1 2 3 4 5 THE NORTH BATTLEFORD WATER INQUIRY 6 7 8 9 10 11 12 13 * * * * * 14 15 BEFORE: The Honourable Justice Robert D. Laing 16 17 18 HELD AT: Tropical Inn, 19 North Battleford, Saskatchewan 20 21 * * * * * 22 23 24 25 October 18, 2001

1 APPEARANCES: 2 JAMES RUSSELL, Esq. ) 3 CHRISTOPHER BOYCHUK, Esq. ) Commission Counsel 4 BLAIR BLEAKNEY, Esq. ) 5 6 WARREN E. BICKFORD ) Executive Director 7 NORM DOELL ) Registrar 8 9 L. TED PRIEL, Q.C., Esq. (np) ) The City of North 10 KEN A. STEVENSON, Q.C., Esq. ) Battleford 11 GARY D. YOUNG, Q.C., Esq. ) The Battlefords 12 MARK VANSTONE, Esq. (np) District Health 13 ROBERT McDONALD, Esq. (np) ) Association of 14 Professional Engineers 15 & Geoscientists of 16 Saskatchewan 17 MICHAEL TOCHOR ) Department of Justice 18 L. M. SCHWANN (np) ) Saskatchewan 19 M. McDONALD (np) ) Environment and 20 Resource Management 21 R. G. HISCHEBETT ) Saskatchewan Health 22 R. E. PETRICH (np) ) Saskatchewan Municipal 23 Affairs and Housing 24 T. MICHAEL McDOUGALL (np) ) Saskatchewan Water 25 Corporation

1 SCOTT HOPLEY, Esq. ) Saskatchewan 2 MS. LESLIE BELLOC-PINDER (np) Environment Society and 3 Nature Saskatchewan 4 N.G. GABRIELSON, Q.C., Esq. ) Dr. L. Gerharde Benade 5 ROCHELLE MASLIN, Ms. (np) ) Dr. David Butler-Jones 6 and Dr. Eric Young 7 R.W. MITCHELL, Q.C., Esq. ) Canadian Union of 8 SANDRA G. MITCHELL, Ms. (np) ) Public Employees, 9 Local 287 10 G.J. SCHARFSTEIN, Esq. ) On behalf of 427 11 individuals and 12 corporations affected 13 by the contaminated 14 potable water in North 15 Battleford 16 17 18 19 20 21 22 23 24 25

1 TABLE OF CONTENTS 2 Page No. 3 List of Exhibits 5 4 5 DAVID BUTLER-JONES, Resumed: 6 CONTINUED EXAMINATION-IN-CHIEF BY MR. BOYCHUK 6 7 CROSS-EXAMINATION BY MR. SCOTT HOPLEY 66 8 CROSS-EXAMINATION BY MR. ROBERT MITCHELL 117 9 CROSS-EXAMINATION BY MR. GRANT SCHARFSTEIN 122 10 CROSS-EXAMINATION BY MR. KEN STEVENSON 131 11 CROSS-EXAMINATION BY MR. GARY YOUNG 185 12 CROSS-EXAMINATION BY MR. MICHAEL TOCHOR 186 13 ERIC ROBERT YOUNG, Sworn: 14 EXAMINATION-IN-CHIEF BY MR. CHRISTOPHER BOYCHUK 190 15 CROSS-EXAMINATION BY MR. GRANT SCHARFSTEIN 257 16 CROSS-EXAMINATION BY MR. KEN STEVENSON 264 17 18 19 Court Reporter's Certificate 281 20 21 22 23 24 25

1 LIST OF EXHIBITS 2 EXHIBIT NO. DESCRIPTION PAGE 3 4 C-28 Sanitation Regulations. 82 5 C-29 Guidelines for Issuing and Rescinding 6 a Boil Water Advisory When Cryptosporidium 7 or Other Waterborne Pathogens are Suspected. 83 8 C-30 A memo dated December the 23rd, 1999 from 9 Deputy Minister Yeates to Department 10 of Finance. 142 11 C-31 Proposed program change which is otherwise 12 unsigned and not otherwise identifiable. 144 13 C-32 Document 107994. A letter dated 14 February 28, 2000, addressed to 15 Dr. Butler-Jones. 147 16 C-33 Memo dated December 29th, 1999 from 17 Acting Deputy Minister of Municipal and 18 Community Services to Finance. 150 19 20 21 22 23 24 25

1 --- Upon commencing at 9:30 a.m. 2 3 MR. COMMISSIONER: All right. Good morning 4 everyone, perhaps -- 5 MR. CHRISTOPHER BOYCHUK: Mr. Commissioner, I 6 understand the witness is not quite available. 7 MR. COMMISSIONER: Oh, that's kind of 8 important, isn't it, yeah, so we'll wait for the return of 9 the witness then. 10 11 (BRIEF PAUSE) 12 13 All right, then perhaps, Mr. Boychuk, I'll 14 turn the floor over to you. 15 16 DAVID BUTLER-JONES, Resumed: 17 18 CONTINUED EXAMINATION-IN-CHIEF BY MR. CHRISTOPHER BOYCHUK: 19 Q: Good morning, Dr. Butler-Jones. 20 A: Good morning. 21 Q: I wanted to pick up on something that we 22 discussed yesterday, pick up this morning on it, and it had 23 to do -- it had to do with the -- the issue of testing of -- 24 for cryptosporidium in water and you spoke about the utility 25 of that kind of test and one (1) of the questions I wanted to

1 put to you is you spoke about the concerns about it; isn't 2 really the issue not the utility of the test so much as 3 interpretation, isn't that what your argument is? 4 As I understand it, you're saying, because a 5 negative test result does not give you an assurance that the 6 water is safe, that somehow that -- that doesn't make the 7 test -- give the test that much utility; is that part of the 8 -- the reason? 9 A: It's -- it's part of it, but the utility 10 -- the accuracy of the test itself is problematic so you 11 combine that with how that might be interpreted and it 12 compounds the problem. 13 Q: But can't you deal with that in the way 14 that the -- the person doing the analysis simply interprets 15 the result, for example, to address your concern that a 16 negative sample doesn't give you an absolute assurance of 17 safe water; isn't that just a matter of interpretation? 18 If the -- if the -- the person doing the 19 analysis understands that, then there -- that shouldn't be an 20 objection to actually doing the test and then, on the 21 converse side, the finding of an organism -- and one (1) of 22 the things you said is that the test won't show you if it's a 23 viable organism or whether it's a species that's infected -- 24 infective in humans, but isn't the test have value anyway in 25 the sense of, all we're really concerned is are organisms of

1 this size breaching our -- our barrier? So wouldn't it still 2 be worthwhile to do the test on -- if you look at it from 3 that point of view? 4 A: That's where -- well, two (2) things, one 5 (1) is, to the extent that a test will change your behaviour 6 will in part determine how useful that test is; in many cases 7 -- in most cases, it won't change your behaviour. 8 I mean, if -- if you don't find it, the 9 important thing is to make sure that your treatment processes 10 are working and you can assess that without the need for this 11 other testing. 12 If it -- if you do find it, it may make you a 13 little more concerned, but is that concern related to, if you 14 find -- say you find one -- one (1) spore, well you could 15 find one (1) spore even with most of the treatment that's out 16 there, but it's not a human health risk. 17 So that's when you start thinking about -- 18 that's when you start thinking about the price and, for eight 19 hundred dollars ($800), how often do you need to do that to 20 reassure yourself. 21 And the challenge then is that the -- what I 22 was referring to, which was sort of the human kind of aspect 23 to its interpretation, if -- sure, if you -- you know, 24 somebody who's -- who's trained and experienced and really up 25 on it and doesn't -- isn't dissuaded by the evidence, however

1 inaccurate, then, yeah, that would be true, but for most of 2 us in most situations, if I got a negative test, I would 3 probably breathe a sigh of relief and maybe not pay as much 4 attention; even in people who are trained, that's part of our 5 response. 6 Q: Okay. But isn't the argument that it's 7 all we have out there right now, in terms of -- as I 8 understand it, that's all we have in terms of checking the 9 water -- the finished water for cryptosporidium, short of 10 actually identifying someone who's contracted the disease and 11 -- and you're able to source it to the water? 12 A: Well, no, because we have assessment of 13 the system itself and, in the -- in the treated water, we 14 have turbidities and other measures that, when you look at 15 it, will give you an indication of whether or not you have 16 much in the way of solids coming through that system. 17 So I -- I think -- the question is what is the 18 most appropriate test to give you the information you need to 19 make the right decisions and, other than when you have an 20 event or periodically, now this is different than -- than 21 surveillance as we do in terms of checking for bacteria, et 22 cetera, periodically large systems often will do that, a 23 couple of times a year just as a check on the system, but 24 without any illusion that that is the -- any protection for 25 -- for the water supply.

1 Q: Okay. But the problem -- you mentioned 2 turbidity, we've heard evidence that turbidity is -- is in 3 itself not a great proxy -- a great proxy test for 4 cryptosporidium if you can -- it takes large numbers of these 5 organisms in the water to have any impact on -- on turbidity 6 readings. 7 A: But it is a proxy for particles of a size 8 getting through the system so, if you have, for example, 9 you're going along and your turbidity is point one (0.1), 10 point one (0.1), point one (0.1), point one (0.1), point one 11 (0.1), point one (0.1) and then it goes to point six (0.6) -- 12 Q: Okay. 13 A: -- still less than one (1), but you have 14 a problem, something is happening there that you can't 15 account for. 16 Q: Okay. Now -- 17 MR. COMMISSIONER: So I take it, Doctor, 18 well, it isn't in evidence, I gather there's been some 19 reference to the fact that perhaps Saskatoon does tests for 20 crypto -- 21 THE WITNESS: Yeah. 22 MR. COMMISSIONER: -- on occasion and I'm not 23 sure with what regularity at this point -- 24 THE WITNESS: Yeah, and I think Regina has in 25 the past and Edmonton, I think, may do it from time to time

1 and I -- I don't -- I'm not arguing that it's totally 2 unreasonable to every once in a while do a test like that to 3 see, just as a -- just as a check on your system. It's the 4 issue of the routine testing in order to -- as part of 5 culture protection system, that's -- that's different. 6 It's much, if I can think of another analogy 7 it would be in terms of there are certain things that you do 8 on an ongoing basis to be sure that your car is working. 9 Every once in awhile you take it in and you do 10 some -- some testing on the valves that you wouldn't normally 11 do, just to see, because you've got five hundred and fifty 12 thousand (550,000) kilometres or whatever on it. 13 So it -- it's in that kind of a realm where it 14 is part of your -- your overall system but it really is a 15 minor one (1) and it's just a check on the system, but not a 16 regular check. If we had a test which was more accurate, 17 simple to do, that you could get a rapid turnover on, then, 18 yeah, then that would -- that would be a different issue. 19 But in terms of the current availability of 20 testing, on a routine basis, in most of our systems, it would 21 weigh us against it. 22 MR. COMMISSIONER: But you wouldn't be 23 arguing against such testing if, indeed there was a problem 24 identified with the water works in this particular period of 25 time?

1 THE WITNESS: Oh, ab -- absolutely. 2 MR. COMMISSIONER: In other words, to the 3 extent we're having this Inquiry is simply not just to 4 discover and possibly make recommendations with respect to 5 Battleford but to the extent it has some -- hopefully some 6 broader context. 7 One (1) of the challenges I guess is that 8 systems, and perhaps not the major city systems but other 9 systems can go down from time to time and the question is, 10 what kind of a response should occur when that occurs. And I 11 guess part of the questioning is, well, in your view, does 12 crypto testing apply in any such situation or do you have any 13 comment on when -- 14 THE WITNESS: Yeah, yeah -- 15 MR. COMMISSIONER: -- it might apply? 16 THE WITNESS: Yeah. Basically, what we were 17 previously talking about was in terms of routine testing, 18 much as we talked about routine screening, in terms of when 19 you have a problem as part of the information you bring to 20 bear on the problem, then, yeah. 21 For example, if -- if in that instance that we 22 talked about where the system seems to be working, yet your 23 turbidities have gone up significantly, they've gone up from, 24 you know, you almost always are point two (.2) and suddenly 25 you're at one (1) for a couple of days, (a) you should -- the

1 system in North Battleford now can bypass that water, right? 2 So you're not putting it into the drinking water supply. 3 In that situation, sometimes as part of the 4 evidence that you bring to understand what's going on, you 5 might do crypto testing on that water to see whether or not 6 that is one (1) of the things that is happening in terms of 7 getting through. 8 But as a routine sort of screening test as we 9 do for bacteria, it's in that situation which it's not 10 useful. But as a diagnostic tool for particular 11 circumstances, I think it's one (1) of the tools that you 12 bring. 13 14 CONTINUED BY MR. CHRISTOPHER BOYCHUK: 15 Q: In point of fact, that is one (1) of the 16 tools you used in terms of developing the protocol for 17 lifting the -- 18 A: Absolutely. 19 Q: -- order in the City of North Battleford? 20 A: Absolutely. 21 Q: And you were involved in the development 22 of that protocol. And just for reference, that's at tab -- 23 tab 9 of -- of the binder. 24 In terms of -- we were talking about utility, 25 though, yesterday. From your point of view, as I understood

1 your testimony, it doesn't pass the utility test so we 2 haven't got to the cost benefit analysis. 3 I'm going to ask this question, do you know if 4 -- if SERM or anyone at Health has sat down and done a cost 5 benefit analysis with respect to the issue of testing? 6 A: Not that I know of, specifically with any 7 of either Health or SERM, however, that national committee 8 that looks at guidelines, CDC, and the EPA in the U.S. have 9 had those kinds of conversations and -- and looking at it. 10 And as part of their recommendations then as a routine 11 screen, again, routine screen -- 12 Q: Right. 13 A: -- it's not -- not considered helpful or 14 appropriate. 15 Q: Okay. Now I'm just going to jump to 16 something totally different and finish up a little bit -- we 17 -- we had started down the road, and that's the events of 18 April 24th, and I know I'm changing gears here. 19 The -- the last thing we had touched on is 20 that the phone call that you and Dr. Young had had with Dr. 21 Benade to discuss the results of -- that he had recently 22 received from the Provincial Laboratory with a new cluster of 23 crypto showing up. 24 And where we left of is we were heading into a 25 meeting, getting the people together and heading into a

1 meeting that evening. And I understand that you attended the 2 meeting on the 24th via tele -- telephone? 3 A: That's correct. 4 Q: And based on the information you had, 5 we've heard testimony, and I don't want to go through the 6 meetings in detail because we've -- we've done that to a 7 large extent. But one (1) of the comments that's been made 8 on a couple of occasions was that you were specifically 9 questioning municipal officials on what was going on in 10 respect of water treatment plants and particularly it seems 11 that you were -- you were looking at the City of North 12 Battleford and can you tell us what your -- what your 13 reasoning is, why were you pursuing that line of questioning? 14 A: Well, it -- because it, through the 15 discussions, it was obvious that the North Battleford water 16 source included a surface water source, which was not true 17 for the Town of Battleford. 18 At that point, then the issue of adequate 19 treatment in the form of filtration, flocculation, those -- 20 those parts of the system that remove particulate matter like 21 cysts became very important and that's why I asked 22 specifically, actually a couple of times, was there anything 23 about the plant that was not working, were there any problems 24 that you could identify with the plant in the previous 25 several months.

1 Q: So you were looking specifically not only 2 at that moment in time, but what was going on -- a historical 3 perspective? 4 A: Yes. 5 Q: And I'm just going to ask you what was -- 6 what was the response you received? 7 A: Basically the response was that they had 8 reviewed their records, there had been no problems at all, in 9 fact, turbidities and the functioning of the plant was better 10 than it ever had been. 11 Q: Okay. Now, do you know, I know you were 12 on the telephone, do you know particularly who was giving you 13 those answers? 14 A: I don't know for sure, I -- I was not 15 familiar with the -- the players, other than those from 16 Public Health prior to that -- 17 Q: Right. 18 A: -- conference call; it was somebody from 19 the City. 20 Q: Okay. 21 A: I think it was -- 22 Q: There was no -- 23 A: No, I don't know for sure, I think it was 24 Randy, but I don't know; somebody else would know who was 25 there.

1 Q: Okay. And, again, and I don't want to go 2 through the meeting, but at -- the decision was made to 3 adjourn over to partly bring in SERM on the -- on the 4 decision that was going to be made, but I understand that on 5 the evening of the 25th you thought, at least, or we've heard 6 were strongly recommending that an Advisory be issued? 7 A: Yes. There were a couple of other 8 factors, I mean, one (1) was the epidemiological evidence 9 that we didn't find another source, et cetera, by the fact 10 that they had a surface water source, the fact that the City 11 had said that they had had experience with sewage in the 12 intake for the water -- water plant. 13 Q: Was that -- was that reported at the -- 14 the 24th? 15 A: Yes. 16 Q: Okay, yeah. 17 A: Yeah. And, even though -- even though -- 18 now, at the time, my understanding was because I was told the 19 filtration system was working fine, even when it's working 20 fine, there's just the possibility that you may get something 21 through, particularly if there's a large enough coming in -- 22 amount coming in, you may get something through, you can't 23 rule that out. 24 So I was concerned, in the absence of 25 something else, that we really needed to advise the public

1 that the water was not suitable for drinking until we figure 2 out what, in fact, is the cause of this outbreak. 3 Q: Okay. Now, you were focusing on the City 4 because of the surface plant; is that because it was your 5 understanding that groundwater is less susceptible to this 6 kind of contamination? 7 A: Yeah, most unlikely and there was 8 conversation that I was aware of in terms of that the -- the 9 wells themselves were well protected, there was no suggestion 10 that they are -- are liable to contamination, they had not 11 had other problems that would suggest surface water 12 infiltration in terms of -- in the pretreatment in terms of 13 having large amounts of bacteria, et cetera, that would 14 suggest that. 15 So it moved us away, though we couldn't say, 16 and that's why the advisory was on both for sure. 17 Q: Right, that's -- that was my -- you 18 anticipated my next question. Now -- and, again, I 19 understood you -- you were in attendance by telephone in -- 20 at the meeting on the morning of the 25th? 21 A: Yes. 22 Q: And, again -- 23 MR. COMMISSIONER: Could I ask you a question 24 there for a moment, just while we're on the topic. None of 25 us are expert in this area to say the least, but by the 25th

1 or indeed one (1) could say earlier, with the sale of anti- 2 diarrhea medications and the anecdotal evidence and the 3 confirmed crypto, was there any other realistic option at 4 this time other than water? 5 In other words, what strikes me is you don't 6 have a food-based thing because it's no particular event or 7 it's broader than that, too large for person-to-person; at 8 some point, did somebody say this is water, no question about 9 it? 10 THE WITNESS: From my perspective, yeah, and 11 -- and I recall saying, now I may have only thought it, but 12 that night that, in terms of the meeting with SERM the next 13 morning that it would be difficult to find some -- something 14 that they might say that would dissuade me from the need for 15 an advisory. But that, obviously, they were the ones who, 16 according to protocol, would issue it. So we needed to have 17 that conversation. 18 In terms of others, you might think about 19 maybe a virus going through the community, something like 20 Norwalk, and cause -- particularly vomiting and diarrhea, 21 very quickly in a -- in a population. But we were isolating 22 crypto. 23 So that then pushes you -- the chances of -- 24 of that many people having, as you say, person to person 25 spread, or a common foodborne outbreak, unless it was a -- a

1 food which is massively distributed that everybody eats, in 2 which case it wouldn't just be the Battlefords. Then, so 3 basically, you're left with essentially one (1) option and 4 that is water. 5 MR. COMMISSIONER: And as I understood, 6 perhaps your evidence or someone else's earlier, usually if 7 it's flu, a viral type thing, you have advance warning of 8 that because it's shown up elsewhere in the province or 9 elsewhere in the country? 10 THE WITNESS: Usually. In terms of 11 influenza, that's definitely true. It's unlikely that 12 Saskatchewan's the first place, though we have had out -- 13 outbreaks, as we see every winter, where Saskatchewan had one 14 (1) of the highest rates. But usually we do see some cases, 15 at least, elsewhere, early in the season. 16 The other is in terms of those other foodborne 17 or other possible things, usually it'll be somewhere else, it 18 won't only be one (1) community. We may, for example, 19 recently we were seeing a couple of entro -- some entro virus 20 and adno-virus and it was in pockets but it was across the 21 province, it was not just Regina or just North Battleford. 22 So, you're right in that. 23 24 CONTINUED BY MR. CHRISTOPHER BOYCHUK: 25 Q: But I just want to keep in mind the

1 information. What was the information that was the trigger 2 that put you into the water? Was it the four (4) new cases 3 or were -- are you thinking that it may be -- 4 A: It's -- it's the -- 5 Q: -- the cases beforehand. 6 A: -- it's no single piece of information, 7 okay, that does it. But the fact that you've got your 8 isolating crypto which is in large -- in relatively large 9 number of people and a large number of people who are ill, 10 based on the -- what they were finding in the Emerg, et 11 cetera. 12 Very few other things, if anything, could 13 possibly the source. 14 Q: And -- and is that -- with keeping in 15 mind this -- I think on the 24th, by that time you had ten 16 (10) lab confirmed cases? 17 A: It was eight (8) or -- 18 Q: Right. 19 A: But it was -- it was an -- an increasing 20 number of -- most of what was coming -- it's not like we had 21 twelve (12) positive tests of which three (3) were crypto and 22 two (2) were something else and something else and something 23 else. 24 All of the positives we were getting back were 25 crypto which suggests that it's a single source in terms of

1 the, whatever this outbreak is. And then you work down in 2 terms of the most likely causes. And they were not finding a 3 common other source, like the inspectors, when they did their 4 investigation, it wasn't like they found that all of these 5 people had been to the Legion for a dinner the week before. 6 Q: Okay. And -- but with that information, 7 what you've just told us, why did we go ahead and complete 8 this extensive epidemiological survey, which I understand 9 part of the reason was to -- 10 A: Yeah -- 11 Q: -- to look at source? 12 A: Yeah. Because in -- in -- answers aren't 13 always neat. And you need to -- we're always open to the 14 possibility of being surprised. And that's why you do a more 15 extensive survey to either rule in or rule out what you 16 thought in the first place. 17 As the evidence from that came it, it only 18 confirmed what, in fact, we had decided. But you can't -- 19 (a) you can't for the study to make a decision and (b) you 20 have to be open to the possibility that your decision is 21 wrong. 22 And when you have a large outbreak like this, 23 you want to be very sure because there's implications to the 24 recommendations that ultimately will come. 25 Q: Okay. And just so I understand you,

1 primarily the reason for -- for adjourning over was -- was 2 you were missing one (1) of the stakeholders, is that -- 3 A: Yes. 4 Q: Because I want to know if you came to 5 those conclusions, why didn't we issue the night of the 24th? 6 A: Yeah. 7 Q: Why didn't we get that out that -- 8 A: Two (2) -- two (2) things: (a) SERM was 9 not on the call. And obviously in the protocol, because SERM 10 is the one (1) to issue it, it'd be necessary to have them 11 involved in the discussions. 12 Secondly -- 13 Q: But -- 14 A: Secondly, secondly -- 15 Q: Yes? 16 A: -- it was -- while I was fairly certain 17 and it would be difficult me to be dissuaded otherwise, there 18 may be other pieces of information that I wasn't aware of 19 that SERM would be aware of which would have pushed us, or 20 possibly pushed us one (1) way or the other. 21 And so I actually made a conscious, from my 22 perspective, I don't know about the group on the other end of 23 the phone, but from my perspective, I was comfortable waiting 24 the twelve (12) hours because in terms of -- as we were 25 hearing this happening twelve (12) hours is not going to --

1 given that the severity of taking that step, twelve (12) 2 hours is not going to jeopardize or whatever. 3 Different story, okay, different story if we 4 had, like, E-Coli where you have bloody diarrhea and people 5 desperately sick in hospital, in which case we would have 6 traced down SERM that night and an order would be issued that 7 night. 8 And that's what happened when we did find the 9 -- the evidence on Thursday about the plant itself. 10 Q: Okay, and just, I want to understand in 11 terms of the comfort level in waiting twelve (12) hours -- so 12 I understand, is that because of the nature of the pathogen 13 we're dealing with here partly? 14 A: Partly. 15 Q: And miss of information. But just so 16 we're understood, had you decided you decided to go that 17 night, if SERM wasn't available. Say it was -- you had the 18 authority to do it? 19 A: If -- if -- if it was, from my 20 perspective, if it was one (1) of the -- the nasties, and 21 SERM was not available, and -- just even if, this is -- this 22 is where the -- the Act is written a way that the Minister 23 can, or as -- the Minister's designate can do it, if it were 24 serious enough and big enough then -- and we couldn't get the 25 necessary people, then we would have to act.

1 Q: Right, and -- and likewise the local 2 Medical Health Officer could have had the authority in the -- 3 A: Yes. 4 Q: -- the Public Health Act to do the same? 5 A: Yes. 6 Q: That evening if he -- if -- if-- 7 A: Yes, but it -- be -- but the nature of 8 the disease, the -- the -- the edges of uncertainty, twelve 9 (12) hours was overnight, was -- was not as critical. 10 If this were -- we were now meeting at 8:00 11 in the morning, we wouldn't have waited twenty-four (24) 12 hours, for example. 13 Q: Okay, and just because we're on the issue 14 of the timing of this advisory, you -- you're familiar with 15 the -- the report prepared for -- by Health Canada on the -- 16 A: Yes. 17 Q: -- epidemiological survey. And would -- 18 and you -- you've seen the epidemiological curves they 19 produced in terms of the outbreak and when it peaked. We 20 talked about it peaking on April 12th or 13th with a little 21 bump after on, I guess the 16th or 18th. In terms of those 22 people that got ill during those two (2) peaks, say would 23 moving up the advisory five (5) or six (6) days made any 24 difference? Do you think? 25 A: In the middle of what you're dealing with

1 you don't know that. There are many -- even some of the 2 meningitis outbreaks that have occurred in Ottawa and 3 southern Ontario and others, when you look back at it, the 4 decision to move forward with immunization based on the 5 number of cases in a number of different areas, et cetera, 6 kinds of indications that move you from, it's not just an 7 isolated event that can be managed with prophylactic 8 antibiotics. 9 When you look back at -- back at it, when you 10 actually do the study, the antibiotic had not kicked in at 11 the point that the outbreak was over. 12 Q: Okay. 13 A: Or not the antibiotic, the -- the 14 immunization rather had not kicked in. When you're in the 15 middle of a -- you don't know where this is going to end. 16 For all we knew at the time, this could have been just the 17 -- the first couple of weeks of a -- of what otherwide would 18 have been an eight (8) or ten (10) week outbreak. 19 So you -- you -- you don't know that. When 20 you look back it you say, yeah, but it wouldn't change the 21 way you act at the time. 22 Q: Okay, but hindsight again being 23 twenty/twenty (20/20), from what I understand it, the 24 incubation periods of this disease, which are on average 25 around seven (7) days, with the peaks on the 12th and the

1 16th, say the order was issued a full week before, on the 2 16th, would that have -- that wouldn't have prevented, my 3 understanding is, any of those people from getting ill? 4 A: Not those, the majority of cases it 5 wouldn't have. On the other hand, what we don't know is 6 would there have been another peak later on if we had not in 7 fact done something about not drinking the water supply, 8 where you have another round coming through the community, or 9 another parasite like giardia, or some other event that would 10 contribute to a second epidemic. 11 Q: Right, okay, and we can't predict in the 12 future whether it did prevent an outbreak? 13 A: No. No. 14 Q: But we pre -- have a pretty good idea 15 that it didn't, it wouldn't have impacted those two (2) 16 peaks? 17 A: Those who were already -- already ill, 18 those who were already incubating the -- the parasite, it 19 would not have prevented, no. 20 Q: Okay, and, sorry. 21 MR. COMMISSIONER: Go ahead I -- just on this 22 timing business and -- a stray thought that occurred to me. 23 On the reporting to Dr. Lipsett, I guess, by the pharmacy, 24 that diarrheals were in big demand, if you wish, at that 25 point in time. I just wonder, in the Public Health area, is

1 there any requirement on pharmacies at any point to report 2 excessive use of over-the-counter medicine to the Public 3 Health officer or is there any kind of a protocol in place 4 for that? 5 THE WITNESS: Not normally. In -- during an 6 outbreak, it's often part of the investigation. Sometimes in 7 the past, when I was a local medical officer, a pharmacist 8 that I knew would call me up and say, you know, something's 9 going on because we're seeing it, but there isn't a specific 10 requirement on them to do so. 11 MR. COMMISSIONER: Okay, jumping ahead a 12 little bit. Based on what you know, would that be a 13 reasonable step to take or to ask local medical officers or 14 their staff, as the case may be, to check the pharmacies from 15 -- I'm not trying to be alarmist about it -- 16 THE WITNESS: No, no -- 17 MR. COMMISSIONER: -- I appreciate -- I mean, 18 a thirty (30) second phone call to five (5) or six (6) 19 locations once a week might tell something or other, not just 20 with waterborne, but in general? 21 THE WITNESS: Yeah, though I -- I would 22 prefer the approach where pharmacists, as part of their -- 23 their education, et cetera, and I think generally they do 24 talk about these -- these issues, when they do see something 25 that they think is out of the ordinary, that they alert

1 Public Health because, even though it's a thirty (30) second 2 phone call, five (5) or ten (10) locations several times a 3 week -- or a year, et cetera, does add up in terms of time, 4 also for the pharmacists' time if they're not actually 5 expensing, and -- and the last time we had an outbreak that 6 this -- I mean, we haven't had one (1) in North Battleford, 7 right, so -- 8 MR. COMMISSIONER: No, no -- 9 THE WITNESS: -- so it -- so in terms of the 10 practicality of it, it's more the issue -- the general kind 11 of thing in terms of it -- you see something going on that 12 you're not sure about, then -- then call Public Health and 13 physicians do that. 14 And, in fact, for diseases, we do have 15 sentinel physicians, for example, for influenza so that we 16 can pick up early so there's a group of physicians across the 17 -- the Province that -- that we -- they sort of report 18 regularly. 19 So, even before we're getting other reports 20 and lab reports, we're starting to pick it up through those 21 sentinel physicians so, conceivably, you could have sentinel 22 pharmacies who, when they see something, are -- are more 23 intentional about that; it -- it wouldn't hurt, it would be 24 worth looking at the practicalities of it. 25 MR. COMMISSIONER: That's a good term,

1 sentinel pharmacies. All right, thank you. 2 3 CONTINUED BY MR. CHRISTOPHER BOYCHUK: 4 Q: Okay. In terms of -- of your -- 5 A: I'm sorry, can I just interrupt, because 6 just before we finish that thought. 7 Q: Sure. 8 A: The other thing which was interesting 9 that I -- we found out subsequent to that is actually there 10 was a school trip leaving the -- the country about that time 11 when it was running off the shelves, which my understanding 12 is they had been advised to purchase anti-diarrheals in 13 advance of their trip so -- and were more likely, given that 14 we haven't seen an outbreak like this in North Battleford and 15 people do those trips, we might see quite a number of false 16 alarms in -- in those events. 17 Q: And I -- actually, I -- 18 A: But we can accommodate -- I'm sorry, we 19 can -- there is the potential to accommodate those based on 20 the way in which you do reporting, et cetera. 21 Q: And I think Dr. Ellis -- I actually 22 touched on that in her testimony that, in isolation, that 23 data for that kind of reason, in people going on trips in 24 February, you might get a spike and it -- without know the 25 reason why they're purchasing the product, it might be -- the

1 -- the use of the data might be limited, I guess, in terms of 2 what you take from it. 3 A: Yes, though, if for example, the 4 pharmacist -- if you had, I mean, I'm -- I'm thinking 5 conceptually here, if you had sentinel pharmacists, you know, 6 one (1) in each -- each larger community or something, who 7 then, as part of that, would ask these kinds of questions 8 first, you know, are you going out of town or is this a 9 sickness, then that might be able to control for that, but it 10 would require some -- some additional planning and work. 11 Q: Now -- 12 A: And possibly little yield, but, you know, 13 it's worth thinking about always. 14 Q: Okay. And, if we've gone there or 15 finished with this little area of inquiry, I'd still like to 16 go back to the -- to the events in the evening. 17 Based on what you've told us, is it fair to 18 say that your -- your mind was made up to go with the 19 Advisory regardless of what the City was telling you about 20 the -- the operation of their filtration system or their -- 21 their operation of their surface water treatment plant in 22 general? 23 A: Yes. 24 Q: Okay. And, on the morning of the 25th, 25 you were at the meeting, this is where we left off, and,

1 again, I understand we've heard testimony that you again 2 raise the issue of the operation of the plant? 3 A: Yes. 4 Q: Right. You were still concerned, you 5 still had a question about where the this is coming from? 6 A: And -- and you always open up the 7 possibility they might have discovered something overnight or 8 recalled something overnight that they hadn't previously. 9 Q: And, again, without belabouring the 10 point, I understand you got a similar -- 11 A: Yes. 12 Q: -- reassurance that there was no problems 13 out there? 14 A: Yes. 15 Q: But in any event, the decision was made 16 to proceed with the advisory that day. Can you tell us what 17 different course you might have taken if, on the 24th or the 18 -- the morning of the 25th, the information had been 19 disclosed to you about the -- the settling problem in the 20 solid contact unit? 21 A: We would have gone directly to an order. 22 Q: Okay. And what -- why is that -- why is 23 that important? 24 A: Well, the -- the advisory is -- is just 25 that. It's a -- we don't -- we're not quite sure but we

1 think there may be an issue here. An order is when you 2 actually have something specific that is a threat to the 3 public that you need to replicate. And the order includes 4 the measure that the municipality, in this case, must take in 5 order to rectify that situation. 6 An advisory is not a direction, it's advice to 7 the public, it is not direction to -- like an order is 8 specifically direction to the City to correct the problem. 9 Q: Right. And that engages a -- a host of 10 enforcement type remedies -- 11 A: Yes. 12 Q: -- in the Public Health Act, that's the 13 dif -- the real difference between the advisory -- 14 A: Yes. 15 Q: -- and the order. And as far as you're 16 concerned I suppose, it doesn't matter how the -- this 17 misinformation came about, whether it was inadvertent or 18 otherwise, in terms of the impact it had on you. You don't 19 care whether they're misleading you or if it's just advert -- 20 inadvert -- you're -- the problem is that they -- they didn't 21 know. Or the information they gave you wasn't -- wasn't 22 correct? 23 I guess I -- I phrased that really poorly, I'm 24 sorry. Do you care, from your perspective whether they knew 25 and were misleading you or just simply didn't know

1 themselves? 2 A: Two (2) -- two (2) things about that in 3 terms of the -- they're response. In terms of the public's 4 health, whether it was out ignorance or intent, this threat 5 was still there, okay? So, from that standpoint it doesn't 6 matter. 7 In terms of what you do about it is different. 8 One (1) is an issue of education, training, support, a 9 culture which is open to asking questions, those kinds of 10 things. If it's with intent, then the strategies may be a 11 little different than that. 12 Q: Okay. And let's go to the 26th. And 13 that's -- that's the -- the meeting when SERM discloses the 14 results of their inspection of the facility or their 15 investigation into the surface water treatment plant. 16 And at that meeting, and we've heard testimony 17 that that's when the settling problem was disclosed. Did you 18 seek an explanation from the representatives of the City as 19 to why, after you had directly asked -- put the point to them 20 on the 24th and 25th, they hadn't -- 21 A: Yes. 22 Q: -- told you about the problem? Okay, 23 could you -- can you tell us what explanation you received? 24 A: I didn't get an explanation, I got an 25 accusation that I had been releasing information to the

35
  1  public which wasn't true.
  2                 Q:   So they never did directly respond?
  3                 A:   No.
  4                 Q:   So do you know whether it was -- you were
  5  being misled or they just didn't know themselves the
  6  significance of the problem?
  7                 A:   I don't know that.
  8                 Q:   Okay.  
  9                 A:   I -- I don't know that.
 10                 Q:   And have you -- has that been pursued
 11  since?
 12                 A:   No.
 13                 Q:   With you?  Okay.  
 14                 A:   I mean at that point we were into trying
 15  to manage all the issues around the -- the outbreak.  I
 16  didn't feel it served any purpose.  At the end of the day,
 17  the City did agree -- while they -- they disagreed, both
 18  times, with either the advisory or the order, felt that there
 19  was no relationship to -- to their role or their facilities,
 20  at the end of the day, they did agree to -- to sign on to the
 21  public advisory and -- and the order, and to cooperate in
 22  that way.
 23                 So at that point there was -- there's no
 24  point.
 25                 Q:   Right.  The issues for you now is, let's

