Better enforcement needed on age limits for tobacco and vape products: auditor’s report

People under the age of 18 in Saskatchewan can’t legally buy tobacco or vape products, and the provincial auditor believes the Ministry of Health needs to do a better job of making sure that’s enforced.

The ministry contracts the Saskatchewan Health Authority to conduct the enforcement, but the auditor’s office found a list of deficiencies.

The auditor said that the ministry didn’t have a full list of all the stores in the province that sell tobacco and vape products that could be inspected.

It also found that 19 per cent of the 1,200 retail locations didn’t get an annual inspection in 2020-2021.

The authority has a program where it will employ youths to go into stores and try to buy tobacco or vape products, but the report said the ministry doesn’t monitor well enough if these are conducted annually, that notices and warnings of violations aren’t sent out quickly enough, and stores that did break the rules aren’t re-inspected quickly enough.

“For example, more than half of the 225 retailers that sold to a youth test shopper were not re-inspected within the six-month time frame that is expected,” said the auditor, Tara Clemett on Wednesday.

Re-inspections happened between seven months and 24 months after a violation.

The report used data from Statistics Canada to show that youth between 15 and 19 years of age in Saskatchewan smoke at nearly three times the national average (22 per cent versus eight per cent), though the overall rate of smoking is declining.

The auditor said the ministry uses these inspections as a deterrent and mechanism to keep such products out of the hands of youth, so the ministry should probably be doing the most effective enforcement it can be.

The recommendations in the auditor’s report include:

– Establish a formal process to maintain a complete list of retail locations subject to inspections

– Work with the Saskatchewan Health Authority to have youth test shopper inspections conducted annually, warning letters and notices of violations delivered promptly, and non-compliant retail locations re-inspected frequently

– Set clear guidance on the frequency of periodic, routine inspections as well as the process for handling complaints

– Enhance written reports on enforcement activities provided to senior management and include follow ups on non-compliant retailers, complaints, trends

– Update Enforcement Manual to align with current practice

Minister of Health, Paul Merriman, said the ministry is accepting all the recommendations.

“And we’re going to work very hard to educate the retailers to make sure that they’re adhering to that.”

Merriman said they’re going to be looking at the program where youth are sent out to try to buy products, saying they’ve got to educate them a bit better.

“So we’re going to enhance some of the guidelines in that and we’re going to send them back out and then we’re going to follow it up with some enforcement,” said Merriman.

Quicker coroner’s reports needed

The auditor also looked at the Coroner’s service and the reports it produces investigating deaths, and found that in many cases the reports should be finished quicker and recommendations need to be followed up on.

“This can negatively affect families waiting for coroners’ reports, and increase the likelihood that public safety remains at risk,” read a news release.

In its investigations, the auditor’s office found two instances where the coroner’s reports were signed 150 and 169 days after getting final autopsy reports. As of June this year, there were 20 coroner investigations that were still open for more than six months.

The auditor’s report noted that there are no formal timelines on when the coroner’s reports should be finished and the results given to families.

The coroner’s service makes recommendations to agencies when it finds something that could or should be changed to increase public safety, like adding a stop sign or traffic lights at an intersection.

During the period the auditor was looking at, 26 recommendations were made but responses were only received for seven of them, and the service didn’t follow up with the agencies on 16 of the remaining recommendations within six months.

“We want to make sure that those recommendations, they set a time frame for how quickly they want to get those recommendations out to agencies. And then there needs to be a mechanism where they do follow-up to almost have the agencies that they’ve reported those recommendations to tell them whether or not they have been implemented,” said Clemett.

The scope of this investigation did not include coroner’s inquests or homicides, as there are several other agencies involved in those, according to Clemett.

The recommendations from the auditor’s report include:

– Consistently complete and review coroner investigations and reports in a timely manner

– Establish formal timelines for communicating coroner investigation results to families, and making recommendations to agencies

– Analyze death investigation data (e.g., location, manner, cause) to inform public safety recommendations and conduct timely follow up on recommendation implementation

– Routinely confirm coroners understand confidentiality and conflict of interest policies

– Centrally log complaints and actions taken to resolve them

– Regularly report on Coroners Service activities (e.g., complaints, recommendations) and investigation results (e.g., data analysis) to senior management

Serious incidents at homes for adults with intellectual disabilities

In this report, the auditor’s office looked at service delivery at homes for adults with intellectual disabilities, and found the Ministry of Social Services needs to do a better job of monitoring whether the homes are providing quality care.

In the year 2020-2021, the 748 serious incidents were reported in group homes and 111 serious incidents were reported in private service homes – the auditor said the ministry doesn’t analyze the incidents to identify homes with ongoing issues.

However, the auditor did say that there weren’t any instances found where homes are operating which shouldn’t be.

Social Services Minister Lori Carr said she wanted to put the serious incidents into context, that many of them were related to COVID-19, while others were related to things like a client getting their medication 10 minutes late.

Clemett said the ministry should be doing a better job of having a central tracking system for home licenses including when they were licensed, which have conditional licenses, what deficiencies there might be and when inspectors should go back. She said the ministry doesn’t have a system to track serious incidents home by home which would allow staff to see a trend.

“The ministry … they don’t have that ability to have that, sort of, detailed analysis in front of them, other than the serious incidents by category,” said Clemett.

The auditor also talked about the person-centred plans developed for clients, that the ministry supports home operators in developing these with a web page, but doesn’t meet with clients to evaluate the plans’ fulfillment. According to the report, 63 per cent of clients’ records that were tested showed that they hadn’t had any direct contact with ministry staff in two years.

The recommendations for the Ministry include:

– Regularly meet with clients in the homes and assess the quality and fulfillment of their person-centred plans

– Update the home inspection checklist to cover key risk areas and annually inspect each group home to assess whether minimum program standards are met

– Centrally track key information about homes and monitor timely resolution of deficiencies at conditionally licensed homes

– Analyze serious incidents for ongoing issues in homes and ensure incident recommendations from investigations are implemented

– Verify completion of periodic criminal record checks for those people in homes supporting clients

Looking ahead

Clemett said her office is outlining priorities for the next few years and COVID-19 will be a bit part of that.

She said work will include the implications that have come about from COVID-19, online learning in the education sector, buying goods and services within the health authority, and recruitment and retention in the authority.

She said, in the longer-term, her office will also be looking at surgical wait times and virtual care, while also staying on top of ongoing situations like cybersecurity and IT risks.