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1 under that Order in Council is responsible for it, 2 right? So it is divided up in that kind of 3 fashion; correct? 4 JUSTINE HARTLEY: Yes, we would still 5 be responsible for ensuring the health services of 6 those individuals who are evacuated, but the 7 Ministry of Natural Resources would have the lead 8 on that emergency. 9 JOHN CALLAGHAN: So can we just take a 10 look, because you have mentioned it, it is the -- I 11 have forgotten, Michael, the number, but it is the 12 Ontario Health Plan for an influenza pandemic, 13 2013. I think it may be document 15. 14 So this is the document that was 15 created in March of 2013 that you referred to. 16 There was an earlier document in 2006; correct? 17 JUSTINE HARTLEY: Yes. 18 JOHN CALLAGHAN: And this one hasn't 19 been updated since 2013; correct? 20 JUSTINE HARTLEY: That is the current 21 version, yes. 22 JOHN CALLAGHAN: So if we could just go 23 to page 17. There we are. And it says: 24 "The effectiveness of PPE as a 25 control measure depends on the

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1 health worker's access to the 2 equipment and their knowledge, 3 skills and experience. It is 4 important that health sector 5 employers provide training in the 6 use, care and limitations of PPE and 7 ensure easy access to PPE that is 8 supplied in appropriate sizes and 9 good working order." 10 All right, so this is the direction, 11 that PPE is going to be required in the face of a 12 pandemic, and I take it that it is the direction or 13 it is advice to say that they need to know how to 14 access it, access supply and how to use it; 15 correct? 16 JUSTINE HARTLEY: Yes, and this is a 17 requirement during routine times as well. 18 JOHN CALLAGHAN: All right. So if we 19 go to the next page, so this is a chart and it says 20 "Exposure scenario", and I appreciate that this may 21 not -- this is intended for influenza, but I just 22 want to make sure I understand what I am reading 23 here. 24 So they have charted the exposure 25 scenarios "Unknown severity", "Low Transmissibility

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1 & low clinical severity" and "High transmissibility 2 & low clinical severity". And it refers to what 3 kind of equipment should be available, and if it is 4 "Unknown severity", you'll see they require gloves, 5 gown, eye protection, not surgical masks but the 6 fit-tested N95 respirator; do you see that? 7 JUSTINE HARTLEY: Uhm-hmm, I do. 8 JOHN CALLAGHAN: I take it is that like 9 the precautionary principle in action, that if you 10 don't know, take the highest standard? 11 JUSTINE HARTLEY: It is, yes. 12 JOHN CALLAGHAN: And then if you have a 13 low transmissibility, if you look, surgical masks 14 are accepted and then "As per RP/AP". Can you just 15 tell us what RP/AP is? 16 JUSTINE HARTLEY: Routine precautions 17 and airborne precautions. 18 JOHN CALLAGHAN: Okay, so that's an 19 issue to be -- 20 JESSICA BAUMAN: May I just interrupt 21 there, sorry? It is routine practices and 22 additional precaution in this case. 23 JOHN CALLAGHAN: Okay, thank you. 24 JUSTINE HARTLEY: Thank you. 25 JOHN CALLAGHAN: And then if it is high

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1 transmissibility, it says: 2 "Recommendation by the MOHLTC 3 determined at the time of a pandemic 4 based on evidence, legislative 5 requirements, precautionary 6 principle, OPS values and health 7 equity." 8 Do you see that? 9 JUSTINE HARTLEY: Yes. 10 JOHN CALLAGHAN: Okay, so let's just 11 break that down. "Based on evidence", I take it 12 that is scientific evidence? 13 JUSTINE HARTLEY: Yes. 14 JOHN CALLAGHAN: "Legislative 15 requirements", is that the Ontario -- is that the 16 Labour Codes, the Health Acts, is it all the -- is 17 it everything that one might -- 18 JUSTINE HARTLEY: Yes. 19 JOHN CALLAGHAN: All right, 20 "precautionary principle", we have talked about 21 that in other contexts, and that comes out of SARS 22 largely -- 23 JUSTINE HARTLEY: Yes. 24 JOHN CALLAGHAN: -- although it 25 probably existed before SARS.

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1 "OPS values", what is an OPS value? I 2 mean, and if you don't know, I appreciate this 3 isn't your document, so... 4 JUSTINE HARTLEY: There are a number of 5 OPS values that guide the work of the Public 6 Service. 7 JOHN CALLAGHAN: And where would one 8 find them? 9 JUSTINE HARTLEY: They may be stated 10 actually in Chapter 1 of this document. 11 JOHN CALLAGHAN: Oh, okay. Well, you 12 know what, I don't want to take the time to go 13 back, but we will take a look at that. 14 And "health equity", what is health 15 equity? 16 JUSTINE HARTLEY: Health equity is to 17 ensure that somebody isn't disproportionately 18 disadvantaged. 19 JOHN CALLAGHAN: So, for example, 20 because you are elderly, we wouldn't want you to 21 get a service less than someone in an acute care 22 setting, correct, if the need is the same? 23 JUSTINE HARTLEY: Yes, to ensure that 24 they both have the same level of outcome, so it 25 means that they may need more than someone else.

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1 JOHN CALLAGHAN: And by "elderly", I 2 meant in a long-term care community. 3 JUSTINE HARTLEY: Yes. 4 JOHN CALLAGHAN: So at page 19, the 5 next page, this is where I think you are talking 6 about. And I'm sorry because it is yellow on gray 7 and so it may not be easy to read, so let me just 8 read this. It is under a title called 9 "Preparedness tip": 10 "The MOHLTC recommends that 11 health organizations develop a 12 four-week stockpile of PPE based on 13 the high transmissibility & low 14 clinical severity scenario outlined 15 in Table 2. This stockpile should 16 account for the protection of health 17 worker, visitors and C/P/Rs, 18 including children who may require 19 smaller sizes of equipment. Health 20 sector employers that implement the 21 careful and rigorous use of PPE for 22 seasonal influenza are able to 23 estimate the volumes of equipment 24 needed based on those used during a 25 seasonal influenza response. As a

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1 general guide, outpatient and home 2 care settings should plan for 3 volumes that are two times what they 4 would normally use in four weeks of 5 an influenza season, while inpatient 6 settings should plan for volumes 7 that are eight times as high. 8 Health sector employers should have 9 supplies of both N95 respirators and 10 surgical masks for health workers so 11 they are prepared to implement RP/AP 12 and/or Pandemic Precautions. 13 Information on how health 14 organizations can access the 15 MOHLTC's stockpile of PPE, if 16 required, will be provided in an IHN 17 during an influenza pandemic." 18 Just what is an "IHN", while I'm on 19 that? 20 JUSTINE HARTLEY: It is an important 21 health...[inaudible] 22 JOHN CALLAGHAN: Okay. 23 COMMISSIONER FRANK MARROCCO (CHAIR): 24 I'm sorry, I missed that, and I am sure 25 the reporter did too. What is "IHN"?

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1 JUSTINE HARTLEY: It is an Important 2 Health Notice. 3 JOHN CALLAGHAN: Okay, so this is a 4 tip. I take it was there a legislative requirement 5 for health organizations, or was this just the 6 document? 7 JUSTINE HARTLEY: There was no 8 legislation. The policy, the OHPIP policy made 9 recommendations. 10 JOHN CALLAGHAN: Right, so it's this 11 tip? 12 JUSTINE HARTLEY: Yes. 13 JOHN CALLAGHAN: And so just to be 14 clear, health organizations in your view or in the 15 government's view and health sector included 16 long-term care? 17 JUSTINE HARTLEY: Yes. 18 JOHN CALLAGHAN: And if we just turn 19 up, just on that point, if we can just turn up 20 document 13. 21 COMMISSIONER FRANK MARROCCO (CHAIR): 22 Just before you leave that -- 23 JOHN CALLAGHAN: Yes, please, 24 Commissioner. 25 COMMISSIONER FRANK MARROCCO (CHAIR):

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1 Could you just, Ms. Hartley, just 2 remind me again what this document is? It came 3 out, but I didn't get it clearly enough. 4 JOHN CALLAGHAN: That is fine. 5 COMMISSIONER FRANK MARROCCO (CHAIR): 6 What am I looking at? 7 JUSTINE HARTLEY: This is the Ontario 8 Health Plan for an Influenza Pandemic, and 9 specifically we are looking at Chapter 5 which is 10 the chapter for occupational health and safety and 11 IPAC. 12 COMMISSIONER FRANK MARROCCO (CHAIR): 13 All right, thank you. 14 JOHN CALLAGHAN: Now, if we could then 15 go to document 3. Now, this is the Auditor General 16 Report of 2007, so it is just after the documents 17 we are looking at. And I take it, and I should be 18 clear, the tip of two weeks of PPE, that was also 19 in the 2006 plan? We were just looking at 2013. 20 JUSTINE HARTLEY: I don't recall. I 21 know that there was calculations and modelling 22 suggestions that were included in the 2006, but I 23 can't speak specifically if that was in there. 24 JOHN CALLAGHAN: Okay, well, we'll take 25 a look at that. I don't have it in my documents,

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1 but let me -- we'll try to take a look at that. 2 COMMISSIONER FRANK MARROCCO (CHAIR): 3 Just while you are doing that, that is 4 based on an influenza pandemic? 5 JUSTINE HARTLEY: That is correct. 6 COMMISSIONER FRANK MARROCCO (CHAIR): 7 How much more contagious is COVID than 8 influenza? Do you have any sense of that? 9 JUSTINE HARTLEY: I don't think they 10 have determined that, to be honest. There is many 11 different strains of influenza, and some of them 12 are a lot higher transmissible and result in more 13 of a severe clinical severity than others. So I 14 don't know quite where currently COVID lands within 15 that spectrum. 16 COMMISSIONER FRANK MARROCCO (CHAIR): 17 Do you think I would be right in 18 assuming that the more contagious the infectious 19 disease, the more personal protective equipment you 20 would need? 21 JUSTINE HARTLEY: I think that would 22 affect the level of personal equipment that you 23 would need. 24 COMMISSIONER FRANK MARROCCO (CHAIR): 25 Thank you.

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1 JOHN CALLAGHAN: If we could go to the 2 highlighted portion, Michael -- well, it is all 3 highlighted. All right, is that it? 4 Okay, so this says -- and I am just 5 going to read this. It is easier for me to just 6 read this out: 7 "During an outbreak, 8 health-care workers and patients 9 would need additional protective 10 equipment and medical supplies to 11 protect themselves from the virus." 12 And over the next page, it says: 13 "The Ministry stated in its 14 pandemic plan that health-care 15 providers are responsible for 16 obtaining their own four-week stock 17 of personal protective equipment, so 18 that collectively, the province will 19 have enough supplies for eight 20 weeks, which is the estimated length 21 of the first wave of an influenza 22 pandemic." 23 Do you see that? 24 JUSTINE HARTLEY: Yes. 25 JOHN CALLAGHAN: And so the four-week

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1 stock is what we looked at in the plan, correct, or 2 what I mean by -- 3 JUSTINE HARTLEY: Yes, it is. 4 JOHN CALLAGHAN: Okay, and it is based 5 off an eight-week estimated length of a first wave 6 of an influenza pandemic? 7 JUSTINE HARTLEY: Correct. 8 JOHN CALLAGHAN: All right, and then it 9 says: 10 "The Ministry gave quantity 11 formulas in the OHPIP so that the 12 broader health-care sector would 13 know what quantities of supplies to 14 buy. We noted two areas in the 15 instructions given to the broader 16 health-care sector for local 17 stockpiling that warrant revision: 18 - The supply of some personal 19 protective equipment, such as masks 20 for patients and gowns for 21 non-clinical staff, would not last 22 for the estimated eight weeks of a 23 pandemic, because the Ministry had 24 not instructed the local health-care 25 sector to buy these supplies.

