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HomeMy WebLinkAbout1991-2855.Wilson.96-05-23 ONTARIO EMPLOYES DE LA COURONNE ~" CROWN EMPLOYEES DE L'ONTARfO GRIEVANCE COMMISSION DE SETTLEMENT R~:GLEMENT BOARD DES GRIEFS 180 DUND~ S~EET WEST SUITE 2100, ~RONTO .ON MSG 1Z8 ~PHONE/~L~PHONE : ~ 1~ 326-1388 1~ RUE DUNDAS OUES~ SUR~U 2~ ~RONTO ~ M5G 1~ ~CSIMILE/T~L~OP~ : ~1~ 326-1396 ~ss # 28~5~9l OPSEU # 92C021 IN THE MATTER OF ANARBITRATION Un4er THE CROWN EMPLOYEES COLLECTIVE B~R~AININ~ ACT Before THE ~RIEVANCE SETTLEMENT BOARD BETWEEN OPSEU (Wilson) Grievor The Crown in Right of Ontario (Ministry of Health) Employer B~FORE O. Gray Vice-Chairperson J. Carruthers Member D. Montrose Member FOR'THE J. Monger GRIEVOR Counsel Gowling, Strathy & Henderson Barristers & Solicitors FOR THE W. Hayter EMPLOYER Counsel Genest, Murray, DesBrisay, Lamek Barristers & Solicitors HEARIN~ January 18, 1993 May 3k__5, 1993 September 8, 1994 October 4, 1994 November 16, 1994 December 5, 1994 March 22, 1995 May 10, 11, 23, 1995 DECISION -.- The grievance referred to arbitration in this matter is dated December 23, 1991. It reads as follows: STATEMENT OF GRIEVANCE I grieve that the employer has failed to provide satisfactory working conditions and the tools to enable me to perform my duties effectively as an Aftercare Coordinator at Queen Street Mental Health Centre. I further grieve that the employer is discriminating against me. SETTLEMENT DESIRED That the employer establish and maintain "coverage" for my role as Aftercare Coordinator on Unit 1. That I be treated equally and be given the same consideration as the other Aftercare Coordinators at QSMI-IC. The grievor is .a registered nurse with advanced knowledge of psychiatric nursing. When she filed her grievance she was employed as the Aftercare Coor- dinator in Unit i of the Queen Street Mental Health Centre ("QSMHC") in To- rontol and had been so employed since 1982. Part of the job of an Aftercare Co- ordinator (as defined in a Position Specification dated June 1, 1990) is to act as primary therapist or case coordinator for outpatients of QSMHC who are re- ferred to that aftercare program. Unit 1 is one of four autonomous units at QSMHC, each of which has its own chief of service, psychiatric and nursing staff and support personnel. When the grievance was filed, three of the four units had aftercare programs. Anyone admitted to QSMHC as a patient, whether inpatient or outpa- tient, must have an attending staff psychiatrist who takes responsibility for the psychiatric aspect of the patient's case, including required periodic reviews and prescribing of medication. Prior to 1982, the Unit 1 aftercare program had an assigned staff psychiatrist who provided this psychiatric coverage for the pa- tients in it. That psychiatrist left prior to the grievor's becoming involved in the program, however, and was ae$ replaced. When the grievor took over as coordinator of the Unit 1 aftercare program in 1982, each of the patients then enrolled in that program was covered by one or other of the remaining Unit 1 staff psychiatrists. Tlxe grievor was told early on that there were no plans to replace the psychiatrist who had left or otherwise assign a psychiatrist specifically to the aftercare program. As some of the pa- tients in the program died or were discharged into the care of their family phy- sicians over the next several years, a smaller and decreasing inflow of new pa~ tients from Unit i psychiatric staff was insufficient to replace them. People out- side the unit sometimes asked the grievor to take a new (or former) patient into her program, but she could not do so without there being a staff psychiatrist pre- pared to provide the necessary psychiatric coverage for that patient. Coverage for new patients had to be arranged on a patient by patient basis. Over the pe- riod between 1982 and the filing of the grievance in late 1991, referrals from Unit i psychiatrists were increasingly infrequent. On occasions when sources outside the unit made the grievor aware of a person who might benefit from her program, she could not find a Unit 1 psychiatrist willing to take that person on as their patient for coverage purposes. There were also occasions, it was alleged, when the grievor had difficulties getting staff psychiatrists to provide the kind of coverage she felt they should provide to patients for whom they were responsible. By contrast, the aftercare program in Unit 2 at QSMHC was organized in such a way that one of the staff psychiatrists in Unit 2 spent part of his/her time as the psychiatrist who would provide coverage to the program during the mornings, and other staff psychiatrists in Unit 2 took part in a roster in which they rota'ted responsibility for providing coverage during the afternoons. It was the grievor's view, and the impression of the coordinator of the aftercare program in Unit 2, that the grievor had a good deal more difficulty getting psychiatric coverage for potential clients whom others wished to refer to her than the coordi- nator in the aftercare program in Unit 2 did. In his opening statement, counsel for the uniSn advised that the only dis- crimination claim being pursued by the union in this matter was that the em- ployer had violated the management rights clause, of the parties' collective agreement by treating the grievor differently from other Aftercare Coordinators "for no legitimate vus~ness purposes. Although the grievor had filed and was pursuing a complaint with the .Ontario Human Rights Commission alleging ra- cial discrimination, counsel for the tmion indicated that the union did not allege violation of Article A. 1 of the parties' collective agreement and was not making any allegation of racial discrimination in these proceedings. 