THE STANDING SENATE COMMITTEE ON LEGAL AND CONSTITUTIONAL AFFAIRS
EVIDENCE
OTTAWA, Wednesday, December 4, 2024
The Standing Senate Committee on Legal and Constitutional Affairs met with videoconference this day at 4:20 p.m. [ET] to study Bill C-321, An Act to amend the Criminal Code (assaults against persons who provide health services and first responders); and to examine and report on the report on the Statutes Repeal Act for the year 2024.
Senator Brent Cotter (Chair) in the chair.
[Translation]
The Chair: Good afternoon, honourable senators.
[English]
I’m Brent Cotter, a senator from Saskatchewan. I’m the chair of the committee. I’m going to invite my colleagues to introduce themselves now, beginning with the deputy chair.
Senator Batters: Senator Denise Batters from Saskatchewan.
Senator McBean: Marnie McBean, Ontario.
[Translation]
Senator Oudar: Manuelle Oudar from Quebec.
[English]
Senator Prosper: Paul Prosper, Nova Scotia, Mi’kma’ki.
Senator Simons: Paula Simons, Alberta, Treaty 6 territory.
[Translation]
Senator Clement: Bernadette Clement from Ontario.
Senator Audette: Kuei. Good afternoon. Michèle Audette from Quebec.
[English]
The Chair: Thank you very much, colleagues.
With the indulgences of the witnesses that we’ll be speaking with in a few minutes, we have one small item of business that is important to deal with today, because we are required to provide a report back to the floor of the Senate by tomorrow. This item is to examine and report on the report of the Statutes Repeal Act for the year 2024 and consider a draft report. Senators, before we proceed to the main item, I would like to take a moment for us to deal with that and get your blessing for us to proceed.
As you will recall from last week’s meeting, we agreed to append observations to our report, and draft observations for the committee’s consideration were reviewed by steering and circulated prior to the meeting today. If members have feedback, now would be a good time to share it. I think there has been a consensus about what we have crafted, but I would like to provide an opportunity for you to speak if any of you have reservations or concerns about the language of the observations.
Hearing none, thank you, colleagues.
Is it agreed that I table the report of the Statutes Repeal Act for the year 2024 and the list of acts or provisions of acts proposed not to be repealed pursuant to the same act, with observations, to the Senate in both official languages by December 5 at the latest? That is tomorrow. Is it agreed? Thank you very much. We will present a report through the chair to the Senate tomorrow.
Honourable senators, we’re now going to move to the main item for today’s meeting and resume our study of Bill C-321, An Act to amend the Criminal Code (assaults against persons who provide health services and first responders).
We are pleased to welcome for our first panel, all via video conference: Chad Drover, Chairperson of the Board, Paramedic Association of Canada; Adriane Gear, President, BC Nurses’ Union; and Denise Waurynchuk, Acting Executive Councillor, BC Nurses’ Union. Welcome to you all.
We will invite you momentarily to deliver opening remarks, then we will move to questions and dialogue from senators. I’m going to go with this order: Mr. Drover, Ms. Gear and Ms. Waurynchuk. I’m going to invite you to limit your remarks to five minutes each, which will then be followed by questions from senators.
Mr. Drover, the floor is yours.
Chad Drover, Chairperson of the Board, Paramedic Association of Canada: Good afternoon, Mr. Chair, senators and guests. Thank you for the opportunity to speak with you today. In addition to being the Chair of the Board of Directors for the Paramedic Association of Canada, I am also a member of the steering committee for the Nova Scotia Paramedic Professional Association and am employed in Nova Scotia as a ground ambulance paramedic.
The Paramedic Association of Canada, representing paramedics across this country, and the Nova Scotia Paramedic Professional Association fully support Bill C-321 as an effort to deter violence against first responders.
To be fair, I had a lot of difficulty figuring out what to say to have the most impact at these proceedings. My colleagues have spoken well and accurately, and there is little value in repeating their words. One of the most common sayings in our industry is, “Nobody knows a paramedic’s job except a paramedic,” so I’m going to relate to you just a few of the incidents that I am aware of.
Picture yourself in the back of an ambulance, assessing a patient. That patient suddenly reaches out and grabs your arm while pulling the other one back in a fist. As you wrench yourself away and fall to the floor, you can see in the man’s eyes that you are going to die.
Picture yourself in the back of the ambulance, treating your patient, when the patient grabs you by the hair and begins smashing your head against the wall of the truck. The only way you can get away is to reach up and pull the patient’s thumb back until it breaks. Consider that in the back of an ambulance, there are limited exits and a lot of things in your way to make that exit not quick. There is no barrier between you and the patient, and in order for your partner to help, they have to stop the vehicle, get out and run around to open the doors. That might take 30 seconds. That is time enough for a career or life to end.
Picture yourself in a hospital hallway, waiting to offload your patient when your patient, upset at the wait time and tired of being told they have to wait their turn, reaches into their backpack and pulls out a knife. You and your partner have to wrestle the knife from the patient before security can arrive.
Picture yourself walking with a patient who, in his frustration at having to wait in a hospital hallway, grabs your arm and pulls his other hand back in a fist. Consider how people are getting frustrated at hospital overcrowding and how fast we have been able to solve that problem.
Picture yourself in a homeless encampment, speaking with a patient, when another resident attacks you with a hypodermic needle. The only thing that keeps the needle from penetrating your skin is that the patch on your shoulder is made of thicker material than your shirt.
Picture yourself speaking with a patient with no fixed address who becomes agitated when you inform them of the need to go to the hospital for assessment. They decide to throw the nearest object at you and release a plethora of rather colourful words. Consider how many moving parts there are in reducing the homeless population and getting them into safe residences.
Picture yourself sitting in the driver’s seat of your ambulance, waiting for your partner to give you the go-ahead to depart the scene for the hospital, when a family member comes running out of the residence, opens the driver’s door and pulls you out while striking you.
Picture yourself kneeling over a patient who has just begun breathing after your efforts to reverse a drug overdose. The patient recognizes their high has been taken away and begins to attack you.
Picture yourself dashing out of a house when a family member enters the room with a rifle.
Picture being a female paramedic who is unable to count the number of times they have been grabbed, touched or spoken to in a sexual manner.
Some of these incidents were due to a medical problem. Some of them were due to a behavioural problem. A couple of them were my own incidents, and some of them were my wife’s experiences. One of the paramedics in these incidents no longer works in the industry.
Those constitute the tiniest fraction of incidents of violence against paramedics.
Now picture yourself at your workplace when someone becomes enraged and violent, and you are told it’s not worth the effort to charge them. Ask paramedics and they will give you a number of reasons why they chose not to report an incident. One of the more consistent answers I have heard regarding this is that there is no point. Paramedics have frequently been told that there is no point to pursuing legal action, as the consequences are not worth the effort. Some have been informed that it was their mistake that led to the incident, and we have all been told, “it’s part of the job.”
All that being said, as paramedics, we are not interested in sending a 90-year-old dementia patient to jail. We are interested in making people who choose to commit acts of violence against paramedics think twice. Can we change these societal issues causing people to act in this way overnight? I think not. However, this legislation is one step in helping those that put their mental and physical health on the line for others know there are people making an effort to help them carry out that task.
Thank you all for your time today and thank you for your efforts to protect those who protect you.
The Chair: Thank you, Mr. Drover. I will invite Ms. Gear and Ms. Waurynchuk to speak together. One of you might lead on this in total for five minutes.
Adriane Gear, President, BC Nurses’ Union: My name is Adriane Gear, and I am the President of the BC Nurses’ Union, or BCNU, representing over 48,000 professional nurses and allied health care workers from across B.C. Joining me today is my colleague Denise Waurynchuk, BCNU’s executive councillor who oversees the provincial health and safety, and mental health strategies of the union.
We are here to share the extent to which the epidemic of violence against nurses is impacting members we represent across the province of B.C. For obvious reasons, it is an issue of significance to us in the work that we do.
As a registered nurse who has spent 31 years in the field, I have a personal understanding of what nurses experience every day while they strive to provide the best safe patient care they can.
I’d l like to share with you just two recent examples of workplace violence shared with me.
Janice, an ER-trained nurse with 40 years of experience, worked in Surrey Memorial Hospital’s emergency department — the busiest ER in the country — until she was viciously attacked by a patient last June. Janice’s story starts like many of these stories do. She was working a busy shift — short-staffed — but was focused on providing the best care she could. She was tending to a young man under the influence of a non-prescribed substance when he unexpectedly lunged at her, grabbed her uniform and repeatedly punched her in the face over and over again.