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1 - The Ministry did not inform the 2 broader health-care sector that it 3 could buy its stocks at the 4 government-negotiated rate once the 5 provincial stockpile was complete. 6 Health-care providers who were in 7 the process of building their local 8 stockpiles or had already done so 9 may have bought their supplies at a 10 higher price." 11 Just stopping there, on the latter 12 point, are you aware of whether long-term care 13 homes in particular were able to buy their PPE at a 14 government-negotiated price? 15 JUSTINE HARTLEY: I am not aware. 16 JOHN CALLAGHAN: As in you don't know 17 the answer? 18 JUSTINE HARTLEY: I don't know the 19 answer. I know that it was opened up to the 20 broader health care sector to take advantage of 21 those price points, but I don't know who took 22 advantage of them. 23 JOHN CALLAGHAN: And then the issue 24 about the plan not being sufficient for 25 non-clinical staff, would PSWs be non-clinical

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1 staff? 2 JUSTINE HARTLEY: I think this would 3 be -- I am not aware of this recommendation, per 4 se, or what informed this recommendation, but it 5 could consider housekeepers and other folks as part 6 of the non-clinical staff. 7 JOHN CALLAGHAN: But you don't know 8 whether it includes PSWs, for example? 9 JUSTINE HARTLEY: I do not know. 10 JOHN CALLAGHAN: So if we could just go 11 to the next page, and so this is 2007 and I 12 appreciate this is before your time, so let's make 13 that clear. 14 So if I am reading this right, it says 15 at the top, and we won't go back, it says: 16 "[...] personal protective 17 equipment, as of January 2007, a 18 significant number of health-care 19 providers had not completed their 20 personal stockpiles." 21 And then if you go down, it says: 22 "Half of the public health 23 units did not have four-week 24 stockpiles for their sites. In 25 addition, many public health units

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1 reported that over half of the 2 facilities and practitioners in a 3 particular category of health-care 4 provider did not have four-week 5 stockpiles. Figure 3 shows the 6 percentage of public health units 7 that reported that more than half of 8 the facilities and practitioners of 9 a particular category of health-care 10 provider did not have the required 11 four-week stockpiles." 12 And of course, we are interested in 13 long-term care, and it is the first one, and 14 basically, if I'm reading the chart right - and 15 tell me if I am - 80 percent of long-term care 16 homes had less than 50 percent of the required 17 stockpile; is that how I read that chart? 18 JUSTINE HARTLEY: That is how I would 19 interpret it. 20 JOHN CALLAGHAN: And I recognize you 21 weren't there, but when you were there, did you 22 know the state of the stockpile in 2019 that was in 23 the possession of long-term care homes? 24 JUSTINE HARTLEY: I did not. 25 JOHN CALLAGHAN: Okay, so why don't we

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1 go back to your slide deck. 2 JUSTINE HARTLEY: So I think we might 3 be on slide 6 now. 4 JOHN CALLAGHAN: Yes, and this is the 5 Health System Emergency Management Branch reporting 6 structure? 7 JUSTINE HARTLEY: It is, yes, and it 8 just details from 2006 the individuals that we 9 reported to at the time. 10 JOHN CALLAGHAN: Okay, so then let's 11 move on to the metrics and assumptions, which is 12 something we have touched on. So why don't you 13 explain, and I will show you the Appendix 6 to the 14 2006, but let's go to your slide deck because it 15 will probably be quicker. 16 JUSTINE HARTLEY: Okay, thank you so 17 much, and Jessica actually will speak to these 18 slides. 19 JESSICA BAUMAN: Thank you, Justine. 20 Yes, in regards to metrics and 21 assumptions to guide purchasing for a stockpile, 22 all volumes in the development of a stockpile are 23 educated estimates, as we have been discussing 24 prior to this. 25 It is impossible to predict precisely

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1 how a pandemic might play out, what the 2 transmission rate will be, infection rate, outcomes 3 or length of time of the pandemic, and two, how 4 much supply will be needed as a result. 5 Therefore, the stockpiles set up in 6 2006 was based on the OHPIP guidelines at the time 7 which were based on expert advice provided by the 8 OHPIP Equipment and Supply Working Group in 2006. 9 So these guidelines were based on a 10 projected 35 percent impact of influenza pandemic 11 to the general population and a 50 percent impact 12 for long-term care homes with vulnerable residents. 13 As Justine mentioned and as we have 14 discussed, OHPIP also recommended that health 15 service providers have a four-week supply and the 16 provincial stockpile have a four-week supply to 17 cover an eight-week wave of a pandemic. The 18 recommendation of an eight-week supply came from 19 the Canadian Pandemic Influenza Preparedness Plan. 20 The CPIPP also referenced at the time the World 21 Health Organization which says each pandemic wave 22 could last from a few weeks to a few months. 23 So based on those overarching OHPIP 24 guidelines, assumptions were then made for each 25 type of health organization or location of care to

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1 determine the expected volume of PPE that would be 2 required. 3 Risk to health care workers in the 4 workplace was considered the highest in settings 5 where people first present with symptoms, in 6 settings providing care for vulnerable people and 7 in settings where staff are performing high risk 8 procedures that create sprays and splashes. 9 So the next slide goes into details on 10 what guided the determination of volume for the PPE 11 needed for long-term care homes. So as discussed, 12 this was done for other sectors as well, but this 13 was specifically the assumptions for long-term care 14 homes. 15 So numbers were based on the projected 16 number of beds for 2006, then the estimate that the 17 total encounter number is 25 patient interactions a 18 day. That would include direct clinical staff 19 interactions and other staff who may be in close 20 proximity to or have contact with patients, and an 21 example would be housekeeping. 22 It also assumed that up to 50 percent 23 of the population in long-term care homes would be 24 an influenza-like illness patient. 25 And then specific item estimates for

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1 each type of PPE were listed below, which are 2 listed below, sorry, in the deck, which determined 3 how many of each item would be required for what 4 percentage of ILI encounters. 5 So the purchases based on these 6 assumptions were made then between 2006 and 2011 to 7 align with these assumptions. 8 JOHN CALLAGHAN: So let me ask you a 9 few questions. So this was based on the number of 10 beds in long-term care in 2006. Did you ever 11 update the plan having regard to the fact that 12 there were more beds in 2019? 13 JESSICA BAUMAN: To my knowledge, no. 14 That remained the underlying assumption. 15 JOHN CALLAGHAN: All right, and you 16 referred FluAid, which is on the previous slide, 17 and we don't need to go back, but that is a program 18 that was specifically designed for these types of 19 projections; is that correct? 20 JESSICA BAUMAN: Yes, FluAid and 21 FluSurge. 22 JOHN CALLAGHAN: I see, and now do 23 those types of programs still exist? 24 JESSICA BAUMAN: Both FluAid and 25 FluSurge continue to be supported by the CDC in the

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1 United States. 2 JOHN CALLAGHAN: And does the province 3 own -- I don't know what you call it, but do they 4 have access to FluAid and FluSurge? 5 JESSICA BAUMAN: They are publicly 6 accessible. 7 JOHN CALLAGHAN: Okay, so let's just 8 look at long-term care. So the assumption that 9 they have is 50 percent of the population will be 10 infected. Do we know what percentage of the 11 long-term care population was infected in COVID? 12 JESSICA BAUMAN: I am not aware of the 13 specific number. 14 JOHN CALLAGHAN: That is fine. I'm 15 sure we can get it. 16 So in masks, just so I understand this, 17 so each time they were to see a patient that had 18 influenza-like illness - and I am not sure exactly 19 what that is, but we'll come back to that - they 20 were to use a mask; correct? 21 JESSICA BAUMAN: Yes. 22 JOHN CALLAGHAN: All right, and that 23 mask was to be disposed, and you would use another 24 mask when you came to another patient; correct? 25 JESSICA BAUMAN: That would be my

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1 understanding. 2 JOHN CALLAGHAN: All right. And then I 3 take it the gloves, "1 pair each for one staff for 4 50%", so I'm assuming you switch them every two 5 patients; is that the idea? 6 JESSICA BAUMAN: Sorry, just I am going 7 to get the lights back on here. 8 JOHN CALLAGHAN: That's all right. We 9 have had all sorts of problems. 10 COMMISSIONER FRANK MARROCCO (CHAIR): 11 Usually, Ms. Bauman, I get phoned by 12 the air duct people in the middle of most of these 13 interviews, so don't be concerned about that. 14 JESSICA BAUMAN: Okay, well, yeah, the 15 air duct people are pretty insistent. 16 I apologize, John, would you be able 17 to -- 18 JOHN CALLAGHAN: Yes, and maybe it is 19 simple math, but I just want to make sure I 20 understand it. "1 pair each for one staff for 21 50%", does that mean that you would switch your 22 gloves every two encounters; is that how I read 23 that? 24 JESSICA BAUMAN: No, that would be 25 based on the idea that gloves would not be required

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1 for all encounters if you were not in close 2 interaction or requiring gloves based on the 3 recommended routine practices or precautions at the 4 time. 5 JOHN CALLAGHAN: I see, and that that 6 would be the same with gowns, for example? That is 7 the way I should -- 8 JESSICA BAUMAN: Correct. 9 JOHN CALLAGHAN: It is not that you 10 change it every third. It is we would assume 11 one-third of the encounters would require a gown; 12 correct? 13 JESSICA BAUMAN: That's correct. 14 JOHN CALLAGHAN: And I won't take you 15 back to the Appendix 6 which is where this comes 16 from, just for the sake of timing, and you probably 17 know this off the top, but the predictions for 18 long-term care would be different than other health 19 care settings, right? Like the 50 percent of the 20 population being infected, I think that -- I think 21 in the work, it has a much lower rate for other 22 parts of the population but this is because they 23 are probably more compromised; is that correct? 24 JESSICA BAUMAN: Yes, the assumptions 25 of OHPIP were that 50 percent of the population in

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1 long-term care homes would be affected. 2 JOHN CALLAGHAN: Right, but that is 3 because they were more compromised or is it because 4 of the setting, or do you know? 5 JESSICA BAUMAN: I am not a hundred 6 percent sure of what exactly underlies that. It 7 very well could be for either of those assumptions. 8 JOHN CALLAGHAN: Okay. Now, we are 9 going to get to this, but in here we know, as I 10 take it, that the Cabinet of the day in 2006 11 approved the purchase and it was 170 million 12 dollars over four years. 13 And I know you did work on the desktop 14 analysis, which we'll take a look at, but just 15 while we are here, was it your finding when you 16 looked back in the records and talking to people 17 that in fact the entirety of the 170 million, part 18 of that was rescinded I think is the word you used 19 in your desktop analysis? 20 JESSICA BAUMAN: Yes, so just to 21 clarify, the amount that was approved for the PPE 22 stockpile was 84 million in supplies as part of 23 that Treasury Board submission. There was then 24 other money dedicated to other aspects of pandemic 25 preparedness as a stockpile submission.

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1 So we are discussing 84 million when it 2 comes to the PPE stockpile, and yes, that was 3 initially given over the course of for five years. 4 However, in 2007 and 2008, as part of the financial 5 planning of the Ministry, it was decided that the 6 remaining money that had not been spent would be 7 rescinded and redistributed into the Ministry for 8 other areas due to funding pressures. 9 JOHN CALLAGHAN: Okay, so just so I am 10 clear, so the 84 million for the PPE, as it were, 11 not all of it got spent in that five-year period. 12 But why don't we take you to the next 13 slide where you tell us -- and I take it we don't 14 know in your research, and again, it is research on 15 your part, it doesn't really tell you how much was 16 spent, am I correct on that, when you did your 17 research on this? 18 JESSICA BAUMAN: Yes, because the 19 purchases were made back in 2006, it is very 20 difficult. 21 JOHN CALLAGHAN: Right. All you know 22 is that portion of that budget was rescinded? 23 JESSICA BAUMAN: Yes, and I apologize, 24 John, I should clarify too that when we do talk 25 about the portion of the budget that was rescinded,

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1 that does go back to the overarching amount that 2 was approved as well, so back to that 170. 3 JOHN CALLAGHAN: So you can't tell 4 which portion of it came from where? 5 JESSICA BAUMAN: No. 6 JOHN CALLAGHAN: Because we are going 7 to see a document where there isn't the 94 million 8 masks, and we'll talk about that in a second, but I 9 just want to -- so 170 million, 84 million, and 10 your research found that part of that budget was 11 rescinded but it is not clear as to what portion of 12 the budget was rescinded; correct? 13 JESSICA BAUMAN: That's correct. 14 JOHN CALLAGHAN: Okay, so let me go to 15 the next slide. 16 JESSICA BAUMAN: Yes, so just to go 17 through what those purchases did look like, so 18 given the significant cost and high volumes of 19 supplies -- oh, sorry -- 20 JOHN CALLAGHAN: Yes. 21 JESSICA BAUMAN: Slide 9. 22 JOHN CALLAGHAN: I think we missed one. 23 I think we are at 9. 24 JESSICA BAUMAN: So given the 25 significant cost and high volume of supplies and

