A new study on Toronto's handling of the SARS outbreak says patients and families weren't properly informed about the decision-making process.

In a new study published Sunday in the U.K.-based Biomed Central, a team of medical ethicists examined the fairness of how decisions were relayed to patients and visitors at one Toronto hospital.

It found that while the hospital imposed a no visitors policy and cancelled surgeries as a protective measure, people weren't adequately told why the events were unfolding, which resulted in much frustration.

Sign posted during Toronto's SARS outbreak in 2003.

"Hospitals operate at their best when staff and patients trust the process," says Dr. Doug Martin, who led the study for the University of Toronto Joint Centre for Bioethics. "But the SARS outbreak raised questions that many hospital administrators and staff had never faced before."

The report concludes that "in the midst of a crisis such as SARS where guidance is incomplete, consequences uncertain and information constantly changing, where hour-by-hour decisions involve life and death, fairness is more important rather than less."

Researchers examined more than 200 documents (including e-mails and minutes of meetings) and 35 interviews with senior administrators, physicians, managers, nurses, other staff, a patient and family members.

The study found there were two distinct phases of priority setting at the hospital during the SARS outbreak: the initial containment phase and the subsequent "ramp up," phase, when the hospital gradually resumed normal activity.

During the containment stage, the hospital's focus was to protect its staff. As a consequence of these tight measures, some family members were unable to be present when a relative died.

The study shows that the prolonged crisis also took a toll on the morale of doctors who admitted to suffering depression.

Severe Acute Respiratory Syndrome killed 44 people during the city's outbreak a year and a half ago.