Update: Monday, November 13, 2007

Last week saw interesting testimony at the coroner's inquest. The jury heard from several experts on the legal process for handling difficult physicians in the hospital setting, and the options available for revoking a physician's privileges.

Witnesses agree that hospitals need to have more authority over physicians, with a view to providing safe, quality patient care, and that changes are needed to ensure physicians are subject to the same sort of arrangements as nurses and other healthcare professionals. Hospitals should have processes and structures in place to create a fair and safe work environment, and institute a standard of behavior that supports zero tolerance for harassment and abuse in the workplace.

Among those testifying was Dr. Keith Rose, an anesthetist at North York General Hospital who has prepared a report and recommendations for the coroner regarding the Lori Dupont-Marc Daniels case.

Dr. Rose testified that, in his opinion, Daniel had broken the terms of an agreement he signed with the hospital, which was an attempt on the part of Hotel-Dieu to get Daniel's inappropriate behavior under control. He noted that Daniel had worked for Hotel-Dieu Grace Hospital for 20 years, had broken a nurse's finger in the operating room, had various complaint letters written against him, human rights complaints against him, and was to be on probation for a year.

Dr. Rose testified that it was clear that Daniel had broken the terms of his agreement with the hospital, and said that Daniel's placement of a semi-nude photograph of Lori on her car “stood out for me as an event that was so abnormal that it would be difficult for anybody to ignore that and not take action…”

He also testified that he is aware of many “serious complaints” against Daniel, including damaging equipment and unprofessional behavior in front of patients. He said he saw no follow-up or action on behalf of the hospital, and added that he has concerns about the culture at Hotel-Dieu Grace Hospital. Dr. Rose testified that it is the Chief's responsibility to monitor a troublesome doctor. He said processes need to be put in place to ensure that employees, patients and physicians are fairly treated and that they work in a safe environment.

Dr. Rose also testified that it appears there were no efforts on the part of the hospital to establish where Marc Daniel obtained the drug he used to attempt suicide.

Under questioning by a lawyer from the Ontario Hospital Association (OHA), the jury heard from the expert witness that there needs to be changes to how physicians maintain their hospital privileges. There are circumstances where physicians are back on the job inappropriately, without restrictions. The OHA is looking for changes to legislation in Ontario , to review the Public Hospitals Act with a view to examining the nature of the hospital-physician relationship and ensure that hospitals can exercise the appropriate degree of authority over physicians working in their facilities, more consistent with that of other regulated health professionals.

Hotel-Dieu Grace Hospital CEO Neil McEvoy also testified last week, and admitted that Lori Dupont should never have been subjected to harassment by Marc Daniel. Under cross examination, McEvoy testified that two years after the workplace murder of Lori, three-quarters of the hospital's physicians have yet to receive mandatory training in the prevention of workplace violence. He said the physicians are “resistant” to the training.

McEvoy also testified that in retrospect, the issue of Daniel's drug use should have been a concern for the hospital. He endorsed the recommendations made by Dr. Rose, and testified that decisions regarding how to handle Daniel were driven by “getting the most positive outcome.”

Update: Monday, November 5, 2007

The coroner's inquest resumed November 5 following the coroner's decision to not discharge a juror who had a conversation in the parking lot with a witness who had just testified.

The proceedings were halted after the coroner was informed that the witness, police inspector Greg Renaud, told a juror that he “could have said a lot more” while on the stand.

Prior to the proceedings being halted, jurors also heard testimony from Laura Eplett, the acting director of criminal policy for the Attorney General, and from other witnesses describing the process for applying for a peace bond.

Hotel-Dieu Grace Hospital Chief of Surgery Richard Stapleford also testified.

Jurors heard that following Lori's murder, the process for obtaining a peace bond when domestic violence was involved was re-examined. Testimony revealed that Lori's application for a peace bond had been handled by an articling student who may have been overworked.

Jurors also heard that Lori believed that she was “only a nurse” and that she didn't want to cause problems for a doctor. Detective Tammy Fryer-Dugan testified that Lori had been sexually harassed by Daniel prior to their personal relationship beginning. Following the end of the relationship, Lori told the Detective that other nurses were intervening and protecting her because they could see what was happening in the workplace.

Police inspector Greg Renaud testified that the culture of physician dominance at Hotel-Dieu likely meant that nurses understood they shouldn't complain about doctors. He also testified that following Lori's murder, administrators at Hotel-Dieu were uncooperative and refused to answer police questions.

