December 8, 2015

“It was a beautiful sunny day. I was just starting my home care visits, and I was at my second patient. A patient who, with his changing mood, sometimes exhibits violent behaviour.Once in the house. I realized he was not in the living room, as was normally the case, but instead in the basement. His wife then told me that I needed to go down to the basement to give him his care. At her insistence, and even if I was hesitant, I slowly went downstairs just the same, trying my best to get a feel for my surroundings. I told myself that the patient absolutely needed his care.

It was then that everything completely changed. The patient was right in front of me, seemed uncooperative and very aggressive. I wanted to call out for help, but at the same time, I felt a sharp pain. My patient was hitting me. With every blow, I said to myself: why did I come downstairs? Why didn’t I listen to myself? Why didn’t I REFUSE to go down there?”

The risk of an assault when providing care and services is, unfortunately, very real for the healthcare professionals, whether in home care or in any other setting. Fortunately, certain measures can be taken to control this risk, and among them is what is called the right to refuse.

The right to refuse is clearly written in an An Act respecting occupational health and safety: “A worker has a right to refuse to perform particular work if he has reasonable grounds to believe that the performance of that work would expose him to danger to his health, safety or physical well-being, or would expose another person to a similar danger.” (OHS Act, sec. 12) However, there are two exceptions (OHS Act, sec. 13) “No worker may, however, exercise his right under section 12 if his refusal to perform the work puts the life, health, safety or physical well-being of another person in immediate danger or if the conditions under which the work is to be performed are ordinary conditions in his kind of work” (for example, a paramedic cannot refuse to go to the scene of an accident on the grounds that the roads are icy, if all the appropriate measures have been taken to control this risk).

When a healthcare professional is in a situation in which she reasonably believes a real immediate danger exists and that she then decides to exercise her right to refuse, it is important to inform her immediate superior, her employer or their representative immediately. Then a joint process of examination of the situation and evaluation of the corrective measures to be applied will quickly begin. It is also possible that the intervention of an inspector from the Commission de la santé et de la sécurité du travail (CSST) (Occupational Health and Safety Commission) will be required in the event of a disagreement on the danger or the proposed solutions.

Obviously, every case is different and must be dealt with as such. In the incident described above, the healthcare professional should have, after having assessed the real and immediate danger which she was being exposed to (context of usual care, unknown setting and lack of a previous inspection, patient aggressiveness, the wife’s insistence, etc.), refused to do down to the basement. However, this is often easier said than done. To properly protect herself against the risk of assault, if she cannot always take action on the source of the dangers, it is important to have the knowledge and the tools to correctly assess the situation and to react appropriately. And above all, it is important not to feel guilty if such an incident happens. Although it is true that the worker must take the key measures to protect herself, the employer is responsible for taking the necessary measures to ensure the health, safety and physical integrity of the person in his employment (OHS Act, sec. 51). In addition, the healthcare professional can always count on the support of her local union team. The latter will be able to enlighten her on the right to refuse, to accompany her throughout the process, to direct her to the relevant resources as needed and to target the ways to avoid that such a situation happen again.

Even if the healthcare professionals are committed to providing care to the patients, they must never put their life in danger, or that of someone else. It must be remembered that, in prevention, sometimes refusing can save you!

Do you know ?

The Association paritaire pour la santé et la sécurité du travail du secteur des affaires sociales (ASSTSAS) proposes an interesting and relevant brochure, Prévention des agressions lors d’interventions dans la communauté – astuces de sécurité.

Section 30 in the OHS Act stipulates that no discrimination, reprisals or sanction may be taken against a worker who exercises his-her right to refuse. If this should occur, he-she can either use the grievance procedure stipulated in his-her collective agreement or submit a written complaint to the CSST. His-her local union team will then be of valuable assistance.

The decision of a CSST inspector, even if it has effect immediately, may be the object of an application for review and a contestation before the Commission des lésions professionnelles within 10 days of its receipt (OHS Act, sec. 20).

A worker who exercises his-her right to refuse is deemed to be at work when he-she exercises this right (OHS Act, sec. 14). The employer may require that he-she remain available in the workplace and temporarily assign him-her to other duties that he-she is reasonably capable of performing (OHS Act, sec. 25). If he-she works in home care, his-her workplace is the CLSC.

Different colour codes exist in the institutions in order to mobilize the intervention team when an emergency situation arises. In cases where we are faced with a violent person, it is the code white procedure which allows staff to ask for help. It is important that every healthcare professional be properly trained in how to use this procedure.

In 2013, 37.7% of all the lésions attribuables à la violence en milieu de travail (injuries due to workplace violence) recognized by the CSST involved the “healthcare workers” category.