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How Beshry Sayed was assaulted makes for distressing reading. Distressing not only because of what happened to a frail man on his 80th birthday but because the attack occurred in the one place where his family thought he was safe: a public hospital.

The Dec. 12, 2004, act of violence by psychiatric patient Joao Carlos Freitas Henriques, who had HIV and hepatitis B, in a Toronto hospital has sparked a lawsuit by Mr. Sayed's family — and posed troubling questions about patient care and safety in Canada.

"What happened with my father is a nightmare," said his daughter, Mervat Sayed, who spoke on the condition she be identified by her birth name. "¡K Every time I saw him and I tried to feed him, I remembered what happened and I started to cry."

As a result of the assault, which reportedly involved human waste, Mr. Sayed can only receive nourishment from a gastronomy tube, according to a statement of claim filed in Ontario Superior Court. He suffered "horribly" from the incident, enduring many medical complications, including E. coli pneumonia, says the claim, which contains allegations not proven in court.

Lawyer Patrick Mazurek said the lawsuit raises a key question not just for his client, Mr. Sayed, but for all patients in health-care facilities: What level of care and protection can a patient expect from our public hospitals?

"People need to know if they are getting any level of protection," Mr. Mazurek said. "If you leave your child or your elderly parent there, can you count on some protection, because if you can't you have to act accordingly. Not to be silly about it, but do you have to bring a bodyguard with you when you go to a public hospital?"

In Ontario, there is no legislation compelling hospitals to report violent episodes between patients to the Health Ministry. Yet if the identical incident occurred in a nursing home, that home by law would have to report it.

In contrast, Alberta, Manitoba and Nova Scotia have acts making it mandatory to report suspicions of abuse, neglect or violence done to patients in hospitals or other health-care facilities.

And it's not just patients who suffer. A national survey of nearly 19,000 nurses found a staggering 29.6 per cent of those working in a hospital said they were physically abused by a patient over the past 12 months, according to the 2005 study done by the Canadian Institute for Health Information, Health Canada and Statistics Canada.

Disturbed by the violence, Lisa Little, associate director of public policy and communications for the Canadian Nurses Association, said her group is exploring whether Criminal Code amendments can be made to include a special provision for violence against health-care workers.

"Nurses are at higher risk than policemen and prison guards in terms of violence in the workplace," Ms. Little said. "They are caught in the fire of trying to deal with aggressive or frustrated clients. There is a misperception that it's part of your job."

Jane Meadus, a lawyer for the Advocacy Centre for the Elderly, said hospitals often take matters into their own hands and do not call police, thinking the patient assaulting other patients may not be mentally capable and so would not be convicted, she said.

"If a person is assaulting people, the police should be notified," Ms. Meadus said. "It's between the police and Crown attorney to determine whether or not that person should be charged."

Part of the problem, said lawyer Laura Watts, national director of the Canadian Centre for Elder Law Studies in Vancouver, is that psychiatric patients, because of their increased health needs, sometimes end up in hospitals where they can mix with the general patient population.

"Imagine your 85-year-old grandmother who is frail and has higher care needs," Ms. Watts said. "Then think of someone being put here near her with psychiatric needs. It's a recipe for abuse."

The assault

What happened to Mr. Sayed is particularly disturbing.

He was sent to Bridgepoint Hospital on Nov. 29, 2004, from North York General Hospital, where he had spent more than two months being treated for confusion and other problems. At Bridgepoint, a complex-chronic-disease and rehabilitation hospital in Toronto, Mr. Sayed was placed in a ward room, bunking with three other patients, including Mr. Henriques.

On the morning of Dec. 12, recalled his daughter Ms. Sayed, she saw Mr. Henriques try to feed another patient in the room a "smelly" dark-coloured fluid she thought was urine. She told him to stop, then went to the nurses' station to alert them. A woman did come and tell Mr. Henriques to leave the man alone; she changed the man's clothes, Ms. Sayed said.

But at about 8 p.m., a nurse found Mr. Henriques standing over Mr. Sayed, feeding him what was believed to be fecal matter. She escorted the roommate out, then returned to examine Mr. Sayed. The nurse contacted the on-call physician and patient-care manager, as well as his daughter.

The fecal matter was removed from Mr. Sayed's mouth, where it was suctioned four times, with deep suctioning by the patient-care manager. After the incident, an infectious disease specialist was consulted and Mr. Sayed was given hepatitis B immunoglobin, in an effort to prevent transmission of the disease. He was sent to St. Michael's Hospital for treatment the next day.

Mr. Sayed is suing Bridgepoint Hospital, three named doctors, a fourth unnamed doctor and an unnamed nurse. In a separate action, he is suing the estate of Mr. Henriques, who died more than one month after the assault, at the age of 43, on Jan. 20, 2005.

He is seeking $250,000 in general damages, and his family is looking for an additional $150,000 for loss of care, guidance and companionship as well as out-of-pocket expenses. Lawyers are also seeking compensation of $750,000, virtually all of it on behalf of the Health Ministry for costs to the public health system resulting from the injury.

"It's not just a matter of compensation to people in a situation like this, but a question of principle and public policy," said lawyer Brian Hunt, who is assisting Mr. Mazurek in representing Mr. Sayed and his family. "The last concern of hospitalized individuals and their family should be physical safety."

