Violent patients at the Ottawa Hospital this year have used furniture as weapons, repeatedly punched nurses and seriously injured a security guard — incidents that have triggered changes at the Civic campus and an ongoing Ministry of Labour investigation.

CBC News has learned the province is currently investigating four incidents this year involving mentally ill patients who attacked three nurses and a security guard on separate occasions between January and May.

The recent attacks have forced management to increase security at the Civic's psychiatric emergency service unit — the most volatile unit of the hospital.

Ontario Nurses' Association president Linda Haslam-Stroud says such assaults have been a problem at the Ottawa Hospital for several years.

Since April 2011 the Ministry of Labour has investigated The Ottawa Hospital for workplace violence 12 times. Provincial inspectors conducted 43 field visits and issued 26 orders to the hospital.

Security guard breaks leg during struggle

The first attack at the Civic campus this year occurred on Jan. 8. One of two security guards was seriously injured while trying to restrain and move an aggressive patient back to his room, according to the Ministry of Labour report.

While the guards struggled to control him, all three fell to the ground, breaking the leg of one guard in the process.

The report states the patient had been brought into ER under police escort a day earlier and while in the emergency psychiatric unit the patient had ripped down the night-vision light from the ceiling of his room.

The four incidents this year all happened at the Civic's emergency psychiatric unit. Between January and May of this year, 636 patients have been assessed in the unit. (Judy Trinh) In his report, the labour inspector found staff didn't know about the man's previous history of violence at other hospitals and that one of the security guards was also not trained in the hospital's violence policy. The guards are non-unionized hospital employees.

The ministry ordered the hospital to consult with its staff on improving training programs and review workplace violence policy and safety measures.

You cannot give order after order after order without ensuring things are improving for nurses at the Ottawa Hospital. Linda Haslam-Stroud , Ontario Nurses Assoc .

While the Ottawa Hospital was in the process of complying with these orders, more attacks on staff in the emergency mental health unit occurred.

On Feb. 2 two nurses were repeatedly punched by a male patient, who also picked up a chair and charged at the nurses. One nurse fell backwards and injured her back before security guards were able to subdue the attacker.

Same nurse attacked twice in 6 weeks

This incident wasn't reported to the ministry, but the nursing manager was informed. An internal memo obtained by CBC shows that staff weren't sure where the panic button was. A unit manager was notified, but a complaint in the memo states that the manager's response involved drawing a "star on the desk" to indicate the location of the alert button.



The third incident involving one of nurses in the Feb. 2 incident took place a month later on March 17 and involved a male patient who was "young, very belligerent, large and paranoid and exit-seeking," according to an internal staff e-mail.

ONA president Linda Haslam-Stroud says Ministry of Labour inspectors are not enforcing the Ontario Workplace Safety Act at the Ottawa Hospital. (CBC News)



According to an internal staff e-mail, the patient stood up and lost his balance, the nurse moved to steady him and that was when she was punched in the "face, head shoulder and left breast while the man screamed 'you f--king bitch, you kept me down for six hours!'" The attack occurred after the nurse and a nursing student took the patient out of his four-point harness so he could eat his dinner.According to an internal staff e-mail, the patient stood up and lost his balance, the nurse moved to steady him and that was when she was punched in the "face, head shoulder and left breast while the man screamed 'you f--king bitch, you kept me down for six hours!'"

The assault lasted 45 seconds and was captured by surveillance cameras. The Ministry of Labour report notes that four security guards were required to pull the attacker off the nurse and restrain him.

In her interview with union representatives, the psychiatric nurse believed she could have died if the drugs used to chemically restrain the patient had worn off.

The student nurse didn't intervene and was not injured.

Nurse suffered broken nose in latest incident

The fourth assault occurred on May 12 at 1:30 a.m. and left a nurse with a broken nose, swollen eyes and sore knee.

While a visitor was in the hallway, a patient with a known history of violence had come out of one of the rooms. The nurse was attacked after she stepped out of the locked, plexiglass-enclosed nursing station to ensure the safety of the visitor.

We need to do a lot better when it comes to health and safety. Debra Bournes, V.P. Clinical Services, The Ottawa Hospital

The union said the nurse was punched three to four times, knocked to the floor and was punched several more times before escaping her assailant and making it back to the locked nursing station to push the panic alarm.

Provincial inspectors have yet to interview the nurse, who has been diagnosed with PTSD.

Union says ministry not doing enough

The province only investigates when serious injuries occur, but according to data compiled from three unions there have been more than 50 complaints of workplace violence and harassment across the Ottawa Hospital just this year alone.

The incidents involve nurses, orderlies and security guards who have been kicked, punched and spat on and required medical attention but did not meet the ministry's threshold for investigation.

Despite dozens of site inspections over the years, Haslam-Stroud believes some of these attacks could have been prevented if the ministry was more diligent in enforcing safety.

While the ministry has issued orders, no charge under the Occupational Health and Safety Act has ever been laid against the hospital.

"The Ministry of Labour hasn't been helpful in trying to ensure our nurses are safe. You cannot give order after order after order without follow up and ensuring things are improving at the Ottawa Hospital for nurses," said Haslam-Stroud.

Ottawa Hospital adds security

The Ministry of Labour's investigations into the recent attacks on nurses have led to changes at the hospital.

Hospital vice-president Debra Bournes says they have improved safety for staff in the emergency psychiatric unit after a spate of assaults by patients.

"We have to take the position that any violent episode is one too many violent episodes and what it's done is lead the hospital to think we need to do a lot better when it comes to health and safety," said Debra Bournes, Vice-President of Clinical Services.

"We're really good about paying attention to patient safety, but staff safety has often not been as much of a focus in health care, and I don't think that our hospital is any different than anywhere else," she said.

"But over the last two years the Ottawa Hospital has had a major focus on how we improve the organization of the health and safety for the staff, she said.

Bournes says what happened to these nurses have "kept her up at night," and that the hospital has improved security measures inside the emergency psychiatric unit of the Civic since the March assault.

A security guard is now stationed in the psychiatric unit 24 hours a day, seven days a week. Prior to the attack, security guards were only on site during evening and overnight shifts.

The panic buttons have also been moved from under the desks to on top of the work stations where they can be easily seen.

Management is also looking at giving nurses personal alarms attached to their clothing like their counterparts at the Ottawa Hospital's General campus.

The hospital is also updating its workplace violence policy and restraint protocols.

To reach the reporter: Judy.Trinh@cbc.ca, @JudyTrinhCBC