Janice, a 60-year-old woman, did what she could do defend herself but suffered severe head and facial injuries. Her colleagues who heard her screams came running to her aid and called a code white, but by then, it was too late. The head trauma was devastating. Since then, she continues to experience nausea, dizziness and double vision. Today, she must wear an eye patch. She can’t read and can’t work because of her injuries. In fact, she may not ever be able to work again.
Janice’s attacker was charged and spent two months in jail, a sentence that Janice feels doesn’t fit the crime.
She shared that in her 40-year career as a nurse, sickeningly, this isn’t the first time she has been assaulted. She told me she’s been bitten, spat on, had human feces thrown at her and been groped numerous times.
Two weeks ago, a terrifying attack on a student nurse made news headlines in B.C. A patient acting erratically was left in the care of this student nurse. The patient pulled out a pocketknife and cut her twice — on the chin and the arm. The student nurse is recovering, but the physical and emotional scars are sure to have a lasting impact. It could mean she never returns to her studies.
As my colleague Ms. Waurynchuk can attest, the stories from my members are mounting, so much so that we commissioned our own member survey last spring to better understand how often and to what extent nurses were subjected to serious health and safety risks.
I would now like to turn it over to Ms. Waurynchuk to speak to the survey results and the broader systemic themes that have emerged.
Denise Waurynchuk, Executive Councillor, BC Nurses’ Union: Thank you, Ms. Gear. Good afternoon, everyone.
We promised members that their responses would help to inform the advocacy needed to make workplaces safer, and speaking to all of you today is me keeping that promise to the nearly 4,000 nurses who took the time to respond.
The findings are eye-opening. At least monthly, 39% say they are exposed to weapons. Sixty-one per cent say they are exposed to illicit substances. Half of them experience physical violence at least once a month, and nearly a third face verbal or emotional abuse daily. A staggering 99% of respondents said they experienced reportable incidents. Yet more than half said they have not reported anything to their employer because they lack faith that anything will be done about it.
Thanks to the advocacy shown by B.C. nurses, there has been a significant increase in awareness about violence in health care, and we’ve seen some positive steps in the right direction. In 2021, we celebrated the passing of Bill C-3, which saw federal legislation amend the Criminal Code to add the commission of an offence against a person who was providing health services as an aggravating sentencing factor.
Fast forward to 2024, we now have the opportunity to strengthen legislation to further protect nurses and other health care workers.
Thank you for your attention. I will now pass it back to Adriane.
Ms. Gear: Thank you, Denise.
While we continue to push for a culture of workplace safety for our members, your support for this bill will send a message to all nurses that when it comes to violence in the workplace, the justice system sees them and that as individual professionals charged with caring for our society’s most vulnerable, the justice system values them.
Toward the end of my conversation with Janice, the ER nurse from Surrey Memorial Hospital, she put it in simple terms:
I’m a master’s level–educated nurse who is now facing the fact that my career is over because of an unprovoked attack. My life will never be the same. We must do more to protect the ones providing care.
On behalf of all nurses in B.C., thank you for taking the time to have us today.
The Chair: Thank you both for your presentations. We will now turn to questions from senators, beginning with Senator Batters.
Senator Batters: Thank you very much, all of you, for appearing in front of our committee today and for all the work that you do every single day to, as Mr. Drover put it, protect us. It’s very apt to say protecting. He was thanking us for our efforts in protecting those who protect you. You certainly do protect us and help us, often at the toughest parts of people’s lives. Thank you for that.
First of all, I would like to ask Denise Waurynchuk a question. Ms. Waurynchuk, you mentioned the important statistics you received in your survey from your members. It’s stunning that half experience physical violence once a month.
There are a few statistics that I had received in looking into this. Given the results of your survey, there were 5,825 vacant nursing positions at the end of the third quarter of 2023. Given the statistics that you have seen and the responses you received in your survey, do you think that workplace violence plays a role in the difficulties in recruiting and retaining nursing staff? What specific impacts — perhaps you heard about some of these in the survey — does workplace violence have on the morale, productivity and mental health of nurses?
Ms. Waurynchuk: I think violence in the workplace plays a significant role in retaining nurses in our workplaces. I think it also has an impact across the board in nursing and in health care. Nobody wants to work in an environment where you’re going to be exposed to violence on a daily basis. Sometimes, it is just what we like to refer to as micro-traumas, the verbal abuse that nurses or health care workers have faced. It might be just that one little piece of verbal violence again and again, then emotional violence, and then it breaks that nurse. Then they are leaving. We see a significant number of nurses who are off work on WorkSafeBC or on long-term disability because of the impacts of physical, as well as psychological, violence that they are experiencing at work.
I think improving our work environments, looking at the work that B.C. is doing with nurse-to-patient ratios and having adequate staffing levels to better care for our patients will then have a positive impact on decreasing violence because nurses are going to be able to have more time at bedsides to have conversations with patients and find out what their needs are. They will also have that extra staff there for support when we need to go in and work with a patient who is showing signs of aggression.
Senator Batters: Ms. Gear, you spoke about the legislative component. Do you think adopting Bill C-321 could send a clear message that violence against health care professionals and first responders will no longer be tolerated?
Ms. Gear: It sends a very clear message. To the point that Mr. Drover made, this isn’t about charging or holding to account elderly people who have dementia or folks who aren’t capable of making decisions. That’s not intentional. However, what we are seeing — and it’s somewhat anecdotal — but based upon some new evidence that’s come out from WorkSafeBC, we are seeing a rise in that intentional violence. There are a lot of mental illness and frustration. Certainly, there are wait times in emergency departments and shortages of staff throughout the health care system.
Whether we’re talking about bricks and mortar hospitals, home and community settings, or long term care, people are at their wit’s end. They’re not accessing services in a timely manner. Nurses and the other health care workers who are on the front line.
This does send a strong message. It’s okay to be frustrated, but you don’t take it out on the nurse, paramedic, orderly or whomever. It sends such a strong and positive message to health care workers and professionals, who show up each and every day to do the very best job they can, that the Government of Canada actually cares, sees them and values them.
Senator Batters: Mr. Drover, thank you for outlining that in many cases, where women are involved in these positions, there’s often a sexual component that makes the workplace violence and other situations they face even worse. Many incidents of violence against paramedics go unreported, and you alluded to some of the reasons that might happen, but could you just explain why paramedics would hesitate to report such assaults? How does that affect the statistics on violence?
Mr. Drover: Paramedics have been told — and it was a while ago that I, specifically, heard this — there is no value in charging a person with the attack, because it was not worth the effort of pursuing the charges. It’s less so now, but in the past, employers have shied away from any sort of legal action against patients. You would have to ask an employer why they would do that. It is for various reasons — again, it is not worth the effort or it makes them look bad. It’s also hard on recruiting. When you’re trying to sell somebody on a job and tell them they’re going to get attacked and there’s very little you can do about it.
There’s a stigma that you have to put up with it or you’re weak. That is a very old stigma. While many of my fellow first responders and health care workers have been recently trying to break it, it still does exist. Much of what we say is anecdotal simply because nobody reports anything for fear of retribution or rumours about your strength.
Senator Batters: Thank you.
Senator Prosper: I want to begin by just telling all the witnesses this: Thank you for your service. I consider it quite a privilege to be able to listen to testimony such as yours and to get a real feel for the challenges you grapple with every day. We are truly honoured, and we appreciate your work.
My questions are quite similar to what Senator Batters got into. Ms. Gear, you mentioned this all within the context of an epidemic of violence against nurses. You got into some of the reasons, potentially: longer waits at hospitals, the lack of availability of services, et cetera.
As a further follow-up to Senator Batters’ question. Your experience spans over three decades and over the course of more than 30 years, I imagine you have undoubtedly experienced a shift. Initially it wasn’t an epidemic, but things have sparked such that this is now the case. Ms. Gear and others, can you add to that shift on how things have changed? Maybe you could provide further context to that.
It was another question pursued by Senator Batters as to reasons why people were not stepping forward. Ms. Waurynchuk, within the survey, you referenced that more than half wouldn’t pursue certain incidents because they really had no faith that anything would actually be done.
I’m looking to get more from any of the witnesses regarding those two elements. Thank you.
Ms. Gear: I’ll start.
