Bill C-434 (Historical)

An Act to amend the Criminal Code (assault against a health care sector worker)

This enactment amends the Criminal Code to require a court to consider the fact that the victim of an assault is a health care sector worker to be an aggravating circumstance for the purposes of sentencing.

Criminal Code

[Gord Johns, NDP, Courtenay—Alberni, BC]

Madam Speaker, like my colleague before me, I also want to pay my respects to all those who have been impacted by the terrible bus crash in the Prairies, and their family members. I thank all the first responders and everybody in our health care system especially. It is a traumatic experience for them and for everybody in those communities.

We are in the middle of a crisis in my riding. There are wildfires that have cut my riding right in half. Over 30,000 of my constituents are cut off from the rest of Canada. Many of them are struggling. I have to give a shout-out to all those people who are fighting the wildfires, all the first responders and the people in our community who are stepping up, like those who work at the food banks. We are looking out for each other. It is what we do in Canada and across this country, especially in rural Canada; we look out for each other.

It is a tremendous privilege to rise to speak to this bill. I have worked with my colleague from Cariboo—Prince George since we both got elected in 2015. He brought forward a bill for a PTSD strategy. He has experience in this area, or at least knowledge of it. He has been a strong advocate for first responders and people working in health care since I have gotten to know him, and I do appreciate his bringing forward this bill. We are both from rural B.C., and we understand the importance of looking out for our health care workers, especially in rural Canada.

We know this bill would amend the Criminal Code to require a court to consider the fact that the victim of an assault was, at the time of the commission of the offence, a health care professional or first responder engaged in the performance of their duties, and that that would be an aggravating circumstance.

The main thing that we, members of the NDP, want to say is that, clearly, no health care worker or first responder should ever be subjected to violence in the workplace. Bullying, abuse, racial or sexual harassment and physical assault should never be considered part of the job. Health care workers take care of us at our most vulnerable times; they look out for us. We rely on them. We have a responsibility to take care of them in return. That has not been happening. I am going to speak to that in depth.

Violence against health care workers is a pervasive and growing problem in the Canadian health care system. Both the number and the intensity of attacks are increasing at an alarming rate. Assaulting a health care worker not only harms the individual person but also puts our entire health care system at risk. I am going to speak to that in more depth. Workplace violence is a major factor driving Canada's dire health care staffing shortage. We know that workplace violence is a pervasive problem in health care settings across the country. However, prior to COVID-19, health care workers already had a fourfold higher rate of workplace violence than people in any other profession. We know it has gotten worse since then. Incidents of violence against health care workers have escalated dramatically during the pandemic and postpandemic.

We were already in a crisis, like I said, prepandemic. We have seen that there is a labour market shortage in the health care system. We have seen the increased demands on the health care system. In 2017, a survey cited that 68% of registered practical nurses and personal support workers experienced violence on the job at least once that year. Imagine someone going to work and that, at least once a year, there will be a violent attack committed against them. Who wants to work in that environment? It is just terrible to hear these stories. Nearly one in five of the RPNs and PSWs surveyed said they had been assaulted nine or more times in that year alone. We have heard, from the Canadian Federation of Nurses Unions, that violence-related incidents and claims for frontline health care workers have increased by almost 66% over the past decade, which is three times the rate of the increase for police and correctional service officers combined, who are also facing an increase.

We really need to step back and look at how, over the last couple of decades, we have seen a huge erosion of our health care system. I am going to speak a bit more about that.

If we look at Canada's ratio of nurses to patients, we have one of the worst in the world. In universal health care, we are at the bottom. We are just above the U.S. That is just a terrible stat on its own. Nurses know this full well. Their patients see them running from patient to patient and the stress this creates.

Nurses are really the victims of the failure of consecutive federal and provincial governments to stabilize and strengthen our health care system. They have been dealing with the huge erosion of cuts. They are dealing with the people at the front line. When there is a wait at an ER or a wait to get the services people so desperately need in their vulnerable state, it is the frontline health care workers who are dealing with a political problem. The cuts from all levels of government are falling on the people on the front line, and that is creating a huge strain on the patients and on their families, as we know. It is slowly eroding staff levels as well because people are having to make difficult choices.

The long-term health care system is now over 50% privatized. Privatization has a huge impact on the health care system as well, as there is a lack of protection for workers, inadequate wages and staffing levels that are quite low. The health care system is in deep trouble, and staffing is a major issue. There is frustration in the lack of care, like I said earlier, and the burnout it is causing people on the front line. This is a crisis, and it is propelling these terrible statistics.

One thing I wanted to highlight is that we need to do a few things to help fix that. We need to invest in our health care system, stop for-profit health care and ensure that we are supporting the staff. The bill before us is a really important start to that, but there is also the burnout.

We are hearing from nurses, and they are saying they have three options. The first is to leave the field. The second is to get burnt out and make a mistake while practising their care. This is falling on them. The overburdening of our health care system is falling on them. Can members imagine going to work, worried they would make a mistake while trying to take care of somebody? The third option nurses have is to reduce to part-time hours, but that creates even further erosion of the health care system.

