It was the "state-of-the-art" facility which was supposed to be Canberra's "insurance policy".
But like most insurance policies, when you need them you realise you probably should have signed up for some "extras".
The Garran Surge Centre was not suitable for the treatment of COVID-19 patients during the peak of the ACT's pandemic response, The Canberra Times revealed this week.
A review of the centre, from October 2021, showed there were concerns about ventilation and airflow and "significant work" had to be carried out for it to be suitable for infectious patients.
Following the public release of this report, the government has sought to brush off the concerns in the review, describing the way they had been reported on as "revisionist".
But, in doing so, it has only raised more questions.
And it has raised yet more concerns about the ACT government's lack of transparency in matters of public interest, particularly in the health portfolio.
'This hospital here is our just in case'
The Garran Surge Centre was announced at a time when COVID was tearing around the world, overwhelming health systems.
It was April 2020 and Australia was in total lockdown. At the time the ACT had recorded 87 cases.
Sensing this threat, the ACT government decided it would spend $23 million on a pop-up emergency department, designed to handle COVID patients when our hospitals did not have the capacity to meet the demand.
The government turned to Aspen Medical, a Canberra-based health service company with a reputation for work in disaster situations or health crises around the world.
It was a seemingly perfect match.
A local company renowned for its work in building pop-up health facilities in low-income countries was now given the opportunity to showcase its work in its hometown.
It took only 37 days for the centre to be built and only $14 million was spent. It was opened to great fanfare by health executives in May 2020.
But in the month it took to build quite a lot had changed.
There were no active cases in the territory and Australia's fast response to lockdown and close international borders had helped to curb the spread at that stage.
At a tour of the facility, health bosses were hopeful the centre would never need to be used.
"No one buys an insurance policy hoping to crash their car. This hospital here is our 'just in case'," Canberra Health Services then-deputy chief executive Dave Peffer said.
The "insurance policy" was never used as an emergency department.
The public was told this was because it was never needed and the emergency department was already able to handle existing demand, even when cases surged in winter 2022.
The public was also told they weren't able to staff the facility as shortages were plaguing the system.
"Obviously to staff a separate emergency department we would need a whole lot of new staffing to go into a third emergency department in the ACT," Health Minister Rachel Stephen-Smith said in July 2022.
"We know that by expanding the size of emergency departments often actually encourages more people to come to emergency departments and doesn't reduce the pressure."
However, the documents now cast doubt on whether this was the true reason the surge centre was never used.
'No change of use of the Garran Surge Centre was clinically required'
After the first wave subsided, the ACT went more than one year with no community transmission between May 2020 to August 2021.
During this point, officials could reasonably have thought the centre would never be needed for its original purpose.
But this changed when the virus started spreading during the Delta wave.
"I have put some time in our calendars for tomorrow to regroup on the approach to responding to the review that CHS have commissioned, programme and critical dates for utilisation of the surge centre potentially for its original intent," a project director of the surge centre said in an email to health officials on October 4, 2021.
One day later, a damning review into the mechanical services of the centre was handed to officials.
This was the review which found the centre was not suitable for the treatment of COVID patients.
The planned meeting into the utilisation of the surge centre never happened.
"No meeting took place as the works required to address the ... report findings were not progressed given no change of use of the Garran Surge Centre was clinically required," an ACT government spokeswoman said this week.
"At no time did [authorities] decide that the pressures were such that warranted standing up the surge centre for that purpose."
But this brings up the age old question. What came first the chicken or the egg?
Was the decision made to not use the centre because of the report or did health authorities simply decide an emergency department was never needed regardless of the report.
And why didn't anyone think the public should be told that this emblem of our COVID defence wasn't fit to be used the way we all imagined it would be?
In the meantime, the centre had been used to administer COVID vaccines. It was later turned into a testing centre and then a COVID-specific walk-in centre.
'Really disturbing revisionist thinking'
Stephen-Smith mounted an angry defence of the centre on Monday, labelling The Canberra Times' reports about the concerns as "revisionist" and said it was "absolutely ridiculous" to suggest it was not fit for purpose.
"There's some really disturbing revisionist thinking about the way that the surge centre both was built in the first place and has been used over time, it was never intended to be used as a ward facility or an intensive care unit," she said.
"To suggest that something went wrong because the design wasn't appropriate for a ward or an intensive care unit is absolutely ridiculous."
But this appears to be at odds with comments made by both Stephen-Smith and health authorities when the centre was announced and under construction.
On April 2, 2020, she said the centre, which did not have a location at that point, would be near the Canberra Hospital to enable movement to intensive care but she noted it would have "a limited amount of intensive care capacity".
On April 16, 2020, Canberra Health Services then-chief executive Bernadette McDonald said while it was designed to be an emergency department, the centre was "flexible in that patients can be treated in those cubicles for significant lengths of time, if required, until they are either discharged home, discharged to a step-down type of facility or moved into intensive care, if required".
And again on May 1, 2020, Peffer said: "It has clear triggers for when we would bring it online as either an emergency department or potential ward capacity, depending on what is required".
But surely these arguments about what defines a "ward area" versus a "treatment area" are besides the point?
Even if the centre was only ever supposed to be an emergency department, even if no one was meant to stay there overnight (surely an absurd idea), the report's findings made clear its fundamental flaws.
Reviewers said "non-compliant exhaust discharges" meant "the facility is generally not suitable for treatment of COVID-19 infected patients as it is".
The report also said it was a problem the centre wasn't designed to be a "ward area". Reviewers said because it was not a "ward area" it meant the centre did not meet the expectations of a "surge centre".
"This seems like a fundamental problem for the effective use of this facility as a COVID-19 surge centre and it seems that the expectation of how the facility can be used has not been met by the end product," the review said.
But Stephen-Smith was not able to say whether, based on the findings of the 2021 report, the centre would have even been able to be used as an emergency department. She said further work would have been needed to understand this.
While she decries "revisionist thinking" the very defence she stood behind this week - that the centre was an emergency department only - is contingent on analysis that never happened.
This hasn't been a great week for health authorities in the capital, and yet again questions have been raised about the lack of transparency in how decisions are made and how uncomfortable truths or mistakes are kept under wraps.
The public was never informed of the findings of this report, nor was the Health Minister. There were recommendations for improvements but these were never acted upon.
Canberrans have never resented their "just in case" COVID surge centre. But the failure for authorities to have levelled with them about the flaws and limitations of this facility have undermined trust.
Instead of updating the city's "insurance policy" when it had the chance, the government decided to hide its limitations deep in the fine print.
We've made it a whole lot easier for you to have your say. Our new comment platform requires only one log-in to access articles and to join the discussion on The Canberra Times website. Find out how to register so you can enjoy civil, friendly and engaging discussions. See our moderation policy here.
