Canberra's multi-million dollar pop-up emergency department set up in response to the pandemic was not suitable for treating infectious COVID patients, a damning review of the centre found.
Documents, released to The Canberra Times under freedom of information, show a review of the centre expressed concerns about ventilation and airflow.
Emails between health authorities show the centre was not suitable for infectious patients during the ACT's second lockdown "without significant work being carried out".
The pop-up hospital was designed based on guidelines developed for facilities in low- and middle-income countries and a review said it did not meet all national standards, documents also showed.
Both the government and Aspen Medical, the contractor which built the centre, have defended the venue, saying it was built during a medical emergency when global health systems were overwhelmed and the spread of COVID was thought to largely be from droplets.
The ACT government has said the emergency department, which was designed to have 50 beds including six resuscitation bays, was never designed to be a "ward area" for overnight patients.
A review conducted in October 2021 by consultants showed concerns about negative pressures in the centre, along with a lack of filtration and "non-compliant exhaust discharges".
"The facility is generally not suitable for treatment of COVID-19 infected patients as it is," the review said.
The review of the centre also found there was a fire risk if ventilators were used within the facility.
"The high use of ventilators that could be expected in a 'ward area' for COVID-19 patients the environment [sic] could be oxygen enriched increasing the fire risks and so places extra emphasis [on] fire related systems," the review said.
But a spokeswoman said this review was commissioned so health authorities could consider a "revised model of care", including whether the centre could be used to treat patients overnight.
"CHS consultants undertook an assessment of the building mechanical services infrastructure at the Garran Surge Centre in late 2021, as part of due diligence, to assess whether the scope of services within the building could be expanded for a short-term, revised model of care," a spokeswoman said
"The decision was made not to progress these works to avoid additional building changes. This did not affect the health, safety and wellbeing of staff and patients in the building for the services it was being used for.
"The facility was constructed in April 2020 and was not designed to be a ward area."
'Acting now to increase capacity of our health services'
The Garran Surge Centre, which only closed last week, was initially built to be an emergency department for COVID patients.
But it was never used for this purpose. Instead, it served as a vaccination centre, a testing centre and a COVID-specific walk-in centre.
It was initially expected to cost $23 million but only cost $14 million. It was built in just 37 days on Garran Oval in early 2020. It was built to specifically handle COVID patients in the scenario where existing emergency departments did not have enough capacity to meet demand.
When announcing the project in April 2020, ACT Chief Minister Andrew Barr said the project was aimed at preventing horror scenes overseas where authorities had to race to set up makeshift hospitals.
"We don't want to be in the sort of situation other cities around the world are currently in," he said.
"We are acting now to increase the capacity of our health services so we can continue to provide emergency care for Canberrans throughout this pandemic."
Authorities had hoped the hospital would never need to be used.
By the time the centre was completed in May 2020 the territory's first wave of COVID was largely finished. There was no community transmission in Canberra until August 2021, which plunged the ACT into a nine-week lockdown.
It was during this second wave that authorities started to consider whether it would need to be used to treat patients.
The government spokeswoman said the centre never had to be used as the demand on the emergency department was "manageable" as long as a range of hospital diversions were in place.
'Not following the relevant state guidelines and Australian standards'
The centre was built by Aspen Medical, which was commissioned to build the facility based on a document from the World Health Organisation. The document provided guidelines on how to set up a treatment centre for severe acute respiratory infections.
"This document... provide[s] recommendations, technical guidance, standards and minimum requirements to setting up a [severe acute respiratory infections] treatment centre in low- and middle-income countries and limited resource setting, including the standards needed to reconvert existing buildings," the WHO document said.
In a design summary report from April 2020, when the centre was under construction, it was noted the centre followed the WHO guidelines "and as such in some cases is not following the relevant state guidelines and Australian standards".
The October 2021 review said while the WHO document's guidelines were tailored for low- and middle-income countries in limited-resource settings, the document did also say it supported the application of national standards.
"It also aspires to support the application of national standards, presumably in countries that already have them," the 2021 review said.
"It does not suggest to rewrite nor to lower those national standards."
Correspondence between officials in September 2021 even shows they had concerns about the centre not meeting the WHO specifications.
