Nurses welcome coroner’s inquest recommendations but say physician dominance must be addressed

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A coroner’s inquest into the murder of Windsor RN Lori Dupont wrapped up on Dec. 11 with 26 recommendations that jurors hope will prevent a similar tragedy in the future. Among the jury’s recommendations:

  • review the Public Hospitals Act with a view to examining the hospital-physician relationship to ensure and promote the safety of staff and patients as well as quality of care in hospitals;
  • ensure that patient and staff safety, as well as patient care, are not superceded by a physician’s right to practice and that hospitals are able to exercise the appropriate degree of authority over physicians working within their institutions consistent with that of other regulated health professions;
  • ensure hospitals have greater authority to manage disruptive behaviour by physicians;
  • implement policies to address domestic violence and abuse or harassment in the workplace; and
  • amend legislation to allow the Ministry of Labour to investigate workplace harassment and abuse

The four-member jury, which sat for 11 weeks, heard from 53 witnesses, and read through thousands of pages of investigative briefs, spent five days considering the evidence. The list of recommendations suggest changes be made by numerous bodies, including the Ontario government, hospitals, the Ontario Medical Association and at Windsor’s Hotel-Dieu Grace Hospital (HDGH) where Dupont worked.

The 36-year-old registered nurse was stabbed to death on Nov. 12, 2005 by Dr. Marc Daniel, an anaesthesiologist with whom she had previously ended a romantic relationship. Daniel then committed suicide.

The Registered Nurses’ Association of Ontario (RNAO) is welcoming the recommendations but cautions that until systemic hierarchies embedded in the health-care system are addressed, physicians will continue to wield a disproportionate amount of power over other health-care professionals.

“We are calling on the government to open the Public Hospitals Act and replace hospitals’ Medical Advisory Committees – which are governed by physicians – with interprofessional committees that represent all health-care professionals,” says RNAO Executive Director Doris Grinspun. “These new committees will re-allocate power among all disciplines, which is vital in dealing with early signs of disruptive behaviour in the workplace. They will also serve to improve teamwork, communication and clinical practice,” she says.

During the inquest, testimony from Dupont’s nursing colleagues revealed that numerous HDGH managers were aware of Daniel’s prolonged, serious misconduct not just toward Dupont, but aimed at others as well. It was revealed that Daniel had a long history of inappropriate outbursts of anger, of aggression and of harassing nurses at work. The jury also learned of how he damaged expensive operating room equipment, broke the finger of a nurse in the OR, and had exhibited disruptive behavior in front of patients.

RNAO President Mary Ferguson-Paré says the tragedy points to the larger need for all health-care organizations to implement policies on violence in the workplace. According to the International Council of Nurses (ICN), nurses are three times more likely to experience violence than any other group.

“We must ensure that what happened to Lori Dupont does not happen again,” Ferguson-Paré says. “The jury’s recommendations outlining a process employees and supervisors should follow to deal with violence in the workplace is a step in the right direction to prevent, identify and deal with instances of violence and abuse in the workplace.”

RNAO’s policy statement on violence against nurses in the workplace also lays the groundwork to prevent these tragedies by addressing the social, workplace and individual factors that contribute to violence and abuse, including that which comes from physicians. The association is currently also developing a best practice guideline on Preventing Violence in the Workplace.

In one of its final recommendations, the jury called on the province’s chief coroner to issue a public report by December 2008 on the status of implementing the recommendations with stated reasons for any that have not been implemented by that time. HDGH has said it will begin an immediate review of its bylaws and policies with an aim to implementing all the jury’s recommendations.