1 control what -- the problem we have and address the main 2 problem, which is the outbreak? 3 A: Yeah, absolutely. 4 Q: Okay. And then I -- I know -- I don't 5 intend to go into all your activities in terms of dealing 6 with the outbreak but I understand that one (1) of the 7 activities you were involved in was, I guess, consulting or 8 advising in the -- in the epidemiological study that was 9 subsequently conducted? 10 A: Yes. 11 Q: Although, to be fair, I -- I understand 12 that Dr. Young was more intimately involved -- 13 A: Absolutely. 14 Q: -- in that study? But one (1) of the 15 things you touched on yesterday was, with respect to 16 cryptosporidium, there's a number of species that are 17 identified as infective in human beings. 18 A: Well, there's a number of species, only 19 some of which infect humans and one (1) of which is specific 20 to humans. 21 Q: Right. And I understand there's been in 22 excess of a dozen species of cryptosporidium that are -- are 23 now known and catalogued -- 24 A: Yes. 25 Q: -- but that, to date, they've only

1 identified two (2) species that actually cause disease in 2 human beings? 3 A: Yes, that's my understanding. 4 Q: Okay. And that's something you're -- 5 you're aware of as -- as an epidemiologist and -- 6 A: As a -- yeah, Public Health type. 7 Q: -- professional of Public Health? And 8 also, as part of the epidemiological survey or study, one (1) 9 of the pieces in the information that -- that was sought was 10 -- that might help source the infection was what species of 11 cryptosporidium do we have; is that right, that was one (1) 12 of the -- 13 A: Yes. 14 Q: -- the things that were being 15 investigated? And that I understand that a -- that a -- 16 there's a -- there was a report prepared and the way this was 17 done, I understand the British Columbia Centre for Disease 18 Control does this type of study to identify what the species 19 is? 20 A: Yes. 21 Q: And this is primarily done through DNA -- 22 A: RNA. 23 Q: RNA? 24 A: Yes. 25 Q: Okay. Analysis and through that analysis

1 they can tell whether you've got a species that is only 2 infective in human beings? 3 A: That's correct. 4 Q: And that's what's known as human -- the 5 human genotype? 6 A: Yes. 7 Q: Okay. And other genotype is what's known 8 as the bovine genotype? 9 A: Correct. 10 Q: And that is infective in both cattle and 11 human beings? 12 A: Yes. 13 Q: And the -- this information tells you, I 14 suppose, that if you have a human genotype, you're pretty 15 sure that the source of the oocysts must have been from 16 another infected human being; is that right? 17 A: Yes, there's only a couple of incidents 18 internationally where they found that human type in another 19 animal, one (1) was I think a tapir in Madagascar, they 20 certainly have not found it in cattle and other animals that 21 we see typically in North America. 22 Q: Okay. And I want to refer you to tab 10 23 of your exhibit binder, I believe it's -- do you have it 24 there? 25 A: I don't think it's that the one (1),

1 that's the -- oh, here. I'm sorry, I was looking in the 2 wrong one. Yes. 3 MR. COMMISSIONER: Binder C-27. 4 5 CONTINUED BY MR. CHRISTOPHER BOYCHUK: 6 Q: I'm sorry, C-27. And at tab 10 there's a 7 report entitled Genotyping of Cryptosporidium Isolates from 8 the North Battleford -- from North Battleford, Saskatchewan; 9 have you seen that report? 10 A: I have. 11 Q: And you've reviewed the report? 12 A: Yes. 13 Q: And I understand that what happened was 14 forty-nine (49) of the fecal samples from patients who were 15 identified -- or from forty-five (45) patients who were 16 identified of getting the infection in North Battleford area 17 during the outbreak were sent for genotyping to the British 18 Columbia Centre for Disease Control? 19 A: Correct. 20 Q: And can you just tell us what the results 21 of their study were? 22 A: Well, basically, epidemiologically you 23 don't need to study everything, you need to study a sample of 24 them so they selected randomly a dozen samples, all of which 25 -- I think it was a dozen --

1 Q: Yeah. 2 A: -- eleven (11) of which -- one -- one (1) 3 which they couldn't -- couldn't do the typing and the other 4 eleven (11) were human-related. 5 Q: So they were positively identified as -- 6 A: Yes. 7 Q: -- as human genotype? And can you tell 8 me what the implications or what conclusion you draw as in -- 9 as a professional epidemiologist from this data? 10 A: Well, basically, the source was -- was a 11 human source, some -- somebody who was infected and excreting 12 the -- the oocysts so it wasn't a matter of cattle or elk or 13 some other species upstream that -- that was causing the 14 infection. 15 Q: And can you go further and -- and 16 pinpoint -- pinpoint further what the source is and, of 17 course, I'm thinking we heard testimony that the sewage water 18 -- or the sewage treatment plant is upstream from the 19 intake -- 20 A: Yes. 21 Q: -- of the surface water treatment plant? 22 A: Obviously that was one (1) that you would 23 quickly jump to, but it doesn't mean that that is the primary 24 source. Given -- once the -- whatever the primary source, it 25 -- it had to be upstream basically, okay, and -- but the fact

1 that -- at least what was stated to me was that they 2 periodically did have evidence of sewage in the intake for 3 the -- the water treatment plant and, given that the -- the 4 floc was down, once it was into the system and people were 5 being sick, obviously it would magnify the problem because 6 you're just recycling the infection. 7 But, in terms of that original source, was it 8 from there or somewhere else upstream, we can't say. 9 Q: Okay. So the point, though, with what 10 you can say about the sewage treatment facility. And, just 11 for the purpose of your answer, assuming it doesn't provide 12 any sort of treatment that is a barrier or disinfectant for 13 crypto, what it -- the impact it has is to amplify the size 14 of your outbreak? 15 A: Yes. 16 Q: Okay. And just so I understand, that's 17 because people -- once you have infection in the population, 18 those people start excreting and of course they excrete the 19 waste that goes through the waste system and then it's 20 recycled back -- 21 A: Yes, yeah. 22 Q: -- and -- 23 A: Yeah, I mean most of those would make it 24 to the toilet and then it would be back into the system. 25 Q: Right. And then picked back up if you

1 have a breach in your barrier at the surface treatment plant, 2 and redistributed -- 3 A: Yes. 4 Q: -- through the population? Okay. Okay. 5 Now, leaving the epidemiological and -- and going back a bit 6 to a bit of the policy discussion and the -- the input -- 7 MR. COMMISSIONER: Doctor, think I'll ask one 8 (1) more question here. 9 MR. CHRISTOPHER BOYCHUK: Okay. If you have 10 some more. 11 MR. COMMISSIONER: Do you have, I mean I 12 appreciate there's various levels of burdens of proof along 13 the way as to how convinced one must be before one will state 14 something to be a fact. 15 I'll put it this way, do you have any evidence 16 of any other -- I mean, as a result of the epidemiological 17 study and those studies that were conducted in the post 18 knowledge event, that suggested if it was a human geno form 19 of crypto, yes, that could have entered into the river, 20 upstream, somewhere. 21 But I guess my question is, do you have any 22 facts that would suggest any other source, other than the 23 sewage treatment plant, based on the investigations 24 conducted? 25 THE WITNESS: Not specifically. We knew -- I

1 mean, it's spring, it's spring runoff, there was a lower 2 volume of runoff because it was relatively dry. So whatever 3 was brought into the river would be more concentrated. So it 4 could have been somebody's septic system or -- or other -- 5 other -- outhouse or whatever. 6 The fact that the sewage treatment plant is 7 upstream and that the barrier was broken, that's -- if you 8 were to put money on it, clearly, that's one (1) of the ones 9 you'd put money on. But to say that, for sure that was the 10 -- the definitive source, you can't say. 11 MR. COMMISSIONER: Thank you, doctor. 12 13 CONTINUED BY MR. CHRISTOPHER BOYCHUK: 14 Q: Now, I understand that there's no formal 15 safe water program within Saskatchewan Health. Is that 16 right? 17 A: In what way do you mean that? You mean 18 in terms of -- 19 Q: In the sense that there's a -- either a 20 standing committee or -- my -- my understanding, and I -- 21 A: Well, there's a -- there's a committee of 22 the -- the Medical Officers, for example, and Tim relates to 23 SERM on water quality issues. I wouldn't say that there is a 24 water quality committee specifically of the Department of 25 Health.

1 Q: Okay. 2 A: But the Department of Health participates 3 and is involved in these other activities. 4 Q: Right. And we talked about the -- what 5 you were talking about before is, I -- I think the Medical 6 Health Officer -- 7 A: Yes 8 Q: -- Council? We talked -- 9 A: Yes. 10 Q: -- about that before. And I understand 11 that that is a point of contact for local Medical Health 12 Officers, yourself, Dr. Young and then other officials within 13 the department? 14 A: Yes. 15 Q: And that water quality concerns are often 16 discussed there? 17 A: Yes. 18 Q: And at -- and this is reviewing your 19 previous testimony, that Mr. Macaulay or Mr. -- Mr. Corkery 20 then are the individuals within Sask Health that liaise with 21 SERM on water quality issues? 22 But formally, you don't formally liaise with 23 SERM on water quality issues, do you? 24 A: Not as a normal thing but as needed. 25 Q: Right. And so in a sense, your role is

1 primarily as a consultant, is that -- 2 A: Yes. 3 Q: -- fair to say? Now, from a public 4 health point of view, though, and with the expertise you 5 bring to your job as the Chief Medical Health Officer, do you 6 think it's important that any kind of policy changes or any 7 changes in terms of regulation or standard setting for 8 drinking water quality be -- receive your input? 9 A: Not necessarily. The reason for that is 10 if -- from my perspective, I don't have any allusions that I 11 know everything or can do everything. 12 Q: But I'm just talking about -- 13 A: And so -- no, no, but -- 14 Q: -- your area of expertise, though. 15 A: -- no, I -- in -- in my area of 16 expertise. But in terms of if it relates to water quality, 17 Tim and Louis, in -- in terms of -- I mean it's one (1) thing 18 once you get the epidemiological and the investigation of a 19 problem and that kind of thing. 20 But in terms of their knowledge base around 21 water quality, treatment and the -- the health implications 22 of that, I would look to them for as much advice as they 23 would look to me. 24 Q: Okay. Well, I'm -- that touches on 25 something because one (1) thing that strikes me about the

1 whole area of regulation and standard setting and water 2 quality is it's really an interdisciplinary type of thing 3 that needs to be brought to the problem, isn't it? 4 A: Yes. 5 Q: You need all sorts of expertise. And the 6 concern it seems to me, and the reason why I'm asking about a 7 safe water program, I guess my next question was is there -- 8 has there ever been a standing committee, interdepartmental, 9 that you're aware of, that is devoted solely to water quality 10 issues in Saskatchewan? 11 A: Not that I'm specifically aware of, no. 12 Q: Or that you've been directly involved in? 13 A: Not that I remember. 14 Q: Because not only is it interdisciplinary, 15 we've got a binder, it's C-1, it's the legislative framework, 16 and you can go through the different roles and 17 responsibilities. 18 And you look at SERM as the regulator, Sask 19 Health as the consultant, Sask Water on the infrastructure, 20 the local health authority in terms of dealing with outbreaks 21 and -- and control the health hazards. 22 You have all these different players. Is 23 there any framework in place whereby all theses people get 24 together, a formal framework within the -- within the 25 government where you would have the kind of communication

1 that it needs to deal with the problems that might arise? 2 A: I mean there are other, sort of, points 3 at which those contacts being -- are made. I mean both in 4 terms of the consultation that goes alo -- on around any 5 regulatory development. Tim's and Louis' role in the -- the 6 liaison function and commenta -- commenting on -- on other's 7 regulations, et cetera. 8 In terms of -- would -- well I guess that's a 9 -- a collective decision about, is water one (1) where you 10 need a specific standing committee exclusively dealing with 11 water issues with all those partners. 12 Q: Right. 13 A: Or is something that can be managed 14 collectively through the other mechanisms that do exists 15 already. In general, in terms of the regulatory framework, 16 those kinds of things have seemed to have worked reasonably 17 well. 18 That was not a cause, from my perspective, of 19 what happened here. So it's a -- it's a point for discussion 20 as to whether you need -- I mean the decision as to when you 21 have formal committees, there's a whole range of factors to 22 that. 23 Water -- I mean, one of the frustrations 24 around water is it is should -- it should be something which 25 is routine, and the regulatory framework that supports that

1 is something that -- it's bread and butter. It's not novel, 2 it's not difficult, it's something that should be part of the 3 regulator -- regular function of municipalities and 4 government. 5 So in that setting -- anyways it's -- it's an 6 open discussion from my perspective. 7 MR. COMMISSIONER: If I could -- one of the 8 thoughts that occurred to me, and it happened to some extent 9 in North Battleford where there was quite a turnover of 10 personnel in a short time -- short time, I can't remember 11 exactly the -- the foreman left the works, utilities director 12 left, the city commissioner was changed and I can't remember 13 exactly the time frame. 14 And then when we get into the situation once 15 the outbreak occurs, we had a pretty detailed indication of, 16 depending on who has holidays, who's on days off, who's on -- 17 which are all every day realities. 18 Whether in the -- we're not talking about 19 monitoring in -- at this point but we're talking about 20 somebody who is there all of the time no matter who's on 21 holidays or who's away or who's just changed jobs and is 22 learning on the job, et cetera, in this whole quality area. 23 And that's, I'm just following up on Mr. 24 Boychuk's comment, whether there isn't room for some agency 25 that will be the trouble shooter wherever a problem happens

1 wherever in the province and irrespective of whether if 2 somebody's on holidays at the time? 3 THE WITNESS: Yeah, there's alway staffing 4 challenges and turnover and things, but the police and fire 5 have the same challenges, so -- 6 MR. COMMISSIONER: They're not usually 7 operating with one (1) or two (2) people but -- 8 THE WITNESS: No. 9 MR. COMMISSIONER: -- hundred. 10 THE WITNESS: That's -- that's well, or 11 whatever, but they do, they do cooperate and collaborate and 12 so whatever mechanisms by which we can do that to ensure that 13 there's no water system, you know, of whatever size that 14 lacks somebody or access to somebody. 15 That's back where I was talking about a 16 culture of comfort around if you have any questions or doubt, 17 you can ask the question from somebody who knows and you can 18 get the right answer. 19 So that in the case of the flocculation 20 blanket that it wasn't, sort of, people struggling to figure 21 out what to do. It's that they immediately got in contact 22 with somebody who actually does know and can make those 23 appropriate decisions. And that's an issue of coordination 24 and -- and function and, whoever does that, you may have some 25 recommendations, obviously, about that, but in terms of

1 whoever does it, the point is that it gets done because, in 2 terms of the impact, when -- when you have water problems, a 3 lot of times we get away with it, okay, but when you do have 4 a problem, it's a lot of people that are affected, it's not 5 one (1) or two (2) at a time. 6 MR. COMMISSIONER: And there would be 7 expertise in Saskatoon and Regina that would be readily 8 available that wouldn't necessarily be available everywhere 9 else in the Province? 10 THE WITNESS: Yes. 11 12 CONTINUED BY MR. CHRISTOPHER BOYCHUK: 13 Q: Well, that -- that leads nicely into 14 another area I wanted to talk to you about and that is, if 15 you have Dr. Benade's binder in front of you, it's -- 16 A: Hmm hmm. 17 Q: -- there's a water safety briefing note 18 at tab number 6. Is that Dr. Benade? I think it's the big 19 one (1) with the -- on your right-hand side. 20 A: This -- this is it. 21 Q: Okay. 22 A: I think I've got two (2) up here. 23 MR. COMMISSIONER: The biggest one (1). 24 THE WITNESS: Yeah, this is the Benade one 25 (1) and it's a water safety briefing note from -- to John --

1 MR. CHRISTOPHER BOYCHUK: Okay. 2 THE WITNESS: -- Yarske. 3 4 CONTINUED BY MR. CHRISTOPHER BOYCHUK: 5 Q: And, if you could just turn to the second 6 page, second paragraph. 7 MR. COMMISSIONER: I'm sorry, what tab are we 8 on? 9 MR. CHRISTOPHER BOYCHUK: I'm at tab number 10 6. 11 MR. COMMISSIONER: Okay, thank you. 12 13 CONTINUED BY MR. CHRISTOPHER BOYCHUK: 14 Q: And I appreciate this is a note that did 15 not go to you so -- 16 A: No, fair enough. 17 Q: -- I'm not -- but one (1) of the things 18 that -- that -- if you look at the first paragraph, it says 19 -- I'm starting mid-paragraph: 20 "Saskatchewan Environment and Parks and 21 Renewable Resources, their focus has 22 shifted to conservation away from public 23 safety. SERM considers municipal water and 24 sewer a mature part of their program and, 25 as such, are scaling back their direct

1 involvement in inspection and monitoring of 2 facilities." 3 Okay. Now, keeping that in mind, I understand 4 we've heard evidence, sometime in the late '90s SERM decided 5 to stop doing on-site inspection of these facilities and, in 6 that sense, that was a change of policy at SERM and my 7 question is was that policy -- I didn't see any documents 8 whereby that policy change was being run by the people at 9 Health to determine what impact it might have on public 10 safety. 11 A: Yeah. I don't know if anybody else in 12 Health had any input to that, certainly the question wasn't 13 put to me. 14 Q: Okay. And you don't know that anybody 15 else was contacted? 16 A: I don't know, I have not heard that one 17 (1) way or the other, sorry. 18 Q: And I guess from a -- and what you told 19 me -- just said a few minutes ago about having somebody 20 available, for example that the operators at the City of 21 North Battleford could contact; do you not think that SERMs 22 pulling back created a void there, there was a resource that 23 was being withdrawn that -- that was lost to these people? 24 A: I don't know the -- I don't know the 25 details of it, but the piece I do know about is the

53
  1  discussions that took place that gave rise to another letter
  2  about, you know, whose responsibility and that kind of stuff,
  3  but, in terms of this specific issue and the input that went
  4  into it, if I were -- okay, you see the -- at least here they
  5  talk about the mature part of a program --
  6                 Q:   Right.
  7                 A:   -- the question is and, again, I don't
  8  know the details, I don't know what planning went into this
  9  or whatever.  The question is, you can back off.  I mean for
 10  example, a hundred (100) years ago, medical -- medical
 11  officers, people interested in public health were very active
 12  in advocacy with municipalities and governments in terms of
 13  the provision of safe water and adequate housing.
 14                 Safe water is something we've come to take for
 15  granted as a mature part --
 16                 Q:   Okay.
 17                 A:   -- of the infrastructure, right, but at
 18  the same time, you have to have in place people who know what
 19  they're doing.  If people know what they're doing and
 20  consistently have shown that they're able to do that, you
 21  don't need to inspect them as often as where you have a
 22  situation which isn't so.  
 23                 So I don't know what criteria they put into
 24  that decision or what assessment they made in terms of the
 25  adequacy of those systems to function without more direct

1 supervision. 2 Q: Right, okay. But you would hope that 3 there was some form of survey taken to -- you said, when you 4 want to move to mature, that's when you're comfortable that 5 the people you're leaving the program whose hands are the 6 hands it's going be in are competent to run the program; 7 isn't that what you hope -- 8 A: You -- you make -- you make some 9 assessments about that -- 10 Q: Right. 11 A: -- and I am not familiar with what they 12 did so. 13 Q: Okay. But, in terms of a -- and I'm -- I 14 -- I talked a little bit about the paper you prepared or the 15 portion of the paper on compliance monitoring and we've 16 already spoken -- in terms of compliance monitoring, you 17 talked about a number of things, one (1) was monitoring and 18 sampling various parameters, chemical, microbiological, but 19 we've talked about crypto doesn't work so, if you can't 20 measure the water for crypto, how do you ensure that you're 21 getting the compliance monitoring you need with respect to 22 that parasite? 23 A: Right. In terms of -- and that falls 24 back onto your mechanical -- 25 Q: Right --

1 A: -- stuff, right? 2 Q: Because you -- you'd said -- 3 A: Turbidity, et cetera. 4 Q: -- we know chlorine doesn't work and we 5 have easy tests for all those levels and bacteriological 6 tests are easy to do, but we don't have effective tests for 7 crypto. 8 So how do you compliance monitor to make sure 9 that the -- the treatment barriers are working? Because we 10 don't have a water sampling method that tells you whether 11 they are or not. 12 A: Right. But that's where your -- your 13 turbidity, your other measures, your, sort of mechanical 14 engineering side that they follow and whatever -- it's not my 15 area of expertise. But whatever measures they follow to 16 ensure that the equipment itself is working appropriately, 17 that's where the focus is. 18 Now, who does that -- I mean one (1) of the 19 problems in Ontario is -- and the chief thing that broke 20 down, from my perspective, in terms of the -- the system, per 21 se, not the operator but the system, was that the reporting 22 of the lab results of the testing on the water did not go to 23 public health. 24 Q: Okay. 25 A: And because the -- they would have, in

1 the old days, when we -- when we got a -- when the public 2 health lab got a positive test, that day there would be a 3 conversation between me, the Chief Inspector of the 4 municipality and Environment. 5 Q: And -- and of course, at post-Walkerton, 6 that is something that we've already heard testimony on, 7 we'll hear a little more from Doc Young, that we moved 8 quickly to remedy with the interim protocol. 9 A: Here -- here, yes. 10 Q: Yes. And, but that is, again, dealing 11 with bacteriological -- 12 A: Yes. 13 Q: -- problems. And I guess my point is, is 14 that if you don't have this water sampling option that 15 provides you with an easy method of monitoring what's going 16 on at these treatment plants, isn't physical inspection the 17 only other way you can do it? 18 A: Well, not if -- I mean, for example, in 19 the -- the guidelines, that same protocol that you referred 20 to, the pre bacteriological one (1) that talks about the 21 general bacteriological protocol, was just a subset of the 22 total. 23 One (1) of those is treatment failures, other 24 things that -- that may pose a risk and if filtration is 25 down, then that's one. And inspection is a -- is a way of

1 identifying things that the operators don't identify, for 2 example. So that if -- and my understanding is that 3 operators are supposed to notify SERM when they have 4 treatment failure. 5 So, in my terms, treatment failure would 6 include when your filtration system, which include 7 flocculation, isn't working. You can't -- unless you're 8 going to inspect every day, you have to rely on the operators 9 to notify you in the interim, when something's going wrong. 10 Q: Right. And I don't -- I don't, for a 11 minute -- I'm not for a minute putting to you that you can, 12 by chance, pick up on this problem by inspecting -- 13 A: No, I hear you. 14 Q: -- it's just not practical. But I'm 15 thinking, isn't there some value in at least, say, an annual 16 inspection where there's a review of the operation, a review 17 of the -- 18 A: Yeah. 19 Q: -- the records? For example, if - 20 A: There's no -- 21 Q: -- we've heard evidence -- 22 A: There's no disagreement with that. 23 Q: Okay. 24 A: It's the same as we do with restaurant -- 25 from a public health perspective we do with restaurants.

1 There should be no restaurants that are never inspected. 2 Depending on the risk analysis, it may be more often than 3 not. 4 But to say that a potentially hazardous 5 facility, in terms of risk to the public, is never inspected, 6 that can be problematic. 7 Q: Okay. 8 A: Even as a teaching moment, right? 9 Q: That -- that was my next point. 10 Inspection is not only just looking -- 11 A: No. 12 Q: -- it's an educational tool as well. 13 A: It's -- it's -- it's to make sure that 14 the -- the people who are the restauranteur, or whatever, 15 understands the links between what they do, in terms of their 16 food preparation, storage and handling, and the outcomes for 17 the -- the public. If they understand that, then they're 18 going to do that -- or they're more likely to do that whether 19 you're there or not. 20 It's not an issue of the measuring of the 21 railings, it's an understanding of the process of the 22 management of that food chain. And -- 23 Q: Right. 24 A: -- it's an opportunity for teaching and 25 reinforcement of that teaching.

1 Q: And, just as an example, concrete 2 example, here we heard evidence that in 1999, they did a 3 similar -- they did a maintenance procedure on this unit and 4 it was still pumping water where you had a similar problem. 5 An annual inspection might have -- a review of the records 6 might have picked up, what happened here? Isn't that right? 7 And then, there was thankfully no disease 8 identified in 1999 -- 9 A: Yeah. 10 Q: -- but an inspection might have been able 11 to say, you can't do it that way in the future? 12 A: No, I -- I -- I - 13 Q: And prevented the -- 14 A: I hope I'm not giving the impression that 15 I'm arguing for no inspections. 16 Q: Okay. 17 A: I'm just -- I was talking to the issue of 18 the decisions you make as to frequency, et cetera, are based 19 on other components of a system that you have in place to 20 ensure compliance. 21 Q: Okay. And I guess the reason why I spent 22 the -- one (1) of the, I guess, starkest comments that came 23 out of Dr. Ellis' is that this outbreak happened while the 24 plant was operating totally within the regulatory 25 requirements that are already existing and that's where I --

1 I see that there's a need for someone to maybe go through the 2 plant and say -- and identify these operational problems 3 because our -- our regulatory requirements obviously don't 4 identify every operational problem that can occur. 5 A: Well, at the same time, I mean it's -- 6 while it's not my -- my area, in terms of the SERM 7 regulations, is that statement that you made that it was 8 operating within regulatory requirements a true one (1) 9 because my understanding is that there's some expectation 10 around -- in regulations that, if there are operational 11 failures, that there is notice of those operational failures, 12 right. 13 And that, just because the -- the monitor of 14 turbidity only goes up to one (1), doesn't mean that, because 15 you can't measure above one (1), that -- that it's okay, it's 16 like saying my thermometer only goes up to thirty-seven (37) 17 so every patient has a normal temperature. 18 So I -- anyways, that's not my area, but I'm 19 just wondering about that statement, if you don't mind, 20 because the other -- the other issue and this is a -- not 21 just an educational one, but regulations are there in place 22 to deal with certain specific aspects, it doesn't take away 23 judgment and intelligence. 24 And -- and that's just a Public Health issue 25 in terms of how we relate to the whole range of functions

1 that we do and, if -- if we -- if we don't need judgment out 2 there and people who can apply that judgment in a sensible 3 way, we only need computers. 4 Q: Understood. Now, in terms of the 5 consultative role that you play, there were questions asked 6 of Dr. Benade regarding a Cabinet information item that was 7 being circulated or not circulated, I suppose, prepared in 8 June of 2000; did you have any input into the -- or, first, 9 are you familiar with the document? 10 A: I -- I certainly am now. 11 Q: Okay. Can you tell me when you first saw 12 the document then? 13 A: It was subsequent to that. In terms of 14 the CII and -- and when the consultations went on with that, 15 I -- I was on vacation in Europe so. 16 Q: So -- I'll just shorten this up. So you 17 didn't have any input into the development of the document? 18 A: Not at -- not at that time, no. 19 Q: Okay. I guess -- could you give him a 20 copy of C-24, it's a letter. 21 A: The other thing, it's just worth saying, 22 I mean, as we worked as a team and maybe this is implied, but 23 I just want to say it is that Eric does a yeoman's work on a 24 lot of these issues and, when Eric's providing comment, I'm 25 quite happy to have that happen so.

1 Q: Okay. So you were comfortable with the 2 input he was providing into the -- 3 A: Yeah, and often we will discuss about it, 4 et cetera, but it's not like I have any great fear there's 5 going to be a problem. 6 Q: Okay. Now, I'm just showing you -- or 7 it's been produced to you, is -- is Exhibit C-24 and that's a 8 letter dated March 31st, 2001 to the then-Minister of Health, 9 Mr. Nilson? 10 A: Hmm hmm. 11 Q: And that's the one (1) from Dr. Benade 12 and I -- I note that it was copied to you? 13 A: Yes. 14 Q: And can you tell us if there's been any 15 action taken by the department in terms of the concerns 16 raised in that letter regarding staffing problems for Public 17 Health inspectors? 18 A: Yeah. Certainly there's a -- in the 19 letter from the Minister outlines a number of those -- 20 Q: Okay. 21 A: -- some of which have been long-term in 22 terms of the development of the Environmental Health Program 23 at the -- in the -- in the Federated College, for example, 24 others in terms of the sort of ongoing -- sort of discussions 25 with other jurisdictions to the extent that we can encourage

63
  1  people that Public Health is a very important profession to
  2  enter, as an inspector, whatever.
  3                 It is however I think -- Ken had identified
  4  it, though it is actually, as long as I've been in Public
  5  Health for the last twenty (20) years, we have always, even
  6  in big jurisdictions like Ontario, had difficulty recruiting
  7  enough Public Health inspectors.
  8                 Q:   Okay.  But, from your perspective, is
  9  that -- we've heard a lot about public inspectors and most
 10  likely they're, in a lot of ways, the front line troops in
 11  terms of --
 12                 A:   Environmental health.
 13                 Q:   -- environmental health.  That a shortage
 14  of -- of these people does -- has a potential to create a
 15  risk in terms of either dealing with an outbreak or dealing
 16  with any kind of potential health hazard?
 17                 A:   The -- obviously --
 18                 Q:   That may be an obvious question?
 19                 A:   Well, I was just going to say, obviously,
 20  if we had more resources in public health, we could do more
 21  in terms of anticipating problems, in promoting health, in
 22  preventing issues and enhancing the health of the population. 
 23  There's no question about that.
 24                 When it comes to health protection, there is
 25  an -- always a prioritization.  And so what you have, there

64
  1  is yet to be and at least -- and we see outbreaks and
  2  different things across the country, and public health
  3  responds admirably.  
  4                 And right now, in terms of even the Anthrax
  5  scares, I mean, public health is out there, they are doing
  6  the job.  The challenge is that some of the more routine
  7  things then need to be -- to be delayed or put aside and some
  8  of the anticipatory stuff, in terms of health promotion, et
  9  cetera, is -- is delayed.  
 10                 But the -- the acute events get dealt with and
 11  get dealt with very professionally, whether north or south of
 12  the border.  And the Americans have the same challenges in
 13  terms of public health resources.  
 14                 Q:   Okay.  In terms of this particular
 15  outbreak, you say these acute events generally get dealt with
 16  particularly well.  From your observation can you tell us how
 17  you thought the local health authority dealt with this
 18  particular outbreak?
 19                 A:   All right.  I was very impressed.
 20                 Q:   Okay.
 21                 A:   When I -- at the point I got brought into
 22  it -- the first -- the first I should say, public health is
 23  organized, internationally, generally organized at the local
 24  level.  Because most of the issues can be best dealt with
 25  locally.  You then have a regional, provincial, national

1 organizations that support that system. 2 Anyways, when I was brought in, it seemed to 3 me that the time that the department was brought in, Eric, 4 myself, the lab, et cetera, was appropriate, given what they 5 were seeing and experiencing. That they're time and response 6 and the kinds of responses they gave at the time that they 7 did were virtually text book. 8 I -- I -- I couldn't find any fault in that 9 process, from my perspective. 10 MR. CHRISTOPHER BOYCHUK: Okay. And, thank 11 you, doctor. 12 THE WITNESS: Thank you. 13 MR. COMMISSIONER: Well, perhaps we'll take 14 the fifteen (15) minute morning break and then allow other 15 counsel to question. Thanks. 16 17 --- Upon recessing at 10:37 a.m. 18 --- Upon resuming at 11:00 a.m. 19 20 MR. COMMISSIONER: Perhaps we'll get underway 21 again, if we could, please? 22 23 (BRIEF PAUSE) 24 25 MR. COMMISSIONER: Yes. Mr. Hopley?

1 CROSS-EXAMINATION BY MR. SCOTT HOPLEY: 2 Q: Yes, Dr. Butler-Jones. I'd like to just 3 -- I'll largely pick up where -- with -- or where Mr. Boychuk 4 left off. But I'd like to start, first of all, with just a 5 couple of questions about your position on the testing for 6 cryptosporidium in -- in the water. 7 Now, it would seem to me that -- that what you 8 were saying is that there is no reason for a program of 9 testing surface water sources for the presence of crypto. Is 10 that -- that -- 11 A: Correct. 12 Q: -- fair to say? 13 A: Not at this point, since we know that 14 most are at -- at any given time will have crypto on them. 15 Q: Okay. And so I think that you made some 16 concession that there may be sort of some basis to spot chest 17 -- spot test for the presence of crypto? 18 A: Can -- can I just ask, you were referring 19 to surface water. Are you thinking of treated water or -- 20 Q: No. 21 A: -- or just lakes and river and -- 22 Q: Raw water. 23 A: -- that kind of stuff? 24 Q: Yes. 25 A: In terms of raw water, from time to time,

1 there is some interest in doing that just to see if there's 2 been a dramatic change. But you don't need to do that on all 3 sources or all times. It's mostly from a -- out of epi -- 4 epidemiological interest. 5 Q: Okay. And -- and would you agree with me 6 that there -- there may be some basis to conduct in a surface 7 water source, leading into a treatment facility? That there 8 may be some basis to do long term periodic testing to find 9 out of there are, over a year space, that there are -- that 10 there are variable rates of contamination with a view to 11 perhaps -- seeing if there's a predictable bad time for that 12 water source for crypto infestation? 13 A: If you had an academic interest in that, 14 that -- I mean, it might be an interesting thing to do to see 15 but we do know, I mean, for example, that your high times are 16 going to be -- and the same for bacteria and other things, 17 are most likely to be during spring runoff and the lowest 18 times, sort of end August when -- when water levels are at 19 their lowest. 20 So, there's no surprise there. You might do 21 that every few years just to confirm that the pattern hasn't 22 changed but to do it on a regular basis would not really tell 23 you anything useful, in terms of what you -- what difference 24 you might do about it. 25 Q: What about if you were able to develop a

1 -- a background rate in a -- in a particular raw water 2 source? Once you had this background rate, wouldn't it help 3 you to -- if you then discovered consistently rising rates of 4 crypto in the water, wouldn't that help you identify changes 5 to the quality of the source water? 6 What I'm thinking of, wouldn't it cause people 7 interested in the integrity of the source water to start 8 saying, hey, why are these changing? Why are these rates 9 going up? And look upstream, perhaps, for livestock 10 operations or if there's been something which has dropped the 11 water level, like a dam? 12 A: You'd be better to look at bacteria 13 levels. Wherever you have -- the thing about crypto is the 14 -- the numbers are -- are lower but because they are a faecal 15 source, if you do not have other indications of faecal 16 material, you're not -- and they will most likely be 17 proportional in some way to those. 18 So if you are looking at faecal coliforms in 19 the water supply that's probably a -- a more accurate 20 indicator of the presence of potential faecal problems, 21 whether it's giardia or crypto or other things, and it's a -- 22 a cheaper test, one (1) that you can do more quickly and 23 overall will give you a better pattern of the levels of the 24 faecal material in the water. 25 Q: Okay.

1 A: Because there's also more of them in any 2 -- so you will -- 3 Q: They're easier to find? 4 A: Yeah, I mean if you find faecal material 5 and you don't find crypto, you're still at risk, but in terms 6 of the tracking you're talking about is the up -- upstream 7 sources of water declining or improving, you're better to use 8 the -- the faecal indicators. 9 Q: Okay, and is it fair to assume that if 10 those other indicators are increasing then you're -- you can 11 assume automatically that you're background levels of crypto 12 are also increasing? 13 A: Likely so. Yes, because the -- it's not 14 like -- patterns of disease will move through communities at 15 various times so today it might be mostly a -- an entro-virus 16 (phonetic), a few months from now maybe there's a little bit 17 more crypto a few months from now, but all of which 18 potentially can cause disease. 19 So in terms of your overall water quality at 20 the source, the -- the presence of faecal organisms is your 21 best indicator of some kind of faecal contamination. 22 And it's the most consistent indicator whereas 23 the specific bugs will vary in their proportions. 24 Q: Okay, so generally, higher faecal content 25 suggests that there's more crypto but not necessarily?