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1 equipment required for the stockpile, Treasury 2 Board approval and procurement protocols were 3 required when purchases were made that were above 2 4 million, which did guide the purchases for the 5 first years of the stockpile. 6 So between 2006 and 2008, Treasury 7 Board purchase approval was given for broad PPE 8 purchases of approximately 84 million dollars in 9 supplies and equipment, including N95s, and 10 supplies for physician emergency infection control 11 kits, mass immunization supplies and equipment. 12 In 2008-2009 we went back for approval 13 to be able to purchase 55 million N95s, totalling 14 approximately 5 million dollars. 15 And then in 2009-2010 additional 16 purchases of PPE were approved by Treasury Board, 17 including N95s, for the H1N1 response, totalling 18 approximately 15 million, the breakdown being about 19 11.9 million for PPE and 3.9 million for N95s. 20 So as of 2010, a basic PPE stockpile 21 had been developed. 22 After 2009 and 2010, smaller purchases 23 were made to add specific supplies to the stockpile 24 based on changes in health recommendations. An 25 example of that would be that legislation came into

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1 effect regarding the use of safety-engineered 2 needles instead of conventional needles which had 3 originally been purchased, so additional purchases 4 were made for the safety-engineered needles. 5 Although, throughout the stockpile's 6 existence smaller purchase volumes were made at 7 various points as needed, and specific supplies for 8 Ebola planning were also purchased in 2015-2016. 9 JOHN CALLAGHAN: And I take it, so for 10 example, in Ebola fluid resistant coveralls and 11 things like that, to be totally -- 12 JESSICA BAUMAN: Yes, that's correct. 13 JOHN CALLAGHAN: So if I could just 14 take you to document 5, and there is a couple of 15 preliminary questions I should have asked earlier, 16 and maybe we skipped over this and I don't know if 17 this is Ms. Hartley's area, but this is a briefing. 18 And I think, could you - and whichever 19 one - but what is the role of the Chief Medical 20 Officer of Health? What is his or her 21 responsibility as it relates to the stockpile? 22 Like with whom does the responsibility for a 23 stockpile rest, and to the extent it doesn't rest 24 with them, what dotted line do they have or 25 visualization do they have into the stockpile, if I

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1 could put it that way? And so we are talking the 2 Minister of Health, Chief Medical Officer of 3 Health, I guess the preparedness people at -- Ms. 4 Hartley, could you just let us -- and I didn't mean 5 to pick on you, Ms. Hartley. I just assumed it 6 would be your type of question. 7 JUSTINE HARTLEY: Ultimately, as we 8 spoke about with the legislation under the 9 Emergency Management and Civil Protection Act, the 10 ultimate responsibility would lay with the Deputy 11 Minister as a component of that program. 12 JOHN CALLAGHAN: But the Chief Medical 13 Officer of Health, as we see from this briefing, 14 they have a line of sight into what is available in 15 the face of a pandemic such as a stockpile? 16 JUSTINE HARTLEY: Yes, I think in 2003, 17 and I would have to refer back to the slide, but I 18 believe that we did report to the CMOH at that 19 time. 20 JOHN CALLAGHAN: Okay, so -- 21 SUNIL MATHAI: Sorry, John, it is 22 Sunil. I am just trying to be helpful here, and 23 I'm not sure if it will assist, but if we could 24 bring back the slide deck, the one that we kind of 25 just cursory went over.

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1 JOHN CALLAGHAN: Yes, and I think you 2 are probably right. Yes, perhaps we should have a 3 clear explanation. So it is slide 6. 4 So, Ms. Hartley, could you just sort 5 of -- 6 JUSTINE HARTLEY: Yes, absolutely, and 7 my memory failed me there. 8 JOHN CALLAGHAN: No, fair enough, I 9 should have asked. 10 JUSTINE HARTLEY: In 2013, we did 11 report to Roselle Martino who then reported to the 12 CMOH at the time who was Dr. Arlene King. 13 JOHN CALLAGHAN: So the responsibility 14 is with Health, but the CMOH being an ADM had 15 responsibility within Health at that time? 16 JUSTINE HARTLEY: Yes. 17 JOHN CALLAGHAN: And what about 2014 to 18 2018, is that the same, or does the Chief Medical 19 Officer of Health not have sight into it? 20 JUSTINE HARTLEY: We reported directly 21 to the ADM who was Roselle Martino, and she would 22 have reported -- not reported, sorry, provided or 23 she would have worked directly with the CMOH at the 24 time. 25 JOHN CALLAGHAN: She would have worked

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1 with the CMOH, and they would have reported to the 2 Deputy Minister of the day, Bob Bell; correct? 3 JUSTINE HARTLEY: Yes. 4 JOHN CALLAGHAN: And then 2018 to 2020, 5 so this is up to mid-year last year. 6 JUSTINE HARTLEY: Yes. 7 JOHN CALLAGHAN: So that would be just 8 the Chief Medical Officer of Health, according to 9 this slide, would have had primary responsibility 10 for the stockpile? 11 JUSTINE HARTLEY: Yes, our branch would 12 have reported to him. 13 JOHN CALLAGHAN: All right, and I 14 wasn't aware - and I apologize, if it is in an 15 earlier presentation, please excuse me - but do you 16 know why that changed in August of this year? 17 JUSTINE HARTLEY: It is a temporary 18 division that has been created to solely focus on 19 the support for COVID, the COVID response. 20 JOHN CALLAGHAN: And that is the 21 division you head up? 22 JUSTINE HARTLEY: Yeah, we are a branch 23 within that division, and ADM Blair is the person 24 that we currently report to. 25 JOHN CALLAGHAN: Okay, so if we can go

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1 back to slide 5. And thank you very much, that 2 helps. 3 So this is a report then to the Chief 4 Medical Officer of Health who at that time would 5 have been the person you reported to but within the 6 Ministry of Health. 7 If we could go to page 2, and I take it 8 that this basically talks about the intense global 9 competition, supply chain disruption, price 10 gouging, and those issues didn't change. Those 11 were always considerations when one talked about 12 the stockpile; correct? 13 JESSICA BAUMAN: Yes, that's correct. 14 JOHN CALLAGHAN: And this is a working 15 group that had responsibility I take it for supply 16 and equipment? This is who is reporting to the 17 CMOH? 18 JESSICA BAUMAN: No, this was an 19 internal briefing that was done to support the 20 Treasury Board submission at the time. 21 JOHN CALLAGHAN: And I am not sure I 22 have the Treasury Board submission, but I may have 23 it. I may have something here that helps, but let 24 me see if we have got the right thing. 25 So this is somebody reporting on the

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1 work of that working group; correct? 2 JESSICA BAUMAN: No -- 3 JOHN CALLAGHAN: The Supply and 4 Equipment Working Group, no? 5 JESSICA BAUMAN: No, this -- sorry, no, 6 this is an overarching briefing to the CMOH 7 regarding the Treasury Board submission which 8 included materials about what had been done to date 9 in 2013, so that included this overview of what 10 would have been done, and I'm sorry, I cannot 11 remember off the top of my head if it speaks 12 specifically to the Supplies and Equipment Working 13 Group. 14 But this was meant for our branch to 15 brief the Executive Director and then the CMOH is 16 where this landed on our Treasury Board submission 17 for the stockpile and what the state of the 18 stockpile was to date. 19 JOHN CALLAGHAN: Okay, so if we go to 20 slide 5, we are talking about the recommendations 21 of the work group, and it says in the bullet, the 22 first bullet highlighted: 23 "The Workgroup was sunset after 24 the release of 2006 [...]" 25 I take it that is, and I hate to be

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1 crass, but government speak that in 2006 that that 2 working group ceased to exist when you say 3 "sunset"? 4 JESSICA BAUMAN: Yes. 5 JOHN CALLAGHAN: And then so it 6 explains how they come to that recommendation, and 7 largely we have seen a lot of that through the 8 Cabinet submission. 9 But those recommendations were carried 10 forward in the 2013, without a working group but 11 they were just carried forward in the 2013 OHPIP; 12 is that what I am to understand? 13 JESSICA BAUMAN: That is my 14 understanding. 15 JOHN CALLAGHAN: So this report is 16 after H1N1. And if we can just go to slide 13 -- 17 and we'll come back. There is one slide I just 18 want to show you. So this slide says: 19 "The deployment of the 20 stockpile during pH1N1 was a 21 success." 22 And it says: 23 "The ministry worked with its 24 third party vendor to deploy its 25 stockpile, with over 28 million

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1 items being distributed to health 2 workers across the province." 3 And I appreciate that, Ms. Bauman, you 4 weren't there, but your research was consistent 5 that the use of the stockpile in H1N1 was 6 considered a success? 7 JESSICA BAUMAN: Yes. 8 JOHN CALLAGHAN: So if we can then go 9 back to page 11, now this is a chart and it has 10 "Stockpile inventory", and so for surgical masks, 11 they deployed 1,718,000 during H1N1 and they had a 12 current inventory of 36,545,000. Now, we know from 13 the Cabinet submission that the estimate worked out 14 through FluAid, et cetera, required 94 million 15 masks. Do we know whether they ever had an 16 inventory of the 94 million masks? 17 JESSICA BAUMAN: I do not know myself, 18 no. 19 JOHN CALLAGHAN: All right. And then 20 you had gowns of 331,000 and you had an inventory 21 of 24 million -- pardon me, 331,000 deployed during 22 H1N1, and then they had a remainder of 24 million, 23 and that is not far off what was in the estimate 24 which was 25 million. 25 But respirators, N95s, they used

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1 4,865,230 in H1N1, and they had an inventory of 2 49,546,000 as of 2013, right? Is that how I read 3 that? 4 JESSICA BAUMAN: That is how I read 5 that chart, yes. 6 JOHN CALLAGHAN: If we could then -- 7 there is a document 13, and I just -- again, I 8 apologize, and I don't want to take the 9 Commissioners' time, but you mentioned a Cabinet 10 submission. I am not exactly sure of the date of 11 this submission, but I can tell you that it was 12 approved. The approvals were set for Deputy 13 Minister Angus and Minister Deb Matthews, and I 14 believe Minister Matthews was 2009 to 2014, and 15 being referenced to October 2014, and this 16 document, I assuming it is in about that time. 17 But this, if you could go to the front 18 then, Michael, was this the Cabinet submission you 19 said they were getting ready for in the submission 20 that we just saw? 21 JESSICA BAUMAN: Yes, that's correct. 22 JOHN CALLAGHAN: And the focus here, it 23 seems to me, and we see this over and over again, 24 it is on the warehousing of the stockpile. That 25 becomes the issue, is that right, because of the

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1 contracting? 2 JESSICA BAUMAN: Yes, that's correct, 3 the contract was expiring and they were seeking 4 approval to extend or to go for a competitive 5 procurement of a new stockpile provider. 6 JOHN CALLAGHAN: Okay, and then if we 7 can go to the top of the second page, and I don't 8 want to belabour this, but it says: 9 "The MOHLTC requires the 10 continued ability to maintain the 11 stockpile and deploy it to health 12 organizations across the province 13 during an emergency." 14 So again, it was a matter of providing 15 a warehousing contract which was the subject matter 16 going to Cabinet; correct? 17 JESSICA BAUMAN: Yes, warehousing and 18 the associated logistics services. 19 JOHN CALLAGHAN: All right, and then if 20 you go down to 3.1, the Cabinet of the day, and I 21 believe it is 2014 because these documents all 22 refer to 2014, given that it is Minister Matthews, 23 it says: 24 "There is a risk that Ontario's 25 health system would be unable to

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1 procure high-demand supplies & 2 equipment at the time of an 3 emergency, given that most suppliers 4 utilize just-in-time logistics and 5 lean manufacturing processes. As 6 well, there may be intense global 7 competition for limited resources 8 during an emergency that has 9 world-wide impacts. Ontario's 10 experience with SARS and the H1N1 11 influenza pandemic demonstrated that 12 a sudden surge in demand for 13 supplies is not easily accommodated 14 by suppliers, which poses a 15 significant obstacle to the 16 management of an infectious disease 17 emergency. In particular, health 18 workers need access to infection 19 prevention & control and 20 occupational health & safety 21 supplies & equipment to maintain a 22 healthy work environment. 23 To mitigate against this risk, 24 the MOHLTC advises health 25 organizations to develop a stockpile

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1 of personal protective equipment 2 sufficient to sustain its response 3 during four weeks [...]" 4 So just 2006 and we are now at 2014, 5 and the considerations are largely the same; am I 6 correct? 7 JESSICA BAUMAN: Yes, that's correct. 8 JOHN CALLAGHAN: All right. And if we 9 could go then to the headline just a little further 10 down, Michael -- or I should say higher up in the 11 document, under "Personal Protective Equipment", 12 yeah, right there, the last line of that paragraph 13 above says: 14 "Together, the local- and 15 provincial-level stockpiles support 16 health system readiness for any type 17 of infectious disease emergency, 18 including an influenza pandemic." 19 So by this time, they are thinking more 20 globally than an influenza pandemic, is that how I 21 should read this? 22 JESSICA BAUMAN: I do not know for 23 certain what informed that sentence or statement, 24 but it does seem to state that there was thinking 25 beyond just influenza.