There is a lot of compassion fatigue happening as well. I really appreciate my colleague before me talking about the lack of mental health support. We now have a two-tiered health care system. Our mental health care system is a two-tiered health care system. There are people who need care. We are hearing from people who cannot get access to that care. They have to get arrested just to get the care they need. That is absolutely ridiculous. They have to get arrested. What kind of state are they in at that point?

When they go to the ER and they are in that kind of state, it is health care workers who are dealing with them. This is not acceptable. We need to ensure that we create parity with physical and mental health, and that we are not reactionary. Right now our health care system is reactionary instead of preventative, and we need to get to a preventative state.

It is an uphill battle, and it is exhausting everybody in this country.

I do want to highlight that our critic from Vancouver Kingsway tabled a very similar bill, Bill C-434, to ensure that we are on this path, and I believe my friend from Cariboo—Prince George tabled a very similar bill.

We want to make sure that we get the definition of health care professional or first responder right, so we are supportive, obviously of this legislation, and we can work on that with our colleague at committee. I am sure we can find a pathway to doing that. This legislation is an important legislation that we have heard support for from the Paramedic Association of Canada, the Paramedic Chiefs of Canada and all important stakeholders.

I have to highlight something before I finish. The majority of health care workers who experience workplace violence are women, and this violence is often connected to gender-based discrimination and harassment. This needs to stop. According to the Canadian Institute for Health Information's 2019 report on health workplace statistics, women account for approximately 82% of Canada's regulated health professionals, which includes nurses, midwives, physicians, dentists, pharmacists and other health professionals.

We have lots of work to do. We are very supportive and appreciative of this bill and legislation.

[Don Davies, NDP, Vancouver Kingsway, BC]

Madam Speaker, I am pleased to rise today to express, on behalf of my New Democrat colleagues, our support for Bill C-321, an act to amend the Criminal Code, assaults against health care professionals and first responders. Once again, I would like to offer my gratitude and congratulations to my colleague from Cariboo—Prince George for his constant attention and care to our frontline responders in this country. This is a continuation of his fine work in this area.

In brief, this legislation amends the Criminal Code to require courts to consider the fact that victims of an assault were at the time of the commission of the offence a health care professional or a first responder engaged in the performance of their duty as an aggravating circumstance when they are the victim of that offence.

I think it goes without saying that no health care worker or first responder, in this country or anywhere, should ever be subjected to violence in the workplace. Bullying, abuse, racial or sexual harassment, and physical assault should never and can never be considered just part of the job. These workers care for us at our most vulnerable, and I think we have a responsibility to care for them in return.

Violence against health care workers in specific is a pervasive and growing problem in the Canadian health care system. Both the number and intensity of attacks are increasing at an alarming rate. Assaulting a health care worker or a first responder not only harms the individual involved but also puts our entire health care system and first response system at risk. Workplace violence is a major factor driving Canada's dire health staffing shortage, and I am sure it is a dissuading and discouraging factor for people pursing this career.

Workplace violence is a pervasive problem in health care settings across Canada. Prior to COVID–19, health care workers had a fourfold higher rate of workplace violence than any other profession. Incidents of violence against health care workers and first responders escalated dramatically during the pandemic. I might say as well that first responders are often the first people on the scene when we are dealing with Canada's overdose crisis, and I do not think I need to point out how pervasive that is in every corner of the country and the danger it presents to them.

In a 2017 survey, 68% of registered practical nurses and personal support workers reported experiencing violence on the job at least once that year. Nearly, one in five said that they had been assaulted nine or more times that year. According to the Canadian Federation of Nurses Unions, violence-related lost-time claims for frontline health care workers have increased by almost 66% over the past decade. That is three times the rate of increase for police and correctional service officers combined. First responders, notably paramedics and firefighters, also experienced violence and threats on a shockingly frequent basis.

That is why on February 28, 2019, I introduced Bill C-434, an act to amend the Criminal Code, assault against a health care sector worker. That legislation would have amended the Criminal Code to require a court to consider the fact that the victim of an assault is a health care sector worker would also be an aggravating circumstance for the purpose of sentencing. I reintroduced that legislation in successive parliaments in February 2020 and December of 2021.

Although the present bill, Bill C-321, before the House today is very similar to Bill C-434, it does not define a health care worker as broadly. This bill is limited to an assault against “a health care professional or a first responder”, but does not define the terms. The bill I introduced was specifically drafted to ensure that, when we talk about a health care worker, we include not only professionals, but everybody who works in a health care setting, from the porter who greets people at the door, to the orderly and the admin clerk, many of whom experience bullying, abuse and violence. I know my colleague has already indicated that he is willing to look at a broadened definition, and I thank him for that because we want to make sure that this contemplated measure does not exclude any health care sector workers who are not members of professional bodies.

As has been pointed out by my colleague on the government side, in December of 2021, Bill C-3 was passed in the House, which amended the Criminal Code to enhance protections for health care workers, those who assist them and those accessing health care services, and it received royal assent at that time.

Among other measures, Bill C-3 amended the Criminal Code to make it an aggravating factor in sentencing for any offence when there is evidence that, one, “the offence was committed against a person who...was providing health services, including personal care services,” as a part of their duties or, two, where there is evidence that the offence “had the effect of impeding another person from obtaining health services, including personal care services”.

