A Brockville judge has acquitted the Royal Ottawa Mental Health Centre of four out of five provincial charges, after a mentally ill patient stabbed a nurse multiple times in the head and neck, leaving her seriously injured.
It's a decision one nurse says is "sickening" and will put more nurses at risk.
"We believe that Brockville is failing totally in their responsibility and accountabilities to everyone," said Vicki McKenna, a vice president with the Ontario Nursing Association.
"It feels like a powder keg there and in other institutions in our province," she said. "The incidences of violence in our institutions and hospitals and long-term care settings in this province is mind-boggling. It's frightening."
The incident happened on Oct. 10, 2014, after an inmate with a history of injuring herself and striking out at guards, was transferred to the Brockville Mental Health Centre which is run by the Royal Ottawa Mental Health Centre.
McKenna says staff were ill prepared to address the serious safety issues the patient posed, while the centre — and a judge — say proper safety and training procedures were followed.
Brockville centre 'noble' in its care
Dr. Adekunle Ahmed, an associate chief with the Royal Ottawa Health Care Group, says the Brockville Mental Health Centre did its best for the patient, with the judge calling their treatment "noble."
"A nurse was injured and it's unfortunate that such a thing happened, but we deal with very complex individuals who are very ill and whose needs we're constantly looking for the safest way to meet," Ahmed told CBC.
Ontario's Ministry of Labour visited the facility twice within a week of the attack, issuing several work orders related to the incident and workplace safety policies.
On Christmas Eve of 2014, it laid five charges under the province's Occupational Health and Safety Act, including failing to "provide information, instruction and supervision to a worker" and failing to "take every precaution reasonable" to ensure the protection of a worker.
The company was found guilty of failing to reassess the risks of workplace violence and ensure related policies and programs continue to protect workers.
Ahmed says the facility quickly made "significant improvements" to their training and procedures, including instituting a daily "safety huddle" where staff gather to assess concerns about patients and evaluating "environmental factors."
This is the second time in a year that charges against the Royal Ottawa Mental Health Centre have been dismissed. The second case involved three nurses who were attacked by a schizophrenic patient.
'How did this happen?'
The 2014 incident was all the more "shocking," said McKenna, since the patient was able to find an item capable of causing such serious injury to a nurse.
"You'd think, how did this happen? What could have brought this on? What was the situation or the environment that allowed for this to happen," she said.
"There has to be the proper assessment each and every day for people when they're in situations like this to say is this the right place for the person? Do we have to remove items from their reach or from their environment because they're at risk to themselves or others?"
When this type of incident is allowed to happen, McKenna says the confidence and trust of nurses is eroded.
"They feel at risk when they go to work and they think 'gee, is it going to be me today?'" she said. "It is frightening and it wears people down."
McKenna said the stabbing was an extreme example of the danger nurses face, but each day staff across Ontario are "punched, kicked, bitten, spit at, pushed [and] tripped."
Patient was first federal inmate at centre
The Brockville Mental Health Centre is a 163-bed facility, of which 100 beds are in the "secure treatment unit" managed with the Ministry of Community Safety and Correctional Services.
Out of 406 staff members, 80 per cent are mental health personnel and the remaining 20 per cent work in corrections.
The patient who stabbed the nurse was the very first Federal inmate at the facility, part of a two-bed pilot project with Correctional Services Canada that has since ended.
She was a difficult patient to treat, who came to Brockville after being in custody for years elsewhere, says Ahmed, but the fact that she was an inmate did not constitute any extra risk.
"We're in the business of treating patients," he said. "We're in the business of assessing the less fortunate members of society.
"In terms of what we do for these patients, I think if we jointly do a detailed risk assessment, we jointly follow the processes and procedures and we work collaboratively, I think we're likely to achieve better results."
Sentencing set for June
The Royal Ottawa Health Centre Group says it looks forward to reviewing the judge's recommendations when the case returns to court for sentencing in June.
For McKenna, that's not enough.
"We certainly have to do things to make it so that other patients and our staff are safe," she said. "It isn't okay for them to be hit or punched or spit at or kicked."
Heightening the emotion among patients and aggravating the situation is the ongoing overcrowding at Ontario hospitals and facilities, with nurses treating patients in hallways and lounges.
"Somehow we have to deal with the situation," she said, "before someone else gets hurt."