THE STANDING SENATE COMMITTEE ON LEGAL AND CONSTITUTIONAL AFFAIRS
EVIDENCE
OTTAWA, Thursday, October 10, 2024
The Standing Senate Committee on Legal and Constitutional Affairs met with videoconference this day at 11:32 a.m. [ET] to consider Bill C-321, An Act to amend the Criminal Code (assaults against persons who provide health services and first responders).
Senator Brent Cotter (Chair) in the chair.
[Translation]
The Chair: Good morning, honourable senators.
[English]
My name is Brent Cotter. I’m a senator from Saskatchewan, and I am chair of the committee. I’m going to now invite my colleagues to introduce themselves, starting on my left.
Senator Batters: Denise Batters, also from Saskatchewan.
Senator D. M. Wells: David Wells, Newfoundland and Labrador.
Senator Prosper: Paul Prosper, Nova Scotia, Mi’kma’ki.
Senator Simons: Paula Simons, Alberta, and I come from Treaty 6 territory.
Senator Pate: Kim Pate, and I live here in the unceded, unsurrendered territory of the Algonquin Anishinaabe.
[Translation]
Senator Audette: [words spoken in Innu-Aimun] Michèle Audette from Quebec.
Senator Clement: Bernadette Clement from Ontario.
[English]
Senator Ross: Krista Ross, New Brunswick.
The Chair: Before we begin, I want to welcome colleagues who join us occasionally. Welcome, Senator Ross and Senator Wells.
Honourable senators, as we agreed last week, we are meeting to begin our study of a House of Commons private member’s bill, Bill C-321, An Act to amend the Criminal Code (assaults against persons who provide health services and first responders).
For our first panel today, we are pleased to welcome the sponsor of the bill in the other place, Todd Doherty, Member of Parliament for Cariboo—Prince George. We want to welcome you, sir, and thank you for joining us.
We will begin by inviting you to deliver opening remarks of roughly seven minutes to be followed by questions and discussion with senators present.
I will turn the floor over to you. It is all yours, Mr. Doherty.
Todd Doherty, Member of Parliament, Cariboo—Prince George, British Columbia, sponsor of the bill: Mr. Chair, I am truly honoured to be with you all today.
Honourable senators, we can’t ignore the headlines: Firefighter attacked by machete-wielding perpetrator; paramedic stabbed while administering naloxone; nurse beaten, hair ripped out in ER; nurse’s throat slashed while taking blood.
How far we have fallen when it’s okay to hunt and hurt paramedics and firefighters or to brutally beat a nurse when they are trying to administer care.
This has to stop. I’m both extremely proud and extremely humbled that Bill C-321 has passed the House of Commons by a unanimous vote at both second and third reading. Very clearly, this is not a partisan issue.
If I may, this bill has seen different iterations since 2019. This is the furthest it has come, so I thank you from the bottom of my heart for being here today.
As you know, Bill C-321 will amend the Criminal Code to make assaults against persons who provide health services and first responders an aggravating factor during criminal sentencing. In recent years, Canadians have been horrified to see violent attacks against health care professionals and first responders splashed across our social media news feeds and become the news headlines on a regular and increasing basis.
The motivation for this bill was a message sent to me two years ago through Facebook from a paramedic, who relayed to me a story of how they attended a call with their partner in a domestic scene. While they were attending to the victim, a family member of the victim picked the paramedic up and threw them down a flight of stairs, then proceeded to stomp on them, breaking their ankles.
They were thrown down a flight of stairs. How, as a society, have we fallen so far that this is normal, that we allow this?
These are the people that keep our communities healthy and safe. They run toward danger when others run from it. Unfortunately, while providing essential care to our communities, our front-line heroes are being assaulted, harassed, hunted, belittled and forced to confront a growing epidemic of violence against them. The stories and statistics are alarming. Their workplaces are, simply put, not safe.
It’s time to send a message. We need to send a message. We need to do everything in our power as parliamentarians to protect those who protect us. The safety of our health care professionals and first responders impacts everything: morale, recruitment and retention.
Canada already suffers from a staggering shortage of doctors and nurses. Unless we do something, it will also suffer from a lack of firefighters, paramedics and correctional officers. Our health care professionals and first responders are ready to answer the call, day and night, without exception. When we call, they answer, no questions asked.
Did you know that a firefighter can’t refuse unsafe work? They can’t refuse a call for help, regardless of the risk to themselves. What they need to know is that just as they protect us, we will protect them. Passing Bill C-321 will accomplish that.
Over a 12-month period, 61% of nurses reported a serious problem with violence, and two thirds considered leaving their jobs as a result. Nearly half of all nurses reported exposure to physical assault 11 or more times, and 84% of paramedics and firefighters have experienced workplace violence.
A recent internal survey by the Peel Regional Paramedic Services found that 97.5% of medics experienced verbal abuse, 86% experienced intimidation, 80% had been physically assaulted, 62% experienced sexual harassment and assault and 13% were sexually assaulted.
The International Association of Fire Fighters, or IAFF, reports 13% of departments experienced acts of violence while responding to structural fires, and 40% reported acts of violence during medical calls.
What are we doing to help those people who help us?
The firefighter who is punched while rescuing people from a burning building, or the nurse who is thrown to the floor and beaten while she is administering care in a hospital ER, there’s nothing that protects them. There’s nothing enshrined in Canadian law that recognizes their job and protects them against violence.
That is the purpose of Bill C-321, to provide protection to those that protect us, that serve us, day in and day out. Whether it’s a nurse, public safety worker, paramedic, firefighter, correctional officer or psychiatric nurse who are performing their duties and are facing increased rates of violence, we need them to know that they are cherished and that we as leaders are fighting for them.
We all know that the violence they are facing is unacceptable. Our health care professionals and first responders should know and be assured that if they are attacked, there is a legal mechanism in place that the perpetrators will be tried and convicted with the full force of the Canadian justice system. As it exists today, many of the health care professionals and first responders who are assaulted while performing their duties do not get support from the legal system and are often told that it’s just part of the job. This is a culture we must change. Getting abused at work is never acceptable. Violence is never part of the job description.
The response to Bill C-321 has been overwhelmingly positive. I have heard from hundreds of health care workers and first responders, not only in person but also online through my social media pages and website. I thank them for sharing their stories with me. As you can see, it’s a heavy burden to carry their voices.
We also heard stunning testimony from witnesses at the Standing House Committee on Justice and Human Rights. Mr. Chair, the stories I’ve heard are both horrific and heartbreaking. I’ve been told about the Ontario paramedic who was sexually assaulted and three weeks later that very perpetrator was back in her ambulance. She was powerless against him. Other stories include the firefighters who were shot at; the Ontario paramedic who chose between defending a colleague in danger or protecting his own personal safety while being attacked by a needle-wielding perpetrator; the nurse who was punched by a patient in the emergency room and was ignored by everyone else in the room; the paramedic who was assaulted while responding to a domestic altercation and now has severe anxiety and has turned to drinking; and the nurse who had her throat slashed.
Mr. Chair, members of the committee, I could go on and on. Tragically, these stories are all too common. As parliamentarians, we all have a responsibility and a duty to change that.
If a simple assault charge were a sufficient deterrent, this debate would be irrelevant, but clearly, the law is not a strong enough deterrent for increasing rates of violence being experienced by health care workers and first responders. That is why the IAFF has come out strongly in support of Bill C-321 in both the U.S. and Canada. That is the reason why the Canadian Association of Fire Chiefs, the Paramedic Association of Canada, the Ambulance Paramedics of British Columbia, the Association of Manitoba Fire Chiefs, the Saskatoon Paramedic Association, the BC Nurses’ Union, the Canadian Federation of Nurses Unions, the Union of Canadian Correctional Officers, the Peel Regional Paramedic Services, the Union of Safety and Justice Employees and many more have all lent their support for Bill C-321, as well as all members of Parliament from all parties.
The House of Commons made its view on Bill C-321 clear when it voted unanimously to pass it in February of this year, but that was not the first time this house made recommendations against the astounding levels of violence that health care workers and first responders face on a daily basis. In 2019, the Standing Committee on Health studied the pervasive physical, psychological and sexual violence experienced by health care workers. The report included the following recommendation: that the Government of Canada amend the Criminal Code to require a court to consider the fact that a victim of an assault of a health care sector worker to be an aggravating circumstance for the purpose of sentencing. Bill C-321 is a direct result of that strong recommendation.
Before I close out my remarks, I’d like to take a moment to thank all the health care workers and first responders who have taken the time to speak with me and send me their stories. I thank you for your service to our country and our communities. Please know that I see you, I hear you and I’m fighting for you. To the organizations and individuals who have lent their voice in support of Bill C-321, including my colleagues in the House of Commons, I thank you.
If we have learned anything over the past few years, it’s that the true heroes are the men and women who serve and protect our communities each and every day at a great cost to their own health and safety. Our nurses, paramedics, firefighters, correctional officers, public safety workers and more, keep us safe, healthy and alive. We should be doing everything in our power to ensure that they are able to perform their jobs safely. Everyone has the right to a safe and respectful work environment. Violence should never be part of the job description.