1 A: Well, it could be crypto or something 2 else. It's -- 3 Q: Okay. 4 A: All of which we're interested in. 5 Q: Thank you, now I'd like to move to -- I 6 don't know if it's been actually put in your exhibit binder, 7 but it is the -- the excerpt that we were given yesterday 8 morning on the background paper that, I understand, you 9 assisted in preparing for the Walkerton inquiry? 10 A: Oh yes. I think that's in -- can you 11 remind me of the tab? 12 MR. COMMISSIONER: Twenty-two (22). 13 MR. SCOTT HOPLEY: Twenty-two (22). 14 THE WITNESS: Thank you. 15 16 CONTINUED BY MR. SCOTT HOPLEY: 17 Q: Now, I understand that you wrote the 18 chapter on surveillance? 19 A: I did. 20 Q: Okay, and I would like to, because this 21 form's part of the -- the -- really the background for the 22 bulk of the questions that I have for you today. 23 And if you could turn to page 156? 24 A: Hmm-hmm. 25 Q: Which is the introduction to the section

1 on enhanced population health surveillance? 2 A: Yes. 3 Q: And if I understand it, the first 4 paragraph to that introduction really gives a definition of 5 -- of health surveillance? 6 A: Yes. 7 Q: And can you -- could you paraphrase that 8 for me? 9 A: Just, basically health surveillance is 10 where you're following events in terms of either a disease or 11 a determinant of health or some other factor relevant for 12 health, where you are collecting data on a consistent basis. 13 You then use that data for analysis and then 14 comparing that data with other data that you might have in 15 terms of creating a picture in terms of health -- health 16 risks or other -- other things that you are -- of interest. 17 It's only useful if you actually do something 18 with it or it has some potential significance, ultimately in 19 terms of changing your mind about something or -- or having 20 some intervention that you need to do. 21 Q: Okay, and -- and the, if I understand it, 22 and I think in your -- not to sort of claim any particular 23 insight here, but by going to your second paragraph, I mean 24 don't you identify in the paper the reasons why surveillance 25 is important?

72
  1                 You say:
  2                   _It is our due line as the ear -- early
  3                   warning of impending danger._
  4                 And it goes on to state:
  5                   _It is also the core part of the system for
  6                   protecting and promoting health and
  7                   preventing disease and injury._
  8                 So--
  9                 A:   Yes.
 10                 Q:   -- surveillance is really central to
 11  public health, is that fair to say?
 12                 A:   Yes, it is.
 13                 Q:   Okay.
 14                 A:   It's one of the five (5) fundamental
 15  functions of public health.
 16                 Q:   Now, going into, I'd like you to turn to
 17  page one (1) --
 18                 MR. COMMISSIONER:   Just on that point,
 19  Doctor, refresh my memory if I ever knew, what are the other
 20  four (4)?
 21                 THE WITNESS:   Let's see if I remember. 
 22  Disease and injury prevention, health protection, health
 23  promotion, surveillance and I think the other one (1) relates
 24  to community health assessment.
 25                 MR. COMMISSIONER:   Thank you.

1 CONTINUED BY MR. SCOTT HOPLEY: 2 Q: Now, on page 158 in -- in this review 3 draft, I -- I notice that you refer to as I think an example 4 of -- of a mature surveillance system functioning, if -- if 5 that's a fair description, you talk about: 6 "The Canadian Food Inspection Agency has 7 responsibility for the safety of food from 8 raw materials through to consumption." 9 And goes on to talk about the Agency 10 coordinating with -- with other agencies and this way, in 11 concluding, outbreaks can be detected, the cause determined 12 and interventions taken sooner than would be possible if -- 13 if there was not this umbrella group or just simply group 14 functioning at the local level. 15 A: Yes. 16 Q: Okay. And so that too is a central part 17 of -- of an effective surveillance program, isn't it, that 18 there be one (1) umbrella group? 19 A: It depends on what it is you are -- 20 you're looking at, in this case in terms of foods, the -- 21 it's not an umbrella -- CFI has a primary responsibility 22 because that's been designated by -- by the Federal 23 Government, but others have their own roles within that and 24 CFI couldn't function without us and vice versa in terms of 25 that sort of function.

1 Q: Okay. But let's turn to water here. 2 Now, at page 161 you talk about the specifics -- or -- and 3 it's in the subheading the Specifics of Water Quality and 4 Surveillance. 5 Now, on page 161 in the -- the second-last 6 paragraph of that page -- 7 A: Hmm hmm. 8 Q: -- I think it might be called the 9 penultimate paragraph. And it starts off by saying that -- 10 that: 11 "Surveillance takes place at several 12 levels, while some may regard the term 13 compliance monitoring as being distinct 14 from health surveillance. It is helpful in 15 the context of this discussion to think 16 conceptually of them together as comprising 17 surveillance at various points in the 18 process. This then defines points for 19 potential intervention to ultimately 20 protect human health." 21 Okay? 22 A: Yes. 23 Q: Now, what I'm interested in and I -- I 24 think, if -- if I understand what you're saying, you go on 25 then and -- and you identify the critical components of a

1 water quality surveillance system. 2 A: Right. 3 Q: The first objective is to protect the 4 water supply. 5 A: Right. 6 Q: Secondly, surveillance detects problems 7 at an early stage thereby allowing intervention to reduce or 8 eliminate the risk of human disease? 9 A: Right. 10 Q: Okay. And, thirdly, it identifies the 11 patterns of human illness suggestive of waterborne illness 12 prompting further investigation and precautionary measures. 13 A: Yes. 14 Q: Okay. And so those are the components; 15 fair -- fair enough? Okay. 16 Now, what does Public Health have to do with 17 water source protection? 18 A: Is that the end of the question? 19 Q: Yeah. 20 A: Okay. Public Health -- a couple of ways, 21 one (1) is in its earlier days and where it's an issue now is 22 its advice around, for example, my advice generally to 23 municipalities is, if they can get an adequate source by deep 24 well that is protected rather than surface water, that would 25 be preferred in terms of improving the likelihood that the

1 quality of your water that you start with is -- is more 2 likely to be safe. 3 It isn't always an option in terms of volume 4 of water, quality of water, other constituents in -- in deep 5 well water that can make it most unpleasant, sulphur, et 6 cetera. 7 So there's -- so that would be the first 8 thing. So the second thing is in terms of generally, we talk 9 and SERM does a lot of work in this, but certainly from a 10 Public Health standpoint, we talk about the importance of -- 11 of conservation that -- that when we think of things -- terms 12 ecosystem health that we are interdependent with the 13 environment around us. 14 So often you'll hear Public Health people talk 15 about those issues and the importance of, for example, I do a 16 lot of work around climate change and the impacts on health, 17 so those -- those are all part of that broader and, in fact, 18 climate change may have related to the Walkerton outbreak in 19 terms of increased levels of -- of rainfall in more monsoon- 20 like rains that increased volumes over a short period of 21 time, et cetera. 22 So there's a -- so anyways, it's those kinds 23 of -- kinds of areas. And obviously, if there's an issue, an 24 environmental issue that has -- poses a threat to human 25 health, then public health will get involved.

1 Q: Okay. Now, if I understand correctly 2 what you described, those are largely public education 3 initiatives? 4 A: Education, as it relates to advocacy, as 5 it relates to consultation where we get involved in the 6 development of -- in the policy debate, more generally. 7 Q: Now I'm thinking more in terms of 8 specific statutory or regulatory obligations. And 9 specifically, if I could refer you to -- 10 A: Yeah, thanks. This is a copy of the 11 sanitation regulations. 12 MR. COMMISSIONER: All right. What has been 13 produced to the witness is the sanitation regulations for the 14 province of Saskatchewan, is that right? 15 MR. SCOTT HOPLEY: Yes. And I understand 16 these are regulations to the Public Health Act. 17 THE WITNESS: Hm-hmm. 18 19 CONTINUED BY MR. SCOTT HOPLEY: 20 Q: Now, these are -- these are on the first 21 CD, it's -- 22 MR. COMMISSIONER: Should you be wishing to 23 make this an exhibit, or -- 24 MR. SCOTT HOPLEY: Well, it's regulations to 25 a statute. I -- I could make it -- I could make it an

1 exhibit. 2 MR. COMMISSIONER: Or make it part of the 3 earlier exhibit? I mean, to the extent you're going to refer 4 to it, I -- 5 MR. SCOTT HOPLEY: Okay. Perhaps -- 6 THE WITNESS: Are these -- are these -- can I 7 just ask -- are these still in place? Because this is a '64 8 regulation? 9 MR. SCOTT HOPLEY: Well, this was referred 10 to -- 11 THE WITNESS: These are the correct versions? 12 I'm sorry, I'm just looking to Richard for that, if you don't 13 mind, your Honour. 14 MR. COMMISSIONER: Hm-hmm. 15 MR. RICHARD HISCHEBETT: It's my 16 understanding that they're still in place. 17 THE WITNESS: Okay. 18 MR. SCOTT HOPLEY: Yes. 19 20 CONTINUED BY MR. SCOTT HOPLEY: 21 Q: Now, and specifically, I'm wondering if 22 you are familiar with regulation or section 21, sub 2, which 23 states, it refers to cattle feed lots. And if I understand 24 this section, it states that: 25 "No person shall locate a feed lot so that

79
  1                   the drainage there from will pollute any
  2                   municipal or private water supply"?   
  3                 A:   Yes.
  4                 Q:   And that's something that is to be
  5  monitored by public health?
  6                 A:   It's under the public health regulations. 
  7  It also relates, though, to agricultural and environment
  8  regulations and approval practices.   So, sometimes some of
  9  these issues you will see across different -- different
 10  regulations.  
 11                 And so there's a -- we obviously have an
 12  interest in this.  The local health department will be
 13  consulted on the placement of, in this case, feed lots, for
 14  example, and other structures that have the potential to
 15  impact on -- on municipal water quality.  So, --
 16                 Q:   Okay.  Now, I think that this, and in
 17  fairness and maybe I should have pointed this out right at
 18  the start, but in the definition section 2 -- section 2, feed
 19  lot, for the purpose of this Act, is defined as basically
 20  being penned ca -- a pen containing twenty-five (25) head of
 21  cattle being prepared for market.  So that's a fairly
 22  restrictive definition.  
 23                 But what I'm interested in is, do public
 24  health inspectors actively monitor feed lots meeting the
 25  definition, to see if they're contaminating water sources?

80
  1                 A:   That's a question I don't know
  2  specifically the answer to, in terms of -- because it's a
  3  local function of the local inspectors and Medical Officers
  4  would manage that.
  5                 I have not heard that that has been an issue. 
  6  They are also involved around the environmental assessments
  7  that take place and providing comment on locations of things
  8  like feed lots, et cetera.
  9                 But in terms of the monitoring of those,
 10  whether that takes place from public health inspectors or
 11  environment or agriculture, I don't know the details of that,
 12  I'm sorry.
 13                 Q:   Okay.  Because what -- I -- I suppose
 14  that assessment certainly would form part of a -- a
 15  surveillance program?  Correct?
 16                 A:   Yes.  Knowing -- knowing the potential
 17  risks in your community is one (1) of the things that you
 18  look at.  I must say that surveillance, public health
 19  surveillance, is not the issues that are exclusively carried
 20  out by public health.
 21                 Q:   Okay.
 22                 A:   And it's a matter of, as a system, what
 23  are the issues you're looking at.
 24                 The other thing, just briefly if I may, is
 25  that there are things that, from a surveillance standpoint,

1 that you do on a regularized basis, as we've identified here. 2 There are other things that you do where surveillance is not 3 appropriate, but you do do periodic surveys or studies to 4 characterize the issues that you're dealing with that are not 5 appropriate for surveillance, but are of interest to you from 6 a Public Health standpoint. 7 So, for example, surveillance in -- in terms 8 of sanitation often will take the form of not a surveillance 9 system per se, but where you do periodic surveys in areas or 10 communities in terms of the quality of, if there's sewage 11 effluent breaking through, septic systems or -- or other 12 things and those -- that's a sort of a -- that's more 13 specific and so we don't call that surveillance, but in the 14 way you're talking about it, it's a kind of surveillance. 15 Q: Okay. But -- and, of course, where 16 you've got a specific problem, and I'll -- I'll get to this 17 more later, but where you've got a particular problem, a 18 breakthrough in a septic system, that relies to do a periodic 19 check, you -- that would be in able -- in order to be able to 20 do that, you'd have to have some reporting; right? 21 A: Not necessarily. Now, again, I have not 22 been a local medical officer in Saskatchewan, but in -- in 23 other experience we would identify areas within our -- our 24 county that there's the potential for concern and we would 25 conduct periodic reviews where, between Environment and

1 Health, we'd go out and actually test septic systems for -- 2 for leakage and other activities because it's a potential 3 high risk -- high risk area so it really depends on -- on an 4 assessment of the -- the risk, the likelihood of problem and 5 the ability to -- to go out and do that. 6 Q: Okay. Now, I don't want to belabour this 7 point about source water protection -- 8 9 (BRIEF PAUSE) 10 11 A: Do -- did you -- did you want this back 12 or should I just keep this up here. You might as well just 13 leave it here if you don't mind, thanks. 14 MR. SCOTT HOPLEY: Now, the next document and 15 perhaps this could be marked as the next exhibit, this is 16 also in the materials disclosed -- 17 MR. COMMISSIONER: All right. Well, we'll 18 mark the Sanitation Regulations just to the extent they've 19 been referred to as -- it will be C-28. 20 21 --- EXHIBIT NO. C-28: Sanitation Regulations. 22 23 MR. COMMISSIONER: And this new document you 24 produced, Guidelines for Issuing and Rescinding a Boil Water 25 Advisory is part of an earlier exhibit, is it not?

1 MR. SCOTT HOPLEY: I don't know if -- this is 2 -- this is not a -- this is a -- 3 MR. COMMISSIONER: Walkerton -- 4 MR. SCOTT HOPLEY: -- CDC -- it's a Centers 5 for Disease Committee -- 6 MR. COMMISSIONER: Okay. So then it will 7 become entitled Guidelines for Issuing and Rescinding a Boil 8 Water Advisory When Cryptosporidium or Other Waterborne 9 Pathogens are Suspected will become C-29. 10 11 --- EXHIBIT NO. C-29: Guidelines for Issuing and 12 Rescinding a Boil Water Advisory 13 When Cryptosporidium or Other 14 Waterborne Pathogens are 15 Suspected. 16 17 CONTINUED BY MR. SCOTT HOPLEY: 18 Q: Okay. And you're familiar with this -- 19 the working group of -- on waterborne cryptosporidiosis? 20 A: Yes. 21 Q: Okay. And that's mainstream, that's 22 attached with -- I believe that's an American organization; 23 isn't it? 24 A: Yes, it is. 25 Q: Okay.

1 MR. COMMISSIONER: I'm having trouble hearing 2 you, Mr. Hopley, I'm not sure if he's too far from the mike; 3 I don't know if other people are. 4 MR. SCOTT HOPLEY: Okay, I'll -- 5 MR. COMMISSIONER: Now I can hear you. 6 7 CONTINUED BY MR. SCOTT HOPLEY: 8 Q: Now, I'd like to refer you to page 3 on 9 that -- of that report and, again, in -- in determining when 10 to and -- and, admittedly, this is document of when to raise 11 a -- 12 A: Yeah. 13 Q: -- or lift a Boil Water Order, but it 14 does, again, point out to -- the first factor to be 15 considered is the source water quality; right? 16 A: That's one (1) of the factors to 17 consider. For example, the same as -- like in the situation 18 here, knowing that the sewage outflow was -- was upstream, 19 that a portion of the water intake is from surface water 20 downstream from that, even independent of other things or, if 21 you knew that there was a feedlot in a position where it's 22 likely to -- to be a problem, then those factors are what 23 they're referring to here in terms of your consideration in 24 the issuing of an Order. 25 Q: Okay. And -- and that the actual

1 genotyping, now that's a fairly complicated and -- 2 A: You wouldn't know that in advance. 3 Q: That's right, so you'd look to, in the 4 North Battleford situation, you'd look to the sewage 5 treatment plant, you'd look to your other feedlots upstream, 6 what else is upstream, are municipalities flushing their 7 lagoons, that sort of thing? 8 A: Yeah, is -- and, if there is a -- if 9 you're experiencing a problem with the treatment plant 10 itself, et cetera. If -- if the treatment plant is working 11 properly then what's upstream becomes less of an issue. 12 Generally, when you're dealing with human 13 outbreaks or epidemics, there's several steps in the process 14 that must have failed. One (1) step in the process usually 15 is not enough to end up in human illness. 16 So whether it's foodborne outbreak or 17 otherwise, it's -- it's not simply that somebody didn't wash 18 their hands. It's that they didn't was their hands and the 19 food wasn't cooked properly and then it wasn't stirred -- 20 stored properly or whatever. 21 The same case here. If the -- the 22 flocculation unit and the filtration system that was in place 23 was working properly, it -- it -- it matters less what's 24 upstream. But if you have an outbreak and you know that you 25 have a surface supply and you know that there's a potential

1 upstream source, which actually, in any North American water 2 supply, there's an upstream source, then it points you more 3 to issuing an advisory or an order sooner, depending on the 4 circumstance. 5 Q: Now, I -- I want to go back and this will 6 be the last question, I think I asked you about 7 cryptosporidium in raw river water. But with the sort of the 8 advent of -- or the availability of geno typing, to identify 9 the -- the source of crypto from either a human as opposed to 10 a bovine source, would there be any public health benefit in 11 -- in sort of doing some testing of -- of raw river water to 12 see, okay, if we've got crypto here, let's find out what kind 13 it is and that would help identify the source of a pollutant? 14 A: That -- that is an issue where you 15 actually do look at the cost benefit. In other words, would 16 it change my decision if I knew that the crypto in the North 17 Saskatchewan was human versus bovine, the decision would 18 still be the same. 19 In terms of the issue of, is it, you know, is 20 it a -- a -- there should be, I mean, because you can -- you 21 should be able to, I mean, I'm not an engineer, obviously, 22 but in terms of the situation of whatever it is upstream, the 23 assessment at the time, when it is developed, and whoever it 24 is that -- that, in terms of Ag or Environment, that is 25 involved in monitoring these, you would have to do an awful

1 lot of testing downstream on a how often basis, at what cost, 2 in order to say, oh, maybe it might be that. 3 And in terms of the yield on that kind of 4 investigation, it would be low. That's different than from 5 an academic standpoint or otherwise, being interested in 6 periodically doing a study to try and figure out what's out 7 there. Much as, for example the University of Saskatchewan 8 did a survey of wildlife in terms of some of the various bugs 9 that are out there. Whether it's busalosis (phonetic), 10 tularemia, et cetera. Because then that's helpful. 11 The -- the human relevance is low because 12 we're not seeing any cases of that. But it's interesting to 13 know that it's out there. But to do it on a regular basis, 14 that's another debate. 15 Q: Okay. And I guess like a true lawyer, I 16 didn't tell you the truth. I do have another question to 17 ask. 18 A: Sure. 19 Q: And I -- I think as -- as -- as maybe a 20 number of criminals are finding out, this DNA testing is 21 becoming both quicker and cheaper. And the question I've got 22 for you is, if the -- if that is changing the cost benefit 23 analysis, are you having ongoing discussions either in your 24 department or with SERM, about perhaps the viability of that 25 sort of testing?

1 A: Not at the moment. If -- if 2 circumstances change dramatically, and it seemed appropriate 3 in terms of, again, from a -- a human health standpoint, 4 which is my particular interest, there may also be an 5 environmental health standpoint which is, you know, of 6 interest to -- to SERM or Ag, then perhaps that would be 7 considered at that time. 8 But you would have to have some experience -- 9 research experience to suggest that, in fact, it's useful. 10 One (1) of the things we haven't talked much about but in 11 terms of the decisions as to how and what you'd use, what 12 become your tools in a routine basis or on an exceptional 13 basis, there's an awful lot of research and debate that, both 14 academically and in the -- the field, before they actually 15 become routine. 16 The same is true in -- in -- in medicine and 17 -- and I'm sure in engineering and others, where before 18 something becomes routine, there are a number of tests it 19 must undergo in terms of its suitability, appropriateness 20 and some of the things we've talked about earlier, so to say 21 that there's a specific conversation that I'm part of, to -- 22 to look at that possibility, no, at this point. 23 To say that that won't happen in the future, I 24 can't say that because it may well as a test. But then I'd 25 want to ask the question how will that change my decision.

1 Q: Okay, now I just -- just to sort of 2 conclude things on -- on this sort of general area of water 3 source protection, what agency or department do you 4 understand to be primarily responsible under the legislation 5 for water source protection? Is there one? 6 A: Sorry, Sask Water, and then SERM, and 7 then us. 8 Q: Okay, and within your regulatory 9 provisions is there any mandatory thing requiring those other 10 agencies to consult with you or is this all done on a 11 cooperative ad hoc basis? 12 A: I -- I won't say that there aren't 13 mandatory on certain issues because -- cause -- just because 14 I'm not necessarily thinking about them right now. 15 But certainly, for example the protocol that 16 we have with SERM, there's guidelines in terms of when they 17 notify public health. 18 Q: Okay. 19 A: So that -- that exists. In terms of some 20 other areas that -- maybe I'm just not thinking about them 21 now. 22 At the same time, there are an awful lot of 23 things that happen across agencies for which there is never 24 any prescription or guideline because there is a general 25 expectation that -- that we do consult across agencies, and

1 with stakeholders, and with others affected in terms of what 2 issues we're facing and before decisions are made, which 3 varies depending on the circumstance. 4 So even if there isn't a specific guideline or 5 requirement, there's a general expectation that when I'm 6 making a decision that effects certain people, depending on 7 the circumstance, it's quite appropriate and important for me 8 to consult with them. 9 Q: Okay, now are you aware of any -- any 10 department or agency responsible for monitoring on a regular 11 basis the quality of surface water sources in the province? 12 A: I won't say I know that for sure. I 13 would expect that Sask Water and SERM are engaged in that in 14 some way but to what extent and what criteria they use, I'm 15 not familiar with them. 16 Q: Okay, they haven't asked you anything 17 about what to test for? 18 A: In terms of -- not that I remember. 19 Q: Okay. 20 A: But, there are days I have a very short 21 memory. 22 Q: But you would be as -- as part of public 23 health surveillance you'd be -- it's your expectation that 24 somebody's out there keeping an eye on what's going on with 25 the quality of -- of our water sources?

1 A: Well, yes. In terms of -- but the -- the 2 reference that you were referring to in terms of the paper 3 that I had written in terms of those things that if, you 4 know, if you listen to Joe Muldoon and others, are talking 5 about that broad -- broad assessment and protection of water 6 sources. 7 I was more specifically focusing on a deep -- 8 the protection of deep Wells and drawing from the most 9 appropriate surface source if you need to do so. That's kind 10 of as far as I usually engaged in it other than the general 11 advice that I give that we -- if we kill our environment, 12 we're along with it. 13 Q: Okay, I think though just -- just so that 14 we're on the same page here, I realize that that paper was 15 written specifically for the Walkerton situation, but the 16 portions that I reviewed with you, I mean those are for gen 17 -- those are general -- 18 A: The -- the -- 19 Q: -- policies, is that right? 20 A: It was written for Walkerton but it is a 21 general principled application applying to virtually any 22 situation in terms of the things you think about. The 23 relative weight you give to them will depend on the 24 circumstance, but you need to be considering all of those 25 issues in your assessment.

92
  1                 Q:   Okay.  Now does public health -- moving
  2  to a -- to a sort of a different area.  Does public health
  3  have anything to do with the construction or alteration of
  4  waterworks or sewage works?
  5                 A:   Not directly, no.
  6                 Q:   Okay, now if I could refer you to binder
  7  C-1?
  8                 A:   Do I have that?
  9                 Q:   That's the legislative framework binder?
 10                 A:   It might be up here.
 11                 MR. COMMISSIONER:   That's the legislation
 12  one.
 13                 MR. SCOTT HOPLEY: Yes.
 14                 THE WITNESS:   Thank you.
 15  
 16  CONTINUED BY MR. SCOTT HOPLEY:
 17                 Q:   Now, I'm -- I'm not expecting that you'll
 18  be real familiar with the Water Corporation Act, that's at
 19  tab 10.
 20                 A:   Yeah.
 21                 Q:   But if -- if I could refer you to section
 22  53.
 23                 A:   Section as opposed to page?
 24                 Q:   Yes.
 25                 A:   Yeah.

1 Q: And it's at page 27. 2 A: Okay, got it. 3 Q: Now, that -- 53 is entitled 4 Administration of Work and it's the Corporation and that 5 refers to the Sask Water Corporation? 6 A: Yes. 7 Q: And it says: 8 "The Corporation has the general 9 supervision, control and regulation of all 10 matters concerning Works." 11 And back in the Definition section it defines 12 Works as including sewage, works and waterworks? 13 A: Yes. Okay. 14 Q: Okay. And it says that it -- and then it 15 goes on to say, "It may issue orders with respect to the 16 operation, maintenance, repair, extension and alteration of 17 Works." 18 And then section 54 goes on and says, "The -- 19 the Water Corp" -- well: 20 "Subject to subsection 2, no person shall 21 commence the construction, extension, 22 alteration or operation of any works unless 23 he's first obtained the written approval of 24 the Corporation to do so." 25 So those sections, do you understand them to

1 -- they speak for themselves, but they -- they provide the 2 Water Corp with authority over -- really to licence 3 construction, alteration of sewage treatment plants and water 4 treatment plants; is that your understanding of that? 5 A: That makes sense to me, yes. 6 Q: Okay. Now, in construction of these 7 things, does -- does the Sask Water Corp ever consult with 8 Public Health as to Public Health concerns with respect to 9 safety of water treatment plants? 10 A: I have no personal experience of that, 11 but that's because I work at the Provincial -- that may be 12 simply because I work at the Provincial level. 13 I know there's actually a great deal of 14 consultation that takes place at the local level between the 15 different agencies in terms of getting Public Health input to 16 environmental-related decisions, but to -- I have no 17 familiarity with how much; Tim Macaulay could speak to that 18 better than I could. 19 Q: Okay. Now, there's one (1) thing and I'm 20 -- I'm not sure if you'll have any familiarity with this, but 21 at -- earlier in this -- in this Inquiry, a witness named 22 Peter Allen suggested that changes or arguably an alteration 23 to the operation of the sewage treatment plant were 24 apparently made by an individual, Mr. Katzell, during -- and 25 this were -- there was some sort of change to the effect to

1 the operation, at least in Mr. Allen's view, to the sewage 2 treatment plant sometime in 1999; now, to your knowledge, did 3 anyone ever get a hold of Public Health about that? 4 A: Well, not to my knowledge, but that would 5 not likely be something that we would -- unless there was a 6 specific question or problem, we wouldn't necessarily know 7 about that centrally so I think you're speaking with some of 8 the other -- the Director of Inspection later, that might be 9 an appropriate question to him. 10 Q: Okay. To your knowledge then, maybe 11 generally, has the Water Corp ever gotten a hold of you with 12 respect to any change to a water treatment or sewage 13 treatment plant? 14 A: It -- it wouldn't, again, because I'm 15 Provincial as opposed to local and the authority is local. I 16 would expect those conversations to take local -- to take 17 place locally and, in terms of -- I have over the years had a 18 couple of conversations with Sask Water at the Provincial 19 level in general terms, but not specific to any single 20 operating plant. 21 Q: Ever any discussion about bringing in a 22 formal protocol requiring notice of these sorts of changes? 23 A: Well, again, I'm -- it may be simply an 24 area that I'm not familiar with so I -- I can't really 25 comment on that. We do have in the SERM health protocol,

96
  1  though, reference to, if there are events or operational
  2  failures that -- that have the potential to affect human
  3  health, there's a requirement for the notification of -- of
  4  public health, and that is locally. 
  5                 Secondly, there is a general provision in the
  6  Public Health Act that refers to anyone who knows of an event
  7  that may potentially pose a risk to the public, in terms of
  8  health, is -- there's a requirement to notify public health.
  9                 Q:   Okay.  And -- and in your discussions
 10  with the Water Corp, they're aware of that provision?
 11  In the Public Health Act?  
 12                 A:   I haven't had a conversation with them in
 13  terms of the regulatory framework or -- or the legislation.
 14  I'm sorry, I'm not the one to answer that.
 15                 Q:   Okay.  Now, if I could refer you to the
 16  Public Health Act, which I believe is in the same binder at
 17  tab 11.  And if I could draw your attention to section 14 of
 18  that Act.  
 19  
 20                       (BRIEF PAUSE)
 21  
 22                 Q:   Basically, do you understand that section
 23  of the Act to impose upon the municipality the duty to supply
 24  a source of potable water?
 25                 A:   Yes.

97
  1                 Q:   Okay.  And so for our purposes, here, the
  2  City -- that section would impose upon the City of North
  3  Battleford the obligation to supply potable water?
  4                 A:   Yes.
  5                 Q:   Now, just going through this, but I -- I
  6  want to establish this, that public health has an obligation
  7  to take steps, under it's -- section 25, if the supply is not
  8  potable.  That's your understanding?  
  9                 A:   Yes.
 10                 Q:   What do you understand to be the purpose
 11  of -- of an order under section 38?
 12                 A:   Let me just ref -- turn to that.  This is
 13  in reference to the issuing of an order, right?
 14                 Q:   Yes.
 15                 A:   Okay.  The understanding of that is that
 16  the capacity to issue an order to require an action to reduce
 17  or eliminate a health risk.  So it's a general kind of
 18  provision that allows the -- the -- the Medical Officer to --
 19  to do so.
 20                 Q:   Is -- is this, getting back to the -- the
 21  -- if -- well, if a Medical Health Officer or public health
 22  -- senior public health officer were having difficulties in
 23  getting either SERM or -- or the City to issue a
 24  precautionary boil -- or a precautionary drinking water
 25  advisory.  Would resort be had to section 38, is that --

98
  1                 A:   In terms of the actual section in which
  2  you would issue the order for a boil water, I'm not sure
  3  whether it's this section or another section but --
  4                 Q:   A precautionary drinking --
  5                 A:   Sorry?
  6                 Q:   A precautionary drinking.
  7                 A:   A precautionary drinking water is not --
  8  it's an advisory, it's not an order.  
  9                 Q:   Okay.
 10                 A:   We have a protocol between us and SERM in
 11  terms of how that takes place.  You could, as a -- as a Med 
 12  -- now I'm speaking as a -- potentially as a local Medical
 13  Officer, local Medical Officers can raise issues, do raise
 14  issues, that they see as -- as a concern because their --
 15  their approach perspective is the protection of the public.
 16                 And if they see that there is a risk to the
 17  public that is not being addressed, then they have broad
 18  ability to -- to raise that issue.  That's why we have them,
 19  or one (1) of the reasons we have them.
 20                 Q:   Now, if I could refer you to section 50 
 21  -- section 53, sub 1, sub d, which states:
 22                   "For the purposes of enforcing and
 23                   administering this Act, the regulations or
 24                   the bylaws made pursuant to this Act, a
 25                   public health officer may, [and then d]

99
  1                   conduct any test, take any samples and make
  2                   any examinations that the public health
  3                   officer considers necessary or advisable." 
  4                 A:   Yes.  
  5                 Q:   What sort of obligation do you understand
  6  that imposes on -- on public health?
  7                 A:   Well, it's a tool for -- it's not an
  8  obligation on public health, it's a tool.  So, for example,
  9  if I'm investigating a situation and I need to have samples
 10  taken and tested in order to assist me in the determination
 11  of the extent of the issue or to help me in my decision 
 12  -making, this gives me the power to -- to require those.
 13                 Q:   Okay.
 14                 A:   And, if I don't think it's -- I mean,
 15  it's -- again, we have people who are there to exercise
 16  judgment in terms of what it is they need to protect the
 17  public, it's not a -- so basically they will order what they
 18  need and they have the power to do so.
 19                 Q:   Okay.  And so in your view it's clear, I
 20  mean, this has nothing to do with requiring Public Health to
 21  do anything, it's -- gives them a tool to do something if
 22  they decide they need to?
 23                 A:   This section here, yes.
 24                 Q:   Okay.  Now, I think yesterday you
 25  mentioned that no one had ever complained to your office

100

1 about the adequacy of the Municipal Drinking Water Quality 2 Objectives? 3 A: Yes. 4 Q: Okay. And those Objectives were set by 5 SERM? 6 A: They're -- they're under SERM's 7 direction, yes. 8 Q: Okay. I take it that SERM consulted with 9 your office before establishing those? 10 A: With -- with the Department of Health, 11 yes, I'm pretty sure they did. 12 Q: Okay. That was before your time? 13 A: I'm not -- what is the date -- I came in 14 '95 so -- later '95, I think it's around that time that those 15 were -- those were set so. 16 Q: Okay. Now, I -- I take it that the -- 17 it's the Water Pollution Control and Waterworks Regs that set 18 the minimum levels for chlorine residuals? 19 A: I believe that's so, yes. 20 Q: Okay. And now I think that that's at tab 21 9 in -- in C-1. 22 23 (BRIEF PAUSE) 24 25 Q: And at page 17 there's section 23, but I'd

101

1 like to draw your attention to actually the section 24, the 2 next section -- 3 A: Hmm hmm. 4 Q: -- that talks about operation of 5 waterworks. And that section sets out that there are -- so 6 23 sets out the specific standards for chlorine residuals in 7 the water and then 24 goes and says that -- well, I'll read 8 it: 9 "The -- the owner of a waterworks that 10 provides potable water shall ensure that 11 the waterworks is operated so that the 12 levels of the following constituents in the 13 treated water delivered to consumers does 14 not exceed the levels specified or falls 15 within the range specified, as the case may 16 be, by the Minister for the following..." 17 And it -- and it lists a series of -- of 18 substances which might be found in water; correct? 19 A: Correct. 20 Q: Okay. Now, to your knowledge, has -- has 21 the Minister -- and that would be SERM or the Minister of the 22 Environment? 23 A: That's in the terms of the -- because 24 these are Public Health regulations, right? These are -- or 25 is this --

102

1 Q: These are the -- 2 A: No, this must be SERM's -- 3 Q: Yes. 4 A: Yes. 5 Q: -- so it would be the Minister of the 6 Environment then. 7 Q: Okay. Now, to your knowledge, has -- has 8 -- have there ever been any actual levels set, to your 9 knowledge? 10 A: For? 11 Q: For any of those constituents? 12 A: Basically, there's not supposed to be any 13 viruses, there's not -- there are the guidelines that you've 14 seen in terms of bacteriological, chemical constituents, et 15 cetera, there -- there are a number of those that are listed 16 in the guidelines in terms of different levels of -- 17 Q: The -- the guidelines set -- the 18 guidelines set a whole series; right? 19 A: Yes, exactly. 20 Q: Okay. But, to your knowledge, is there a 21 specific way in the legislation anywhere a standard as 22 opposed to a guideline? 23 A: I'm probably -- in terms of that, that 24 distinction there, I'm not sure I'm the right one (1) to -- 25 to give you advice on that.