I think the question was this: Is it really getting worse, given that we’re characterizing this as an epidemic? Again, referring to our survey results, when 39% of our members who responded say they are exposed to weapons and that, on a daily basis, nurses are exposed, perhaps not to physical violence but certainly verbal aggression, threats and things like that, then I would say it is an epidemic.
I do think there’s more awareness, but I don’t think that is reflected in the reporting. That is because the employers’ reporting mechanisms are quite onerous. For a nurse who is already working very shorthanded and trying to care for patients, taking the time out to report and then never having any follow-up and never seeing how reporting changes the system — that is an issue.
I would say there is a lot of underreporting. I think there’s a lot of literature to support this. It’s not unique to health care, but I would say it’s very problematic in health care in terms of underreporting.
In my over 30 years being a nurse, one of the direct correlations — and this is researched. When patients are denied care or care is delayed, it increases the risk of violence. I don’t think it’s a surprise to any of you that our health care system is very challenged right now. As much as we value our publicly funded health care system, it is stretched beyond belief. There are not enough providers in the system to provide care.
I would say that is one of the primary reasons we’re seeing increases in acts of violence and aggression. We have people who are in pain. They have high anxiety levels, might be in poor mental health and are not getting care in a timely manner. Care is delayed and, sometimes for that person, it feels like it’s denied, so they’re acting out.
I think it is reaching epidemic proportions. When you look at WorkSafeBC — and each province has their own health and safety regulator — in the statistics we’re seeing, some of the longest claim durations are due to violence. So not only are these injuries happening, but they’re taking people out of the system for longer periods. Also, a lot of times, there’s a secondary psychological component to it.
When we think about the fact that we need to bolster our health care system and have more people working in the system, nurses — I will speak for nurses — are a finite resource. Why employers aren’t taking every step possible to protect us, I don’t know. The reality is that more nurses are becoming injured, and nurses are leaving the profession.
What’s very unfortunate is that we actually have empty nursing seats in the province of British Columbia. When I was a young person wanting to go into nursing school, there was a three-year waitlist, and now we have empty seats at a time when we are in a provincial, national and global nursing shortage, and that is really concerning. I think it’s tied to the conditions of work, and the conditions of work for many nurses is that they don’t feel safe.
Senator Simons: Thank you very much to all of our witnesses. Your stories are horrifying, and the data is almost as shocking.
I understand you’re saying that this bill would give workers in your field a bit of a morale boost. It is not that I oppose the bill, but my concern is that the bill only functions if people are caught, arrested, charged and convicted. Only then does this bill do any good. It creates an aggravating circumstance in sentencing.
From what you’re telling me, it’s very difficult to get those charges to stick, and especially in cases where people are assaulted by members of the community who are not able to form criminal intent, whether they’re suffering a psychotic break, an excited delirium from drugs or they are just so mentally ill or neurologically compromised that no Crown prosecutor is going to proceed against them.
The question I have for all of you is: What needs to be done to provide more security to you so that you’re not attacked in the first place?
Mr. Drover, should there be police or sheriffs assigned to go out with paramedics on calls, especially on calls to high-risk areas? Should hospitals in British Columbia have more security on the wards, because this bill — and it’s not that I’m opposed to it, but it’s a little bit of shutting the barn door after the cows have raced out.
Mr. Drover and then Ms. Gear.
Mr. Drover: We already do some of that. When a call comes in, and it’s identified as a high-risk or a potentially dangerous situation, police are sent prior to an ambulance. We call it “staging.” An ambulance will wait prior to entering a scene.
We do have some locations that are flagged, and when a call goes on at that location, ambulances will not enter without police assistance, so we do a fair bit of that. At any point in time when a paramedic is reading call notes as they come in, if they feel unsafe, they can say that we’re going to remain out of scene until we can have police enter prior to us going in.
With regard to the patient that does not have the capacity to make choices, for lack of a better phrase, be it a mental health issue or a physical issue, such as diabetics, these are not the patients that we are looking at for this bill to solve the problem. We are going after the patients that make an active choice to be violent with somebody who is providing care to either them or somebody in their proximity. Those are the patients that we become much more concerned with.
This is a deterrent, and in the case where things get out of hand, this is the punishment. Right now, we, as paramedics, feel like we are fair game.
The Chair: I’m going to invite Ms. Gear, so she has a chance to address this as well.
Thank you very much, Mr. Drover.
Ms. Gear: Thank you, and I absolutely appreciate the question and also the response from Mr. Drover.
What else is needed? Is this the answer? Not in its entirety; it is one piece.
What do we need? We need improved staffing levels. We need staff to have the education required to manage aggressive and violent patients, so violence prevention education is important.
Do we need to have improved security, more security and security that is trained in cultural humility and de-escalation? One hundred per cent, we need that.
What we really need is for employers to enforce the zero violence policy, which they often choose not to enforce. We really need improved reporting mechanisms, and, as important, we need appropriate investigation and follow-up. That is a requirement of the employer. I think there’s more the regulator can do.
If this bill is passed, I believe it does serve as a deterrent. Is it after the fact? One hundred per cent, it is. That means that someone has been assaulted on the job, or we wouldn’t even be having this conversation, and this bill wouldn’t even be contemplated.
It is one piece. It’s a deterrent, but I think it’s a very important piece, and it sends a strong message to society, and it sends a strong message to health care workers and health professionals that they matter and that this won’t be tolerated.
[Translation]
Senator Oudar: I fully support the objectives of the bill. I spent the last eight years of my life at the head of an organization in Quebec, the Commission des normes, de l’équité, de la santé et de la sécurité du travail. I can tell you that the statistics also reflect the situation in Quebec. There have been meteoric rises in physical and psychological violence against not only health care workers, but also those in the education sector. That’s another issue I won’t open the door on, because there’s a lot to be said on that.
I fully subscribe to the objectives of this bill. Witnesses have told us that it’s a first step forward and a recognition of what’s happening in the workplace. My question has more to do with the absence of denunciation. This is something we’ve been working hard on. There’s still a lot of work to be done in all the provinces to ensure that there’s no underreporting.
Underreporting is attributable to several factors. The first is the climate of trust that must exist between employer and employees. In each of your areas of activity, do you have what I call a prevention program, which is developed in conjunction with employees and the employer, and which provides for training and measures to counter the elements of violence? It could potentially identify risk factors, such as working with a certain clientele, and include not only reporting mechanisms, but also victim support and, of course, staff compensation mechanisms.
I wanted to hear from each of the witnesses more specifically on prevention programs.
[English]
The Chair: Who would like to answer first?
Ms. Gear.
Ms. Gear: Yes, and thank you for the question.
The answer is, I think, yes, to all of those things. Do we have elements of a violence prevention program in health care settings in the province of British Columbia? Yes, we do. It is, I would say, outdated. I would say that those that access the education find it somewhat helpful. It is one piece.
Do we have a regulator? Yes, we do. Do they conduct work site inspections, and do they follow up, to some extent? Yes, they do, but it’s not enough.
Ms. Waurynchuk is probably better situated to speak to this part than I am, but by regulation, each employer is required to have a joint occupational health and safety committee. It’s very challenging for nurses to participate when there’s not enough of you to provide the care for patients. It makes it very difficult to leave your patients to participate in health and safety programming. It makes it very challenging.
I would say that we do have all the elements that you speak of but probably not to the standard in which they should be.
I don’t know if Ms. Waurynchuk wants to add anything from her experience.
Ms. Waurynchuk: When I’m speaking with nurses across the province, I do hear that they want to be involved, and they want to make positive change. They want to see improvements in their work environment and keep themselves and each other safe.
The problem is that they are working short-staffed. They are not able to attend the joint occupational health and safety committee meetings to be a part of the solution. They can’t be proactive.
I’m finding in this role that, when I’m working with nurses, we’re very reactive; we’re looking at what has happened. Yes, we do look at how to prevent it in the future, but we’re not getting ahead of it. We’re not really looking at the risk factors of certain populations and how we do a point-of-care risk assessment to ensure we are going in safely. How does the employer provide us with security on the site in order to keep us safe and in order for us to go in there and know that we will have someone who will back us and who has the knowledge, training and education to support female nurses at 3 a.m. in a rural facility where there is one other female nurse there with me? If something does happen, my employer is then going to say that they support me pushing this forward and support me pressing charges. That’s not what we are hearing right now; there is a lot of reporting, with no change and no real support from the employer to press charges.
The Chair: Mr. Drover, what is your perspective?
