Board orders Inuulitsivik to fix safety problems

The Inuulitsivik health and social services board in Puvirnituq is working against a legally-enforced, 99-day deadline for fixing employee safety problems at its hospital, seven community health clinics, and rehabilitation centre.

Quebec’s workers’ health and safety board, La Commission de la santé et sécurité au travail (CSST), imposed the deadline last month, following an investigator’s visit last January.

An earlier report was handed over to the Inuulitsivik board last October.

The safety board started paying attention to conditions at Inuulitsivik after employees complained about workplace health and safety issues last September, especially those who deal with the mentally ill.

The hospital treated 139 patients with mental illnesses during the six-month period between December 2002 and June 2003.

The complaint said nine assaults by patients had taken place against Inuulitsivik hospital staff in 2002 and 2003, and that the “level of assaults keeps rising.”

The health board has 400 employees working at health and social services clinics in seven Hudson Bay communities, at the rehabilitation center in Inukjuak, and at the Inuulitsivik Hospital in Puvirnituq.

The safety board’s March 2004 report makes the following recommendations for improvements at the 25-bed Inuulitsivik hospital in Puvirnituq:

* Given its large number of patients with mental health problems, properly qualified personnel should provide care for them;
* Patients with mental health problems should be housed in a separate wing of the hospital, accessible only to health workers and authorized visitors;
* A better emergency alert system should be in place;
* An emergency intervention team must be available at all times;
* Documents in the hospital’s archives centre need to be stored on more solid shelving;
* Qualified security guards should be on site and equipped with a good communication system;
* Social workers responding to a crisis in the community must have back-up support from either another worker or police, a reliable means of communication, and a designated vehicle for transportation;
* The isolation room must meet Quebec standards;
* The interview room must be made safer and be accessible to social workers for consultations;
* Staff should get training in crisis management; and
* Inuulitsivik needs a policy to deal with violence, and emergencies.

According to the report, a January visit to the Inuulitsivik Hospital revealed:

* Entry and access by people to the various wards and offices is largely uncontrolled during the day;
* The mentally ill are housed in the same rooms as other patients;
* There’s no special nurse with psychiatric training;
* Psychiatric patients are usually escorted by people who have no special experience dealing with mental illness;
* No emergency communication system other than a portable panic button is available;
* Fire extinguishers haven’t been checked since 1998;
* Shelves in the archives are unsteady; and,
* There’s no camera surveillance in the drug dispensary, or in the dentist’s office.

In the social services unit, most social workers said they have either been targeted by verbal abuse, or they have been physically assaulted.

But the CSST investigator saw other dangers in their workplace.

“There are two or three social workers in the same office. Consultations often take place in their offices because the interview room isn’t available. I see several objects, such as a stapler, a chair, and other items which could be used as a weapon against the social workers,” the CSST investigator said.

The report says panic buttons are not easily accessible if emergency assistance is required. In the interview room, there are a mirror, lamp, toys, chairs and tables that aren’t fixed to the floor and could all serve as weapons.

In an action plan, which the CSST asked for last year, Inuulitsivik’s management and union agreed to:

* Involve Canadian Rangers in evacuation plans and consult with them about other emergency measures;
* Ask for more police officers in Puvirnituq;
* Look at having a psychiatric unit or crisis centre in Puvirnituq;
* Establish procedures for use of the isolation room;
* Hire reliable and trained security staff;
* Start a counseling program for workers; and,
* Establish a mental health program for Nunavik.

Since last December, security staff are getting more training and about 70 workers have received crisis management training.

With respect to Inukjuak’s health clinic, the CSST says:

* A toilet should be accessible directly from the clinic’s isolation room;
* Any objects that could serve as weapons in the room adjacent to the isolation room must be removed;
* The clinic’s emergency door should remain closed at all times — and staff should always use the main entrance;
* Broken windows must be fixed; and,
* A policy for violence in the workplace and an emergency and evacuation plan should be established.

At Inukjuak’s rehabilitation center, which serves eight clients with mental illness from around Nunavik, the safety board says:

* Kitchen chairs and tables should be fixed to the floor;
* Emergency exit signs should be illuminated; and,
* A policy for violence in the workplace and an emergency and evacuation plan should be established.