Coroner’s Inquest Makes Recommendations on Workplace Violence Arising out of the Murder of Nurse Lori Dupont

Jury Recommends Reviews of the Occupational Health and Safety Act and of the Public Hospitals Act to Enhance Workplace Safety

By Janina Fogels and Elizabeth McIntyre

The Coroner’s Inquest called to investigate the deaths of nurse Lori Dupont and doctor Marc Daniel has concluded with detailed recommendations to preventing similar deaths in the future.

The recommendations are of significant interest, both from the perspective of human rights and workplace safety, and from the perspective of professional regulation and governance in the health care sector. Although the Inquest arose in the health care setting, key recommendations apply to all Ontario workers.

Background

Lori Dupont was a Registered Nurse and member of the Ontario Nurses’ Association working in the recovery room at Hotel-Dieu Grace Hospital in Windsor, Ontario. On November 12, 2005, she was murdered by her former partner and colleague, Dr. Marc Daniel. Daniel, an anaesthesiologist at the same Hospital, who died several days later from a self-inflicted drug overdose.

Dupont had taken steps to end her relationship with Daniel in February 2005, after he attempted to commit suicide as a controlling gesture over her. In April 2005, she applied for a peace bond to limit their contact and his access to her. Daniel, however, continued to pursue Dupont at the workplace both before and after his return to work in late May 2005. In spite of ongoing indications of harassment and stalking of Dupont by Daniel, known to a variety of individuals in their workplace Daniel was allowed to continue working in the same areas as Dupont. The first time Daniel and Dupont were scheduled to work on a weekend together with very few other staff in the area, Daniel stabbed Dupont to death in front of one of her colleagues. Dr. Peter Jaffe, an expert in domestic and workplace violence, retrospectively identified 16 risk factors in the relationship between Dupont and Daniel as well as numerous missed opportunities for intervention.

The Inquest began in September 2007. Over the course of the ten-week hearing, the Inquest heard from over 50 witnesses on issues such as:

• a lengthy history of abusive conduct, both verbal and physical, on the part of Daniel that included damage to hospital equipment, a fracture of a nurse’s finger, shouting and swearing and other unprofessional behaviour in front of patients, and a refusal to work with a particular nurse;
• a culture of physician dominance at Hotel-Dieu Grace Hospital in which nurses were reluctant to complain both because complaints were not responded to by management and because a complaint could subject them to retaliation from the physician; 
• a systemic problem of physician disruptive behaviour in Ontario, which the College of Physicians and Surgeons has addressed in a recent report;
• a governance system under the Public Hospitals Act which makes it extremely difficult for a hospital to visit any consequences on a physician who fails to comply with hospital policies, including those setting out codes of conduct and zero tolerance for harassment;
  
  • the response of the criminal justice system to Dupont’s attempt to secure a peace bond in the months before her death.

The jury’s Recommendations respond to the wide range of systemic problems focused on by Ontario Nurses’ Association during the course of the Inquest.

In summary, the jury recommended:

• A review the Public Hospitals Act, on a priority basis (see below),
• A review of the Occupational Health and Safety Act (see below).
• A review of by-laws and policies by Hotel-Dieu Grace and all public hospitals to ensure that patient and staff safety and quality of care are the most important factors and are not superseded by a physician's right to practice. This includes adherence to clear codes of behaviour, evaluation processes, progressive discipline practices, and role definitions, i.e. for Chief of Staff and Chiefs of Departments.
• Simplification of the processes for immediate suspension, probation, or revocation of physician privileges.
• An assessment program with clear guidelines for treatment and follow-up of physicians who present with issues of mental health and/or disruptive behaviour. This shall include an independent assessment prior to the re-integration of the physician at work, consultation with the Chief Nursing Executive and advising of the nursing staff.
• Design and implementation by workplaces of policies to respond appropriately to domestic violence and abuse or harassment as it relates to the workplace, including training staff to identify signs of abuse and requiring employees to report witnessed abusive or violent behaviour. The policy at each workplace should reflect an analysis of the power differentials that exist between different groups of employees/workers/staff. Mediation should not be utilized for incidents of violence or abuse because of the power imbalance between the parties in these circumstances.
• Education for the public and professionals about the dynamics of domestic violence, including an awareness of risk factors for potential lethality.
• Development by Health and Safety Associations, in consultation with the Ontario Women's Directorate, of educational materials for workplaces to train staff about the dynamics of domestic violence, abuse and harassment.
• Education of health care disciplines about the dynamics of domestic violence and risk assessment and intervention strategies.
• A requirement that, in situations involving an allegation of drug misuse, abuse or theft, a hospital should be required to conduct a meaningful investigation and complete and file a report within 30 days.
• The establishment of domestic violence courts which focus on early intervention and vigorous prosecution.
• A review of Hotel-Dieu Grace’s Workplace Violence Prevention Program and Policy and the Domestic Violence Awareness Training by Peter Jaffe.
• Training by Dr Jaffe of physicians at Hotel Dieu Grace regarding the Violence policy.
• A review by Hotel-Dieu Grace of security policies or measures where employees are exposed to dangers from staff, patients or visitors.
• Availability to hospitals of the services of a "diversity officer" who can provide assistance to employee/complainants in cases of violence, abuse and harassment. The Ministry of Health and Long Term Care should consider and implement funding options for these positions.