Lastly, Mr. Chair, honourable senators, I want to reiterate that this is not a partisan piece of legislation. The former Minister of Justice, David Lametti, wrote a letter in support of Bill C-321 and said in his letter of support that Bill C-321 had the full support of the government. The Liberal members of Parliament in second and third debates all said that this bill, Bill C-321, complemented and enhanced Bill C-3.
Our health care workers and responders are always there for us. They run into burning buildings. They hold our hand as our loved ones depart, they heal our broken bones, and they hold our hand as we take our final breath.
But who is there for them? It has to be us. It has to be this Parliament. We have to send a message to our silent sentinels that they matter. This had been a conversation that goes back years, as I said, five years. This is the furthest this bill has come in five years.
Senators, none of us have the benefit of having a crystal ball and knowing what future lies ahead of us. We all know there are a lot of rumours and a lot of talk going around this hill. This Parliament could be dissolved at any time. You have the power here today to send a message to the 126,000 firefighters, the 30,000 paramedics, the 450,000 nurses and the 20,000 correctional workers that they matter, that their lives matter.
With that, I’ll cede the floor, and I thank you for the time, Mr. Chair. I know I probably went over, so thank you.
The Chair: I think it was worth it for us. Thanks very much, Mr. Doherty. We will now invite senators to pose questions to our witness, beginning with Senator Batters who is the deputy chair of the committee.
Senator Batters: Thank you, Mr. Doherty, for being here today.
It’s Mental Illness Awareness Week and World Mental Health Day as you’re very well aware, and I wanted to start by thanking you from the bottom of my heart for all the tireless work that you did to make the three-digit national suicide prevention hotline a reality, 988. Now all someone needs to do to get help is to call that number, 988, and I know that no doubt many of the first responders and health care professionals that you’re helping with this Bill C-321 are probably also going to be helped because of the 988 help line, so thank you.
Dealing specifically with this bill, what you’re seeking to have here is to have this be an aggravating factor in sentencing like what has been done for police officers and other professions for quite some time. First responders and health care professionals also put themselves in a very vulnerable position, similar to that of a police officer, when they are trying to help people.
Given that it is World Mental Health Day today, I’m wondering about that in particular. In your discussions with nurses and paramedics and firefighters, what psychological and emotional impacts have you observed as a result of these assaults, how does that affect their ability to continue performing their duties, and what’s being done to support them after those types of incidents?
Mr. Doherty: That’s a great question. As you can tell, I get emotional. I was elected in 2015 and immediately started my work on Bill C-211, which was the national framework on post‑traumatic stress disorder for first responders, veterans and the military. The stories we heard then and the stories we continue to hear today — some that you’ll hear after me as well — are absolutely horrifying. It’s heavy. It’s weighty.
You have a nurse that might be all of about 110 pounds relay the story of being repeatedly thrown to the ground and kicked or when you have a firefighter or a paramedic that has to wear a bulletproof vest just to do their job, yet they still get up every day. They put their boots and uniform on, and they go out to serve your family and my family despite knowing that they are going to experience people at their worst and hear, see and smell some of the most horrific things. Those experiences stay with you for a lifetime. You can’t just turn that off.
Sadly, what happens is if they are assaulted or they experience violence, they are told, far too often, that the justice tools in place carry very little weight. There’s very little deterrent. This bill would allow us and those organizations to say violence is not a part of our job description and it’s against the law. They can’t say that today, and so I appreciate the question. I know that you will hear more of that, and it’s probably far better for those stories to come out of the mouths of the people that experience it every day, far more impactful than just hearing it from me.
Senator Batters: Thank you. Obviously, it is against the law. However, it’s not that aggravating factor in sentencing to potentially give the judge another tool to show the severity of the action that they take in assaulting someone who is in such a vulnerable position, which we ask them to do to help people.
You were mentioning previously that violence against first responders and health care professionals has intensified in recent years. What do you think the main factors are that have led to that increase? Is that something that affects everywhere in Canada equally, or are there places that impacts more?
Mr. Doherty: That’s a great question. What we’re hearing from the organizations and the associations that are on the ground, it’s the increased rates of drug use, increased rates of crime, the general frustration and anger that’s out there in our communities, and it’s being taken out on those who wear uniforms to protect and serve our country.
Senator Batters: Being from Saskatchewan, we have excellent firefighters and first responders that we have often had the opportunity to meet with as part of our regional caucus and that sort of thing. We’re hearing there are so many situations where firefighters and first responders — but firefighters in particular — are often the people who get to an overdose situation first.
Mr. Doherty: Yes.
Senator Batters: Is that part of what has intensified things, just how much scarier those situations have gotten to be in the last several years?
Mr. Doherty: The opioid crisis is a huge underlying factor that we have right now. I was talking with an ambulance attendant from B.C. last weekend, and a firefighter as well, and they are reporting to me that they are administering NARCAN to somebody who has overdosed, and that person is coming up swinging and they are angry. They are even angrier when later on in the day, as the very same person who has, perhaps, over dosed again, and the firefighter or ambulance attendant revives them again. When that patient gets to the hospital as well too, we are seeing the violence taken out on the nurses and doctors in the emergency room.
Senator Batters: Thank you very much.
The Chair: We went a little bit longer with Senator Batters, but mainly because she was asking excellent questions, questions I wanted to ask.
I will invite us to try and stay within about five minutes each so each senator has a good chance to have a dialogue with our witness.
Senator Prosper: Thank you, Mr. Doherty, for coming in, championing and being a leader on such an important issue. I really liked Senator Batters’ questions. In fact, I was thinking about those two areas as well.
I want to look at data in terms of tracking these incidents. You got into some of the shifting landscapes, opioids, things of that nature that might contribute.
Can you tell me a bit how data is tracked with respect to incidents? Within your opening statements, you provided quite a few statistics. From the data that exists, what are some of the things that just shine through for you that say, “Here it is, folks, you can’t avoid this.”
Mr. Doherty: That’s a great question. There are a couple great organizations that have started tracking the data. To be truthful, it really wasn’t tracked for a long time. It just was considered part of the job. Our paramedics, our firefighters, even our nurses are told that essentially it’s part of the job, saddle up, get over it, you got to go to the next call. Justin Mausz is a paramedic, and I believe was going to school to be a doctor as well too. I wish he was here at that time, but we do have his study. I don’t know whether it was provided to the committee, but we can provide it as part of the documents that looked at the prevalence and characteristics of violence against paramedics in his area.
The Canadian Federation of Nurses Unions also has a study that looked at the prevalence of violence against nurses as well. We have that study as well.
It is shocking the amount that we are hearing. The International Association of Fire Fighters who are here as well today to speak to you, they have their own data as well. The more that we talk about it, the more this has become an issue. It is being tracked, and those associations have that data for you.
Senator Prosper: Thank you for your answer. Are there any jurisdictions you know where this exists as an aggregating factor in sentencing that it actually deterred?
Mr. Doherty: I believe Canada would be among the first to pass or to add this to Canadian legislation or to the federal legislation. Canada could be a leader on this as well.
Senator Prosper: Okay, thank you.
The Chair: Thank you both.
Senator Dalphond: Welcome to the Senate. Thank you very much for raising this important issue and putting the focus on it.
My question is more technical. You have chosen to propose that we add a new clause, 269.0.2 to the Criminal Code, which is the one section of your bill. It deals with a person that is providing personal health services, among other things. We already have in the Criminal Code in section 700, the sentencing principle at section 718.2 of the Criminal Code, which indicates that in imposing a sentence, a judge must factor in many things, including subparagraph (a)(iii.2) which reads:
evidence that the offence was committed against a person who, in the performance of their duties and functions, was providing health services, including personal care services.
So, it seems that health services are already covered by the sentencing principles that apply to judges. Why do you think it has to be repeated at 269.02?
Mr. Doherty: Could you read that over again for me, please?
Senator Dalphond: Yes. One of the sentencing principles is whether the offence was committed against a person who, in the performance of their duties and functions, was providing health services, which are the words you use in your bill. I was wondering if there is a kind of redundancy here.
I understand it’s not applied for firefighters. Ambulance attendants are covered by that but firefighters are not. I was wondering why we have to have it twice.
Mr. Doherty: Senator Dalphond, there are far smarter people on this board and on this committee than I am. I believe you have seven lawyers on this committee.
Senator Dalphond: I’m sorry. I’m a former judge. I’m always asking technical questions.
Mr. Doherty: I really appreciate that.
We also add in our preamble where there are an increasing number of incidents involving violence against health care professionals and first responders, so to include that in there as well.
I probably didn’t answer your question appropriately, but clause 269.02:
When a court imposes a sentence for an offence referred to in paragraph 264.1(1)(a) or any of sections 266 to 269, it shall consider as an aggravating circumstance the fact that the victim of the offence was, at the time of the commission of the offence, a person who provides health services, including personal care services, or a first responder engaged in the performance of their duty.
Senator Dalphond: Thank you.
Senator Simons: Thank you for meeting with us, Mr. Doherty. I wanted to delve into that phrase, “including personal health services.” That encompasses a much wider range than just nurses, paramedics and firefighters. That would include than health care aides who are looking after seniors, registered massage therapists who might be sexually assaulted by patients. It would include, presumably, staff at an abortion clinic, who might be assaulted by pro-life activists. You talked with Senator Batters about the opioid crisis, but there is also a crisis that has gripped this country since COVID of health care deniers, people who have harassed doctors and nurses and harassed pharmacists providing vaccines. Those would all be encompassed?