Mr. Drover: We do have some things in place, as I said earlier, about staging such that, when calls come in, certain key words come up to the dispatcher that indicates there may be violence or the potential for violence at that location, at which time, police can be sent with us.
Our problem is that our workplace changes with every single scene we go to. All of the things we can base sending police are based upon that phone call and the dispatcher being told the truth. That is not to mention that things can evolve very easily if a patient treatment doesn’t go well, a patient’s illness evolves or anything of that sort.
Our reporting ability has been onerous in the past, and that becomes a huge problem for anybody trying to take a moment out of their shift to report an incident. There has been a recent improvement, but, again, it’s hard in coming. It’s going to take time to break any past problems that paramedics have had. The ones we identify are typically not the ones we have issues with; it’s the patients who are unidentified who change their behaviours quickly. We learn de-escalation techniques, but there is only so much de-escalation you can do, especially if you’re not expecting it.
The Chair: Thank you.
Senator McBean: Thank you all for sharing all of this and for having patience with us. I’m going to assume it’s not the first time you’ve been telling someone there is a problem. I feel as if we’re coming along now and digging at a Saharan sand dune with a beach shovel.
You have all mentioned that, in some fashion, it’s not this type of violence that’s the problem; it’s that type of violence that’s the problem. How would you explain to somebody else how you tell the difference? We’re looking at adding to the sentencing process — to the charges — so I’m wondering how you would differentiate between the intention or the capacity of the person who is harming you. That’s a question for everyone. You have all been sharing the same examples. I’ll start with Mr. Drover.
Mr. Drover: My assessment and experience are the things that tell me whether somebody has the potential for violence, and it really does come down to that. With 20-plus years on the job, I have been caught off guard by people. There are certain parts of our training that tell us that certain conditions that a patient is suffering from can produce violence at times, but it really comes down to one’s own assessment and experience, which I’m sure most nurses will attest to, as well.
Ms. Gear: I certainly agree with the comments of Mr. Drover.
I think the question you’re asking is how this would apply? We’re all acknowledging there are patients out there regarding whom it wouldn’t be appropriate to charge or for this bill to apply. Is that the question?
Senator McBean: Yes, but also how it would be applied fairly and maybe without bias or anything like that.
Ms. Gear: The test is whether there are charges and if the person is convicted. That is not a test that health care workers make. That is a test for the legal system.
My understanding is that if they are convicted, it would be considered an aggravating circumstance. This is expanding upon something we already have. In terms of patients who are, for example, demented. For an elderly person in a long term care facility, there is generally a well-documented history of aggression, what the triggers are and things like that. So this really doesn’t apply to that patient population. This applies to those who make an informed decision about perpetrating violence against a health care worker.
I can’t speak for the rest of Canada, but in B.C., we are seeing a rise in gang activity, as an example. That spills into our hospital settings. We have had criminals trafficking illicit substances in hospital settings. We have weapons coming in.
This bill is about that type of violence. This isn’t about vilifying people who are demented or mentally ill and unable to form that willful intention.
Does that type of violence have an impact on people? For sure it does, but this is not going to fix that. What would address that are proper staffing levels, enhanced training to deal with those responsive types of behaviours from elderly people, for example, who are confused or demented.
This is about the people who are choosing to perpetrate violence. They are frustrated, and they haul off on a nurse or paramedic. I understand the frustration, but there needs to be consequences for the fact they have poor impulse control.
Senator McBean: The other side of it, then, is the reporting. How do we create an effective reporting mechanism? That’s where it starts. If people aren’t reporting it — everyone is underreporting — how do we create an effective reporting process so that all the violence goes through the system and then it gets caught later on?
Ms. Gear: Reporting at the work-site level is where there needs to be a lot of work. That’s where we see underreporting, which is because there isn’t a follow-up.
As a young nurse many years ago, I was involved in an incident. I still remember the manager looking at me and saying, “What did you do to provoke the attack?” There is so much that needs to be done to change the culture of safety. In other industries, safety is held up. It means profits. A work site would be shut down if it were unsafe.
In health care, it’s a shrug of the shoulders from them and we just keep going. We need to change that culture.
Certainly, provincial governments have a role. I think the regulators have a role to ensure that there are appropriate reporting mechanisms and that they are accessible because part of the problem is that they are not even accessible, for example, if they only run 9 a.m. to 5 p.m. Health care is a 24-7 operation.
People need to be encouraged to report, and they need to be thanked for reporting, not told, “Oh, you reported an incident. I wouldn’t have done that. What’s the big deal?” Those are the type of conversation that my members are having with their employer unfortunately.
I’ll use the example of being exposed to illicit substances. I know I’m taking us down another path, but nurses are coming forward saying, “I’m concerned about my personal safety,” and that’s being weaponized. People will say, “So you don’t support harm reduction?” That’s not the conversation. I don’t want to be exposed to illicit substances. We have similar conversations. People say, “Well the patient didn’t mean it” or “It’s part of the job.” We have a monumental task. We have to change the culture, one hundred per cent.
As I said in my previous answers, it’s the employer and it’s the regulator. They have a responsibility to ensure that the reporting mechanisms are accessible, that there is appropriate investigation, that there is a follow-up and that people are actually appreciated for bringing safety concerns forward instead of being made to feel like they are a burden. That has to change. One hundred per cent, this is how we get in front of this. This is how we prevent injuries. But we are not there right now. That’s not the experiences of the nurses in British Columbia.
The Chair: Thank you. I’m going to ask a few questions myself, if I may. I have a couple of observations first.
The work that you and your colleagues do is heroic. It’s beneficial to people who are often in vulnerable circumstances, whether it’s in relation to first responses or struggling in the hospital and those kinds of circumstances. It continues to be a tragic mystery to me that people would treat you and your colleagues so poorly in those kinds of circumstances.
I have family members who do each of the kinds of work that you described. A lot of what you had to say is personal to me. I think it is to so many people in our country.
What you shared with us is depressingly enlightening, if I can put it that way, about the work you do. We have heard that from other witnesses as well. What you have described, particularly, Ms. Gear, in your last remarks, is that this is a system-wide issue that requires intervention in all kinds of ways. However, this intervention is at the very tail end.
I support this bill, and I’m confident that my colleagues do as well. I want to put it to you that it’s unlikely to change behaviour very much. Firstly, you have identified that many of these circumstances arise at the last minute, suddenly and unpredictably. Mr. Drover, I think you made that point very well. They also tend to be delivered in many cases by people who are not, let me use the phrase, in their right mind. As a result, as Senator Simons identified, it’s very difficult for prosecutors to make that call.
I also think that the people that you have identified who are consciously attacking you and your colleagues are not likely to read the Criminal Code and realize that “Oh, my God. I might be subject to an aggravated level of punishment if I’m convicted.” For the most part, that tends not to happen.
I guess I’m suggesting to you that there is not much hope that this bill will achieve much in terms of deterrence. It may be effective in making people be held rightly accountable for the kind of behaviour that they engage in, and I get that point fully. But do you think I am right, based on what I have described, that this is a very tail-end initiative on the side of accountability and that we aren’t going to get very far on deterrence without addressing a lot of the other features that you have identified?
Ms. Gear: I certainly agree with your comments. However, if this deters one, two or even ten assaults in a month or in a year, I think it’s worth it. It’s a start. It’s a piece of the puzzle. It’s a start to transform a system to become one where we truly have a culture of safety.
The other point I’ll take the opportunity to make right now is: If health care isn’t safe for the people who are providing the care, then those who are seeking the care are also at risk. There are also very unfortunate stories of violence that gets perpetrated on patients.
I think this is a piece. I agree with you. Is this going to have a huge impact? Likely not. It’s a start. It sends a clear message to society. It sends a clear message to health care workers, and I think that’s really all I can say.
The Chair: I think the last point you made is a compelling one — that the system, at least this part of the system, significantly supports the work that you and your colleagues are doing by sending a message to them. I’m just worried that it’s not going to solve the problem or deter very many people. Mr. Drover?
Mr. Drover: I think this is one part of a bigger problem just as you said. On top of that, while it may not deter people this month or next month, after it has been passed and after some people have been charged and the charge has been increased, the word will get around. Not only will it get around to people who may perpetrate these incidents, but it will also get around to our paramedics and first responders that somebody does care and recognize the work that you’re doing, the difficult work that you’re doing, and those that would perpetrate violence will be punished for choosing to do so.