103

1 MR. COMMISSIONER: We're pretty far afield 2 with the Doctor, who is not a lawyer, Mr. Hopley, and we've 3 been reviewing all of these -- 4 MR. SCOTT HOPLEY: Yes. 5 MR. COMMISSIONER: I mean, fine, you've asked 6 the question does he know of any, he said no. 7 MR. SCOTT HOPLEY: Fair enough, and -- 8 THE WITNESS: I mean, we have standards 9 around bacteriological quality of water, right, and there are 10 standards in terms of the -- at least as I understand your 11 term, standard related to chlorine residuals, et cetera. 12 Many of them are guide -- you know, many of them guidelines, 13 some of them are -- are requirements so -- anyways, I'm not 14 sure where you're going with this so I'm not sure I'm very 15 helpful. 16 MR. COMMISSIONER: The individual permits 17 also have various requirements in them, as you know, but 18 you're asking -- 19 THE WITNESS: Yeah. 20 MR. COMMISSIONER: -- a more broader standard 21 than an individual one. 22 MR. SCOTT HOPLEY: Well, mainly I'm -- I'm -- 23 actually, I'm -- I'm asking him to -- to -- just to see what 24 his understanding is because -- 25 MR. COMMISSIONER: Yeah, but I'm concerned,

104

1 Mr. Hopley, of moving the Inquiry along -- 2 MR. SCOTT HOPLEY: Oh, sure. 3 MR. COMMISSIONER: -- with the most 4 appropriate witnesses. And so while it's interesting, it may 5 not be -- it's not particularly relevant to me, at the 6 moment, and I'm not sure what it does for how we, you know, 7 investigate what happened or prevent what happened, happening 8 in the future, at the moment. 9 MR. SCOTT HOPLEY: Well, I -- I -- I guess it 10 would be, eventually, my -- my client's concern that this 11 will happen again unless there's something done to move away 12 from vague guidelines. 13 MR. COMMISSIONER: Well, that may be a valid 14 argument. I'm not arguing with that. But it's just a 15 question of what is appropriate for this witness to be 16 questioned about at the moment. 17 MR. SCOTT HOPLEY: Okay. 18 MR. COMMISSIONER: And I've given you a 19 fairly -- 20 MR. SCOTT HOPLEY: Sure. 21 MR. COMMISSIONER: -- loose rein up until 22 now -- 23 MR. SCOTT HOPLEY: Okay. 24 MR. COMMISSIONER: -- but I think we're 25 starting to run out of time unless you have something that's

105

1 a little more direct. 2 MR. SCOTT HOPLEY: Okay. 3 4 CONTINUED BY MR. SCOTT HOPLEY: 5 Q: Well, the Commissioner has referred to 6 the -- the reporting requirements under -- under the 7 operating licenses. And so you're aware that -- that the -- 8 the City is required to report certain things to SERM? 9 A: That there are -- I -- I know what -- 10 that those exist. 11 Q: Yeah? 12 A: I know that SERM and the City's 13 responsible for making sure it happens. I don't necessarily 14 know the specifics of them. 15 Q: Okay. Now, you know those exist. Did 16 your office have any consultation with SERM over the 17 frequency of the things to be sampled for or the things to be 18 sampled for? 19 A: Perhaps Tim -- Tim did in the 20 consultations with SERM. But I don't -- I don't know that. 21 Q: Okay. 22 A: Usually -- a lot of these things are -- 23 are engineering technical types of functions. There -- 24 there's a relationship, I mean, engineers do know something 25 about the impacts of their activities on health without

106

1 having to be experts in health. And the guidelines are 2 developed in a way to try and address those. But it's an 3 engineering expertise often, for it. So -- 4 Q: Okay. 5 A: Anyway, I'm not much help there, sorry. 6 Q: Okay. Does SERM provide -- 7 MR. COMMISSIONER: Mr. Gabrielson's also 8 standing up at the moment, Mr. Hopley. I think I'm going to 9 -- I mean you're going to have to demonstrate more relevance 10 than you have to-date. 11 We've taken a lot of time with the doctor to 12 find out that he doesn't deal in those areas. You keep 13 asking questions and I think it should be obvious now what 14 the doctor's role is in the whole health system and he's not 15 a line person who's dealing with line decisions on every 16 project that comes along, et cetera. 17 I mean, I have no doubt about that. And 18 unless you have something you want to bring to his attention 19 that suggests he should have competence in an area, then 20 there's not much point questioning him on it. 21 MR. NEIL GABRIELSON: I -- I'm satisfied with 22 -- with that comment, Mr. Commissioner. What I'm -- what I'm 23 -- my concern is, in fairness to this witness, he has -- he's 24 not here to speak for the government's role as a whole. He's 25 here to speak for his role as the Chief Medical Health

107
  1  Officer.  And I think we're well beyond all of those --
  2                 MR. COMMISSIONER:   Hm-hmm.
  3                 MR. NEIL GABRIELSON:   -- areas.
  4                 THE WITNESS:   Maybe I should be flattered.
  5                 MR. COMMISSIONER:   You should be, you should
  6  be.  
  7  
  8  CONTINUED BY MR. SCOTT HOPLEY:
  9                 Q:   I take it that public health -- now,
 10  public health does an annual inspection of the water
 11  treatment plants that it's responsible for, under four
 12  thousand (4,000) gallons a day?
 13                 A:   They -- the plants that it's responsible
 14  for, that's generally true.  I -- whether some they do more
 15  often or just what the -- how each district manages that, I'm
 16  not sure.  
 17                 Q:   Okay.  Now -- and generally speaking,
 18  though, you don't understand public health to have any role
 19  in -- in monitoring the water treatment plants, not under
 20  your responsibility?
 21                 A:   Not the routine monitoring, --
 22                 Q:   Okay.  
 23                 A:   -- no.  We --
 24                 Q:   Now, I believe Mr. Boychuk referred you
 25  this morning to Dr. Benade's letter at tab 6 of his

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1 materials. 2 A: Yes. 3 Q: And there's a concern raised there that, 4 I think, just below the paragraph that he referred you to, 5 that environment officers of SERM no longer conduct routine 6 inspections of water treatment plants as they did in the 7 past. They only respond to complaints. Correct? 8 A: They -- they do res -- they do do routine 9 inspections, that's my understanding. What -- what number 10 they do and in what way, I -- I do not know that. 11 Q: Okay. But -- but as this concern worked 12 its way up the chain, I take it that there was 13 correspondence, if I could refer you to para -- to page -- or 14 tab 9 in Dr. Benade's materials? 15 A: Hmm-hmm. 16 Q: At the second page of that letter there's 17 reference to, sort of, what SERM's going to be required to 18 do, and in the third bullet it says: 19 _SERM will report water treatment system 20 failures that may create potential public 21 health risks to Medical Health Officers or 22 Senior Public Health Inspectors._ 23 A: Correct. 24 Q: Okay, and that correspondence is dated 25 June 14th, 2000?

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1 A: Correct. 2 Q: Okay, now not too long after that, 3 September 15th, 2000, at the next tab, tab 10? 4 A: Hmm-hmm. 5 Q: There's the interim procedure for 6 bacteriological follow up? 7 A: Yes. 8 Q: Okay, and that -- that sets out the 9 protocol for positive bacteriological tests? 10 A: Yes. 11 Q: Okay. 12 A: It doesn't -- it's not the broad -- the 13 way I view it is the first document is the broad relationship 14 issues and responsibilities. The second document is a 15 specific one (1) because of the need for much clearer 16 articulation around the protocol for bacteriological follow- 17 up. 18 Q: Okay, and so the first one (1), tab 9, do 19 you consider that to set a -- set a protocol so that SERM is 20 obligated to report those things to Sask Health? 21 A: Yes. 22 Q: Okay, and that's -- 23 A: Well, no to the -- not just Sask Health, 24 to the local district. 25 Q: Okay.

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1 A: So that an assessment from the health -- 2 I mean what, SERM recognizes that they have great expertise 3 in a range of issues but when it comes to the human health 4 implications, they may not have the same level of expertise 5 as -- as the Medical Officers for example. 6 Q: Okay, and so in -- you were active in 7 discussions about the development of that protocol? 8 A: I was involved in discussions at various 9 times around that and I would -- I would certainly support 10 that. 11 Q: There seems to be a bit of a -- a 12 contradiction, which may be not as great as I had thought as 13 it's your understanding that there may be some monitoring, 14 but was there any discussion over the difficulty of -- of 15 reduced inspections versus obligation to report? I mean if 16 -- if they're -- 17 A: The -- 18 Q: -- they're not finding out about them -- 19 A: No, you can't -- 20 Q: -- how are they reporting them? 21 A: Okay, from my perspective you cannot 22 depend on inspections in terms of this provision. This 23 provision relates to the fact that the municipal operator, 24 when they recognize a treatment failure of some kind, they 25 alert SERM and then SERM is obligated to inform the local

111
  1  Medical Officer or the senior inspectors so that some
  2  assessments and determination in terms of the potential
  3  health issues can be addressed.
  4                 Unless you're going to have a SERM inspector
  5  in every water treatment plant every day, there's still a
  6  requirement for some judgement and activity from the
  7  operator's perspective.
  8                 Q:   Yes, I think you said this morning
  9  judgement and intelligence?
 10                 A:   Something along those lines.
 11                 Q:   Yeah. Okay.  And this brings me to my
 12  last area, and it won't be long, but -- now I think you said
 13  yesterday that Milwaukee put crypto on the screen for public
 14  health and waterworks people?  I think those were your words?
 15                 A:   Oh, yes.  I'm sorry, yes.
 16                 Q:   Okay.
 17                 A:   Yes.
 18                 Q:   And I think it -- it -- I think that your
 19  description of what happened in the Battlefords Health
 20  District was, in terms of the -- the public health people,
 21  the response was text book I think you said?
 22                 A:   In terms of when they received
 23  information and how they used that information, yes. 
 24                 Q:   And -- and one (1) of the things I'd like
 25  to just go over here briefly is that in -- in public health,

112
  1  if I'm understanding what's being described here, there
  2  appears to be sort of an inter -- and a pretty well
  3  integrated interdisciplinary team going on?
  4                 A:   Yes.
  5                 Q:   And I think, you touched on this this
  6  morning but it -- it seems that the public -- well first of
  7  all public health inspectors, they're required to take a two
  8  (20 year certification course?
  9                 A:   I think it's three (3) years now.
 10                 Q:   It's not three (3) years?  Okay.  But in
 11  any event they benefit --
 12                 A:   Or actually it's -- I think it's a degree
 13  at Ryerson, a four (4) year degree now.  But anyways that --
 14  that-- that's neither here nor there, sorry.
 15                 Q:   Okay, but now the -- but in any event,
 16  regardless of whether they're -- they've changed the two (2)
 17  year course that the earlier witness took, it would seem to
 18  me that the Public Health Inspectors benefit from this
 19  collaborative approach to problem solving.  They're part of a
 20  team and they work with the Public Health Nurf -- Nurses, the
 21  Medical Health Officer, the epidemiologist?
 22                 A:   Absolutely.
 23                 Q:   And there's continuing legal education
 24  benefits to that, right?
 25                 A:   There's ongoing education, reading,

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1 discussions and practical experience and learning from that. 2 Q: Okay. And -- and, as part of that whole 3 package, Public Health inspectors who are -- are really the 4 -- they are the foot soldiers in your department, they're 5 capable of exercising that judgment and -- and to -- to -- 6 A: In -- 7 Q: -- barrier? 8 A: At the local health district, they are 9 the primary persons engaged in the environmental health work. 10 Q: Okay. 11 A: And they -- they have, just as Public 12 Health nurses in -- in their field, have a fair bit of 13 autonomy to -- to address issues or to raise issues as need 14 be. 15 Q: Okay. Now, the -- the -- Dr. Benade's 16 letter, that I just referred you to at tab 9 of his 17 materials, this -- the next bullet after the one (1) that I 18 read says, okay, is: 19 "SERM is moving forward with new 20 regulations that require all communities to 21 participate in the Operator Certification 22 Program." 23 A: Yes -- 24 Q: Okay. 25 A: -- as I understand it.

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1 Q: And -- and that, actually, I -- I think 2 the Act was -- was amended in July of 2000 to -- to bring in 3 a graduated certification requirement for operators. 4 Now, to your knowledge, has -- has SERM 5 consulted with Public Health on what content the 6 certification program for its operators should include? 7 A: I would think that there's been those 8 discussions with Tim Macaulay in particular, but beyond that, 9 I'm not sure. 10 Q: Okay. And -- okay. Now, are you 11 familiar with section 14(3) of EMPA? 12 A: I'm sorry, where are we now? 13 Q: Of EMPA? 14 A: I'm -- I'm -- 15 MR. COMMISSIONER: Section 14(3) of what? 16 17 CONTINUED BY MR. SCOTT HOPLEY: 18 Q: Environmental -- Environmental Management 19 and Protection Act. 20 A: Okay. Just lead me there and we'll have 21 a look. 22 Q: Well, let's see if I can find it. 23 A: If you can tell me the tab. I'm 24 presuming we're in the legislative binder now? 25 MR. COMMISSIONER: Yes.

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1 (BRIEF PAUSE) 2 3 MR. COMMISSIONER: The regulations or the Act 4 itself? 5 MR. SCOTT HOPLEY: It's in the Act, I 6 believe. 7 8 CONTINUED BY MR. SCOTT HOPLEY: 9 Q: Tab 8. 10 A: Tab 8, page 16, thank you. 11 12 (BRIEF PAUSE) 13 14 MR. COMMISSIONER: What's the question, Mr. 15 Hopley? 16 17 CONTINUED BY MR. SCOTT HOPLEY: 18 Q: Oh, well, I -- actually, I thought that 19 section specifically referred to the -- to the -- to Dr. -- 20 to the Chief Medical Health Officer, but in any event, that 21 section puts an obligation on or provides the ability for the 22 Minister of the Environment to consult with other agencies -- 23 A: Yes, and there is, if you look at 3, it 24 refers to the Medical Health Officer of the -- of the local 25 jurisdiction as an adviser and consultant to SERM and that's

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1 clearly so. 2 I mean, one (1) of the things I -- I should 3 say too is that SERM has responsibilities and expertise that 4 go far beyond me and I -- I would never see myself as being a 5 monitor of SERM per se. 6 I have pretty good expertise that can be 7 useful to them and vice versa, but in general day-to-day 8 activities, they carry that out. 9 Q: Okay. And so -- and this is my final 10 question then. In relation to the certification program of 11 operators, you anticipate that as part of a surveillance 12 program and protecting the integrity of the system, that 13 Public Health would be consulted on issues as to what these 14 operators need to know and what they need to be doing? 15 A: Eventually at some point I would expect 16 that SERM, in the development with the educational 17 institutions that are involved, are looking at similar 18 programs elsewhere which also would have input from -- from 19 the Health perspective to them. 20 At some point during its development, I expect 21 that there would be a conversation in terms of have we 22 adequately covered some of these areas? 23 But in terms of its basic development, et 24 cetera, I think that they -- there are many resources out 25 there that they would draw on.

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1 MR. SCOTT HOPLEY: Okay. Thank you. 2 MR. COMMISSIONER: Thank you. 3 4 (BRIEF PAUSE) 5 6 MR. COMMISSIONER: All right, Mr. Mitchell? 7 MR. ROBERT MITCHELL: Thank you, Mr. 8 Commissioner. 9 10 CROSS-EXAMINATION BY MR. ROBERT MITCHELL: 11 Q: I think you know I represent the -- the 12 workers in the water treatment plant? 13 A: Yes. 14 Q: I want to refer to the exchange that you 15 had this morning with Mr. Boychuk about the -- about whether 16 the treated surface water was meeting standards for the 17 period when the solids contact unit was, in the words of Pete 18 Allen, sub-optimal. That's a good term, I think. 19 And specifically, at least to my ears, you 20 spoke rather critically of the turbidity measurements? 21 A: Yes. 22 Q: I heard correctly? 23 A: Yes, you did. 24 Q: Yeah. And your criticism was that those 25 measurements have a capacity to measure turbidity --

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1 turbidity to a maximum of one (1)? 2 A: That's my understanding, in terms -- at 3 least in terms of the -- the -- 4 Q: Finished water? 5 A: -- the instrument in -- in Dr. Ellis's 6 testimony -- 7 Q: Yes? 8 A: -- there's reference to -- to that and 9 that it maxed out at one (1) which meant that it was one (1) 10 or higher. 11 Q: Yeah. And -- and what I want to ask you 12 is, are you aware that -- that the turbidity in the final 13 treated water is measured by another instrument as well? 14 A: I have heard that. 15 Q: Yes? 16 A: I won't say I know of all the details. 17 Q: Okay. I -- I just wanted to ask you 18 whether you were aware of that and whether you have looked at 19 the records, which are before this Inquiry, about the 20 turbidity reading from that -- that second unit? 21 A: I only know what I've been told. I did 22 not review them myself. 23 Q: And if those measurements were within 24 standards -- if those measurements were within standards, and 25 I think they were, would you then agree that the final

119

1 treated water from Water Treatment Plant Number 2, was within 2 standards? 3 A: If that is true, then it is within 4 standards. It does not, however, change my comment as it 5 regards to when you have a problem with a plant -- with a 6 unit, and you see increasing levels of turbidity from what 7 you normally see, that should trigger a response. 8 Q: Yes. And if -- and if there are no such 9 spikes in the turbidity level, then there would be no 10 response that you would expect to be triggered? 11 A: No, there would be, if, in fact, -- that 12 is only one (1) indication, okay? The other is the fact that 13 the flocculation unit was not working -- 14 Q: Ah, yes -- 15 A: -- which would be -- would be, in itself, 16 another. If I can use a medical analogy, when you've got a 17 patient lying on a respirator, you don't just look at the 18 standards. You also look as to whether or not the patient is 19 breathing and whether they still have a pink colour and 20 whether and whether and whether. 21 Q: Yeah. 22 A: And so it -- it -- 23 Q: I'm not sure your analo -- 24 A: -- requires an overall assessment. 25 Q: I'm not sure your analogy is apt but I

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1 get -- I get the message that you're trying to get across. 2 A: It's the only one (1) I could think of at 3 the time, I'm sorry. 4 Q: Now with respect to the -- the obligation 5 to report, which you referred to in your evidence and which 6 you've just referred to now, that is the -- that is the duty 7 that is imposed by section 21 of the Public Health Act, I 8 think? 9 A: Yes. 10 Q: Yeah. Would you be surprised to know 11 that no one has ever suggested to the water treatment plant 12 operators that they had such a duty? 13 A: Yes and no. I mean, again, because not 14 being familiar with all settings, where things happen, I know 15 there are many things that, in retrospect, we figure people 16 should know and should act on that they may or may not have 17 known at the time. 18 One (1) of the general -- and the reason for 19 that general provision is back to the encouragement that, if 20 people recognize any problem that might lead to a risk to the 21 health of the public, that that gets identified. It's 22 different in terms of those involved with waterworks in terms 23 of the potential impact of that because it's not just one (1) 24 or ten (10) people, it is hundreds and thousands. 25 Q: Of course.

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1 A: And so my hope would be that in their 2 training and in the support within their organization, that 3 that would be encouraged. 4 Q: Okay. Now you've said the -- that's the 5 no part of your answer which was yes -- yes or no -- yes and 6 no. On the yes side, would you be surprised if no one had 7 mentioned to these eight (8) operators that they had any 8 duties at all under the Public Health Act? 9 A: In terms of specification that it's a 10 Public Health Act requirement, that wouldn't surprise me -- 11 Q: No. 12 A: -- because there's no need for an 13 operator to know the -- the Act, but that they would not be 14 encouraged to -- to report problems and to address them and 15 to seek other advice as necessary, that would certainly 16 disappoint me. 17 Q: Would you expect that to be part of the 18 training that they received at SIAST or through the 19 Wastewater Association or with whoever is -- 20 A: Yes, and I -- 21 Q: -- providing that education? 22 A: -- would think that they would be 23 encouraged by their supervisors. 24 MR. ROBERT MITCHELL: Thank you. 25 MR. COMMISSIONER: All right, thank you.

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1 Mr. Scharfstein, are you up next? 2 MR. GRANT SCHARFSTEIN: I'll be very brief. 3 4 CROSS-EXAMINATION BY MR. GRANT SCHARFSTEIN: 5 Q: Dr. Butler-Jones, I want to follow-up 6 just a bit on the last question. We talked about what you 7 think or what your expectations would be of a plant operator, 8 I want to ask you what you think your expectations would be 9 of a Public Health inspector; what should, to your view, a 10 Public Health inspector know in the field in relation to the 11 issues of the water treatment plant? 12 A: In terms of -- they should -- they will 13 not have detailed knowledge of the operation of plants, they 14 will have a general knowledge in terms of different 15 constituents in the plant. They may not recognize the 16 terminology that is familiar to an operator or an engineer. 17 They should be in a position to, when there is 18 an encounter with a disease, to ask the appropriate questions 19 of the person in terms of trying to figure out the potential 20 sources, and then, with the assistance of the medical officer 21 as they gather evidence and as other workers gather evidence 22 eventually, hopefully they come to a determination; in many 23 cases, we never actually find the source. 24 This one (1), with the number of people and 25 the issues that are involved, we did, but there's many others

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1 we do recognize there are one (1), two (2), three (3) cases 2 for which we never actually find the ultimate cause. 3 Q: If you were told, prior to the 23rd or 4 24th of April, that there was a problem with the flocculation 5 and lack of settling in the solid contacts unit at the plant, 6 would you have recognized that as a potential for crypto and 7 giardia to get through the system? 8 A: I -- yes -- 9 Q: Would you expect -- 10 A: -- whether -- 11 Q: Go ahead -- 12 A: -- if I -- if I might say and then, if I 13 didn't, I would have asked the question then well what does 14 that mean. 15 Q: And your expectation of the Public Health 16 inspector out in the -- in the workforce, would he -- if he 17 or she would not have known specifically what that meant, you 18 would expect though they would follow that up with more 19 specific questions about what -- what is the process doing 20 and -- and could that cause a problem? 21 A: I would hope they would, but at the same 22 time I recognize that there are lots of questions that I wish 23 I had asked in the -- in my history. 24 Q: They usually come to me after I sit down. 25 MR. COMMISSIONER: Yeah, Mr. Scharfstein, on

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1 that point, there's already been discussion and I'm just 2 raising this so you can address it that, fine, perhaps the 3 operators or the owner/operators should be reporting to SERM 4 anytime there's a problem. 5 And, as I understood Dr. Benade, he said, yes, 6 we want to know when there's a problem, not from the point of 7 view of fixing it, but simply from the point of view, if 8 something else goes wrong, then at least we have that as a 9 clue. 10 MR. GRANT SCHARFSTEIN: Yes. 11 MR. COMMISSIONER: And I wasn't clear from 12 your questioning here whether you were suggesting that the 13 Health Department should, you know, be duplicating SERM, if 14 you wish, and if -- 15 16 CONTINUED BY MR. GRANT SCHARFSTEIN: 17 Q: Yeah, I wasn't specifically -- I was just 18 sort of generally -- I mean, my gut reaction is that I would 19 have hoped that a Health Inspector would know that, if he 20 hears of sedimentation or -- or settlement processes not 21 working, that -- that that's a health hazard specifically or 22 a potential health hazard? 23 A: Not -- I mean, quite honestly, not 24 necessarily because, again, the determination is based on a 25 whole range of pieces of information at the time of doing an

125

1 investigation and you hear something and you don't recognize 2 it. At the same time, you're thinking about these other 3 potential factors and recognizing that by and large most 4 causes of crypto are -- are outside of that. 5 You may not make that link between that 6 statement that you're not really familiar with and the issues 7 that you're addressing, so you may or may not recognize that 8 at the time. 9 Eventually, as the other pieces come in, you 10 may go back to that, but at -- in practical reality, I think 11 even diagnostically, it's often only in retrospect that you 12 recognize the significance of a test or a statement or an 13 event. It -- it would be nice if we were quicker on these 14 things, but it doesn't always happen. In fact, most often 15 it's only when you get the fuller picture that that becomes 16 clear. 17 Q: And I think the Commissioner had pointed 18 out that, at least prior to this incident, the protocol would 19 have been for someone at the plant to notify SERM of -- of a 20 malfunction had everything worked properly? 21 A: Well, yeah. Yes. And if it's not my -- 22 my area, the amount that -- attention I pay to it may vary if 23 I know there are others who are responsible. 24 Q: Certainly the protocol that we read and 25 have looked at and I think, again, alluded to by the

126
  1  Commissioner, is that at least at this point in time the
  2  protocol is if there's a breakdown, that report will also go
  3  to public health --
  4                 A:   Yes.
  5                 Q:   -- and not just SERM?  Correct?
  6                 A:   Absolutely.
  7                 Q:   Okay.  You had talked briefly about --
  8                 A:   But usually -- if I might say --
  9                 Q:   Sure.
 10                 A:   My normal expectation is that would come
 11  through SERM, okay?  Because -- and the reason for that, I
 12  mean, obviously if -- if -- if a plant operator -- this would
 13  be my hope, okay?  It's not a clear -- but my hope is if a
 14  plant operator recognized that there was problem, and they
 15  were unable to get in touch with SERM and they thought there
 16  was a potential health hazard, that they wouldn't wait until
 17  they were able to get in touch with SERM, they would call the
 18  Medical Officer.  Okay?  
 19                 Just -- they would avoid that.  But in
 20  general, it's better if it can go through SERM because they
 21  can then bring they're technical expertise that public health
 22  doesn't have, to that determination.  
 23                 Q:   Just two (2) other quick areas.  Talking
 24  about cryptosporidiosis.  It's a disease that's reportable
 25  under the -- the regulations, correct?

127

1 A: It is. 2 Q: And in fact, the other night you had 3 explained to me sort of how something gets on that list and I 4 don't need to go over that. But I was a bit concerned about 5 a comment you made this morning on timing. And in the timing 6 of this, whether you issue at twelve (12) hours or twenty- 7 four (24) hours, earlier than what in fact occurred -- 8 A: Yeah. 9 Q: -- you look at the nature of the disease 10 and -- and I can appreciate that this might not be as serious 11 a disease as some others. But you will acknowledge, I hope, 12 that cryptosporidiosis and certainly in immunol-compromised 13 people, can be fatal. Would you agree with that? It can be 14 a contributing factor to a death? 15 A: It can -- it can be a contributing 16 factor, absolutely. 17 Q: Very seldom would be a cause of death but 18 a contributing factor? 19 A: It can be, yes. 20 Q: And in a city of this size, certainly 21 there's no shortage of immunol-compromised people, correct? 22 A: In any city of any size, that's the 23 potential. At the same -- at the same time, I mean, for 24 example if you looked -- I've looked at the guidelines that 25 some physicians provide for their patients. If they do, in

128

1 fact, have a severe immunol-compromised condition, often they 2 will recommend that they boil their water in any case. 3 Q: That's not uncommon, as I understand it? 4 A: No, it's not uncommon. But again it's a 5 degree -- it's -- that's an individual patient situation 6 assessment. 7 Q: I just didn't want the impression left 8 that this wasn't a disease that you really had to worry 9 about? 10 A: Oh, no, no. I -- 11 Q: Okay. 12 A: It's -- it's -- as one (1) of the 13 factors, in terms of the -- the degree of severity and also 14 the practicality of getting out a notice that -- at midnight, 15 when you're not even certain, you're pretty certain but not 16 certain, it -- it just -- anyways. 17 Q: I appreciate that. 18 A: That information -- 19 Q: The last question or area I want to talk 20 very briefly about is, you had spent some time talking about 21 testing for cryptosporidium in both raw water and in finished 22 water, correct? And that you seriously questioned the 23 efficacy of doing that on a regular basis? 24 A: On a routine basis, yes. 25 Q: And in fact I think your evidence was

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1 that it probably -- it may be harmful if it's done on a 2 routine basis? 3 A: It has that potential. 4 Q: And we'll be hearing from someone from 5 the City of Saskatoon. And they do they're testing on a 6 monthly basis, as I understand it. And you've not discussed 7 with them why they do it or -- or anything of that nature? 8 A: I -- I think it -- well, if a 9 municipality chooses to do that for whatever their reasons, 10 and in their -- in their assessment, I'm not there to argue 11 them out of it, okay? 12 But in terms of its utility from a public 13 health standpoint, if you're looking strictly from the human 14 health impact of that or -- or the risk assessment of that, 15 it's -- it's low. I'm not going around to municipalities 16 saying, you must do this because it would not be appropriate. 17 Q: Are you familiar with the American 18 experience as sort of the Environmental Protection Agency, 19 EPA, there and they're requirements or guidelines at all, on 20 testing for crypto and giardia? 21 A: Somewhat, yes. 22 Q: Yeah. And I think they're -- they're a 23 little more towards the regular testing, would you agree with 24 that as a general principle? 25 A: For -- for very large systems.

130

1 Q: Just for very large systems? 2 A: Just for very large systems is my 3 understanding. 4 Q: Okay. 5 A: So if you've got, I mean, again, while 6 cryptosporidium itself is unlikely to kill, even in those who 7 are immunol-compromised, the risk is higher but is still 8 unlikely to kill. But you have a population of three million 9 (3,000,000) people, then even if the rate of death is one (1) 10 in hundred thousand (100,000) in three million (3,000,000) 11 people, that's still a lot of deaths. 12 Q: Yes. My -- my final question is, is your 13 view on testing for cryptosporidium in raw water or finished 14 water, would it be changed at all by the fact that thirty- 15 five hundred (3,500) metres upstream is a sewage plant 16 dumping effluent into the river? 17 A: In terms of the -- the testing? 18 Q: Yes? 19 A: No. 20 Q: Okay. 21 A: It would reinforce my -- my perspective 22 that being on top of the appropriate treatment is the 23 essential one. 24 MR. ROBERT MITCHELL: I have no further 25 questions, Mr. Commissioner. Thank you.

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1 MR. COMMISSIONER: Thank you. Well, doctor, 2 I thought we might get through with you this morning but it 3 doesn't look like -- 4 THE WITNESS: Not quite. 5 MR. COMMISSIONER: -- we are going to, based 6 on the fact there's still several counsel that may wish to 7 ask you some questions. So, we'll adjourn now and resume at 8 2:00 p.m. this afternoon. 9 10 --- Upon recessing at 12:21 p.m. 11 --- Upon resuming at 2:00 p.m. 12 13 MR. COMMISSIONER: Right, perhaps we'll get 14 the proceeding under way. Dr. Butler-Jones is in the stand 15 and Mr. Stevenson is the questioner. 16 17 CROSS-EXAMINATION BY MR. KEN STEVENSON: 18 Q: Thank you, Mr. Commissioner. Dr. 19 Butler-Jones I -- I'd like to just understand in what 20 position you are here today, and when you give evidence 21 whether that is your position or whether that is the position 22 of your department or the Department of Health? 23 A: I'm -- I'm presuming my role here is as 24 Chief Medical Health Officer and for my expertise on these 25 issues. So I do not speak on behalf of the Minister of

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1 Health and the Minister may choose to disagree with me on 2 issues of policy or whatever. 3 Q: Okay. 4 A: I'm here to provide my expertise. 5 Q: Okay, and primarily, I guess what I was 6 concerned with was not the matters dealing with the incident 7 but testing and looking at cryptosporidium and whether or not 8 there should be testing and raw water/treated water. 9 Am I to understand that is the personal 10 opinion, and not necessarily the position of the Department 11 of Health? 12 A: It relates to my expertise in these areas 13 and my position on them. Other than those items which 14 already some stated Ministry or government policy, they rest 15 as my opinion. 16 Q: Okay, and because I understand that Mr. 17 Thon Phommavong is a representative of SERM on the drinking 18 water subcommittee, the federal drinking water subcommittee, 19 is that correct? 20 A: He is, and Tim Macaulay from Health is 21 there in his capacity as it relates to another federal -- 22 provincial committee on plumbing. 23 Q: And it may be that Mr. Phommavong, 24 through his capacity, and on behalf of SERM, has taken a 25 different position on behalf of the province in connection

133
  1  with those subcommittee hearings is that --
  2                 A:   I'm not privy to those subcommittee
  3  hearings so I -- I don't know.  I -- I would -- if I may be
  4  so modest to -- to suggest that most of what I have said is
  5  reflective of the field of public health and the perspectives
  6  that are held in it.
  7                 Q:   In the province of Saskatchewan?
  8                 A:   Nationally and internationally.
  9                 Q:   Okay, and I don't want to go into this in
 10  depth, but as I understand it, there is a fair degree of
 11  pressure on the drinking water subcommittee to move into the
 12  area of testing.  And do those people not represent the
 13  interest of health and public safety?
 14                 A:   I'm not sure -- I'm not sure in your
 15  questioning, when you're talking about pressure in terms of
 16  testing for cryptosporidium or testing for --
 17                 Q:   Yes and other pro -- other -- other
 18  protozoas?
 19                 A:   Well I wouldn't be surprised if there
 20  isn't a bi-- I mean obviously from the questions here there
 21  is -- there is debate.  In terms of the public health
 22  perspective on it, I think I'm fairly reflecting what my
 23  colleagues would say from other jurisdictions.
 24                 And -- but decisions -- if I might interject,
 25  I do recognize that decisions that are made bring to bear a

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1 number of different perspectives and it is not simply the 2 public health perspective alone that is looked at in that -- 3 that whole thing. 4 Obviously it's a very serious important one 5 though. 6 Q: Right, and I guess that's all I wanted to 7 do is draw to the attention of the commission that there are 8 other interests and there might be different interests even 9 within the province of Saskatchewan? 10 A: Oh, I've no doubt that there are people 11 in this province who disagree with me on a whole range of 12 topics. 13 Q: And people, probably in the 14 administration, who would disagree? 15 A: No, I don't know that. 16 Q: Okay. 17 A: I have not, quite honestly, I have not -- 18 it has never been an issue of debate where I have found 19 disagreement. 20 Q: Okay, and you are, as you said, involved 21 in an advisory and an advocacy role for the department? 22 A: I'm hired by the government in that role. 23 Q: Right, and you are connected with the 24 policy branch? 25 A: That is where I am physically located

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1 yes. 2 Q: And as such you have input on policy 3 within Sask Health? 4 A: That's one (1) of the aspects of my work, 5 yes. 6 Q: Okay. In that connection, in the last 7 let's say five (5) years since you came here, have you made 8 submissions in respect of water quality and water quality 9 safety issues on an advisory or recommending capa -- 10 situation to Health? 11 A: I have been asked my opinion. I have been 12 involved in discussions, informal and otherwise, in my role 13 as the Chief Medical Officer. I have not done a -- authored 14 a report on drinking water safety. 15 Q: Okay, nor has anyone under your direction 16 authored a report? 17 A: No. And it wouldn't be at my initiation. 18 It's not likely that it would be at my initiation unless we 19 had seen it as a major public health threat because of 20 difficulties we're encountering. 21 Q: Okay. You were aware that there had been 22 a transfer of authority from Health to SERM in terms of 23 monitoring water quality and regulating water plants? Water 24 treatment plants? 25 A: That was in the `80s I think.

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1 Q: Right. 2 A: And that's quite consis -- actually it's 3 quite consistent with other jurisdictions did a similar move 4 in the `70s and `80s in one (1) way or another. 5 Q: Okay, and did you become aware that SERM 6 in 1999 was proposing to get out of that duty and 7 responsibility? 8 A: Basically, only -- in terms of what's 9 being said here, I was never of a sense that there was a 10 serious attempt to actually eliminate their role. There were 11 discussions that I'm aware of. I've never seen that they 12 came to anything, and in fact SERM was given additional 13 resources to ensure or improve their ability to meet that 14 mandate. 15 Q: And when was SERM given these additional 16 resources to meet the mandate? 17 A: That was over the past -- well since -- 18 since 2000. 19 Q: Since Walkerton? 20 A: Since Walkerton -- 21 Q: Right. 22 A: -- that's my understanding. 23 Q: And -- 24 A: I'm not sure what -- that's what I've 25 heard of, there may have been others before that time.

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1 Q: The events I'm addressing are prior to 2 Walkerton and you were familiar with those events? 3 A: I'm aware of them. 4 Q: Okay. Before I lead into that, were you 5 -- I'd like to just refer to a document authored by Peter 6 Thiele of SERM dated April 18, 1995, wherein he raises, in -- 7 in terms of a quarterly report, problems with a high number 8 of complaints and inquiries and he relates it to reduction of 9 inspection activities in water and sewage works area. 10 It's a Commission -- well, it's a document 11 which has the number 1019336 and I don't have the six (6) 12 digit number and I apologize for that; it's -- it's in SERM's 13 production, as I understand it. 14 I guess really all I'm -- where -- want to 15 know is whether, as a medical health officer, you had been 16 made aware of the issue being raised in SERM about problems 17 arising as a result of SERM's reduction in inspections? 18 A: At that time, I was still stuck in 19 Ontario. 20 Q: Okay. And, subsequent to your coming, 21 you -- you weren't aware of that? 22 A: It wasn't raised with me, no. 23 Q: Okay. 24 MR. COMMISSIONER: Do you want that entered 25 as an exhibit or?

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1 MR. KEN STEVENSON: No, Mr. Thiele will be 2 here later and I will -- 3 MR. COMMISSIONER: Yes. 4 MR. KEN STEVENSON: -- deal with it through 5 there. 6 I wonder if I might have document 107989 7 brought up please? 8 9 (BRIEF PAUSE) 10 11 CONTINUED BY MR. KEN STEVENSON: 12 Q: This is a memorandum dated December 23, 13 1999 from Glenda Yeates, who's Deputy Minister of Health as I 14 understand; is that correct? 15 A: She is. 16 Q: And she wrote a memo on December 23, '99 17 to Shaylene Salazar of the Department of Finance re SERM 18 proposal to eliminate drinking water standards; are you 19 familiar with that correspondence? 20 A: I don't think I am actually, no. 21 Q: Okay. So, as the Chief Medical Health 22 Officer, you were not consulted prior to the Deputy Minister 23 responding to a financial proposal or a budget submission? 24 A: I wouldn't say that because I'm not sure, 25 I may have been consulted, I mean, Tim or one (1) of the

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1 Assistant Deputies may have talked to me about this in terms 2 of does this make sense and I would given -- have given my 3 opinion, but I don't recall that conversation. 4 I mean, it's not unusual that that would 5 happen, but there's sort of several dozen issues a day and -- 6 and I don't -- I'm afraid I don't remember all of those 7 consultations. 8 Q: Okay, I appreciate that, but this would 9 appear to be a fairly significant issue in respect of public 10 health and safety dealing with who is going to regulate or 11 monitor water treatment and water quality in the Province. 12 A: I would not disagree with that, but, in 13 terms of do I see myself as the primary mover or actor in 14 that if I'm satisfied that the Department is carrying out 15 their work in terms of health and -- health raising the 16 issue, then I would, from there, probably go on and allow 17 them to do that work. 18 Q: Okay. And the Deputy Minister, in second 19 paragraph, says: 20 "We believe the proposal of some serious 21 potential implications with respect to the 22 maintenance of safe water supply in the 23 Province." 24 Would you have agreed with the Deputy 25 Minister's position?

