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May 8, 2004. 01:00 AM

TB inquest angers groups
Coalition vows to challenge recommendations in court

Jury wants government to set up centralized clinic system

PETER SMALL
STAFF REPORTER

A coalition of health clinics and anti-poverty advocates vows to challenge
recommendations made at an inquest into the tuberculosis death of a homeless
man, saying they don't go far enough.

"With all due respect to the jury, they were denied a lot of options and
evidence that would have really protected the living," said Cathy Crowe, a
nurse and member of the Tuberculosis Action Group. "The results here are not
going to protect people from tuberculosis. It's very, very, very upsetting
to us."

The jury hearing evidence into the 2001 death of Joseph Teigesser released
13 recommendations yesterday after an inquest that began last November.

Lawyer Peter Rosenthal said the group was limited in the evidence it could
call from housing and street-health experts to fully examine the underlying
causes of Teigesser's death.

Nor could the jury tour a homeless drop-in or shelter to witness
overcrowding, something the group had suggested, Crowe said.

In addition, presiding coroner Dr. James Edwards' instructions and the
suggestions made by his counsel, David Carruthers, to jurors were so
limiting as to constrict their recommendations, Rosenthal said.

The group plans to ask the Divisional Court to quash the inquest results so
another inquest can be called, he said.

Teigesser died of TB at St. Michael's Hospital on Dec. 13, 2001, during a
17-month-long outbreak of 15 active cases among Toronto's homeless. Although
he stayed at several downtown homeless shelters, his disease remained
undetected and untreated until it was too late.

Crowe said she was concerned that the jury did not even adopt the primary
recommendation suggested by all parties with standing, including the
coroner's counsel: that the provincial and federal governments fund an
affordable social-housing strategy to end homelessness.

Also conspicuous by its absence was another of the 25 recommendations
jointly suggested by all parties: that the province increase welfare rates
to "liveable levels," she said.

In an interview, Carruthers said he did not wish to comment in detail
because he had not heard the criticisms. He said it is the group's right to
challenge the inquest's outcome in court. Edwards declined to comment,
except through Carruthers.

"Everyone had a complete opportunity to make complete submissions on every
single point," Carruthers said. "(The group) was entitled to call several
witnesses."

Carruthers praised the jurors' recommendations, noting that they recognized
there was a "fundamental need for increased resources to the entire
infrastructure of public health."

The recommendations include:

The Ministry of Health and Long-Term Care should establish a centralized
clinic system for the management of tuberculosis that is 100 per cent
provincially funded.

Ontario is the only province with a decentralized system for fighting TB.

The province should require all shelter and homeless drop-in workers be
screened for TB before being hired and then on an annual basis.

The province should provide adequate funding to all local public-health
units so they can offer sufficient TB prevention, detection and treatment.

The health ministry should convene a committee of experts to review
ventilation systems in shelters to ensure they meet or exceed standards.

Dr. Michael Gardam, director of infection control at the University Health
Network, welcomed the recommendations. "I think they hit on a number of key
issues." Many of the jury's suggestions involve better organization of
existing resources, he said, adding that a centralized TB clinic system is
overdue.

Gardam, who testified at the inquest as an expert witness on ventilation,
said the jury's recommendation is important. "If you have no fresh air
coming in, you're far more likely to get transmission." He also said the
recommendation that shelter workers be screened for active TB will provide a
safeguard.

The city has 350 to 400 active cases a year, Gardam said.

Marg Mulholland, acting manager of the TB program at Toronto Public Health,
said although she couldn't say such a TB outbreak among the homeless would
never recur, her department is now able to identify cases faster, she said.

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