Ford’s choice of ‘Dr. Dirk’ sparks criticism
Coroner whose office was the subject of a scathing report now holds key public health role
While taking questions from reporters at Queen’s Park last week, Premier Doug Ford paused to praise the newly minted leader of the province’s COVID-19 outbreak response standing by his side, calling him “Dr. Dirk.”
“I think everyone needs to listen to the doc,” Ford said of Ontario’s Chief Coroner Dr. Dirk Huyer. “He’s a champion.”
Ford is saying little about criticism of his decision to vault Huyer, who acknowledged at that same press conference that he is not a public health expert, to the front lines of the province’s pandemic response, less than a year after Ontario’s auditor general identified serious problems in the coroner’s office.
The cascade of failures found by the auditor included a lack of oversight and inadequate analysis of available mortality data. The Office of the Chief Coroner and Ontario Forensic Pathology Service “misses the opportunity to make more effective use of its death investigation data to identify actions to improve public safety and reduce preventable deaths,” auditor general Bonnie Lysyk concluded in her December 2019 report.
In a statement on Friday, a spokesperson for Ford said Huyer, who was previously appointed in May to lead the province’s testing approach, “has played a key leadership role in Ontario’s fight against COVID-19,” crediting him as “a driving force behind Ontario’s aggressive push to increase testing capacity.”
“Premier Ford has absolute confidence in Dr. Huyer and is incredibly grateful for the work he has done and continues to do in helping Ontario respond to COVID-19,” the spokesperson said.
The province did not address questions from the Star about how Huyer was selected for the role and the deficiencies the auditor general identified in the coroner’s office Huyer has led since 2014.
A spokesperson for the coroner’s office said “questions about Dr. Huyer’s role are best addressed by the Premier’s Office.”
NDP Leader Andrea Horwath said the government’s silence is “troubling” and speaks to an ongoing concern she has had about a “lack of transparency” during the pandemic around who is providing medical advice and influencing key policy decisions.
“It’s absolutely fair to say that there are legitimate concerns that have been raised,” she said. “People deserve information. They deserve transparency. That’s what gives people confidence.”
There are also questions about the impact Huyer’s leadership role, which includes preventing and minimizing outbreaks in schools, daycares, farms and health-care settings, could have on the impartiality of the COVID-related death investigations conducted by the coroner’s office.
Dr. Nav Persaud, a former research scientist at the Ontario coroner’s office and a former investigating coroner in Toronto, said “it is important to have some separation between the coroner’s office and other branches of government.”
This independence is “especially important in a pandemic,” Persaud said, citing investigations of COVID-related deaths of migrant farm-workers and personal support workers in long-term care homes as examples.
“The coroner’s office doesn’t assign blame but the recommendations sometimes point to gaps in public policy or gaps in procedures,” said Persaud, who is a family doctor in Toronto and Canada Research Chair in Health Justice at University of Toronto.
In response to this concern, Ford’s spokesperson said that Huyer has “delegated all responsibility for COVID-related death investigations to the Deputy Chief Coroner,” adding that “it is beyond disappointing that anyone would look to disparage someone who has served the Ontario public with integrity and skill for nearly thirty years.”
But Persaud said he is “not sure how delegating pandemicrelated investigations within the office of the chief coroner ensures independence.”
“The issue of independence ... is not about the qualifications and track record of any individual,” he added.
“It’s about the integrity of the death investigation system.”
The government’s response also does not satisfy Horwath, who said: “There doesn’t seem to be an appropriate firewall there.”
“Not to suggest that there is going to be anything nefarious, but people have to have confidence … that there’s complete accuracy, that there’s no bias, and (not) even unconscious bias, when it comes to how these death investigations occur and are separate from the policymaking when it comes to COVID-19,” she said.
In a pandemic that disproportionately impacts racialized people, Horwath is also calling for more transparency around the appointment process to ensure that the medical experts selected for leadership roles “reflect the communities they serve.”
She said it appears that “Mr. Ford, once again, has handpicked someone he feels comfortable with.”
Huyer has served as a coroner in Ontario since 1992, and has been involved in more than 5,000 coroner’s investigations.
He was appointed to chief coroner in March 2014, after serving as regional supervising coroner.