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1 JOHN CALLAGHAN: That is 2 understandable. 3 And then it says under "Personal 4 Protective Equipment": 5 "PPE refers to the clothing or 6 equipment that prevents exposure to 7 a hazard by placing a barrier 8 between the source and an 9 individual's mucous membranes, 10 airways, skin and/or clothing. 11 It prevents the transmission of 12 infectious agents from 13 patients-to-workers, 14 patients-to-patients, 15 workers-to-patients and 16 workers-to-workers. The use of PPE 17 is an important IPAC & OHS measure 18 that is applied in all health 19 settings during regular operations - 20 and would be more rigorously applied 21 during an infectious disease 22 emergency. Given the importance of 23 PPE in protecting health workers and 24 patients, the MOHLTC must maintain 25 sufficient inventory to provide

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1 adequate protection for Ontario's 2 480,000+ health workers and their 3 patients. The MOHLTC's stockpile 4 includes surgical masks, N95 5 respirators, eye protection, hair 6 covers, gloves and gowns. Many of 7 these items would need to be changed 8 after each patient interaction." 9 So to your mind, that is consistent 10 from 2006 to 2014? There is no change there, is 11 there, as far as you can see, Ms. Bauman? 12 JESSICA BAUMAN: That's correct. 13 JOHN CALLAGHAN: And am I to 14 understand, and I appreciate you were doing 15 research and so you weren't there, but was there 16 another analysis? I mean, here we are talking 17 about 480,000-plus health workers. Did they do an 18 analysis of the number health workers, or do you 19 know? 20 JESSICA BAUMAN: To my understanding, 21 broadly speaking, no. 22 JOHN CALLAGHAN: All right. 23 JESSICA BAUMAN: Not specific to this 24 broader PPE stockpile. 25 JOHN CALLAGHAN: All right, but I take

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1 it, and if we can go to page 16, it really is just 2 I guess -- and I don't want to put words in your 3 mouth, but I take it that it is just reflecting the 4 impacted population. You will see they have a 5 section called "Population impacted", and they say: 6 "Health workers and health 7 sector employers across the health 8 system [...]" 9 And they go through including long-term 10 care homes, clients, patients, residents and their 11 visitors, right. 12 So I take it that the stockpile, again, 13 was intended to protect health workers, clients, 14 patients, residents and their visitors; correct? 15 JESSICA BAUMAN: Actually, I would just 16 want to see the top of that chart in terms of the 17 title of it before -- 18 JOHN CALLAGHAN: Yes, for sure, 19 absolutely. 20 JESSICA BAUMAN: -- answering what that 21 spoke to. 22 JOHN CALLAGHAN: I think you need to go 23 to 4.6, Michael. If you go down a little further, 24 the title is right there, because I think it rolls 25 off. So it says:

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1 "SCLC TB/MBC approval to 2 procure a vendor to provide 3 warehousing and logistic services 4 ensures that the MOHLTC maintains 5 its capacity to coordinate the 6 health system's response to 7 emergencies." 8 And then it has this chart, and it has 9 various issues in terms of anticipated outcomes, 10 including health of -- 11 JESSICA BAUMAN: Yes, so this chart 12 specifically would be speaking to the broader idea 13 of as a whole who would be affected by the outcomes 14 of this Treasury Board submission. 15 That said, your question about who was 16 being considered in terms of that impact would go 17 back to the original assumptions that we did talk 18 about that did indicate health care workers and 19 those interactions with clients, patients and 20 residents. 21 JOHN CALLAGHAN: And as it says in the 22 line above that, it says: 23 "Health organizations have 24 access to supplies and equipment to 25 support their response to an

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1 emergency." 2 So the idea wasn't to provide 3 day-to-day support for PPE. The idea was only in 4 respect of a pandemic -- or an emergency, I 5 shouldn't say pandemic, but an emergency; is that 6 right? 7 JESSICA BAUMAN: Yes, that's correct, 8 as a support to local supplies. 9 JOHN CALLAGHAN: All right. So let me 10 just catch up here on my notes here. 11 What we are going to step into then, 12 and we have your desktop analysis which comes out 13 of the modernization initiative, and could you just 14 tell us a little bit about that and your work, Ms. 15 Bauman, or I guess Ms. Hartley could tell us, 16 whichever, but I know Ms. Bauman did some 17 background work. 18 JESSICA BAUMAN: So broadly speaking, 19 the stockpile modernization and review was first 20 initiated in 2016. I then took up the review again 21 in 2019 after the review, the initial review in 22 2016 had been paused following the Auditor 23 General's 2017 value for money audit which noted 24 that the Ministry was paying to store expired 25 product, and the direction was given at the time to

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1 proceed with destruction of the stockpile. 2 So once that was started, I then picked 3 up the review in 2016 -- or sorry, 2019, and with 4 the goals, in addition to the 2016 goals, to 5 evaluate the current model of the Ministry's 6 emergency stockpile against best practices, align 7 the stockpile strategy with the government's 8 modernized supply chain strategy and then develop a 9 policy, a new policy framework for a modernized 10 emergency stockpile strategy. 11 The current state assessment that I did 12 was one part of that review that was going to then 13 inform what the policy recommendations would be for 14 an emergency stockpile. 15 So the current state desk analysis is 16 looking specifically at what is the state of the 17 stockpile at this point in time. 18 JOHN CALLAGHAN: And so can you just 19 give me the dates, when did the modernization 20 program start? 21 JESSICA BAUMAN: So it began at the end 22 of 2016. It continued into 2017, as I said, and 23 then it was paused at that point in time and then 24 it was re-initiated again at the end of 2018, with 25 the majority of work beginning at the very

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1 beginning of 2019. 2 JOHN CALLAGHAN: Right, and so I have a 3 couple of documents. I just don't know which goes 4 first, but I will take you to document 7. 5 COMMISSIONER FRANK MARROCCO (CHAIR): 6 Can I, just before you do that -- 7 JOHN CALLAGHAN: Sure. 8 COMMISSIONER FRANK MARROCCO (CHAIR): 9 When had the stockpile expired? 10 JESSICA BAUMAN: Products within the 11 stockpile had expired over a number of years just 12 based on when they were first bought and the 13 manufacturer designated shelf life. 14 I believe the documents that we gave -- 15 actually, in the presentation, as of 2019 16 approximately 85 percent to 90 percent had expired, 17 but that expiry was over the course of a number of 18 years. 19 COMMISSIONER FRANK MARROCCO (CHAIR): 20 So when it says on page 10, "At the 21 time, approximately 80% of the stockpile had 22 expired", that is at the time of the Auditor 23 General's 2017 report? 24 JESSICA BAUMAN: Sorry, could you just 25 tell me what page 10? What document is page 10?

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1 COMMISSIONER FRANK MARROCCO (CHAIR): 2 The one on the screen. 3 JESSICA BAUMAN: Oh, the one on the 4 screen, yes, yes. 5 COMMISSIONER FRANK MARROCCO (CHAIR): 6 The "10" is on the left side at the 7 bottom. 8 JESSICA BAUMAN: Yes, I appreciate 9 that, thank you. 10 Yes, that is correct, it is referring 11 to as of 2017 80 percent of the stockpile was 12 expired. 13 COMMISSIONER FRANK MARROCCO (CHAIR): 14 So as the years progress, and correct 15 me if I'm wrong, but as the years progress from 16 2006 to 2017, the stockpile is being created, and 17 at the same time, as time goes by, stock is 18 expiring; and in 2017, or whenever the Auditor 19 General actually looked at it, 80 percent of it has 20 expired? 21 JESSICA BAUMAN: Yes, that's correct. 22 COMMISSIONER FRANK MARROCCO (CHAIR): 23 Okay. 24 JOHN CALLAGHAN: And the -- 25 COMMISSIONER FRANK MARROCCO (CHAIR):

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1 And so that when you say later on 2 "Items were not replenished as they were 3 destroyed", they were actually expired by then? 4 JESSICA BAUMAN: Yes, that's correct. 5 COMMISSIONER FRANK MARROCCO (CHAIR): 6 So it would seem to me that you could 7 also say that items were not replenished as they 8 expired. 9 JESSICA BAUMAN: Yes, that is correct. 10 COMMISSIONER FRANK MARROCCO (CHAIR): 11 Okay. 12 JOHN CALLAGHAN: So if we could then go 13 to document 7, and while that is pulled up, on that 14 point, Ms. Bauman, your research showed that the 15 way the stockpile was maintained, and I am just 16 doing this for brevity, and we have your report, 17 but was that it was a static stockpile. In other 18 words, the material didn't rotate in and out of; it 19 just sat there waiting for an emergency, correct? 20 JESSICA BAUMAN: That's correct. 21 JOHN CALLAGHAN: So even though 22 hospitals were using masks every day, it wasn't as 23 if the hospitals would buy from the stockpile and 24 the stockpile would get new stuff to keep a fresh 25 set of inventory; correct?

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1 JESSICA BAUMAN: That is correct. The 2 provincial PPE stockpile was separate from regular 3 supply chains. 4 JOHN CALLAGHAN: Right, and you have 5 come up with certain recommendations that would 6 change that; correct? 7 JESSICA BAUMAN: Yes, I do state some 8 early thoughts and recommendations regarding the 9 stockpile. 10 JOHN CALLAGHAN: No one is going to 11 hold you to making government policy in that way, 12 so it is just a matter of I know you are the one 13 that did the research and you -- 14 JESSICA BAUMAN: Yes, that's correct. 15 JOHN CALLAGHAN: So this is a note, and 16 really it is 2017, and it is an amendment to the 17 supply chain submissions which I believe are a part 18 of a Cabinet or a Management Board submission. But 19 if we can go to the submission, the "Purpose" says: 20 "The Ministry of Health and 21 Long-Term Care is seeking Supply 22 Chain Leadership Council approval to 23 proceed with:" 24 And perhaps I should stop there. What 25 is the Supply Chain Leadership Council and who sits

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1 on that? 2 JESSICA BAUMAN: I am not aware who 3 sits on the Supply Chain Leadership Council, but it 4 was a council, a subcommittee set up by Cabinet 5 that was meant to look specifically at any 6 submissions related to supply chain. 7 JOHN CALLAGHAN: So this issue would 8 have gone to the Cabinet of the day? And I think 9 the date of this is May of 2017 at the bottom. 10 JESSICA BAUMAN: Yes, it went to Supply 11 Chain Leadership Council. 12 JOHN CALLAGHAN: I see, all right. And 13 what they were looking to proceed with is: 14 "- an open competitive 15 procurement to create a three + two 16 + five year agreement for 17 warehousing [...] 18 - a non-competitive procurement 19 to enter into a 1 + 1 + 1 year 20 agreement with the incumbent vendor 21 [...]" 22 And a third one is: 23 "- an open competitive 24 procurement process to create a 3 + 25 2 year agreement for destruction

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1 services for the expired products in 2 its emergency stockpile." 3 And I take it that they got the 4 approval at one level or another for these things, 5 including the destruction of the stockpile; 6 correct? 7 JESSICA BAUMAN: Yes, this submission 8 was approved. 9 JOHN CALLAGHAN: Did you ever see a 10 submission going to Cabinet in your research 11 suggesting that they buy or replenish the 12 stockpile? 13 JESSICA BAUMAN: Not in terms of the 14 full PPE stockpile, no. 15 JOHN CALLAGHAN: So if we can go to 16 page 4, and it says "Stockpile Modernization 17 Project": 18 "The ministry is initiating a 19 stockpile modernization project in 20 order to revise its stockpile 21 policies and program. The 22 objectives of this work are to: 23 - ensure the health system has 24 rapid access to supplies, equipment 25 and pharmaceuticals during an

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1 emergency." 2 So that continues to be the focus of 3 what the stockpile was intended for; correct? 4 JESSICA BAUMAN: That's correct. 5 JOHN CALLAGHAN: All right, and then 6 the last one -- or before that: 7 "- ensure the effective 8 management of the stockpile 9 inventory." 10 And the last one is: 11 "- develop a sustainable 12 program through dedicated funding 13 and ongoing destruction and asset 14 replenishment." 15 So the idea was to find a way not to 16 have this to be subject to financial issues but 17 really to provide a way to have a sustainable 18 stockpile? Was that part of the exercise? 19 JESSICA BAUMAN: That's correct. 20 JOHN CALLAGHAN: And if we could go 21 over to tab 6, just to -- or page 6, I should say, 22 just to illustrate to the Chair part of what he 23 asked about, there was a planned destruction 24 schedule for this stuff. For example, in Q2 of 25 2017 they were going to destroy 900 pallets of

