The complaint
A woman in a hospital had a high fall risk. The staff followed basic fall-prevention procedure but when it was not enough, they opted for stricter means of control. The woman’s family was upset and complained to the Québec Ombudsman.
The context
- An elderly person was hospitalized. Because she was at high risk of falling, the staff used basic fall-prevention procedure.
- Despite these precautions, the woman was found on the floor the next day.
- To prevent another fall, the staff used stricter means of control that included a lap belt, which reduced her freedom of movement.
What the investigation showed
- The hospital had not gotten consent for applying means of control from the woman’s legal representative. Despite this, the staff used them continuously for several hours a day for nearly two weeks, including steadily for up to 50 hours.
- All this time, no new fall-risk assessment was carried out.
- As the Québec Ombudsman saw it, use of means of control had been premature. Other less severe measures could have been used. In fact, other measures were suggested in the institution’s protocols.
The outcome
The Québec Ombudsman intervened with the institution concerned. To prevent such a situation from recurring, detailed training was established and given to the staff concerned.
This case was taken from our 2019-2020 Annual Report.
The Québec Ombudsman ensures that your rights are upheld in your dealings with Québec public services. Are you dissatisfied with the services of a Government of Québec department or agency? Or with those of a health and social services network institution (2nd level of recourse)? File a complaint with the Québec Ombudsman by calling 1-800-463-5070 or use our online complaint form.