Renaud also testified that in his view, Hotel-Dieu allowed Daniel to return to work too early because they had a shortage of anesthetists and they would not make money if they couldn't perform enough surgeries. He also believes administrators should have come to the police regarding Daniel's behavior.

Dr. Richard Stapleford testified that he was aware of Daniel's difficult personality and the incident in which he broke a nurse's finger in the operating room. He was also aware of the difficult relationship Daniel had with nurse manager Kathy McGowean.

Stapleford said he believed the hospital was working to resolve the issues with Daniel's behavior but that it was a lengthy process with many interruptions.

He also testified that he was aware of the uncomfortable atmosphere Daniel was creating at Hotel-Dieu after his return to work, and that he asked Lori if she was all right. He was aware of the need for extra security for Lori, about her request for a transfer and about rumours throughout the hospital about what was occurring.

Update: Friday, October 26, 2007

Prior to taking a one-week break (October 22-26), jurors heard from a number of witnesses who described incidents of aggressive/inappropriate, ongoing behavior by Marc Daniel at work.

Psychiatric nurse Connie Tellier testified that she treated Daniel following his suicide attempt and that he was a generally cooperative patient. However, she added that she had heard from Daniel’s father at this time, who described his son as having violent episodes, including one in which Daniel had dislocated his brother’s shoulder during a dispute.

Dr. Brijesh Arya, chief of anesthesiology for Hotel-Dieu from 2004 to October 2005, testified that Daniel had displayed temper tantrums in the past and had broken the finger of a nurse in the operating room in 2004. Arya was appointed as one of Daniel’s workplace monitors when he returned to work following his suicide attempt, and said he was never told what being a workplace monitor entailed. Arya said he did not communicate with Daniel’s other workplace monitor or with the Physician’s Health Program or Daniel’s treating physicians.

Arya said no one on the unit had ever approached him about Daniel’s harassment of Lori Dupont and he was unaware that Lori had filed a peace bond application. He told the jury that he was upset that he had had no involvement in the decision to allow Daniel to return to work, and said Daniel exhibited the same behaviors following his return to work.

Arya described the process for revoking a physician’s hospital privileges as lengthy, and said physicians are allowed to continue working throughout this legal process.

Lori’s fiancé, Norbert Hirth, testified that Lori had confided in him that she did not want to proceed with a formal complaint against Daniel at work because she was worried that he would lose his privileges and that this would cause financial hardships for his wife and children. She was also concerned that he would launch a lawsuit against her. Lori told her fiancé that the hospital was pressuring her to give up her secured parking spot.

Clinical Resource Nurse Michelle McArthur testified about Daniel’s controlling behavior in the workplace and the outburst in which he broke a nurse’s finger. McArthur also testified that she rarely kept notes, but rather preferred to have verbal conversations with staff when incidents occurred. She also testified that shortly before Daniel murdered Lori and committed suicide, she noted a change in his behavior and that he had been falling asleep on the job.

OR nurse Donna Cassagrande testified that she had witnessed an incident in which another nurse feared that Daniel was going to hit her when a lead fell off a patient during a procedure and Daniel became angry. She told the jury she was unaware that Daniel had two workplace monitors who should have been informed of this incident.

Physician’s Health Program Testimony

The jury heard extensive testimony about the Physician’s Health Program (PHP) that was to oversee Daniel following his return to work. Testimony revealed that the program relies on the physician to provide information and feedback about the case, and doesn’t actively seek input from others – such as Lori or the physician’s colleagues.

ONA legal counsel Liz McIntyre questioned the PHP’s representative about differences between the hospital, the College of Physicians and Surgeons of Ontario and the PHP. The College has the mandate of protecting the public in its governance of physicians, by either taking away a physician’s license or putting terms and conditions on the license of an incapacitated physician. The College can also refer the physician to the PHP.

The PHP witness testified that Daniel had not reported any concerns being raised by Lori Dupont about fears for her safety, nor his behavior toward Lori. The PHP representative was not informed by the hospital of any conditions on Daniel’s return to work, nor given the initial psych assessment of Daniel.

The PHP witness agreed with Liz McIntyre’s suggestion that the hospital was relying on the PHP, the PHP was relying on Daniel’s psychiatrist, and the psychiatrist was relying on Daniel’s workplace monitors for information. But none of these people raised any red flags about Daniel’s behavior following his return to work.

The clinical psychologist treating Daniel testified that her treatment would have been radically different had she known of Daniel’s ongoing harassment of Lori, and that she assumed Daniel’s workplace monitors would inform her of any incidents involving him.