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1 whatever that is, and again 3,000 pallets in the 2 third quarter, and then in the fourth quarter 3 another 3,000 pallets, right? This had to be done 4 in a very organized fashion; correct? 5 JESSICA BAUMAN: Yes, this was the 6 schedule at the time. 7 JOHN CALLAGHAN: And the schedule went 8 all the way through to Q4 2019 -- 2020, so when you 9 say that they had it -- just so I am clear, they 10 were continuing to destroy expired product through 11 Q1, January to March of 2020? That is what that 12 schedule says. Did that happen? 13 JESSICA BAUMAN: So there was -- yes, 14 there was a scheduled destruction between January 15 and March 2020. However, destruction was paused 16 when COVID was recognized as possibly presenting a 17 threat to Ontario, and that pause occurred toward 18 the end of January, early February. 19 JOHN CALLAGHAN: Right, and just to -- 20 COMMISSIONER FRANK MARROCCO (CHAIR): 21 Mr. Callaghan, just before you go any 22 further, but they were destroying expired product? 23 JOHN CALLAGHAN: Right. 24 JESSICA BAUMAN: Yes, that is correct. 25 COMMISSIONER FRANK MARROCCO (CHAIR):

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1 So the pause, it was the pause in 2 destroying product that was already expired? 3 JESSICA BAUMAN: Yes, that's correct. 4 COMMISSIONER FRANK MARROCCO (CHAIR): 5 Am I right that if it is expired, you 6 can't use it? 7 JESSICA BAUMAN: Yes, best practice is 8 not to use expired product. Because of the supply 9 chain shortages in the COVID response, there were 10 specific recommendations on how to use expired 11 product if that was necessary and the option of 12 last resort. 13 COMMISSIONER FRANK MARROCCO (CHAIR): 14 So what is happening is the product is 15 expiring as time goes on - and correct me if I'm 16 wrong because I don't want to make a mistake about 17 this - and it is not being replaced. 18 JESSICA BAUMAN: No. 19 COMMISSIONER FRANK MARROCCO (CHAIR): 20 And then when COVID hits, there is a 21 pause in destroying the expired product because 22 there is an overall shortage because it is a 23 worldwide emergency. 24 JESSICA BAUMAN: Yes, the pause was 25 initiated I believe prior to it being considered a

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1 pandemic, but the decision within the Health System 2 Emergency Management Branch was in the case that we 3 might end up in a situation that the growing threat 4 became larger, we wanted to have on hand what 5 product we had. 6 COMMISSIONER FRANK MARROCCO (CHAIR): 7 Did you ever see anything in the work 8 you were doing which suggested that the Public 9 Service ever recommended to anybody that they not 10 replace the stockpile? 11 JESSICA BAUMAN: No, I did not see 12 anything in regard to a recommendation to not 13 replace the stockpile. 14 COMMISSIONER FRANK MARROCCO (CHAIR): 15 All right. Now, would you agree that 16 would be kind of odd, to create the stockpile for 17 these reasons, it expires through some problem, 18 that it's not used anyway, and then not replace it? 19 JESSICA BAUMAN: It did create a risk, 20 yes. 21 COMMISSIONER FRANK MARROCCO (CHAIR): 22 Thank you. 23 JOHN CALLAGHAN: And if we could go to 24 document 8, and again, if you can help me with 25 this, I think this relates to the 2017 approval and

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1 the approval for the modernization, but the dates 2 aren't clear. This is a Decision Note. 3 JESSICA BAUMAN: Yes, this is a 4 Decision Note essentially approving the start of 5 the stockpile modernization review again and the 6 scope of that review. 7 JOHN CALLAGHAN: So this would be 2017? 8 JESSICA BAUMAN: No, that document is 9 early 2020. I think the date on the -- or sorry, I 10 apologize, February 22nd, 2019 is the date. 11 JOHN CALLAGHAN: 2019. 12 JESSICA BAUMAN: Yes. 13 JOHN CALLAGHAN: All right, so why 14 don't we -- okay, so 2019, so I am not -- pardon 15 me, but I am not sure, a Decision Note, whose 16 decision is this? Is this of the Ministry and the 17 Chief Medical Officer of Health at the very top 18 you'll see? Can you explain what this is? 19 JESSICA BAUMAN: Yeah, this was a 20 decision internally within the branch, so it was 21 the decision of the Director or the approval of the 22 Director to re-initiate the stockpile modernization 23 policy review. 24 JOHN CALLAGHAN: In February of 2019? 25 JESSICA BAUMAN: Yes.

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1 JOHN CALLAGHAN: And can you tell us 2 why it was paused? 3 JESSICA BAUMAN: Yes, following the 4 2017 Auditor General audit which focussed as a 5 value for money audit -- sorry, I am just referring 6 back to my notes here. 7 JOHN CALLAGHAN: Please do. It is not 8 a memory test. 9 JESSICA BAUMAN: So yes, following the 10 value for money audit in 2017, which specifically 11 called out and noted that the Ministry was paying 12 to store expired products, noting the fact that at 13 this point in time 80 percent of the stockpile was 14 expired and we were paying for the storage of that 15 product, in response to that, the direction was 16 given to focus on the destruction of the stockpile 17 that had expired. 18 JOHN CALLAGHAN: And the -- 19 JESSICA BAUMAN: And so during the time 20 of 2017 to the end of 2018, that was the focus of 21 the work. 22 JOHN CALLAGHAN: Would that have been a 23 Cabinet direction, a direction from senior 24 management or the Minister, or can you say? 25 JESSICA BAUMAN: That was a direction

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1 that we received via our Director based on 2 direction he had received. I cannot speak to where 3 he received that direction from. 4 JOHN CALLAGHAN: Fair enough. So this 5 is February 2019, and if you go to the second page, 6 did you prepare this? 7 JESSICA BAUMAN: I did. 8 JOHN CALLAGHAN: So again, there is the 9 highlighted bits. I won't go through all of this, 10 but here again, if someone were to read this, it 11 says things like: 12 "The ministry has maintained a 13 stockpile based on two main 14 assumptions: (1) that the system 15 would be unable to procure the 16 required medical supplies and 17 equipment during medical 18 emergencies, given that most 19 suppliers utilize just-in-time 20 logistics and lean manufacturing 21 processes; (2) the lag-time for the 22 manufacturing and supply of medical 23 supplies during [a] period of 24 intense global competition would 25 limit the ministry's ability to

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1 effectively deal with health 2 emergencies without a medical 3 stockpile." 4 These were the same issues that you 5 were looking at back to 2006, right? 6 JESSICA BAUMAN: That's correct. 7 JOHN CALLAGHAN: And I think at this 8 point the concern that the focus is is in the third 9 bullet there, and that is: 10 "[...] due to the lack of an 11 overarching stockpile strategy, the 12 items within the ministry's 13 stockpile have been procured in 14 reaction to various emergency 15 situations [...] or as part of other 16 hazard-specific programs [...]" 17 And then you go on to say there is no 18 strategic policy to inform what items are 19 purchased, and that is what you were trying to 20 address; correct? 21 JESSICA BAUMAN: That's correct. 22 JOHN CALLAGHAN: And I won't take you 23 through this, but you did a lot of work then 24 reviewing literature and what is going on in other 25 jurisdictions, if you scroll down to Appendix A,

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1 and I won't take you through it, and you have a 2 background memo that you have given us. 3 So you were going through and you did a 4 whole desk review and you did a literature review. 5 You called the provinces, and they would call you 6 back. You reviewed other jurisdictions; correct? 7 JESSICA BAUMAN: That's correct. 8 JOHN CALLAGHAN: And then you provide 9 an overview of your views in the note, and again, 10 it essentially follows the discussion we have had 11 today which is, you know, the need for a stockpile 12 identified in SARS and proven its worth in H1N1, no 13 overarching policy guideline, and then various 14 policies for strategy regarding funding a 15 stockpile. 16 And just on that, was it your 17 recommendation there should be a cycled inventory 18 as best one can in the stockpile so as to allow it 19 to be replenished without it expiring? 20 JESSICA BAUMAN: Yes, that was one of 21 my early thoughts in regard to what I was seeing 22 and -- 23 JOHN CALLAGHAN: So if we just take -- 24 oh, my apologies, go ahead. 25 JESSICA BAUMAN: No, that's okay. Yes,

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1 it was one of my early thoughts in terms of what 2 could help support an ongoing stockpile management 3 strategy and to prevent expiry. 4 JOHN CALLAGHAN: And so -- 5 COMMISSIONER FRANK MARROCCO (CHAIR): 6 Sorry to interrupt, but was the idea 7 that as product was expiring or approaching an 8 expiry date you make it available to hospitals and 9 other providers so they could at least use the 10 equipment before it expired? Was that the idea 11 behind the warehouse or the inventory? 12 JESSICA BAUMAN: Yes, the idea was that 13 in order to prevent the stockpile from expiring and 14 ensure that product was used prior to that point in 15 time, to in some way incorporate it into the 16 regular supply chain so that product could be used 17 prior to expiry. 18 JOHN CALLAGHAN: So if I could just 19 direct the attention of the Commissioners to the 20 third bullet, Michael, on Appendix B, and I don't 21 know -- 22 MICHAEL FINLEY: Sorry, John, I thought 23 we were in the desktop analysis. Are we back into 24 document 8 now? 25 JOHN CALLAGHAN: Yes.

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1 MICHAEL FINLEY: Yes, okay. 2 JOHN CALLAGHAN: So if you go down to 3 the bottom of the screen there, the bullet that 4 says: 5 "No life-cycle management 6 processes are incorporated - this 7 has led to over 80% of the stockpile 8 expiring before it could be rotated, 9 used, or destroyed as appropriate." 10 That is the point, is it, Ms. Bauman? 11 JESSICA BAUMAN: Yes. 12 JOHN CALLAGHAN: And of course, this is 13 2017. More expired -- I think you said 90 percent 14 had expired by the end of 2019; is that correct? 15 JESSICA BAUMAN: By the beginning of -- 16 yes, by the tend of 2019. 17 JOHN CALLAGHAN: And then if we could 18 go then -- this issue came before Treasury Board, 19 Management Board of Cabinet as late as last July; 20 is that correct? 21 JESSICA BAUMAN: Sorry, "this issue" 22 being? 23 JOHN CALLAGHAN: The issue of what to 24 do with the -- well, let me show you rather than 25 making this a guessing game.

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1 If we could go to document 11, so this 2 is Treasury Board/Management Board of Cabinet 3 Request Assessment Note, so this is a note that 4 goes to Treasury Board and Management Board and it 5 is dated July 25th, 2019. 6 JESSICA BAUMAN: July 10, 2019, yes, 7 that's correct. 8 JOHN CALLAGHAN: So it is tracking to 9 Cabinet, and so it was supposed to go to Cabinet on 10 July 25th. 11 JESSICA BAUMAN: Yes. 12 JOHN CALLAGHAN: And it says: 13 "Receive a report back on the 14 progress of the destruction of 15 expired emergency stockpile of 16 medical equipment and supplies, as 17 directed in June 2017, and approve a 18 ceiling price increase to the 19 existing contract to warehouse the 20 expired emergency stockpile of 21 medical supplies and equipment." 22 So is it fair to say we are continuing 23 to focus on the cost of warehousing and the 24 destruction at this time? 25 JESSICA BAUMAN: Yes.

