Patient death at HSC renews calls for change at hospital, Crisis Response Centre

WARNING: This story contains mention of suicide and self-harm.

A death inside Winnipeg's Health Science Centre campus has sparked calls for more safety measures to protect patients and staff at the hospital and the province's Crisis Response Centre — including dedicated security at the CRC.

Shared Health confirmed on May 14 that two separate incidents two weeks ago  — one at the CRC and another at the Health Sciences Centre — led to the death of a patient.

The health authority launched an internal investigation into the events. It said it can't confirm any details while that's ongoing, but three sources spoke to CBC News about what happened. CBC is not identifying them because they're not allowed to talk publicly on the matter

The sources said that on May 11, a patient who had just been admitted to the CRC grabbed scissors that were there and harmed himself. Police said they responded to the suicide attempt, which involved a young man in his 20s.

Sources said the officers Tasered the patient, and that he was then transferred to HSC for surgery.

They said that while he was recovering the following day, his restraints were removed. The patient then escaped, and died by suicide inside the hospital, sources said

"It was a violent and traumatic incident for everybody involved. The entire staff team at the CRC remains very devastated and shaken," said a health-care source. They "are probably going to be traumatized forever."

That source said the incident was one of the most severe staff have ever seen, but that cases of violence and self-harm regularly happen at CRC.

She said staff have been bringing up security issues with the employer for years, but nothing's been done.

One security guard is stationed at the centre, and their desk faces the front door. Sources said because the guard is shared with HSC, the guard can be pulled from the centre at any time, leaving no security at the facility at times.

Security not properly equipped, source says

Another person who works at the hospital said the guard on the first night of the incident at the CRC was an institutional safety officer (ISO) — staff who have taken additional training on de-escalation, use of force and detaining — but that they were poorly equipped to deal with the situation.

The security source said the officer was in the room with the patient when he was harming himself, but that he could not deploy his pepper spray gel because they were in an enclosed area, and it could've gotten into the ventilation system.

The source said there was little the officer could do without getting seriously harmed himself.

"Giving us a pepper spray gel is not going to solve anything inside the hospital, maybe in parking lots but not for inside," he said. The source said ISOs need either a baton or Taser to respond to some indoor incidents inside the facilities, and ISOs at the University of Manitoba carry batons.

Meanwhile, the health-care source said backup is often far away. She said it often takes between three to five minutes for security at HSC to get to CRC, which is "way too long" for them to intervene during a critical incident.

"Vice versa, if there is a critical incident at HSC, our security guard leaves us to go tend to that, and then we have no security at all," she said.

"We are a 24/7 facility and we never close our doors.… We have folks who are high on meth, we have folks who are psychotic, suicidal, homicidal."

The security guard posted at CRC isn't regularly someone with the additional ISO training enabling them to physically intervene.

Nurses not supported: Union

The Manitoba Nurses Union has been calling for dedicated security at HSC, and for more ISOs in the facilities.

The first class of such officers began patrolling the HSC campus last month, three years after the law establishing them came into effect. The union said training isn't done yet, so even if the administration eventually plans to have one at CRC, they're not there presently.

"All nurses take non-violent crisis intervention training annually. They have extensive experience in dealing with these situations daily and a team of colleagues to rely upon," MNU president Darlene Jackson said in a statement on Friday.

Jackson also that what nurses lack is immediate support in a crisis.

Unlike the HSC ER, the CRC only has one locked room, and the health-care source said once that's taken, they have nowhere to put Form 4 patients — those who've been involuntarily sent to the psychiatric unit.

The source said there were four such patients the first night of the incident, even though standard operating procedure states they should only have two involuntary admissions before diverting patients to other care centres.

"They just kind of are at the CRC and they can leave anytime, and our policy is for us to let them leave and then call 911," she said.

"That is not a safe policy, like we should either have more locked rooms or we should transfer our Form 4s elsewhere immediately."

The centre also does not have a dedicated overnight psychiatrist, and the psychiatrist is only there for four hours on the weekend, which means the CRC relies on HSC residents instead.

Understaffed and over capacity

Jason Linklater, president of the Manitoba Association of Health Care Professionals that represents some-health care workers at CRC, said in a Thursday interview that CRC is often understaffed and over capacity.

He said the number of crisis clinicians hasn't increased since the centre opened in 2013.

"The building itself is likely not suitable for the number of patients they're treating at the moment," he said.

"They need to be able to move patients, and without the appropriate people … they're not able to do that."

Linklater said sometimes the CRC has a full slate of 15 patients who need help overnight, but only two clinicians and two nurses on staff.

CUPE Local 204, which also represents health-care workers at the HSC campus, also called for increased security measures in a Friday statement, adding that staff in all areas of the health-care system are dealing with an increase in violent incidents, and that many incidents like the ones at the CRC and HSC aren't publicized.

Shared Health discussing 'increased security presence'

A Shared Health spokesperson said in a Friday statement there is still a security guard on-site at the CRC 24/7, that the facility has multiple panic buttons and that it will install additional panic buttons at the centre.

The spokesperson said it's implemented safety changes at CRC throughout the years, including improvements to the front desk, the addition of the security desk in the waiting room, new windows and security cameras.

The spokesperson said the results of the internal review will be shared with the patient's family.

The health-care source said the CRC has contracted an additional security guard, but that staff were told it's a temporary arrangement.

"Every few years, something horrible will happen at the CRC and it will hit the news, and then some small changes are enacted and then people forget about it," she said.

"These things don't cost a lot of money. What we really need is a real second security guard … that's permanent, and we need more investment in staffing."

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