The coroner's jury at the inquest into the deaths of Lori Dupont and Marc Daniel has heard from Daniel's colleague, psychiatrist and more nurses.

Dr. William Taylor, chief of anesthesiology at Hotel-Dieu Grace Hospital , was named as Daniel's workplace monitor upon his return to work on May 30, 2005, following a suicide attempt.

Dr. Taylor testified that he believed Daniel should have taken more time off work, given the seriousness of his suicide attempt. He said he was unaware that Daniel had left a compromising photo of Lori on her car in April 2005, and that she had applied for a peace bond.

Dr. Taylor testified that he'd been informed that Daniel had been seen coming to the recovery room area prior to his return to work, and that nurses were uncomfortable around him; he was asked, and said he did, speak to Daniel about this.

He also testified that he had informal discussions with Daniel's psychologist and the two agreed that Daniel seemed to lack insight into his mental condition.

On October 24, Taylor received a letter from the Physician's Health Program, run by the Ontario Medical Association, asking for an update on Daniel's condition. He testified that he sent a report to the organization that said Daniel lacked insight into his mental condition and had returned to his “old ways” of being confrontational with staff.

Dr. Taylor also admitted that he'd heard through the grapevine that nurses were trying to protect Lori and that at least one nurse complained to Dr. Taylor about Daniel. He again spoke with Daniel and heard no further complaints from nurses.

There was no pressure to bring Daniel back to work too quickly, Dr. Taylor testified, adding that the hospital had an adequate number of anesthetists to run the department.

Regarding where Daniel got the medication he had used to attempt suicide, Taylor testified that there is no perfect system and if a doctor wanted to steal medication, it could be done.

Finally, he testified that he was responsible for making up the anesthetists' schedule, but had never been told not to schedule Daniel and Dupont together on weekends, when only a skeleton staff is on hand.

Claire Larocque, Patient Care Resource Leader for the recovery room (similar to a Charge Nurse) testified that she was responsible for scheduling recovery room nurses, subject to the approval of manager Kathy McGowean. Ms. Larocque testified that she was unaware of the extent to which Lori was being harassed by Daniel, and that Lori told her on more than one occasion that she was fine and did not require assistance. Ms. Larocque testified that Daniel stared at everyone, and she did not view his staring at Lori as being out of the ordinary.

Later, Ms. Larocque testified that she did witness other nurses intervening when Daniel tried to interact with Lori. She agreed that complaints of harassment need not to be put in writing to be investigated under the hospital's harassment policy. Ms. Larocque agreed that the hospital had a “zero tolerance” policy regarding harassment.

Ms. Larocque prepared the schedule that had Daniel and Lori working together on November 12 – but testified that she had never been told to keep them apart.

Daniel's psychiatrist has testified that he diagnosed Marc Daniel as suffering from borderline personality disorder following his February 2005 suicide attempt. When he discharged Daniel on March 10, he said Daniel showed no sign of harming himself or others. Daniel had been prescribed lithium as a mood stabilizer, as well as two anti-anxiety medications; while still on the psych unit, testing was done that showed Daniel was not taking the lithium.

The psychiatrist who treated Daniel while he was hospitalized testified that these tests were inconclusive, but conceded that there was no way to force Daniel to take his medications. He did not treat Daniel following his release from the psychiatric unit as Daniel opted to continue treatment with another physician.

Psychiatric nurse Marnie Burns treated Daniel following his suicide attempt, and testified that she spoke to Lori and her mother, who documented their concerns that Daniel was not being honest about the reasons for his suicide attempt. Burns concluded that Daniel minimized the seriousness of his suicide attempt and lacked insight into why he was in the psych unit.

Recovery room RN Pam Groh had worked with Daniel both in the recovery unit and in the ICU; she testified that she had always believed that Daniel was unstable, and had observed his sexually inappropriate conduct on more than one occasion.

Ms. Groh testified that she disliked Daniel immensely, and that she was one of the nurses who intervened when Daniel would come to the recovery room to stare at Lori. Groh had offered to go to the nurse manager on Lori's behalf, but said Lori was afraid of Daniel's reaction should a complaint be made.

Ms. Groh testified she'd been told by the nurse manager not to become involved when nurses were surrounding Lori when Daniel came onto the unit.

When asked if the hospital was applying its “zero tolerance” policy to harassing behavior now, Ms. Groh testified that physician harassment continues in Hotel-Dieu's operating room to this day.