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1 A: If -- if the proposal and, again, I'm not 2 familiar with the SERM proposal referred to here, if the 3 proposal would -- would, in fact, do that and put that at 4 risk then, of course, I would agree with the Deputy. 5 Q: Okay. But you didn't review it to see 6 whether or not it would have put -- 7 A: No -- 8 Q: -- health at risk? 9 A: -- generally those issues would be 10 reviewed by -- by Tim Macaulay and Louis Corkery and -- and 11 others at that -- trying to think of that time, in terms of 12 -- anyways, I -- I -- I don't have -- I have vague 13 recollection of discussions on that. But, unless I was 14 dissatisfied with the approach of the department, then I 15 wouldn't pursue it. 16 Q: Right. And the note does show that it 17 was copied to Tim Macaulay in Health? 18 A: Yes. 19 Q: So that -- in fairness. And just on page 20 2, if I might, the second bullet. Again, it says: 21 "If water safety is not monitored 22 adequately, concerns will only become known 23 after water related illnesses have 24 occurred. Dealing with such issues after 25 the fact rather than through preventative

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1 actions places the public at risk." 2 A: That's true statement. 3 Q: You'd agree with that? 4 A: I would. 5 Q: It goes on to say, in the next bullet: 6 "SERM currently has a mandate to maintain a 7 provincial water quality database to track 8 municipal water quality. How will the 9 government ensure that water quality 10 objectives are being met?" 11 Is that a legitimate question arising in that 12 circumstance? 13 A: Those -- that paragraph, those are all 14 legitimate questions to be asked. 15 Q: Thank you. 16 A: I don't know what the response was, 17 though. 18 Q: Okay. I wonder if I might have that 19 marked, Mr. Commissioner? 20 MR. COMMISSIONER: Do you have a hard copy of 21 it that we can mark? 22 MR. KEN STEVENSON: I do have a single copy 23 of it, yes. And then we can extras made. 24 MR. COMMISSIONER: Yeah. Yes, so it will be 25 C-30. And let's see, there will be a hard copy available

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1 shortly, I guess. Thank you. All right. That'll be C-30. 2 MR. KEN STEVENSON: Thank you. 3 MR. COMMISSIONER: A memo dated December the 4 23rd, 1999 from Deputy Minister Yeates to Department of 5 Finance. 6 7 --- EXHIBIT NO. C-30: A memo dated December the 23rd, 1999 8 from Deputy Minister Yeates to 9 Department of Finance. 10 11 MR. COMMISSIONER: Yes, thank you. 12 13 CONTINUED BY MR. KEN STEVENSON: 14 Q: If I might have document number 107992 15 brought up please? 16 17 (BRIEF PAUSE) 18 19 Q: And I suspect you probably haven't seen 20 this but I simply want to ask you if -- whether you have or 21 not? 22 A: I -- 23 Q: If we -- 24 A: I don't recall ever seeing it, no. 25 MR. COMMISSIONER: It's pretty hard to read

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1 without -- 2 MR. KEN STEVENSON: Could we get -- 3 THE WITNESS: Good thing I brought my 4 glasses. 5 6 CONTINUED BY MR. KEN STEVENSON: 7 Q: It'S a -- on the same area we were 8 talking about proposed program change, eliminate drinking 9 water standard program, and as I understand it, it's a 10 budgetary Treasury Board note? 11 A: It would certainly provoke a response. 12 Q: Right. And in that second paragraph, it 13 says: 14 "According to the Department, it recently 15 has narrowed it's focus to compliance 16 inspections where there are pressing 17 drinking water quality issues. Currently, 18 the department is proposing to delegate 19 responsibility for protecting water quality 20 to municipalities. Municipal governments 21 have legislated responsibility to provide 22 potable drinking water." 23 Was that general matter a subject of 24 discussion with you, within the Department of Health, at that 25 time?

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1 A: Specifically with me, I think there was a 2 conversation about, did I think that it was adequate simply 3 to have municipalities be both responsible for the provision 4 and their own monitoring. That does not often work. 5 Q: And you would have then, as I -- 6 A: So my advice back would be, no, I would 7 support the department's view that we need to have something 8 other than that in place. 9 Q: Right. If I might have that marked, then 10 please? 11 MR. COMMISSIONER: All right. The proposed 12 -- how is it headed up? Proposed program change which is 13 otherwise unsigned and not otherwise identifiable -- 14 MR. KEN STEVENSON: And if I might just have 15 the second page of that also brought up, just as a -- because 16 it is attached. 17 MR. COMMISSIONER: -- will be C-31. 18 MR. KEN STEVENSON: Thank you. 19 20 --- EXHIBIT NO. C-31: Proposed program change which is 21 otherwise unsigned and not 22 otherwise identifiable. 23 24 CONTINUED BY MR. KEN STEVENSON: 25 Q: And there reads than a recommendation:

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1 "Finance recommends Treasury Board 2 tentatively approve the elimination of 3 drinking water standard program which will 4 provide a cost savings of three hundred and 5 fifty thousand -- or three hundred and 6 fifty K ($350,000), 6 FTE's, pending advice 7 of Sask Health Municipal Affairs Culture 8 and Housing." 9 That would be a standard format as to a 10 recommendation coming for budgetary purposes? 11 A: I would think so. It -- it also does 12 make the point that Treasury is -- and Finance are not in a 13 position to assess the health implications and so that's why 14 they consult with other departments in government. 15 Q: Right, and I appreciate that and at some 16 time we'll find out where this ultimately went, but I -- I 17 really wanted to ask the question of what was going on in 18 government or within SERM at that time? 19 A: Yeah, and that's where, I think there are 20 -- will be SERM officials speaking and they could give you 21 better -- 22 Q: Right, but I want you then to go, and if 23 I could have document 107994 brought up, and it's a letter 24 from Saskatoon District health, public health services from 25 Dr. Cordell Neu -- Neudorf and Bryce Graham, you know those

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1 people do you? 2 A: Yeah. 3 Q: This is a letter addressed to yourself on 4 February 28, 2000? 5 A: Yes. 6 Q: And it's re: SERM legislative review? 7 A: Yes, I see that. 8 Q: You would have received that letter? 9 A: I would have and if -- I think if you 10 look in the top right corner it says to Louis Corkery, I 11 think, so -- 12 Q: You would have passed it off to him too? 13 A: Yes. 14 Q: Sent it -- 15 A: Right, yes. 16 Q: And I guess really the point on this is 17 it appears that people within the districts, Medical Health 18 Officers and other people charged with public health and 19 safety were responding to you as the Chief Medical Officer 20 about this proposal? 21 A: That's, at least in terms of as to the 22 extent that they understand it, yes. 23 Q: Right. Right, I appreciate that and 24 there was nothing submitted? It was simply proposal and 25 discussion at that point?

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1 A: Well it's -- it's -- I would assume from 2 this, which would make sense to me, that the -- the letter 3 from Glenda was copied to the districts. And the districts 4 are affirming their support for -- for the department's 5 position. 6 Q: Okay. If I could have that marked also 7 please? 8 MR. COMMISSIONER: All right, letter dated 9 February 28, 2000 addressed to Dr. Butler-Jones will be C-32. 10 11 --- EXHIBIT No. C-32: Document 107994. A letter dated 12 February 28, 2000, addressed to 13 Dr. Butler-Jones. 14 15 CONTINUED BY MR. KEN STEVENSON: 16 Q: If I could have brought up document 17 105663. And this is a memorandum from John Edwards, acting 18 assistant Deputy Minister of Municipal and Community Services 19 Division to Finance, re: Drinking Water Standards Program. 20 And I take it you probably haven't seen that 21 or have you seen it? 22 A: No, well not `til this moment, no. 23 Q: Okay. Were there discussions between 24 Health, to your knowledge, and Municipal and Community 25 Services Division concerning SERM's proposal?

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1 A: I would be surprised if there was not. 2 But I was not the person doing that. 3 Q: Okay, again contact would have probably 4 been Tim Macaulay or -- 5 A: Either Tim or Louis I expect or even 6 could have been ADM to ADM or, I mean there's -- there's a 7 fair bit of conversation that goes on, quite appropriately I 8 think. 9 Q: Right, and if we look at the second 10 paragraph, the second bullet they write: 11 _There is a conflict between the roles of 12 providing and paying an essential service 13 and setting minimum standards and 14 monitoring/policing the service._ 15 Would you agree with that? 16 A: Yeah, it's back to my prior comment. 17 Q: Right. 18 A: So yes, that's why we generally have the 19 regulator separate from the deliverer. 20 Q: Okay, and two (2) bull -- or another 21 bullet down. Two (2) bullets down. The 1995 study of 22 drinking water quality, which Mac was involved in, found that 23 there already were significant deficiencies. If anything SERM 24 should be allocating more resources to the function. 25 Were you aware of a 1995 drinking water study,

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1 quality study? 2 A: I understood that there were periodic 3 reviews that SERM does. I -- I don't recall actually ever 4 seeing that study. It was done before -- before I arrived. 5 I think the general statement is that SERM addresses the 6 priority areas in terms of where there are problems so -- 7 Q: And that study would be available in SERM 8 or within your department? 9 A: I expect there are people within the 10 department that -- that might have a copy but I -- I won't -- 11 I don't know. 12 Q: Okay, was there a -- another formal 13 drinking water quality study after `95, before 2001, to your 14 knowledge? 15 A: I thought there was one done just in the 16 last year or so -- 17 Q: Okay. 18 A: -- and that gave rise to the -- the Boil 19 Water Advisories that have gone out from SERM to a range of 20 -- quite a few -- quite a number of small communities 21 particularly. 22 Q: Was Health involved in that study? 23 A: Yeah, we were -- well, I'm sure there was 24 a lot of discussion with Tim, I was also involved in some 25 discussions on that and the implications.

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1 Q: Okay. 2 A: Yes. 3 MR. KEN STEVENSON: If I might this -- have 4 this marked also please. 5 MR. COMMISSIONER: All right. Memo dated 6 December 29th, 1999, from Acting Deputy Minister of Municipal 7 and Community Services to Finance will be C-33. 8 9 --- EXHIBIT NO. C-33: Memo dated December 29th, 1999 10 from Acting Deputy Minister of 11 Municipal and Community Services 12 to Finance. 13 14 CONTINUED BY MR. KEN STEVENSON: 15 Q: You were talking this morning about some 16 water quality objectives or guidelines and one (1) of the 17 issues touched upon was turbidity in the treated water going 18 into the distribution system. 19 A: Hmm hmm. 20 Q: And you were referring to the standard of 21 one point zero (1.0) NTUs? 22 A: Hmm hmm. 23 Q: Has the appropriate level for turbidities 24 of water and in the treatment distribution -- or the treated 25 water entering the distribution system been addressed by your

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1 department either prior to or since April '01? 2 A: I'm not sure what you're -- like, help me 3 please with the question, I'm not sure I understand. 4 Q: Well, there is a current municipal guide 5 -- the objectives are there. 6 A: Yeah, which -- which the standard is one. 7 Q: Yeah, and the Canada Water Quality 8 Guidelines are there -- 9 A: And that's being revised nationally. 10 Q: Still, the latest revision, March of this 11 year, still has one (1) though? 12 A: Yeah. 13 Q: Right. And I -- it's being revised. I 14 guess what I'm wondering is, within Health, have you looked 15 at that issue and, if so, have you had any input on what the 16 appropriate level for -- 17 A: Yes. 18 Q: -- NTUs would be? 19 A: Yes, I mean, my advice has been that the 20 debate nationally around reducing that down to something 21 closer to point three (0.3) is appropriate, given the issues 22 of parasitic infection. 23 Q: And you referred to the protocol for 24 removing the Boil Water and, in fact, that point three (0.3) 25 standard is what was required of the City of North Battleford

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1 in order to remove the Boil Water Order? 2 A: Yes. 3 Q: You made a brief comment to Mr. Boychuk 4 and I believe I remember correctly that the more turbidity, 5 the greater the risk of -- or the risk of exposure is higher; 6 is that a fair paraphrase of what you said? 7 A: Not exactly, the -- the point is that, 8 when you see turbidity as one (1) indicator of what's going 9 on in the system, when you see increases in turbidity, then 10 you should be thinking there's an increase -- a potential for 11 an increased risk. 12 Q: And -- but generally speaking also, the 13 higher the turbidity, even if it's not changing, the higher 14 the turbidity, the more probable that something is in the 15 water? 16 A: Well, that there's more stuff in the 17 water. 18 Q: Right, particulates of some sort? 19 A: Yes, which aren't quantified or qualified 20 actually. 21 Q: And I believe your position is that it's 22 probably more important to monitor water for fecal coliforms 23 or fecal particles than -- than cryptosporidium or other 24 parasites; is that? 25 A: In terms of -- if you have to pick one

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1 (1) thing to measure in terms of the potential for health 2 risk, then bacterial content in water, fecal coliforms and 3 that gang in particular, is the one (1) that you would pick, 4 but I wouldn't stop there. 5 Q: No, okay. There is in your binder, which 6 is C-27, at tab 6... 7 A: Is that, sorry, is that the legislative 8 binder? 9 Q: No, your -- your binder -- 10 A: Oh, mine -- 11 Q: -- of your evidence. I think it's 27, 12 yes, C-27. 13 A: In this one (1) there is nothing. 14 MR. COMMISSIONER: Nothing in mine either. 15 Oh wait a minute. 16 THE WITNESS: This is the witness binder and 17 there's -- 18 MR. COMMISSIONER: Cryptosporidium infections 19 in Saskatchewan? 20 MR. KEN STEVENSON: Yes, that's right, Mr. 21 Commissioner. 22 THE WITNESS: In 27, you said? There's 23 nothing in 27. Is there another -- 24 MR. COMMISSIONER: He must have a blank in 25 his volume then.

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1 THE WITNESS: I'm sorry. 2 MR. KEN STEVENSON: Tab 6 within that binder? 3 I'm sorry. 4 THE WITNESS: Tab 6, oh thank you, yes. I do 5 have a tab 6. And I do have a listing of cryptosporidium 6 infections. 7 8 CONTINUED BY MR. KEN STEVENSON: 9 Q: I just wanted to talk a bit about that 10 with you, if I could. This is a historical recording since 11 you've started assembling information? 12 A: That's correct. 13 Q: And you show the breakdown in 14 Battlefords, at the bottom line, for months? 15 A: Yeah, that was during -- just during 16 1994. 17 Q: Four (4). 18 A: Yes. 19 Q: Do you have available a breakdown as to 20 occurrence of cryptospordium in -- in the province by month? 21 Or can you give me just a general sense as to when it -- 22 A: Generally crypt -- in -- in general -- 23 Q: Yes? 24 A: -- crypto is a summer -- summer 25 experience.

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1 Q: And that in part relates to surface 2 waters and swimmers -- 3 A: Yeah, swimming -- 4 Q: -- and recreational use? 5 A: -- hiking, canoeing, et cetera, yes. 6 Q: Right. And do you have any records or 7 statistics dealing with occurrences of foodborne crypto in 8 Saskatchewan? 9 A: In terms of -- I don't remember a crypto 10 outbreak food wise in Saskatchewan. 11 Q: So is it fair to say that the outbreaks 12 that you've identified, insofar as they have been identified, 13 are water related? 14 A: The -- as an out -- outbreak? 15 Q: Yeah -- as -- 16 A: Beyond the sort of incidents -- general 17 incidents, the only real outbreak is North Battleford. 18 Q: Okay. But as I recall, in the summer 19 hearing you on the radio talking about people getting cases 20 of crypto this fall -- 21 A: Yeah. 22 Q: -- relating to -- 23 A: That was -- that was this -- this summer 24 and we were seeing cases scattered across the province which 25 appeared to be most likely related to -- it was largely kids,

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1 kids playing in pools. So it was a reminder to people that 2 swimming pools were not water for drinking. 3 Q: And if we look at tab 7 in that same 4 binder, please? 5 6 (BRIEF PAUSE) 7 8 CONTINUED BY MR. KEN STEVENSON: 9 Q: This is a breakdown by health district 10 for the occurrence of cryptosporidiosis? 11 A: Yes. And clumped into service areas. 12 Q: Right. Why does -- why do you keep these 13 records? 14 A: A couple of reasons. One (1) is just 15 back to the -- the notions we've talked about earlier of 16 surveillance, is that, so over time, you get a picture of the 17 patterns of disease that are endemic, which means the sort of 18 the base line levels of disease. 19 And when -- which helps you then in 20 recognizing when something is out of the ordinary. 21 Q: Okay. And did your department then 22 establish or keep what might be called a baseline and send 23 that information to the districts? 24 A: Health districts get -- get data on a 25 regular basis in terms of the reportable diseases.

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1 Q: Okay. So in April of '01, the records 2 from Sask Health about the occurrence of cryptosporidiosis in 3 this Battlefords district and service area, would have been 4 available to the medical health staff? 5 A: Yes. But it is -- it is in -- in delay. 6 So in April -- I'm not sure whether that would be the 7 February data or what it was that they had because there's a 8 -- a -- a cleaning process of data in terms of making sure 9 that we don't have three (3) reports on the same person, 10 those kinds of issues. 11 Q: Right. Seen in different health 12 districts -- health districts? 13 A: Well it -- it's -- for example if -- if I 14 have a stool sample taken when I go to the doctor and it's 15 positive for crypto, and then he decides to repeat the stool 16 sample three (3) weeks later and it's also positive, you need 17 to clean it for the fact there's still one (1) case. 18 Q: Right, okay. 19 A: Those -- those kinds of issues. 20 Q: So if we looked at the records available 21 and what that tab tells us, it shows in the year 2000, and it 22 was preliminary I appreciate, there had been one (1) case in 23 Twin Rivers in the Battleford service district? 24 A: That's correct. 25 Q: And 1999, again a preliminary, there had

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1 been one (1) case in the Battleford service district, in 2 Lloydminster? 3 A: Correct. 4 Q: And in 1998 there had been a total of 5 eleven (11) cases? 6 A: Correct. 7 Q: Okay, five (5) of which were -- occurred 8 in the Battlefords? And I take it the Battlefords is treated 9 as one (1) unit, not town of Battleford one (1) way and -- 10 A: Yeah, these are -- well these are health 11 districts, so the Battlefords Health District would include 12 the town, the city and surrounding area. 13 Q: Okay, so that -- that would show a 14 relatively low rate of occurrence, is that fair to say? 15 A: Yes. 16 Q: Over that period of time? Did you review 17 this to determine, kind of, the circumstances under which 18 those cases in this district had occurred? 19 A: Those would have been investigated at the 20 time in terms of -- as -- as Ken was outlining in terms of 21 the investigations that they do. Those cases would have been 22 followed by public health as well as our others. 23 Q: I guess just simply for this process, 24 you'd never reviewed those to consider -- 25 A: Oh me, oh no, no.

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1 Q: Yes. 2 A: I, no, there's no reason for me to. 3 Q: Okay. So the -- they -- those records 4 would be designed to provide background information for the 5 use by medical health people in the district? 6 A: Eventually. Again there's the -- the 7 incidents as they happen and then the investigation of those 8 incidents, over time we collect the data so we can understand 9 better the patterns of disease. 10 And depending on the issue we'll also 11 sometimes do generate reports in terms of looking at are -- 12 is it mostly children, is it mostly adults? 13 And that, for example, that gave rise to the 14 -- the notice this summer because a number of health 15 districts were seeing an increased number of kids with crypto 16 linked back to -- the common element was swimming pools, 17 water parks, those kinds of settings. 18 Q: Sure. Dr. Butler-Jones, is it fair to 19 say that it's well recognized that there's a significant 20 under-reporting for gastro illnesses? 21 A: Absolutely. 22 Q: Okay. 23 A: It depends on the -- it depends on the 24 illness though. For something like Shigella or E-Coli, ones 25 which give arise to bloody diarrhea, cholera were somebody

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1 generally is deathly ill, you get much closer to the accurate 2 numbers. 3 Milder illnesses, particularly viral illnesses 4 will be grossly underestimated. 5 Q: And any statistics on cryptosporidiosis? 6 A: In terms of what percentage of them 7 are -- 8 Q: Probabilities under-reported? 9 Q: It will vary. This year we will have a 10 higher percentage of them reported because you will have more 11 doctors looking for it. In low years you'll have a smaller 12 percentage reported because they're not -- and the same for 13 other diseases. You'll get a lot more diagnosis of measles 14 and an accurate diagnosis of measles in an outbreak than in 15 the interim times. 16 Q: And Dr. Ellis I believe rejected that 17 there had been about twenty-five (25) percent or thirty-one 18 (31) percent reported to physicians, a physician or went to 19 the ER -- 20 A: Of the -- 21 Q: so reporting that range, would that seem 22 likely? 23 A: In -- that's reasonable in the event 24 where there's a lot of public awareness and physician 25 awareness of something going on, yes. It -- it -- to some

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1 extent, and again we don't -- I won't say we know because it 2 -- to some extent it works both ways, depending on the bug 3 and depending on the communications on the issue. 4 In some outbreaks it actually will drop 5 because people -- now they know what the problem is that they 6 have. They don't feel that sick. They don't feel the need 7 to go to the doctor. 8 In others it increases it. I suspect in this 9 case it did because of the -- the number of people and 10 particularly the level of fear in the community that was 11 generated at the time. 12 Q: You used the word outbreak and do you 13 have a definition of what an outbreak is? 14 A: An outbreak is more than you expect. The 15 technical definition for an epidemic is one (1) more case 16 than you would expect to see. 17 And so that varies. If I saw a case of 18 smallpox in Saskatchewan, we would be in an absolute tither, 19 if I saw a hundred and fifty (150) cases of chickenpox, I'd 20 say oh, it's just another typical year. 21 Q: In your evidence, you made a comment, I 22 believe, that -- in response to Mr. Boychuk that one (1) of 23 the first things I would think of is the state of the water 24 supply; do you recall saying that? There are one (1) of two 25 (2) things I think you said you would consider and the first

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1 one (1) was the state of the water supply? 2 A: I'm sorry, I can't remember the context 3 of the question. If it was in the context of having had that 4 information that Gerharde provided in terms of no alternate 5 source, multiple cases, all of which are crypto and a large 6 number of other people ill in the community, then my first 7 assumption would be rule out water. 8 Q: Sure. And, if you in the course of doing 9 it had looked at water on a fixed date and thought, well, 10 perhaps the water supply in a community might be a relevant 11 factor and would you also look at other water distribution 12 systems in the community as part of your investigation? 13 A: Now, I'm not sure what you mean, if you 14 mean in terms of other -- does -- does everybody buy Culligan 15 and that kind of thing -- 16 Q: Right. 17 A: -- then -- then that would be one (1) of 18 the factors we'd look into -- 19 Q: Sure. 20 A: -- is that what you're getting at? 21 Q: No, I'm getting at the Battlefords as a 22 community. If you look at the Town of -- of Battleford's 23 water supply -- 24 A: Yes. 25 Q: -- and you're thinking water, should you

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1 -- and people are sick in the Battlefords, should you not 2 also be looking at the water supply in the City of North 3 Battleford? 4 A: If you're at the point where you're 5 starting to think of -- of water, you would start with where 6 your cases are. If you then started getting cases in both 7 communities, you would move very quickly to looking at the 8 water supply in both communities, but that would happen at 9 that time. 10 Q: The Battlefords is really one (1) 11 community though, I mean, people -- Dr. Benade lived in 12 Battleford -- 13 A: Works in North Battleford. 14 Q: -- and Startup lives in Battleford, works 15 in North Battleford? 16 A: Yes, but, quite honestly, when you have 17 two (2) cases or even three (3) or four (4) cases of a 18 disease which the most common cause is picking it up in the 19 environment somewhere as opposed to municipal drinking water, 20 it's not where you go first, I mean, what's the old saying, 21 you go where the money is. 22 Q: Yeah. If you go where the money is in 23 Battleford on the water supply, shouldn't you go for the 24 coins in North Battleford also? 25 A: I can't speak for Ken or Gerharde's

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1 thinking at the time, which sounded to me quite reasonable 2 because that was just one (1) of the things to look into and, 3 if finding that that was fine, you wouldn't necessarily jump 4 across the river. 5 Q: Right. Except you said, if you knew that 6 there had been persistently low chlorines in a water system 7 and they had had a Boil Water Advisory in the few months 8 before that, that would be something that you should take 9 into account? 10 A: Well, and I think eventually they 11 obviously did. 12 Q: Right, eventually, but perhaps not when 13 you were looking at water, you might have first of all went 14 to that system? 15 A: Well, but in terms of the assembly of 16 evidence, okay, and the process that you go through to try 17 and figure out what the source is, you're looking at 18 potential of a whole range of sources, right, so you're work 19 -- you're doing your elimination through that and the point 20 at which you pick off 'A' or 'Q' may get you there quicker or 21 slower, but it doesn't mean that those decisions were any 22 worse or better. 23 Q: But you said it was a textbook case and I 24 -- I assume -- 25 A: Yeah, in terms of how they approach the

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1 problem, it was -- it was as good as I've seen anybody 2 approach it. 3 Q: Okay. And I guess I'm wondering what 4 textbook we were talking about? 5 A: Well, textbooks of epidemiology and the 6 control of communicable diseases. 7 Q: Okay. And, in investigation of 8 communicable diseases, are there time lines when you ought to 9 be responding? 10 A: In most cases, it's an issue of judgment 11 we provide in terms of there are always discussions and, as 12 I've spoken of earlier, if -- if you get a call about a case 13 of meningitis, that's something you deal with immediately. 14 When -- when you get a lab report of crypto, 15 if you deal with it today or tomorrow or the next day, almost 16 never does it have an impact in terms of the individual's 17 health and it is exceedingly rare, even though we have 18 experience in a few communities, we're looking at half a 19 dozen communities in North America out of tens of thousands, 20 it is not a very common event, certainly North Battleford is 21 the exception. 22 Q: Right. And -- and crypto, after all, is 23 self-limiting so there's not a degree of urgency? 24 A: No, I wouldn't -- it's -- it's -- it's 25 self-limiting, it's unlikely to be disastrous. It doesn't

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1 mean you ignore it. 2 Q: Okay. 3 A: But if you've got something else going on 4 at the same time that's more likely to be a problem, I'd 5 probably wait until the next day. 6 Q: Even if you've got a -- an epidemic or a 7 -- lots of other things happening in your ER room, lots of 8 gastrointestinal -- 9 A: But I -- if I must say -- 10 Q: -- pharmacy anti-diarrheal's falling off 11 the shelves? 12 A: Well, except that as Dr. Benade 13 explained, when he looked into it, there was not evidence of 14 that at that time, based on the cases that he was seeing and 15 his conversations with physicians -- other physicians. 16 You -- I -- just as a -- as an example, every 17 year I get several calls a year from the media about, do you 18 know about this? Everybody at work is sick, the whole 19 community is -- is -- is home sick. And it's a perception. 20 Q: Sure. 21 A: And that's -- and when you investigate 22 it, you find, yes, there are a number of people sick but 23 it's, in fact -- even in the years when influenza was at it's 24 lowest, I had calls about, this is the worst we've ever seen 25 it.

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1 Q: Sure. 2 A: So it's -- you have to work through the 3 investigation before you go off on a handle. 4 Q: And I appreciate that and you have to 5 look at all of the elements, you have to make a -- 6 A: Hm-hmm. 7 Q: -- systematic surveillance and judgement. 8 You should look at ER records, you should call nursing homes 9 and talk to them, should you not? As part of your 10 investigation? 11 A: Well, it -- it -- depending on what it is 12 you're looking for and at what point in time you are. 13 Q: And you should have set up sentinel 14 positions to report to you in terms of things? 15 A: Well, we have -- we have, for certain 16 diseases, because influenza's is one (1) that's particularly 17 unique to anticipate, so we have sentinel physicians for 18 that. 19 In terms of other routine diseases, that's why 20 we have the reporting regulations. 21 Q: Okay. And you should monitor and look at 22 surveillance at the schools and day cares, attendances and 23 what's happening in those -- that environment? 24 A: If -- if you have an indication that 25 there's a problem, those are one (1) of the areas that you go

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1 for questions. But we do not -- and I don't advocate, that 2 you call every person -- possible school, nursing home, et 3 cetera, every week and say, do you have a problem this week? 4 It is not very productive. 5 Q: But if in the course of your 6 investigation by your PHI's, the word is a lot of sickness at 7 the schools, lot of diarrhea at the schools and you got 8 positive one (1), two (2) or three (3) cryptos, and that's 9 the word coming back, is that not a logical chain of inquiry? 10 A: I think they started to pursue those 11 events. So they were -- I mean both in the emergency 12 department and in talking to physicians -- 13 Q: Okay. 14 A: -- and it didn't bear out at the time. 15 Eventually it did. 16 Q: Sure. 17 A: But not at that time. Those -- the 18 questions that were asked were reasonable in the 19 circumstances. The avenues that they pursued were reasonable 20 under the circumstances. In retrospect -- 21 Q: Well -- 22 A: -- if we knew in advance we were going to 23 have an epidemic then we would act differently. But we never 24 know that. 25 Q: Okay. But with respect, Dr. Butler-

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1 Jones, I wasn't asking you about this case, I was asking you 2 if that's not what you should be doing in the course of an 3 investigation? 4 A: Yeah. And -- well, but I -- I think 5 you're coming back to this case. And my reference to this 6 case is a text book case and so that's why I'm referencing 7 this case. 8 Q: I think the Commissioner will have to 9 make his decision as to whether it was reasonable or not and 10 I -- 11 A: But -- 12 Q: -- I'm simply trying to lay the 13 groundwork of what you should look at. 14 A: No, I agree. I'm just telling you my 15 opinion, from a public health standpoint, that it was a 16 textbook case and we outlined that. The Commissioner 17 obviously will make up his own mind. 18 Q: And if -- if a report of a communicable 19 disease sits uninvestigated for seven (7) days, is that 20 textbook? 21 A: It -- quite honestly it depends on what 22 else is happening in the district. What else is on the plate 23 for the investigator and what that disease is. For a -- one 24 (1) case of crypto to not be investigated over a weekend, I 25 would not fault the inspector.

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1 Q: Okay. And if a public health 2 investigator has a report of a case of crypto, get's another 3 one (1) in the next day, confirmed positive from the lab, and 4 gives it to his fellow co-worker, should that person say, oh 5 by the way, I've just invested -- gated a case of crypto over 6 in the Battlefords yesterday? Should that be passed on? 7 A: I would -- usually that would be part of 8 the conversation, but not always. I don't know, I wasn't 9 there, I'm sorry. 10 Q: No, and I appreciate that. And we're all 11 by hindsight but, do you in the normal course of your duties 12 and as your responsibility to conduct reviews of case -- the 13 way cases are handled by the district Medical Health 14 Officers? 15 A: Not normally, no. 16 Q: No. 17 A: Now having said that, particularly when I 18 was more directly involved, I would have frequent 19 conversations with them in terms of the management of issues 20 and their approaches so that I became quite comfortable with 21 their general competence and ability to deal with issues. 22 Q: Sure, and you were called in as a 23 consultant on this case? 24 A: I was. 25 Q: Because there's no need for Dr. Benade to

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1 go to you? 2 A: I think it's a -- when you think you have 3 an outbreak, it is -- it is quite appropriate and expected 4 that you -- that you involve the province or at least advise 5 of us what's going on -- 6 Q: Sure. 7 A: -- because inevitably we'll get the calls 8 too. 9 Q: Okay. And normally do you come and 10 attend meetings, either by teleconference or otherwise, when 11 your looking at Boil Water Advisories or -- 12 A: Totally depends on the issue. 13 Q: Okay. 14 A: And the circumstance of it. Not -- not 15 necessarily, but there are times. And there are times when I 16 will interject myself because of the -- in the case of North 17 Battleford, it had implications beyond the community of North 18 Battleford, both in terms of people who were affected who ate 19 in the restaurants or whatever, as well as -- as it 20 transpires into an inquiry in terms of maybe there are issues 21 we can learn from this in terms of application elsewhere in 22 the province. 23 Q: Sure, and hopefully that's what is going 24 to happen out of this inquiry. Every party to it will -- 25 A: Absolutely.

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1 Q: -- have learned some things? 2 A: Absolutely. 3 Q: And I take it that Health has learned 4 some and I'm sure the City of North Battleford has? 5 A: You -- you never stop learning. 6 Q: Right. You -- you mentioned being 7 present -- I'm not going to belabour the meetings, but you 8 were present at these meetings on the 24th, 25th, 26th, by 9 teleconference only? 10 A: By conference call only. 11 Q: Only, yeah. 12 A: Yes. 13 Q: Right, and in the course of those 14 meetings is it fair to say that the city was, in effect, 15 asking some questions. I mean they -- they wanted to know 16 some answers also about what was going on in the health of 17 the city? 18 A: Yes. 19 Q: Right, and they wanted to know what the 20 connection was to water or why it was being tied in that 21 fashion? 22 A: Hmm-hmm. 23 Q: And what was told to them as to why it 24 was tied to water? 25 A: Basically as I've outlined here, which is

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1 the -- the epidemiological evidence, the experience from 2 elsewhere that would suggest that there is not another likely 3 source, and that's why we went for an advisory. 4 Even though we knew that North Battleford was 5 the only community on the surface water source, we did the 6 advisory in both because we weren't certain. 7 Q: Okay. 8 A: And it is conceivable that a Well could 9 have become contaminated as well. 10 Q: Sure, and I'm -- I'm glad you mentioned 11 surface water because I hadn't gone that route. We knew that 12 North Battleford's water system was in part supplied by 13 surface water, which is more likely to have crypto in it, 14 isn't that fair to say? 15 A: It is the more likely, yes. 16 Q: Right, and as a Medical Health Officer 17 that's something you should take into account when you're 18 looking at water supplies? Investigating crypto? 19 A: Yes, of course, sure. 20 Q: Now Dr. Butler -Jones, and I -- I don't 21 want to particularly to go into this area but I think it's 22 important for me to put on the record that you were asked 23 some questions by Mr. Boychuk concerning the sewage treatment 24 plant and relationship to the water plant? 25 A: Yes.

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  1                 Q:   I had reviewed your statement of
  2  anticipated evidence and I didn't see anywhere in there where
  3  -- that you were going to testify in that area.  Is that a
  4  recent development that you were now asked those questions?
  5                 A:   That was a question I was asked tomor --
  6  this morning and I thought that's a reasonable response from
  7  a public health standpoint.  A hundred and fifty (150) years
  8  of experience would suggest that --
  9                 Q:   Okay.
 10                 A:   -- that's not ideal.
 11                 Q:   Well, I guess I'm just surprised if there
 12  was much experience why it wouldn't have been in the Can Say. 
 13  Did you not discuss that with Mr. Boychuk prior to giving
 14  evidence?
 15                 A:   I can't remember that specific
 16  conversation.  We've talked about a lot of --
 17                 Q:   Sure.
 18                 A:   -- a lot of things.  I'm not sure, in
 19  terms of -- well anyways you can speak better to the issues
 20  of process there than I can, but I think the in -- from a
 21  public health standpoint it sure is relevant.
 22                 Q:   Oh sure, and it's -- it's relevant also
 23  that the Department of Health, fifty (50) years ago, built a
 24  water treatment number plant, two (2) plants, thirty-five
 25  hundred (3,500) metres downstream from the sewage effluent

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1 discharge? 2 A: Yeah, there's -- if I might -- 3 MR. COMMISSIONER: Well, okay. We have a 4 time problem and I meant to identify it earlier so, if it's 5 really important, then let's get into this debate, but 6 otherwise -- 7 MR. KEN STEVENSON: Well -- 8 MR. COMMISSIONER: -- it's -- you're arguing 9 with the witness at the moment and let's -- 10 MR. KEN STEVENSON: Well, Mr. Commissioner, 11 my only point is, if he says it's a health concern, I guess 12 it might have been a health concern fifty (50) years ago when 13 the Department of Health built the water treatment plants. 14 MR. COMMISSIONER: Well, why don't you just 15 put it to him as a question? 16 MR. KEN STEVENSON: And that's really what I 17 want to know. 18 MR. COMMISSIONER: So I take it, it would 19 have been the same concern fifty (50) years ago -- 20 MR. KEN STEVENSON: That's right. 21 MR. COMMISSIONER: -- when the Department of 22 Health put it there; yes or no? 23 24 CONTINUED BY MR. KEN STEVENSON: 25 Q: Would that have been the same concern?