Mr. Doherty: I believe that Bill C-3 captured that exact issue.
Senator Simons: For doctors, yes.
Mr. Doherty: For doctors, health care workers and nurses, I believe it is all captured in there, and Bill C-321 would further enhance that.
Minister Lametti, as well as the parliamentary secretary and Liberal MPs who spoke to it, have all commented that Bill C-321 only serves to enhance Bill C-3, which deals with protests, harassment and threats against those individuals.
Senator Simons: One of the challenges, I think, that the health care system faces is that many of these assaults are carried out by people who are suffering from mental illness or from dementia. In the example you gave of somebody coming out of an overdose from NARCAN and flailing, they probably couldn’t be found guilty of a crime, because they are not able to form criminal intent.
I know from my mother’s own time in a dementia care unit that many of the staff had been assaulted by dementia patients, whom you could never convict much less have aggravating circumstances. I appreciate the symbolism of this, but it seems to me that we have a crisis facing our health care workers, who are often very vulnerable to assault from people who cannot be held criminally responsible for their actions. I don’t know what we do about providing a safe workplace for people who are looking after people who can’t be held accountable.
Mr. Doherty: Senator, that is a great comment, and I think, again, that this legislation and other legislation, at the time of sentencing — as Senator Dalphond mentioned — it is at the will and the advisement of the judge at that time. The judge can take a look at that. If it’s not included in the Canadian legislation, then there is no opportunity to apply that.
I think it sends a stronger message to those who are put on the front lines every day that we are there to help them. We trust in our officials, our judges and our lawyers that they can use sound judgment when you have somebody standing before you, whether they were in the throes of a —
Senator Simons: Drug-induced psychosis.
Mr. Doherty: Yes, absolutely.
Senator Simons: I imagine that some of these assaults in emergency rooms are —
Mr. Doherty: I don’t disagree with you, but what we are trying to do today is to say, “What about the ones that are not?”
Senator Simons: Absolutely. If you are a home health aide, and you are giving home care, and you walk into a home, and you are assaulted by one of the householders, you should be protected — not just protected, but you should be given the same consideration, I think, as a paramedic that is assaulted.
Mr. Doherty: I agree.
Senator Simons: I guess the question is: Does the person have to be engaged in the performance of their duty, or if somebody is angry and tracks you down afterwards on your way to the car, would they be also encompassed?
Mr. Doherty: Bill C-3 and Bill C-321, they are the reason why.
Senator Simons: They work together.
Mr. Doherty: That’s why they work together, and that’s why the government saw this not as an either/or but a complementary piece of legislation and one that they agreed with.
Senator Simons: Thank you very much, and thank you for your efforts. Who knows what will happen with our timing, but I hope we can —
Mr. Doherty: The power is in your hands. I remain hopeful.
Senator Simons: I wish it were.
The Chair: We are not entirely sure of that.
Senator D. M. Wells: Mr. Doherty, I’ve known you for 10 years. Thank you for your exceptional work, your unending work and, sometimes, thankless work on behalf of Canada’s first responders and those who are not always appreciated as much as they are, so thank you for that and, particularly, for the work you have done on the suicide hotline.
My question is similar to what my colleague Senator Simons asked, and that is who is captured under that generally broad term of “first responders,” and could it include a good Samaritan who happens to be a nurse and sees her duty is required but is not an official first responder? Would that be included in the definition?
Mr. Doherty: My understanding is that it is.
Senator D. M. Wells: Is that your desire, because when this is challenged in court — and it could be — someone could say, “Well, she was not a first responder; she was simply a bystander with skills.”
A legal professional might look back at this committee and say, “Well, the intent of this was for that person to be included in that.”
Mr. Doherty: I appreciate your comment, Senator Wells, but just because a nurse doesn’t have their uniform on, or just because a doctor is not wearing a tag that says “doctor,” or a firefighter is not wearing their uniform, if an incident happens, and they respond, they are acting on behalf and with the knowledge of their skills and training. In my opinion, I believe they would still be considered a nurse, a doctor, a firefighter or a police officer, whether they are on duty or not. They are still responding to an incident that calls on their training.
Senator D. M. Wells: You would consider that to be in the performance of their duty —
Mr. Doherty: Absolutely.
Senator D. M. Wells: — even if they are a bystander walking home from the store?
Mr. Doherty: Yes.
Senator D. M. Wells: That’s all I had, chair.
I also want to say that I think you gave Senator Batters extra time because of the Saskatchewan bias.
The Chair: That happens a lot in this committee, Senator Wells.
Senator Pate: Thank you very much for your work, and as someone who has spent a lot of time trying to ensure that women and children, in particular, are protected in violent situations, which then led me to be working in prisons, because when they weren’t protected, and they acted to protect themselves, many of them ended up criminalized and imprisoned.
One of the things that has always struck me is that the first thing offered in these kinds of situations is criminal law and longer, more punitive sentences rather than the supports that many — including nurses and my neighbour, who is a paramedic, and others whom I have talked about this — and what they really need is the supports in situ, in the places where they work, to have others assist to bring down the temperature and assist when one is having a mental health crisis.
Unfortunately, the people who often get caught by these provisions are the ones who don’t have the lawyers or who don’t look as appealing to others, and the ones who can give an explanation for how they acted or have someone else advocate for them can avoid being criminalized and imprisoned.
That, for me, is always the dilemma with these types of pieces. It is not the desire to protect people. Absolutely not. We all live in the community. We want that. You have family members, as do many of us, who could potentially be directly impacted.
Mine is a broader question: How do we stop this continual push of going to the Criminal Code instead of really addressing the issues that need to be addressed, because we would have fewer of these concerns if we had the social, economic and health supports that most people need in the community?
Mr. Doherty: That’s a question that I’m not sure I have enough time to answer, and that’s a great question.
I’m going to go off script here, but I had Brianna MacDonald’s parents in Ottawa this week. She was a young girl who died in a homeless encampment. She was 13 and died of an overdose. They took their daughter to the hospital over 22 times from the age of 10 to 12 and pleaded with the system to keep her in there. I firmly believe that they were cast aside perhaps because they didn’t look at the way that the health care workers, or whomever was in there that made these decisions at that time, thought that they should.
The day before yesterday was the 16-year anniversary of the death of my First Nations brother-in-law who died by overdose. It was not investigated. It was a suspicious death. His phone was wiped clean, broken. He was left alone to die. There are so many stories like this. That’s the work we all have to do to try and change that.
I could not imagine working in a prison and seeing what you saw. I did social work for the first part of my life. I’m going to date myself, but back in the 1980s, I worked with at-risk youth and kids on the street in suicide and crisis intervention. We have to look within the First Nations communities and the challenges that we have with intergenerational trauma and trying to break the cycles. Far too often, when they turn for help, they are not getting it.
Obviously, my response to you is not an answer to your question, but it is something that’s out there, and it is something that we have to deal with as leaders, both in this house and in our house. This is a nonpartisan issue. We have to do everything we can to stem the violence against those serve our country and our community, which is why we are here today. We have to go further as well. I’m not sure that this legislation is that piece. I’m not sure you can accomplish that through legislation. I think that’s more of a general question. We, as a society, have to do better.
Senator Pate: My worry is that this looks easier to do than some of the other work. It allows some to avoid the hard work. There are some legislative possibilities —
Mr. Doherty: I’m sorry. I’m not disagreeing with you on that, but this bill is easy to do. We have gotten this to where we are today. I think the harder question is, how do we solve what you just brought up? I’m not sure we have the time either in this Parliament or the next Parliament to try to figure that out.
I think there has to be a stronger commitment from us as leaders, whether we are here in Ottawa or in our provincial capitals or in our communities, to figure out how we do that. It is something I strive to do in my region. I have one of the largest ridings in Canada. My wife and children are First Nations. We have to do better as leaders.
I try to walk the walk — I don’t know if that’s the right way to say it, but every moment that I’ve been in this house since I was elected, I’ve tried to lead by example. Are there times for partisan politics? Yes, there are, but we are here to try to enact change, and that’s what we are here trying to do. I appreciate your comment.
[Translation]
Senator Audette: I thank you for your presence and your involvement, and for what you do, of course, because it’s important. I’d also like to thank my colleagues for the questions they asked, on topics which are of concern to me.
First of all, if the federal government and the provincial and territorial governments implemented the calls for justice from the National Inquiry into Missing and Murdered Indigenous Women and Girls, it would affect all Canadians. In my opinion, there are a lot of solutions that come from a lot of people; we mustn’t forget that.
Will social workers — we call them nursing assistants in Quebec — and attendants also be protected? If so, I thank you.
Next, with regard more specifically to Indigenous women or Indigenous people in the territories and communities, do you have any data indicating that they, too, have been victims of aggression in the course of their duties from intoxicated, aggressive or unwell people?
In closing, do you feel comfortable continuing this process? Your work is a little gem, but in keeping with the overall holistic approach, no matter which party is in power, we must collectively depoliticize the issue; the systemic roots run deep. Thank you for your work.
[English]
Mr. Doherty: I appreciate your comments. Thank you.
