Hanif Kassam, York Region medical officer of health, didn't flinch when an aggrieved doctor demanded an apology for the brusque treatment he received at the hands of public-health officials on Easter Sunday.
"He certainly will not be getting an apology, because I do not take this matter lightly," a defiant Dr. Kassam said yesterday. Nor did he retract his earlier characterization of the unnamed doctor, who became sick after working with SARS patients at Sunnybrook hospital, as "obnoxious, threatening and belligerent" when presented with an order to stay in quarantine.
It is the doctor who should apologize, the unrepentant medical officer added, "to the hundreds of individuals he put at risk" by attending funeral ceremonies over the weekend while sick with SARS-like symptoms.
Dr. Kassam dismissed the doctor's published claims that he became sick only after visiting the Ward Damiani funeral home in Woodbridge on Friday and attending the mass and burial on Saturday. On the contrary, Dr. Kassam said, a growing dossier of evidence obtained from others at the funeral and even the doctor's own mother suggests he was clearly sick all weekend long.
"I would have thought that, being a health-care professional, he would have exercised better judgment," Dr. Kassam said.
As a result of the weekend encounters, the number of people quarantined in York Region has doubled, from about 150 to more than 300. And it has become clearer than ever that public-health officials struggling to control SARS are playing for keeps.
While Dr. Kassam took pains to distinguish his Woodbridge colleague from the vast majority of "responsible" health-care workers, he deplored the potentially disastrous consequences of such behaviour. "We will have to maintain the same amount of vigilance, if not more," he warned. "And I will be even more strict in the future."
It has been a century since Torontonians experienced the full, virtually unaccountable power of activist medical officers of health, epic figures who shaped the lives of millions in their determined battles against cholera, tuberculosis and other infectious scourges of the 19th-century city. Thanks to SARS, however, the forgotten generals have suddenly reappeared — with all their considerable powers intact — to wage another world war.
Dr. Kassam of York Region has already emerged as a notable hard-liner in the struggle to curb SARS. On April 2, he went further than any of his colleagues have yet by issuing mandatory isolation orders against two quarantine-resistant York Region residents who had come in contact with SARS. The orders put them under police guard.
Dr. Kassam also remains suspicious of the Woodbridge doctor, who has still refused to sign the document ordering his quarantine. "Should he not comply, I will take swift and affirmative action to . . . have police coverage available 24 by 7 to ensure that he does not put any other people at risk," he said.
Meanwhile, hard feelings about the infected Mount Sinai nurse who travelled to work on GO Transit persist. On Monday, hospital officials took the unusual step of defending the nurse against implied criticism that she had endangered the health of others. She remains in isolation in the hospital where she works.
But the authorities are clearly not backing off in their increasingly aggressive campaign. Yesterday, Health Minister Tony Clement announced the deployment of new "rapid-response teams" to enhance the province's public-health capacity, and health leaders are meeting this week to discuss even harsher control methods that may become necessary if SARS continues to spread.
"They're moving tenderly in that area because nobody wants the public-health equivalent of the War Measures Act in a situation that can be managed with a defter hand," said Scott Dudgeon, director of the Toronto District Health Council, a provincial planning agency.
But if that deft hand falters, as it has repeatedly in the Toronto outbreak, the iron fist is always available — with enormous consequences to the lives and livelihoods of millions of Torontonians.