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1 A: It would have been the same concern, with 2 the exception that there was a belief that engineering 3 solutions could address those problems -- 4 Q: Sure. 5 A: -- and ensuring the adequate treatment of 6 the water supply would -- would address that problem and, as 7 long as the plant was functioning properly, it would do that. 8 Q: Perhaps? 9 A: That was the -- 10 Q: Is that -- 11 A: -- I'm -- I'm speaking to what my 12 understanding of the belief of the time was. 13 Q: Sure. 14 A: Would you build a plant there today, I 15 don't think so. 16 Q: Right. And, even if your plant's working 17 optimally, no guarantee you're going to remove the critter -- 18 A: Oh, no, my advice would never have been 19 to put a sewage treatment plant a little bit upriver from a 20 drinking water plant, never has been, never would have been. 21 We're -- I'm -- you know, I'm speculating 22 about the time, I do know from records of the time there was 23 a tremendous belief in the ability of engineering solutions 24 to solve all humanity's problems; we've learned that that's 25 not always the case.

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1 Q: Yes. And, of course, there are other 2 sources of human fecal contamination beyond that plant 3 upriver; is there -- not correct? 4 A: Oh, of course -- 5 Q: Yeah, Edmonton -- City of Edmonton -- 6 A: -- even -- even Edmonton. 7 Q: Yeah. And -- 8 A: Though -- though they do work hard at 9 their effluent control. 10 Q: Sure. And the oocysts do survive though, 11 don't they, a long period of time and could easily flow down 12 that river too -- 13 A: They can, though over time you get a 14 dilution effect and -- and that's why proximity is important. 15 I mean -- I mean, the same issue is when you have a septic 16 system where you have septic beds and you keep the well a 17 certain distance, but it depends on the soils and some aren't 18 appropriate because you have fracture in the limestone, et 19 cetera, so all of those need to be considered in the decision 20 so it's -- the guidelines are -- are helpful, but there are 21 some exceptions to those. 22 Q: Yeah. And the source could be anyplace 23 upriver? 24 A: The potential source could be anywhere 25 upriver, generally you go to the closest source.

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1 Q: Okay. 2 A: Because dose -- because dose is 3 important. 4 Q: But not -- you haven't done any 5 investigations of this aspect? 6 A: Not specifically, though I was told by 7 the City -- 8 Q: Well -- 9 A: -- they have sewage coming into their 10 water treatment plant from time to time, it's unlikely that 11 that would be from any other source than the sewage outflow. 12 Q: Who in the City told you that when? 13 A: On the conference call. I don't know who 14 it was because I didn't know the players, but it was from the 15 City. 16 Q: And when did they say they had sewage 17 coming into the treatment -- 18 A: When I asked about -- because the 19 question came up in terms of the fact that the sewage plant 20 was upstream, so I was asking about, if there was any 21 evidence, did they ever have evidence when, because there are 22 issues of dilution and -- and that and -- and flow and so we 23 were clarifying the point of is there ever times when you 24 have evidence that there was sewage actually at the intake 25 and I was told that, yes, in fact, they -- from time to time

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1 they do. 2 Q: Okay. And you don't know who told you 3 that? 4 A: It was from the City, but I don't know 5 who. 6 Q: And did they say when they had last had 7 an occurrence of that? 8 A: No. 9 Q: Okay. 10 A: No, the only comment was recent, but not 11 -- you know, is that two (2) weeks or two (2) months, I don't 12 know. 13 Q: And just one (1) last area before I leave 14 it. You were asked about and you've referred continually 15 through your evidence about the obligation of someone at the 16 water plant to report to SERM if something -- some piece of 17 equipment is not working properly -- 18 A: That's -- yes. 19 Q: -- and where is your understanding of 20 where that obligation arises under? 21 A: My understanding that obligation relates 22 to the operator of plants in terms of when there is a system 23 malfunction, that they -- they should be advising somebody. 24 Q: Okay. Is there a statutory requirement, 25 is that what you're suggesting?

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1 A: I -- I mean I'm not as -- I'm not 2 familiar with SERMs Regs, but my understanding is that that's 3 an expectation. 4 Q: Okay. 5 A: And it's a reasonable expectation -- 6 Q: Oh, that might be, but I guess what I'm 7 -- you referred to it as an obligation and I guess I wondered 8 where you -- 9 A: Okay. 10 Q: -- based that statement on? 11 A: Well, even if -- okay, I'm quite 12 comfortable with that because, even if it is not in SERMs 13 regulations, in our Act, anything that someone is aware of 14 that may pose a potential hazard is reportable to Public 15 Health, for example, and in terms of those of us who are 16 charged with the responsibility of looking after things on 17 behalf of the public, I think we do have an obligation to 18 advise the public or others who are responsible when we do 19 have a problem. 20 Q: Well, my question then, is, can you tell 21 me when the Department of Health has at any time investigated 22 a malfunction of a piece of equipment that might have 23 affected water quality at any place in the Province of 24 Saskatchewan? And when they ever enforced section 21 on the 25 basis which you're proposing?

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  1                 A:   I don't -- I don't know about that
  2  because normally Health is not the one (1) who's directly
  3  involved.  That provision is in place to address the issue
  4  and -- and increase the likelihood that people, in fact, will
  5  act in a way which we think -- most people would think is
  6  reasonable.  In terms of --
  7                 Q:   And no one's arguing about that --
  8                 A:   Can I just -- let me just -- let me just
  9  finish.  I've been in the province only six (6) years, okay? 
 10  I'm not intimately involved with those prosecutions and
 11  actions that SERM have carried out.
 12                 Q:   Okay.
 13                 A:   I have worked in other provinces where,
 14  in fact, we have been -- I have been involved with
 15  municipalities who are not properly treating their water
 16  supply and we addressed that directly.
 17                 Q:   Sure.  And that, from the regulatory
 18  standpoint, is commendable.  But what you're saying is that
 19  someone knows there's a health hazard and first of all,
 20  that's a presumption that you know there's a health hazard --
 21                 MR. COMMISSIONER:   Well, Mr. Stevenson, I
 22  think -- to the extent section 21 of the Health Act is there,
 23  Dr. Butler-Jones has indicated how he regards that section
 24  and the evidence is pretty clear that your clie -- the
 25  operators at the plant didn't know about the section, I don't

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1 think there's much argument about that. 2 And -- 3 MR. KEN STEVENSON: Well, -- 4 MR. COMMISSIONER: -- whether they should 5 have known about it or not, or whatever, that's another 6 matter. 7 MR. KEN STEVENSON: Well, and I think even 8 more clearly, I think they didn't know about any health 9 hazard. And that's where the onus comes from and that's what 10 I'm trying to pursue is that it's knowledge of a health 11 hazard that's -- 12 MR. COMMISSIONER: Well it depends on how you 13 interpret the evidence of the operators. I mean I'm not 14 going to get into that and I certainly don't have an opinion 15 on it because I haven't reviewed it. 16 MR. KEN STEVENSON: And there's -- there is 17 in the permit, as I understand it, a specific obligation on 18 the City to report a malfunction of its chlorination 19 equipment. And that's specifically in the permit. 20 21 CONTINUED BY MR. KEN STEVENSON: 22 Q: Is that what you were thinking of, Dr. 23 Butler-Jones? 24 A: No, that's not because that's 25 specifically with chlorination and it's more in terms of when

183
  1  there is a problem with the treatment process, that's where
  2  even -- and now, I'm not the regulator here so you can
  3  dismiss it if you like but from my perspective, when you have
  4  a problem with a piece of equipment which is essential to the
  5  protection of the health of the public, and you have a
  6  problem, you don't ignore it.  
  7                 Q:   Okay.  Now, as I understand it, there are
  8  many systems which exist and function in the Province of
  9  British Columbia which are coagulation, filtration systems,
 10  direct filtration systems, and they operate on a standard
 11  basis, without any sedimentation process involved at all.
 12                 Are you familiar with those systems?
 13                 A:   I am.
 14                 Q:   Okay.
 15                 A:   And the public is told about them.
 16                 Q:   Sure.  And -- but they are permitted and
 17  operate under --
 18                 A:   At -- yes, they can.  My issue, from a
 19  health standpoint, is if -- if the coagulation system is down
 20  and it's not working, people need to know who can act on it. 
 21  And in B.C., people know that their system does not remove
 22  cryptosporidium and the people know and they're advised so.
 23                 People did not have that assumption here in
 24  North Battleford when they had that problem.  And so they
 25  continued to drink the water.

184

1 Q: But did people in North Battleford have 2 any assumption about cryptosporidium, prior to this outbreak? 3 A: Well, it's not -- 4 MR. COMMISSIONER: Well, listen, we're 5 getting too far afield, Mr. Stevenson. This argument, that's 6 fair enough. 7 MR. KEN STEVENSON: I appreciate but I'm also 8 getting voluntary things about the state of affairs which I'm 9 not sure are helpful. 10 MR. COMMISSIONER: Yeah. But I -- 11 MR. KEN STEVENSON: Those are the only 12 questions I have. 13 THE WITNESS: Well, do -- do -- if I'm 14 speaking in a way which is inappropriate or unhelpful, I 15 don't mind being -- 16 MR. COMMISSIONER: No, no, you were being 17 asked -- Mr. -- you were engaged in a debate which is valid 18 enough and I was just indicating that we'd covered the area, 19 basically. 20 THE WITNESS: Okay. Thank you. 21 MR. COMMISSIONER: Thank you. All right. 22 After -- who's to next question Dr. Butler-Jones? Mr. Young? 23 THE WITNESS: You mean we're not done? 24 MR. COMMISSIONER: Two (2) more, two (2) more 25 to go.

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1 THE WITNESS: It's okay, I'm just kidding. 2 3 (BRIEF PAUSE) 4 5 CROSS-EXAMINATION BY MR. GARY YOUNG: 6 Q: Doctor, under cross-examination by a 7 counsel, I believe it might have Mr. Scharfstein, a question 8 was put to you relating to Public Health Inspectors and it 9 may be that the question was intended as a hypothetical as it 10 was not said to reflect evidence that has been led before 11 this Inquiry. 12 However, the question went something like 13 this. If a Public Health Inspector was told that there was a 14 floc problem and a settlement problem at a water treatment 15 plant, would you expect that Public Health Inspector to 16 understand that there was a possible risk to the water 17 supply? 18 And I believe your answer, at least in part, 19 was that you would not necessarily expect a Public Health 20 Inspector to identify this as meaning that there was a 21 problem. 22 Do you have a general recollection of what it 23 is that I'm referring to? 24 A: Yes, I do. 25 Q: Okay, and I hope that I've stated it

186

1 accurately so far as I've gone? 2 A: Sounds close to me, yes. 3 Q: Okay. Now if indeed the Public Health 4 Inspector was told by the owner of the plant that there was a 5 floc problem, with no mention of there being a problem with 6 settling, and was also told as part of the same conversation 7 that there were no problems with the quality of the water 8 being produced by the treatment plant, would that reinforce 9 or influence your answer as to what you might expect from the 10 Public Health Inspector under the circumstances? 11 A: I would expect that in the vast majority 12 of cases the inspector would take that on face value. 13 Q: Okay, I have no further questions, thank 14 you. 15 MR. COMMISSIONER: All right. Mr. Tochor? 16 17 CROSS-EXAMINATION BY MR. MICHAEL TOCHOR: 18 Q: I just have one (1) area, Dr. Butler- 19 Jones. Do you still have exhibit C-30 in front of you? 20 That's the letter of December -- I'm sorry the memo of 21 December 23rd, 1999, from Glenda Yeates, the Deputy Minister 22 of Health? 23 A: No, I don't, but I -- I do now. 24 Q: And I take it, just to summarize, that 25 was a proposal to eliminate the drinking water program.

187

1 That's what you understood from being referred to it? 2 A: Yes. 3 Q: And I take it that proposal was never 4 followed through to your understanding, is that fair? 5 A: Correct. 6 Q: I think you earlier indicated that quite 7 to the contrary there were additional resources given to 8 SERM? 9 A: Correct. 10 Q: And that in fact that proposal was not 11 acted on and it appears that SERM was going in the opposite 12 direction, is that fair? 13 A: I'm sorry, please restate that. I'm not 14 sure I caught it. 15 Q: Wasn't that good of a question. I take 16 it that the proposal not being acted upon, and reviewing that 17 additional resources went to SERM -- 18 A: Right. 19 Q: -- it appears that SERM was going in the 20 opposite direction of that proposal, is that fair? 21 A: Oh, in a positive direction you mean, 22 yes. 23 Q: Certainly, an op -- opposite direction 24 from that proposal? 25 A: Oh yes, yeah, yeah.

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1 Q: I worded that -- 2 A: Gearing up rather than down. 3 Q: I worded that awkwardly. 4 A: Okay. 5 Q: I'm sorry. That's all I had. 6 A: No that's fine. I do understand thank 7 you. 8 MR. COMMISSIONER: Thank you. Mr. 9 Gabrielson? Well, I believe that concludes the parties who 10 were entitled to question. Any re-examination Mr. Boychuk 11 MR. CHRIS BOYCHUK: No, Mr. Commissioner. 12 MR. COMMISSIONER: All right, and Dr. Butler- 13 Jones thank you for your evidence. 14 THE WITNESS: My pleasure. 15 MR. COMMISSIONER: And for being here over 16 the last day or two (2). 17 To counsel, I'm not sure, we're going to I 18 gather hear next from Dr. Young, who has, if at all possible 19 we're going to see -- try and have him come -- or we're going 20 to have him try and complete it in his evidence today, which 21 may mean we'll sit past five o'clock. 22 Now if that's a major problem to anyone, it 23 won't be past five o'clock on the basis of examination-in- 24 chief but we are not expecting that all cross and 25 examination-in-chief will be accomplished by 5:00, and so I'm

189

1 just alerting you, if that's a major problem then perhaps you 2 can tell Mr. Russell. 3 And otherwise I think at this point it's 4 reasonable to take -- well make it a ten (10) minute break at 5 this point rather than fifteen (15). 6 7 (WITNESS STANDS DOWN) 8 9 --- Upon recessing at 3:05 p.m. 10 --- Upon resuming at 3:17 p.m. 11 12 MR. COMMISSIONER: All right, Mr. Boychuk, 13 and this is Dr. David Young? 14 MR. CHRISTOPHER BOYCHUK: This is Dr. Eric 15 Young. 16 MR. COMMISSIONER: Eric Young, sorry. 17 THE REGISTRAR: Would you hold the Bible in 18 your right hand please. 19 20 ERIC ROBERT YOUNG, Sworn: 21 22 THE REGISTRAR: Give your full name to this 23 Inquiry. 24 DR. ERIC YOUNG: Eric Robert Young. 25 THE REGISTRAR: And spell your last name.

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1 DR. ERIC YOUNG: Y-O-U-N-G. 2 3 EXAMINATION-IN-CHIEF BY MR. CHRISTOPHER BOYCHUK: 4 Q: Good afternoon, Dr. Young. 5 A: Good afternoon. 6 Q: I understand that you are the -- 7 currently the Deputy Chief Medical Health Officer for the 8 Province of Saskatchewan? 9 A: That's correct. 10 Q: And in that capacity you're employed 11 within the Population Health Branch of the Department of 12 Saskatchewan Health; is that -- 13 A: Yes. 14 Q: Okay. And that you -- your appointment 15 as Deputy Chief Medical Health Officer was in June of 1997? 16 A: Correct. 17 Q: And that that position is a -- was a 18 newly-created position at that time? 19 A: Yes. 20 Q: And you are -- so you are the first 21 Deputy Chief Medical Health Officer that the Province -- 22 A: Yes. 23 Q: -- has had? Okay. And, subsequent to 24 that, I understand that you are -- or in April of 1998 you 25 were appointed Director of the Communicable Disease Control

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1 Unit of the Population Health Branch? 2 A: Correct. 3 Q: And that, prior -- prior to your 4 appointment as the Director of the Communicable Disease 5 Control staff reported to Mr. Louis Corkery, who is the -- 6 formerly did your function as a Director of the Communicable 7 Disease Control Unit? 8 A: That's correct, actually a new unit was 9 created called the Communicable Disease Control Unit which 10 was formed by a union of the Communicable Disease Control 11 staff and Surveillance staff and the TB Control Program so I 12 took on the administrative directorship of the Province's 13 Tuberculosis Control Program as well. 14 Q: So -- so that unit was created at the 15 time you became the Director, it was a new creation? 16 A: That's correct, and I -- as I recall, 17 that was in May 1998. 18 Q: Okay. And I understand, as far as 19 reporting within the Department, you report to Mr. George 20 Peters, who is the Executive Director of the Population 21 Health Branch? 22 A: Yes, I do currently. 23 Q: And prior to coming to Saskatchewan in 24 1997, you were the Associate Medical Officer of Health and 25 Director of Communicable Disease at the Scarborough Health

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  1  Department in -- in Ontario?
  2                 A:   Director of Communicable Disease and
  3  Clinical Services --
  4                 Q:   Okay.  
  5                 A:   -- at Scarborough Health Department,
  6  that's correct.
  7                 Q:   Okay.  And in terms of your educational
  8  background, you're a medical doctor?
  9                 A:   Yes.
 10                 Q:   And you obtained your medical degree from
 11  the University of Ottawa in 1974?
 12                 A:   Correct.
 13                 Q:   And after graduating, you've been in
 14  private practice on and off from 1974 --
 15                 A:   I took --
 16                 Q:   -- private practice --
 17                 A:   -- I took three (3) years post graduate
 18  training including one (1) year of internal medicine
 19  residency --
 20                 Q:   Okay.  
 21                 A:    -- then did locums for a couple of
 22  years.  And then after was in my own family practice, in
 23  Newton (phonetic), Surrey, British Columbia from 1980 until
 24  1992 when I went back to specialize at the University of
 25  Toronto.

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1 Q: Right. And the -- when you went back to 2 the University of Toronto, that was to specialize in 3 community medicine? 4 A: Correct. 5 Q: And that you obtained your Masters of 6 Health Science Degree in Community Health and Epidemiology 7 form the University of Toronto in 1994? 8 A: Correct. 9 Q: And that's the same degree that Dr. 10 Butler-Jones has, isn't that correct? 11 A: Yes. 12 Q: Okay. And also in 1994 you received your 13 certification in Family Medicine from the College of Family 14 Physicians of Canada? 15 A: Yes, I wrote my Family Practice specialty 16 exams as a practice eligible physician. 17 Q: And in 1996 you were admitted as a Fellow 18 of the Royal College of Physicians and Surgeons of Canada as 19 a specialist in community medicine? 20 A: Correct. 21 Q: Okay. And that currently you hold 22 licences to practice medicine in Ontario, British Columbia 23 and Saskatchewan? 24 A: Yes. 25 Q: Okay. Now, if -- and I -- and I produced

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  1  for the benefit of the Commission, at tab 11, your CV. 
  2  That's your CV that you produced to me, just for reference?
  3                 And I'm looking at tab 12, Dr. Young, and this
  4  is a -- it's called "Autoscope (phonetic) Job Assignment".  I
  5  just want to briefly -- is this a description of the types of
  6  duties you have as the Deputy Chief Medical Health Officer
  7  for the province?
  8                 A:   This is the job description that was
  9  created when my position was created as Deputy Chief Medical
 10  Health Officer.  At that time the position was designed to
 11  serve as the Deputy Executive Director of the Population
 12  Health Branch reporting to Dr. David Butler-Jones with the
 13  Directors reporting to me.
 14                 That was because Dr. David Butler-Jones was
 15  also working with the Primary Health Services Branch as its
 16  Executive Director.  So it was written to reflect that.  So
 17  there are some things in there from 1996 or '97 when this was
 18  written that no longer apply.
 19                 Q:   Okay.  Well maybe we'll touch on those. 
 20  But just in broad stokes, I understand, as I read this, one
 21  (1) of your fundamental responsibilities, as a public health
 22  expert, is to provide leadership to health care providers in
 23  the province on public health matters, including communicable
 24  disease control?
 25                 A:   That's correct.

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1 Q: And that's still part of your job 2 function? 3 A: Yes. 4 Q: And also that, to provide direction and 5 management to the Population Health Branch with primary 6 emphasis on disease and injury prevention? 7 A: Well, that was the original intent with 8 respect to the management aspect of that. 9 Q: Okay. 10 A: But when Dr. David Butler-Jones returned 11 as Executive Director, we created a communicable disease unit 12 and from that time I managed the unit staff and the TB 13 control program directly. 14 Q: Okay. Well, that's fine. One (1) of the 15 important part of the -- the thing is, I see here is, 16 identifying priority issues and developing and implementing 17 provincial policies and strategies. That's still a -- a 18 major part of your function? 19 A: Yes, it is. 20 Q: The policy development? And that's 21 identifying public health issues and developing policies to 22 deal with those issues? 23 A: Correct. 24 Q: Okay. Now I also understand that you are 25 designated as the coordinator of communicable diseases

196
  1  pursuant to section 13 of the Public Health Act?  
  2                 A:   That is correct.
  3                 Q:   And as the coordinator, you have the
  4  overall responsibility in terms of carrying out the
  5  province's, or, I should say, Saskatchewan Health's
  6  obligations under the Public Health Act in relation to
  7  communicable disease control.  Is that correct?
  8                 A:   No, I don't that's correct.  
  9                 Q:   Okay.
 10                 A:   The Act specifically states that there
 11  are -- there's one (1) function for the communicable disease
 12  control person and that is to receive the information on
 13  communicable diseases from the Medical Health Officers,
 14  public health officers --
 15                 Q:   Okay, that's one (1) of the -- one (1) of
 16  the duties you have as coordinator, then?  And that's a
 17  statutory duty that you have, right?
 18                 A:   Under the Act that is, I think, the duty
 19  that is legislated under the Act, as Director of the
 20  communicable disease control unit, I have many
 21  responsibilities.
 22                 Q:   Okay.
 23                 A:   But I think the coordinator of
 24  communicable is disease is a specific term used only in the
 25  Act so that Medical Health Officers and Public Health

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1 Specialists can provide me at CD control with -- 2 Q: I think I was conflating the two (2) and 3 I -- 4 A: Yeah. 5 Q: So I'll -- I'll just separate them. 6 A: Okay. 7 Q: But, okay, let's just talk about your job 8 as a director -- 9 A: Right. 10 Q: -- of communicable disease control in the 11 province. Is the -- is the management in control of 12 communicable disease does that have a -- a water safety 13 component to it? 14 A: The water safety area is the main 15 responsibility of the Health Protection Disease Prevention 16 Unit, or Disease Prevention Health Protection Unit, of which 17 Louis Corkery is the director and Tim Macaulay is the manager 18 of environmental health. 19 The communicable disease control unit and that 20 unit work very closely together so that we'll talk frequently 21 about issues that cross our directorships. 22 Q: Okay, but what I was getting at -- as -- 23 as the director of Communicable disease control, though, 24 water safety is a -- is a concern for someone that occupies 25 that responsibility or has that responsibility?

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1 A: Yes. 2 Q: Because often communicable disease can be 3 waterborne? 4 A: Absolutely. 5 Q: That's right. 6 A: Okay. 7 Q: So in a sense the things that you do in 8 your unit, although maybe not directed solely to water 9 quality, have a -- water quality is an important issue? 10 A: I think we focus mainly -- we focus on 11 the communicable disease aspects of any environmental or 12 other type of communicable disease threat. 13 Q: So in terms of water issues, your focus, 14 just to paraphrase, is on communicable disease control and 15 management, those kinds of things? 16 A: Correct. 17 Q: And can you tell us briefly what kinds of 18 activities the unit is involved in, in terms of, I understand 19 surveillance is one of the most important aspects of 20 communicable disease control? 21 A: Correct. The unit is -- the unit is 22 involved in many functions. One of those key functions is 23 surveillance as you described. Another key function is the 24 management of the vaccine programs for the province of 25 Saskatchewan, the contract negotiations for those,

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1 purchasing, distribution, that type of thing. 2 We also manage the tuberculosis control 3 program staff and issues in that respect. We are also 4 expected to conduct research on diseases that are of 5 particular interest to the province. 6 So we've assisted with a number of research 7 projects on HIV, injection drug use, that type of thing. We 8 are responsible for producing reports on epidemiology as part 9 of the surveillance and we feed those back to the health 10 districts. 11 Q: Okay, anything in terms of, you say, 12 doing studies on diseases. Any thing specific to waterborne 13 pathogens? 14 A: No, we haven't been involved in 15 waterborne pathogen research. 16 Q: Now, you -- you did state that you're not 17 directly involved in setting standards for water -- water 18 quality, do you perform any kind of consultive role in that 19 regard? 20 A: I would consult if I'm asked to consult. 21 Q: Okay. 22 A: So if Tim Macaulay's working on an area 23 that he considers -- that he needs my expertise or input, he 24 will come and ask me. 25 Q: Okay, what about consultation from SERM.

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1 Is that something that will happen from time to time? 2 A: We've had a lot of consultation with SERM 3 since Walkerton has happened. 4 Q: Okay, prior to Walkerton? 5 A: No, prior to Walkerton, Tim was the lead 6 in the -- in the branch on that. 7 Q: Okay, so far as you, as the Deputy Chief 8 Medical Health Officer, your involvement in water quality 9 issues, in terms of providing consultation to SERM would be 10 around the time that the Walkerton outbreak occurred? 11 A: That's correct. And the advice would be 12 to Tim, to our executive director, to SERM, so it wouldn't 13 just be limited to advice to SERM. 14 Q: Okay, so in terms of providing that 15 advice, is it primarily through Mr. Macaulay and Mr. Corkery? 16 You mentioned those two (2) individuals. Is that how you 17 would get your input to SERM on water -- 18 A: They take -- 19 Q: -- water sampling. 20 A: They take the lead on that, but I was 21 present at a number of meetings with SERM officials. 22 Q: Okay. Now, can you tell me, as I 23 understood, we've heard some evidence already, but the 24 primary responsibility for the management and control of 25 communicable disease, we understand, rests with the local

201
  1  authority, is that -- is that correct?
  2                 A:   That's correct.
  3                 Q:   So can you tell us what -- what is the
  4  function that your unit then plays in -- in terms of control
  5  and management of communicable disease?
  6                 A:   One (1) of the major control aspects of
  7  our unit is that of the Province's vaccine programs.  We --
  8  we provide all of the publicly-funded vaccine for the vaccine
  9  preventable diseases that are currently covered in the
 10  Province, so four hundred thousand (400,000) doses a year and
 11  $4 million budget; that's one (1) of our largest aspects of
 12  prevention.
 13                 The main function that have with respect to
 14  most communicable diseases is to provide Provincial
 15  surveillance and provide feedback back to the health
 16  districts to liaise with the Federal Government and provide
 17  them with our Provincial numbers after they've been
 18  reconciled by the health districts, to work with other
 19  provinces when there are outbreaks that may cross provincial
 20  borders, to work with Health Canada, such as David has been
 21  doing in this last couple of days on issues like Anthrax --
 22                 Q:   Right.
 23                 A:   -- which cross national borders; that
 24  type of thing.
 25                 Q:   Okay.  In terms of the way the

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1 surveillance worked though, is it -- is it fair to say that 2 the structure of it is provided for in the Public Health Act 3 and the Communicable Disease Control Regulations? 4 A: Correct. 5 Q: And, again, it works in a way local to 6 Provincial, the Act or the Regulations mandate reports on 7 notifiable communicable disease to you as Coordinator of 8 Communicable Disease Control? 9 A: Correct. 10 Q: Okay. And what -- what does your unit do 11 with this data once it receives it? 12 A: It depends on how we receive the data. 13 There are a couple of health districts in the Province that 14 have computerized their communicable disease information and 15 what they do is they provide us with a diskette of that 16 information on the follow-up on communicable diseases that 17 they do in their notification process. 18 Many of the health districts, however, appear 19 not to have that capability and so they will provide us with 20 hard copies of a -- of a laboratory slip which advises us of 21 the patients' name, address, telephone number and the type of 22 disease which we will do the data entry on ourselves so we're 23 actually doing quite a lot of data entry at a Provincial 24 level for a number of districts that aren't able to do that. 25 We also receive most of our communicable

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1 disease notifications through an initial lab slip from the 2 Provincial lab which is extremely good at providing us copies 3 of those lab slips. 4 Q: Okay. And so do you, in terms of the 5 data you receive, is this data tracked in any way or what -- 6 what does -- I -- I just don't assume that you're collecting 7 the data just for the sake of collecting the data? 8 A: No, we have a reason for collecting the 9 data. 10 Q: That's -- that's -- I should have just 11 asked you what's the reason for collecting the data? 12 A: But what happens is the Communicable 13 Disease staff, under the legislation, receives the data 14 within two (2) weeks or so, from the Provincial laboratory we 15 receive it sooner, and the districts -- it depends on the 16 workload of the health districts, but I would say by and 17 large we receive the data in a fairly timely fashion from the 18 health districts. 19 That data is then given to a data entry clerk 20 for those pieces of data that have to be done specifically by 21 us. That person then prioritizes the data entry along with 22 other responsibilities and does the data entry which usually 23 is done within a week or two (2). 24 Once that data entry is done, then we collate 25 the data with the computerized information that we receive

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1 from some of the larger health districts. Once we have done 2 that, then we send back the unreconciled preliminary data to 3 the health districts for reconciliation. 4 We will give the health districts, you know, a 5 month to reconcile the data and then send it back to us as 6 fully reconciled data. We hope -- and generally we do get it 7 back fairly quickly, within that month period of time, but 8 sometimes it's a little longer, depends again on the -- on 9 the staffing of the Public Health Unit. 10 Q: Okay. And I understand that -- 11 MR. COMMISSIONER: I'm not sure I understand 12 what reconciling the data means; I can guess, but? 13 THE WITNESS: I'm sorry. Reconciling the 14 data is basically part of data cleaning so there are a number 15 of health districts, it is possible that -- that information 16 that we receive might be from two (2) health districts on a 17 single patient because the patient might have been diagnosed 18 in one (1) health district, have a family physician in 19 another health district and live in another health district. 20 So quite often we may -- we may get data that, 21 you know, is triplicate, duplicate so we -- we send it back 22 to the districts to say these are the numbers that we have 23 been provided, we collect the data by place of residence of 24 the patient so then it goes back to the district, they look 25 through all of their reportable diseases that they have

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1 provided to us, they go through the numbers that we have 2 given them -- given them and then they say, well, no, we've 3 got one (1) more case, you know, we forgot to send you this 4 one (1) or, no, this is a duplicate from another health 5 district so it's been counted twice, et cetera, and that 6 takes quite a bit of time to do. 7 MR. COMMISSIONER: All right, okay, thank 8 you. 9 10 CONTINUED BY MR. CHRISTOPHER BOYCHUK: 11 Q: And I understand then you generate a 12 monthly report that goes out to all the Health Districts that 13 provides a summary of the numbers of cases of notifiable 14 communicable disease within the Province; is that -- is that 15 right? 16 A: It is a report by month, as opposed -- 17 Q: Right. 18 A: -- to a monthly report. 19 Q: Okay. 20 A: There's a distinction there. The report 21 is done on a month by month basis, but when it goes out to 22 the Districts, it depends on how much data we have coming 23 into us, it depends on the form that that data is in, it 24 depends on staffing issues, et cetera. 25 But we do sent it out every month back to the

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1 -- we send out a monthly form back to the Districts for 2 reconciliation and then they send it back to us. 3 Q: Okay, and at tab 14, there's a number of 4 monthly reports and we have them -- those are the example of 5 the -- those reports by month that you spoke of? 6 A: That is correct. And those are the 7 typical reports that we send back for reconciliation. 8 Q: And I -- I see that the -- the reports I 9 had go up -- take us through to March of 2000 or the end of 10 March 2000, is that the last report for all the data that's 11 been reconciled, is that -- or you -- 12 A: That -- that -- to my knowledge that's 13 the last reconciled data that we have. But we -- we have 14 sent out reports in May and June for the month of April, May 15 and June I think it is, for reconciliation. 16 So we are still -- the data has come back from 17 the Health Districts, but now it's simply a matter of the 18 staff reconciling it with our own databases and then we will 19 send out a final report to all of the Health Districts. 20 Q: Okay. And can you tell me though, 21 specifically in relation to control of waterborne disease, 22 what is the value of this surveillance system that you just 23 described to us? 24 A: The value of this is that you need 25 baseline data, good surveillance data before you can make

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1 appropriate judgments on what you need to do with respect to 2 your system in the reduction of communicable diseases. 3 If you don't have really good baseline data, 4 month by month, year by year, you can't look at trends, you 5 can't look at emerging patterns and emerging illnesses. 6 You can't say, my goodness, this year we've 7 had a hundred (100) cases of this particular disease and 8 we've only seen five (5) of them over the past ten (10) 9 years, what's going on. 10 You need to pull that together at the 11 Provincial level, and then we take that data at the 12 Provincial level and we send it to the National level, and 13 they pull it all together to look at National trends. 14 So they look at, you know, what's changing in 15 each Province, what's changing in the Country as a whole, and 16 then they look at what's going on internationally in that 17 sense, internationally after that. 18 Q: Okay, so you're talking about monitoring 19 for trends and things like that. How specifically might that 20 assist say a local Medical Health Officer in trying to 21 identify a potential problem with communicable disease, water 22 -- and waterborne or otherwise within his -- the areas he's 23 responsible for? 24 A: Well I think what it does is it provides 25 the local Medical Health Officer with as many years of data

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1 and reports that we've sent out as is -- as available. 2 So for example, that table that you were 3 referring to previously, which had I think it was seven (7) 4 or eight (8) year set of data for cryptosporidium -- 5 Q: That's the one (1) that Dr. Butler- 6 Jones -- 7 A: Right. 8 Q: -- was referring to? 9 A: That was brought together from all of the 10 data that was sent out on a regular basis. 11 And so what we do at the end of the year of 12 each year, is send out a report for that year end, with all 13 of our reconciled data to all of the Health Districts. 14 So they will receive an annual report, they 15 will know of all of the communicable diseases that are 16 reportable within the Province for the whole year, by Health 17 District. 18 And they can keep files of that so that it can 19 go back as long as we have been sending these reports out. 20 Q: Okay, and for example, the one (1) that's 21 in the binder is for cryptosporidiosis in Saskatchewan, 22 that's the one (1) that was -- that you're referring to? 23 A: That was a special report pulled 24 together -- 25 Q: Okay.

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1 A: -- just for cryptosporidium. 2 Q: So that's not something you do on a 3 regular basis for each disease? 4 A: No. The annual report pretty much looks 5 like the reports that you've indicated in tab 14, except 6 it'll give the final numbers for the year by Health District, 7 as opposed to by month. 8 Q: But the report includes all of the 9 notifiable diseases as set out in the regulations; is that 10 right? 11 A: It -- it doesn't include them all, it 12 doesn't include those for which we've had no cases -- 13 Q: Right -- 14 A: -- by and large. 15 Q: -- okay. 16 A: So there may be -- there are seventy (70) 17 reportable diseases under the Communicable Disease 18 Regulations under the Public Health Act, and we don't have 19 seventy (70) communicable diseases listed here, so those 20 diseases for which we've had no cases tend not to go on here 21 unless it's a specific disease of interest. 22 Q: But not -- notwithstanding that, any 23 medical -- local Medical Health Officer can use this data and 24 pick a disease like cryptosporidiosis and have a good feel 25 for what's happening.

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1 If it's happening -- you should know what's 2 happening in your own District, but this also gives them the 3 province-wide picture as well? 4 A: That's correct and it also gives the 5 staff the picture. 6 Q: Okay. Would it also -- this data, also 7 be of assistance in identifying whether you had a potential 8 water quality problem in your district? For example, if you 9 were seeing over and over again increased numbers of a 10 waterborne pathogen? 11 A: I think it would be very helpful for 12 that. I think what the Medical Health Officers do and their 13 staff do is look at these statistics -- I mean they produce 14 these statistics in the first place and provide them to us. 15 So we're just feeding them back what they know 16 already basically. 17 Q: Okay. 18 A: But we give them the provincial picture 19 as well. But this allows them to go through their types of 20 disease, look at what diseases are suddenly changing, and 21 then to act upon that. 22 For example we had an outbreak of HIV that was 23 noticed in Prince Albert in 1997 and at that time the local 24 Medical Health Officer contacted us. We arranged for a 25 research study with Health Canada and found that a lot of the

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1 symptoms related to some injection drug use and found a lot 2 of Hepatitis-C, et cetera. 3 So these reports that they produce, they 4 actually are seen first. They look at their numbers, then 5 they can look around the province and say, oh my goodness, 6 this is quite a lot higher than we'd expect here. And then 7 follow up on the necessary action. 8 Q: Right. By comparing what's going on with 9 the rest of the province you can see if you've got a higher 10 incidence and it may be a problem? 11 A: That's correct, and also comparing to 12 previous years in your own area. 13 Q: Okay. In terms of your relation to the 14 local Medical Health Officer, we heard from Dr. Butler-Jones 15 that's -- they are -- are independent and report -- Medical 16 Health Officers don't have report to you other that the 17 obligation to send you report on communicable disease in 18 their district, is that right? 19 A: Officially, that's correct. But they do 20 consult frequently on a wide variety of issues and we have 21 very good communication through the Medical Health Officer's 22 council as well. 23 Q: Okay, and that's something that you sit 24 on? 25 A: Yes.