My stripes don’t change. I am who I am, and I wear my heart on my sleeve. We have to do better as leaders right across the board, whoever you are — municipal, federal, provincial. The temperature has been turned up right now. We have to do everything in our power to bring it down. Whether it is this government or the next government, we have to work to bring people together and not divide them.
Again, to go to the previous question, why do we see the rates of violence against those who are wearing uniforms or those who just want to help us, heal our broken bones, fix our broken hearts and be there when we take our last breaths? For whatever reason, we have slid so far back in this society that it is okay to strike a nurse or to shoot or stab a paramedic or to be violent against police officers systemwide. We have to be better.
Again, I don’t have all the answers, but I just know that we have to carry ourselves differently.
Senator Clement: MP Doherty, thank you for running for office and being in office and for showing emotion here with this bill. I am a lawyer at a legal clinic with a focus on representing injured workers. Of course, this is of interest to me. I was also the mayor of the city where I live. Paramedics, first responders, police officers and firefighters were always beloved people in my community.
Mr. Doherty: Can I ask what community?
Senator Clement: Cornwall, Ontario. Any day I can mention Cornwall is a good day, so thank you for that.
Have you heard from other professionals? Senator Audette was getting at other workers. What about the teachers and non‑profit workers, some of whom go into those encampments to provide services? Have they been saying, what about us? When I represent my injured workers, the unionized ones are a little bit better protected. The non-unionized ones don’t have the same protections. Have you heard from your constituents or from those groups that say, can we get equal treatment under this bill?
Mr. Doherty: Again, that’s a great question. Again, with the scope of this bill, we have focused on first responders, health care workers and social workers. Do we hear about violence in the workplace? Yes, we do, but for the most part, I think the Criminal Code has protected them in that sense.
No one has asked to be included in this aside those that are mentioned in the bill. We were targeted in what we were doing, trying to make it more about those who are serving our communities, whether in the hospitals or on the streets.
It is a great question, and perhaps, that is something I can work on in my next piece of legislation.
Senator Clement: Part of the reason I was asking is because I have an issue with how we are amending the Criminal Code bit by bit and drip by drip. It is part of a larger issue I have with how we are proceeding. I’m not questioning why you are doing this. The genuine feeling is there, but I have a bit of an issue.
I endorse the questions around data from Senator Prosper, but Senator Batters and Senator Pate asked you about the why. Why this increase in attacks? Do you have conversations with your constituents around bigger programs, like poverty reduction, like homelessness?
Mr. Doherty: Yes.
Senator Clement: Where do we go as a society? I think that’s where we go; we should be making those investments. Do you have those conversations? Does your government prioritize those things —
Mr. Doherty: One hundred per cent.
Senator Clement: Sorry, your caucus. Wow. Sorry about that.
Mr. Doherty: I appreciate that. Thank you.
Senator Clement: Stop smiling, Senator Batters.
MP Doherty, sorry about that.
Mr. Doherty: If you have heard our leader speak, he talks about making life more affordable for Canadians, to turn the hurt into hope. Those aren’t just slogans. I know it sounds like a slogan, but it’s true. We are inundated with Canadians who are hurting, who are feeling the pinch, who are $200 away from being bankrupt at the end of every month. There are 2 million Canadians who use food banks each month. We have to do everything in our power to try to turn that around, to bring that back. How do we do it? It’s a lofty question for whomever forms the next government. Obviously, I have my hopes, but to keep this nonpartisan —
Senator Clement: Of course.
Mr. Doherty: That’s a great question. There is more hurt, more hope. You can’t look even outside the doors of this building without seeing people who are struggling, more and more Canadians. It’s affecting everyone.
I just shared the stories about my brother-in-law and Brianna MacDonald. She was 13 years old, found in a homeless encampment. She died from an overdose. All ages, all walks of life, are affected. Our communities have been turned into war zones. I ask all senators who are here today — and this is off‑topic, but I love the conversation. Does Cornwall look like it did when you were the mayor? It has changed; it really has. It’s not just a slogan from our leader or others; it is real. The hurt is real.
Senator Clement: Thank you.
Senator Ross: Thank you, Mr. Doherty. When I was asked to come to this committee today, I was learning about your bill. It brought to mind a terrible assault that happened in 2019 in New Brunswick. A nurse manager was cornered in her office and attacked by the husband of a patient who wanted his wife moved to a quieter room. She was pulled from her chair by her hair, punched in the temple and thrown against a wall and so on. Another nurse who tried to intervene was also assaulted.
This nurse manager says that her life has forever changed from that 11-minute attack. She has brain injury, daily chronic pain, post-traumatic stress disorder, or PTSD, and major depressive order. The person who assaulted her was found guilty in 2020 of two criminal charges of assault and sentenced to six months in jail. I am really interested in getting a sense of the impact that this bill would have had on that sentence.
Mr. Doherty: That’s a great question. I would leave that to the lawyers who are here today to reply. I am not a lawyer; I cannot tell you. Again, the bill mentions that the judge can use it as an aggravating circumstance at sentencing, to perhaps give a heftier sentence, depending on the circumstances.
Perhaps, if Bill C-321 were law at that time, or if violence against a health care worker or first responders was in place in the law at that time, it may have been a deterrent. What would have stopped that person? How do we stop that person from doing that? Hindsight is always 20/20, so I can’t answer that question for you because I don’t have the answer to that.
[Translation]
Senator Oudar: First of all, I’d like to apologize for being late. Today is World Mental Health Day and I had a commitment as part of this event. I’m sure you all share my concerns about mental health. I’ve spent the last eight years of my life working in health and safety. So I salute your work because, indeed, the statistics we have in Quebec, especially in the wake of the pandemic, are truly worrying. The organization of which I was CEO also dealt with compensation. When we calculate the number of work-related injuries, we cross-reference them with acts committed against health care workers, and this confirms exactly the picture you’ve painted. Assaults, especially post‑pandemic, are unfortunately on the rise: We’re talking about a 73% increase in occupational injuries caused by physical violence, and a 67% increase in those caused by psychological violence.
On this World Mental Health Day, then, I wonder why we’ve stuck to assault only in the bill. When we look at the type of acts committed in relation to the statistics I’ve given you, of course we’re talking about assaults, threats with a weapon, pushing, pinching and hitting, but also sexual assaults and, in 65% of cases, psychological violence. In Quebec, the Act respecting occupational health and safety has just been amended to add the same obligation for employers with regard to psychological violence. Whether the violence is physical or psychological, health and safety obligations must remain the same.
So I wonder why the bill was limited to assault, especially since it talks about psychological health in the preamble. When I read the preamble, I thought we were moving towards something that targeted a person’s overall health, but I see in the article that it only targets assault, or at least physical violence.
I’ll have another question about worker categories later, time permitting. For the time being, I’d like to have an answer regarding psychological health.
Thank you again for the work you do.
[English]
Mr. Doherty: Again, I’m not a legal expert. When I presented this to the Library of Parliament and their legal team, specifically with the word “assaults,” they felt it was the language that would best serve and would capture that, whether physical, verbal or sexual and what have you. I don’t know if I answered your question.
[Translation]
Senator Oudar: You understand that an assault is a physical assault, whereas in another act that includes everything I listed for you, there is psychological violence that is not generated by a physical blow, but by a psychological act. This can be psychological harassment, verbal threats or denigration. It’s very common. As I was saying, we’re talking about a 65% increase in psychological injuries, and half of them involve health care workers. So we’re dealing with something real. I understand your comment that there are assaults that cause post-traumatic shock, but some of the acts that are committed are not assaults, but cause the same injury that is not apparent; there are no bruises or blood, but there is a significant psychological injury.
[English]
Mr. Doherty: I fully understand your comment. Senator Ross mentioned a very traumatic incident in 2019. I have spoken with them, and I am very well aware of that one.
The paramedics we’ve talked to who are in the back of an ambulance are verbally assaulted and threatened, and that strikes fear with them. These are the things that we hear all the time. They have asked for Bill C-321 to be there. They believe it will be a deterrent.
Again, I’m not a legal expert. I’m going on the advice of what we’ve been told, both by the Library of Parliament and by the legal teams that have looked at this, that this is the appropriate wording for this amendment. The former Minister of Justice, David Lametti, also said that this bill, Bill C-321, would complement their Bill C-3 that dealt with the harassment, the threats and the intimidation that these health care workers and first responders would face.
The Chair: I will assert the liberty of the chair and not move to a second round. We have nearly expired our time, but I do have a couple of questions myself, Mr. Doherty.
Let me say at the beginning that I support the direction of the bill and the objectives that you’re seeking to achieve and won’t intend to suggest what one might think of as amendments, but I do want to ask a couple of technical questions along the lines that Senator Dalphond asked.
In 2015, some additional provisions were built into the Criminal Code to try to achieve the same goals for public transit operators, in fact, almost identical language, and perhaps you or those who assisted you borrowed from that language.
Mr. Doherty: Right.
The Chair: Included in that was a definition of public transit operators so that it would be clear. I guess I’m a little worried that the phrase “first responders” is understood in the culture — I think I have a sense of it. You probably do too — but it’s a bit vaguer than one would normally expect. So my first question is whether you have considered a definition of first responder so that we would have a precise understanding of the boundaries. That’s my first question.
