London hospital staff call on labour minister to step in on purple armband issue

Ontario's minister of labour is being asked to intervene in a London, Ont., hospital policy that doctors say is discriminatory and violates the human rights of patients.

Patients have to choose between refusing treatment and being publicly labelled as violent, letter says

An exclamation mark outside of a patients' room at the London Health Sciences Centre denotes that someone inside could potentially be violent or aggressive. (Supplied)

Ontario's minister of labour is being asked to intervene in a London, Ont., hospital's use of a violence assessment tool that doctors say is discriminatory and violates the human rights of patients. 

The tool assesses patients at the London Health Sciences Centre for their potential for violence. If they receive a score of moderate or higher, they're forced to wear a purple armband.

For those who refuse, a sign with a large exclamation mark is taped to the doors or curtains of the patient's room to warn staff of the potential risk. 

There are further interventions for people in the outpatient mental health section of the hospital. If they refuse to wear the armband they have to be escorted by staff wherever they go, including the bathroom. And, if they refuse the escort, the patient will be denied treatment that day, according to internal hospital emails obtained by CBC. 

The use of the assessment tool is the result of a settlement between the hospital and the Ontario Nurses' Association, using an Ontario Labour Relations Board (OLRB) mediator. The settlement was reached after a male patient with a history of violence assaulted a registered nurse in April, 2017. 

Those who work with patients with mental illness say the violence assessment tool, developed by the Public Services Health and Safety Association, unfairly targets an already vulnerable population. 

Numerous LHSC staff have sent a letter to the labour minister.

"This policy causes extreme numbers of vulnerable patients receiving mental health care to wear bright visual markers of their 'potential for violence,'" the letter states.  

"At our hospital, whole units of patients are being flagged as being a risk for violence. This does not protect staff." 

'Human rights violation'

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The violence risk assessment tool (see above) requires just one to three "observed behaviours" to be present before a patient is flagged. Those include being confused, irritable, boisterous or agitated. 

The flag is permanently placed on patients' files, so each time someone comes back to the hospital as an outpatient, they are required to wear an armband, staff say. 

"The OLRB orders are discriminatory and violate the human rights of patients, with mental health outpatients targeted based on their diagnosis, even though there is no evidence that they pose any risk of violence," states the letter from staff. "No other outpatient service at LHSC is required to actively use the (violence assessment tool) for all appointments." 

"We respectfully ask that you immediately suspend use of this invalid tool and consider utilizing evidence-based assessments and procedures. There are several established violence assessment measures that have greater predictive validity. We also ask that you ensure patients are only flagged for a 24-hour period and then reassessed, and that you ensure assessments are not only effective in protecting workers but are also non-discriminatory and non-stigmatizing to our vulnerable patients."

A spokesperson for Minister of Labour Laurie Scott said the minister responded to the letter, saying that the ministry commends staff for their commitment to patient safety. The response also said the minister takes workplace violence very seriously but cannot comment on the specific decision-making or administrative process of the Labour Relations Board. 

Executive Director at the ARCH Disability Law Centre, Robert Lattanzio tells London Morning the LHSC policy to identify patients with violent or aggressive behaviour with a purple armband or door sign will not reduce the stigma of mental illness. 9:11

About the Author

Kate Dubinski

Reporter/Editor

Kate Dubinski is a radio and digital reporter with CBC News in London, Ont. You can email her at kate.dubinski@cbc.ca.

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