In its statement of defence, Bridgepoint Hospital said it provided reasonable hospital and nursing care to Mr. Sayed, and it denies he suffered the damages he is claiming.

In an interview, Heather MacDonald, Bridgepoint's vice-president of medicine, said she couldn't speak about this specific case, because of the outstanding legal issue and patient confidentiality. However, she said the hospital does all it can to manage safety situations compassionately and quickly.

"At Bridgepoint we care for people who live with complex chronic conditions and they often have unique safety needs, for example, management of multiple drug prescriptions that they take, pain management, falls, avoiding choking hazards and behaviours associated with neurological diseases or dementia," said Dr. MacDonald, who is also a geriatrician. "So our safety challenges are very specific to the type of population we care for."

In a separate statement of defence, the trio of doctors deny allegations of negligence, saying they each "exercised a reasonable and competent degree of professional skill, care and attention in the treatment provided by them."

A palliative patient with a "do not resuscitate" order, Mr. Sayed was in a severely weakened state suffering from numerous pre-existing medical problems, including chronic seizure disorder, high cholesterol and urinary tract infections, according to the statement.

The lawyers for the three doctors declined comment.

The dangers of nursing

Ontario legislators have tried to make it mandatory to report suspicions of abuse, neglect or violence done to patients in hospitals or other facilities.

An Act to Protect Persons in Care from Abuse has twice been introduced, but it died both times on the order paper. A third piece of legislation that would have given the province's Ombudsman the ability to investigate hospitals and health-care facilities also died in 2006.

As it stands, virtually all hospitals have a health worker assigned to do risk management, as well as processes to assess patients before placing them in rooms, said Pat Fryer, chairwoman of the Ontario Healthcare Risk Management Network, a group of health-care workers who have an interest or work in risk management.

If a patient is known for being aggressive, a plan of care is developed. But there are cases, she said, where patients are not aggressive and "then for some reason people become unexpectedly violent. They could be the calmest person on Earth and then one little thing gets them going."

As a result, nurses have described violence and abuse in hospitals as being endemic. Consider these cases:

Registered nurse Karen Brooks was attacked by a patient in an Eastern Ontario hospital who did the one thing that can damage a hand for life — pulled the index finger and longest finger next to it in two different directions.

"She wish-boned my fingers; they were dislocated," said Ms. Brooks, 48, who has not been able to return to bedside nursing since that 2002 assault. "All these people came in, she attempted to physically abuse them as well. ¡K It took seven people to get her off."

Charles Caldwell was 70, sick with kidney failure and diabetes, when he was admitted in the fall of 2006 to St. Joseph's Healthcare Hamilton, and transferred to its transitional unit in nearby Dundas, said his sister, Pat Slabosz. The only way he could stop a wandering patient from barging into his private room was to put up a chair against the door. (He has since died, although his death was unrelated to his dealings with the difficult patient.)

"He was stealing from him and he tried to pull the chair from underneath him," Ms. Slabosz said of that troublesome patient, who also stole her brother's chocolates and his Aruba hat. "My brother threatened to hit him with his walker. You can't go to sleep at night."

Romeo Cercone, vice-president of quality, complex care, rehabilitation and long-term care at St. Joseph's Healthcare Hamilton, could not comment on the case due to patient confidentiality, but he said as many as 70 per cent of long-term care residents suffer from dementia.

ƒÞEmergency room staff at the Humber River Regional Hospital have asked for Plexiglas barriers and increased security at the department's registration and triage desks after one nurse was assaulted at the hospital's Church Street site. At its Finch Avenue site, a nurse was swarmed and a third had a bloodied wound dressing thrown in her face by an angry patient, according to Michael Howell, the Ontario Nurses Association bargaining unit president for the hospital.

"The public is frustrated, now it's escalating into violence," said Mr. Howell, a nurse who was assaulted in 2000 by a patient who hit him so hard, it broke his glasses and cut his face.

Gerard Power, the hospital's director of public and corporate communications, said it takes workplace safety seriously and is looking into the request.

He also pointed out that the hospital won the 2007 Ontario Hospital Association/National Quality Institute Healthy Hospital Innovators Award, which recognizes a commitment to the continued development of a healthy workplace.

MR. SAYED TODAY

After the attack in Toronto, Mr. Sayed was unable to communicate, was constantly restless, moaning, crying and agitated. He fought against those who touched him and spit out medication provided to him, according to the amended statement of claim against Mr. Henriques.

As a result of the incident, Mr. Sayed not only has a permanent gastronomy tube, but he has continuing complications with ulcers, nervous shock, a loss of dignity and autonomy "arising from his embarrassment and helplessness over the incident," the statement says. Among the various medical ailments caused or aggravated by the incident were aspiration pneumonia, C. difficile diarrhea, E. coli infection and recurrent abdominal pain.

Now, three years later, Mr. Sayed is 83 and resides at Providence Hospital in Toronto, a rehabilitation and complex continuing care facility, where his family says he is receiving good care. He rests in bed most of the day and is still on the feeding tube.

"I wish everything could go back again. I wish this had not happened to my father," said his daughter, Ms. Sayed. "¡K He's something big to me, he's a very nice man. I never ever thought in my life something like this could happen to him or anyone."