It is important to highlight a chronology of events that affected ONA and OPSEU members. It demonstrated to union representatives the Ministry of Labour’s lack of involvement throughout the crisis.
During the first round of SARS, which emerged in mid-March at the Grace site of the Scarborough Hospital, approximately 64 employees (paramedics, clerical staff, nurses, and doctors) were diagnosed with SARS as a result of workplace exposures. It was documented in various media, popular and scientific, that healthcare workers were contracting SARS.
1. On March 31st a senior ministry representative spoke with one of the authors (LMcC) about various health and safety issues. The represen- tative was unable to answer questions without first running them by the command center because he had not seen the directives. We questioned why a key ministry official had not yet seen the directives. He was then sent the directives by this author because he did not know when he would be receiving them through ministry channels.
2. On April 1st one of the authors (LMcC) wrote on behalf of ONA to the Ministry of Labour, requesting guidance and clarification on a number of SARS-related issues, among them the specific health and safety needs of pregnant workers. In its response, the ministry cited the section of the Health Care Regulation relating to reproductive hazards, but offered no guidance on how the specific risks related to SARS were to be dealt with.
Early in May, the same representative advised me by telephone that the ministry would not be issuing any special guidance for pregnant workers.
This was later confirmed at an Ontario Hospital Association (OHA) tele- conference, where attendees were advised that neither the Labour nor
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Health ministries would issue a directive on the issue of pregnant workers.
As a result worker anxiety and mistrust could only increase.
In that same letter to the Ministry of Labour, ONA also inquired about several other health and safety issues. We asked whether the ministry would employ a heightened response to our members’ unresolved health and safety concerns and complaints, given their limited right to refuse unsafe work under the OHSA. On April 15th the ministry replied, stating that they were responding to concerns, complaints, and work refusals.
However, the ministry did not respond specifically to the query on the possibility of a “heightened response.”
3. On April 11th the bargaining unit president at North York General Hospital reported to ONA that the ministry of Labour was advising workers that SARS was not a critical injury under the OHSA. ONA vigor ously opposed this interpretation. It was ONA’s position that the ministry’s refusal to recognize SARS as a critical injury under the Act diminished the employer’s responsibility to immediately investigate with a view to pre- venting a recurrence. It also removed a fundamental right under the Act for worker members of the joint health and safety committee to investigate and prevent further injuries.
It was the position of both unions that suspect cases of SARS were an occupational illness under the OHSA. It was also our position that probable cases of SARS must be considered as critical injuries under the Act. Employers have an obligation to report critical injuries immediately, both to the Ministry of Labour and to the joint health and safety committee. These reports must also be produced, in writing, within 48 hours. These reports are intended to trigger employer, joint health and safety committee, and Ministry of Labour investigations with a view to preventing a recurrence. Employers also have an obligation to report all occupational illnesses within four days.
The Ministry of Labour had an obligation under its own policy to investigate critical injuries to ensure that employers were taking all pre- cautions reasonable to protect workers. Although the Act is silent on the ministry’s obligation to investigate occupational illnesses, the ministry’s own policy indicates that an inspector shall respond to all reports of occupational illness or disease.
Both unions have been informed that the Ministry of Labour is inves- tigating the two SARS related fatalities; however, to date, neither union has any knowledge of the ministry initiating any form of critical injury or occupational illness investigation into what factors contributed to so many workers contracting SARS.
At the joint OHA/Ministry of Health/Ministry of Labour teleconference meetings, ONA repeatedly asked the Ministry of Labour for its position on SARS as a critical injury. Several ministry representatives on various dates promised a response, yet none fulfilled that commitment.
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4. On May 1st a Ministry of Labour representative finally informed ONA that the ministry was taking the position that SARS was not a critical injury. It continued to be ONA’s position that the ministry’s interpretation of “critical injury” was further endangering workers. One author (LMcC) asked that ONA’s position be taken back for further consideration. She agreed.
Later that same day the ministry’s representative contacted LMcC. The only question that had come back from her superiors was, “Why do you care?” It was explained that among many reasons, the definition of an injury as critical, triggers investigations, which then should lead to better prevention.
Shortly thereafter, the Ministry of Labour’s Provincial Physician advised ONA that the ministry had accepted that “probable SARS” was in fact a critical injury and that it would be calling all healthcare employers to advise them of their reporting obligations under the Act.