The second one, not dissimilar — and here I’m now looking at the actual provision in the bill — the bill says that aggravating circumstances will apply to a victim of the offence who was:
. . . at the time of the commission of the offence, a person who provides health services, including personal care services, or a first responder engaged in the performance of their duty.
I guess here is my point. The way it’s structured, it appears to suggest that aggravating circumstances for sentencing will apply to first responders engaged in the performance of their duty; but the other category, which is the people providing personal health services, doesn’t say anything about it having to be in the performance of their duty. So if I’m a nurse and I get assaulted, in theory at least, if I’m just walking down the street on the way to the movies, I might fit in the category of someone who provides personal health services.
I’m a bit worried. I know you probably did not draft it word for word, but I’m a little bit nervous that the structure of it is not quite as precise as one might hope. We have enough trouble with the Criminal Code as it is and the amendments that come our way and trying to get them exactly right because these are sort of liberty-constraining provisions. They are important provisions. What you have in mind I’m supportive of, but I’m nervous that we haven’t quite got it right in the language. Can you comment on that?
Mr. Doherty: On the first responder, our understanding was using “first responder” captures all the professions — firefighters, paramedics, correctional officers, and what have you. We have dealt with that term in other pieces of legislation. Perhaps we should have had that in there, I guess.
In terms of duty, I think it can be said that whether you are on a shift or off shift, if you are a paramedic, if you’re a firefighter or a police officer, you’re always on duty 24 hours a day. You will respond accordingly, and I think that’s where we went with that.
The Chair: Thanks.
Mr. Doherty: It’s probably not the answer you’re looking for.
The Chair: I don’t think we’ll have a second round for anyone, including the chair.
Senator Simons: I think it’s clearer in the French where there’s an “and.”
The Chair: We will maybe study that independently. Thanks, Senator Simons. That’s a useful point.
We will bring this portion of our hearing to a close. Let me begin by thanking Member of Parliament, Todd Doherty, for joining us, providing a thoughtful presentation and openly, candidly and helpfully fielding our questions.
I would thank senators for their engagement in this important and difficult question and the work that he’s brought us to currently.
For our second panel, we’re pleased to welcome from the International Association of Fire Fighters, Paul Hills, President, Saskatoon Paramedic Association, whom we welcome for more reasons than just his testimony today.
Secondly, from the Ontario Nurses’ Association, Erin Ariss, Registered Nurse, Provincial President, and Andrea Kay, Registered Nurse, Chief Executive Officer.
Welcome and thank you for joining us today in person. We’re going to begin by inviting you to provide opening remarks, and then we will move to questions and conversation with the senators.
You’ll have roughly five minutes each, and we will begin with Mr. Hills. The floor is yours, Mr. Hills.
Paul Hills, President, Saskatoon Paramedic Association, International Association of Fire Fighters: Thank you very much. I’m not a prepared speech kind of guy, so I will try to avoid reading as much as I can.
I also wanted to thank Todd Doherty for his kind words and for saying more than even I can cover. I just want to thank him for his time.
I also want to thank my wife for coming and supporting me during this. She’s been with me for my whole career and has seen me come home with a lot of this stuff and heard the stories. I want to thank her.
Thank you, Mr. Chair and honourable senators.
Good afternoon. I’m pleased to join you today to speak in support of Bill C-321. I am the President of the Saskatoon Paramedic Association, which is part of the International Association of Fire Fighters, or IAFF, local 3270. I acknowledge that our members reside on Treaty 6 territory and homeland of the Métis. I’ve had the privilege of serving there as a paramedic for 25 years, and I’ve been a passionate advocate for my profession for 18 of those years.
Serving in one of the busiest emergency medical services, or EMS, cities per capita in Canada, I’ve supported those around me and personally experienced the increasing violence that public safety personnel, such as paramedics and firefighters, face every shift, 24/7 and 365 days a year in that line of duty.
A day in the life of a paramedic is physically, mentally and emotionally demanding. We often work entire shifts without breaks, with little to no time off after bad calls or to catch our breath and no time for even a simple meal, all while responding to emergencies in some of the most heart-wrenching situations that society presents.
Early on in my career, it was never like this. When I began my career, we never needed bulletproof vests, yet society has changed, and in Saskatoon, paramedics have been wearing them for over 15 years. This is not equipment that we should need, yet it has become essential for our safety as violence against public safety personnel rises exponentially.
On behalf of over 29,000 paramedics and firefighters across Canada who belong to the IAFF, we strongly support Bill C-321. For over a decade, I’ve personally been coming to the hill advocating for this legislation. It proposes tougher penalties for those who commit violence against public safety personnel and health care workers. The Criminal Code already recognizes the importance of protecting peace officers, which includes K9 and transit operators but that’s it.
Like law enforcement, we face violence regularly while serving the public, often at their or even our most vulnerable moments. This is the time to extend those same protections to paramedics and firefighters along with our allied professions.
The examples of violence are countless and increasing, as I said, exponentially. In Saskatoon alone, we’ve had ambulance windows smashed while paramedics were attending to patients inside. Medics have been attacked with weapons. This year, an ambulance was stolen with two medics working inside on patients. One person was tossed around inside the vehicle, and both medics sustained injuries resulting in time away from work.
I have had my life, and my family’s lives threatened too many times to count. To go off script a little bit, this is one of those things where I don’t have the ability to have anonymity in my job. Any person can find out which attendant was at their call. I’m in the phone book. I’m down the street, and gang members, rival gang members, they can find me. They track me from work. They know where my family lives and where my kids go to school. That’s the kind of thing that really hits home when you get told that in the back of your ambulance. We’ve had bats, machetes and knives pulled on us and removed guns from patients all while trying to provide care.
This problem isn’t limited to Saskatoon. It’s a national issue. There are stories from across Canada, as Mr. Doherty has told us about, including firefighters being attacked with piping while extinguishing a fire at an encampment or a firefighter stabbed in the back while responding to a medical call. Medics often face violent outbursts from patients they’ve just saved. That’s patients and their family members as well.
Statistics back this up. There are internal surveys from the IAFF and from other organizations such as the Peel Region that are gathering and tracking the data in order to further back our claims.
These violent incidents not only cause physical harm but also leave lasting psychological scars. In Montréal, a firefighter who was chased by a man with a knife has been on long-term disability for over 10 years due to the trauma that he endured. Violence like this is real, and it’s happening right now across our country. Paramedics and firefighters are being assaulted simply for being there and doing their jobs serving the public in moments of crisis.
All these types of violent acts and many more incidents cross over from our professional lives to our personal lives far too often. It’s another form of erosion on these heroes that they don’t deserve.
While we understand that societal issues such as mental health and addictions contribute to this violence, immediate action is still necessary. Bill C-321 provides an essential tool to possibly deter these acts, but more importantly, it holds perpetrators accountable and possibly gives closure to those who are victims.
By showing that decision makers see and value the work of paramedics, firefighters and other allied professions do, this bill sends a clear message that we deserve protection and care for the critical and dangerous roles we assume every day on the front lines.
We need to use these tools to be available to address the violence and to support those who support our communities. Bill C-321 is a critical step in that direction, and it expands on Bill C-3. It won’t solve every issue, but it represents progress and a commitment to protecting the helpers.
Please work to pass this piece of legislation as soon as possible. Consider it your way of issuing us a legislative Kevlar vest. I thank you for your time, and I’m open to any questions.
The Chair: Thank you, Mr. Hills.
Erin Ariss, Registered Nurse, Provincial President, Ontario Nurses’ Association: Good afternoon, everyone. Thank you for the opportunity to speak with you today. My name is Erin Ariss. I’m a registered nurse, and I’m the president of the Ontario Nurses’ Association, or ONA. I’m joined today by Andrea Kay who is ONA’s chief executive officer and also a registered nurse.
ONA represents over 68,000 nurses and health care professionals in Ontario, and we represent 18,000 nursing student affiliates who are the future of health care in Ontario. On behalf of Ontario’s nurses, I am proud to speak in support of Bill C-321. All orders of government must do more to protect nurses, health care workers and first responders from violence and abuse.
Bill C-321 complements Bill C-3, which amended the Criminal Code to make it an offence to harass or intimidate health care workers. Now Bill C-321 proposes to expand protections to include first responders, and we support these changes to the Criminal Code.
As nurses and health care workers, we are subject to violence and abuse every single day, and it is on the rise. We provide care when someone is in crisis, yet the existing measures in place do not take care of us.
We are on the front lines in the hospitals, nursing homes, clinics and in our communities. When we work in teams, we are most often understaffed. When we work alone, such as in home care, there is no one else around, no one to call on when a situation becomes unsafe. As nurses, we are assaulted, pushed, spat on, sworn at and experience intentional needle-stick injuries.
I worked on the front line as a nurse in an emergency department for 20 years, and while I worked at the bedside, I’ve been assaulted too many times to mention. I had my hand broken by a patient. I’ve been threatened with a gun, a machete, box cutters, knives, and assaulted with the equipment that we use to provide care. I was kicked in the abdomen when I was eight months pregnant with my son.
My experience as a front-line nurse is the reality of health care workers today. The statistics speak for themselves. Nine out of ten nurses experienced physical, verbal or psychological abuse in the last year. Eight out of ten nurses experienced bullying from patients in the last year. Nine in ten nurses report feeling burnout, and this is up since 2023.
