The verdict of the Coroner’s Jury in the inquest into the deaths of nurse Lori Dupont and Dr. Marc Daniel at the Hotel-Dieu Grace Hospital in Windsor, which was released on December 11, 2007, made 26 recommendations that touch on a wide range of issues including hospital governance, patient and workplace safety, domestic violence, credentialing of physicians, and education and training of hospital staff.
Key Learning for Hospitals
The key learning for hospital boards in the verdict is that they are charged with the duty to “ensure that patient and staff safety, as well as patient care, must be the most important factors and not be superseded by a physician’s right to practice”. Hospitals must be able to exercise the appropriate degree of oversight of the physicians working within their facilities in order to discharge this duty. However, the verdict also highlights that the current legislative framework, specifically the Public Hospitals Act (PHA), and culture within hospitals create challenges that may impede hospitals from discharging this duty.
We do not believe that hospitals have to wait for any of the proposed changes to the PHA to start implementing many of the Jury’s recommendations that are aimed at Ontario’s public hospitals.
Board’s Role is Critical
If such important changes are to occur, individual hospital boards must demonstrate leadership. This can be achieved if the hospital boards:
- educate themselves about the verdict and the recommendations; and
- embrace and institutionalize the tenets of patient and workplace safety, specifically those pertaining to physician behaviour.
At a basic level, a hospital needs to act when a physician’s behaviour or demeanour causes staff to hesitate or delay paging, asking questions, or raising concerns or issues. For example, if a physician reacts negatively to being paged, staff might delay paging, thereby affecting quality or patient safety. In other cases, some hospitals might be reluctant to address behaviour due to the potential for disruption of service or negative community reaction. However, impact on service or community reaction cannot be allowed to interfere with addressing unacceptable behaviour. The message must be clear: zero tolerance for unacceptable behaviour and no individual is exempt.
Importance of a Comprehensive Code of Business
The board should review and, if necessary, revise the hospital’s values, and ensure that the organization has a comprehensive set of policies that enshrine and reinforce the values and desired culture throughout the organization. The policies that address the culture and the board’s ability to entrench it throughout the organization should start from the top, with a code of business conduct and ethics (Code of Business) endorsed by the board. The Code of Business establishes the key business and ethical principles that “are designated to promote integrity and to deter wrongdoing1”. These principles are then expanded in separate board and corporate policies and by-laws. A Code of Conduct and Whistleblower Policy are essential components2 of the hospital’s ability to enforce all aspects of its Code of Business. Once established, the Code of Business and related policies and by-laws should be strictly enforced, particularly at the board level.
By-law Changes Required
We have carefully reviewed the Jury’s recommendations and considered our template health facilities Code of Business, Code of Conduct, Whistleblower Policy and By-law and have updated them to address the recommendations that are directed to public hospitals. The template Code of Conduct is comprehensive, applying to all persons working at the hospital, including volunteers, employees and physicians. It holds everyone to the same standard of behaviour. The portions of the Code of Conduct that apply to physicians have been updated to reflect the recently released CPSO Physician Behaviour in the Professional Environment Policy and Draft Guidebook for Managing Disruptive Physician Behaviour.
Recommendations Heighten Government/Public Expectations
The Jury’s recommendations are timely as they have created an incentive for health facilities to review their oversight policies. At the same time, the Ontario legislature and the public are increasing their scrutiny and expectations of hospital patient care and safety and workplace safety.
The risks to hospitals that continue to turn a blind eye to the concerns identified in the verdict are significant. We believe that the hospitals that proactively implement the recommendations will be in a better position to meet these heightened expectations.