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1 Q: And that's a body of all the local 2 Medical Health Officers in the province? 3 A: That's correct -- 4 Q: And -- 5 A: --and the provincial Medical Health 6 Officers such as myself , Dr. David Butler-Jones, Dr. William 7 Osei all are ex officio members. 8 Q: Okay. And you said they would -- they 9 can consult with you, so in that sense you're a resource for 10 local Medical Health Officers? 11 A: That's correct. 12 Q: In the area of communicable disease 13 control? 14 A: They could call for a number of issues, 15 it doesn't have to be related to communicable disease control 16 specifically, but it tends to be and David tends to get the 17 calls for the more general issues. Plus he gets a lot of 18 calls for CD issues as well. There's just so much going on 19 that it takes two (2) of us. 20 Q: Okay. Now and you said they'll contact 21 you directly and -- and we have an example of that, and I 22 want you just to look at Dr. Benade's binder if you could. 23 And that's -- that's at tab 8. 24 And what I'm looking at is a letter form Dr. 25 Benade to yourself dated June of 2000. And it related to a

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1 request for additional resources to enable, enhance the 2 health district involvement in water quality moni -- just 3 reading the title of the document. 4 And attached to it is a -- it looks like a 5 briefing note. And what I understand and maybe you could 6 tell me -- from -- you received this memo, did you not? 7 A: Correct. 8 Q: Okay. Did -- did you -- did you 9 subsequently discuss the memo with Dr. Benade? 10 A: No, we had had discussions prior to his 11 sending the memo. 12 Q: Okay, so you knew the memo was coming? 13 A: I didn't know the memo was coming. We 14 had had discussions in some of the Medical Health Officer 15 meetings -- 16 Q: Okay. 17 A: -- about the concerns that some of the 18 Medical Health Officers felt with the -- the -- the word that 19 seemed to be indicating that SERM might be pulling back from 20 dealing with water issues. 21 Q: Okay. 22 A: So there was quite a lot of concern at 23 the MHO group and I think Dr. Benade expe -- expressed his 24 concern in this letter. 25 Q: Okay, and if -- if you look at the memo

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1 at page 2 it say -- there's a proposal part at the bottom. 2 And specifically I'm looking at paragraph number 1. It says 3 he's looking for increasing staffing levels of the Public 4 Health Inspectors by one (1) full time position. One (1) of 5 the purposes to monitor SERM operated municipal water 6 systems, in community -- in communities that do not routinely 7 submit water samples by sampling and enforcing standards; and 8 can you tell me, in terms of your discussions with Dr. Benade 9 exactly what his -- his concern there was? 10 A: Well, actually, I think he expressed it 11 well when he was on the stand. His concern here was to 12 advise me of the general concerns with respect to SERM 13 pulling back and pulling out of water quality issues, so I 14 took this as information which confirmed what he had told me. 15 Q: Okay. Now, did -- but what I understand 16 is he was looking for more -- he though they would have to 17 fill the gap that was going to be left by SERM. Isn't this 18 what -- what the memo is about, he's looking for -- to you to 19 maybe lobby for an extra -- extra funding for an extra Public 20 Health inspector? 21 A: Yes, as he said on the stand, he was 22 concerned about SERM pulling out and the gap it would create 23 and, if that did occur, he would be looking for more Public 24 Health inspection capability. 25 Q: Did it occur?

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1 A: No, it didn't occur, as a matter of fact, 2 as is listed in other areas of this binder, there were quite 3 a number of things going on within Saskatchewan Health and 4 SERM to address those issues so actually SERM ended up with 5 much more staff, which gave them quite a bit more capability 6 than they currently had. 7 Q: Okay. So, in your mind, did that address 8 that particular concern that Dr. Benade had? 9 A: Yes, it did. And also I think Dr. Benade 10 knows -- knew, and as did his CEO to whom this was copied, 11 that the Population Health Branch doesn't line by line fund 12 health districts so, you know, I did not view this as a 13 request for funding from us. 14 The responsibility for assigned staff, et 15 cetera, are the responsibilities of the health district and 16 it would be in discussions between Dr. Benade and the Chief 17 Executive Officer where that would be dealt with. 18 Q: Okay. And the -- if you just look above 19 the proposal -- the heading Proposal on page 2, there's -- 20 the next bullet point said health districts would not be 21 aware that a municipal water supply is a health hazard unless 22 the municipality or SERM notified us of problems with 23 treatment procedures; that was another concern he was 24 expressing. Was -- were any steps -- was any steps taken to 25 direct -- to address that concern or were any steps being

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1 taken at the time? 2 A: Yes, I took this information that he 3 provided to me to Mr. Louis Corkery and we discussed it and 4 you'll see that that particular issue is addressed in the -- 5 in at least one (1) of the memos I sent to -- one (1) of the 6 memos that I wrote commenting on the Cabinet information 7 item. 8 Q: Okay. And also, though -- and we'll get 9 to the Cabinet information item in due course, but if you 10 look at tab 9 of Dr. Benade's binder? That's a memo dated 11 June 14th, almost around the same time that Dr. Benade's 12 passing his memorandum on to you? 13 A: That's correct. 14 Q: And it's signed off by yourself and Mr. 15 Corkery? 16 A: Correct. 17 Q: And is this a memorandum you prepared 18 with Mr. Corkery? 19 A: Actually, Mr. Corkery prepared this memo. 20 Q: Okay. Would you have had input in terms 21 of the substance of the memo? 22 A: Yes, the comments that I had made 23 previously and the comments on the Cabinet information item, 24 which I sent to Tim Macaulay, undoubtedly were seen by Louis 25 and, because many of the items that I had mentioned are --

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1 are included in this memo -- 2 Q: I -- I notice they're -- they're almost 3 identical. And I guess you're looking -- just so everybody's 4 on the same page, looking at tab 18 of your binder; are you 5 referring to the -- the memo that you prepared June 1, 2000? 6 A: Oh, in my binder, just a sec. 7 Q: Yeah, sorry. 8 A: I'm still looking in Dr. Benade's binder. 9 That's -- June -- sorry, which one? 10 Q: I'm looking at tab 18. 11 A: June the 1st? 12 Q: Yeah. 13 A: Correct. 14 Q: Okay. So what you're saying is a lot of 15 the items in this June 14th memorandum at tab 9 of Dr. 16 Benade's binder were adopted from your -- your memo of June 17 1st? 18 A: I think quite a few of them. 19 Q: Okay. And, as I look at the first bullet 20 point on the June 14th, again, Dr. Benade's concern was 21 notification on a potential problem with water treatment. 22 The first item there is Medical Health Officers or Senior 23 Public Health Inspectors for the eleven (11) local 24 authorities will be sent all first positive bacteriological 25 tests from water sampling in municipal systems?

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1 A: Correct. 2 Q: And, in your mind, did that address the 3 concern that Dr. Benade's raising in his briefing note to 4 you? 5 A: Which particular concerns -- 6 Q: About notification of -- and I hate -- I 7 want to -- I'll flip back to it if you like, but if you look 8 -- the -- the concern I read, it says: 9 "That Health Districts would not be aware 10 that a Municipal water supply is a health 11 hazard." 12 Was this one (1) of the ways to address that 13 concern? 14 A: This was a way to address the concern 15 that -- that we needed a shorter turnaround time between the 16 testing that was being done in water treatment facilities, 17 and the time at which the Medical Health Officer or the 18 Public Health Inspection staff in his or her Health District 19 would then be apprized of a positive E. coli test. 20 Q: Okay. Well this is specific -- well not 21 just E. coli, this is -- this is broader than E. coli isn't 22 it? This is -- this is bacteriological, is it not? 23 A: That's true, it includes coliforms and 24 fecal coliforms as well. 25 Q: But in terms of addressing -- did you not

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1 understand that this was what you were trying to do in -- in 2 addressing the concern of a potential health hazard at a 3 water treatment facility? 4 Maybe -- maybe not at all, but at least with 5 respect to bacteriological hazards at water treatment 6 facilities? 7 A: This certainly addressed one (1) of the 8 major ones. 9 Q: Okay. 10 A: I think that prior to the interim 11 protocol and the input that we had into the Cabinet 12 information item, it took a considerable amount more time 13 before any Medical Health Officer found out that there was a 14 positive E. coli test, because there was a whole set of 15 testing that had to be done under the old protocol. 16 So that old protocol was revised so that it 17 reduced that time from ten (10) to twelve (12) days to three 18 (3) to four (4). So we reduced it by about 60 percent with 19 that change in the protocol. 20 Q: Okay. Now I don't want to get -- I want 21 to make sure we're not confusing. You're talking -- there 22 was some sort of previous protocol in place -- 23 A: That's correct. 24 Q: -- that's amended by this June 14th 25 memorandum?

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1 A: This June 14th memorandum is sort of a -- 2 a supplement to the old protocol -- 3 Q: Okay. 4 A: -- that had been in place and put in 5 place by SERM years ago. 6 Q: Okay, can you tell us a little bit of the 7 history that led to the development of this June 14, 2000, 8 memorandum? 9 A: I can tell you my part in the -- in this. 10 Tim Macaulay was probably the -- was the lead in our branch 11 dealing with SERM on putting the memorandum -- putting the 12 new protocol together and all of the background information 13 that was going with that. 14 Q: Okay. 15 A: So this memorandum resulted, as I say, 16 from the information that Tim was pulling together from the 17 branch, from myself, from Louie, I'm not sure who else, and 18 working with SERM on, to produce the Cabinet Information 19 item. 20 And this memorandum basically lists many 21 things that are in the Cabinet Information item. 22 Q: Okay, but what -- I guess what I was 23 looking for, and maybe I'll just say it, was Walkerton -- the 24 outbreak in Walkerton really the -- the thing that led to all 25 of this activity, in terms of the cre -- first off, the

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1 creation of this June 14th memorandum? 2 A: Well certainly I think Walkerton and 3 across the entire Country made a huge difference in terms of 4 systems being reviewed, protocols being reviewed, et cetera. 5 And within a couple of days of being advised 6 of Walkerton, I was on the phone to the Chief Medical Health 7 Officer in Alberta, to the Deputy Chief in Manitoba, I talked 8 to one (1) of the specialists in British Columbia about what 9 they were doing with their systems and what they were testing 10 for and what their protocols looked like. 11 And then Tim and I had discussions, he was 12 having discussions with SERM, and we put together this -- 13 with a lot of consultation, this Cabinet Information item 14 that went forward before this memo was sent out. 15 Q: Okay. So the -- the Cabinet -- the -- 16 the June 1 letter at tab 18, that you were putting together 17 for the Cabinet Information item -- 18 A: Hmm hmm. 19 Q: -- preceded this. But let's deal with 20 the two (2) together then. Your -- was Walkerton -- I -- I'm 21 assuming then, because it was an outbreak of E. coli, what 22 happened is there was an immediate concern, what do we do to 23 safeguard our water systems from a potential outbreak such as 24 E. coli, which is a bacteria? 25 A: I think that was the major focus. We did

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1 look at what our Provincial rates of enteric disease were. 2 And our cryptosporidium rates in this Province for years now 3 have been very low, probably around 6 percent of the major 4 enteric diseases -- 5 Q: Right. 6 A: -- compared to salmonella, Shigella, 7 campylobacter, E. coli 01 -- 8 Q: Which are all bacteria? 9 A: Which are all bacterial diseases. As 10 well as giardiasis, which is a protozoa disease. 11 Q: Okay. Now, but obviously this came out, 12 so that you must have identified some problems in terms of -- 13 or, I guess may -- I don't know if problems are the right 14 word, maybe some areas were improvement could be made in 15 terms of safeguarding the water supply in Saskatchewan? 16 A: Yes, that was the whole purpose of the -- 17 Q: Okay. 18 A: -- work with SERM and also the cabinet 19 information item that came forward out of that. 20 Q: Okay, and the cabinet information item, 21 in term -- how -- how did you get involved in -- in -- in 22 participating in the development of that document? 23 A: On -- Tim Macaulay invited -- had a -- 24 was working on a draft as I understand it. 25 MR. COMMISSIONER: Sorry, what cabinet

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1 information item -- 2 MR. CHRISTOPHER BOYCHUK: Oh I'm sorry. 3 MR. COMMISSIONER: -- are we talking about 4 here. We're moving back and forth between Benade and this 5 binder and I'm unclear. 6 7 CONTINUED BY MR. CHRISTOPHER BOYCHUK: 8 Q: That's because they developed these two 9 (2) documents pretty close in time I believe so, but the 10 cabinet information item that you're referring to is at tab 11 21 of Dr. Young's binder. It's dated June 9th, 2000. Is 12 that the -- that's the thing you're referring to? 13 A: That's correct. 14 MR. COMMISSIONER: Addressed to the Honorable 15 Judy Junor (phonetic). 16 THE WITNESS: No, it's addressed to the 17 premier as I understand it. 18 MR. CHRISTOPHER BOYCHUK: Actually it's 19 addressed to -- it starts off addressed to Judy Junor. 20 THE WITNESS: Right the transmittal form was 21 addressed to Ju -- the Honorable Judy Junor but the actual 22 cabinet information item was addressed to the Premier from 23 the Honorable Judy Junor and the Honorable Buckley Boulanger 24 (phonetic). 25 MR. COMMISSIONER: Yes, thank you.

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1 CONTINUED BY MR. CHRISTOPHER BOYCHUK: 2 Q: Well what -- we'll just stay with the 3 cabinet information item because it just seems that what's in 4 there ends up in the -- a lot of it ends up in the June 14th 5 memorandum just for ease of reference. 6 A: So as I was saying I was provided by 7 draft of that Cabinet information item and asked to comment 8 upon that. And -- or I can't actually -- I'm not even sure I 9 was provided by a draft. Let me just read my note here to 10 Tim to see if I had a document I was working with or this was 11 just my thoughts. 12 Actually I think -- I think all I did with 13 this is just put down my ideas on what I though would be 14 useful to improve water quality and disease control through 15 water in the province. 16 Q: Okay. So I -- we're all on the same 17 page, you're referring again to the memorandum dated June 18 firth -- June 1st at tab 18? 19 A: Correct. 20 Q: Okay, and -- and you're not sure that you 21 actually saw the draft cabinet information item at that time? 22 A: Well there may not even have been one. 23 Q: Okay. 24 Q: I mean I see dozens of documents a day in 25 the work that I do, comment on national, provincial, local

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1 documents, protocols, read numerous journals and I can't 2 remember and I don't write notes about every single document 3 that I look at and when I do. 4 So I think this was just basically, I knew 5 that a Cabinet information item was going forward and I had a 6 number of ideas that I thought would be useful and I sent 7 them to Tim as our representative who would then be talking 8 to SERM. 9 Q: Okay. And in terms of from what ended up 10 in the Cabinet information item from your memo, do you know 11 who made those decisions or were you part of that decision 12 making process? 13 A: No. 14 Q: So this was provided for information for 15 the preparation of the Cabinet information item? 16 A: Yes, I'm supposed to work in an advisory 17 capacity to Saskatchewan Health on issues of communicable 18 disease, and this is the advice that I was providing from my 19 expertise that would then be, I'm sure, taken into account by 20 the group that put together the Cabinet information item. 21 Q: Do you know specifically what -- which 22 group was -- was involved in putting together the Cabinet 23 information item? 24 A: Tim Macaulay was the lead from the 25 population health branch and my understanding is that the

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1 SERM lead was Thon Phommavong and perhaps Joe Muldoon. 2 You'll have to actually talk to SERM or to Tim about that. 3 Q: Now, I just want to look at the 4 memorandum of June 1st and I guess what I'm interested in is 5 just looking at a couple of the items and see what made it in 6 and, I guess , what made it out and what was acted on and 7 what wasn't. 8 And number 1 we already know was acted on 9 because it shows up in the June 14th action memo? 10 A: And also in the interim protocol. 11 Q: Okay, and we'll get to the interim 12 protocol. Number 2 says: 13 _Local Public Health Officer will receive 14 same day notifications from the local water 15 authority of treatment system failures._ 16 Do you know if that ended up in any policy 17 document anywhere, or protocol or guideline? 18 A: That's in the Cabinet information item. 19 Q: Okay. 20 A: On page 6, the bottom of the page. 21 22 (BRIEF PAUSE) 23 24 Q: But that looks -- you're looking at the 25 last paragraph there?

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1 A: Sorry. Let me see. Page 6, number 1, 2 where enhancements to follow-up of positive bacteriological 3 results, the last sentence, "Medical Health Officer or 4 designates will be sent all first positive bacteriological 5 tests from water sampling and municipal systems." Oh, sorry, 6 I'm actually looking at the wrong one, sorry. 7 Q: Right, I'm looking at -- that's -- 8 that's -- 9 A: The first one (1), you're looking at the 10 second. 11 Q: Right. 12 A: Pending notification -- 13 Q: And I couldn't find anywhere in a -- in a 14 document and it may come forward, but it's -- I didn't see it 15 in the -- in the interim protocol that we'll get to later -- 16 A: Sorry, it's where I said it was 17 initially, page 6, bottom of the page, last sentence. 18 Q: Yeah. But it doesn't say we'll receive 19 notification from the local water authority? 20 A: No, it just says: 21 "Will receive same day notifications of 22 municipal water system failures that may 23 carry a public health risk, particularly 24 related to chlorination problems." 25 Q: Okay. And does local water authority

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1 mean the municipality that's the owner or the operator or are 2 you referring to SERM here? 3 A: My suggestion in -- my suggestion in this 4 bullet that I sent with my memo was that it be from whoever 5 was responsible for the system locally. 6 Q: Okay. So that would mean the 7 owner/operator of the -- the water treatment system? 8 A: Well, I think I would expect that it 9 would come from both the owner/operator and SERM. 10 Q: Okay. Do you know if -- if SERM took 11 that forward and made that a requirement in relation to the 12 municipal treatment facilities that they regulate? 13 A: I know from SERM that they do provide 14 information to the Medical Health Officers of system 15 treatment failures of which they have been made aware. 16 Q: Okay. I guess what I was specifically 17 looking for, do you know of any communication from SERM to 18 the municipality that this obligation was being created on 19 them to report to the local Public Health officer? 20 A: This obligation is not created on them. 21 Q: Okay. 22 A: In the Cabinet information item it says 23 -- it doesn't say who. 24 Q: Okay. 25 A: So I -- I didn't draft the Cabinet

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1 information item so I'm not privy to the discussions that led 2 to some slight modifications of my suggestions. 3 Q: Okay. So I -- I take it though, in early 4 June, as a result of Walkerton, there was -- a lot of your 5 time and attention was directed in terms of developing these 6 documents to respond to or prevent a prevential -- a 7 potential Walkerton from occurring in Saskatchewan -- 8 A: Yes. 9 Q: -- fair to say? And the next thing that 10 ended up as a follow-up to the -- the June 14th letter partly 11 and from the Cabinet information item I understand was the -- 12 the interim protocol that you referred to at -- which is at 13 tab 10 of Dr. Benade's binder? 14 A: Correct. 15 Q: And that's entitled Interim Procedure for 16 the Bacteriological Follow-up; is that the protocol you're 17 referring to? 18 A: That's right, and that's the protocol 19 that followed on the letter of June 14th, 2000 to all the 20 Medical Health Officers. 21 Q: Okay. And I don't intend to go through 22 the protocol in detail because it's been discussed at length, 23 but I see that it was signed off by Mr. Muldoon, who is the 24 Director of the Environmental Protection Branch which I 25 understand is part of SERM?

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1 A: And myself. 2 Q: And yourself. So were you involved in 3 drafting this protocol? 4 A: The lead in drafting the protocol from 5 the Population Health Branch was Tim Macaulay. 6 Q: Okay. Would you be reviewing what he was 7 doing and providing your input in terms of the protocol? 8 A: Yes -- 9 Q: And -- 10 A: -- I'm sure I would have been. 11 Q: Okay. And the protocol though is, as it 12 states, it's -- in its title deals primarily with 13 bacteriological component of water quality and the only 14 reference I could find and we're dealing, of course, with the 15 -- an outbreak of cryptosporidiosis, was at page 18 of the 16 protocol? 17 A: That's correct. 18 Q: Okay. Now, a lot of the protocol is 19 given to dealing with sampling of water for bacteriological 20 quality; can you tell us why the protocol was not 21 recommending the sampling of water for either parasites like 22 cryptosporidium or giardia? 23 A: The protocol was a detailed procedure for 24 follow-up of the current Saskatchewan Drinking Water 25 Guidelines with respect to bacteriological follow-up.

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1 Giardia and cryptosporidium were not in the Saskatchewan 2 Drinking Water Guidelines nor in the Canadian National 3 Drinking Water Guidelines. 4 We were enhancing the process for the tests 5 and the -- the reports on those tests from what was currently 6 being done in the Province. 7 Q: Okay, so it was an enhancement to the -- 8 the monitoring program for -- for bacteriological problems -- 9 A: Correct. 10 Q: -- basically? And you said it was based 11 on the -- the existing Municipal Water Quality Guidelines. I 12 understand those are the 1996 guidelines you're referring to? 13 A: Correct. 14 Q: And the existing Health Canada Drinking 15 Water Guidelines? 16 A: Correct. 17 Q: And is -- so those -- and I know those -- 18 neither of those recommend testing. So is that the reason 19 why there's no testing recommended in this protocol? 20 A: Correct. 21 Q: Okay. Was there any consideration at 22 that time given to going beyond those guidelines, in terms of 23 testing for prot -- para -- parasites such as 24 cryptosporidium? 25 A: No.

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1 Q: Okay. Any reason why? 2 A: At that time, as I say, we had a 3 Provincial protocol in place, there -- there was no 4 suggestion at that time that we needed to revise or review 5 the Provincial Water Quality Guidelines. 6 There was no National change in the Guidelines 7 provided by Health Canada. So we didn't feel that we needed 8 to look at changing those. 9 This was to deal with the situation as we 10 currently had it and improve that situation. 11 Q: Okay. Did -- did you, yourself, because 12 you're in the position of the Director of the Communicable 13 Disease Control Unit, had you identified these types of 14 parasitic infections as a problem? 15 A: We hadn't actually, as I mentioned to 16 you, the rates of cryptosporidium in this Province compared 17 to our other enteric diseases is about -- over the last four 18 (4) or five (5) years, 6 percent. 19 Q: Okay. 20 A: So it's -- it's a very low percentage and 21 has been for a number of years now, of our total enteric 22 disease. 23 Q: And -- and this is in the protocols being 24 developed in the summer of 2000. Had there been any other 25 outbreaks of cryptosporidiosis in Saskatchewan, to your

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1 knowledge, either waterborne or foodborne? 2 A: Not that I know of. 3 Q: Okay. And I want you to look at though, 4 I want to ask your opinion, on page -- page 18, I guess we're 5 looking at the third paragraph, next one (1) up, yeah. 6 And just in light of what we've heard over the 7 last, I guess number of days, and I -- specifically in 8 dealing with waterborne outbreaks of crypto. 9 And I know this is the same with any kind of 10 waterborne outbreak of disease, because it's consumed by so 11 many people, the potential for the -- the number of people to 12 be ill is large, generally speaking; would you agree with me 13 there? 14 A: True. 15 Q: and in terms of -- there's a sentence 16 here -- well let's just read the -- the introduction: 17 "The mere presence of parasitic cysts or 18 oocysts in treated drinking water is not 19 usually sufficient to justify -- or is 20 sufficient justification for issuing a Boil 21 Water Advisory." 22 And -- and then it jumps down and then it 23 talks about the finding this type of parasite in the water. 24 It says: 25 "In such cases Health officials may wish to

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1 monitor the public for the associated 2 gastrointestinal illness before considering 3 issuance of an Advisory." 4 And I wanted to ask you specifically, and I 5 know this is twenty/twenty (20/20) hindsight, I'm not saying 6 you drafted this paragraph either. 7 Do you agree with that approach now, based on 8 the experience we've had in North Battleford, that we should 9 sit back and wait until we see disease in the -- 10 A: This says that if you do see a cyst or 11 oocyst in the drinking water -- 12 Q: Right. 13 A: -- that then you should look and see if 14 there's disease in the community, because you can't tell for 15 sure if the presence of a crypto cyst is causing ill health. 16 And I think that that makes total sense, 17 because I know in one (1) particular jurisdiction there was a 18 cryptosporidium found on a routine test, and a Boil Water 19 Advisory was issued. 20 There was no evidence of disease in the 21 community at all, the businesses were extremely upset, it was 22 a burden to the community and this resulted in some major 23 issues for that community. 24 So it's not something that you would do 25 lightly.

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1 Q: Okay. And in terms of though, if you 2 find cryptosporidium -- well let's just say, so you're saying 3 it's okay to wait until the disease presents itself before 4 issuing an Advisory? 5 A: No, no -- 6 Q: I don't want to put words in your 7 mouth -- 8 A: -- what I'm saying -- 9 Q: -- okay, good -- 10 A: -- what I'm saying is that -- 11 MR. COMMISSIONER: I think I understand 12 him -- 13 MR. CHRISTOPHER BOYCHUK: Okay, I won't go 14 further. 15 THE WITNESS: -- if you have -- if -- if 16 someone is doing a testing for cryptosporidium, and you know 17 as you mentioned, there may be some water treatment 18 facilities in this Province that are doing those tests. 19 This is to give guidance to those people, to say that finding 20 of one (1) cyst or oocysts doesn't measure the viability. It 21 doesn't measure the infectivity. What's not mentioned here 22 is it doesn't even tell you which species it is. 23 Q: Right. 24 A: So you don't even know out of the ten 25 (10), twelve (12) numbers surround that -- number of species.

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1 You don't even know which one (1) it is. You don't know if 2 it's cryptosporidium parvum or not. 3 Q: Right. 4 A: So this is saying you can't tell from a 5 water test. That's one (1) of the issues about crypto -- a 6 cryptosporidium guideline, in that it -- it doesn't give you 7 the whole picture. 8 Q: Okay. 9 A: And this is just saying if you find one 10 then you have to look at the community and see what's going 11 on -- 12 Q: Okay that's-- 13 A: -- before you react to it. 14 Q: What it's really saying to you is you've 15 got to -- if you see it then let's start looking at the 16 community right away to make that there's no illness there? 17 A: Correct. 18 Q: Okay. Now just flipping back -- then 19 this was developed, and I understand it was -- it was 20 distributed. Was there input from local Medical Health 21 Officers and Senior Public Health Inspectors in the 22 preparation of the protocol; is that something you would have 23 sought? 24 A: Yes. There was. This was sent out to 25 all of the Medical Health Officers and Senior Public Health

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1 Inspectors by, I'm sure, Tim Macaulay or Louis for review as 2 are all of our protocols that we produce -- 3 Q: Okay. 4 A: -- within a population health branch. We 5 always consult with the health districts on these types of 6 issues and then Tim would have received feedback from them. 7 We also had discussions at the Medical Health 8 Officer council meetings about these new guidelines that were 9 coming up in this protocol. 10 Q: Okay, and as well -- and just to confirm, 11 this document was prepared in collaboration with SERM? 12 A: Yes. 13 Q: And likewise -- 14 A: I think actually SERM was taking the lead 15 on this document. You'll have to ask Tim or one of the SERM 16 representatives. 17 Q: Sure, okay. But of course you're -- in 18 the summer of June 2000 it looks like you're having a lot of 19 collaboration with SERM on water quality issues? 20 A: Tremendous amount. 21 Q: And moving to address in particular in 22 relation to the bacteriological quality of water? 23 A: Correct. 24 Q: Okay. And I understand this protocol was 25 put in place, the cover letter is dated June 15th so that's

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1 the time the final draft was sent out? 2 A: September 15th. 3 Q: September 15th, okay. 4 A: Correct. 5 Q: And I say in the protocol then the letter 6 of June 14 that one (1) of the things that's contemplated is 7 the creation of a liaison committee between health and SERM? 8 A: Sorry which letter was that? 9 Q: Okay, let's go back to it. Let's look at 10 tab number 9 of Dr. Benade's binder, page 2 under Next Steps. 11 Okay you see that there? 12 A: Yeah. 13 Q: It's a paragraph B? 14 A: Correct. 15 Q: And it refers to the Health/SERM liaison 16 committee has been reestablished in order to ap -- improve 17 communications, et cetera. 18 Do you know if the committee was ever re- 19 established? 20 A: It's my understanding from Tim Macaulay 21 that that committee was re-established. 22 Q: Okay. 23 A: That they had one meeting and then a lot 24 of this CII, CDI, interim protocol, all that stuff took over. 25 So basically from then on it was a core group of people from

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1 Sask Health and SERM that met, and only recently, I 2 understand, have Medical Health Officers as mentioned here 3 and Senior Public Health Inspectors been invited to 4 participate not that we've gotten through all of this. 5 Q: Okay, so we've got through this, so now 6 they're starting to meet on a regular basis as far as you 7 understand? 8 A: You have to ask Tim about that. 9 Q: Okay, you're not directly involved -- 10 A: No. 11 Q: -- in the liaison committee. 12 A: No. 13 Q: Do you know that -- this is an interim 14 protocol? 15 A: Correct. 16 Q: Do you know if there's been any further 17 work of the protocol or is it -- is this the protocol that's 18 still being used right now in Saskatchewan? 19 A: There's a lot of work that's been going 20 on. This is a protocol that is currently in use. There is 21 a committee -- subcommittee including Medical Health 22 Officers, who are a protocol review committee and who are 23 following this up and looking at it in detail. 24 Q: Okay, are you part -- 25 A: And there's quite a few discussions going

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1 on about it. 2 Q: Is that something you're part of? 3 A: No, I haven't been part of that. It's a 4 number of Medical Health Officers, you'd have to ask Tim 5 who's -- how that' going. 6 Q: Okay. Now, in terms of the CII, have you 7 had any further involvement with that? I understand it went 8 on to become a Cabinet decision item at some point. I don't 9 have that here, but were -- did you have any involvement 10 after the CII was developed? 11 A: I think most of my involvement was 12 actually providing those three (3) or four (4) pages of sort 13 of consultative advice that I provided to Tim so that he 14 could take it forward to -- to the table for the CII. 15 I don't recall having much involvement in the 16 CDI. The CDI is -- 17 MR. COMMISSIONER: What's CII? 18 MR. CHRISTOPHER BOYCHUK: It's a Cabinet -- 19 I'm sorry, it's Cabinet information item, it's -- that's the 20 abbreviation, I'm sorry. 21 MR. COMMISSIONER: CDI is? 22 MR. CHRISTOPHER BOYCHUK: Cabinet decision 23 item. Sorry. 24 MR. COMMISSIONER: I think if anybody ever 25 reads this transcript, we better use the full name --

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1 MR. CHRISTOPHER BOYCHUK: Oh, yeah. 2 MR. COMMISSIONER: -- and not the acronyms. 3 MR. CHRISTOPHER BOYCHUK: I'm so used to 4 hearing it from these people, in terms of their shorthand, 5 I'm sorry. 6 THE WITNESS: And the Cabinet decision item 7 is more an item that talks about budget, scope, those kinds 8 of issues. 9 10 CONTINUED BY MR. CHRISTOPHER BOYCHUK: 11 Q: Okay. Now, after the development of the 12 interim protocol, have you had much in the way of -- provided 13 much in the way of advice or consultation to SERM or Mr. 14 Macaulay or -- or Mr. Corkery on -- on water quality issues? 15 A: Yeah, we have meetings frequently. 16 Q: Okay. 17 A: And SERM has come to the Medical Health 18 Officers meetings on a number of occasions, been involved in 19 teleconferences with the Medical Health Officers, has -- Tim 20 Macaulay and Louis Corkery have been going to Medical Health 21 Officers meetings very frequently, so, there's been a lot of 22 consultation. 23 Q: Okay. Has that resulted in any other 24 protocols that -- in addition to the interim protocol that we 25 had here or any amendments to any regulations or regulatory

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1 standards, as far as you know as yet? 2 A: That particular discussion has revolved 3 -- or a lot of that discussion has revolved around making the 4 protocol work and ironing out the bugs. So, you know, issues 5 such as who's on-call when and how do you get a hold of 6 people and have you got their names and addresses, all of 7 those kinds of things. 8 Q: Okay. 9 A: There have been other -- there has been 10 other work in the Department in terms of water quality issues 11 on the health hazard regulations and the drinking water 12 supply and guidelines, which has been going on for a number 13 of years, as well in parallel through Louis' shop. 14 Q: Okay. And, again, those types of things 15 would be with Mr. Corkery and Mr. Macaulay? 16 A: Correct. 17 Q: Okay. Now, I want to speak specifically 18 in relation to your involvement in the outbreak here in April 19 of 19 -- of this year. 20 21 (BRIEF PAUSE) 22 23 Actually, before we go there. In relation to 24 surveillance, it's -- it's largely a paper reporting system 25 right now; isn't that right?

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1 A: As I explained previously, it's partly 2 paper reporting from those health districts -- 3 Q: Right. 4 A: -- that don't have the computer systems 5 to generate computer reports or don't have the technical 6 expertise to provide those reports, but from the major health 7 districts like Regina and Saskatoon and I'm not sure which 8 others, we receive it in electronic format. 9 Q: And I -- sorry, because I -- I forgot to 10 cover this before we left your June 1st memo, again, at tab 11 18 and I'm looking at page 2, paragraph 3. 12 Do you see it? 13 A: Yes, I see it. 14 Q: Do you have that? And this is the one 15 (1) that speaks to one (1) of the things on your wish list, 16 as I see it from your June 1st memo, is a -- the development 17 of a Public Health electronic information system for all 18 health districts and I understand the idea is to set up 19 electronic database that all health districts would have 20 access to and that would be -- that would normally improve -- 21 increase the speed of reporting of communicable disease, but 22 allow for the better tracking of that disease. 23 Has there been any steps moved -- any movement 24 made towards setting up an electronic database for the 25 Province?