By the way, I also think it is important to point out that we ensure that this bill is broadly defined to include any setting in which a health care worker may perform health care services, including in the home, long-term care centres or any other non-conventional place other than a hospital.

Unlike Bill C-3, the bill before the House, Bill C-321, broadens that protection, I think very laudably, to apply to first responders who are engaged in their duties but not necessarily engaged in providing health services. This is a welcome improvement. Again, I thank my hon. colleague for broadening this important protection.

Assaulting a peace officer is already a stand-alone offence under section 270 of the Criminal Code. The punishment for assault of a peace officer is no more serious than the legislated sentence for common assault. However, the court is likely to consider that the victim, as a peace officer, is an aggravating factor at sentencing.

The Criminal Code offences in sections 129 and 270 do define public officer and peace officer, but case law on the interpretation of section 2 shows the varying occupations that have been counted as peace officers for the purposes of prosecutions under the Criminal Code in particular contexts. They have been included to define members of the Anishinabek Police Service and military police. However, despite the existence of cases which mention paramedics or firefighters that cite section 270 of the Criminal Code on peace officers, there are none that I am aware of where the person assaulted was a paramedic or firefighter. Therefore, current case law suggests that first responders are not considered peace officers under the Criminal Code. This omission must be rectified and would be rectified by this bill that is before the House.

I have already talked about Bill C-321 employing the term “health care professionals” and how that is not defined in this bill, so we are going to work, I hope collaboratively, to ensure that that definition is broadly expanded. It is similar with first responders, who are not defined in this bill because the Criminal Code does not define this term. Other federal statutes do not either, so it will be important for us to have a good, broad description of that to ensure that any person in this country who is providing first response services in our communities is covered by this legislation.

I want to just mention that this is an important step because the Criminal Code is an expression of society's values and priorities. I think sending a message to the Canadian public that these health care workers are taking care of us, that they deserve to be protected and are inviolate is an important message for Parliament to send.

I am not sure I understood completely the comments by my hon. colleague from the Bloc Québécois. He did mention some important points about broadening this protection to many other kinds of workers, but there is one key difference. Health care workers and first responders do a job that we ask them to do. We ask them to be there for people when they are in trauma, and we are putting them in a situation that regular workers are not often in. They have no choice but to be there. They have to be there. That is why I think it is particularly important to send the message that they are inviolate and we must protect them. We have to send a message that under no circumstances is it ever acceptable to violate those people, either by word or deed.

Finally, I want to recognize that, as important as this bill is, it is only a first step. To keep health care workers and first responders safe, they need resources and tools. We want to prevent them from getting assaulted in the first place so they need proper security. They need proper physical barriers. They need sufficient staffing.

We all need greater mental health supports because we also have to recognize that many times the people who are doing the assaults are in some cases victims and are suffering from mental illness and trauma themselves. We have to recognize that we need a comprehensive holistic approach to this problem so we are doing everything we can to prevent the situations that often lead to assaults from happening in the first place instead of dealing with the sentencing after the assault occurs.

[Matthew Green, NDP, Hamilton Centre, ON]

Madam Speaker, I rise quite sheepishly, having not received the memo on the festive tone of this afternoon's debates, so I will ask members to indulge me. In my community, plain talk is not bad manners, and I have prepared a full speech that does identify some gaps, which I think are germane to the conversation. This is not intended in any way to end off on a bad note or a sour note, but to really contemplate deeply what is at stake here in the House. It keeps me up at night, like many members I am sure, and it wakes me up early in the morning.

While there remains much to be said about the timing and need of the last election called by the Prime Minister, I have to admit the opportunity for me to retreat from this place of privilege and return to the doorsteps of my constituency provided me with an invaluable grounding for what is at stake among these future proceedings of the session. This is a monumental day, and I do not want to take anything away from that. It is a burden that we carry. In fact, we have asked millions of Canadians to carry a very heavy burden in order to make it through this COVID pandemic.

While returning to this topic and supporting Bill C-3, having heard the various interventions pertaining to the same, many members have questioned the relationship between the first two parts of this bill, which would amend the Criminal Code, and the third part, which would be establishing something under the Canada Labour Code.

For those from the public, and who may be tuning in to this debate through livestream, or perhaps reading it in the Hansard, I will provide a summary of Bill C-3. The first two parts would amend the Criminal Code by creating two new offences relating to the protection of health care professionals and patient access to health care. The first offence would apply to any act of intimidation that is intended to cause fear in a patient, health care professional or any person who supports them and prevents them from accessing or providing health care services. The second offence would also cover intentional acts that prevent a person from accessing services provided by a health care professional. Both offences would be punishable by a maximum term of imprisonment of up to 10 years and up to two years on a summary conviction.

Part three, which seems to be where perhaps some people have the disconnect between these two, pertains to amending the Canada Labour Code to establish 10 days of paid sick leave. This leave would be available each calendar year to employees in federally regulated private sectors who have been continuously employees for more than one month.

