Politician works to untie elderly patients

When Francis Lankin walked in to her mother’s hospital room a year ago, she was in for a shock. Her mother, now 88, has Parkinsons and Alzheimer’s.

“After giving clear family instructions she was not to be restrained, we were to be called if she was agitated at all, I found her the next day in a restraint jacket, tied to the bed, crying and stripped of all dignity,” says the NDP member of the Ontario legislature.

Lankin says her shock that day led her to introduce a private member’s bill to strictly govern the use of physical restraints in Ontario hospitals. Bill 135, Public Hospitals Amendment Act, reached second reading and public hearings before it died when the Ontario Legislature ended its session in March 2001.

Now, Lankin has re-introduced the bill and is working with government health staff to help win the support of the government. She says the reasons for the bill are still there and it’s an issue that needs attention right across Canada. She hopes the bill passes before she leaves politics to take up new job with the United Way in the fall.
Seniors tied up
“I could not believe that this could happen in an Ontario spital, with supposed laws around patient consent and with a daughter who’s a strong advocate and knows the system,” says Lankin, who represents the downtown Toronto riding of Beaches-East York.

“What I found out just appalled me. I had no idea literally thousands of seniors are tied up every day and every night in hospitals. And in fact, I had no idea that if you have any confusion when you come into the emergency room, it’s pretty well standard practice to have written on your chart ‘PRN’-which means ‘physical restraint if necessary’. And there are no appropriate checks and balances, I believe, in the system from that point on,” says Lankin.

Lankin’s old bill proposed regulations for the use of restraints, including a written order from a physician. The old bill also proposed that any use beyond two hours require reassessment and a new order.

Lankin says her new bill may contain fewer specifics. She says some of the detail, like the length of time between monitoring and physician re-ordering, could be covered in regulations in a new policy under development by the Ontario Hospitals Association. This umbrella groups represents hospitals in Ontario.

Laws not policies
“For me, what is really critical is that there be a statement in the legislation that makes it very clear that this province does not accept the practice of unnecessary restraint of patients, primarily in this case the elderly,” says Lankin.

“Hospitals will argue that they have policies. I’ve seen first hand that they’re not adhered to. In stressed wards that are understaffed, where people are just trying to get by, sometimes, with a confused patient, the easiest thing is to keep them from being a problem. And all too often, what that means is to tie them up,” she says.

Laws elsewhere
Across Canada, there are hospital policies but not laws regarding the use of restraints in hospitals. In Quebec, the use of restraints can’t be implemented without a doctor’s ‘prescription.’ In British Columbia, a law amended in 1999 puts restrictions on restraints in adult care facilities.

The B.C. Community Care Act says a restraint may only be used in care homes if “all alternatives to the use of a restraint have been exhausted; the restraint is as minimal as possible” and approved by the resident or the resident’s doctor. The B.C. act also requires training for staff on how to use and monitor the restraint.

In the United States, a federal law passed in 1999 withholds federal funding for any institutions without restraint policies. Lankin says there are also a number of American states now working on laws similar to her proposals.

“Quite frankly, if you go to other jurisdictions around the world, there aren’t laws, because they don’t need them. They don’t have a cultural practice of tying up old people like we do. It’s something that we seemed to have accepted. I’m just amazed. As far as I’m concerned, it is a criminal, physical assault on a human being,” she says.

Comments on proposals
At the public hearings into her original bill held in February in Toronto, 12 organizations appeared before an Ontario legislative committee. CARP, the lobby group representing Canada’s 50plus, was one of them. Bill Gleberzon, CARP associate executive director, said chemical restraints should also be included in the definition of restraints.

He proposed that alternatives be identified and implemented before resorting to physical restraints. He also wanted patients, their families or substitute decision-makers to receive copies of hospital policies and procedures with regard to restraining patients, with consent given before restraining a patient.  

Lankin says she knows a private member’s bill doesn’t usually fare well in the legislative process. But the overwhelming support she has received for her initiative gives her hope that some changes will be made.

“The nurses and the doctors have said they support something. They think it can be done in regulation as opposed to with a bill. I’m still pushing for the bill,” says Lankin.

Hospital response
“The only people who have said don’t do it at all is the Ontario Hospital Association. They have undertaken some other initiatives. They are revising their policy, updating it. And they are holding a major educational conference this fall, spurred by my bill, which is all very positive. But hospitals don’t want further regulation. I have made it very clear that I don’t believe behaviour will change unless we put it in place by law and we require them by law to change,”

“The minister thus far has been very open with me to consider support for this and has been very sympathetic to what I am trying to achieve.” says Lankin.

Public awareness
“But the biggest goal of all of this is to raise public awareness of what is happening in our hospitals and to hold hospitals accountable for changing their behaviour. I think we’ve taken some huge steps down that road already, just by the introduction of the bill, the public hearings and media exposure on the issue. We’ve still got a long way to go, and I’m going to continue,” she says.

Lankin says her mother now lives with her brother, and she does respite care on weekends.

“Because we recognize from experience that someone who can’t advocate for themselves and who has confusion and would be a ‘problem’ patient, would have just a horrible life in any institution. And so we struggle to do our best. Since this incident in the hospital, my Mum has had her 88th birthday-and we hope and look forward to many more with her,” says Lankin.