Health Committee on May 14th, 2019

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

Doug.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you so much, Sonia.

I want to expand a little on the questions between my friend Mr. Davies and Dr. Drummond.

I'm a bleeding heart Liberal and if anything my liberal....

[Dr. Alan Drummond]

I didn't say “bleeding heart”.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

I'm actually more liberal than Mr. Davies on this point.

I'm generally not predisposed to laying criminal charges. In the one assault I refer to where my head left a dent in the wall, the patient was very clearly in the presence of a severe psychosis. The police were called because the incident was ongoing, but I told the police in my statement that I was not predisposed for charges. This man needs a hospital, he is in a hospital and he is getting treated—enough said.

In regard to the police presence, would there be a use—and Ms. Silas, you could also weigh in on this—for the presence of them just for protection, as people who are highly trained and can help to deal with a dangerous situation more than your standard security guard? Would there be a role for that, more from the prevention aspect?

[Dr. Alan Drummond]

I don't work in urban communities—I have—but there is a subset of the population for whom a police uniform is a red flag. That may not be the best choice of a security service for the hospital setting.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you.

I have a comment for Mr. Mellow. It was interesting that you said you're not allowed to hold back and wait for the police unless you're sure of a danger.

Is this a province-wide protocol, or is this unique to your area?

[Randy Mellow]

This is an issue in Ontario. We have made some headway, as my colleague was discussing, in actually being able to flag residents—

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Are you using MPDS protocols?

[Randy Mellow]

No.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Okay, that's the problem.

This is a medical priority dispatch system. One of my jobs, as well as an EMS director, was as the medical director of Manitoba's ambulance dispatch centre for six years. MPDS is an internationally recognized standard for ambulance dispatch.

You might want to talk to your superiors about this because it actually has a default which is the opposite of what you say. If there is even the slightest bit of doubt, the crews are obligated to stage and wait until law enforcement comes to ensure it's safe.

So if you have the opposite of that, I would suggest that you have something in your system that is actually predisposing your paramedics to injury.

[Randy Mellow]

Ontario is moving at the speed of a glacier in that direction.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

All right. Thank you.

[The Chair, Liberal, Bill Casey]

Maybe we could help.

Thanks very much.

Now we will go to Ms. Gladu.

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

Thank you, Chair.

I'm going to start on the topic of the infrastructure changes that could help with this problem. I'm from an urban and rural split type of community and I see in rural communities across the country that the hospital infrastructure has not been well maintained because there is so little money in the system. In addition to the actual electrical and mechanical failures that may ensue, the money to convert an emergency room to try to have lockdown, have a single point of entry and all of those things is probably difficult.

Do we have an idea what a typical cost to convert to a best practice would be?

[Dr. Alan Drummond]

No.

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

I'm not surprised.

Let's talk a little about the long-term care facilities, because we need more and they're building more, but the issue with people and the aging demographic is, increasingly, they are living long enough to then have dementia. Now you have a situation where you have a bunch of long-term care facilities and you have multiple residents in there who may have dementia and may, multiple times, not know where they are or be reacting violently to the situation that they're in.

What are the recommendations about how that should be staffed in order to protect the safety of both the patients and the workers?

Miranda, maybe we'll start with you. Do you have any ideas on what we should do there?

[Miranda Ferrier]

I have lots of ideas.

I actually worked in a lockdown unit in a long-term care facility—I'm specialized in mental health and dementia—and I had my nose broken by an 80-pound old lady, who threw me across the room. I was alone on an overnight shift, and I was one worker with 32 residents. The public, in general, believe that at night, people go to sleep. Unfortunately, there's something called sundowning. That happens when people have dementia. On an overnight shift, in a lockdown unit in long-term care, at least half of the residents will be awake, wandering the halls and having behaviours at that time.

What really needs to be looked at is increasing staffing ratios on the overnight shift. Currently across Ontario—I can speak for New Brunswick as well, and a bunch of other provinces—it's one personal support worker or health care aide—whatever we want to call them right now—with up to 50 residents in a lockdown unit. You have a nurse. You're lucky if she or he is in the lockdown unit with you the whole time, because they have a huge job. It's a disaster, not waiting to happen, because it's happened in many different situations.

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

Does anybody else want to weigh in on that one?

[Linda Silas]

I totally agree.

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

Good.

I liked your idea, Linda, about signage to try to disincentivize people, and let them know that if they do attack a health care worker, there are consequences. People forget where they are. They forget that there are consequences, and that it's an actual attack.

[Linda Silas]

We have to take it out of the hands of health care workers. If a health care worker or a nurse gets injured due to violence, and the patient or family member, whoever attacks—the accused—breaks hospital equipment, the hospital will put a charge against them to recoup the hospital equipment, but will not help the health care worker bring a charge.

I alway say, “I'm not a lawyer. I'm not a criminal expert. Why is it for me to decide if a criminal charge should be placed?” It should be automatic, unless the court decides. It's not about the diagnostic. The diagnostic is all about safe staffing and appropriate training. That's how we take care of the sick. If it doesn't work, then it's a criminal issue.

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

Do you have a quick question, Len?

[Len Webber, Conservative, Calgary Confederation, AB]

Yes, I can ask a quick question here.

Mr. Mellow, is it common that paramedics are doubled up around the country?

[Randy Mellow]

Yes, they're most frequently in pairs.

[Len Webber, Conservative, Calgary Confederation, AB]

Miranda, with these personal care workers, it's just one person in a home, most of the time. I lost your volume there, but I can see you nodding yes. I know that you're short of personal care workers, but I think doubling up in these homes should be considered. Do you have any thoughts on that?