The Chair: There is also another feature — I’ll make this observation and then turn it over to Senator Clement — that when the more senior people in your workforces seeing this is regarded as a more serious victimization than it is at present, it might enable them to take it seriously and be more supportive of you when these issues arise. I can’t predict that, but it seems to me that’s at least possible.
Senator Clement: Hello to all of you. Thank you for your careers. I have nurse and paramedic friends. You’re a group of remarkable people, obviously, for the work that you do.
When I was mayor of Cornwall, paramedics were among my favourite employees of all. I worried about you all the time. Because of time, I’ll engage with Mr. Drover.
This maybe follows up on what Senator McBean was saying. The culture around toughness and not wanting to admit weakness, particularly in this type of work, is a problem. I endorse this bill, and I endorse all of the comments and questions. What is the association doing around that, if anything? What would you need from any order of government to be able to deal with that? And my last question is: Do you have a survey like the one that Ms. Waurynchuk described, which is very instructive? Are you doing that kind of survey work as well?
Mr. Drover: That’s a couple of questions. With regard to the survey, I actually went to my employer to get some statistics from them regarding violence, and the response I got was that the statistics we have are unvetted at this time and they would not allow them to be released to another industry or to another organization.
They have started to make some improvements in how they deal with violence against paramedics, but it’s young and requires some time before it becomes robust.
Statistics-wise, I know in Ontario, they have a more robust approach to gathering statistics that they have been carrying out for a little while. I believe Mr. Mausz will speak to that when he gets his opportunity. I wouldn’t want to want steal his thunder. They are doing good work around simplifying reporting and producing those statistics to have that impact on employers and stakeholders, and how they can help improve things.
What we need from government, as everybody needs from government, is legislation and funding. With funding comes extra training, training in increased recognition of violent situations, de-escalation techniques, potentially even self‑defence techniques.
The legislation says, yes, we are going to do something about this. I see this as a problem. I recognize the stress you’re under and how this affects you, your workplace and home life.
The paramedic who has violence committed against them, I can guarantee you, does not sleep well at night for a little while. That would be what I would say.
This legislation is a message, not only to those who would commit violence, also to those who have the violence committed on them. Not only are we going to punish you for that, but we will protect you for doing your job.
Senator Clement: Thank you.
The Chair: Thank you both.
Colleagues, this brings us to the conclusion of our first panel. I wish to extend on my behalf and yours a thanks to Mr. Drover for joining us, and for Ms. Gear and Ms. Waurynchuk for enlightening about the difficult circumstances of the work you do and your judgment, the importance of this amendment.
Before the second panel, colleagues, let me bring to your attention that we have been unable to connect in an effective way with Ms. Poirier. She will provide us with a written submission in relation to her perspectives. We will have only two witnesses on the second panel.
Thank you colleagues. We are resuming to study Bill C-321. For the second panel, we are pleased to welcome Justin Mausz, Clinician-Scientist, Peel Regional Paramedic Services, Adjunct Faculty, Department of Family and Community Medicine, University of Toronto. Mr. Mausz is joining us by video conference.
We are also joined in person by Elizabeth Anne Donnelly, Professor, School of Social Work, University of Windsor. I want to thank you, Ms. Donnelly, for joining us here in Ottawa.
As I mentioned, Ms. Poirier is unable to connect with us effectively for translation services. We have had a dialogue with her. She will provide us with her thoughts in writing to the committee through the clerk.
I’m going to invite Mr. Mausz to speak to us first for roughly five minutes, sir, followed by Professor Donnelly. That will be followed by questions and conversations with senators.
[Translation]
Justin Mausz, Clinician-Scientist, Peel Regional Paramedic Services, Adjunct Faculty, Department of Family and Community Medicine, University of Toronto, As an individual: Good evening, and thank you for the invitation, Mr. Chair.
[English]
I am grateful to be speaking with you today. My name is Justin Mausz. I am an advanced care paramedic with the Region of Peel’s Paramedic Services, an adjunct faculty member in the Department of Family and Community Medicine at the University of Toronto.
I have just shy of 20 years of clinical experience working as a paramedic in the Region of Peel. After having completed a PhD in 2022, my role has shifted to focus primarily on research.
In collaboration with my colleague, Professor Donnelly, I undertake research on occupational health and wellness issues affecting paramedics, a good chunk of which is devoted to workplace violence prevention.
I wish to begin by saying paramedics are a vital part of Canada’s public safety and health care infrastructure. We provide care to Canadians who are experiencing life-threatening illness and injury across the country.
In the years leading up to the COVID-19 pandemic, paramedics in Canada have been found to have some of the highest rates of work-related mental illness among public safety personnel, this includes post-traumatic stress disorder, depression, anxiety, disturbed sleep, chronic pain, exposure to trauma and, tragically, suicide.
In an earlier study in Peel Region, my colleagues and I found that one in four, or 25%, of the active-duty paramedics in our service met the screening criteria for current symptoms of PTSD, major depressive disorder or generalized anxiety disorder as recently as February 2020. An additional 7% had contemplated suicide or self-harm within the previous 14 days. What this tells us is it was an at-risk workforce vulnerable to worsening health from violence.
We know from the existing research that situations that involve threats to physical safety, such as violence, are known to increase the risk of PTSD and other adverse mental health outcomes.
I wish to point to a recent review of the United States Bureau of Labor Statistics, emergency medical services personnel in the United States were found to experience a risk of lost time injury requiring medical care from violence that is five times higher than the general U.S. population, more than six times higher than firefighters and 60% higher than other health professions such as nurses.
Unfortunately, similar data in a Canadian context are quite sparse and difficult to come by. We know from other research that, in the wake of the COVID-19 pandemic for incidents of violence, violent attacks against health care professionals have been growing.
Like the other witnesses before us, we know from research — and from their testimony — the majority of incidents of violence against health care providers go unreported; this means the true scope of the problem is difficult to ascertain and remains largely unknown.
Among paramedics in Canada, a 2014 study highlighted this problem of pervasive underreporting and recommended the creation of specific incident reporting systems that are intended to document incidents of violence; that is what my team at the Region of Peel, in collaboration with research colleagues, has been working on so diligently.
In partnership with industry and community experts, our paramedic service has developed a new reporting process embedded in the electronic patient care record where our paramedics are prompted to complete a violence report if they experience violence after each 911 call they attend.
This generates first-in-kind tangible data on the prevalence of violence. We have attached research to this type of data. Over a two-year study period between 2021 and 2023, we found that 48% of our active-duty paramedic workforce was exposed to violence. Forty per cent of those reports documented a physical or sexual assault; Twenty-five per cent of the reports documented abuse on identity grounds, including gender, race, ethnicity or sexual orientation such as racist or sexist slurs. In all, 211 paramedics indicated being emotionally impacted or distressed by the incidents, and 81 indicated they were physically harmed because of the violence. If you average this out over the study period, our findings correspond to a paramedic being exposed to violence every 18 hours, physically or sexually assaulted every 46 hours and harmed as a result of a violent attack every nine days.
This reporting process that we developed in Peel Region has since been adopted by more than 20 paramedic services across our province. Our team is now in the process of analyzing nearly 3,000 violence reports from more than a dozen services that are contributing data as part of a collaborative research study on violence, and of these nearly 3,000 reports, 44% — over 1,200 — indicate that the paramedic was physically or sexually assaulted. In 265 cases, the report indicates that the documenting paramedic was physically harmed because of an assault.
I would ask you to bear in mind that these findings are preliminary and have not yet been peer reviewed.
This has implications for the health and well-being of our members. This now well-documented exposure to workplace violence creates the potential for significant physical and psychological harm, and our team is currently in the process of a new study reassessing paramedic mental health as our country emerges from the COVID-19 pandemic. We are studying paramedics from two services in Ontario, again, for symptoms consistent with PTSD, and other adverse mental health outcomes.
Although our findings are preliminary, our early indications are that the rates of PTSD, depression, anxiety and suicidal ideation have increased by as much as 10% to 15% over our pre‑pandemic 2019 study.
I would conclude by saying that as the role and scope of paramedics within Canada’s health care system continue to expand, more Canadians are relying on paramedics to fill gaps in primary health and social care. But with high rates of work‑related mental illness that are compounded by high rates of violence, the safety and well-being of paramedics as a health human resource is vital to ensure that Canadians are able to depend on paramedics for skilled, compassionate and high quality health and emergency care.
Thank you.
The Chair: Thank you, Dr. Mausz.
Professor Donnelly?
Elizabeth Anne Donnelly, Professor, School of Social Work, University of Windsor, as an individual: Thank you so much for the invitation to be here and to speak to you today.