Update: Wednesday, October 10, 2007

At the inquest into the deaths of Lori Dupont and Marc Daniel, evidence has continued to mount that administrators at Hotel-Dieu Grace Hospital were very aware of Daniel's inappropriate behavior.

Testimony from numerous witnesses has shown that Lori Dupont and other nurses had complained to management about Daniel's stalking of Lori and aggression toward other nurses and staff.

Barbara Dupont, an RN and former ONA member, testified that on March 2, 2005, she contacted the psych unit while Daniel was a patient to raise concern for the safety of her daughter following Daniels' eventual release. Ms. Dupont also reported to staff that Daniel was not being honest with them regarding the reasons for his attempted suicide on February 27, 2005.

Ms. Dupont also testified that she was unaware that her daughter had been scheduled to work with Daniel the day of the murder and said she believes if Lori had known she was scheduled to work with him when there was just a skeleton crew on duty, she would have refused to go in.

Ms. Dupont made a number of recommendations to the jury, including:

• there be no distinction between formal and informal complaints under the hospital's harassment policy.
• workplace harassment be covered as a health and safety issue under the Occupational Health and Safety Act (OHSA).
• there be staff education on early intervention in workplace harassment issues.
• when intervention does take place, it be done in an efficient, effective and enforced manner.
• those who seek peace bond applications be given better information on how the process works and the delays involved.
• every peace bond be reviewed by the police.
• peace bond applications not be delayed based on the availability of lawyers.
• articling students should not be assigned as advocates on behalf of the applicant.

Lori's father John also testified, discussing the safety measures he and his daughter took after she ended her relationship with Daniel. Mr. Dupont sought advice from Amherstburg police but was told his daughter would have to come to the station in person and make a formal complaint.

Linda D'Alsio, a friend of Lori's who worked in the public relations department of the hospital, testified that she met with the hospital's risk management lawyer about concerns related to Marc Daniel's behavior. She was told by the lawyer that Lori would have to come in person to complain. Linda also said she advised the lawyer of the likelihood that Daniel was stealing medications from the hospital and that perhaps this could be reason to suspend the physician's hospital privileges. Lori later met privately with the lawyer.

She also testified that in the Fall of 2005, Lori again met with the risk management lawyer to discuss quitting her job and working elsewhere, but that she was talked into staying at Hotel-Dieu and that she would be protected there.

Linda recommended to the jury that a monitoring system should be put in place for the use of drugs by physicians, that there be automatic investigations when there are suspicions of a theft of drugs, and that staff should be able to make anonymous complaints. She also recommended that there be protection against reprisals for those who come forward with complaints.

ONA member Barb Porter also testified, detailing for the jury a series of incidents of aggressive behaviour by Daniel toward her. She filed a formal complaint against Daniel in June 2004; and the complaint remained unresolved up to the date of Lori's murder in November 2005.

Ms. Porter testified that Lori Dupont was extremely afraid of Marc Daniel; she urged Lori to contact police to obtain a restraining order. Barb provided a witness statement in support of Lori, which was eventually used to support her peace bond application. This fact was revealed to Daniel and his lawyer. Upon Daniel's return to work following his suicide attempt, the doctor refused to attend a mediation session with Barb if she attended with her ONA representative.

Ms. Porter was a witness to incidents of Daniel's harassment of Lori, and against her. She described meeting with human resources in August 2005, where she warned that Daniel was going to “go postal” in the workplace. At that meeting, management confided that they, too, had concerns.

Despite further complaints and the hospital agreeing not to schedule Ms. Porter to work alongside Daniel, she was scheduled twice in a row to work with the doctor – the manager had failed to inform the scheduler. The weekend before Lori's murder, Ms. Porter called in sick rather than work a shift with Daniel.

She also testified that following Lori's murder, she received a call from the manager of human resources; the manager confided to Ms. Porter that she believed if she'd been at work the day of the murder, Daniel probably would have killed her, too.

Ms. Porter testified that she was frustrated with management, and that Mr. Daniel was allowed to manipulate the process to delay mediation for more than a year and a half. She said she is disappointed that the hospital was aware that her safety and Lori's safety were at risk, yet failed to act.

Update: Tuesday, October 2, 2007

Week two of the coroner's inquest into the deaths of ONA member Lori Dupont and Dr. Marc Daniel has begun with the jury hearing testimony from Lori's mother, Barbara Dupont, and Lori's friend Sonia Iovino-Hooper.