"In summary, I understand that the surge centre was originally built to a WHO informed specification, incorporating negative pressure compartments. The notes in this email indicate that we are not currently meeting achieving the specification required," an email from a senior Canberra Health Services executive said.
"Before we embark on any upgrade work can I get your understanding of what specification should exist and what was commissioned in 2020."
The government spokeswoman said the facility was built in the context of a medical emergency and said, despite this, it was still built to the required specifications of a centre of this nature. She said it still met relevant Australian standards.
"At the time, public health systems around the world were being overwhelmed, and international governments were responding to modelling predicting that millions of people may die from a virus with no vaccine," she said.
In response to questions about comments suggesting it did not meet standards, the spokeswoman said additional infection control measures, such as personal protective equipment, hand sanitising and regular cleaning helped it meet standards to reduce transmission.
"The totality of all these measures was considered to be sufficient to mitigate the risk of transmission. It is also important to note that at the time of design and build, the coronavirus was considered to be spread predominantly through droplet transmission," she said.
A spokesman from Aspen Medical said given the building was temporary there were exemptions to depart from normal Australian standards. But he said we "did so very rarely as this would have created inefficiencies".
'Will no doubt create some controversy'
The October 2021 review recommended a series of improvements were needed to the centre, including the installation of extra exhausts and HEPA filters and improvements to the exhausts.
The consultant said this was expected to cost between $60,000 and $75,000. It was expected to take four to six weeks to complete. The updates were never made.
Without these updates, the consultants said the centre could not be used as a ward area but rather it could only be used for triage, a small area of administration and public waiting areas. It could have no long-term bed occupation and no long-term intensive care.
However, bureaucrats were worried about the reaction to the report.
"Updating of the report can be done over the next few days. I'm happy to work with you on this to get it right, as it will be provided to senior members of CHS/ government, and will no doubt create some controversary [sic]," a health official said in a message to the consultant.
A spokeswoman said Health Minister Rachel Stephen-Smith or other cabinet ministers were not given the October 2021 report which showed the concerns because authorities ultimately made the decision to not use the centre as a ward.
But there were even some concerns raised during the construction of the facility.
'Does not have allowance for UV, or HEPA filtration'
A peer-reviewed design of the Garran Surge Centre, taken while the centre was under construction, expressed concerns that beds in the pop-up hospital were not appropriately spaced.
The review also noted resuscitation bays were physically separated but were not isolation rooms.
"High level exhaust will draw substances at staff caring for the patient in resus (during intubation)," reviewers said.
Reviewers noted the facility was designed to have beds that were separated by three metres, but it pointed to a recommendation from VicHealth that there should be 3.6 metres between beds.
"3m x 3m bays is the design," Aspen Medical responded.
The Aspen Medical spokesman elaborated on this when asked by The Canberra Times, saying the decision to reduce the bed footprint was made to "achieve efficiencies in construction" and was based on an interpretation of "the guidelines for the situation at hand".
"The decision was to reduce the bed footprint to one that we knew to be functional," he said.
The report said HEPA filtration, high-efficiency filters that capture more than 99 per cent of particles, did not appear to be included as part of the design. Reviewers also recommended the use of UV sterilisation.
"The current design and agreed process does not have allowance for UV, or HEPA filtration," Aspen responded.
A spokesman from Aspen Medical said COVID restrictions meant there was no access to imports and the company had to use equipment that was already in the country. He said the mechanical system used at the centre would not have been able to turn around the desired number of air changes.
"It was not clear at that time if a HEPA filtration system would 'catch' the virus at all," the spokesman said.
"As such, a decision was made early on for full evacuation of returned air and 100 per cent fresh air being brought in to ensure patient and staff safety."
Health authorities or the ACT government have never publicly revealed the concerns with the facility. There were questions about why it was not being used during the 2022 winter surge when there were more than 100 patients in hospital with the virus.
When asked about why it wasn't being used during the winter surge, Ms Stephen-Smith said staffing issues had prevented the centre from being used.
"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," she said in July 2022.
"One of the challenges we're facing at the moment is staffing shortages because of the impacts of respiratory illness and other responsibilities and illnesses across the ACT, including in our emergency departments."
The centre will be dismantled in the coming months but the government will need to hire consultants to inform this process and provide advice on whether the centre can be repurposed.
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