While violence and intimidation are not new, it increased during the pandemic. Years of violence, harassment and unsafe working conditions have taken a toll on the nursing workforce. In the past five years, nurse vacancies in Canada increased by 147%. More and more, nurses are leaving our profession, and as a result, we see unprecedented wait times and hospital closures. But we are here today because we refuse to accept that violence is an inherent part of our job.
The passing of Bill C-321 is a step toward progress, but we need these changes to be publicized and enforced for it to be a deterrent and to reduce violence in our profession.
We urgently need more preventative measures that protect nurses and health care workers. We need to see measures that address the magnitude of this issue and the impact that nurse and health care worker burnout has on patient care.
Preventative measures that improve safety and reduce burnout include staffing ratios. We reiterate the call from the Canadian Federation of Nurses Unions for the federal government to develop a pan-Canadian framework to prevent violence in health care settings. No nurse, health care worker or first responder should be unsafe at their workplace or while performing duties.
Bill C-321 takes us a step closer to where we need to go. We urge all senators to support this bill and fight for the safety of nurses, health care workers and first responders.
Thank you.
The Chair: Thank you, Ms. Ariss.
I will now invite senators to pose questions and engage you in conversation, beginning with Senator Batters.
Senator Batters: Thank you to all of you for being here and for the work you do every day to keep people safe and healthy.
Mr. Hills is from Saskatchewan. It’s great to see you here. Thank you for making the trip and for everything you do so importantly on these issues that affect all those in your profession and first responders in general. You’re a frequent and very strong advocate for these types of issues. Thank you for that.
I was just looking at the wording of both the Bill C-3 provision that came into effect a couple of years ago, I think, and this provision, and one thing that I see, as you say, Ms. Ariss, is it complements Bill C-3. I see that as well, because the new section that’s proposed under this private member’s bill would apply to health care professionals and first responders engaged in the performance of their duty, even when they are not providing health or emergency services, because the Bill C-3 provision limited it. It had to be an offence committed against a person who was providing health services at the time. So that expands that protection, a little more.
Mr. Hills, could you tell us about the frequency of assaults that firefighters and paramedics face during their interventions? Do you also agree, as Ms. Ariss was just referring to, that she sees this as an increasing problem? If so, what do you think the main causes of that are?
Mr. Hills: I appreciate the questions. If I may, just before I answer that question, there has been a lot of talk about the definitions of this. In some of our work that we were doing, we did some digging behind, and the Public Health Association of Canada, I believe, has actually defined very clearly health care workers and public safety personnel/first responders in some of their codes in regard to the PTSD framework, so those definitions are clearly laid out. That might help some of you as far as your parameters that you’re seeing in this bill, if it’s going too far or not far enough. I just wanted to offer that when you’re speaking to that.
Senator Batters: Thank you.
Mr. Hills: As far as how often now, the easiest way I can put it is early on in my career, I would walk into houses and deal with patients and families and, more often than not, getting hugs. Now when I walk into a house or walk into a scene or even seeing an emerge, it’s more often I might end up in a headlock or dealing with that than getting hugs.
I know that sounds kind of trite, but it’s the truth. I’m a fairly large man, and when I go in there, just my size alone deters a lot of situations, but it still doesn’t stop it. When we have people of all shapes, sizes, colours, ethnicity and everything like that working on our front lines; there’s no discrimination now. Violence is happening on a daily basis. It is verbal; it is physical; it is pushing; it is intimidation; it is kicking; it is punching; it is stealing ambulances; it is threatening with weapons. It’s all of the above. I have never seen it like I have now.
As far as where this is coming from, again, as simply as I can put it, society isn’t as kind as it used to be. There just is a general lack of kindness and civility. There’s a lack of respect for those in situations like uniforms or authority and a lot of pushback in those areas.
That is what I’ve seen. That’s what I’ve felt. That’s what I’ve experienced. I don’t know how we get back to a better place, but I think acknowledging that that is a root cause of what’s going on and just the general lack of kindness and calling it what it is. Looking for more hugs and fewer headlocks, honestly, that’s really what it comes down to.
Senator Batters: Thank you very much. And also to point out that this new section that would be proposed in this bill, it also applies not only to assaults but to the offences of uttering threats to cause death or bodily harm to any person. So that is included in it. Any type of assault, including aggravated assault, and also unlawfully causing bodily harm. So that’s sort of the parameters of it as well. And no doubt economic impacts, as what we’re seeing right now. Life is tough for a lot of people, so that impacts as well.
Mr. Hills, how do you see violence affecting the morale of your members? It’s Mental Illness Awareness Week. It’s World Mental Health Day today. Have you observed an increase in early departures or recruitment difficulties due to that violence? Is that a problem that you see just in Saskatoon or is it a trend that you see across Canada when you talk to your colleagues?
Mr. Hills: I think Ms. Ariss spoke to it quite well. As far as recruitment and retention, talking about the violence is getting a lot of airtime these days. We talk about PTSD. We talk about other ways that our job is eroding us as human beings.
I was never prepared to be a paramedic. I am not the same person that I was when I started 25 years ago. There’s a piece of your soul that’s taken from you doing these types of jobs. And now when you factor in the unsafe environment that we work in, where there’s legitimately weapons pulled on us, physical acts, mental attacks, verbal attacks, it does wear you down.
I can’t speak specifically to a person’s decision that might be, “Hey, I want to be a firefighter, paramedic, and serve my community,” versus it’s probably safer to go flip burgers at McDonald’s.
Honestly, right now the state of health care — and this is the first time I’ll ever say this publicly — I would recommend that people go into any profession other than health care right now just because how terrible it is. That’s a terrible thing for me to say, because I need more people to come into our profession to help us, but it’s a double-edged sword right now. I’m asking you to put yourself on the line physically, mentally, emotionally, spiritually, and to take a piece of yourself and hand it over for the rest of your career.
I can’t quantify the level that it’s impacting, but it is definitely now, more than ever, a big piece of the reason that we’re losing people and not getting people.
Senator Batters: That’s so sad. Thank you.
Senator Prosper: Thank you to all of you for the service you provide. I just want to get some clarity, because what you mention is that violence is not an inherent part of your job.
I remember when I was a chief in my community. I lived in the community, and I would see ambulances and paramedics going up the reserve all the time.
I am curious. Can you walk me through — in both of your professions — some of the thinking you have to go through. Do you have that discretion to refuse service, and if you don’t, what are the steps you are going through in your mind for your personal safety?
Because what I am getting is that the resources are not there, obviously, if you are in home care or if you are out on a call. Could you help me in that regard and walk me through that a bit?
Ms. Ariss: Registered nurses have a regulatory body and professional college, and we have standards that we must meet. One of the standards is a therapeutic relationship, and we are required to provide care. If we don’t care for our patients or residents or clients, depending on the setting, that could be considered patient abandonment and could result in a suspension of our licence to practise.
That is always hanging over our head, and we are taught — it is pervasive within health care but also in school — that you put yourself second, that you care for your patient, no matter what.
The other thing that you will find across all sectors of health care, and particularly for nurses, is that if you are assaulted, or subjected to violence, quite often you are made to feel as if it was something that you didn’t do. You are blamed for the violence or the assault and that it was a delay in care, or it was something that you missed, and, therefore, it is your fault as the nurse.
Senator Prosper: It reminds me of the saying that the client is always right.
Ms. Ariss: Yes.
Mr. Hills: If I may, one of the areas that we focus on a lot is the troubled patient, the drug situation and coming out of things. But we run into situations where people call and say, “My back hurts,” and we get there, and that person — for whatever reason — or a family member or a friend in the house is the one who now creates a problem for us.
We don’t know what the situation is. As far as refusing dangerous situations, there are times where we know there might be a weapon at the scene or an active shooter. A shooting happens, and we will stage for police, and the police get there and clear the scene. It still doesn’t mean it is completely safe, but there is some inherent safety there.
However, when I go into a house with a person who calls for back pain, and I get there, and they have a nine millimetre in the chair beside them or a knife on them or knives in their backpack, that’s something I can’t foresee. Then my mind goes to what am I doing to not only care for this person, but how do I maybe exit this situation safely?
I often tell the story to my students and new paramedics about the movie Patch Adams with Robin Williams. People go into a person’s house to render help or care and to have a conversation. That situation, obviously, turns south, and there is an incident there that is very violent and unfortunate.
That is what happens to us. It is not the situation, necessarily, of the drugs and coming out from an overdose. We understand those situations. If someone punches me in that situation, it happens.
But if I go into a house, and I am rendering care because of a back issue, and all of a sudden I get punched in the face or kicked because someone else doesn’t like me there, that’s where the line is crossed and things are unacceptable.
It is such an unforeseen world out there that we walk into. We really don’t know what kind of call is going to happen and how things are going to unfold each time. It is a level of concern that you always have in the back of your mind.
Senator Prosper: Thank you.
Senator Dalphond: Welcome to the Senate. My preferred uncle was a fireman. I always wanted to be a fireman. I have been an assistant nurse for six years in a hospital, so I like you all. I can tell you that. You are my stars.