In fairness, perhaps on the surface these two policies under different acts may not appear to be connected. It is in fact my intention today to offer my support for the deep relevance between these two interconnected parts. I would argue that the deep despair and well-documented societal impacts of four consecutive waves of COVID, each with its own circumstances of social isolation and economic hardships, are ultimately due to all levels of government's failure to adequately respond to the scale and the scope of this pandemic.

The utter fear, uncertainty and doubt experienced by segments of our population have made them especially susceptible to this anti-science, anti-government and, by extension, anti-health care movement, from which come many of the targeted and vile attacks we are now legislatively responding to

Since the beginning of the pandemic, health care workers have faced a high risk of infection and violence. In fact, since long before the pandemic health care professionals are four times more likely to experience violence in the workplace than other profession. Unfortunately, many of these acts of violence go unreported. According to the Canadian Federation of Nurses Unions, in 2019 61% of nurses reported experiencing violence, harassment and assault on the job, and because women make up a significant portion of the health care workforce, they are disproportionately victimized by these acts of violence.

To discourage these acts of violence, the Canadian Federation of Nurses Unions has recommended amending the Criminal Code, which is what is before us today, so I commend them on their long-standing work. This request was also the subject of a 2019 health committee recommendation. Specifically, the committee recommended amending the Criminal Code to require that it be considered an aggravating factor in sentencing if the victim of assault is a health care worker. This recommendation was based upon the NDP's bill, Bill C-434, introduced by my dear friend and NDP caucus colleague, the hon. member for Vancouver Kingsway.

As it pertains to putting the 10-day paid sick leave issue into context, people should never have to choose between their income and their health. Since the beginning of this pandemic, the NDP caucus has been demanding that the Liberals provide workers with 10 days of paid sick leave.

After winning an initial concession on this leave by offering it to people with COVID-19, we succeeded in forcing the Liberals to offer two weeks of federally funded leave through the CRB sickness benefit. The New Democrats not only support 10 paid sick days, we led the calls for it in the House. My hon. colleague for Rosemont—La Petite-Patrie fought hard at committee, where he tabled four amendments, two that were unanimously supported and two that were rejected.

I feel it important to note on the record today that the NDP fought for amendments that were accepted unanimously. One is that an employer cannot request a doctor's certificate for less than five consecutive sick days. This is major because stakeholders say that asking for a doctor's certificate is a barrier to its use and people would rather go to work than chase an appointment. Plus we know that it clogs up the health care system when it does not need to.

The second amendment that passed due to the hon. member is after 30 days of employment, the employee gets one day of sick leave. In the original version of the law, it was at the beginning of each month, which would have meant that someone hired on January 1 would have to wait until March 1 for their first accrued day.

Both amendments were intended to make sick days more accessible and the NDP forced the issue to make the program more accessible to workers and more responsive to their needs. This is a victory. The five consecutive days before the employer has the option to request a doctor's certificate will make a significant difference.

We did, however, have two other amendments that failed. The first amendment opposed by the Liberals was that all employees, upon hiring, would have access to four paid sick days. They would accumulate another six, one per month, as proposed in the bill, of up to 10 per year. Having four days right from the start is very important because stakeholders tell us that very rarely do people take a day off work and an illness often requires a few days off.

The minister, in his testimony yesterday morning, said that he was open to such an amendment, speaking of the urgency of the current omicron context. By voting against the amendment, the Liberals have refused to speed up access to paid sick days in the midst of another pandemic winter. Workers will continue to go to work sick since they will not have access to enough days to isolate themselves at home until next November at the earliest. This is irresponsible.

The second amendment that the Liberals opposed was that all employees with two or more years of seniority would get 10 sick days when the law came into effect. This would have provided access to the full strength of the program immediately for the majority of employees under federal jurisdiction. Since this amendment was rejected, all employees will begin accrual as if they were newly hired. I suggest that this is precisely because of these types of gaps in our social safety nets that we ultimately remain in this mess of targeted attacks on our hospitals and health care workers.

Last week, called on the hon. member on the Conservative side to join our calls for more advances and protections. We have the opportunity to take a first step in the right direction in the House today as an informal form of sectoral bargaining for workers. We know this is going to be a vital protection.

This past election allowed me to speak to my constituents on their doorsteps. It is heartbreaking to feel as though people who I know to be rational, family members and classmates who I grew up with, neighbours I have known to be caring and compassionate, have been manipulated by the rhetoric of right-wing populism, grifters and agitators who would seek to turn this profound moment of suffering into some sort of personal sales pitch or nationwide tour targeting our front-line health care workers fighting the onslaught of successive waves of COVID.

For those caught up in this fear and confusion, I offer to endeavour to work harder as a member of Parliament to ensure that their basic needs are met and the most current evidence-based information is communicated without political interference or manipulation.

I call on the members of the House, who have rightly identified the divisions in our country, to recognize its root cause. It is the failure of all levels of government to adequately take care of the basic needs of all people, not just throughout COVID but in the decades preceding it.

I will close with the simple reassertion that these three parts of Bill C-3 are the cause and the effect of the social isolation, political estrangement and economic isolation felt by everyday people and, most unfortunate, targeted at our front-line health care workers. In taking better care of them, we will take better care of each other.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

I fully agree.

