MUHC security: Is policy being followed?

Incident at birthing centre called for emergency alert, experts say

A threatening incident involving an emotionally disturbed man in the birthing centre of the McGill University Health Centre on Sunday has renewed concerns about whether the MUHC’s security protocols are being followed properly.

A 53-year-old man showed up in the birthing centre around 10:45 a.m. asking to see a member of his family. However, the man suddenly grew agitated in front of a nurse, claiming there were people trying to kill him, a Montreal police spokesperson told the Montreal Gazette.

“The man tried to explain this by (gesturing his thumb and forefinger) like a pistol,” Constable Caroline Chèvrefils said. “He pointed his hand at himself and toward her.

“The nurse was scared and she called security.”

What followed next has raised questions about whether the private security guards at the Glen site superhospital followed protocols to ensure the safety of both staff and patients, and to deal with the man who, as it turned out, ultimately required medical attention.

Despite the fact the nurse felt threatened by the man, no one activated a Code White, an emergency alert that triggers a hospital-wide response.

During a Code White, a team of health professionals and guards race to the scene to “subdue a patient (or visitor) who is expressing extreme agitation and/or violent behaviour,” according to the MUHC’s own guidelines.

The incident also underscores how MUHC nurses are still anxious months after a psychiatric patient nearly strangled an emergency room nurse at the Montreal General Hospital on Sept. 3, 2017.

Three guards responded to the call by the nurse in the birthing centre. The guards assessed the man, observing that he was calm, but they decided to escort him out of the building anyway.

The man lingered in the parking lot outside for more than an hour when someone from the birthing centre called 911, a source told the Montreal Gazette.

Police confirmed that a member of the hospital personnel placed the 911 call to report that a man was acting in a threatening manner toward staff.

In response to a series of questions Sunday night by the Montreal Gazette, the MUHC released a statement late Monday afternoon that differs from the police incident report in key respects, such as the timeline. The MUHC statement also does not mention that the man was suffering from mental-health issues.

“On June 17, at around 11:40 a.m., three trained security guards working at the Glen site responded to a situation in the birthing centre, where a person showing signs of aggressiveness had been making threatening remarks,” Gilda Salomone, an MUHC spokesperson, said in the statement.

“Upon arriving at the unit, the security guards followed protocol by briefly analyzing the situation and acting quickly to ensure the safety of patients, families and staff. Since the individual was calm at their arrival, they removed him from the birthing centre and the MUHC building, and then called the SPVM (Service de police de la ville de Montréal), who arrived quickly and took charge.”

Salomone added that a nurse also called the police. According to the police incident report, officers responded after a single 911 call.

“It’s important to note that unlike the security guards, the nurse initially called the police to report the incident, not to ask them to intervene,” Salomone explained. “The person showing signs of aggressiveness was later brought to the RVH (Royal Victoria Hospital) emergency department.”

Ultimately, it was the police — and not the guards — who learned that the man was suffering from a mental illness and had not been taking his medication.

Instead of arresting him or expelling him from the MUHC, as the guards decided was the best course of action, the police concluded the man “did not show criminal intent and he was handed over to the personnel of the hospital for examination by a doctor,” Chèvrefils said. “The police spoke to the man, and they quickly realized that the man was very confused in his words and he was in a state of distress,” Chèvrefils continued.

The police had interviewed witnesses earlier who said the man did not make any specific threats to anyone in the birthing centre, but he did act in a highly agitated state and was paranoid.

Two hospital security experts whom the Montreal Gazette consulted said Sunday’s incident warranted a Code White. “A Code White should have been called immediately to get backup,” said one of the experts, who spoke on condition of anonymity because of the sensitivity of the issue. “The police should have been called immediately.”

The MUHC superhospital is run as a public-private partnership, with the private consortium in charge of providing security. Asked whether the MUHC has ensured that the Glen site guards have received proper training to deal with potentially aggressive patients, Salomone responded: “Security guards working at the Glen site have the necessary training to intervene quickly and to ensure the safety of patients, families and staff during such situations. These security agents have a minimum of 70 hours of training, plus an additional minimum 80 hours of training at the MUHC and 16 hours training on Code White procedures (aggressive individuals). That’s a total of 166 hours of training, specialized training in MUHC protocols and Code White protocols.”

The nurse who faced the emotionally distraught man had the day off on Monday. “The nurses who were working (Sunday) have been debriefed and it is confirmed that they did not feel any distress as security came rapidly and escorted the person from the unit . ...

“However, (Sunday) following the incident, the assistant head nurse and her colleagues took some time to support her. She was OK at the time.”

Amy May, co-president of the Central Users’ Committee of the MUHC, expressed concern over how Sunday’s incident was handled. “After the attack at the MGH last fall, we expected that security measures had been improved at all sites of the MUHC to protect both patients and staff,” she said.

“This incident at the Glen causes us great concern because it exposes a weakness in training and protocol as to how to handle potential aggressors and/or mentally ill patients.”

They quickly realized that the man was very confused in his words and he was in a state of distress.