I’m coming to you as a human being who has been a nationally registered emergency medical technician, or EMT, for 25 years. In the last 15 years of my professional life, I have focused on workforce health in paramedicine, and I’m privileged to work with Dr. Mausz in the violence against paramedicine project and other things.
Similar to the themes that the last panel talked about, I want to acknowledge that violence in this space is a really complicated and complex problem, and it’s of tremendous concern to the paramedic community.
We acknowledge that a lot of different things have to change, so in 2019, the Paramedic Chiefs of Canada put together a position paper, and they called for four separate things: They called for research to understand better the scope of the problem and the impact on paramedics; they called for evidence-informed strategies to be developed to protect staff; they called for increased public awareness of the impact of violence — and I can’t tell you how many times I’ve had conversations, and people are like, “Paramedics get attacked?” In response I’m like, “Yes, they absolutely do.” It’s not part of our public consciousness right now. Finally, they called for — and this is where you come in — changes in policy and legislation.
The paramedic community has been really active in trying to solve these problems. You heard my colleague talk about the research we’re doing to try and understand the scope of the problem. We’re exploring different preventative strategies, like how we may be able to flag differently or put different kinds of hazard flags on addresses using phone numbers. We’re looking at different ways of deploying training so that folks can be better equipped to understand threats and remove themselves from dangerous situations.
We have this really unique collaboration with all of these paramedic services across Ontario, who have contributed their violence reports so that we can understand what is going on — not just in Peel Region but across the province — and we’ve had a lot of interest from other provinces as well.
This is a part of this culture change that we were talking about that we really needed. This is something where we’re making reporting more accessible, and we’re able to do stuff with it, and services are able to respond in real time ways to try and keep their folks safe.
Why are services concerned? Because it hurts paramedics. Mr. Mausz talked about the psychological consequences and the statistics we have around the harm that paramedics experience. There is significant correlation in other populations between exposure to violence and depression, anxiety, burnout and different mental health consequences.
While it’s not in the paramedic community, there is data that says exposure to violence is linked with intent to leave the profession. Similar to nursing, there are more places for paramedics than there are paramedics. This is another industry where we’re really struggling to get staff.
It doesn’t just hurt paramedics; it hurts the whole community. This is a public health threat.
Paramedics are helpers. They’re driven to serve their community. They show up in the night, in the rain and in any circumstances to help our community.
Would you be at your best if you had someone yelling slurs at you, threatening you and your loved ones? Would you be doing your best work? Is it possible that we can expect paramedics to do their best work to serve you and your families while they’re exposed to this kind of violence? Legislation alone isn’t going to solve this problem. This is complicated.
We’re trying to do some of these other things. We’re trying to do the research. We’re talking about it, and trying to create culture change.
The Canadian government can do their part with policy and legislation. Changing legislation is going to do a number of really important things. First, there was a report issued, Violence Facing Health Care Workers in Canada, Report Number 29, which called for changes in legislation. That was issued back in 2019.
That meets the call of this report and communicates to public safety personnel that they’re valued, that we see the work, and we value their work.
Legislation raises awareness and educates the public. It’s not necessarily about the criminal that’s going to read the Criminal Code, but it’s about the media that may come out that’s going to talk about this issue as the legislation changes. It can increase public awareness, as right now your awareness is being raised by giving us the opportunity to talk to you today.
It communicates to law enforcement that this is serious. It communicates to the Crown that this is serious, and it’s something that needs to be considered. It communicates that it’s a threat to public safety, so I strongly encourage you to support this bill.
It is a small piece, but it is a very necessary piece of addressing this problem.
Thank you.
The Chair: Thank you, Professor Donnelly.
Senator Batters: The more I hear from witnesses on this, I’m just so proud of my national caucus colleague, Todd Doherty, for bringing this bill, because you’re right, the public doesn’t know about such things.
Thank you very much to both of you for your service in such difficult professions. You have a very, very difficult job in these types of situations every day without having all of this added to it. I mean, the things you see, the people — you are dealing with people usually at the worst day of their life, and you’re having to deal with all the family members and all these other sorts of things. It’s a very difficult environment. That’s why we have to try to do what we can.
I’m glad you said that, Professor Donnelly, about public awareness, because I think that that could be a big component of this bill. We just heard from people in some significant organizations, national or provincial bodies, and this is the kind of thing that I imagine there’s going to be both earned media and, I’m sure, a tonne of social media, but maybe some of these associations will do ads about this to get the word out, if need be.
My first question, I guess, would be to Mr. Mausz. That one statistic, it broke my heart to hear that 7% of your colleagues had contemplated suicide in the past 14 days. That’s just so shocking, actually.
To just ask a bit about that, if you can tell me a little bit more about the psychological and emotional repercussions you’ve observed following these types of assaults that you’ve spoken about today. How do they affect the ability of paramedics to continue performing their duties? What is currently being done to help support them when they do experience these types of incidents and mental health concerns?
Mr. Mausz: Thank you very much, senator, for the question.
There are enormous psychological impacts from the nature of the work, as you alluded to. Paramedics encounter traumatic events on a fairly regular basis, and from the existing research, there are consequences to that among public safety personnel. As I said earlier, in Canada, paramedics have some of the highest rates, second only to either RCMP or corrections officers, for rates of symptoms consistent with different indicators of mental illness.
The 7% statistic that you referred to was from a study we did in 2019. We’re repeating that study now. Again, these data are preliminary and are not yet peer-reviewed; the data is still being collected. However, our early indications are that, on the suicide question, specifically, the figure now sits at 10%, so it appears to have increased over the years. It’s difficult to say with certainty what might be driving that increase at this point, but it’s absolutely a cause for concern.
To the second point, there are programs in place, being developed or have been newly introduced — to speak specifically of Ontario, where I have a little bit more knowledge of the local context — to try to make programs and services available to support the mental health and well-being of public safety personnel, including paramedics. However, there are challenges to overcome.
Violence — to bring it back to this particular focus — compounds the risk. There are baseline levels of risk and mental health challenges among this group, but we understand that violence increases those, so mitigating that potential risk will help. Thank you.
Senator Batters: Thank you.
To go back to the last part of my question, which is that for many years, suicide prevention has been a personal cause of mine, owing to a personal situation. You have significant, tough circumstances, so I want to know what is currently being done to support people in your profession after these types of incidents happen.
Mr. Mausz: I can say quite honestly and with a degree of bias that I think you should take into consideration that the Peel Regional Paramedic Services is a model of excellence in regard to both the promotion of psychological health and safety among our workforce and in workplace violence prevention. From the 2019 study we did, we implemented suicide intervention training for all of our supervisors, as well as our union stewards because we have a very strong collaborative relationship with our labour union.
We developed a new program that is a partnership with Trillium Health Partners where our members are able to access expedited mental health assessment and treatment for work‑related mental illness. Through collective bargaining, we increased the psychology benefit coverage to be provided to all full-time members.
The service has taken a number of concrete steps to support the psychological health and safety of our paramedics. Some of these efforts are being expanded upon, provincially.
In many cases, however, they are implemented on a local level. It’s one service, another service, another service and so on. Many things fall under the purview of either the individual paramedic services or the provincial governments through existing health programs. It tends to be a bit piecemeal, not in a derogatory way, just that it’s service-dependent.
Senator Batters: I’m very happy to hear you say that they’re a model of excellence. I hope many paramedic organizations and other first responder organizations watching this today will look to those types of methods to help their members. Thank you.
Senator Prosper: Thanks to both of our witnesses for sharing your expertise, and thank you for your service.
I have a few questions, one being for Dr. Mausz. You mentioned that a majority of incidents go unreported, according to your research. Can you delve into that to give some of the reasons related to that finding?
Ms. Donnelly, you got into a four-pronged approach — research, evidence-informed strategies, public awareness, and a certain place for policy and legislation — where you said it’s a complex issue. Your testimony was that, with this piece of legislation, you do actually see some tangible benefits. Why do you think this legislation will have real positive impacts on the ground?
I will go to Mr. Mausz first and then over to you, Ms. Donnelly. Thank you.
Mr. Mausz: Thank you for the question, senator.
We did a study in 2019. We asked our members in the Peel Regional Paramedic services if they had experienced violent incidents, if they reported the incidents and if they didn’t, why not. We did a qualitative analysis of the survey responses we received, and we identified a framework largely to do with the organizational culture that we believe is broadly reflective of the profession. Violence is so widespread and so chronic that it becomes perceived as unpreventable.
