Policy change focus of inquest into nurse’s death

from Canadian Occupational Health & Safety News

A coroner’s jury examining the murder of an Ontario nurse two years ago has recommended that hospitals implement a policy to address abuse, harassment and domestic violence as issues that may make their way into the workplace.

Jury members from the 10-week inquest — which began in September and heard from more than 50 witnesses — issued 26 recommendations on December 11. Among them, the jury recommended that: hospitals educate staff about the dynamics of domestic violence, abuse, harassment and the workplace; staff scheduling, work reassignments and transfers be accommodated in situations involving domestic and/or workplace violence; and, various health and safety associations develop educational material to train workers about what to do if violence invades the workplace.

The recommendations follow the death of Lori Dupont, a nurse who died on November 12, 2005 after being stabbed several times in the chest with a military-style dagger at the Hôtel-Dieu Grace Hospital in Windsor, Ontario (COHSN November 21, 2005). Dupont, 36, was attacked by Dr Marc Daniel, a 50-year-old anesthesiologist at the hospital, with whom she had a relationship that had ended months earlier. Dr Daniel committed suicide and was pronounced dead three days after the attack.

The jury — which deliberated for five days — found that there had been “significant and documented complaints of serious” problems regarding Dr Daniel’s behaviour and “there seemed to be much confusion and indecision as to how to deal with” the doctor.

“There were multiple complaints from the nurses regarding Dr Daniel’s disruptive behaviour starting in 2000,” the inquest revealed, including “damage to equipment, fracture of a nurse’s left ring finger, verbal abuse, unprofessional behaviour in front of patients and refusal to work with a specific nurse.”

In their wide-ranging recommendations — directed at, among others, the Hôtel-Dieu Grace Hospital, the Ontario Hospital Association (OHA), public hospitals in Ontario and the Ministry of Labour — the jury focused on hospital-physician relationships and reviews of existing acts and legislation. For example, the jury recommended that:

- there should be a review of the Public Hospitals Act (PHA), which addresses a process for the early identification of disruptive physician behaviour, including timely and effective disciplinary actions (such as revocation or suspension of privileges);

- there should be a review of the Occupational Health and Safety Act (OHSA) to examine the feasibility of including domestic violence (from someone at the workplace), abuse and harassment as factors warranting investigation;

- the elimination of the “current system of repetitive hearings,” to be replaced by a system whereby physicians have the opportunity for an immediate hearing before an external tribunal;

- a review of the Hôtel-Dieu Grace Hospital’s workplace violence prevention program to include specific training with regard to domestic and workplace violence.

Hospital has tailored program to physicians

Hôtel-Dieu Grace Hospital spokeswoman Kim Spirou says that, in August, the hospital added an “intimate partner” component to the hospital’s violence prevention program, tailored specifically to doctors. It is believed that the hospital is the only one in Canada to have implemented such a program, Spirou adds.

Although Spirou acknowledges that some of the recommendations are beyond the hospital’s scope and involve changes to legislation, “we do need an ability to have more rigour around the relationship between hospitals and physicians,” she says.

“Unfortunately, domestic violence, abuse and harassment can occur in the workplace and hospitals are not immune to these incidents,” adds OHA president Hilary Short, noting that the association sponsored workplace violence prevention programs as a “common safety program” for association members in 2005.

The OHA is “particularly pleased” that the jury recommended a review of the PHA, Short says, adding that although the act was proclaimed in 1931, “an updated, modern legislative framework for hospitals is needed.” Linda Haslam-Stroud, president of the Ontario Nurses’ Association, agrees. “The Public Hospitals Act really has put up barriers with relation to hospitals dealing with this kind of behaviour,” Haslam-Stroud contends.