Mrs. Dupont, an RN and former ONA member, testified about her daughter's harassment by Daniel and how she and Lori kept him alive by administering CPR when he attempted suicide on February 27, 2005.

Mrs. Dupont testified that the syringes and vials that Daniel had used to attempt suicide were turned over to officials at Hotel-Dieu Grace Hospital , as well as the doctor's suicide notes. Lori's mother also testified about helping her daughter end the relationship with Daniel while he was still in the psychiatric unit of Hotel-Dieu.

Sonia Iovino-Hooper, a nurse who worked for the WSIB and whose sister worked in the public relations department of Hotel-Dieu Grace Hospital , testified that in June, 2005 she sent an e-mail to her sister and asked her to present it to the hospital's risk manager responsible for monitoring Marc Daniel.

Sonia expressed her frustration with the hospital, which ignored reports that Daniel was continuing to stalk Lori and ignored that Daniel had stolen drugs from the hospital to attempt suicide, as detailed in the e-mail.

Iovino-Hooper also testified that Lori was afraid of Daniel retaliating against her if she lodged more complaints, and that she was aware of other nurses being told to mind their own business when they lodged complaints with the hospital.

Lori Dupont had attempted to post to another unit, but was unsuccessful as she lacked seniority.

Iovino-Hooper made a number of recommendations, including greater education for nurses in the area of workplace rights, improvements to communications at the hospital, improvements to addressing complaints against doctors and removing doctors' privileges in the hospital setting.

Update: Friday, September 28, 2007

Week one of the coroner's inquest into the deaths of ONA member Lori Dupont and Dr. Marc Daniel has concluded.

The coroner's jury heard testimony from several nurses and a surgeon from Hotel-Dieu Grace Hospital as well as from EMS responder Tony Jaroszewis.

Nurses Vivian Bitonti and Brenda Hooper both testified that they had repeatedly reported incidents of aggression toward both Lori Dupont and other nurses on the part of Dr. Daniel but that management took no action. Brenda Hooper further testified that she had been reprimanded by management for complaining about Daniel's behavior.

Evidence emerged of a toxic workplace. As well, testimony from Dr. Craig Pearce, a surgeon who had worked alongside Daniel, led the coroner himself to question Pearce about what the coroner perceives to be a “culture of physician dominance” at Hotel-Dieu.

Nurse Lisa Pannunzio recounted Daniel kicking her out of the OR when she was eight months' pregnant for not retrieving an item quickly enough for him. She described nurses' morale as “poor” in the months leading up to Lori's murder.

She also testified that Daniel made inappropriate sexual comments to her and to other nurses, had a history of throwing temper tantrums in the OR and a condescending attitude toward nurses in general.

Lisa described the general level of demoralization on the unit, and told the jury that at one point, she complained to the chief of surgery about another doctor's behavior and was told to take it up with the College of Physicians and Surgeons – but the chief of surgery then implied that it would not be in her interest to do so. The nurses in this unit were so fed up with these issues going unaddressed that they requested a meeting with the hospital's Vice-President of Nursing – the request was denied and no meeting took place.

When questioned about the doctor's access to narcotics and other controlled substances, Lisa Pannunzio testified that they were easily accessible on drug carts and that there was no process in place for doctors to have any wastage of controlled substances witnessed, as is required of nurses. Daniel used the drug Versed to commit suicide; the drug was used in the hospital regularly.

The jury also heard testimony that the nurse manager had personally assured ONA members that Daniel and Lori Dupont would never be scheduled to work together during a weekend or afternoon shift, when a skeleton staff was on duty.

ONA legal counsel Liz McIntyre told the media that hospital harassment policies are useless unless enforced, and that clearly, Hotel-Dieu management was aware, but ignored, problems with Marc Daniel.

The inquest resumes Monday.

Update: Tuesday, September 25, 2007

Detective Scott Ritchie from Windsor Police Services testified on September 24, giving an overview of police responses and the investigation into the Dupont murder and subsequent suicide of Dr. Daniel.

ONA's cross-examination of Ritchie focused on the police investigation of the hospital's role in the period leading up to the murder, including the inaction of the hospital to various complaints about Dr. Daniel's harassing behavior.

Prompted by Liz McIntyre, the detective admitted he was surprised that Lori Dupont was scheduled to work the “skeleton shift” alongside her murderer, and surprised that Dr. Daniel was allowed to return to work so quickly after a previous suicide attempt.

Today, nurse Vivian Bitoni will testify; she was with Lori when the murder took place.