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UHNBC cited by WorkSafeBC following trouble with violent patient

Planned power outage caused door locks to fail in hospital's psychiatric ward

A WorkSafeBC investigator has "strongly" recommended the University Hospital of Northern B.C. take steps to prevent a repeat of an episode in which a patient with a "high risk for violence" escaped a seclusion room in the psychiatric ward during a planned power outage.

According to an inspection report, the incident took place Oct. 20 when the patient had been placed in a "closed and electronically locked" seclusion room prior to the outage. It had been scheduled for 2 p.m. but was delayed by 2 1/2 hours and when it did occur, the doors unlocked.

The patient left the room and made their way to the nurses station and was "agitated and threatened staff and other clients with violence and also demanded their belongings and discharge from the hospital," the investigator said in an unredacted version of the report provided to the Citizen from a source outside WorkSafeBC.

An attempt to remove the patient from the workplace was then hindered because the central elevator had stopped working. The staff service elevator remained operational but the worker involved in trying to remove the patient did not know this, the inspector said in the report.

As well, a worker had to use their personal cellphone to contact the RCMP because the ward's landlines were not working. RCMP were called three times but did not respond, saying they did not have any officers available, a UHNBC worker told the investigator.

The incident at UHNBC occurred at about the same time RCMP were dealing with a man who allegedly forced a woman into his car at a downtown motel. She suffered serious injuries when the car subsequently crashed on Boundary Road just west of Prince George Airport.

Security at UHNBC escorted the patient out of the hospital via the stairs without RCMP's help. What happened with the patient after that is not stated in the report.

Staff were then told to prepare a seclusion room for another patient and to use handcuffs to keep the patient under control because the rooms were still not locking. Noting the patient could "still freely move using their legs for ambulation or other functions," the investigator had "difficulty understanding" how handcuffs would keep staff safe from harm.

The investigator was told that the practice was for staff to hold the doors shut during power outages although it was not a formal policy. On one occasion, two workers were needed to hold one of the doors shut because a door wedge was not enough.

"Without undue delay, this employer must remedy the above described violence risk control deficiencies," the investigator said and "strongly" recommended 17 actions including installing physical locking redundancies on the seclusion room doors and repair the ward's external door so it can no longer be pulled open when locked.

Since the Oct. 20 incident at UHNBC, the doors have been added to a circuit powered by the emergency generator and a battery back-up system with a higher capacity and alarms built in to alert staff if the power runs low has been ordered, the investigator was told.

Concern was also raised over how well staff could deal with a "code white" situation when staff feels unsafe due to aggressive behaviour. If a "code white" reaches level three status, an "advanced team response" of trained workers is to respond to a call for help in a "formal organized manner." 

According to a UHNBC policy document provided to the investigator, the team is able to provide a "show of presence and de-escalation, up to and including physical escalations," However, the investigator was told the only help who do show up are security guards or the patient care coordinator and that staff were concerned even less help is available at night.

On Oct. 25, Health Minister Adrian Dix said the provincial government is in the process of hiring  320 "protection service officers" and 14 "violence prevention leads" to deal with such situations at 26 hospitals and mental health facilities across the province.

Staff will also receive training that "teaches them to have an acute awareness of patients and their surroundings, as well as how to anticipate, de-escalate and ultimately prevent aggression," a Health Ministry spokesperson said in an email to the Citizen.

UNHBC has been asked to provide an update on steps it has taken to deal with the issues by Nov. 26.