Dear Colleagues,

Below you'll find a piece by Kevin Connor of the Toronto Sun which describes how he and a staff photographer gained access to a variety of treatment areas at Toronto-area hospitals including the Emergency Department at Toronto General. I think the story is somewhat sensational in its approach but it does underline the difficulty we have in operating a public facility which has to be accessible, while protecting the privacy of the individuals we are treating. For me, it underlines the importance of three things we can all do to make our environment safer for our patients and for all of our staff:

  • Wearing your UHN photo identification card is policy. Your card indicates that you work here and that you have access to areas of the hospital which are
  • If you notice people in treatment or restricted areas who do not have an identification card, you can then ask them if they are lost or need help in finding where they are going.
  • If there are areas which we should consider 'locking down' and restricting access, you should talk to your manager about your concerns who will, in turn, talk to Security about the need to restrict access to specific treatment areas.

Security in the hospital is a fine balance. We need our patients, their family members and visitors to be able to use our facilities in a way that makes them comfortable while ensuring that treatment areas, sensitive equipment and other areas of the hospital are not open and available to someone with destructive intent. You can help by owning your work environment and complying with respect to identification cards. It's important that only individuals who have a reason to be in treatment areas are allowed entry.

I'd welcome any thoughts or suggestions you might have about this issue.


Unrestricted access 
Sun team found it had free rein of 4 GTA facilities - including ERs and patient rooms - no questions asked

Patients at some Toronto hospitals may be safe from acquiring bacterium infections during their stay but their security is in serious question, a Toronto Sun investigation has found.

In the second week of April, a male Sun reporter and a female Sun photographer -- using test kits and procedures supplied by Noraxx Inspections Inc., a medical company that performs laboratory audits -- went into four GTA hospitals and took swab samples in CSI fashion.

Although no bacteria, such as C. difficle or Staphylococcus aureus, were found, the investigation showed that someone in street clothes and without any identification could walk into a hospital, go into restricted areas and do what they wanted, with no questions asked.

The Sun collected swabs at Sunnybrook Health Sciences Centre, The Hospital for Sick Children, Toronto General Hospital and Trillium Health Centre in Mississauga.

Swabs were obtained from some very sensitive areas, including exam rooms in emergency departments and from patient rooms.

At Trillium, a swab was taken from the emergency department's registration table in the presence of a nurse. The nurse -- who never looked up -- said "I'll be with you in a minute" while the swab sample was taken.


The Sun investigation shows that an unauthorized person in street clothes could introduce a contaminant to a hospital, said Dave Harris, a former chief of strategic planning and security, and president of Ottawa-based Insignis Strategic Research, a counter-terrorism and national security consulting company.

"It's horrifying that someone could gain that kind of access," Harris said. "This three-piece suit kind of infiltration is better than having bio-tech ID cards.

"It's amazingly unacceptable because patients are highly vulnerable or helpless.

"There is a duty of care that needs to be attended to," he said, adding "someone could contaminate all manner of items with whatever they want ... equipment presumed to be sanitized. With this lack of security an unauthorized person could create a mass casualty attack on a hospital."

Earlier this month, an intruder tried to kiss and touch a 91-year-old bedridden woman in her room at Toronto East General Hospital. A man was later charged.

Earlier this year, a woman was taken to Sunnybrook after she was shot in the face. Police allege on more than one occasion the shooter went to the hospital looking for his victim. An armed guard was stationed at the woman's door.

Hospitals are public places and security is an issue, Hilary Short, president of the Ontario Hospital Association, said, adding it would be easier if the media didn't report the name of the hospital treating victims of violence.

"(The hospital access the Sun was able to achieve) has taken me by surprise. Most people in hospitals have legitimate business, but hospitals face challenges occasionally with people who have evil intent," Short said.


Sun staffers were able to enter an exam room at Sunnybrook, close the door and lock it, and take swabs and photographs.

They were also able to gain access to a palliative care patient's room adjacent to the nursing station.

No one should be able to just walk into an exam room, Craig DuHamel, spokesman for Sunnybrook, said.

"I'm concerned that there could be such free access. People could be looking for sensitive material. I guess it doesn't surprise me that it could happen during the day when there are visiting hours, but at night we go into lockdown and the only access is the emergency department," DuHamel said, adding while someone could leave contaminants behind, no one would be able to access narcotics.

"Clearly, this is something that needs looking into. Wow. This is concerning. We definitely have to look at this ... balancing security with the rights of people to visit their loved ones."

He said patients who are victims of violent crimes are very secure in the hospital.

"You need a proximity card to get near them," he said.


Hospitals are "public institutions" that encourage visitors, Trillium spokesman Larry Roberts said.

Three security guards and an officer with Peel Regional Police were present in Trillium's emergency department while it was swabbed.

"Visitors are allowed and we have security in place. In this case we didn't get you. I don't know why you didn't arouse suspicion," Roberts told the Sun. "We will remind our staff to watch out and challenge people."


Toronto General Hospital will be more vigilant with the identification of strangers following the Sun's investigation, said Todd Milne, manager of security for the University Health Network.

"I'm absolutely concerned, because we take security very seriously. We have bi-weekly security sessions. The hospital is like a small city, but from now on we will be asking 'Can I help you?' to verify the identification of strangers. If a person is not wearing hospital identification, there should be that question," Milne said.

Swabs at Toronto General were taken from a patient's room in the emergency department and from a ward.


The Hospital for Sick Children was the most secure facility, mainly because of the layout of the building.

Most wards have a reception that needs to be passed and a visitor/parent ID badge is required. However, the Sun bypassed security in the ambulatory care department and swabbed an exam room.

Sick Kids may be secure from outsiders, but the hospital has had security problems with staff in the past.

A former male nurse was convicted of having a collection of child pornography and was placed on the national sex offender registry.

And in the 1980s, nurse Susan Nelles was charged with the murder of four babies after tests indicated up to 43 infants had been poisoned by digoxin in the cardiac ward. Nelles was exonerated and the charges dropped, but a royal commission later concluded that at least eight infants had been murdered. Suspicion fell on another staff member but no one else was ever charged.


Sick Kids is prone to have small clusters of viral infections, said Richard Wray, with the hospital's infection prevention department.

"There are a number of factors why we are a clean facility. Fortunately, we are a new facility. The design and products used in construction help to keep it clean," Wray said.

The two dozen swabs taken at the hospitals and two other control sites contained concentrations below the government's reportable detectable levels as set by the Standards Council of Canada for bacterium, such as staphs.

"It could be because the hospitals have good maintenance or that they are using cleansers with a high alcohol content, which leaves a residue that kills bacteria for a time after cleaning. Or the swabs could have been taken soon after a surface was cleaned," said Al Brewer, a biotechnologist with Noraxx.


The government takes the issue of hospital security very seriously and is confident that our institutions do as well, said George Smitherman, Ontario's minister of health.

"Our expectation is that hospitals put in place the appropriate security measures, protocols and personnel in keeping with the specific needs of their individual institution," he said.

"It is the hospital's responsibility to provide adequate security for patients and staff, while allowing for the appropriate flow of visitors and other authorized personnel," he said. "Where a hospital has identified that security measures need to be improved, it is our further expectation that this will occur in a timely way." ​

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