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1 JOHN CALLAGHAN: All right, and as I 2 think you just told the Chair, as far as you are 3 aware, there was no corresponding, well, requests 4 or inquiry. Was there any request or inquiry from 5 anybody, from a Minister or Cabinet, back to you or 6 anywhere that you are aware of as to what are we 7 doing about having supplies for emergency 8 preparedness? 9 JESSICA BAUMAN: Not that I recollect, 10 no. 11 JOHN CALLAGHAN: And then in this -- 12 COMMISSIONER FRANK MARROCCO (CHAIR): 13 Can I just pursue that for a minute? 14 The decision not to replace the expired equipment, 15 who has the responsibility -- well, let me put it 16 more positively. Who has the responsibility for 17 purchasing equipment to replace the equipment that 18 expired? 19 JESSICA BAUMAN: So legislatively, 20 again, it is overarching Ministry responsibility 21 via the Deputy Minister. The Health System 22 Emergency Management Branch does advise on that. 23 However, in 2017 we were given the direction to 24 focus on the destruction of the stockpile. 25 The intent was to eventually move the

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1 stockpile to a new vendor, and therefore, the focus 2 was on reducing those costs and moving that -- and 3 preparing the stockpile for that type of move. 4 COMMISSIONER FRANK MARROCCO (CHAIR): 5 So the decision to purchase or not 6 purchase replacement inventory of personal 7 protective equipment is the decision of the 8 Minister of Health, the Deputy Minister of Health? 9 Whose decision is it? 10 JESSICA BAUMAN: I apologize, it is a 11 difficult question to answer directly in the sense 12 of the program area and the branch area and the -- 13 and sorry, the division area responsible would make 14 that recommendation. 15 Specifically in regards to PPE, because 16 of the costs associated with purchasing PPE and 17 supplying it, that decision would ultimately have 18 to go to Treasury Board and Management Board of 19 Cabinet for a decision to proceed. 20 COMMISSIONER FRANK MARROCCO (CHAIR): 21 So a decision to proceed with 22 purchasing replacement PPE would go to Management 23 Board for a yes or no? 24 JESSICA BAUMAN: If we were requesting 25 funds at the time. If we were requesting policy

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1 approval, that would depend on the extent of the 2 impacts of that policy approval or the just general 3 direction to go forward with a purchase of a 4 product, and that I can't speak to directly who 5 ultimately that decision would land with because it 6 would be dependent on the impact of what was being 7 recommended. 8 COMMISSIONER FRANK MARROCCO (CHAIR): 9 And sorry to keep at this, but I'm 10 having a little trouble figuring out who is 11 responsible. 12 In 2017 if the instruction you are 13 given is to destroy the expired equipment, the 14 expired PPE, the person giving that instruction 15 would know that unless there is an instruction from 16 Treasury Board to replace the PPE, there will be 17 no -- that the warehouse will be empty or 80 18 percent empty. 19 JESSICA BAUMAN: Yes, if someone is 20 directing the destruction of the PPE, then it would 21 be known that there is no product replacing that. 22 COMMISSIONER JACK KITTS: Could I just 23 ask for clarification. So I am sort of trying to 24 follow this and I know it is complex, but am I 25 right in assuming that there really wasn't a

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1 decision to either replace or not replace? 2 JESSICA BAUMAN: That's correct. 3 COMMISSIONER JACK KITTS: There was no 4 decision? 5 JESSICA BAUMAN: That's correct. 6 COMMISSIONER JACK KITTS: Okay, thank 7 you. 8 JUSTINE HARTLEY: And sorry, could I 9 just add to that? I would say there was an 10 acknowledgment that the stockpile did need to be 11 rebuilt, but that in order to do that, we needed to 12 undertake the policy review to ensure that we were 13 creating a stockpile that was sustainable and 14 cost-effective. 15 JOHN CALLAGHAN: So you are trying to 16 put the policy in place before you acquire a new 17 stockpile; is that correct? 18 JUSTINE HARTLEY: Absolutely. 19 COMMISSIONER FRANK MARROCCO (CHAIR): 20 And just to carry on, and, Ms. Bauman, 21 you came up with a policy which was basically to 22 keep track of when the PPE is expiring and to use 23 it before it expires, to house it in a way that 24 allows you to identify equipment that's getting 25 close to expiry so that you can use it?

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1 JESSICA BAUMAN: So what I had come up 2 with by the end of 2020 was a series of thoughts 3 and observations and early recommendations based on 4 the desk analysis that had happened and the review 5 that we had done. 6 However, there was an acknowledgment as 7 well that we still needed to do a little bit more 8 research before making formal recommendations as to 9 how a stockpile should be managed. 10 JOHN CALLAGHAN: And can we -- why 11 don't we do that. Let me finish the next couple of 12 documents and then let's go and I think, Ms. 13 Bauman, I am going to need some help from you as to 14 what the best document will be to illustrate the 15 work you did and where you think the best -- 16 because the Commissioners have an obligation to 17 provide recommendations, and they might as well 18 hear the hard work that you did and the thoughts 19 you did. 20 So if we go down to the bottom of page 21 1 of this document, just to continue and let's 22 finish this, and it won't be very long, so I just 23 want to point out: 24 "The Ministry is responsible 25 for ongoing public health emergency

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1 preparedness. It maintains an 2 emergency stockpile of medical 3 equipment and supplies that may be 4 needed in a health emergency." 5 So to the extent Cabinet at the 6 point -- there would be no doubt in your mind that 7 Cabinet was directly told about the need to have 8 supplies for the purpose of emergency? 9 JESSICA BAUMAN: That's correct. 10 JOHN CALLAGHAN: I mean, that was the 11 intention of your memo and the note? 12 JESSICA BAUMAN: The purpose of this 13 note was actually to report back on what our 14 destruction activities had been to date, but that 15 is noted here about the need to ensure that we do 16 have a stockpile. 17 JOHN CALLAGHAN: If we could just go to 18 document 10, and this is a Q&A and I am afraid -- 19 well, there, so does this accompany that 20 submission? It seems to be dated June of 2018. 21 Does that accompany the submission to Cabinet, or 22 is this in case the Ministers asked? 23 JESSICA BAUMAN: It accompanies the 24 submission. 25 JOHN CALLAGHAN: All right, so let's

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1 just go to number 2 just at the bottom there, and 2 so it says: 3 "Most of the ministry's supply 4 and equipment stockpile is expired." 5 So this is June of 2019. Do you see 6 that in the note there? Do you see that right 7 there? 8 JESSICA BAUMAN: Yes. 9 JOHN CALLAGHAN: Okay: 10 "This includes PPE, such as 11 surgical masks, N95 respirators, 12 isolation gowns, hair covers, eye 13 goggles, coveralls, powered-air 14 purifying respirators, boot covers, 15 aprons, and disposable scrubs; and 16 mass immunization supplies and 17 equipment, such as safety-engineered 18 needles, syringes, sharps 19 containers, absorbant balls and 20 bandages." 21 So I take it that by June of 2019, 22 those supplies have expired but you had other 23 supplies, the remaining 10 percent or 20 percent by 24 this time that were around that weren't these types 25 of supplies; correct?

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1 JESSICA BAUMAN: That is correct, 2 sorry, with one caveat being that some of the 3 supplies that are noted as being expired, there 4 were still some of those ones that were unexpired, 5 but there was generally a holding of various PPE 6 items that were unexpired. 7 JOHN CALLAGHAN: Okay, so can we just 8 go to this is a slide deck number 12, December 9 2019. I don't know, Ms. Bauman, if this is a good 10 place for you to provide your explanations, but 11 this is an update on the stockpile review, which I 12 take it you were continuing to do, right? 13 JESSICA BAUMAN: Yes, that's correct. 14 JOHN CALLAGHAN: And then if you go to 15 the second page, it shows what you have been doing 16 to date and we saw some of this, and you were in 17 the midst of doing an analysis of the results and 18 identifying where further information and 19 validation was required. 20 So I take it is that to say that you, 21 Ms. Bauman, had your own recommendations but there 22 was a validation process of what you were 23 recommending? Is that how I am to take that? 24 JESSICA BAUMAN: There was that, yes, 25 and then in addition it was because of the limited

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1 results from our literature review and 2 jurisdictional scan which we felt, if we were able 3 to find more information in those areas, then we 4 would have a better understanding of what other 5 best practices have emerged in other jurisdictions 6 as well as what other possibilities might exist for 7 a stockpile. 8 JOHN CALLAGHAN: And I take it as a 9 policy person that you would make the 10 recommendation and it would get vetted by the Ms. 11 Hartleys of the world and the Assistant Deputy 12 Ministers, right? 13 JESSICA BAUMAN: That's correct. 14 JOHN CALLAGHAN: This is a step in the 15 process. 16 JESSICA BAUMAN: That's correct. 17 JOHN CALLAGHAN: And again, I am using 18 this because it seemed to be the best document that 19 I found and the latest that allows us to understand 20 your findings, but if you could just -- do you 21 remember this slide deck? 22 JESSICA BAUMAN: I do. 23 JOHN CALLAGHAN: Okay, "Key findings", 24 which is the next slide, could you just explain to 25 the Commissioners what your findings were and --

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1 JESSICA BAUMAN: Yes. Apologies, John, 2 did you have something else? 3 JOHN CALLAGHAN: Well, I am just trying 4 to -- well, I'll take you through it. Let me do 5 that. 6 So your key findings are that: 7 "Many issues experienced by the 8 current stockpile stem from a lack 9 of defined intent and outcomes for 10 the stockpile." 11 What did you mean by that? 12 JESSICA BAUMAN: So this is an overview 13 of what was discovered during the current state 14 analysis, so the details are in that desk analysis 15 review document. 16 JOHN CALLAGHAN: Okay. 17 JESSICA BAUMAN: So those issues 18 include things as mentioned such as a lack of 19 ongoing management of the stockpile, criteria to 20 guide those purchases, et cetera. 21 JOHN CALLAGHAN: Okay. 22 JESSICA BAUMAN: As well as -- and I 23 apologize, I'll just point out too as well as the 24 lack of an official and formal policy to guide the 25 stockpile program as a whole.

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1 JOHN CALLAGHAN: And was there a 2 discussion about whether the requirement of a 3 stockpile from the government side should be 4 legislated? I mean, you had mentioned that -- Ms. 5 Hartley had mentioned there is no legislative 6 requirement. It sort of comes up through -- 7 JESSICA BAUMAN: It was under 8 consideration as part of this review and what 9 recommendations might stem from that. 10 JOHN CALLAGHAN: And similarly, was it 11 only a consideration of the provincial stockpile or 12 was there consideration given as to requirements of 13 the health sector? I mean, we saw that there was 14 the tip about four weeks. Was there some 15 consideration on that side of it? 16 JESSICA BAUMAN: Yes, the intention of 17 the review was to look fully at the stockpile 18 program as a whole, which would have included what 19 does that mean for the Ministry's recommendations 20 or other supporting aspects regarding local 21 stockpiling. 22 JOHN CALLAGHAN: Okay, and is there a 23 view as to whether there should be one large 24 provincial stockpile as opposed to regional 25 stockpiles?

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1 JESSICA BAUMAN: At this point in time, 2 there was not a concrete view in that regard. We 3 were seeing evidence of both ideas working 4 depending on the structure of the system. 5 So when we went to some jurisdictions, 6 they had regionally distributed stockpiles and they 7 found that that system worked best, and in others 8 they had centralized stockpiles and they found that 9 that worked best. 10 JOHN CALLAGHAN: And were you of a 11 view -- and again, I don't want to put you on the 12 spot, but in terms of your findings were you of a 13 view as to how Ontario should be best able to 14 manage its stockpile? 15 JESSICA BAUMAN: Yes, I believe I noted 16 a view -- sorry, I'm just looking for it right now 17 in the deck itself. 18 JOHN CALLAGHAN: Michael, can you turn 19 up the eighth page of the deck. It may be, and I 20 don't know, but this is your general observations, 21 because I appreciate there are others that had some 22 input to come. So you have "Emerging findings for 23 Ontario's consideration." 24 JESSICA BAUMAN: Yes, so at the time 25 what I had looked at, I was indicating that it

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1 would likely require a combination of decentralized 2 and centralized, especially dependent on what was 3 being recommended or whatever other mechanisms were 4 in place to guide that stockpile program. 5 Thinking in regard to if we are looking 6 at a broader stockpile program, do local stockpiles 7 count as a regionalization of a broader stockpile 8 program of which local stockpiles and provincial 9 stockpiles would be components thereof. 10 JOHN CALLAGHAN: And just on that 11 basis, so we have the health sector as a whole. I 12 take it the institutional sides like hospitals are 13 required -- I mean, the idea would be they have 14 their own four-week supply, right, that they would 15 not count as part of the provincial stockpile; 16 correct? 17 JESSICA BAUMAN: That's correct, they 18 wouldn't be part of the provincial stockpile. We 19 were looking broader, though, in terms of if we are 20 talking about a stockpiling strategy for the 21 Province of Ontario, what does that mean in terms 22 of the health sector as a whole. 23 JOHN CALLAGHAN: I see. 24 JESSICA BAUMAN: But the provincial 25 stockpile in and of itself would be one component

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1 of that and its own component. 2 JOHN CALLAGHAN: And was there a 3 discussion about having the Ontario Health Regions 4 that are in the midst of being created to have 5 their own stockpile, or again, was it supposed to 6 be a centralized provincial stockpile? 7 JESSICA BAUMAN: That was definitely 8 under consideration, given the creation of Ontario 9 Health. 10 JOHN CALLAGHAN: Okay, but that is yet 11 to be decided; correct? 12 JESSICA BAUMAN: That's correct. 13 JOHN CALLAGHAN: If we could just go to 14 slide 9, I think this may -- and I am assuming, 15 given that you have said things stopped because of 16 COVID, that this is kind of where everything is at 17 in terms of the need to continue to develop a 18 policy to guide the modernized stockpile strategy, 19 and then you list a couple of elements, and then 20 the actual development of the program. Those are 21 the two steps that you see were still yet to be 22 done that I take it from what you have said have 23 been stalled -- or not stalled, I shouldn't say 24 that, but have been put on hold while we deal with 25 COVID; is that correct?

