Health Committee on May 14th, 2019

[Dr. Alan Drummond]

I'm not aware of any.

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

So that's something we definitely will need.

The paramedics go in pairs, but my daughter was a nurse in home care, and in home care you're alone. I consider this to be very dangerous. One protection would be to pair up in home care and make sure that there are multiple people who are trained in security-type interventions. Would you agree?

[Linda Silas]

It's not only about intervention. It's also about having a security device on you. I'm sure Miranda could answer this too, but it's about having a security device on you. If you press a button and nobody comes...like the nurse in the regional hospital where it took 11 minutes before somebody other than her co-worker showed up. I feel for your daughter. It is scary what can happen there. They can't even negotiate to have a cellphone with them, never mind an emergency device.

[The Chair, Liberal, Bill Casey]

Ms. Ferrier, do you have an answer?

[Miranda Ferrier]

I was just going to say that in home care for PSWs currently, in different provinces they're not allowed to carry their cellphone with them on their person into the home. They say that if there's an issue, the support worker has to then use the client's phone in order to call in for help. Well, if you're in a dangerous situation and you can't get to that phone, which we hear from our membership all the time.... They get cornered; they have to talk their way out of it.

Let's keep in mind too that support workers have different training across our nation. Some have a lot of training, some have no training, but almost none of them have crisis prevention and intervention training. They have no idea how to talk down a drug addict, an alcoholic.

We're putting really vulnerable people with vulnerable people, doing a job where they're in danger all the time.

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

I totally agree with what you're saying.

I liked your point about how essentially the working conditions for PSWs are so unacceptable. You have 15 clients you're trying to manage.

I think Alberta has a standard of seven clients maximum per PSW. I wonder if there is a definition that we should adopt, as the federal government, to set a standard across the country.

[Miranda Ferrier]

Absolutely.

We just started a campaign through the association in Ontario for a resident-to-personal support worker ratio. What we're seeing across the board is one for 15, one for 20, one for 35 to 40 in the overnights. It's a scary situation.

We've heard a lot of talk through the provincial government here about one for eight. However, if the federal government could intercede to say it is mandatory across the board, this needs to happen. Otherwise, we're not going to have the support workers to care for our loved ones.

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

True enough.

With regard to the working conditions for support workers, I heard what they're doing—I see this quite often in Ontario—is making them work multiple part-time jobs instead of making it a full-time position with benefits. For that reason, a lot of people are also leaving the profession. If you consider the working conditions and the violence and the lack of benefits, that's an issue that needs to be addressed as well.

Would you agree?

[Miranda Ferrier]

In the province of Ontario, what we hear from members—and also in our New Brunswick chapter and out in Alberta and British Columbia—is that the full-time work is what they really desire. They always start the sentence with “I get no respect. I have no recognition. Nobody listens to what I have to say.” Then they go on to talk about wages, full-time versus part-time, benefits on the job.

That's why we are really stressing that self-regulation model for personal support workers, so that they can have something to call their own.

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

You had some great recommendations in talking about limited access and a security presence.

Can you talk a bit more about the security presence part of it?

I think that Ms. Silas has already talked about how if it takes them 11 minutes to get there, it's no good. If you had one security guard for the whole hospital, that's not really what you need.

What would be the best practice there?

[Dr. Alan Drummond]

I think it depends on the facility to a certain extent, and the realization that the health care budget is not endless and hospitals are struggling to provide basic care sometimes. Such things as security of health care workers sometimes assumes a low priority when you can't balance your budget for operative procedures. So it's always an afterthought.

There are about 850 emergency departments in this country, divvied up into about five levels of classification from tertiary trauma centres to small rural hospitals such as my own.

Clearly the urban hospitals, with the issues of gangs and substance abuse, often have a very clear and present security presence. Rural communities often don't, and rely on local police detachments for some kind of immediate response, should it be required.

There is often not a direct line to the local police detachment; you have to call 911 to get a policeman to come. The delays can be quite extensive.

My colleague mentioned administrative response to violence in our hospital. Two years ago the nurse in our sister hospital in Smiths Falls was stabbed by a violent patient. Our hospital, then and only then, installed lockdown access to the emergency department. You had to be buzzed in after hours to be allowed in. Only then did they hire a security company to sit after hours, because that's usually when a lot of this stuff happens. The security personnel are octogenarians wearing a jacket, and are probably not of much use, but it looks good in the hospital. Our nurses still feel unsafe.

Why is it an afterthought? I believe administrations embrace the concept that it's part of the job. We have to get beyond that once and for all. As you've heard, a broad consensus of health care workers.... The extent of violence in the emergency department or in the emergency sector or in the hospital sector or in the community sector is such that our most talented and experienced people are saying they'll forget about it. They're leaving their job.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Ms. Ferrier, why can't you take your cellphone into your work?

[Miranda Ferrier]

I think that in a lot of cases there were complaints from clients that personal support workers or support workers were on their cellphones while they were doing their jobs. I guess employers were trying to do their due diligence by saying they couldn't have their cellphones on them so they would focus more on their duties. I'm sure that happens in home care, but it really puts these people at massive risk.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Thank you to all the witnesses for being here.