When it comes to increasing the criminality of attacking a health care worker, I think Bill C-434 is a good one. I don't know if you remember the incident where there was a fellow on a bus who killed another fellow and got off because of his mental health condition. While increasing criminality might be a disincentive for people who are of sound mind, I'm worried that for those with mental health disorders, that's probably not going to be the thing. What are the important things that we should do?

I'll start with Mary Schulz from the Alzheimer Society.

[Henrietta Van hulle, Vice-President, Client Outreach, Public Services Health and Safety Association]

Thank you for the opportunity to speak to you today.

My name is Henrietta Van hulle, and I am a nurse with 17 years of front-line care experience before shifting to occupational health nursing. I am the vice-president of Ontario's Public Services Health and Safety Association, PSHSA.

PSHSA is a non-profit organization, funded by the Ontario Ministry of Labour, with a mandate to reduce and prevent work-related injuries, illnesses and fatalities.

As a product and technology organization, we focus on advancing intelligent safety. We leverage technology to drive change in health and safety outcomes, which enables us to stay ahead of the curve.

PSHSA has been actively involved in furthering violence prevention efforts within Ontario's health care community, and I'd like to spend a few minutes sharing what we've been up to.

Our journey began when PSHSA, along with its stakeholders, noticed, similar to what we've heard today, an increase in the severity and frequency of violent events towards health care workers. Nurses and personal support workers, PSWs, here in Ontario were being stabbed, punched and sexually assaulted, and we knew it had to stop.

Along with the Ontario Nurses' Association, we met with the Ministry of Labour to discuss how we could lead the province with the development of some new resources. This led to our violence, aggression and responsive behaviour, VARB, project. We included the term “responsive behaviour” as there are many events, as you've heard from others, where there is no intent to cause harm to the health care worker. However, these situations still require strategies to mitigate the harm that could occur.

In our VARB project, we used an evidence-informed approach that started with a literature review, a jurisdictional scan and input from focus groups. We engaged multiple stakeholders from various levels and subsectors across the health care system in Ontario to identify priority areas that had a focus on prevention of injury.

We further refined those to make sure that the topics that we chose would produce usable tool kits and would support consistent, scalable and consensus-based approaches for violence prevention. This led us to the development of five tool kits.

The first began at the foundation for prevention and was designed for completing workplace violence risk assessments at the organizational and the departmental levels.

The second tool kit focuses on the patient as the source of the most common type of violence that occurs in health care, and it was designed for conducting individual client risk assessments that assess observed behaviours and are not focused on diagnoses.

We then moved to making sure that everyone would be aware of the risks that could be assessed, and we developed a risk communication or flagging tool kit that we've heard others speak about.

This was followed by a security tool kit to assess what type of security and/or training programs are needed in the health care setting.

The fifth tool kit is the personal safety response system, a guide to ensure that workers at risk of or involved in a violent event have the means to call for help.

The design and development of the tool kits was led by one of our health and safety specialists with support from a working group that included both management and front-line staff from across health care. We also engaged our product development team in the knowledge translation tools that were developed to support the tool kits.

We further refined the tool kits by combining technology and subject matter expertise. We created a website and automated interactive risk assessment that supports employer self-sufficiency and subsequently provides a cost-effective solution for organizations to improve their workplace violence prevention programs.

The tool kits were so well regarded that, in 2017, a joint Ministry of Labour and Ministry of Health and Long-Term Care leadership table on workplace violence in Ontario recommended the use of PSHSA's tools in all Ontario hospitals.

Two years following the launch of our VARB tools, there have been over 20,000 visitors to our website, and a recent evaluation of the tool kits found that 75% of Ontario's public hospitals are aware of the tools and that 67% are actively using at least one of the tool kits. The researchers have told us that this degree of awareness and uptake is unprecedented for this type of complex intervention.

Since then, we've used the same approach to develop four additional tool kits at the express request of the joint leadership table, many of which, we've heard today, are needed. These tool kits focus on incident reporting and investigation, patient transit and transfer, code white and work refusals. They will be released this summer. We believe the path forward for Canada is to scale some of these regional successes to effect sustainable change. In fact, we have already shared our resources with members of the National Alliance for Safety and Health in Health Care, and four provinces outside of Ontario are actively using at least one of the tool kits. We shared our approach at the recent International Conference on Violence in the Health Sector, and have been approached by other countries for use of the tools.

While regional adaptations may be needed, the general solutions required to address workplace violence are fairly consistent, as we've heard, and we're happy to share our work. We also support many of the previous speakers’ recommendations on things such as the need for staffing ratios, human resource strategies that will make sure we have sufficient staffing available, infrastructure investments, and the need for a national standard for workplace violence. In fact, PSHSA and the CSA Group are currently working together on a research project to identify whether there is a need for a national standard on workplace violence and harassment. A report will be published this summer by the CSA Group. Based on our experience thus far, we have five additional recommendations to put forward.

Number one is to spark a paradigm shift.

