|The Ottawa Citizen|
A coroner's jury will hear a list of recommendations today that includes measures to stop dozens of psychiatric patients from wandering off the grounds of the Royal Ottawa Hospital, as Mark Wiens did when he died in May 2002.
Erecting a security fence around the unguarded ROH property and having staff patrol the grounds are two changes being suggested by Crown attorney Mark Holmes at the close of the two-week inquest.
"Up until this point, we have had this impression that (staff) have a certain amount of indifference to people not following the rules they are supposed to, and staying on the grounds," Mr. Holmes told the Citizen yesterday.
He will also recommend that the hospital launch a public investigation that would make all staff and police aware of the hospital's problem with wandering patients.
Since January, police have been called 74 times to locate missing patients, 57 of whom were committed to the hospital against their will, but managed to leave the hospital.
Criticizing the hospital for its "culture of non-adherence to policy," Mr. Holmes will suggest more rigorous enforcement of the sign-in, sign-out policy for patients who have privileges to leave the ward, but not the hospital grounds.
He will also recommend a patient safety officer be appointed immediately to serve as a watchdog for patients' physical well-being.
Mr. Wiens was an in-patient at the Royal Ottawa Hospital when he wandered off the hospital grounds and onto the Queensway where he was struck and killed by a bus.
Two weeks of testimony have revealed that psychiatric patients like Mr. Wiens leave the hospital property on a "daily basis." Although hospital policy dictates that these incidents, called unauthorized leave, must be reported, staff members testified that often they are not.
"I think it's worthwhile that if the policies are unenforceable or not being followed, then there has to be a candid examination of that by all the people that work at the hospital," said Mr. Holmes.
Psychiatric patients with privileges to leave the unit are expected to return under an "honour system" that dictates patients will confine themselves to the hospital grounds.
Mr. Holmes said yesterday the system is inadequate in keeping patients -- and the surrounding community --safe.
During his stay at the Royal Ottawa in April and May 2002, Mr. Wiens alternated between earning and losing his grounds privileges.
Two weeks before he died, Mr. Wiens left the ward twice without permission, prompting a suspension by hospital staff of his privileges.
In the days before his brief disappearance, Mr. Wiens had told them he was going to leave and "never be seen again."
On May 28, the 23-year-old was once again forbidden from leaving the ward after attacking an orderly who tried to take away his cigarettes just after midnight.
The altercation prompted the night nurse to administer a chemical restraint against Mr. Wiens' will -- an injection of anti-psychotic medication -- and suspend his grounds privileges.
They were reinstated later that day by fourth-year psychiatry resident Dr. David Hamilton, who saw Mr. Wiens while his regular psychiatrist was on vacation.
Despite Mr. Wiens' earlier disregard for his lack of privileges, and his unusual violent outburst the night before, Dr. Hamilton said he believed the patient was capable of handling an increased level of responsibility.
While Mr. Wiens had previously told the doctor he was unqualified to treat him, Dr. Hamilton said his patient was unusually open during their meeting on May 28.
Mr. Wiens' calm demeanour and candid conversation led Dr. Hamilton to believe the patient was in a better state of mind.
Putting all these things together, "giving him access to the grounds with a level-five (privilege level) was the decision I took at the time," said Dr. Hamilton.
An expert in psychiatry who testified yesterday questioned how the hospital granted grounds privileges, saying it was something that needed to be done incrementally and with extreme care.
"The important thing is to look at the rationale for increasing the privileges," said Dr. Gary Chaimowitz, a forensic psychiatrist from St. Joseph's Healthcare Centre in Hamilton.
"The onus is to make sure that you've justified why you've done that because in this particular case, there was a critical incident a couple of hours before where physical and chemical restraint were applied. What was the rationale?"