When I was in the hospital, and I was lying in the emergency ward for a day or two, I saw a nurse being punched in the face by a patient right in front of me, so I know the climate is difficult, but do we have statistics and data about it? For example, do the first responders call the police when they are threatened or, even more so, when they are attacked? The same question about nurses? Is there a way that you have — either of your organizations — some data about the number of cases we have and the increases in cases?
Mr. Hills: Ms. Ariss will probably answer a bit better than I can.
The front line answer is that we are very humble people who do this work, and we don’t often report these things. We do and have come to the point where some of this is, supposedly, part of our job, because there have been situations where we’ve been turned away by the legal side, by Crown prosecutors saying, “It is part of your job. You getting pushed down the stairs, it’s not really a big deal.” That person had this, or that person had that.
I would say that that has caused an issue where there is under‑reporting and a lack of self-reporting, because we are just accepting of those situations. I think there are organizations that are taking a line and saying that enough is enough and that we still need to track these things.
Ms. Ariss: We certainly have a lot of data. The problem is, as Mr. Hills mentioned, it is under-reported.
When I answered Senator Prosper earlier, nurses do not want to report this, for the most part, because of the stigma, because of the blame that they face and because of the risk that they face by reporting it.
I can give you a very quick story of when I was a young nurse, and a patient, who could easily have fit in this room, whom would be unremarkable among us, said to me, basically, “I will kill you and your two beautiful children, who I noticed are out in the car waiting for you after your shifts every day.” I tried to report that, but nothing was done, senator. Nothing occurred until that same person threatened a human resources vice‑president in our hospital, and then something was done and action was taken.
My story is not unique to me, though. That is the story of nurses across the country.
Senator Dalphond: That brings me to another question. We amended the Criminal Code sentencing principles to include, a few years ago, as an aggravating factor in sentencing the fact that the person was providing health services. Are you aware if there have been more charges after that as a result of this indication of the seriousness with which Parliament considers the threatening or attacking of health services people?
Have you noticed a change, or has nothing happened?
Ms. Ariss: I can tell you that in order for it to be enforced, it needs to be publicized. Canadians are not aware of it. That is the first part of it.
The second part is the fact that nurses are willing to take action and file charges, but to be perfectly frank, they are being dissuaded from doing so. They are being told across Ontario that this is part of your job and to just let it go.
Senator Dalphond: Which it is not. I agree with you. Thank you.
Senator Simons: That is exactly where I wanted to pick up. Thank you to Senator Dalphond and everyone.
Mr. Hills, you said you were hoping this legislation would be like a legislative Kevlar vest. I would like to wrap all of you up in Kevlar, but the problem is that this legislation only comes into force at sentencing. First, somebody has to be arrested; prosecuted; found guilty; and then, at sentencing, this would be an aggravating circumstance. It sounds as if it won’t be very useful if the prosecutions aren’t happening in the first place.
Ms. Ariss, you listed a litany of assaults to which you personally have been a victim. Did any of them result in an arrest or a conviction?
Ms. Ariss: None.
Senator Simons: Mr. Hills, when you talk about going to help one gang member and three other gang members then follow you home. Paramedics work closely with the police. Do you get any kind of police protection? Is there any kind of response when that happens?
Mr. Hills: No, we’re a small enough community that we just take it as part of the job.
If I may expand upon your comment, what I learned with the transit changes to the Criminal Code — when transit operators got adopted in 2015 — they were recently on the Hill because they have had very limited to no prosecutions because of a lack of public acknowledgement and display or a sharing of the legislation.
We were told quite clearly — I will be bold and say that, when or if this passes, we need education as the next thing. It needs to move from this room out to the public forum to educate police, lawyers and judges that this is a new piece of legislation that offers us protection. We need to introduce it to our members so they need to know to push for this and advocate for the change that has happened to be enacted. It will take that first person, second person and third person to come along, then maybe we will see more prosecutions.
Again, this is not to put more people in jail. This is not to have that big book of defence, the Criminal Code, that is a deterrent already for so many things. This is about closure. This is about support. This is about offering to Ms. Ariss the understanding that, when her hand was broken, the person will be held accountable. The gentleman who went to jail for six months — unacceptable. You will be in time out longer than that.
Senator Simons: This is for Ms. Ariss and Ms. Kay. What percentage of patients — I guess not all assaults come from patients; some might come from a family member in the ER who is angry that their family member is not being triaged as they would like. But I would imagine that a good number of these assaults are carried out by patients who are not compos mentis — who could never be held criminally liable, because they are in a drug-induced psychotic state, a regular psychotic state, are suffering from dementia or are on the autism spectrum and are lashing out.
To what extent do you think — I don’t know if you can quantify it when you are doing your data — how many are mens rea criminal assaults versus things for which you deserve every protection and all the support of your union and your management but which are not prosecutable?
Ms. Ariss: Mens rea criminal assaults happen daily in all sectors of health care.
Senator Simons: But this is not just my mom with dementia biting a nurse.
Ms. Ariss: I think that would be a misnomer. I would be telling an untruth if I said to you that it is only folks suffering from addictions, dementia or whatever it may be. That would be factually untrue, yes.
Senator Simons: Okay. But you could not say two thirds — one third? Is there data, or is it just, anecdotally, that you observe —
Ms. Ariss: Anecdotally, I think we could get some data for senators.
Senator Simons: I don’t know if that would help us in time for this, but I would be very curious to know for future public policy. Thank you very much.
Ms. Ariss: Yes.
Senator Simons: Thank you very much for all of your service.
[Translation]
Senator Oudar: First of all, thank you for your work and thank you for being here, Ms. Ariss, Ms. Kay and Mr. Hills.
In Quebec, the commission I headed, the Commission des normes, de l’équité, de la santé et de la sécurité du travail (CNESST), publishes statistics, which I mentioned earlier. They show the same things, and the figures paint the same picture as you mentioned. There has been a meteoric rise in physical and psychological violence, particularly against front line workers in health care, paramedical, police, ambulance and other services. I don’t understand why.
You mentioned earlier that when the incident was part of the job, it wasn’t reported. In Quebec, it’s the other way around: if it’s part of the job, it’s an employment injury that must be compensated by the board.
We’ve done a lot of work with people on the front line. My question is for Mr. Hills. Although I’ve spent my life defending women’s rights, it’s incredible how difficult it was to get men to talk. Firefighters, police officers, paramedics, we couldn’t get them to talk and express themselves. That’s the first step to healing, and it’s hard.
We’ve had cases of burnout. People are leaving the profession. This has consequences for workplaces, burnout, difficulties in relationships with colleagues and family, and irritability. Unfortunately, there have been cases of suicide; it’s serious. The first step is to talk.
You’ve chosen a profession — and nurses too — where you’re there to do good, give care and be strong. That’s what you learn when you study, when you graduate: to be strong and show that you are. We couldn’t get them to talk, and we made a lot of use of associations like yours, Mr. Hills, to get these men and women who work in these environments to talk and heal rather than isolate themselves. Most of the time, that’s what we saw, isolation and a deterioration in psychological health.
I’m going off the topic of the bill a bit, and I apologize, but this is too important a subject, especially today, on World Mental Health Day.
What could be done, in partnership with the provinces and your associations, to get people talking, which is a first step towards recovery?
[English]
Mr. Hills: Thank you for that. It is a very good point. It might stray a little bit from the bill, as you said.
I spoke earlier about coming to this job. I feel I was built for this job. I am someone who can go and attend to the worst of the worst, see things that most of you don’t want to hear about, and then go home and be a dad and a husband. The reality is that, over 25 years, as I said before, I’m not the same person. What I have learned through my struggles over the past few years with post-traumatic stress disorder, or PTSD, and operational stress injuries, or OSI, was that — to use a quote from a guy like Fred Rogers — whatever is mentionable is manageable. The reality is that I was not talking about. When I did start talking about it, healing did begin to happen. The problem is that the damage is already done.
It is still important to talk about it.
One of the things the International Association of Fire Fighters has recognized is that, in a male-dominated profession, we do hide our emotions. We don’t talk about it. That leads to significant suicide rates among first responders whether they are police and RCMP. That is not to take away from any other profession, such as nursing or anything like that, but I can speak to what I know better.
The IAFF has recognized the importance of it to the point where they created their own centres to just treat firefighters. We need to teach men, and the boys coming into the profession — and in the culture in general — to talk about their feelings. It is important. I know men who have friends who have never had a real conversation with another man to the point where they shed tears, where they talk about feelings are real about things, and that is a problem. To tie that into what is going on, I might be punched at work, I might be kicked, I might be threatened by a gang member, and I might feel I can’t share that or share my fear around that, and that cuts a bit when you realize there could be gang members at my house or my house was vandalized. Was that from teenage pranks or from something else going on? It does play on the back of your mind.
It all ties together. I’ve talked about it as a deterrent. I see it as closure. It is one of those areas where people like yourselves can acknowledge the fact that I need to be heard in the way that the violence toward me is real, it has happened and having that person held accountable is another area of closure. With that closure, I could maybe talk about how it has affected me, how it made life difficult mental health-wise.
My colleagues across the country — firefighters, police, paramedics — it is an environment where we are supposed to keep our feelings in. That is what I was taught. More and more it is okay to have those feelings out. These are forums where it is important to talk. Sorry, I went off point a little bit, but I hope it helps.