This first recommendation speaks to the way violence is viewed in health care workplaces. We believe that a fundamental shift in thinking needs to take place in two key areas. First, health care employers consider violence an occupational health and safety issue, but it needs to be considered a care issue. There is absolutely no hope for quality care without considering worker safety. Having safe health care workers means having better care. Second, there is an inequality in the way many organizations treat physical safety versus psychological safety. The prevention of psychological harm has been less of a focus, and there are fewer supports available. It needs to be reinforced that workers’ psychological safety is just as important as their physical safety.

Number two is to conduct actionable research.

We feel strongly that there is sufficient evidence—as Dr. Keith mentioned, over 1,000 studies—around the risks, occurrence, severity, effects and contributing factors to workplace violence, but now it is time to evaluate leading practices and the types of interventions that are being used to make sure they're reducing the risk of violence or to tell us more about what is and what isn’t working.

Number three is to supplement health care curricula.

Beyond the necessary clinical knowledge, health care students require base-level safety training to ensure they're work-ready in a way that allows them to deal with escalating behaviours. This would include awareness, effective communication skills, recognition of escalating behaviours, de-escalation techniques and situational awareness. This training is not intended to replace existing leading practices, such as those that have been mentioned: the GPA program for older adults, which is in use in all but two provinces and territories across Canada; or the organization-specific training that may be required for dealing with specific populations.

Recommendation four is to enhance accountability.

Unless organizations are held accountable, we can't blindly hope for change. In our province, there is no mention of workplace health and safety within health care organizations’ service accountability agreements. As a result, we recommend that all funders explicitly require health care workplaces to integrate worker safety into care practices.

The last one is to amplify public awareness.

While those of us working in the health care sector and those close to it are aware that violence is a pressing issue, there is little awareness on a mass scale about the risks that health care workers face on a daily basis. A public awareness campaign that communicates the government’s position would call attention to the issue. Further, we encourage support for Bill C-434, under which assault of a health care worker will be considered an aggravating circumstance for the purposes of sentencing.

This bill will send a strong message that those who provide critical services such as health care must be treated with respect and have their safety and security protected.

Thank you, again, for the opportunity to speak to you today. We are grateful and heartened to see that the federal government is taking this issue seriously. We look forward to working together to effect healthier and safer workplaces.

[Jenna Brookfield, Health and Safety Representative, Canadian Union of Public Employees]

Good afternoon, and thank you for the opportunity to address your committee today.

I speak on behalf of the 680,000 members of the Canadian Union of Public Employees. Our members are on the front line of the health care system, and as such are personally dealing with the phenomenon of workplace violence. Of our members, 158,000 work in health care environments, including hospitals, public health, residential long-term care facilities, community health, home care and the Canadian Blood Services.

Our written submission contains many statistics that help illustrate the prevalence of violence in our health care system. I hope to spend my time here today highlighting the impact on our health care system and on the individual workers that Canadians count on in their times of greatest need.

Almost 1,700 years ago, the Roman poet Juvenal famously asked, “Who watches the watchmen?”, a question that helped articulate the fears of a society concerned with the abuse of power and centralization of that power. If there were a Canadian equivalent to that question in 2019, it would be “Who cares for the caregivers?”

As a society, we have decided that health care is a priority and we've dedicated many resources to its provision, yet we have failed to tend to the needs of those who are on the front lines providing those essential services.

Employers have failed to take appropriate actions to address workplace violence. Provincial governments have failed to appropriately regulate and fund our health care workplaces to address these challenges. Our judicial system has failed to introduce accountability for those who assault our careworkers.

Who cares for the caregivers? Their families do, and so do the unions, but most importantly, the countless Canadians who look to them every day for help and support care deeply for our caregivers in this society. We need to make sure that they feel those in power care as well.

Violence in our health care system is reaching epidemic levels, and that is not just hyperbole. The statistics from workers' compensation boards in all Canadian jurisdictions attest to the fact that workers in long-term care settings alone report more incidents of violence than any other workplaces. A care worker in a long-term care setting is more likely to experience violence on any given day than a police officer or a prison guard.

I wish I could say that now is the time to act, but sadly, that moment passed long ago. Now is the time we can try to limit the damage and do what we can to protect those workers who care for us.

My role at CUPE brings me into contact with care workers every day when their workplace health and safety system fails to protect them and the judicial system fails to hold their assailants accountable and they turn to their unions for support. I am not able to provide the resources they need to be safe at work and I am not able to impose sanctions on those who have assaulted them, but I am able to advocate for them, and that is why I'm here today.

I am here to give voice to our members working in the home care sector who have been beaten and sexually assaulted because when this female-dominated workforce is sent into the homes of their clients, they have no control over their working environment and have no colleagues to turn to when things go wrong. I have met these people. Just last month, I spent an afternoon listening to one of our members who was sexually assaulted at work and didn't want to report it because the last time it happened, nothing happened, except that she had one less client the next day and four hours' less pay.

I'm here to speak on behalf of our members in long-term care workplaces across this country, those workers who strive to provide safety and dignity to a generation of Canadians who built much of what we all enjoy today. Unfortunately, these workplaces have changed dramatically in recent years.

