The culture at the Royal Alexandra Hospital, where the city's most vulnerable people are treated as nuisances, must change if deaths like that of a homeless woman who died tied to a wheelchair in an ambulance bay while drunk on hand sanitizer are to be prevented, says an Edmonton judge.
"They are banned, issued tickets for trespassing and public intoxication and escorted off the premises to go home, even if they are homeless," provincial court Judge Janet Dixon wrote in a fatality report released Wednesday.
"Vulnerable individuals suffering from addictions and other mental health issues should be assumed to have a health purpose in coming to the RAH and not be treated as nuisances and trespassers."
On Dec. 28, 2009, Sharon Lewis was tied to a wheelchair by hospital security staff because she could not sit or stand after drinking Microsan, a hospital hand cleaner containing 70 per cent alcohol.
Lewis, 35, was homeless, a chronic alcoholic and a frequent visitor to the hospital. She was placed in the ambulance bay until she could sober up, when security intended to charge her with trespassing and remove her from the hospital.
When Lewis was later found unresponsive, she was taken into emergency where she died a few minutes later, the report said.
Following the fatality inquiry held last summer, Dixon's report issued eight recommendations to prevent similar deaths.
The recommendations involve changes to policy and standards in dealing with intoxicated people, better tracking of hand sanitizer misuse, improve education around addictions, and reviewing a patchwork of discharge procedures.
But even if all the recommendations were put in place, Dixon warned they may not be enough to prevent similar deaths.
"Underlying all of the evidence heard in this inquiry was a fragmentation of policies and procedures designed to meet various issues that have arisen over time, without considering the collateral impact on the individual involved," she wrote.
Much of the evidence at the inquiry described the challenges faced by staff at the inner-city hospital who deal with the demands of those coming to emergency while intoxicated, to panhandle, or for food, warmth or to consume hand sanitizer, she said.
"The culture of the RAH in 2009 and at the time of this inquiry is generally to regard these individuals as nuisances," she wrote.
"There appears to be little recognition that the deliberate design of the security operations of the RAH builds an invisible wall around the emergency department."
That wall must come down, Dixon said.
"It is critical to ensuring the success of any programs being offered from or through the RAH."
AHS responds to criticism
Alberta Health Services said its hospital staff prevented Lewis from leaving on that cold winter day.
"They did this out of compassion for Ms. Lewis," AHS said in a news release Wednesday. "They were concerned she would have nowhere safe and warm to go to sober up, and decided that keeping her in the ambulance bay was the safest option."
There are now many more options for hospital staff trying to provide care and support to patients like Lewis, AHS said.
This February, the hospital renovated space in the emergency department, adding four designated detox beds and 10 stretcher spaces administered by a team of addiction and mental health specialists aided by consulting psychiatrists.
An additional six complex medical detox beds will open in November 2017, AHS said.
The hospital also implemented a program to address root social causes for patients struggling with mental health issues, drug use, poverty and homelessness, AHS said.