[Translation]
Senator Audette: The senator asked my question. Thank you very much. In Quebec, we have two First Nations individuals who have the same responsibility as you do as nurses. We call them “supernurses” and there are two of them, one Atikamekw and one Wendate. Thank you for what you do.
When you decided to work in this profession, for love or any other reason, was it written that this was normal and that you were going to be hurt in your classes? When you applied for a job, was it stated that you would be hurt? I say this because it’s like normalizing events when you ask for help. Would this bill, if passed, allow you to stop getting these answers? I hope it wasn’t in your job description. The concept of employment injury should always be present in all our orders and in our work, and if on top of that it can be attached to a law or a section of law to better protect you, that’s even better.
[English]
It is so nice, the way you are looking at me.
Ms. Ariss: I am a nurse. We have small ears. That’s a tough one. In nursing, we need any protection. The question you asked about whether we were taught to accept this in school —
Senator Audette: No, no, what I was trying to say was, when you decided to become a registered nurse, was it written that your life might be in danger?
Ms. Ariss: No.
Senator Audette: When you went into school or when you applied, was there a bullet saying, by the way, your life could be in danger?
Ms. Ariss: No.
Senator Audette: And now you are asking for help and this bill that could be one of the many initiatives to protect you.
Ms. Ariss: Yes, it is. I think that it is not only complementary to Bill C-3, it would be complementary to other actions, legislation and frameworks that we could implement across the country.
Senator Audette: I want to say thank you for reminding us that there are other places where we need to act.
Senator Clement: Thank you for your careers. In Cornwall, paramedics are beloved, and they fight for attention with the police and the firefighters. It is a tough gig, being a paramedic. The public status is different. Union powers are different as well. I wanted to acknowledge that.
I also want to endorse the questions from Senator Dalphond and Senator Simons around the need for data. As we make public policy, we need to understand who is attacking, who is being attacked and who is being disproportionately attacked. I am very aware that the nursing profession is female-dominated as well. These are all things that I think we need to study further.
I wanted to engage with you, Ms. Ariss, because you talked about those preventive measures, and you responded to Senator Audette to say that you would like to see others, and you talked about a framework. I want to know if the province is supporting you sufficiently in those preventive measures. Does the federal government need to add their voice to what provinces are doing or not doing around the preventive measures?
I support this bill, but I also think that it’s limited. I know we will talk about it outside of this chamber and we will do public awareness, and that’s part of the point, but the Criminal Code changes don’t always do what they need to do and some of the preventive stuff is actually more important. Can you speak to that?
Ms. Ariss: You asked, first, senator, if the province is —
Senator Clement: I did ask that first. I did.
Ms. Ariss: The answer is no. The province is not doing all that they can. In fact, the province is underspending their health care budget by billions. I will leave that aside.
Senator Clement: No, but it is important, what you just said.
Ms. Ariss: It is. I spoke about nurse-to-patient ratios, why that’s important and how it affects the work environment. Not only is it best for patient care, but one of the reasons nurses and health care professionals are being assaulted is because of the understaffing. There are not enough. Treatments are delayed, care is delayed, care is not as good as one might expect. Emergency departments are inundated or closed, forcing patients to go elsewhere, and when they arrive there, they are ill and not in the mood.
Ratios would solve this. It would mandate that there are enough nurses at the bedsides to care for all. That would reduce the incidence of violence. We know that.
Also, it would impact those working alone. We see that understaffing is creating environments where nurses would not work alone, but now they are working alone and they don’t have the ability to summon immediate assistance. They don’t have communication. Home care, for example. Mr. Hills would probably experience this. These nurses are out in rural areas without cell service, where the entire community has been on lockdown because of threats of violence related to gunfire or related to active shooters. Yet that nurse is out there without a way to communicate and without a way for anyone to communicate with them to keep them out of harm’s way.
There are a lot of solutions that exist beyond this bill, but this bill is a step in the right direction as long as it is publicized.
Mr. Hills: Senator Clement and Senator Audette, you both touched on the fact that it is like job postings. Right now, we are advertising to come be a paramedic or a nurse — everything is on fire.
This is one of those little steps that, when we are talking about being taught safety on the job, the reality now is that there could be aggression in your workplace or violent acts. One nice thing we could put out there is that there is protection for you or an acknowledgement of that. It’s almost like we need to start rebuilding the job postings for our professions like it’s a Mexico‑all-inclusive vacation. Again, I don’t want to go on vacation to any of the places we are advertising, but I think this is one of those steps where we can go in the right direction to advertise better for our professions and attract more people so that we have more people to help us do our work.
Senator Pate: It is hard to say this, but having done the work I have done for the better part of 50 years, this would not be my first step as a legislative move. That is not because I don’t want to support all of the things you have raised. You heard what I said to the sponsor of the bill, but because of all of my experiences, the more we heap into the Criminal Code, the longer, more punitive sentences, the less likely we see people held accountable for behaviour because people lawyer up. The issues that Senator Simons has raised very clearly. I know the people who end up in the system because of these.
All of the evidence, the government’s own evidence, every party knows this, but they continue on this track of creating more criminal law as though that will deter or change behaviour instead of exactly the things you talk about, what we know will do it, which is more supports, resources, especially people, and I’d say that in schools, in hospitals, in the community. So we keep adding on to the Criminal Code and avoid doing what we know really needs to be done.
Those of you who don’t know me — my colleagues do — I’ll be completely transparent: I don’t think this is the way to go, and I worry every time we do this, that we just feed a perception that this will solve the problem.
I have no doubt it will pass. That’s not the issue, and do I think it’s a bad thing to be protected? Of course — well, I shouldn’t say “of course not.” Most people who know me know I would say “of course not,” but do I think it will achieve it? Not in the slightest, because deterrence doesn’t come from what the law says. We provide supports for people, and then you’re less likely to see this behaviour in the first place.
Mr. Hills, you talked about it. Whether it’s working with nurses, whether it’s working with social workers, whether it’s working with my neighbour paramedic, whether it’s others, this is an issue right across the board that we’re not taking care of people, and the results we’re seeing are what you’re experiencing on the front line.
The Chair: Senator Pate, is there a question in there?
Senator Pate: If I’m saying something you disagree with, I would like to hear it.
Mr. Hills: I think it’s not a disagreement, and I don’t think it’s an either-or. I think it is an “and.” From the lens, maybe, of closure, if you can maybe come on side with us and talk about closure for the person, and I will use Ms. Ariss’s testimony, if I may. Let’s say it was an unprovoked family member that broke her hand. Do you think that this would be an opportunity for allowing some closure for her if it were recognized that she was taken care of and less maybe what needs to be dealt with that person? Is that —
Senator Pate: I think that the charges should have been laid in the first place. I don’t think you need this provision to do that. It’s all of the other issues you’ve talked about, the reluctance of the profession to take it seriously, the expectation that you will take things that are [Technical difficulties].
Senator Clement: Literally take it on the chin.
Senator Pate: Yes. If I thought this law would change that, I would be the first one in line to support it. That’s not the issue. It’s that I think it allows us to all feel better — no offence to my colleagues — all feel better that we’re taking this step and forget the other stuff that we’re not doing.
Ms. Ariss: I believe it’s not an and/or issue. I do believe that it would be the final safety net. It would be after we implement everything else that was suggested here. But, to be perfectly frank, senator, this has been going on for a long time in Canada, and we’ve known that we need more resources. We know that we just need to spend what is budgeted. We know this; yet it continues year after year, government after government.
Senator Pate: I agree.
Ms. Ariss: Yes. So this would be an important first step, something achievable.
Senator Pate: On that I disagree. But that’s not — should not be heard as not supporting what you’re trying to do.
The Chair: Thank you both.
That concludes our round of questioning, and I want to just say this is — the testimony is depressing. I think it fills all of us with admiration for the work that you and your colleagues do, probably more than we had before you came in the room. The question seems, to me, to be: How do we come to the aid of the good Samaritans? It’s ironic that that has to be done. This is a step. There’s a powerful argument that we are taking a step at the very tail end. I think a point that Senator Pate is making, and it is not — it could have some assistance, but it’s really not preventative in a most obvious and direct way. These are the kinds of anxieties that I think you have expressed and you have heard from some of the folks around the table, none of whom have spoken against the bill but would certainly like to see more being done.
I want to just, if I may, bring this to a conclusion, and thank you, each of you, for coming and speaking to us, answering our questions as frankly and as openly as you have, assisting us greatly in understanding the terrain within which this bill would operate.
Mr. Hills, Ms. Ariss, Ms. Kay, thank you very much. Your personal, physical presence here is a further endorsement of the message you’re conveying to us about how important this is for you and your colleagues and your professions. I wanted to thank you very much for that.
I wanted to thank senators for the way in which you have engaged with our witnesses on some really difficult questions, and also to all of you, since this will be our last meeting this week, I want to wish all of you a happy Thanksgiving. Our intention, subject to developments, is that we would continue our study of this bill when we return after the Thanksgiving break, and the steering group is working out specific plans for doing that. As I say, subject to developments, any of which could occur as early as this afternoon or evening, but thank you all, and I’m going to bring the meeting to a close.
(The committee adjourned.)