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HALIFAX, N.S. —

A man admitted to the Halifax Infirmary with a broken hip and a history of drug addiction continues to threaten nurses and staff two years later.

Although the injury has healed, the patient has not been discharged from hospital and it’s not clear why. A security guard is stationed outside his room 24-7 to protect staff and patients from his abusive and unpredictable behaviour. The room itself has been fortified with a portable door made of wood topped with a plexiglass shield.

A cancer patient who recently spent weeks on the same eighth floor orthopedic unit told The Chronicle Herald the man regularly disrupts sleeping patients by repeatedly banging on the plexiglass shield and shouting obscenities. A repeated phrase is, “You’re just a f---ing nurse, you’re not God.”

Although the identity of both patients is known to this newspaper, we have chosen not to report their names while they remain patients at the QE2 Health Sciences Centre.

The Nova Scotia Health Authority has a strict policy that prevents employees from sharing personal information, which includes the name and birthdates for all patients. No employees broke that trust while this article was being researched.

Nurses 'at wit's end'

The cancer patient said others on the ward become tense and anxious when the individual — a white male in his mid-to-late 50s — roams the corridors and lobby of the hospital accompanied by a security guard. Nurses will not enter the patient's room alone, and the union representing staff at the Halifax Infirmary said he has assaulted two previous security guards.

“The behaviour this person displays does not fit within an acute-care setting,” said Jason MacLean, the president of the NSGEU. “He has threatened nurses and also been very racist to staff. Our nurses are at wit's end and they fear for their safety at work.”

After a few weeks of discussion, MacLean said the union finally made a written transfer request to the NSHA on Jan. 30. The NSGEU has suggested the Nova Scotia Hospital or the Quest Residential Rehabilitation Centre in Lower Sackville with 24 beds would be more appropriate placements.

“This man is not well. Our employee relations and occupational health and safety officers have had meetings with the employer,” said MacLean. “The union believe he needs to be moved because he is out of control.”

MacLean said he understands the health authority is now conducting “an assessment” of the patient for whom a psychiatric assessment was done previously.

The health authority declined a request for an interview to explain why it has taken so long to discharge someone who has recovered from their injury.

'Challenging issue,' long waiting list

“You've touched on a challenging issue for Nova Scotia Health Authority that requires a solution through collaboration with partners in government and in the community," said a written statement from Victoria Sullivan, executive director of operations for the NSHA's central zone.

"There are long-stay, alternate level of care patients waiting in acute care beds across Nova Scotia Health Authority, where discharge is significantly delayed or not an option, as appropriate housing and resources to meet their complex and unique needs do not exist in the community. In NSHA's central zone, there are currently 152 people waiting for some level of placement; 30 of those patients face significant barriers to appropriate housing."

In situations where patients do not have a fixed address or family members to return to, MacLean said the discharge process is always slow because the health authority must coordinate with the Department of Community Services and, potentially, the Department of Health to find a placement.

MacLean said he was unaware this individual has been a guest of the taxpayer and the Infirmary for about two years. The health authority cited “patient confidentially” as its reason for refusing to say how it will respond to the union's request to move the individual.

“NSHA can't provide any personal health information about a patient. In general, we can share that we have care plans in place to meet an individual's needs while also ensuring the safety of staff and physicians,” Sullivan said in her written statement.

In the Nova Scotia Health Authority's central zone, "there are currently 152 people waiting for some level of placement; 30 of those patients face significant barriers to appropriate housing," said Victoria Sullivan, executive director of operations for the zone. - Eric Wynne / File

Care crunch

In March 2017, the NSGEU released a report called Code Critical, which examined the problem of overcrowded emergency rooms and long wait times at the Halifax Infirmary.

“A key cause of that problem is that more and more people are registering for care at the Halifax Infirmary emergency department," it said. "At the same time, inpatient floors are not able to discharge patients fast enough to admit (emergency department) patients in a timely fashion.”

The report made 15 recommendations to address overcrowding — one of which said: “The NSHA should conduct an automatic review of any (alternate level of care) or (longterm care) patient whose stay on an in-patient floor has exceeded four months with the objective of placing that patient in an appropriate facility within 30 days.”

The patient at the heart of this story is not a candidate for a nursing home. Homeless shelters such as Metro Turning Point and Out Of The Cold will house people with addictions, but reserve the right to deny entry to someone they consider too difficult to manage. No shelter will breach their confidentiality policies and comment on whether the individual who is the subject of this article is known to them or barred from their premises.

“Decisions on whether to deny shelter to someone are made on a case-by-case basis,” said Stacey Dort, senior operations manager with the non-profit group Shelter Nova Scotia. “If an individual has assaulted someone or caused a lot of property damage, they may not be welcome unless they can demonstrate their behaviour has changed."

Complex, costly problem

It's unclear how long taxpayers have been paying for around-the-clock security personnel on the eighth floor of the Infirmary. The NSHA declined to provide an estimate, although it's difficult to see how doing so would breach patient confidentiality.

According to statistics provided by the Canadian Institute of Health Information two years ago, the cost of a hospital bed in Nova Scotia ranges from $605-$962 a day.

Patients who have mental health or addiction problems often remain in hospital longer than others because they have no place to go. In 2017-2018, Nova Scotia hospitals admitted 2,738 people who — after they no longer needed medical care — required an alternate level of care. This group represented only 3.2 per cent of all hospital admissions. But the same challenging group accounted for 16.5 per cent of all patient days while waiting for housing outside the hospital.

This disturbing case illustrates the need for better transitions and co-ordination of care among hospitals, nursing homes, and community-based services. It's a complex and thorny problem that was also flagged in the report from the expert panel on long-term care a year ago. Solutions continue to be elusive.

The panel recommended the establishment of four behavioural management units across the province. "The acute care system is burdened and not ideal for persons with dementia or responsive behaviours," said the panel's report.

A responsive behaviour is a disruptive one often involving physical or verbal abuse. "More specialized units for responsive behaviours would alleviate pressures in both acute and long-term care settings," said the report.

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