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1 A: Yes, there have. We've been actually 2 working for this -- working on this for a number of years 3 now. As you know, electronic databases are multi-million 4 dollar systems generally and we've been trying to bring into 5 the Province a system that, initially, Health Canada was 6 going to develop so we've been in negotiations and 7 discussions with Health Canada since pretty much 1998 -- 8 Q: Right. 9 A: -- looking at the development of a really 10 good surveillance and case management system, not that -- 11 would not only serve Health Canada's need for surveillance at 12 a National level, but also allow the provinces to have top 13 quality data in a timely fashion, and allow the Health 14 Districts to have a tool that would assist them with not only 15 surveillance capabilities but also case management 16 capabilities. 17 And so what we've done is over the last couple 18 of years under the -- some of the National initiatives that 19 are going on with respect to surveillance and enhancement of 20 systems, we've been working with the Province of British 21 Columbia, which has a Public Health Information System, that 22 is actually reasonably good, and that they've just within the 23 last two (2) years put into most of their Health Districts. 24 It's not in the kind of database format that 25 we need; it doesn't have some of the surveillance

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1 capabilities that we need. So, our Corporate Information 2 Technology Branch staff have been in negotiations with both 3 Health Canada and British Columbia to see if it would be 4 possible for us, as part of a national collaborative with a 5 number of other provinces, to take that British Columbia 6 system, modify it into a system that would work in the 7 Saskatchewan computer environments, given the different types 8 of -- of databases that we have in the Province, like Oracle 9 based programming, sequel server programming, that kind of 10 thing, and then bring that into Saskatchewan. 11 So those negotiations are ongoing and we're 12 hoping that they will result in a successful outcome and that 13 we will have a system here. 14 Q: Is there any timetable for that? 15 A: Federal/Provincial negotiations. 16 Q: Okay. Because what I -- what I can see 17 is there's -- there's clearly a benefit again to a local MHO 18 with that kind of system that may assist them in a number of 19 ways, particularly identifying a potential outbreak a lot 20 quicker? 21 A: Absolutely. 22 Q: Okay. So I won't go into -- 23 MR. COMMISSIONER: But will it, though? I 24 mean, if you're reporting monthly, if there's an outbreak of 25 anything --

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1 MR. CHRISTOPHER BOYCHUK: Well, this -- 2 this -- 3 MR. COMMISSIONER: -- by the time you get 4 around to doing your reporting though -- 5 MR. CHRISTOPHER BOYCHUK: -- gets you away 6 from the monthly reporting, though, as I understood it. 7 MR. COMMISSIONER: Pardon? 8 MR. CHRISTOPHER BOYCHUK: I was going to ask 9 him, this is what gets you away from the monthly reporting, 10 you get real-time reporting is what my next question was 11 going -- 12 THE WITNESS: Correct. 13 MR. COMMISSIONER: Yeah, and I'm just 14 devilling you in this respect. If the Medical Officer is 15 sending in and saying I've got one (1) crypto, two (2) 16 cryptos, three (3) cryptos, whether -- he doesn't need a 17 reporting system to tell him he's got a problem? 18 MR. CHRISTOPHER BOYCHUK Well, actually -- 19 well maybe I'll back up and explain why -- or maybe the 20 witness can just take -- 21 MR. COMMISSIONER: Well, I appreciate -- what 22 I'm getting at is, obviously, this system may be very valid 23 for any number of reasons on the seventy (70) communicable 24 diseases, but you haven't demonstrated the relevance to how 25 we prevent what happened in North Battleford, or what -- how

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1 it's going to help us -- 2 MR. CHRISTOPHER BOYCHUK: That's -- that's 3 exactly where I'm going though. 4 MR. COMMISSIONER: Well then just ask the 5 question. 6 MR. CHRISTOPHER BOYCHUK: Okay. 7 MR. COMMISSIONER: How is this system going 8 to help us avoid what happened in North Battleford, if that's 9 the question? 10 THE WITNESS: I think what this system will 11 do, assuming we can, you know, negotiate this and get the 12 system into the Province, is it will give us real-time 13 reporting capability, so that it may not help prevent a North 14 Battleford situation, where it's in one (1) District alone. 15 But currently, the -- there -- there may be 16 outbreaks ongoing in the Province that could be water 17 related, perhaps aren't that -- where you might see for 18 example, a -- a particular case of disease say like giardia 19 or salmonella in Battlefords, but you might see it in another 20 health service area, et cetera. 21 And if all of the Health Districts are 22 entering this data all at once, and it's real time, then you 23 can look with the press of a button at how many cases in the 24 whole Province. 25 And when you're looking at a single District,

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1 with, you know, one (1), two (2), three (3), four (4) cases, 2 small numbers, because -- because it's a small number, it's 3 hard to sometimes make sense out of is this important or is 4 this not important. 5 But, if you can see there's three (3) cases 6 here, two (2) there, four (4) there, four (4) there, and you 7 now -- 8 MR. COMMISSIONER: I can certainly see that 9 in any -- in terms of any number of other communicable 10 diseases, I mean, I have no doubt -- 11 THE WITNESS: Yeah. 12 MR. COMMISSIONER: -- about it. 13 THE WITNESS: But it would help also, for 14 example, if I may take a moment. 15 If for example, you had say three (3) 16 cryptosporidium cases reported from say Saskatoon, and three 17 (3) cases from Prince Albert, three (3) cases from 18 Battleford, that kind of thing, each Medical Health Officer 19 might not know that there are three (3) cases, you know, 20 cases in these other areas. 21 When you look at the Provincial numbers 22 they're fairly stable over time, so you usually see between 23 thirty (30) to fifty (50) cases of cryptosporidium a year out 24 of the eight hundred and fifty (850) or more enteric diseases 25 a year.

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1 If all of a sudden you're seeing ten (10) in 2 three (3) adjacent Health Districts or service areas within a 3 two (2) week period of time, then there's something more 4 going on. 5 So even the three (3) cases that you've got 6 might mean something very much more to you if you had that 7 capability and that real-time reporting, when you saw in the 8 -- in your neighbourhood health service areas a few cases 9 here, a couple of cases there, or a case there, then you 10 might think, well this is way beyond normal and what you can 11 build into these systems is, you can build in ranges to the 12 systems where you can say, beyond a certain number of cases, 13 based on fifteen (15) month averages, you should not see more 14 than "x" number of cases, not "x" plus five (5) or "x" plus 15 ten (10). 16 And then you can also do statistical 17 calculations on that to say, what's the probability that this 18 number that you're seeing is very unlikely. So the "P" value 19 or probability. 20 You can say it's less than 5 percent likely 21 caused by chance. 22 THE COMMISSIONER: No, I'm not denying and I 23 didn't mean to deny the value of the system for many others 24 and I can see as it was touched on earlier. Swimming pools 25 are a problem this summer and there's a bunch of crypto

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1 showing up in various places, you put out a swimming pool. 2 But based on the evidence we've heard as to 3 how fast crypto travels, once it's in the drinking water, I 4 just was questioning how the system would add much to the -- 5 to the investigation and determination and prevention of that 6 type of outbreak, that's all I'm getting at. 7 THE WITNESS: Okay. And I -- 8 THE COMMISSIONER: And I've heard the answer 9 and thank you. 10 THE WITNESS: Thank you, okay. 11 12 CONTINUED BY MR. CHRISTOPHER BOYCHUK: 13 Q: Now, we've spent a lot of time already 14 reviewing the meetings and things that happened. I 15 understand your first involvement was April 24th, 2001? 16 A: Correct. 17 Q: And you were -- your provincial CD 18 epidemiologist, Helen Bangura had advised you that there had 19 been a phone call from a Public Health Inspector in 20 Battleford? 21 A: Actually, she sent me an e-mail at about 22 eleven o'clock in the morning. I was in meetings that 23 morning and then I was in meetings in the afternoon til 3:00, 24 so I actually saw a fax that Dr. Benade had sent to the 25 physicians in the district and copied to me before the

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1 afternoon. 2 Q: Okay. 3 A: And then once I saw the fax, then I went 4 and spoke to Helen. And the fax talked about four (4) or 5 five (5) cases; I can't recall exactly, and then Helen said, 6 oh, there's eight (8) cases and then I went and got further 7 information from other people. 8 Q: Okay. And I don't want to go through 9 your -- you were at a number of the meetings, but I want you 10 to tell me -- I understand that your main involvement in 11 terms of the control and management of the outbreak was 12 assisting in the epidemiological investigation that went on? 13 A: That's correct. Initially, we 14 coordinated some of the tele-conferences that went on, 15 bringing together this provincial team that was formed. 16 Well, actually, I ended up being a national team that was 17 formed with -- I -- I had discussions with Health Canada as 18 early as 8:30 in the morning on the 25th to see if -- if the 19 Battlefords did need an epidemiologist; if they could send 20 one out. 21 They have a particular program within Health 22 Canada called Field Epidemiology Program and they can do that 23 for provinces where there is a possible outbreak and where 24 the province and the district request assistance. 25 So, I had been on the phone to her, was

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1 helping to organize the tele-conferences, participating in 2 tele-conferences in terms of giving advice. 3 My CD epidemiologist was providing constant 4 updates on these tele-conferences with respect to how many 5 new cases were appearing, where they were appearing, on a 6 regular basis. 7 Q: So you were the person that brought 8 Health Canada in? 9 A: Yes. 10 Q: Okay. And you've given us an overview of 11 the kind of things you did. Were you involved in preparing 12 the questionnaires and the line item surveys? 13 A: Yes. I was working with both my 14 communicable disease epidemiologist, Helen Bangura, in a form 15 for those persons who resided outside of the Battlefords' 16 area. 17 Helen and I were also very involved in the 18 epidemiology group, working on, well designing the study, 19 which type of study we were going to do. 20 The type of study that we were looking at 21 doing changed of course when we found out that the water was 22 positive. Initially, when Health Canada was first in the 23 discussions, we didn't know that the water -- that the solid 24 contact unit was down. 25 But we also didn't have the positive water

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1 test from, I think it was the 28th, or the 29th. So 2 initially, the type of study that we were going to design was 3 a study to look at, did water make a difference, to try and 4 identify that it was the water. 5 And once we found out actually that the solid 6 contact unit was down and then we got a positive water test, 7 then the questions changed somewhat. It was, you know, do we 8 still -- can we still basically show that it was highly, 9 highly, highly probable that it was water, and then how big 10 was this outbreak, how many people did it involve, how 11 extensive was it, did it travel across borders and across 12 provinces, did it affect anywhere else? 13 Q: And this -- as a director of the CD unit, 14 would the Health Canada people in developing their final 15 report, which you've seen a copy of I understand -- 16 A: Yes. 17 Q: And would have had -- 18 A: I have one here. 19 Q: -- input into the development of? 20 A: I beg your pardon? 21 Q: Were you asked to provide input into -- 22 in terms of the drafting of the report? 23 A: The Health Canada epidemiologist in 24 charge of that was Dr. Stirling and he I think was the main 25 person drafting the report, but we were given drafts of the

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1 report and asked to comment upon those. 2 Q: Okay. And what important statements made 3 in the -- in the report to substantiate their conclusions is 4 that there didn't appear to be any other increases in enteric 5 disease rates in the Battleford Health District during -- 6 we're talking the period April when the -- the outbreak was 7 identified; is that -- is that right? 8 A: Can you show me which page -- 9 Q: Well, I don't -- I won't show you the 10 page, but I understood -- well, let's just do it this way. 11 I understand that you would be providing 12 information to Health Canada regarding numbers of enteric 13 disease showing up in the Battleford Health District? 14 A: That's correct, and I think it does say 15 that in here. 16 Q: Okay, well let's leave that. But the 17 question simply is: Did you see any increase of any other 18 enteric pathogen in the Battleford Health District or service 19 area during late March, April, early May of 2001? 20 A: Yeah, I would refer you to tab 17. 21 Q: Okay. That's of your binder? 22 A: Correct. What this is, it's a summary 23 produced by one (1) of the disease surveillance assistants of 24 the numbers of cases of our sort of big eight (8) enteric 25 diseases in the Province for the month of January to June and

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1 it shows the numbers of cases of aeromonas amoebiasis 2 (phonetic), campylobacter, giardia, salmonella, shigella and 3 verotoxigenic E. coli or E. coli 0157:H7. 4 And as you can see from these numbers, the 5 totals for Battlefords in total of all of those enteric 6 diseases is eight (8) and the total -- the sum total of all 7 of those and that's excluding cryptosporidium, is two hundred 8 and eighty-five (285) so that's about 3 percent which, based 9 on the population, is pretty close. So there's -- there's 10 nothing that jumps out at you here in terms of any other 11 particular disease outbreak, either parasitic like giardia or 12 bacterial like salmonella, shigella, campylobacter. 13 Q: Okay. From the data you have, there's no 14 other pathogen that's been identified that can explain the 15 outbreak of gastroenteritis during that time period in the 16 Battlefords region? 17 A: Well, this chart shows all the Provincial 18 numbers to date for those two (2) particular types of 19 organisms. The -- my understanding is that Dr. Horsman will 20 later speak about other laboratories that were doing testing 21 as well during this outbreak, and my understanding from him 22 is that there was no obvious bacterial disease that was going 23 on that these other labs found, but you'll have to speak to 24 him directly about that. 25 And I also understand that there were some

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1 random tests done on a number of stools -- stool specimens by 2 Dr. Horsman's lab for viruses and that those didn't show 3 anything in particular, but, again, you'll have to speak to 4 him, but my understanding is that there was nothing else 5 going on. 6 Q: Okay. Or that you could identify and 7 that, as I understand it, keeping in mind that reportable 8 disease has to be reported to your office? 9 A: That's true. 10 MR. CHRISTOPHER BOYCHUK: Okay. Thank you, 11 Dr. Young. 12 MR. COMMISSIONER: All right. Order of 13 cross-examination, I suppose one (1) of the things that would 14 be helpful, I think, if we had some idea of how much cross- 15 examination in terms of time is going to be desired by 16 various counsel, so, what I'm going to do is I'll break for 17 -- we'll take a ten (10) minute break and you can -- counsel 18 on cross-examination side, can organize themselves, give us 19 -- come back, we'll decide if we can -- it's worth 20 proceeding past five o'clock or if the Doctor has to wait 21 until tomorrow for further cross-examination; if that's all 22 right, Doctor. We'll do what we can, but we're not sure. 23 THE WITNESS: That's fine, thanks. 24 25 --- Upon recessing at 4:35 p.m.

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1 --- Upon resuming at 4:40 p.m. 2 3 MR. COMMISSIONER: All right, perhaps we'll 4 get underway as quickly as we can here in order to finish up 5 that much sooner. 6 7 (BRIEF PAUSE) 8 9 MR. COMMISSIONER: All right, Mr. 10 Scharfstein...? 11 12 CROSS-EXAMINATION BY MR. GRANT SCHARFSTEIN: 13 Q: Good afternoon, Dr. Young, just a couple 14 of things. 15 I note in your evidence and -- and in your 16 anticipated statement, you had made reference to the fact 17 that Saskatchewan Health has the ability to develop 18 regulations and set standards for public water supplies that 19 are not regulated by SERM; correct? 20 A: Sorry, where are you -- 21 Q: Oh, I'm looking at number 23 of your -- 22 your anticipated statement of evidence. 23 So that for those -- those water systems that 24 aren't regulated by SERM, Public Health is the one (1) that 25 has the ability to develop standards?

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  1                 A:   That's correct.
  2                 Q:   Have they done that?  Is there a list of
  3  standards for those types of utilities?
  4                 A:   There are two (2) -- my understanding
  5  from Tim Macaulay, and Tim would be probably the more
  6  appropriate person to talk to, is that there are two (2) sets
  7  of standards, one (1) is the public accommodations
  8  regulations and the other one (1) is the -- public
  9  accommodation and public eating establishment, or Eating
 10  Establishment Regulations.
 11                 And those govern a number of areas of water
 12  quality and that Public Health Inspectors function under
 13  those.  And Tim will actually be able to give you all of the
 14  guidelines or the -- the recommendations around those.  I am
 15  not familiar with them all.
 16                 And -- and in terms of other guidelines or
 17  regulations, it is my understanding that there is a Health
 18  Hazard Regulation that has been in -- that is being drafted
 19  and has been worked on now for over a year that Mr. Corkery
 20  has been taking the lead on, and I think Tim probably has
 21  been working with him.
 22                 And a set of guidelines on public water
 23  quality, public water -- I've forgotten the exact name of the
 24  guidelines that go with that Health Hazard Regulations that
 25  are being developed and that have been sent out already for

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1 comment to a number of stakeholders. 2 Q: Okay. 3 A: So that's in the works. 4 Q: And are these for the utilities that are 5 not governed by SERM -- 6 A: Right. 7 Q: -- these are the smaller ones under four 8 thousand (4,000) gallons per day I think is what their limit 9 was; correct? 10 A: That is my understanding, and as I say 11 you'd be best to talk to Louie or Tim. 12 Q: The sec -- question 24 then also 13 mentioned that you're also consulted because it's an 14 important issue for public health on standards for water 15 treatment facilities that are governed by SERM. 16 And I think your evidence was that, yeah, you 17 may be consulted from time to time on setting those standards 18 or your opinion in that regard? 19 A: When the -- when the standards were set, 20 and I think it was 1996, I wasn't in the Province, so I 21 didn't actually have any input into those standards. 22 Q: And so, yeah, your evidence is that you 23 personally haven't had any input into the standards as they 24 exist -- 25 A: Correct.

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1 Q: -- currently today? 2 A: Correct. 3 Q: Okay. Finally, I just need a 4 clarification on something. 5 In your evidence I think you had indicated 6 that if you find a cyst or an oocyst in water, finished 7 water, that wouldn't trigger the Boil Water Advisory or a 8 Drinking Water Advisory, because that doesn't necessarily 9 mean there's a problem where people could get sick. 10 And in that instance you would watch very 11 closely to see if anyone did get sick, is that kind of how it 12 would go? 13 A: That's what the guide -- that's what the 14 interim protocol says. 15 Q: Okay, and -- and you're comfortable with 16 that? 17 A: Very. 18 Q: But in 2 -- in the year 2000, if I 19 recollect, there was a Drinking Water Advisory issued in 20 North Battleford based on a count of one (1) or two (2) 21 coliforms, and they were determined not to be E. coli or 22 fecal coliforms, and in fact no one got sick. 23 But on the basis of that, because there could 24 be a problem, a Drinking Water Advisory was issued; is that 25 correct?

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1 A: I don't know all the details of that 2 September Boil -- Drinking Water Advisory. 3 Q: Okay, well the evidence was quite clear, 4 that nobody got sick from it, there was a reading -- three 5 (3) readings, the first one (1) was one (1) coliform the 6 second one (1) was two (2) coliforms and the third one (1) 7 was two (2) coliforms. They weren't fecal, they weren't E. 8 coli, it was from a period of August 31st to September 15th. 9 And -- and then an Order -- a Precautionary 10 Drinking Water Advisory was issued, and I'm wondering why -- 11 why the difference there? Why, in that case would they issue 12 one, yet if you find an oocyst or a cyst showing a protozoan 13 in there, you wouldn't issue a Drinking Water Advisory? 14 A: I think that that's simply following the 15 protocol. The finding of a repeat specimen of coliforms 16 indicates that there is not E.coli in the system, but it 17 indicates that there's a potential problem with the system in 18 terms of potentially the chlorination. 19 If there's a problem with chlorination, then 20 you are at risk of -- the public might be at risk of 21 ingesting fecal coliforms which might include E.coli 0157:H7 22 even if you don't culture it. 23 And so you don't want to take a chance with a 24 disease that has a very high case of fatality rate that ends 25 up with people with humalidic urenic (phonetic) syndrome, on

262
  1  dialysis, et cetera, when -- when that comes up.
  2                 So usually, I think the protocol's quite clear
  3  that if you start seeing the peak sample problems, then you
  4  have a -- to consider a precautionary Drinking Water
  5  Advisory.
  6                 Q:   And my final question is: from -- from a
  7  public health perspective, if you're not testing your
  8  finished water for cysts or oocysts, how would you know if
  9  they're there?
 10                 A:   I think the issue of what you do to
 11  protect the public has to be considered in a much broader
 12  perspective than a test.  I know the Americans have gone,
 13  let's do tests and have, you know, limits here and there and
 14  everywhere.
 15                 But Australia's chosen a different approach
 16  and there's merit to the Australian approach and that's the
 17  multi-barrier approach.  So you don't rely on a test, which
 18  you might get a week, or two (2), or three (3) later, when
 19  hundreds and thousand -- or thousands of people might have
 20  already been exposed.
 21                 What you do is, you look at things from before
 22  the plant, in the plant, and sort of after the plant, if you
 23  wish.  The before the plants issues would be the watershed,
 24  and so you consider whether that's an important thing to look
 25  at.

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1 You look at the treatment process itself and 2 quite often, the treatment process, if you -- if you 3 recognize that there is a problem with that, that it's not 4 creating the barrier and you advise of that right away, then 5 that's weeks or days before you're going to get a positive 6 test. 7 So -- and if -- and so you look at that and 8 it's extremely important. Then you look at the communication 9 of any information that's -- that's found with respect to 10 something that's different, up the line to the appropriate 11 people who then can assist you. 12 And then downstream from that, you look at, 13 okay, so what are the tests we're going to do that will 14 basically tell us the most about the system that we can get, 15 in a reasonable way. 16 And then you have surveillance for illness 17 kind of down here. And it's -- it's a multi-barrier approach 18 as opposed to just one (1) piece. 19 So I think that if one looks at all of that 20 together, you get a much better picture than just with one 21 (1) particular test, which may or may not tell you anything. 22 Q: I have no further questions, thank you. 23 THE CHAIRPERSON: Is there -- Mr. Stevenson? 24 25 (BRIEF PAUSE)

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1 CROSS-EXAMINATION BY MR. KEN STEVENSON: 2 Q: I don't have a -- a lot of questions, but 3 there's a few areas I'd like to have clarified. 4 In terms of communicable disease reporting, 5 just -- could you explain the procedure to me, when a lab 6 finds a positive, just how does that system work and what's 7 the expected turnaround times? 8 A: I think you'd have to talk to the lab 9 about that. I have a general knowledge of that from my time 10 in family practice and a general knowledge from discussions, 11 but I don't have first-hand knowledge. 12 Q: Okay. And -- and I guess I was looking 13 more at the outside once the lab gives a pro -- positive 14 report to a district; do you know what their obligations are? 15 A: It depends on what the lab test is. 16 Q: Okay. 17 A: As I mentioned to you, cryptosporidium is 18 6 percent of our enteric diseases. So if you have -- and so 19 let's say you're getting reports in your public health 20 department, there are six thousand (6,000) reported diseases 21 in this province out of the seven (70), there's six thousand 22 (6,000) reports every year, including HIV, Hepatitis A, 23 Hepatitis C, Shigella, Verotoxigenic E. coli, a number of 24 very, very serious illnesses, and so all of this is coming 25 across the desk of the people who work in Public Health and

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1 what they need to do is look through all of these diseases, 2 make value judgments and assessments based on their 3 professional judgment on what issues they need to deal with 4 immediately, what issues are issues of lesser concern and 5 lesser pressure, et cetera. 6 So there -- I don't think there is an exact 7 time -- 8 Q: There's not a forty-eight (48) hour time 9 frame within which you're to act on these reports? 10 A: The -- under the Public Health Act, a 11 physician finding a patient with a particular communicable 12 disease, category 1 or -- category 1, I think it is, should 13 report this disease within forty-eight (48) hours to Public 14 Health, and I think category 2 diseases is reporting 15 requirement of seventy-two (72) hours to Public Health and 16 the -- and the labs, I'm not sure, but it would be in the Act 17 and I can -- I can have a look at it and refer you to the 18 section. 19 Q: No, I -- I don't want to actually go 20 there, no. 21 A: Okay. 22 Q: And is crypto a category 1? 23 A: Correct. 24 Q: Okay. And I might be wrong, but just if 25 you would look at binder C-16 and at tab 14.

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1 A: C-16 -- 2 MR. COMMISSIONER: Dr. Benade's -- 3 4 CONTINUED BY MR. KEN STEVENSON: 5 Q: Dr. Benade's? 6 A: Oh, Dr. Benade's, yes, right. 7 Q: I'm just trying to follow up and see if I 8 can understand that that CD -- surveillance and reporting is. 9 Do you -- are you familiar with this manual, 10 this communicable disease manual? 11 A: Yes, I am. 12 Q: Okay. And on page 7 there's a schedule 13 and I'd just like to understand it if I could. And for 14 cryptosporidiosis, where there's a lab confirmed and then the 15 right-hand column says, "Start follow-up", the first one (1) 16 says, "Immediate within forty-eight (48) hours", and there's 17 a checkmark; is that -- have you found the page? 18 A: Yes, I have. 19 Q: Okay. Does that mean what I read it to 20 mean, there's the -- start the follow-up within forty-eight 21 (48) hours and that's at the district level? 22 A: This is a guideline for health districts 23 with respect to follow-up that was an agreement reached upon 24 by the Medical Health Officers and Health Inspectors. 25 Q: But it does mean it's supposed to be

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1 followed up in forty-eight (48) hours; is that -- 2 A: Well, it's a guideline and -- 3 Q: No, I appreciate that. 4 A: Yeah, it's not a regulation so I think 5 one has to look again at what disease is around, what other 6 issues you have on your plate, what are the priorities, if 7 you have meningitis in your community, I mean, you know, 8 there's a lot of issues. 9 Q: Yeah, and I understand that and we have 10 all the evidence of what, if anything, was happening -- 11 A: Right. 12 Q: -- in the City of North Battleford, but 13 you said it's a guideline, not a regulation and it's an 14 interesting concept because, of course, a lot of these water 15 things are objectives and guidelines too and not regulations? 16 A: That's true. 17 Q: So are they that flexible also? 18 A: The advantage to guidelines and there's 19 debate across the country of whether one (1) should have 20 guidelines or standards, as you well know. The advantage to 21 guidelines is it allows you to make judgments on a case by 22 case basis, otherwise you're basically following by rote and 23 not thinking. And there are many who believe that guidelines 24 actually serve a better purpose, allow you to personalize 25 basically each particular set of -- of actions, as opposed to

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1 just a knee-jerk reaction, yeah, this is a guideline, I'm 2 following it and then you stop thinking; so there's pros and 3 cons to guidelines versus standards. 4 Q: And that sounds like Dr. Butler-Jones' 5 approach to things also; would you agree that he and you seem 6 to think alike on that view? 7 A: I think we both feel that guidelines is a 8 reasonable approach to -- to this issue. 9 Q: Okay. And that takes me to the next area 10 where you indicated, you know, if you find a single crypto 11 oocyst in the water -- treated water, the protocol says you 12 wouldn't call a Boil Water Advisory or Order on that and you 13 said you very much agreed with that -- 14 A: I think the Boil -- 15 Q: -- without looking at the community? 16 A: Now, let me just read it again because I 17 think that the -- it -- that's not quite it. Could you refer 18 me to the tab? 19 Q: 14, thank you. 20 A: Of Dr. Benade's or of mine? 21 22 (BRIEF PAUSE) 23 24 MR. COMMISSIONER: The protocol is at tab 10, 25 yes.

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1 THE WITNESS: 10 of Dr. Benade's. 2 MR. COMMISSIONER: Tab 10 of Dr. Benade's. 3 4 (BRIEF PAUSE) 5 6 MR. COMMISSIONER: Sorry, if I gave you some 7 bad information. 8 THE WITNESS: What it exactly says, and this 9 is what I agree with: 10 "The mere presence of a parasitic cyst or 11 oocyst in treated drinking water is not 12 usually sufficient justification for 13 issuing a Boil Water Advisory." 14 And then it goes on to give reasons why. 15 So this doesn't say you shall not issue a Boil 16 Water Advisory, it just says that it's the mere presence does 17 not usually provide sufficient justification, however, if you 18 in your full assessment, and you don't make an assessment on 19 -- as -- as I've been saying, on one (1) test -- on -- on 20 anything in Public Health, you have to take the whole picture 21 into account. 22 If the picture tells you that you have to do 23 something, then you do. 24 Q: And part of the picture you said you'd 25 look at in the community was was this something unusual

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1 happening in gastroenteritis or problems of that nature in 2 the community? 3 A: That's what the guideline says. 4 Q: Right, and you said you very much agreed 5 with that, I believe? 6 A: I agree with that. If you're doing 7 testing and you do find it, then that's the logical step to 8 do next. 9 The big question is whether you should be 10 doing the testing or not, and how effective that is. 11 Q: No, and I'm -- I'm not going there -- 12 A: Yeah. 13 Q: -- I'm -- I'm trying to take the next -- 14 and I'm wondering if you have the reverse where you -- where 15 you have positive crypto in your community and you also look 16 and you find you have gastrointestinals. 17 Might you not then be led back to the water? 18 A: Again, that's all part of your Public 19 Health invest -- your disease investigation. If -- you have 20 to put all of the pieces together, it's never just a one (1) 21 piece thing. 22 So for example, if you have no cases in one 23 (1) area, a couple of cases in another area, no other cases 24 going on, and you see a couple in the periphery, that doesn't 25 lead you to anything until you do the full investigation and

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1 rule out all the usual things, which are swimming pools, 2 food, person-to-person spread, et cetera, et cetera. 3 Or is it livestock, I mean no one (1) knew 4 this was human at the time, human genotype. So is it 5 livestock, what is it? We know that livestock -- the vast 6 majority of livestock have -- have -- or farms with cattle, 7 et cetera, have crypto on it. 8 So all of that has to be taken into account, 9 it's not just a number that gives you a direction. 10 Q: No, and I appreciate that, but I -- I 11 guess I was falling upon if you said, well I wouldn't want to 12 jump on it with one (1) oocyst. I was trying to take the 13 reverse of it and said, might this not lead to a chain of 14 inquiry that would take you then logically back to water? 15 A: Eventually it would. 16 Q: Okay. And you don't know whether that's 17 one (1) positive lab, two (2) positive labs, three (3) 18 positive labs, and this is general. I'm not asking -- 19 A: Yeah. 20 Q: -- you about North Battleford. 21 A: I understand what you're saying. 22 Q: Okay. 23 A: What I'm saying is that it's never a 24 number, it's never a one (1) or a two (2) or a three (3) for 25 enteric diseases. You have to find out what's causing or

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1 most likely to be the contributing risk factor to this 2 particular group of illnesses that you're seeing. 3 And first of all you have to see a group, 4 usually, you know, many of these outbreaks of crypto have 5 been picked up after thirty (30) and forty (40) cases of 6 positive crypto tests. 7 Many of these outbreaks across the country 8 haven't had Boil Water Orders in -- because the -- you know, 9 the cryptos gone through the community and it's gone. 10 So it's all very individual, that's why we 11 have specialists in each area, who are Public Health 12 specialists, to make those judgments. 13 Q: I -- I sensed in your evidence that when 14 I look at the correspondences leading up to June 1st and -- 15 and concerns by Dr. Benade and the correspondence that was 16 referred to in -- in May and June, that right up until 17 Walkerton we have SERM going in one (1) direction, and that's 18 out of monitoring and regulation of water in Municipalities; 19 is that fair to say? 20 A: I wasn't very knowledgeable of that, that 21 would be Tim's area -- 22 Q: Okay. 23 A: -- so I can't comment on what they -- how 24 -- where they were moving. I've heard since then from 25 testimony here that that appears to have been the case. But

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1 I don't know, I don't know how many staff they had initially, 2 how many they had later, how much monitoring they were doing 3 for it. 4 Q: Okay, it just appeared like there was 5 about a one eighty (180) done very quickly after Walkerton, 6 and I was just wondering if that was your perception of what 7 happened? 8 A: I can't comment on that, because a one 9 eighty (180) means you know which direction they're going in 10 the first place, what I know is after Walkerton, everyone 11 across the entire country in this area, was looking at their 12 water systems and their water protection and their 13 guidelines, its protocols, et cetera. 14 Q: Okay. Now am I right in understanding 15 your evidence to be that while you put forth a recommendation 16 on the Cabinet Information item, that there should be the 17 obligation upon the plant operator to report any suspected 18 health hazard, but that did not reach the protocol? 19 A: I think you're confusing protocol and 20 Cabinet Information item. 21 Q: Okay. Well, let's go both then. 22 A: Okay. Let's do the Cabinet Information 23 item first because that came before the protocol, if that 24 would be okay with you? 25 Q: Sure. And I believe it's tab 18, then

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1 in yours, I'm not sure? 2 A: My comments were at tab 18 and -- 3 THE COMMISSIONER: Twenty-one (21). 4 THE WITNESS: That's correct, 21. 5 6 (BRIEF PAUSE) 7 8 CONTINUED BY MR. KEN STEVENSON: 9 Q: I thought your comments were at tab 18? 10 A: Yes. 11 Q: Okay. 12 A: They are. My ta -- they're on tab 18 and 13 the Cabinet information item is 21. 14 Q: Right. So your comment was that you were 15 recommending that the local Public Health Officer will 16 receive same day notification from the local water authority 17 of treatment system failures that may carry a public health 18 risk, particularly related to chlorination problems. 19 Was that your recommendation? 20 A: That is exactly correct. 21 Q: Okay. And did that go through then into 22 the Cabinet Information item? 23 A: As discussed with Commission counsel, in 24 a revised form and that's on page 6 -- 25 Q: Okay.

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  1                 A:   -- at the bottom of the page.
  2                 Q:   And what does it say there?
  3                 A:   It says: 
  4                   "Medical Health Officers or
  5                   designates will receive same-day
  6                   notifications of municipal water treatment
  7                   system failures that may carry a public
  8                   health risk, particularly related to
  9                   chlorination problems."
 10                 Q:   Okay.  And that's all it related to was
 11  the chlorination problem?
 12                 A:   No, no.  This says -- this has the same
 13  intent that my suggestion did, which was 
 14                   "...will receive same-day notifications of
 15                   municipal water treatment system failures
 16                   that may carry a public health risk,
 17                   particularly related to chlorination
 18                   problems."
 19                 So that does include any other assessment of
 20  treatment systems failures that may carry a risk.
 21                 Q:   Now, did that then make the protocol?
 22                 A:   Well, it made the Cabinet Information
 23  item, and let me just -- the protocol, sorry, the protocol
 24  was not designed to incorporated everything that was
 25  suggested in the Cabinet Information items.

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1 Q: No. 2 A: The -- so the protocol was with respect 3 to the bacteriological quality of water and then improving 4 that. 5 Q: Well -- 6 A: In terms of what was sent out to the 7 Medical Health Officers, on June the 14th, 2000, it did enter 8 the words, SERM will report on page 2 of my co-signed letter 9 with Louis Corkery on June 14th. 10 Q: And what tab is that on, I'm sorry? 11 A: Sorry, that's tab number 9. It says on 12 page 2: 13 "SERM will report water treatment system 14 failures that may create potential public 15 health risk to MHOs or senior Public Health 16 Inspectors." 17 So, it was reflected both in the Cabinet 18 Information item and also in this memo of June 14th, 2001. 19 Now, I didn't write this memo of 2001, Louis 20 Corkery did and he wrote it in the absence of Tim Mccauley 21 who was actually working the most on the Cabinet Information 22 item and in -- in discussions with SERM and working from -- 23 well Tim was away on holidays, from his notes and that type 24 of thing. 25 So, you'll have to ask Tim, in terms of the

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1 complete accuracy of this -- of this particular bullet. 2 Q: Okay. And I guess what I'm getting at, 3 when you're suggesting that this go forward, was it your 4 understanding that there wasn't in place such an obligation 5 prior to that time? 6 A: I didn't know what the obligation was. 7 What I was asked to do was provide comments on what I think 8 would be a good system and so I put down as much as I could 9 think of that would logically help to improve the system. 10 Q: And do you know if anything went forward 11 from your department, or from SERM, to the municipalities, in 12 particular the Municipality of the City of North Battleford? 13 A: Well, this document of June the 14th went 14 forward to all the Medical Health Officers and Senior Public 15 Health Inspectors, whether they passed this information on to 16 any other people in the health district or with the water 17 system, I'm not aware. 18 Q: Right. You -- there was no instruction 19 given that it should go out and that they should disseminate 20 it to the municipalities? 21 A: No, we did not provide that instruction. 22 Q: Thank you. Somewhere in the documents I 23 recall seeing what I believe was some participation by 24 yourself in a water quality seminar or something in October 25 of 2000?

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1 A: That's correct. 2 Q: And where was that held? 3 A: I think it was in Saskatoon if I'm not 4 mistaken. 5 Q: And -- and in the course of -- 6 A: Actually, I could check my files and give 7 you an exact location? 8 Q: I -- I think it was Saskatoon, but it's 9 not particularly important. What I'm more interested in is 10 at that water quality seminar was there any addressing of 11 cryptosporidium or giardia as you recall it in your 12 presentation? 13 A: When I did my presentation, I did an 14 overview of the communicable diseases that were related to 15 enterics in the Province, and enterics come from water, they 16 come from person to person, food, et cetera, et cetera, et 17 cetera, as we've been hearing. 18 I did an overview of the major enteric 19 diseases, what their rates were, what they were in comparison 20 to the rest of the country for those diseases that we had 21 comparisons. 22 As you probably have heard, cryptosporidium 23 only became nationally reportable in January of 2000 so we 24 don't have good national data, but I did a presentation 25 covering all of those illnesses.

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1 Q: Okay. At that presentation, was there a 2 presentation of a case study about Vanscoy and -- and are you 3 familiar with the Vanscoy circumstance? 4 A: No, I'm not. 5 Q: Okay. 6 A: Now, there may have been some mention of 7 Vanscoy at the meeting, unfortunately I had other obligations 8 so I only attended a very small piece of that meeting. 9 10 (BRIEF PAUSE) 11 12 MR. KEN STEVENSON: Those are my questions I 13 have, thank you. 14 MR. COMMISSIONER: All right. Shall we go 15 down the row; Mr. Mitchell, do you have any questions? 16 MR. ROBERT MITCHELL: No questions. 17 MR. COMMISSIONER: Mr. Young...? 18 MR. GARY YOUNG: No questions. 19 MR. COMMISSIONER: Mr. Gabrielson...? Or I 20 guess you'll be at the end. Mr. Hopley...? 21 MR. SCOTT HOPLEY: I have none. 22 MR. COMMISSIONER: Mr. Tochor...? 23 MR. MICHAEL TOCHOR: Nothing. 24 MR. COMMISSIONER: Well, and, Mr. Gabrielson, 25 you have none?

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1 MR. NEIL GABRIELSON: No. 2 MR. COMMISSIONER: Well, Doctor, I think that 3 concludes it. 4 THE WITNESS: Thank you very much. 5 MR. COMMISSIONER: Well, thank you for being 6 available and your evidence today. 7 THE WITNESS: Thanks. 8 9 (WITNESS STANDS DOWN) 10 11 --- Upon adjourning at 5:10 p.m. 12 13 14 15 16 17 18 19 20 21 22 23 24 25