5. Between April 15th and 21st nine healthcare workers at Sunnybrook Hospital were diagnosed with SARS following exposure to a SARS patient during a complex and prolonged medical intervention. These exposures and subsequent illnesses were well documented in the popular media and shortly afterwards in scientific journals. In one scientific journal article, the authors speculate on the various reasons that there were so many exposures and illnesses among health care workers. All were related to lack of training on how to minimize exposures during high-risk proce- dures. One worker was documented as wearing a beard while he had his respirator on. No one had advised him to shave it. There had been no fit testing of respirators. To date, neither union is aware of any Ministry of Labour investigation into events at Sunnybrook that contributed to this volume of occupational illnesses.
6. On May 22nd and 23rd news of a new SARS outbreak (SARS II) emerged at St. John’s Rehabilitation Hospital and North York General Hospital (NYGH). It quickly emerged that a number of patients who had SARS had been transferred to other Toronto hospitals. In addition, it was discovered that a large number of healthcare workers had contracted SARS during the time that the initial outbreak appeared to be waning. This news was in the media by the time union representatives met with Ministry of Labour managers on May 27th. To the knowledge of both unions, the ministry took no action as news of this situation was revealed.
ONA also received verbal reports that healthcare workers at North York General had been reporting the unusual patient illnesses to their supervisor. Workers reported they were cautioned that they were overre- acting and no action was necessary. This indicated to both unions that the infection control system and the internal responsibility system were inadequate to protect workers, as workers reported that their complaints
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about a hazard to their own health were discounted. A total of 42 workers from North York General were diagnosed with SARS by early June.
7. On May 27th a number of union representatives met with the director of the Ministry of Labour’s Occupational Health and Safety Branch Oper- ations Division and the ministry’s regional directors. Union representatives raised a number of enforcement issues at this meeting. OPSEU and ONA specifically raised the SARS issues again and advised the ministry that they believed it was not fulfilling its role. Both unions pointed to the number of occupational illnesses, contradictions in the operations center directives, confusion regarding personal protective equipment within the hospital sector, lack of fit testing, and lack of training. Both unions strongly advised the ministry that it needed to get involved more proactively and that it should not rely on POC directives and internal hospital infection control practitioners to ensure workers’ health and safety during the SARS out- break. This meeting had no apparent effect.
8. By June 6th ONA had received numerous enquiries from individuals seeking answers to their health and safety questions. During SARS II, it became apparent to OPSEU and ONA that many employers were not responding to healthcare workers’ concerns about their health and safety.
Calls from workers about masks not fitting and their fears of exposure led three of ONA’s representatives to call the Ministry of Labour themselves on June 6th requesting the ministry to go into North York General and St. Michael’s Hospital to issue orders at least ar ound fit testing and supervisor competency under the OHSA.
9. On June 6th an RN who is a member of the Ontario Nurses’
Association initiated a work refusal because her N95 mask did not fit her properly. For the first time, to OPSEU’s and ONA’s knowledge, the Ministry of Labour became directly involved in the issue of respirators and fit-testing.
The ministry inspector determined that the work refusal was valid under the OHSA. At the investigation meeting on June 9th the inspector issued orders to the employer with almost immediate compliance dates.
The orders required the employer to implement a respirator program for all workers with direct patient care in the SARS unit, the ICU, the emer- gency department, all employees and patient screeners and cleaning staff who were entering the rooms of SARS patients. At this meeting, it appeared to ONA that the employer’s focus was on fit testing and training of nurses and doctors. It was ONA who had to remind the employer that fit testing must include all workers who enter SARS patient rooms. Similar orders were also issued to St. Michael’s Hospital.
Shortly after this, the ministry advised ONA that it was going to start targeting all Toronto hospitals regarding the fit testing and training issues, starting with category 3 and 2 facilities. This was almost three months
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into the outbreak. During all this time it had been reported repeatedly that healthcare workers were one of the groups at highest risk of con- tracting SARS. Over 100 healthcare workers had contracted SARS as a result of workplace exposures and two nurses and a physician had died.
Many more healthcare workers were quarantined as a result of workplace exposures, and countless people’s lives were disrupted. The emotional and physical toll has yet to be accounted for.
In this same week ONA reported to the Ministry of Labour that we had received complaints that Mount Sinai was refusing to fit test. ONA requested that the ministry include Mount Sinai in the first round of its investigations. On June 11th, one author (LMcC) was advised by the Ministry of Labour that they would visit Mount Sinai either on June 13th or June 16th. (June 13th was later confirmed.)