What we used to refer to as “retirement homes” now house everybody who needs care but does not fit anywhere else within our health system. That includes people like a former bodybuilder who suffered a traumatic brain injury and is now unable to regulate and control his violent impulses. This is a real resident in a real long-term care facility. I have personally witnessed the aftermath of his assaults every time adequate staffing resources are not available when he needs care. The lucky ones only have bruises. Three workers over the last two years who have worked with this resident have had bones broken.

It is not just the young and physically vigorous residents who are a source of violence. Rates of cognitive impairments in the elderly are on the rise, and many, such as Alzheimer's or dementia, can compromise the residents' ability to regulate their own behaviour. Through no fault of their own, these residents have also become a frequent source of workplace violence. A lack of resources puts staff at these facilities at risk, as well as the other residents in care.

I'm here to advocate for our members in the acute care sector: the workers in hospitals who provide care to us in our moments of greatest need and all of those who keep these services running, including everyone from the dietary workers in the kitchen to the administrative workers and the environmental service workers who keep our hospitals sanitary and safe from pathogens and bacteria. They are all suffering from violence in their workplaces.

Our hospitals are difficult workplaces at the best of times, but when violence occurs, it makes this difficult work almost untenable. Employees in almost every other sector can pause work in dangerous situations by using the right to refuse unsafe work. This system has broken down in the acute care sector. Licensed staff are threatened that to pause care in any situation could be construed as abuse and cost them their licences and their livelihood. Others are compelled by their empathy to put themselves at risk because someone else is in need.

While other workplaces can bar people with a history of violent behaviour from entering, hospitals must accept everybody and find some way to provide care to anyone who is in need. Our members would be the first persons to advocate for the right of everyone in Canada to receive quality care. CUPE advocates for the right to be safe while providing that care.

The factors causing violence in our health care system are complex and multi-faceted. Researchers have identified four distinct types of workplace violence, and each one is truly a unique workplace hazard that requires a different approach to solve.

What is known as type I workplace violence occurs through criminal acts. Legislative changes such as those proposed in Bill C-434 will help deter some of these events. I would implore the committee to not stop there and to also turn its attention to other forms of violence that plague our health care workplaces.

What the researchers refer to as type II workplace violence is caused when those whom the workplace provides services to become the source of violence. It is incredibly complex in a health care setting. This risk is increased by heavy workloads, staff shortages and a lack of adequately trained security professionals fully integrated in the care teams.

The federal government has the ability to help address these challenges through specific targeted funding as part of the Canada health transfer. Such targeted funding could be earmarked to increase staffing levels and ensure replacements for staff who are sick or injured to ensure that nobody works alone. We could expand health services so that specialized treatment facilities are available and patients are not kept in settings that don't meet their needs or that don't have the training and infrastructure to provide care safely.

Other recommendations on what targeted funding could achieve include the provision of comprehensive in-person training for all staff to better equip them to recognize the signs or conditions that might lead to violence, as well as training on how workers can de-escalate violence and protect themselves if attacked. We can provide front-line workers with personal alarms and ensure that other stationary alarms in the facilities are available and functional, which is not always the case.

Also, we can provide support for workers who have been injured and/or traumatized, such as counselling services, and allow adequate time away from work to recover from an incident. We can provide province-wide access to chart information to inform staff of previous behaviours in patients who have been transferred between facilities, because in many provinces this is not the case.

As well, we can increase the provision of one-to-one care. We can also provide therapeutic programs to reduce patient stress, fear, frustration, boredom and anger. We can increase security personnel with high levels of training and the capacity to intervene with violent individuals.

Our written submission highlights these and other specific recommendations on how the federal government can take practical steps to reduce the risk of violence in health care facilities.

I thank the committee for inviting us to speak today. We look forward to further opportunities to help care for the caregivers in our society.

[Don Davies, NDP, Vancouver Kingsway, BC]

Bill C-434, which I introduced in the House a week or two ago, would make violence against a health care professional in a health care setting an aggravating factor in sentencing.

I'm just wondering if you could give our committee some sense of how your members and the people you represent would take that. If that were legislated into law, what would be the response?

[Linda Silas, President, Canadian Federation of Nurses Unions]

Good afternoon, everyone.

Thank you for inviting me on behalf of CFNU. We represent over 200,000 nurses across the country. My name is Linda Silas. I am a proud nurse and a proud New Brunswicker. Thank you to the committee for doing this study. I remember testifying here on other issues. When violence in the workplace was mentioned, it was a surprise to everyone, so we are very pleased to see this.

Workplace violence is a growing epidemic among health care workers as staffing levels heavily decline, patient acuity increases and weak security protocols fail to offer adequate protection. From a Canada-wide survey, 61% of nurses reported abuse, harassment and assault on the job during the last year. A recent survey here in Ontario said that 68% of nurses and personal support workers experienced violence on the job. We know that these numbers are unacceptable.

