SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
Volume 2
Number 3,
November 19, 2003
This Health Hazard Alert for OPSEU members is provided to supplement information from Public Health, Ministry of Health (MOH), and Health Canada, and explains your rights under the Occupational Health and Safety Act and the Workplace Safety and Insurance Act.
OPSEU members not consulted on “New Normal” Directives
OPSEU hospital professionals work alongside doctors and nurses, and face the same risks on the job. During the recent SARS outbreak, our members had to fight to get the same equipment other medical professionals were given. In many cases the directives did not address
the specific information needs of OPSEU members who provide services just as critical as doctors and nurses. For example, at times during the outbreak, and amid the changing directives, clerical workers in emergency departments were not given protective equipment because they weren’t considered to be “in direct contact” with patients. This didn’t make sense and
placed these workers at greater risk. On many occasions, OPSEU members had to fight to get the protection they are entitled to under the Occupational Health and Safety Act (OHSA). In fact, by the end of the SARS outbreak, five clerical OPSEU members contracted SARS. Workers such as respiratory therapists, dietary aides, diagnostic imaging and housekeeping aides
also contracted SARS; some of these were OPSEU members.
Recently, other unions were invited to provide feedback on draft directives—but not OPSEU on behalf of OPSEU members. This is not acceptable. On October 22, 2003, OPSEU President Leah Casselman wrote a letter to the Ministry of Health and Long Term Care to address the
continuing lack of consultation with OPSEU, “The purpose of the directives should be two-fold, to protect the public and to protect workers from this highly infectious and sometimes fatal disease. This cannot be accomplished without input from those who understand the work processes and the knowledge base of all the different groups of Health Care Workers who may be
affected in the next crisis.”
OPSEU will continue to take an active role in ensuring that OPSEU members participate in the health and safety issues that may ultimately save their lives.
New “Infection Control Task Force”
The Ministry of Health and Long Term Care is setting up an Infection Control Task Force to make recommendations on infection control standards. The task force will review existing directives and draft directives for non-outbreak conditions, routine practice
guidelines from Health Canada, and other relevant material and make recommendations to improve infection control standards in all types of facilities.
While at least one other union has been invited to participate on the Task Force, OPSEU has not. OPSEU is requesting to participate to ensure that the new standards meet the needs of our members.
October 22 Directives
The Ministry of Health and Long Term Care released a new set of directives on October 22, 2003, primarily focussing on outbreak procedures. New directives will be released shortly regarding non-acute care facilities.
· Provincial Inter-Facility Patient Transfer Directive during outbreak conditions (PIPT03-03)
· SARS Risk Management Algorithm and Risk Factor Screening Tool
· Directive to All Ontario Acute Care Facilities for High risk respiratory procedures (includes both outbreak and non-outbreak conditions) (HR03-12)
· Directive to all Ontario Acute Care Facilities under outbreak conditions (ACO03-05)
· Directive to all Acute Care Facilities regarding the application of respiratory and contact precautions (enhanced) with: Patients with febrile respiratory
illness and a SARS contact history; Persons under investigation; SARS patients; and SARS units (RCPE 03-01)
Discuss the directives at JHSC meetings
One big failing during the SARS outbreak was the employer’s refusal in many cases to hold regular, or any, Joint Health and Safety Committee (JHSC) meetings—despite repeated requests from our committee members. OPSEU continues to advise members to insist on
regular JHSC meetings to discuss the directives and how they can best be implemented in OPSEU workplaces to provide all workers with appropriate protection. This is especially important for OPSEU members, who haven’t been given equal consideration in drawing up the directives. OPSEU members know OPSEU jobs best—therefore our JSHCs must review the directives and
recommend to the employer to implement them in a way that protects OPSEU members.
OPSEU members report that where JSHCs did meet during the SARS crisis and after, they were successful in improving health and safety measures.
Insist upon appropriate personal protective equipment and training before the next outbreak —SARS directives are a MINIMUM standard
Committees should review the directives now to see whether the personal protective equipment (PPE) described will be sufficient for all jobs OPSEU members do. Committees must also consider whether training on safely implementing the Directives and using
appropriate Personal Protective Equipment (PPE) is adequate. Remember, worker rights under the OHSA apply even under outbreak conditions. All workers must be protected when dealing with anyone suspected to have SARS.
The employer has an obligation to make reasonable provisions for workers’ safety. This obligation is known as their “general duty” under OHSA. It’s not a normal condition of work to do your job without these precautions; which may include special personal protective
equipment where necessary. Some workers used their right to refuse unsafe work in the last outbreak, and were successful in getting the equipment and training they were entitled to. So knowing your rights under the OHSA will help keep you safe in your job, and will help make sure that employers meet their obligations to make the workplace safer for all workers.
Work Refusals work
Since it is the Ministry of Labour (MOL)’s job to investigate workplace illnesses and injuries and to enforce the Occupational Health and Safety Act, OPSEU feels that the MOL should have played a more active role in the SARS crisis.