I realize that when we talk about the health care system, we're talking about diverse settings that require specific responses. I want to focus for a bit on the major urban hospital.

How frequently would an episode of violence occur in a typical major hospital in a major urban centre: daily, weekly?

[Dr. Alan Drummond]

Daily.

I mentioned crystal meth because that's an increasing concern for our members out west. They've seen increased use of crystal meth in Alberta, Saskatchewan and certainly Winnipeg. You're now starting to see increased use of crystal meth in Hamilton. It leads to psychosis, intensely aggressive people and violent behaviour.

Violence in the emergency department has been bad for the last 10 years, engendered by all these other issues such as nursing staffing ratios and crowding. But now you dial in this other little monster to the picture, and our members are quite concerned.

[Don Davies, NDP, Vancouver Kingsway, BC]

Ms. Silas, would you agree that violence would occur on a daily basis in a major urban hospital?

[Linda Silas]

Yes. If you look at Dr. Doug's region, we've seen a 1,200% increase in violence in the last five years due to crystal meth in the Winnipeg area: 1,200%.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay, I'm going to get to the rate in a minute.

One of the first suggestions that comes to my mind: I know that in Vancouver we have police officers permanently located in schools, so there's a police presence in a school. It occurs to me that for a major urban hospital, where we can predict a crime, an assault, being committed every day in that location, would it not make sense to establish a permanent police presence in the emergency ward of a hospital, not security guards, octogenarians or people with radios, but a police officer as a prevention?

[Dr. Alan Drummond]

You used the word “crime”. I have concerns about that, because for the octogenarian who is delirious from his pneumonia and who tries to strangle you with his Foley catheter, is that really a crime? How is that a crime? It's beyond his control. For the patient with substance abuse issues such as crystal meth and who is psychotic and violent, is that really a crime? Or is that really a reflection of the toxic syndrome he is having?

I'm a Tory-blue Conservative, believe me, so I'm a big fan of punishing crime, but in the context of the emergency department, I have grave concerns with characterizing it as criminal activity and not as aberrant behaviour on the basis of organic disease or toxic syndromes. That's my first thing—

[Don Davies, NDP, Vancouver Kingsway, BC]

Sir, if I could just stop it there, I'll delve into that in a minute.

In my point of view, an assault on someone is a crime, but what potential consequence flows from that is a matter for the courts. That could come later on.

If we're going to have zero tolerance and if health care workers are going to go to work with the expectation that they are free from being choked, spat on, assaulted, pinched or strangled, then, to me, we need to have some form of security presence there that is effective in dealing with that. We'll leave the judicial determination to others.

I want to turn now to the Westray principle, which is a very interesting point that you brought up, Ms. Silas. Has any facilities administrator in the country ever been charged under the Westray principle?

[Linda Silas]

We only had one hospital in Ontario where it was brought in front, and it was thrown out immediately.

[Don Davies, NDP, Vancouver Kingsway, BC]

Let's say I'm a hospital administrator and I know that in my facility every day my workers are going to be subjected to a workplace danger. The consequences you've described are already there and are causing people to have PTSD and leave their workplace and suffer all manner of things. Is that any different from a manager at a factory who sees unsafe oil on the floor or some other unsafe sharp, jagged pieces sticking out...? If that happens in that kind of environment, we would expect the managers to take all reasonable steps to make sure their workers are not injured.

Yet it seems that we all can see this and we all know this is as predictable as rain in Vancouver in January. It's going to happen, yet are we placing the right responsibility on health care administrators, as you said, Dr. Drummond, to change it from an afterthought and to move this up to not only a priority but an obligation under the law?

[Linda Silas]

You bring up an interesting point, especially in comparing it to the private sector. The private sector puts security as number one. We don't put that security in the public sector, and far from it in health care. If you look at just Ontario, you'll see that in the recent study on benefits to Ontario health care workers due to violence, close to $5 million was paid out in the last year, so it is associated with dollars.

On your comments in regard to a police officer, that's a symbol. We've seen two positive cases in Ontario at the Michael Garron Hospital and right here in the Ottawa region at the Ottawa Hospital after major violent incidents happened. It's all about training in-house security. It's about having more than one. You don't need a gun, but you need a baton.

I asked my security expert what I needed to recognize the right security guard: is it the lines on their uniform? No. If they have a baton, that means they have a higher level of security training and they're good. You have to work with them. It's about making sure that there are well-trained, supportive security staff everywhere. The Michael Garron Hospital, for example, increased this when they started putting security as number one. Throughout the hospital, they had had 29 cameras. They increased that to 350 cameras. You can see every corner of that hospital. In Nova Scotia, in Bill Casey's area, there was a severe incident in the premier's riding, and I guarantee you that violence became a number one issue.

We can have that in all your ridings. We have to talk about health and safety through training proper security and working with the care team, and the care team is everyone—from physicians to personal care.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Mr. Mellow, you wanted to say something.