The 2008 Saskatchewan case of Prosko v. Regina Qu'Appelle Regional Health Authority may provide some answers to these questions. 

Carolyn Prosko claimed damages against the Regina Qu'Appelle Regional Health Authority  for injuries she suffered when she was attacked by a man in the women's washroom of the Pasqua Hospital in Regina, Saskatchewan. Prosko sued the Hospital alleging that it was negligent in its security measures.  The Hospital denied any negligence or that that it breached any duty of care that was owed to Prosko.  In fact, the hospital filed a third party claim against the perpetrator of the assault, Tyrane Prettyshield, also known as Tyrone Prettyshield, claiming that it was he who caused all loss or damage to Prosko.

Prior to the lawsuit, Prettyshield, who was apprehended shortly after the incident, was charged, plead guilty to assault causing bodily harm, and was sentenced to six months in prison.

Prosko alleged that the hospital did not have adequate security measures, that it failed to monitor the movement of persons within the hospital, and that it specifically failed to monitor the movement of men in the vicinity of the women’s washrooms. The two liability questions were, “whether Prettyshield’s conduct was foreseeable and whether the hospital did enough to protect users of its facilities from such conduct?”

The Saskatchewan Court of Queen’s Bench held that:
“There is no question that the Health Authority does contemplate that its hospital facilities may be visited by intoxicated persons or trouble-makers. The Health Authority's position description for its security officers includes duties such as:

Ӣ Diffuse potentially violent situations and control or restrain violent and/or intoxicated people;

Ӣ Attempt to prevent harm to persons or property in crisis situation;

Ӣ Monitor security systems, react to alarms and closed circuit TV systems, as required;

Ӣ Ensure that all hospital property is physically checked, all doors are secured or open, as required, and all alarm systems are functioning properly; and,

Ӣ Generally maintain law and order on the hospital property and grounds.

Another document describing the duties of security officers states that it is the responsibility of the security officer to deal with intoxicated and other undesirable people. It goes on to say: "Always be on the lookout for visitors who seem to be just 'hanging around'. Approach the visitor and politely ask if you can be of assistance. If the visitor is legitimate, you are likely to be given an honest response. If the visitor is evasive, further inquiries should be made and perhaps the visitor should be asked to leave."

The manager of security services for the health authority gave evidence that he supervised over 50 employees in the position. He explained that the security office is located near the emergency department because that is where most problems occur. People are admitted to emergency in an intoxicated or drugged stupor and emotions can often run high, both on the part of patients and those who accompany them to the emergency department. After hours, entry into the hospital is restricted to those who attend at emergency and are allowed to enter after checking in with security.

It is clear that the health authority does contemplate that undesirable persons or persons with illegitimate motives do enter the hospital facilities. The fact that the health authority provides security services manned by trained security personnel on a 24 hour per day basis is acknowledgment that someone somewhere sometime may cause a problem for the hospital or those who use it. The purpose of the security detail is to prevent occurrences if possible and if an incident does arise, to provide assistance to diffuse it. In this regard, it was foreseeable that someone may some day commit a criminal act within one of the health authority's facilities.

There is a duty of care on the part of the health authority to protect the users of the facility — patients, staff, and visitors.

Having determined that such an incident as happened in this case is foreseeable and within the scope of the duty of care owed to users of the health facility, the next question to be answered is whether the health authority met the required standard of care.”

On the issue of whether the Hospital met the required standard of care, the court commented that neither Prosko nor the hospital led any evidence on the issue of the level of security which a health facility like the hospital normally provides.

The trial judge observed that “[T]here was no attempt to compare the number of security officers on staff or the number of cameras used for surveillance compared to other health facilities of similar size. Instead, Prosko's counsel pointed to the failures to implement the health authority's own protocols, such as allowing Prettyshield to leave the emergency department without ascertaining his reason for being there in first place; for failing to have someone monitoring the front entrance to ensure that no one entered as others were leaving after visiting hours; for failing to educate staff to call security as soon as suspicious individuals are spotted and not 20 minutes later; and for not staffing the security office with enough officers to ensure that the video monitors are being watched continuously.”

In response, the hospital’s lawyer argued that the level of security provided by the health authority did meet the required standard. In support of this argument, he pointed to the actions of the security officers who were on duty that evening to prove that security was being provided.

The Saskatchewan Court of Queen’s Bench Judge was “satisfied that the security measures that were in place at the Pasqua Hospital were reasonable given the likelihood that an individual like Prettyshield should choose this facility to commit a criminal offence against another innocent person. The presence of security officers in the hospital premises along with the restricted entry and other measures such as the video monitoring is obviously sufficient to deter most people from committing acts of criminal violence against other users of the facility. There was nothing in Prettyshield's demeanour while in the emergency department that indicated that he had any ulterior motive to be on the hospital property. While the staff member in distribution could have been more diligent in reporting a suspicious person on Level 2, that person could not have known that Prettyshield would strike out in a violent manner minutes later. His actions were unexpected and unpredictable. He was not known to the hospital staff prior to the incident and the health authority should not be held responsible for his criminal impulse.”

That the perpetrator was not known to the hospital staff was also considered by the trial judge to be an important factor in balancing the risk of harm befalling upon a user of the hospital at the hands of an intruder.  
The trial judge held that “it would not be reasonable to find that the staff member from distribution who delayed calling security about a "suspicious" individual on the second level should have known that he would physically assault someone in a women's washroom on the first level a few minutes later. No one in security was aware of Prettyshield's presence in the hospital until that call was made and after it was received, they reacted swiftly to try to locate him.

This is as much as could be reasonably expected of the security staff.  Accordingly, considering the security measures which were in place at Pasqua Hospital on March 27, 2002, and the random nature of the assault committed by Prettyshield upon Prosko, I find that the health authority did meet the requisite standard of care to all users of the health facility. Prosko was the victim of a traumatic and vicious attack while inside the Pasqua Hospital, but the security measures employed by the Health Authority were reasonable considering that incidents of this nature had not occurred for many years prior or since.  Action dismissed.”

It is interesting that neither party called evidence on the issue of the level of security which a health facility like the Hospital normally provides.  Plaintiff’s counsel argued that the Hospital’s alleged failure to implement its own protocols was evidence that the Hospital had not met the required standard of care.  Defendant’s counsel argued that presence of security refuted this allegation.

Undoubtedly, the outcome of the Prosko case would have been different had the assailant been a hospital patient known for his/her violent behaviour.