10. On June 10th Lisa McCaskell wrote to the director of the Ministry of Labour’s Occupational Health and Safety Branch Operations Division to follow up on the numerous health and safety issues that had been raised with the Ministry of Labour at the January and May meetings with the ministry and the Ontario Federation of Labour: to date ONA has not received a response.
11. On June 12th and June 13th Barb Wahl, ONA President, wrote to this same director asking for more ministry resources to facilitate the
“proactive investigations.” She also wrote regarding the disclosure of information under the OHSA, about ONA members who contracted SARS, and requested the ministry to investigate forthwith any and all critical injuries. To date no response has been received.
12. On June 13th, the Ministry of Labour’s Provincial Physician advised ONA that the ministry would not be doing any more proactive investi- gations. Despite Linda McCaskell’s questions, the representative would not disclose who in the ministry had made this decision or what had influenced it. It is the position of both unions that critical decisions like these should be a matter of public record. Although the ministry later resumed some proactive investigations, to our knowledge the ministry never visited Mount Sinai.
13. On June 17th, North York General sent the ministry an updated list advising them of all occupational illnesses. The unions are not aware of any critical injury investigations initiated by the ministry at North York General to date, despite this notice having been received.
14. On June 18th, ONA President Barb Wahl wrote to the then-Premier regarding her concern for member and public safety due to the Ministry of Labour’s decision to scale back the proactive inspections, and the Ministry of Health’s decision to reduce protection to health care workers in its June 16th directives. Although the Premier did respond, ONA was not satisfied with the response as it did not, in the union’s opinion,
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adequately explain the Ministry of Labour’s actions or the Ministry of Health’s rationale.
15. On June 28th, one healthcare worker, registered nurse Nelia Laroza, died from SARS following a workplace exposure at North York General Hospital during the second SARS outbreak. The second outbreak was identified May 23rd, approximately two months after the first outbreak.
The Ministry of Labour has initiated an investigation into this fatality but ONA has not seen a fatality report at this time.
While it may be that no one factor will be identified as responsible for this worker’s death, both unions must ask what responsibility the Ministry of Labour may have in this case given its reluctance to investigate previous occupational illnesses, complaints from workers, and knowledge of possible violations of the OHSA and the Health Care Regulation. Both unions believe it was ONA’s formal complaints in June that finally triggered the issuing of orders in some of the facilities. Both Unions believe that if a similar situation had emerged in an industrial setting that the ministry would have acted swiftly and proactively to ensure that all reasonable precautions were being taken to protect workers from further illnesses.
16. On July 19th a second registered nurse, Tecla Lin, died of SARS.
She had been exposed early in the first outbreak when she had volun- teered to work on the SARS unit of her hospital, West Park Healthcare Centre. Although little was known about SARS when West Park opened its interim SARS unit, the illness was known to be highly communicable, either by droplet or respiratory transmission. West Park has a state-of-the- art respiratory unit, opened in February 2000, featuring negative pressure isolation rooms for highly infectious clients and specific procedures such as protective respirators for staff. The unit is designed to care for patients with complex and multidrug resistant tuberculosis.
Neither union knows if the SARS unit was housed within that special respiratory unit; however, even if it was not, one would have assumed that West Park would be one of the safest hospitals in the province in which to care for highly infectious respiratory illnesses given their repu- tation and their expertise. The unions await the fatality report from the Ministry of Labour, which may explain what went wrong.
The authors have presented in this chapter many examples of a health and safety system that failed.
It is clear to both ONA and OPSEU that if the culture of worker health and safety is to ever improve in the healthcare sector, the culture of health and safety must be changed by this government and its ministries.
The Ministry of Health and Long Term Care when developing directives must incorporate health and safety law directly into the directives. The government must also ensure that the Ministry of Labour will enforce the OHSA and that they will have the means to do so. The ministry must
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ensure that all employers in this province are complying with this most superior legislation.
Since the mid-1990s, Ontario’s Health Care Regulation has required employers to fit test workers before they don their equipment. Section 54 of the OHSA gives the Ministry of Labour the power to enter into any workplace at any time without warrant or notice. However, we are unaware of any instance (prior to June 6th, 2003) when the ministry exercised that power and ordered employers to fit test and develop respirator protection programs. In this instance alone it appears that it has taken the ministry over ten years to finally realize that many employers in health care were not complying with this section of the Regulation under the OHSA.
We must ask ourselves how many other possible violations are not addressed by the Ministry of Labour when enforcement of the OHSA in the healthcare sector is not made a priority. How many other workers can be spared the trauma that healthcare workers endured and how many lives could be saved if only the health and safety of workers wer e everyone’s top priority.
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