When the MOL did get involved, they supported worker concerns. For example, the MOL ruled that a nurse’s right to refuse was justified when she was directed to enter a SARS area wearing a mask that had not been properly fitted. The MOL inspector ordered the hospital
to immediately commence a fit-testing program and training for workers. This decision by the MOL was followed by orders to a number of other hospitals that had also neglected to fit-test and train their workers. These MOL decisions acted as the catalyst to urge other healthcare facilities to begin fit testing and training workers on the use of N95 masks and other
protective equipment. (All health care facilities should have a respiratory program that fits and trains workers on respiratory equipment.) We need to ensure that the MOL is made aware of problems and that they come in to support workers as they try to enforce their health and safety rights.
Don’t forget the “Complaint” process
It’s important that OPSEU members use the complaint process at the MOL if necessary. For example, if discussions at the committee level do not resolve your concerns about directives, or the employer won’t meet with the committee to discuss them, file a written
complaint with the MOL. When the Ministry of Labour receives a complaint, they schedule a time to investigate at the workplace.
It’s important however, to make (and document) your attempts to resolve the issue prior to complaining to the MOL. Bring issues up at the JHSC, and “minute” the discussions. Keep records of complaints to supervisors and all responses from management. Collect all
relevant documents and show the inspector the steps you have taken to try to resolve the problem.
SARS deemed a “Critical injury” triggers ‘reporting’ and ‘investigating’ provisions of Act
After intense lobbying, the MOL designated probable SARS as a “critical injury” that triggers the “notice” and “investigation” provisions under Section 51 of the Occupational Health and Safety Act.
That means that the employer must immediately report all probable and fatal cases of SARS to the MOL, the JHSC (or health and safety representative in smaller workplaces), the unions and the Workplace Safety and Insurance Board (WSIB). Section 51 further requires the
employer to send the MOL director within 48 hours a full written report of the circumstances of the occurrence containing prescribed information listed in the Health Care Regulation 5 (1).
Section 9 (31) of the Act entitles the worker members of a committee to select one or more such members to investigate critical injuries or deaths. (Section 8 (14) for the H&S representative in smaller workplaces) After investigating, the committee makes
recommendations to the employer aimed at preventing future occurrences.
If an MOL inspector inspects or investigates these occurrences at a workplace, Section 54 of the Act entitles a worker committee member, or a health and safety representative in smaller workplaces to accompany the inspector. If those representatives are not available,
a worker selected to represent workers by the union because of knowledge and training should accompany the inspector.
Cases of suspect SARS should be treated as occupational illness, not critical injuries. Section 52 (2) of OHSA requires the employer to report all occupational illness within four days to the MOL, the JHSC (or health and safety representative) and to the union.
OPSEU has concerns that many employers were slow to report critical injuries and occupational illnesses. Additionally, we are not aware of the Ministry of Labour initiating any investigations into any of the critical injuries. They have begun investigations into the
two SARS fatalities.
For more information, contact OPSEU’s Health and Safety Unit: 1-800-268-7376, 416-443-8888, ext. 772. Check the OPSEU website at www.opseu.org for future updates.
Current Directives from SARS Provincial Operations Centre
General
NEW ! SARS Risk Management Algorithm and Risk Factor Screening Tool
NEW ! Contextual Framework for SARS Response—October 22, 2003
Acute Care settings:
NEW ! Directive to all Ontario Acute Care Facilities under outbreak conditions (ACO03-05) October 22, 2003
NEW ! Directive to All Ontario Acute Care Facilities for High risk respiratory procedures (includes both outbreak and non-outbreak conditions) (HR03-12) October 22,
2003
NEW ! Directive to all Acute Care Facilities regarding the application of respiratory and contact precautions (enhanced) with: Patients with febrile respiratory
illness and a SARS contact history; Persons under investigation; SARS patients; and SARS units (RCPE 03-01) October 22, 2003
NEW ! Provincial Inter-Facility Patient Transfer Directive during Outbreak Conditions (PIPT03-03) October 22, 2003
Directive to All Ontario Acute Care Hospitals regarding Criti-Call Database(03-02 April 20, 2003)
Directive to All Ontario Acute Care Hospitals concerning discharge of non-SARS patients (03-02 June 20, 2003)
Directives to All Ontario Acute Care Hospitals concerning Discharge of SARS patients (including probable and suspect cases) (03-03 June 20, 2003)
Other Health Care settings:
Directive to All Ontario Rehabilitation, Complex Continuing Care and Specialty Hospitals (R03-02) – July 15, 2003
Directive to All Ontario Rehabilitation, Complex Continuing Care and Specialty Hospitals (R03-01) – June 16, 2003
Directive to all Ontario Non-Acute Care Facilities (L03-05) July 15, 2003-11-05
Directive to all Ontario Non-Acute Care Facilities (L03-04) June 16, 2003-11-05
Directive to all Community Care Access Centres (CC03-04) June 17, 2003-11-05
Directive to Ontario Health Care Providers in Community Settings and
Community Health Care Agencies (excluding Community Care Access Centres) (HCP03-02)– July 15, 2003
Directive to Ontario Health Care Providers in Community Settings and
Community Health Care Agencies (excluding Community Care Access Centres) (HCP03-01)– June 16, 2003
Directive to all Ontario Pre-Hospital Care Providers and Ambulance Communications Services—May 13, 2003
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