The Jury specifically recommended that Chief Coroner’s Office should provide a one-year report, publicly reporting on the status of implementation of the recommendations and reasons provided by the parties for failure to implement any of the recommendations.

Call for Legislative Review

Importantly, the jury recommended review of the Occupational Health and Safety Act as well as the Public Hospitals Act.

I. Occupational Health and Safety Act: guard against violence at work

Ontario unions including ONA have advocated that the Ministry of Labour under the Occupational Health and Safety Act regime needs to recognize violence from co-workers as a hazard. This Inquest demonstrated that the current health and safety regime suffers from two main problems. First, the Act itself does not explicitly acknowledge violence or threats of violence from persons as a danger requiring intervention by the Ministry. Second, internal policy at the Ministry distinguishes between physical acts of violence and non-physical violence resulting in emotional or psychological harm.

The jury heard evidence from Ministry of Labour staff that while acts or threats of violence are considered a “hazard”, according to internal policy (Module 19), only violent acts or threats of violent acts will prompt Ministry action, up to and including the issuance of orders. These orders mandate that the employer take steps, such as conducting a risk assessment or instituting a workplace violence policy, within a strict time frame. If the employer fails to comply, the Ministry can prosecute.

The jury heard that the Ministry will not, however, respond to complaints of emotional or psychological violence or harm. Expert evidence by Dr. Peter Jaffe confirmed that psychological and emotional abuse has long-term consequences and can affect worker productivity and efficiency. It is also a demonstrated precursor to physical violence.

The jury recommended a review of the Occupational Health and Safety Act to examine the feasibility of including domestic violence, abuse and harassment as factors warranting investigation and appropriate action by the Ministry of Labour when the safety and well-being of an employee is at issue. The review should consider whether safety from emotional or psychological harm ought to be part of the mandate of the Ministry and examine legislation and policies in place in other jurisdictions.

II. Public Hospitals Act: empower hospital administration to manage physicians

The jury heard evidence that nurses work within a culture of physician dominance, a power dynamic aggravated by a gender divide. Testimony revealed that hospitals like Hotel-Dieu Grace have difficulty exercising authority over disruptive physicians and those who are not compliant with hospital policies. In order to restrict, or terminate its relationship with a “privileged” physician, the hospital must go through a multi-step complex legal process; under the Public Hospitals Act.

Despite significant and documented incidents of disruptive, harassing and violent behaviour from Daniel, the evidence revealed that Hotel-Dieu appeared confused and indecisive as to how to deal with him. As a result, the jury recommended a review of the Public Hospitals Act – conducted on a priority basis – with a view to examining the hospital-physician relationship. The jury agreed expert witness Dr. Rose that patient and staff safety as well as patient care should not be superceded by a physician’s right to practice and that the process of privileging physicians needs simplifying.

The jury also recommended that the Public Hospitals Act explicitly recognize the application of the Occupational Health and Safety Act and the Ontario Human Rights Code to physicians with privileges at public hospitals. The evidence before the Inquest demonstrated that even the CEO of the Hospital was not sure whether physicians were caught by the obligations and duties of the legislation, leading to the conclusion that physicians may not be considered subject to the same legal obligations as other members of the hospital community.

The Ontario Nurses Association was extremely pleased with the extensive recommendations made by the jury as they addressed all of the systemic issues which had been focused on by the Association throughout the inquest.

ONA was represented in the Inquest by Elizabeth McIntyre and Janina Fogels.

To view the Coroner’s ruling on the scope and focus of the Inquest, please click here

To view the full text of the Inquest Recommendations, please click here