Ethical & Legal Issues for Schools of Nursing During SARS: Lessons for Pandemic Planning

1. Ethical & Legal Issues for Schools of Nursing During SARS: Lessons for Pandemic Planning Betty Burcher, RN, MSc Faculty of Nursing, University of Toronto CASN Council Breakfast: November 15, 2006

2. SARS & the Faculty of Nursing • Extraordinary impact on Faculty of Nursing • Created SARS Fast Response Team • “To protect the health and safety of our students, faculty and staff during the SARS situation.” • Community of 670 individuals [May 2003]

3. Impact on Education During SARS 1 • BScN program: • Students suspended from hospitals for 6 - 8 weeks, missed parts of rotations • Classes continued • Web-based learning, creative alternatives • MN program: • Classes suspended week by week • Hospitals needed staff or prohibited intermingling with other health care workers

4. SARS 2 - Our Turn • 185 BScN students in 22 clinical sites • 50 students & faculty in quarantine • 8 students ill during quarantine and/or placement in level 2 or 3 units • 2 students infected with SARS (from workplace exposures) • Disrupted, delayed, extended or replacement clinicals but all completed!

5. Lack of Information & Communication • Lack of communication between: • university administration, • health sciences faculties, • hospitals and • public health • No central “desk” for education sector • Resorted to newspapers, scanning of websites, personal contacts, rumours, frequent back-door calls to Toronto Public Health & expertise of each other

6. Issues Re Clinical Placements • Truth-telling: did we have confidence in reported hospital status? • Some hospitals delayed reporting their status to public health • Inconsistent infection control practices across and within 22 clinical sites: we needed to be consistent for our students • Who makes the decision? Clinical site, educational institution, local public health agency or the provincial MOH

7. Issues Re Students • Complex status of ill students: • Students (full-time or part-time), • Health care workers (full-time or part-time), • Ill patients in the health-care system, • Suspect SARS case or PUI [person under investigation]: surveillance from public health • No occupational health services so we did it ourselves: • Privacy issues: faculty monitoring the health of students & other faculty • Confidentiality issues: quarantine, PUI & SARS cases: sharing information with h-c providers, workplaces, students & faculty • Classmate/faculty support versus stigma

8. Decision-making Issues for Our SARS Team • Decision-making: fear or evidence? • What were our parameters of responsibility? • No precedents for decision-making during a crisis • Many students and part-time faculty were also hospital employees • What was our risk-management and liability? • Issues of communication within the faculty & university • Repercussions of our decisions for relationships with our hospital partners

9. SARS to Pandemic Planning • Health sciences education sector advocacy post-SARS • SARS was primarily a nosocomial infection • Ontario health plan for an influenza pandemic [2006] • Council of Ontario Universities • U. Of Toronto Health Sciences Pandemic Planning Committee

10. Summary: Legal Issues • Clarity re authority, roles & decision-making responsibilities • Decision-making body in university • Decision-making body in Faculty with clear parameters • Risk-management & risk-communication expertise • Infection control, occupational health & disease surveillance

11. Summary: Ethical Issues • Privacy for students, faculty & staff • Confidentiality for students & faculty • Transparency & accountability • Duty to care • Planning, priority-setting & preparedness • University of Toronto Joint Centre for Bioethics Pandemic Influenza Working Group (2005). Stand on Guard for Thee: Ethical considerations in preparedness for pandemic influenza. Retrieved from http://www.utoronto.ca/jcb/home/documents/pandemic.pdf

12. Thank You