Excessive restraints, deviations from protocol at Lakeshore Hospital ER: ombudsperson

Quebec's ombudsperson is intervening after receiving "several reports of negligence in the quality of care and services provided by Lakeshore General Hospital emergency staff."

The investigation into the Montreal-area hospital looks into concerns around the "excessive use of restraints, as well as deviations from the protocol in effect governing their use."

"Despite their heavy workload, all staff members are concerned about providing quality services and care to users," Ombudsperson Marc-André Dowd wrote, adding the goal is to determine if people's rights are being respected.

It comes after the Quebec Health Ministry requested an independent investigation into the hospital last February.

That report was published on June 1.

"The Quebec Ombudsman nevertheless investigated shortcomings that were brought to its attention but not addressed in the independent report, namely, control measures," the report states. "The investigation showed that there were several flaws in this area."

According to the ombudsperson, restraints are control measures designed to limit a person's movements to ensure both their safety and that of others.

Restraints can be physical, such as barriers, bindings and force, or chemical, such as sedatives.

During the investigation, Dowd noted three points about the Lakeshore General Hospital:

1. emergency staff lacked knowledge about the protocol governing control measures;
2. restraints were sometimes used too quickly without alternative measures attempted first;
3. there were shortcomings when it came to supervising and record-keeping use of the control measures.

Dowd notes that several steps have already been taken to correct these problems.

Both the Quebec Health Ministry and the CIUSSS de l'Ouest-de-l'Île-de-Montréal say they are aware of "the issues of difficult working conditions and work overload at Lakeshore General Hospital," according to the document.

As a result, Dowd issued one recommendation to the Quebec Health Ministry: ensure rigorous and diligent monitoring of the action plan required by the independent report.

Dowd also gave four recommendations to CIUSSS de l'Ouest-de-l'Île-de-Montréal, which oversees the hospital:

1. Take the necessary steps to implement the recommendations made in the independent report commissioned by the Quebec Health Ministry.
2. Assess the need to update documents and forms required when using control measures.
3. Remind emergency responders of the conditions under which they can use bedrails.
4. Continue to audit the use of emergency control measures.

"These recommendations are aimed in particular at better supervising and documenting the use of control measures in the Lakeshore General Hospital emergency department," the report notes. "The recommendations were all accepted. The Quebec ombudsman will monitor their implementation closely."

Stephanie Iasenza, a spokesperson for the CIUSSS de l'Ouest-de-l'Île-de-Montréal, said the hospital is integrating the ombudsman's recommendations.

"88 per cent of staff are trained. There's definitely a bit of turnover, so we're always continually training staff on proper use of restraints, and we are putting in place various actions to address the other recommendations as well," she told CTV News in an interview Thursday.

"Obviously, it's always very difficult for families to see patients and their family members in restraints, and we offer all our sympathies for patients who have passed away at the Lakeshore emergency," she added.

"It's always our first priority for patient safety and quality of care, and we're continuously improving our patient quality of care."  

According to the Quebec Ombudsperson, the Lakeshore General Hospital serves a population of more than 225,000, and its emergency room receives more than 40,000 visits a year, making it one of the busiest in Montreal.

The Quebec Ombudsperson says it expects both the Quebec Health Ministry and the CIUSSS de l'Ouest-de-l'Île-de-Montréal to report back to it by April 30.