CFNU members across the country recently shared with me different examples. I literally sent an email to my board telling them I was appearing at the committee on May 14 and asking for any examples that came to mind. Last June a nurse in Newfoundland and Labrador was stabbed multiple times with a pen. Last fall a nurse supervisor in P.E.I., working in a long-term care facility, was punched over and over in the throat and tripped and pinched by a resident. This March, in my own hospital in New Brunswick, a nurse was attacked and strangled for 11 minutes by a patient's spouse before security showed up. Of course, she is still off. In Nova Scotia, violence in some facilities has reached a point where the nurses have begun pursuing charges against patients and family members who strike them. Earlier this month in Manitoba, on three consecutive days a nurse was punched in the stomach by a patient.

Studies in Manitoba also talk about ER, as Dr. Drummond mentioned, where 30% of ER nurses have been physically assaulted once a week in the last year. Last year, a nurse in Saskatchewan was brutally assaulted by a patient to the point where one more blow to his nose would have been fatal. That was March 2018 and he is still not working. He will probably never work again. In March of this year, a patient's visitor brought a gun into a hospital in Alberta. The last time Dr. Drummond and I testified together in front of you, it was about gun control.

We deeply appreciate the support provided by MP Doug Eyolfson for supporting the e-petition that the CFNU recently submitted on violence against health care workers. I cannot emphasize enough how important it is for Canada to tackle this crisis, not only for the health care workers from coast to coast to coast who signed the e-petititon but for all Canadians. As we frequently say in nursing, when nurses and health care workers aren't safe, patients aren't safe either. Nurses are even more susceptible to violence in the workplace than any other type of workers who work directly with the public. There were more than 4,000 incidents of serious workplace violence against nurses—serious enough to prevent them from going to work—reported in the last five years. That number—4,000—is higher than for police and firefighters combined. In order to tackle this mounting crisis, we need to go to the heart of the problem. For this we need to have an occupational health and safety lens in both staffing and training.

On January 17 of this year, a nurse and a security guard were assaulted at the Southlake community health centre in Newmarket, Ontario. The nurse, a 33-year-old mother with young children, was struck in the face and suffered skull fractures and a brain bleed. Between April 2018 and December 2018, an eight-month period, we saw 170 violent incidents reported by staff in the same hospital. Nurses describe the hospital as bursting at the seams.

We're calling on the federal government to undertake a comprehensive study in health care human resource planning to determine the current and future shortage and to equip governments across the country with tools to address this shortage. The federal government can, once again, lead by example. lt can implement the highest recognized, comprehensive violence-prevention programs and infrastructure, including hands-on de-escalation training, appropriately trained in-house security, communications devices for staff, wellness programs focused on the physical and mental health of health care workers, and the flagging of patients with a history of violence.

We are calling on this committee to recommend that the federal government legislate national minimum standards of security training for health care environments. To ensure that positive training programs are put in place in a harmonized fashion, minimum standards must exist for health care environments across the country through appropriate legislative changes.

Further, security must be part of the circle of care and viewed as an integral part of the care team. The CFNU is advocating for a revision to the Criminal Code through Bill C-434 as a tool to deter violence against health care workers. The bill amends the Criminal Code to require courts to consider assaults on health care workers as aggravating circumstances for the purposes of sentencing. A similar provision already exists for police officers and transit workers. We commend MP Don Davies for introducing this bill and urge this committee to recommend that Parliament adopt Bill C-434. The CFNU is calling on the federal government to enforce the Westray law, which holds employers criminally responsible for negligence causing physical injury to workers.

Currently, standardized national statistics on workplace violence do not exist. The Canadian lnstitute for Health Information, CIHI, which collects and reports facility-level data, needs to publicly report data on facility-level violence in the workplace.

ln closing, Canada's nurses are appealing to members of this committee to amplify your voice in the committee's report to the federal government. We are calling for a comprehensive federal study on health human resources planning; targeted federal funding to enhance protections for health care workers through violence-prevention infrastructure and programs, with community police included as an essential partner within joint health and safety committees; the adoption by the federal government of best practices around violence prevention in federally regulated health care settings; the legislating of minimum national standards for security training in health care environments; support from this committee for Bill C-434 and the promotion and use of the Westray law by Crown prosecutors in cases involving health care workers; and federal funding toward CIHl's collecting and reporting of data on facility-level violence in the workplace.

Thank you.

[Don Davies, NDP, Vancouver Kingsway, BC]

moved for leave to introduce Bill C-434, An Act to amend the Criminal Code (assault against a health care sector worker).

Mr. Speaker, I am honoured to rise today to introduce an important bill to Parliament. I would like to thank the hon. member for Port Moody—Coquitlam for seconding this motion.

This legislation would amend the Criminal Code to require a court to consider that if the victim of an assault is a health care sector worker, this fact would be an aggravating circumstance for the purposes of sentencing.

Violence against health care workers has become a pervasive and growing problem within the Canadian health care system. Over the last decade, violence-related lost-time claims for front-line health care workers has increased by 66%, three times the rate for police and correctional officers combined. National data also show that 61% of nurses experienced a serious problem with some form of violence over a recent 12-month period.

This bill sends a strong message that those who provide such critical services must be treated with respect and security. They take care of our health and safety, and we must take care of theirs. I call on all parliamentarians to support this vital legislation.

(Motions deemed adopted, bill read the first time and printed)