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1 JESSICA BAUMAN: Yes, that's correct. 2 JOHN CALLAGHAN: Okay, and then if we 3 could go over to the next -- or not the next slide, 4 but the slide after that, and then again, I don't 5 mean to put you on the spot but this is your best 6 guess as to where things might go because you are 7 very clear where you say "likely type of 8 recommendations". This is you saying that we 9 should be prepared for these types of 10 recommendations that might come, right? 11 JESSICA BAUMAN: Yes. 12 JOHN CALLAGHAN: Right, and then you 13 are saying: 14 "[...] establishment a 15 stockpile policy with clearly 16 defined goals [...] 17 [...] a decentralized regional 18 stockpiling structure, supported by 19 limited provincial-level 20 stockpiling, both of which are 21 guided by ministry direction." 22 So the idea was it would stay within 23 the Ministry and not be off-loaded somewhere else; 24 that is the current -- or that was your thinking? 25 I don't want to put anybody else's.

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1 JESSICA BAUMAN: At the time that was 2 my thinking, yes. 3 JOHN CALLAGHAN: And we'll hear more 4 about this later: 5 "Establish a stockpile program 6 with cabinet support, funding, 7 responsibilities and performance 8 measures." 9 So that there would actually be funds 10 to complete the stockpile; correct? 11 JESSICA BAUMAN: To complete and 12 continue the management of the stockpile. 13 JOHN CALLAGHAN: And it says: 14 "Stockpile for all-hazards 15 using multi-hazard products for the 16 purposes of consequence management." 17 Was there a filing by you at least that 18 the stockpile was narrowly focussed on influenza 19 and that there could be a broader view to the 20 emergency stockpile? 21 JESSICA BAUMAN: Yes, my desk analysis 22 goes into a bit more detail on that, but mainly 23 that it was -- at that point in time with the Ebola 24 components that had been purchased as well, it was 25 generally speaking infectious disease-focussed, but

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1 yes, there was a heavy, especially given the 2 historical creation of the stockpile, on influenza 3 as well. 4 JOHN CALLAGHAN: And just because of 5 the time constraints, I am trying to do it this 6 way, but you should be aware that the Commissioners 7 have been given your memo and so they will read it. 8 So feel free to keep on mentioning it. If you need 9 to refer back to it, we are happy to pull it. I am 10 not trying to not show you that. It is just that 11 we are kind of overtime as it is, and I wanted to 12 finish this off. 13 If we could just follow down the slide 14 then, you recommend -- the next slide, please. You 15 recommend a subject matter expert group to inform 16 stockpile inventory decisions and to review 17 inventory regularly. Is this kind of like the one 18 that was sunsetted back in 2006? Is that the same 19 kind of idea? 20 JESSICA BAUMAN: Yes, it is the same 21 idea. 22 JOHN CALLAGHAN: And there has been no 23 decision on that yet, I gather? 24 JESSICA BAUMAN: No, there has not 25 been.

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1 JOHN CALLAGHAN: And then: 2 "Include criteria for what to 3 purchase and when to purchase to 4 ensure good life-cycle management." 5 That is the point you are talking 6 about, let's not let it expire again? 7 JESSICA BAUMAN: Yes, that's correct. 8 JOHN CALLAGHAN: And I suppose there is 9 stuff that can't be used every day that might, but 10 okay. 11 "Align stockpile contracts with 12 broader system contracts to increase 13 product use and minimize costs where 14 possible." 15 What is that? Is that a larger 16 strategy? 17 JESSICA BAUMAN: Yes, that would be 18 looking at a larger strategy, essentially saying 19 that we should be purchasing the products that are 20 in use in the system and also taking advantage of 21 potentially those contracts when possible -- 22 JOHN CALLAGHAN: Okay. 23 JESSICA BAUMAN: -- to ensure that the 24 products that we are purchasing are the ones that 25 are regularly used and that health care workers are

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1 familiar with, and then also for the cost 2 implications that could result from that. 3 JOHN CALLAGHAN: And I appreciate this 4 is not a government policy, but was your idea that 5 this broader system would purchase product that 6 then would in turn be purchased say by hospitals? 7 Like surgical masks is a perfect example. So we 8 know they are going to expire at some time, but 9 they would sit in the stockpile and then would be 10 sold off to the hospital or given or however, 11 whatever that economic transfer is, and then you 12 would be able to replace them. Was that the idea 13 or was your idea that there would be one central 14 agency purchasing for everybody, or had you got 15 that far? 16 JESSICA BAUMAN: Had I have gone that 17 far, I would say that both of those were under 18 consideration. Both of those were ideas that were 19 forming with some of these initial thoughts. 20 JOHN CALLAGHAN: And the last one is 21 warehousing and then I guess sort of tracking, 22 like, you know, as an ordinary business person; is 23 that the idea, the last two? 24 JESSICA BAUMAN: Yes. 25 JOHN CALLAGHAN: So I think, Michael,

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1 could you put up the slide deck. I just want to 2 make sure. Those are the documents I think we were 3 looking at, unless -- given the time constraint, 4 can we just go back to where Ms. Bauman was to make 5 sure that she doesn't have any more comments she 6 wants to make on her slide deck or Ms. Hartley. I 7 don't know. I can't say where we -- I can't 8 remember where we are. I think we were at slide 12 9 myself, but I think we were just finishing that. 10 JESSICA BAUMAN: We have covered slide 11 11 and 12 in our conversation to this point. 12 JOHN CALLAGHAN: Okay, so what about 13 13? Is there something more you want to say on 13? 14 I fear I have covered a lot of this, but -- 15 JUSTINE HARTLEY: Yes, I believe we 16 have covered the items on slide 13 as well. 17 JOHN CALLAGHAN: Okay. And then 14, 18 and I did the December 2019, which was your ideas, 19 Ms. Bauman. So I wonder if someone could explain 20 slide 14 and the Supply Chain Management Act, et 21 cetera. 22 JUSTINE HARTLEY: Yes, absolutely, and 23 I feel that we have spoken to many of these things, 24 but certainly there is acknowledgment that we do 25 need a stockpile and that we are in the process of

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1 determining how best to rebuild that stockpile. 2 And for us to do that, we certainly needed to 3 finish that policy review to ensure that we would 4 build something that was sustainable and 5 cost-effective and built on the principles of today 6 and certainly reflected our current health system 7 configuration so that we wouldn't end up in five 8 years in the same position that we are currently 9 in. 10 As we were hoping to wrap up that 11 policy review work, we were certainly aware that 12 there were some other policy components and some 13 other initiatives that had been started within the 14 government, and one of those was the establishment 15 of the Supply Chain Management Act. And certainly 16 I know that is still quite early in its stage of 17 development, but that would be something that we 18 would be looking at to see how our policy 19 recommendations would align with the work that was 20 going on with Supply Ontario. 21 JOHN CALLAGHAN: Could you explain for 22 the Commissioners the intention behind Supply Chain 23 Management Act, where it's at and how it might 24 relate to the stockpile? 25 JUSTINE HARTLEY: I'm afraid I don't

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1 have that information as to where it is. I do know 2 that that work has been taken up fairly recently 3 within the last few months to really move the 4 establishment of that agency forward, but I am not 5 familiar with the details as to the status of that. 6 JOHN CALLAGHAN: And in terms of the 7 stockpile, leaving aside the agency that is being 8 set up under the Act, are you aware how the future 9 stockpile might relate to that? Is that something 10 you are able to comment on, or is there -- 11 JUSTINE HARTLEY: I am not aware, and I 12 am not sure that they have gotten to that point 13 yet. 14 JOHN CALLAGHAN: I see, okay. 15 COMMISSIONER ANGELA COKE: Can I just 16 ask a question, John? 17 JOHN CALLAGHAN: Yes, absolutely, 18 please interrupt. 19 COMMISSIONER ANGELA COKE: So you are 20 obviously continuing with your policy work, but is 21 that policy going to inform the operations in this 22 new agency? 23 JUSTINE HARTLEY: So we haven't been 24 able to continue our policy work yet, but certainly 25 we hope to do that as soon as we can, we can

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1 support that work as we are supporting the 2 response. But there will be alignments with the 3 work that Supply Ontario is doing with the Ministry 4 of Health stockpile. 5 COMMISSIONER ANGELA COKE: Okay, 6 because I am just saying that this obviously sounds 7 like some operational agency, and they will have to 8 be operating under some policy framework. And so I 9 am just trying to understand the connection, if you 10 are providing the policy framework under which they 11 are going to operate, the operations of that 12 agency, or are they going to have their own, you 13 know, policies, directives, whatever, in terms of 14 how they operate? 15 JUSTINE HARTLEY: Yes, they will have 16 their own, and the policy framework is being 17 established through Cabinet Office. 18 COMMISSIONER ANGELA COKE: Okay, so 19 your work will have to dovetail with theirs in some 20 manner at some point? 21 JUSTINE HARTLEY: Correct. 22 COMMISSIONER ANGELA COKE: Okay, thank 23 you. 24 JOHN CALLAGHAN: I have nothing 25 further, Chair.

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1 COMMISSIONER FRANK MARROCCO (CHAIR): 2 Well, I should say and repeat what I 3 said at the outset. If it occurs to you after this 4 that there is some clarification, then please send 5 it along to us and send it along to John, and he'll 6 make sure that we all see the clarification, or if 7 there is something you didn't cover inadvertently, 8 just let us know what it is and what you wanted to 9 say about it. 10 But thank you all very much for the 11 participation and for answering the questions, some 12 of the questions that we have had about PPE. It 13 has been very helpful. 14 JOHN CALLAGHAN: Thank you. 15 JESSICA BAUMAN: Thank you very much, 16 Commissioners. 17 COMMISSIONER JACK KITTS: Yes, thank 18 you very much. 19 COMMISSIONER ANGELA COKE: Thank you. 20

21

22 -- Adjourned at 12:10 p.m. 23

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1 REPORTER'S CERTIFICATE 2

3 I, DEANA SANTEDICOLA, RPR, CRR, 4 CSR, Certified Shorthand Reporter, certify: 5 That the foregoing proceedings were 6 taken before me at the time and place therein set 7 forth; 8 That all remarks made at the time 9 were recorded stenographically by me and were 10 thereafter transcribed; 11 That the foregoing is a true and 12 correct transcript of my shorthand notes so taken. 13

14

15

16 Dated this 7th day of January, 2021. 17

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21 ______22 NEESONS, A VERITEXT COMPANY 23 PER: DEANA SANTEDICOLA, RPR, CRR, CSR 24

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1 CLARIFICATIONS 2

3 PAGE/LINE COMMENT 4 18/24-25 After "Treasury Board" the word 5 "submission" is missing. 6

7 19/2 The word "placed" should be removed - 8 it was not used. 9

10 20/24 Missing word - the line "We did see 11 with H1N1 did not" should read "We did 12 see with H1N1 that it did not" 13

14 45/18 John says "the tip of two weeks of 15 PPE" - the "tip" from the document 16 being referenced is actually 4 weeks. 17

18 64/16 Justine is quoted as saying 2003 but 19 it was actually 2013 20

21 97/16 Typo - should be "by the end of 2019" 22

23 103/2 Should be "by the end of 2019" not 24 2020 25

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1 CLARIFICATIONS 2 (Cont'd) 3