It is particularly relevant for the bill being considered that the perception among the paramedics is that the violence is often without consequence for the people who perpetrate it. If you connect the dots between A to B to C — it is widespread and chronic, and it is unpreventable and without consequence — the implicit expectation for paramedics is that it normalizes the idea that in order to be a successful paramedic, you need to be able to brush it off or move on from violent incidents. It normalizes this degree of tolerance as an expected professional competency.
We don’t think that organizational culture is helpful from the standpoint of violence prevention, and a lot of research and organizational efforts we’ve undertaken in the region of Peel and elsewhere have started to disrupt that culture.
Senator Prosper: Thank you.
There was a further question for Ms. Donnelly.
Ms. Donnelly: If I could just tag on to Mr. Mausz’s comment, we’re fighting 40 years of headwinds in organizational culture in challenging the idea that there’s no value to reporting it. Whatever these data show, it’s absolutely an underreport, because paramedics still believe it’s not that bad, they should be able to put up with it and they’re not going to bother.
We’re going to get more and more reports of violence. Is that a good thing? We’re going to be hearing more about it. Is violence increasing, or are we getting more reports? That’s going to be an interesting question to ask.
But we have to change this culture.
I just wanted to tag on to Mr. Mausz’s comment and note that we’ve got a lot of work to do in changing people’s minds about this.
As far as the value of this legislation, we talk about disrupting culture and changing people’s minds. If the Government of Canada says they think we’re special enough to create a piece of legislation that says that if we’re criminally assaulted, they’re going to create a designation that says it is an aggravating factor. That’s a pretty powerful, positive message for paramedics to hear.
In talking about doing the work of trying to disrupt culture, this could help. It does a really lovely job of potentially raising public awareness about this, because it’s largely invisible in the public consciousness.
We need to continue to have collaborative and collegial discussions with police officers in local municipalities around charging and with local Crown authorities about when to lay charges and what meets the bar for criminality. Those conversations have to be had so they understand, first, that paramedics aren’t the police. They’re different people doing different work, and when they experience violence, it should be treated differently. Then, raising awareness with the Crown is to inform them that this is something that is happening and should be taken seriously.
When we think about deterrence, I love the point that was made in the last panel: Deter 10 people. That’s great; that’s 10 fewer assaults that our folks have to deal with. But there are a lot of other consequences to the paramedic community — to all first responders. There are a lot of paramedics here today, but it is also to firefighters and other folks on the front line, including all the folks in health care settings.
It does a lot of work in that way to try and change what we can expect for ourselves in our workplaces.
[Translation]
Senator Oudar: Thank you to both witnesses. You’ve shed some very relevant light on this matter for us. I also believe that the bill will make a strong gesture towards zero tolerance of violence. Zero tolerance means accepting complaints within the organization, and even encouraging them.
I spoke to the previous witness about the importance of building prevention programs that cover all elements of violence. There are two risk factors, among many I won’t go into here, that are less well identified in the literature. Both witnesses mentioned them.
The first risk factor that has been identified, which I haven’t seen elsewhere in all the literature, is the challenges posed by the public health care system. We all thought there would be fewer acts of violence after the pandemic. On the contrary, from what I’ve learned in my work over the past eight years, these incidents are on the rise. According to the Association of Workers’ Compensation Boards of Canada, with whom I’ve worked, the statistics are the same.
The second risk factor identified is the labour shortage in the sectors of activity under discussion, particularly health care.
I’d like to hear from you more specifically on these two risk factors, i.e., the degradation of the health care system, which generates these violent events on the part of clients, and the shortage of personnel, which is also becoming a risk factor.
Do you share the same findings as previous witnesses on this subject?
[English]
The Chair: By eyesight, that is directed initially at you, Professor Donnelly?
Ms. Donnelly: I don’t know that I can effectively comment on that. The research that I’ve done and the space that I inhabit doesn’t capture some of those larger structural questions. I love that you’re asking those larger structural questions, and it goes back to our need for more research.
I don’t know if my colleague has any further thoughts, but I don’t have an evidence base that I can point to around how those risk factors may be exacerbating the risk of violence.
Mr. Mausz: Like my colleague, I’m hesitant to get too far out and comment on things we don’t have reliable data to support.
There’s an indicator in our 2023 study where we looked at the prevalence of violence. One thing we did find that might speak to this in an indirect way, perhaps, is when paramedics experience an offload delay with a patient being received at an emergency department at a hospital after they brought the patient in, we see the risk of violence goes up where the delay exceeds 30 minutes. The risk of assault more than doubles where that offload delay time exceeds 30 minutes.
I should emphasize these are relative increases in risk, and the absolute risk is still rather low, but there is something there. That increase was statistically significant. I think offload delay is a symptom of a strain on the health care system. It may not be a function of absolute numbers but perhaps of alignment between existing needs of what the health care system, including paramedics, are able to deliver, and if there’s a mismatch between those things. I think it’s reasonable to expect that could create conflict and the conflict could escalate to violence.
The Chair: Thank you.
[Translation]
Senator Oudar: Indeed, I don’t think there are any precise data, but you’re putting your finger on something important, which is the impact of waiting periods, which creates a greater mental or emotional load on clients that causes these outbursts. Nor do we understand why, after a pandemic period during which benevolence was at the forefront, and when we shouldn’t be seeing these acts of violence, the statistics show the opposite, since these acts of violence are, unfortunately, on the increase. We need to look elsewhere for the causes. We’re taking a first step with this bill, which I hope will send a strong message. However, we will then have to find the reasons for this problem, so that it doesn’t happen again.
[English]
The Chair: I see a couple nods of the head, which I think interpreted your comment as a question, and they agree.
Senator McBean: Thank you. I’d love to think we’re coming in on this and protecting paramedics, nurses and the first responders, but I have the sense it’s responding. The response will always be a value of the reporting, because this is all about sentencing; this is what we’re doing; is it affecting sentencing, coming from charges, which is coming from reporting?
I’m wondering, Professor Donnelly, if you have any idea how institutions should be better supporting staff and navigating the reporting process.
Ms. Donnelly: I think this has to start in institutions. I’m not sure — do you mean employer institutions, or?
Senator McBean: Well, for any of the first responders or paramedics who have been victims of violence, we need them to have a better system and feel more comfortable and more embraced. One of the other witnesses said that they want a value to reporting, and in fact, she said it would be nice if people were actually grateful that somebody reported versus the opposite.
Have you given any thought in your research on how to report? Because if we’re trying to make people feel better about the whole process, also having people listen to the fact that it’s happening, do you think there’s any sense of how a system can be created for better reporting?
Ms. Donnelly: I’m happy to answer that question, but I want to acknowledge that I’m going to be talking about what is going on at Peel Region so this is also something that Mr. Mausz can weigh in on as well.
The decision to try to address this issue was an institutional one, and it came from the leadership. The leadership supported one of their employees by the name of Mandy Johnston to develop this violence-reporting tool.
There was policy changes and training was deployed; and they did early research to understand why people didn’t want to report, and then they created this program to address all those concerns.
One of the mechanisms they built into this reporting structure is that supervisors have to follow up on every report. That can be, “Hey, do you need help filling out paperwork?” or “Hey, let’s talk about contacting the police,” or “Hey, I’m sorry that happened to you.”
There’s an institutional commitment to follow up with paramedics and make them understand that the reports are being taken seriously and they’re not just disappearing into the ether. You have this organizational commitment to say, “I hear you, thank you for reporting.”
Another really cool secondary consequence to this reporting structure is that paramedics have occasionally reported — and this is secondary, I’m repeating something that Mandy Johnston told me — that “I filled something out and I felt so much better about it. I just downloaded this experience into this report, and I was able to release it.” There’s almost this cathartic experience in just being able to document it and know someone will see this; this is going to be heard and respected and this is going to be a part of my experience that is valued.
Whether or not at the end of the day charges are laid, having the sense that an organization has your back is really powerful. I just stole a lot of thunder that doesn’t belong to me. That is very much the work that Mr. Mausz and Ms. Johnston have done.
Mr. Mausz, do you want to pop in on that?
Mr. Mausz: Thank you for the question, and I’ll make it very brief. Our 2019 study, when we asked people if they reported the incidents, less than 40% indicated they did. Our service, particularly under the leadership of now commander Mandy Johnston, it was a herculean effort to develop a comprehensive, prevent violence programming, new equipment, new procedures, new policies, new everything.
