Inspections find 13 Ontario hospitals unprepared for Ebola cases

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One hospital in northwest Toronto did not have Ebola protective gear readily available for its lab and emergency room staff. Another, in Hamilton, had three members of its housekeeping staff refuse to clean the room of a suspected Ebola patient because the cleaners felt they had not been trained to do it safely.

Those are some of the litany of shortcomings uncovered during the Ontario Ministry of Labour's Ebola-related inspections of hospitals in the province, The Globe and Mail has learned.

The ministry has issued 50 compliance orders to 13 hospitals and one paramedic service since August, most citing failures to properly train staff, provide personal protective equipment for everyone who needs it or draw up adequate plans to contain a lethal virus that has ravaged Sierra Leone, Guinea and Liberia and is now sowing panic in North America.

Preparing for a possible Ebola case in Canada took on a new urgency this week after a pair of nurses in Texas caught the viral hemorhaggic fever from a Liberian patient who succumbed to the disease. The many failures that led to those infections prompted U.S. President Barack Obama to appoint an Ebola "czar" on Friday, the same day the World Health Organization admitted it botched the early response to the West African outbreak, which has now killed more than 4,500 and infected nearly 10,000.

Ottawa, meanwhile, announced Friday that it would donate another $30-million to the global effort to tackle Ebola, nearly doubling Canada's contribution so far.

Summaries of the Ontario compliance orders, compiled at the request of The Globe, back up claims from nursing leaders across Canada this week that some hospitals are no better prepared for Ebola than their beleaguered counterpart in Dallas, despite reassurances to the contrary from top public health officials.

"I don't think we were well-prepared," said Doris Grinspun, chief executive officer of the Registered Nurses' Association of Ontario. "We actually approached and spoke with the [health] minister himself, because we felt … the province needed a very clear plan."

On Friday, Ontario Health Minister Eric Hoskins unveiled new "enhanced measures" to contain Ebola if a case turns up here. Among the slew of new directives and guidelines Dr. Hoskins announced is the availability of preliminary Ebola testing at Public Health Ontario's provincial labs, starting Monday, and the designation of 10 Ontario hospitals as Ebola treatment centres.

Asked later about the inspection reports, he said by e-mail, "We are confident that Ontario was and is prepared for Ebola virus."

The province has conducted 16 Ebola preparedness inspections so far, nine of which were "reactive" inspections, meaning that a complaint from an employee or a suspected Ebola case likely triggered the visit. Only two hospitals, North York General in Toronto and Lakeridge Health in Oshawa, passed the inspections without being served with compliance orders.

There have been 10 suspected cases of Ebola in Ontario and 25 in Canada, all of which have turned out to be false alarms.

One of those potential patients came to McMaster University Medical Centre in Hamilton on Sept. 1. Three housekeepers refused to clean the isolation room of the suspected patient because they had not been adequately trained and could not find all the personal protective equipment they needed.

The work refusal sparked an inspection that led the ministry to issue five orders against the hospital concerning how it prepares staff to clean the rooms of Ebola patients – orders the hospital says it has heeded.

"We're prepared," said Kirsten Krull, the chief nursing executive at Hamilton Health Sciences, which includes the McMaster hospital.

"We want to do even more, no doubt about it, because people get extremely nervous about the situation."

Three of the 10 designated hospitals are on the list of hospitals that received compliance orders from the Ministry of Labour: Hamilton Health Sciences, Sunnybrook and Toronto Western – a hospital that had extra reason to prepare for Ebola because it has been tapped to treat any Canadian aid workers who contract the virus in West Africa.

Toronto Western received six compliance orders after a pro-active inspection Oct. 8, most for minor violations such as failing to have personal protective equipment immediately available for security staff in the emergency room. The hospital said a cart containing the PPE had been moved and the problem was rectified before the end of the visit.

Officials at Toronto Western and Toronto General – which received four compliance orders after an inspection Oct. 10 – provided full copies of their inspection reports, which also praised the hospitals for going beyond the Ebola preparedness requirements set out by Public Health Ontario.

The Ministry of Labour summary document cited a Peterborough hospital for not developing procedures "in consultation with the joint health and safety committee in the workplace."

Hospital spokeswoman Jane Davidson said the staff in infection control "are fully engaged in training and have been for some weeks, and are running extra training simulations."

Editor's Note: The original newspaper version of this article and an earlier online version incorrectly said a hospital in Peterborough had not developed any Ebola procedures. In fact, the Peterborough Regional Health Center was cited in a Ministry of Labour summary document for not having developed procedures "in consultation with the joint health and safety committee in the workplace." Hospital spokesman Jane Davidson said the staff in infection control "are fully engaged in training and have been for some weeks, and are running extra training simulations." This online version has been corrected.