4 PAGE/LINE COMMENT 5 117/16 Missing words - should say "I had not 6 gotten that far" not "Had I have gone 7 that far" 8

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WORD INDEX 2003 36:11 80:3 81:1, 15 57:4, 21 58:19, accompanies 64:16 124:18 88:8 91:10, 11, 25 104:23 < $ > 2006 5:13, 15 14, 24 93:5 55 62:13 accompany $10 28:22 9:5, 21 11:8 97:14, 16 98:5, 104:19, 21 $14 28:14 12:8 13:23 6 105:5, 21 < 6 > account 42:16 $24 28:17 14:14 16:15 106:9 118:18 6 52:3, 13 $3 28:22 18:21 20:23 124:21, 23 58:15 65:3 acknowledgment $8 28:17 26:2 30:12 2020 7:16 87:21 102:10 103:6 $800 19:9 37:16 45:19, 22 22:11, 12 33:7 64/16 124:18 118:24 52:8, 14 53:6, 8 66:4 88:8, 11, acquire 13:7 < 1 > 54:16 55:6, 10 15 91:9 103:2 < 7 > 14:2 102:16 1 11:4, 21 59:10 60:19 124:24 7 81:4 83:13 acquired 10:16 26:16 41:10 62:6 68:24 2021 1:16 73,000 18:13 act 11:15 35:8, 57:3, 20 85:19 69:1 74:4 123:16 27:16 12, 20 36:15 93:14 103:21 76:10 82:16 22nd 91:10 7th 1:15 123:16 64:9 118:20 1,718,000 70:11 94:5 115:18 24 70:21, 22 119:15, 23 120:8 10 29:8 81:20, 2007 45:16 25 26:19, 25 < 8 > Acting 2:10 25 82:6 98:6 50:11, 17 60:4 54:17 70:24 8 22:18 90:24 7:11, 15 104:18 105:23 2008 60:4 62:6 25th 98:5, 10 96:24 action 39:9 10:00 1:16 4:1 2008-2009 62:12 28 69:25 80 51:15 81:21 activities 10:2, 103/2 124:23 2009 9:11 82:11, 19 92:13 3 104:14 11 70:9 98:1 62:22 71:14 < 3 > 97:7 101:17 Acts 40:16 118:11 2009-2010 62:15 3 13:21 25:4 800 28:8 actual 19:12 11.9 62:19 2010 62:20, 22 29:8 45:15 84 59:22 60:1, 112:20 11:30 1:16 2011 7:21, 25 51:5 85:24 10 61:9 62:8 acute 41:21 117/16 125:5 55:6 3,000 88:1, 3 85 81:16 add 62:23 12 11:7 106:8 2012 7:21 20:20 3.1 72:20 102:9 118:8, 11 2013 14:14, 17 3.9 62:19 < 9 > addition 23:10 12:10 122:22 37:13, 15, 19 331,000 70:20, 9 61:21, 23 50:25 80:4 13 24:25 26:20 45:19 65:10 21 112:14 106:25 44:20 69:16 68:9 69:10, 11 35 53:10 90 81:16 97:13 additional 5:3 71:7 118:13, 16 71:2 124:19 36,545,000 70:12 900 87:25 18:13, 15, 17 134 26:21 2014 65:17 94 26:17 61:7 27:17 39:22 14 27:12 71:14, 15 72:21, < 4 > 70:14, 16 47:9 62:15 63:3 118:17, 20 22 74:4 76:10 4 25:13 34:18, 97/16 124:21 address 94:20 15 37:13 62:18 2015 8:8 19, 23 86:16 adequate 26:13 16 77:1 2015-2016 63:8 124:16 < A > 31:4 76:1 17 37:23 2016 79:20, 22 4,865,230 71:1 a.m 1:16 4:1 Adjourned 170 29:2, 6, 24 80:3, 4, 22 4.6 77:23 ability 16:16 122:22 59:11, 17 61:2, 9 2017 79:23 41 28:20 72:10 93:25 ADM 65:14, 21 18,000 18:16, 22 80:22 81:23 42 26:18 absolutely 5:13 66:23 27:17 82:11, 16, 18 45/18 124:14 7:3 9:2 65:6 Adriana 3:10 18/24-25 124:4 84:16 85:9 480,000 76:2 77:19 102:18 advance 5:18 19 42:4 87:25 90:25 480,000-plus 118:22 120:17 6:2 19/2 124:7 91:7 92:4, 10, 76:17 absorbant advantage 20 97:13 98:17 49,546,000 71:2 105:19 49:20, 22 116:20 < 2 > 99:23 101:12 accepted 39:14 advice 11:11, 2 14:12 18:15 2018 8:9 65:18 < 5 > access 38:1, 7, 15 38:13 53:7 26:24 27:16 66:4 80:24 5 16:7 34:23 14 43:14 56:4 advise 99:22 42:15 62:3 92:20 104:20 45:9 62:14 73:18 78:24 advises 73:24 67:7 85:25 2019 17:21 63:14 67:1 86:24 affect 20:18 93:21 105:1 18:2 20:20 68:20 accessible 56:6 21:9 46:22 20 105:23 21:11 30:9 50 51:16 53:11 accommodated afraid 104:18 20/24 124:10 33:6 51:22 54:22 56:9 73:13 119:25 55:12 79:21

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neesonsreporting.com 416.413.7755 Long Term Care Covid-19 Commission Mtg. Meeting with MS. Hartley and Ms. Bauman on 1/7/2021 4

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neesonsreporting.com 416.413.7755 Long Term Care Covid-19 Commission Mtg. Meeting with MS. Hartley and Ms. Bauman on 1/7/2021 5

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neesonsreporting.com 416.413.7755 Long Term Care Covid-19 Commission Mtg. Meeting with MS. Hartley and Ms. Bauman on 1/7/2021 6

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neesonsreporting.com 416.413.7755 Long Term Care Covid-19 Commission Mtg. Meeting with MS. Hartley and Ms. Bauman on 1/7/2021 7

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neesonsreporting.com 416.413.7755 Long Term Care Covid-19 Commission Mtg. Meeting with MS. Hartley and Ms. Bauman on 1/7/2021 8

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neesonsreporting.com 416.413.7755 Long Term Care Covid-19 Commission Mtg. Meeting with MS. Hartley and Ms. Bauman on 1/7/2021 9

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neesonsreporting.com 416.413.7755 Long Term Care Covid-19 Commission Mtg. Meeting with MS. Hartley and Ms. Bauman on 1/7/2021 10

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neesonsreporting.com 416.413.7755 Long Term Care Covid-19 Commission Mtg. Meeting with MS. Hartley and Ms. Bauman on 1/7/2021 11

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neesonsreporting.com 416.413.7755 Long Term Care Covid-19 Commission Mtg. Meeting with MS. Hartley and Ms. Bauman on 1/7/2021 12

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neesonsreporting.com 416.413.7755 Long Term Care Covid-19 Commission Mtg. Meeting with MS. Hartley and Ms. Bauman on 1/7/2021 13

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neesonsreporting.com 416.413.7755 Long Term Care Covid-19 Commission Mtg. Meeting with MS. Hartley and Ms. Bauman on 1/7/2021 14

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neesonsreporting.com 416.413.7755 Long Term Care Covid-19 Commission Mtg. Meeting with MS. Hartley and Ms. Bauman on 1/7/2021 15

sheet 6:21 52:18 spent 60:6, 11, 14:24 15:8 111:6, 8, 9 shelf 81:13 slowing 6:8 16 16:9 23:11, 15, stockpile's 63:5 shifted 9:6 small 15:4 splashes 54:8 21 24:5 25:17, stockpiling 10:3 shortage 89:22 smaller 42:19 spoke 64:8 20, 21, 24 26:5, 16:19 20:2, 20 shortages 89:9 62:22 63:6 77:21 10, 15 29:16, 19, 23:19 48:17 Shorthand Smith 3:16 6:1, spoken 118:23 24 30:1, 7 35:4, 109:21 111:20 123:4, 12 11, 14 spot 110:12 17, 19 36:3 113:18, 20 shoulders 24:4 SOC 2:13 113:5 42:12, 15 43:15 stocks 49:3 show 52:13 society 27:21 sprays 54:8 49:5 51:17, 22 stop 84:24 69:18 97:24 sold 117:10 staff 48:21 52:21, 22 53:16 stopgap 16:2 115:10 solely 66:18 49:25 50:1, 6 59:22, 25 60:2 24:1 showed 83:14 somebody 4:14 54:7, 18, 19 62:1, 5, 20, 23 stopped 112:15 shows 51:5 41:17 67:25 57:3, 20 63:21, 23, 25 stopping 49:11 106:15 soon 120:25 stage 119:16 64:15 66:10 storage 92:14 sickness 19:12 sorry 7:4 34:18 stakeholders 67:12 68:17, 18 store 79:24 side 82:6 36:10 39:21 23:24 69:20, 25 70:5, 92:12 109:3, 15 42:6 43:24 stalled 112:23 10 71:24 72:5, strain 17:6 sides 111:12 55:2 57:6 standard 39:10 11 73:25 76:3, strains 46:11 sight 64:14 61:19 64:21 start 4:21 21:1 24 77:12 79:19 strategic 94:18 65:19 65:22 68:5, 10 80:20 91:4 80:1, 6, 7, 10, 14, strategies 33:18 significant 80:3 81:24 started 7:24 17 81:9, 11, 21 strategy 13:5 32:16 34:2, 8 91:9 92:5 96:6, 8:7 80:2 119:13 82:11, 16 83:15, 80:7, 8, 10 50:18 61:18, 25 22 97:21 state 30:13 17, 23, 24 84:2, 94:11 95:14 73:15 100:13 101:9 51:22 68:17 9 86:2, 5, 12, 14, 96:3 111:20 similarly 109:10 102:8 106:2 74:24 80:11, 15, 16, 19, 20 87:3, 112:18 116:16, simple 57:19 110:16 16 84:7 108:13 8, 18 90:10, 13, 18 sit 117:9 sort 65:4 stated 35:12 16 91:5, 22 strengthening sites 50:24 101:23 109:6 41:9 47:13 92:13, 16 93:13 14:7 sits 84:25 85:3 117:21 statement 34:6 94:3, 11, 13 strong 21:7 situation 22:9, sorts 57:9 74:23 95:11, 15, 18 structure 52:6 10 32:3 34:5 sought-after states 35:2 96:2, 13 97:7 110:4 113:18 90:3 20:14 56:1 98:15, 20 99:24 studies 28:15, situations 94:15 sounds 36:24 static 83:17 100:1, 3 102:10, 18 sizes 38:8 121:6 statistically 17:2 13, 17 103:9 stuff 83:24 42:19 source 17:3 status 120:5 104:2, 16 105:4 87:24 116:9 skills 38:3 75:8 stay 113:22 106:11 107:7 subcommittee skin 75:10 speak 45:23 stem 108:8 108:8, 10, 19, 25 85:4 skipped 63:16 52:17 69:1 109:9 109:3, 11, 17, 24 subject 72:15 slide 8:25 9:18 93:2 101:4 Stenographer/Tra 110:14 111:4, 6, 87:16 115:15 18:8 25:1 27:2, speaking 76:21 nscriptionist 7, 15, 18, 25 submission 6 34:13, 18, 19, 78:12 79:18 3:23 112:5, 6, 18 11:7 15:7, 24 24 35:2, 14, 15 114:25 stenographically 113:15 114:5, 22:20 29:12 52:1, 3, 14 54:9 speaks 68:11 123:9 10, 12, 14, 18, 20 59:23, 25 67:20, 55:16 60:13 Special 2:13 step 79:11 115:2, 16 22 68:7, 16 61:15, 21 64:17, specific 54:25 107:14 116:11 117:9 69:8 70:13 24 65:3 66:9 56:13 62:23 steps 112:21 118:25 119:1, 71:10, 11, 18, 19 67:1 68:20 63:7 76:23 stock 30:10 24 120:7, 9 78:14 84:18, 19 69:16, 17, 18 89:10 47:16 48:1 121:4 86:7, 10 104:20, 106:8 107:21, specifically 82:17 stockpiles 21, 24 124:5 24 112:14 15:2 45:9, 23 stockpile 4:25 22:24 23:17 submissions 113:3, 4 115:13, 54:13 55:18 5:11 6:23 7:13, 26:11 49:8 84:17 85:6 14 118:1, 6, 8, 68:12 78:12 19, 21, 24 8:9, 50:20, 24 51:5, Substantiation 10, 16, 20 80:16 85:5 14 9:3, 9, 13, 21, 11 53:5 74:15 16:23 slides 34:13 92:10 100:15 25 10:14, 17, 21 109:25 110:6, 8 success 69:21 spectrum 46:15 12:4, 8 13:8, 17

neesonsreporting.com 416.413.7755 Long Term Care Covid-19 Commission Mtg. Meeting with MS. Hartley and Ms. Bauman on 1/7/2021 16

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neesonsreporting.com 416.413.7755 Long Term Care Covid-19 Commission Mtg. Meeting with MS. Hartley and Ms. Bauman on 1/7/2021 17

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neesonsreporting.com 416.413.7755