We surveyed our members again two years after this effort was undertaken, and willingness to report more than doubled, over 80%.
I would like to read you one quote we’ve published from that survey we did attributing this to change in culture and the concrete benefits that have strengthened paramedic safety.
They said:
I understand the value of reporting to support change within the profession, even if not impacted myself, I [file reports] to keep my co-workers safe. I see the efforts of the service to address violence and I appreciate them. Reporting is me doing my part.
Thank you.
Senator McBean: Thank you very much for that.
The Chair: Thank you both once again.
Senator Clement: Thank you to the witnesses. Thank you for your work. I think you listened in on the previous panel, so you heard me say that paramedics are some of my favourite people.
I want to ask a big question, but I’ll leave that one for last.
The first one, though, is around intersectionality. Dr. Mausz you talked about people with intersectionality being maybe disproportionately impacted. Could you lean into that?
I just want to say, as an Ontario senator, I’m very proud of the work done in Peel Region. I’m a legal aid lawyer by profession and from the social services background. I grew up in my profession always admiring Peel Region and that whole area for leaning into research and innovation. I want to say as an Ontario senator that I’m very proud. I’m not surprised at all that Peel Region is doing this kind of work.
Back to the question about intersectionality, if either of you have any comments about that.
Mr. Mausz: I’m proud to be a part of Peel Region. We have been tremendously forward thinking in supporting research of this kind, particularly on this and other topics. It advances our profession and the quality of the service we provide considerably.
To your question about intersectionality specifically, this is in reference to a paper we published earlier this year that looked at an analysis of one year of violence reports. We had two supervisors qualitatively review the free-text narrative descriptions from these reports. When a paramedic files a report, there is one free-text narrative box and they type a detailed description of what happened. They are encouraged to include quotes. Two supervisors reviewed one year of these reports and qualitatively analyzed each one to see if there were overt references or undertones of intersections, anything that touched on a protected identity grounds as explained under the Ontario Human Rights Code, particularly gender, sexual orientation, race or ethnicity. We found that 25% of the reports met that. They contained some form of verbal abuse on these identity grounds.
The other thing is the reports gather whether or not the paramedic is emotionally distressed at the time of reporting. We found that compared to other forms of violence, paramedics were 60% more likely to indicate they were emotionally distressed at the time of the reporting when the report documented abuse on one of those protective identity grounds, more so than physical assault, for example. Is that helpful, senator? Thank you.
Senator Clement: Not surprising, based on some of the other research I have seen in terms of systemic racism and even my own personal experiences.
Professor Donnelly, do you have anything to add?
Ms. Donnelly: I’m so grateful we were able to do this work because that kind of violence, that subtle violence and the words and the language that is used, has not been captured previously in this space. That is hugely impactful. As a woman who has worked in ambulances, having sexist and misogynistic things said to me, I’ve done my best. You think to yourself, “You’re not the best person on the planet to hang out with. I think I’ll try to move you along.” At the same time, it takes a toll.
Senator Clement: They stay in your heart, those issues.
The big question, I think, is around the increase in violence overall because I know you quote the 2019 study, but I wondered if, since the pandemic, you noticed more violence overall?
I guess that question comes too because, Professor Donnelly, you talked about it being a public health threat and that it hurts everyone in the community. I suspect that we’re struggling more with collective action these days — I don’t know why I’m smiling because it’s terrible. I wonder if you could comment on whether you have seen more violence since the pandemic and why you think there was an increase in violence overall.
Ms. Donnelly: I can’t answer your question because this data is the first time we’ve ever captured it at the point of event. There have been surveys that have happened in the past, but those surveys ask questions like “How often has this happened to you in the last 12 months?” or “How often has this happened to you in your lifetime?” This project that Mr. Mausz and I have been privileged to work on is the first time we have been able to describe the incidents and the prevalence of violence in the paramedic community.
I can’t speak to increasing violence from our data. I know that we can now describe it and that we are continuing to gather data so, moving forward, we’ll be able to ask, “Are there more reports coming in?” and “What are we seeing in these reports?”
But this is a brand new research effort for the paramedic community, so it’s really difficult for me to comment.
Senator Clement: Dr. Mausz, do you have any further comments around increasing violence overall and whether that has an impact on —
Mr. Mausz: I wish I had a better answer for you, but like my colleague Professor Donnelly said, we are just starting to get a handle on this insofar as the paramedic group is considered.
There are research studies that look at other health care professions, and they point to an increase in violence. Many of them use surveys. Like Professor Donnelly was explaining, surveys are helpful for drawing attention to an issue, but what makes Peel Region’s approach to this unique is that we are gathering event-level data documented by the paramedic after the 911 call.
Certainly, that’s useful for research, which we have done, but it is enormously useful for violence-prevention programs. Now we can trend it. Now we can trend it, and we can identify risk factors. We can try to get ahead of them. We can develop new policies and programs. We can put together business cases for training and for equipment. We can collaborate with police partners. That’s where the real value of this data has demonstrated itself over and over. That’s why our members are more than twice as willing now when they see the effects of this to file reports.
But I am sorry that because it’s so new, I can’t tell you if it’s increased.
Senator Clement: You’re sharing this beyond Ontario as well. That’s my understanding. I know things are local, but you’re — you’re what? Sorry?
Mr. Mausz: We are certainly trying. Absolutely.
Senator Clement: You’re trying. Thank you.
The Chair: I have a question, but I’m going to lay a bit of a platform for it. One of the questions is whether this legislation is able to be effective. One dimension of it is, as we have discussed, the psychological message that it sends to first responders and nurses and caregivers that the Parliament of Canada cares, is concerned about and is beginning to understand the challenges and the environment in which you and your colleagues’ work. That’s not easily measurable. It’s not unimportant, but it’s not measurable.
Another is: Does this legislation, just in the statement it makes, modify the behaviours of the way in which people act toward first responders, nurses and the like?
The third is: Do we see more people held accountable for the aggravated circumstance of attacking or assaulting basically a front-line worker? It’s not entirely clear to me that the justice system precisely measures that. I’m wondering, Mr. Mausz, since you’re deeper into the numbers and the information gathering, whether it’s likely in the coming years that you will see a way of tracking that question about whether, for example, first responders in your work are making complaints that lead to criminal sanctions against people at the level that this legislation is intended to achieve.
I’m trying to anticipate for the future reflectors on this, including yourselves, if this legislation will have had a positive impact in the range of ways that you’re hoping for.
Mr. Mausz: Certainly, I understand and acknowledge that, on the one hand, it’s not by its nature preventative, but I do think that it can have a significant impact. Earlier we saw that the reasons why our members don’t file reports are, in part, because they feel that there aren’t consequences for the people who perpetrated the violence, and therefore, it’s not worth reporting. I do think we can see an impact there. It’s measurable, even if it takes a bit of time, with data.
But on the prevention side, this needs to work in combination with organizational efforts at the service level, at the level of the provincial and municipal governments, to identify 911 calls in our context with a risk of violence and develop proactive strategies to mitigate the risk. I do think we are making progress on that as well.
The Chair: Professor Donnelly, any observations about this question of measuring success if I could call it that?
Ms. Donnelly: I think that if you were to champion some funding and research calls, we could measure that.
The Chair: You sound like a professor. I would give the same answer in your shoes. Thank you. That is inciteful. It’s important in all kinds of ways.
In fact, even the interest in knowing how well this is working sends a message that we actually care about it. Your testimony and the testimony that we have been hearing in the study of this bill has raised our awareness and appreciation for your work, but also awareness of the vulnerabilities that the system is not adequately addressing right now.
I don’t think there are any other questions. As a result, I will take this opportunity to thank Ms. Poirier in advance for the submission she will provide us. Unfortunately, we weren’t able to hear her live and in person today. I want to thank Dr. Mausz for his presentation and sharing — though not finalized — the research that he and others have undertaken.
Thank you, Professor Donnelly, for making the point of coming here in person and sharing your thoughts, perspectives and expertise and responding as well as each of you have to help us understand this question more fully.
A reminder colleagues, our intention tomorrow is to move to clause-by-clause consideration of the bill. I hope we will have a good turnout and a good discussion. I have a small feeling that it will be a short meeting tomorrow. I think the shorter the meeting, the more positive an endorsement to the first responder and nursing community we can make.
Having predicted that, I’m going to bring this meeting to a close and thank you all once again. We will see you tomorrow.
(The committee adjourned.)