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A Canadian judge’s recommendation that caregivers should have all of a patient’s information to remain safe after one was killed by a client “is not so much a wake-up call as it is a swift-kick to the rear,” an Alberta lawyer said.
Judge Bart Rosborough’s report said the petite caregiver, Valerie Wolski, was assigned to spend the night alone caring for 6-foot-5, 300-pound Terrence Saddleback in February 2011 in Camrose, Alberta.
She was found strangled to death the next morning.
The severely developmentally disabled Saddleback was asleep on a nearby couch.
The then-25-year-old man had a long, well-documented history of violence with caregivers, especially women, the report said.
Edmonton-based occupational health and safety lawyer Christopher Spasoff of F2 Legal Counsel told Bloomberg BNA Feb. 8 that while a prosecution didn’t proceed, the Feb. 1 report contains recommendations that should be heeded by occupational health and safety regulators and employers.
The duty of regulators and employers to ensure the safety, if not the lives, of employees working in dangerous situations is one of increasing importance for regulators in Canada and the U.S.
In the U.S., a federal rule to curb violence in health care and similar settings began a slow path to adoption Jan. 10 when the Occupational Safety and Health Administration’s director granted two petitions to start work on a workplace violence standard.
Private-sector, health-care workers at in-patient facilities experienced workplace violence-related injuries requiring time off from work at an estimated rate of at least five times higher than the rate for private-sector workers overall, according to a March 2016 U.S. Government Accountability Office report.
Health-care employees, correctional officers, social services employees, teachers, municipal housing inspectors, public works employees and retail employees are the most at risk, the agency said.
Saddleback was diagnosed from an early age with a pervasive developmental disorder, moderate to severe mental retardation and a disruptive behavior disorder.
He was found mentally unfit to stand trial in Wolski’s death.
Among other confinements, in 2004, Saddleback was involuntarily committed for psychotic behavior and aggression directed toward his caregivers and, in 2008, for unpredictable and violent behavior, the report said. After a 2009 incident, five police officers were required to subdue him with pepper spray and handcuffs, the report said.
Rosborough recommended facilities do a better job of communicating information about such clients and that they only be placed in fully accredited homes.
The judge said information inventories should be compiled and transferred with clients for access by care workers. He also recommended that female care workers not work alone with aggressive clients, or ones they cannot physically manage.
“At no time should a careworker be assigned to the care of a resident that the careworker cannot physically manage at that time,” he said.
He recommended the government have an outside agency review how the province shares information when it has safety concerns about people in care and complete a report on how it has followed up on all Alberta fatality inquiry recommendations.
“The government of Alberta is responsible for ensuring proper care for developmentally disabled persons presenting complex needs,” Rosborough said. “There were direct and immediate failings in this case which contributed to the death of Wolski.”
Spasoff said the actual wake up call, as Rosborough noted, “came years earlier in recommendations following a similar tragedy, but apparently went unanswered.”
He said the provincial government has indicated it is reviewing occupational health and safety legislation after another assault on a worker.
Further, he said, the province acknowledged the need to develop a formal process for tracking, reviewing and implementing future recommendations.
He said Alberta’s occupational health and safety legislation, like that of the other provinces and territories, already contains provisions for addressing workplace hazards, working alone, and violence in the workplace.
Spasoff said Alberta’s provisions currently fall somewhere along the middle to higher-end of the spectrum in terms of both specificity and strictness.
“Whether the legislation needs to be amended to afford greater protection to workers, or employers, including the province, simply need to a do a better job of complying with it, remains to be seen,” he said. “One thing is certain, however. As Judge Rosborough confirms, little is to be gained by simply talking about the same problem over and over again. Now it’s time for action. “
Melanie Sauriol, of the Montreal-based Langlois law firm’s employment and labor law group, agreed with the concept of patient inventories.
Workers, she told Bloomberg BNA Feb. 10, have the right right to a protected working environment.
“The institution or the employer has to be aware of exactly what kind of patient he is receiving,”she said.
In Wolski’s case, she said, “the employer did not know he was handing her a time bomb. He did not communicate all of that information.”
She said an employer should ensure a worker has exact information about a patient so they can work in a safe environment. But, she said, that could present difficulties with privacy law as patient documentation moves from one organization to another.
OSHA’s staff was “shocked at the high rate of workplace violence,” which motivated them to grant the petitions to move forward with a rule, the agency’s previous director, David Michaels, told a public meeting Jan. 10.
National Nurses United and AFL-CIO, among others, petitioned OSHA in July 2016 for a standard that would require health-care employees to develop violence prevention programs, forbid retaliation if workers seek law enforcement help during violence in the workplace, and provide training and investigations for incidents.
The future federal standard could be modeled after a New Jersey law and recent California regulation, which is the first regulation to limit and better report violence against workers in hospitals, jails and hospices in the U.S.
If finalized, the rule would subject health providers and hospitals to federal penalties if they failed to the create workplace violence prevention programs.
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