He previously worked in the Suspected Child Abuse and Neglect Program at the Hospital for Sick Children, and is an assistant professor of pediatrics at the University of Toronto.
In a press release announcing his new pandemic leadership role, the government praised his work on his office’s investigation of opioid-related deaths that helped inform prevention and response strategies.
Ford’s spokesperson said Huyer has “transitioned to help lead the province’s operational response to COVID-19 outbreaks, supported by some of the best public health advice and talent in the country.”
Dr. Mustafa Hirji, acting medical officer of health in Niagara Region, said “it’s a bit curious” that someone with Huyer’s background has been tapped to lead the province’s outbreak response.
“This would be something better suited to public health physicians to be taking on … Stopping the spread of infection in the community is the expertise of public health,” Hirji said.
Amy Greer, Canada research chair in population disease modelling and specialist in infectious disease epidemiology at the University of Guelph, appeared to echo this sentiment on Twitter this week.
“I just had lunch with my 5year old,” she tweeted. “In response to my comment that Dr. Dirk Huyer (the coroner) is coordinating outbreak response she said, ‘... if someone doesn’t know much about something you should probably not put them in charge.’ ”
Dr. Jack Stanborough, a former regional supervising coroner in the Hamilton area, has a different take.
He said the chief coroner “has a long track record of working symbiotically with public health on germane issues” and “is in a good position to recognize and monitor a surge in natural deaths and to appraise the efficacy of preventative measures.”
The auditor general’s scathing 2019 report found, among other things, that coroners investigated the deaths of former patients without declaring conflicts of interest, coroners conducted death investigations while no longer licensed to practice medicine, and questionable OHIP billing practices such as coroners billing twice for the same service.
There was no data tracking to assess whether coroners completed death investigations in a timely and high-quality way.
The report said, “Although the motto of the Office is ‘we speak for the dead to protect the living,’ we found that the Office performs limited analysis on the data it collects to identify death patterns or trends.”
The Office of the Chief Coroner and Ontario Forensic Pathology Service said it welcomed and accepted the insights and recommendations from the auditor general in an overall response included in the report. It said at the time that key improvement initiatives were already underway and detailed ways it would implement the recommendations.
In an interview with the Hamilton Spectator in 2019, Huyer said he endorsed and appreciated the recommendations in the report.
“They’ve identified things that are challenging and things that we didn’t necessarily know were there and caused us some surprise,” Huyer said. “But we are going to build better policies, procedures and approaches and evaluate the concerns that have been brought to our attention to ensure that we have a full understanding of things and move forward in a way that these sorts of things don’t continue to happen.”
Weaknesses were also identified late last year by the Death Investigation Oversight Council, an independent agency that investigates complaints against coroners and forensic pathologists and makes recommendations.
The council had been investigating a complaint against Huyer and Ontario’s chief forensic pathologist, Dr. Michael Pollanen, made by the former director of the Hamilton Regional Forensic Pathology Unit.
During the oversight council’s investigation into that complaint, Huyer and Pollanen shut down the Hamilton unit, moving the death investigations to Toronto in stages over eight months.
The decision drew fire from Hamilton Mayor Fred Eisenberger and Horwath, the Hamilton Centre MPP, who appealed without success to the solicitor general to halt the closure until the council’s investigation was complete.
The council’s recommendations, which were obtained by the Spectator but not released publicly, included further leadership and management training for “all staff holding management positions,” including Huyer and Pollanen.
Neither Huyer nor the province responded to a question from the Star about whether he has completed the recommended training.
Huyer first took on a key leadership role in Ontario’s pandemic response in May, when he was tapped to lead the province’s testing approach.
Ford’s spokesperson credits Huyer with expanding testing capacity from 3,000 tests to as many as 35,000 a day in a matter of months, “making Ontario a global leader in testing.”
As the surge in demand for testing leads to hours-long waits at some assessment centres, straining hospitals and labs, Colin Furness, an infection control epidemiologist with the University of Toronto, said the unadulterated praise of the testing system Huyer has led is not warranted.
“On one hand, we’ve heroically increased our testing capacity,” Furness said. “On the other hand, our testing strategy is completely flawed .... We don’t have nearly the capacity we need.”