'Union counsel said'that the grievance was also based on Article 18.1 of the parties' collective agreement, which provides that 18.1 The Employer shall continue to make reasonable provisions for the safety and health of its employees during the hours of their employment. It is agreed that both. the Employer and the Union shall co-operate to the fullest extent possible in the prevention of accidents and in the reasonable promotion of safety and health of all employees. He alleged that the lack of psychiatric coverage for the Unit 1 aftercare program, management's lack of concern about the grievor~s difficulties in that regard and the differential treatment of her position in relation to other Aftercare Coordina- tors left the grievor feeling undervalued, frustrated and professionally humili- ated. He further alleged that the work environment created by the employer had caused the grievor to become increasingly depressed. She sought treatment for this depression from her family physician starting in January 1992, and from a clinical psychologist, Dr. Wood, beginning in August of 1992. In September 1992 the Aftercare Coordinator position in Unit i was declared redundant and the grievor was transferred to another position. At around this time the grievor took a medical leave of absence because of her depressed state. She was still on medi- cai leave in January 1993 when she gave her evidence in chief, and in May 1993 when she was cross-examined. (The grievor returned from her medical leave of absence in July in 1993, and was working in another nursing position at QSMHC thereafter.) It was the union's position that the employer created a work environment for the grievor that caused her stress, and failed to adequately respond both be- fore and after it was advised that she was finding it stressful. The union's posi- tion was that this amounted to a violation of Article 18.1 of the collective agree- ment. ~ The relief sought, as~_out!ined by counsel for union in his opening state- ment, included: · A declaration that the employer violated Article 18.1 of the collec- tive agreement by failing to make reasonable provisions for the grievor's health and safety and failing to cooperate with the union as contemplated by that article. .7 A declaration that..management violated the management rights clause of the collective agreement by treating the grievor's aftercare program differently from other aftercare programs in the institu- tion. · A direction that should the grievor be returned to a position equivalent to that of Aftercare Coordinator, proper psychiatric coy- erage be provided so that these health and safety concerns do not arise again. · An order that the employer pay the griever damages covering the following: - Loss of vacation credits used to top up her short term disability benefits during her absence due to the depression she says was caused by the employer. - Cost of the psychological counseling she received from and after August 1992. - The short fall between the short term disability benefits and the wages she would have earned had she been able to continue working during the period of her absence due to the depression she says was caused by the employer. - Damages for mental anguish. The employer's position was that while it acknowledged that Unit 1 had not devoted psychiatric resources to its aftercare program in the same way as Unit 2 had, this did not constitute a breach of the collective agreement. There was no dispute that the grievor was absent from work due to depression from September 1992 to July 1993, nor that the grievor wa~ entitled to and received sick benefits in respect of her absence. The employer denied, however, that her illness resulted from any fail~-Ye on its part to make reasonable provisions for the health and safety of its employees. Workplace Events Prior To September 1991 The grievor testified that she had problems with psychiatric coverage al- most from the beginning:' There was no psychiatrist assigned to Unit l's after- care program when she became its coordinator. Some time in the mid 1980's she spoke with Dr. Gray about the problem of coverage and he invited her to provide a proposal. She prepared a proposal which in her view could be implemented using existing resources. Dr. Gray said he would take the proposal to Dr. Malcolmson, the Chief Psychiatrist and Director of QSMHC, to whom he re- ported. She said he never came back to tell her what Dr. Malcolmson had said. There had also been a committee established in the mid 1980's to look at outpa- tients and they way they were handled in Unit 1. Anotl/er staff member, Mort Mates, presented a proposal that would have involved the elimination of the af- tercare program in Unit #1. She presented a proposal of her own, the details of which are not before us. Nothing came of her proposal, she said. The grievor also testified that Unit 1 staff psychiatrists who referred pa- tients to her program in the period 1982 to 1985 ceased doing so thereafter. She stated that five of the psychiatrists -- Doctors Cava, Gauld, Lawrey, Thuriarajah and Jain -- had all told her at one time or other that the chief of service, Dr. Gray, had said they should not take on additional outpatients or aftercare patients. She further testified that in November 1989 Dr. Jain had asked her to discharge all the aftercare patients for whom he was responsible, saying this was a directive from Dr. Gray. She reported Dr. Jain's discharge request to her su- pervisor Anne Kutty, the Unit i Nursing Coordinator, who suggested that she ask Dr. Jain for the reason for his request. She testified that when she asked him that, Dr. Jain said he had too many patients. Ms. Kutty arranged for the grievor to met with Dr. Gray about this. Prior to the meeting, Ms. Kutty told the grievor that she understood that Dr. Jain had just had an appraisal by Dr. Gray and had complained to him about having too many patients. The grievor stated that at her meeting with him Dr. Gray denied telling Dr. Jain to discharg~-her segment of his outpatients. He told the grievor that he had said Dr. Jain should discharge some outpatients, but not specifically hers. The grievor~s problems with coverage were discussed at this meeting, but from the grievor's perspective nothing was resolved. She said that Dr. Gray and Ms. Kutty both told her that the program had to remain as it was or it would be closed. After the meeting, Dr. Jain did not renew his request that his patients in the aftercare.progra.m b~._dischargedo In cross-examination, the grievor agreed that there had been a number of changes in the institution since she took on the position of Aftercare Coordinator. She agreed that in the intervening period legislative changes had increased the amount of work each psychiatrist had to do with respect to each patient for whom he or she was responsible. She agreed that in that period the number of staff psychiatrists in Unit 1 had remained constant and the total number of in- patients with whom those psychiatrists had to deal had increased. She acknowl- edged that when a Unit 1 patient no longer required inpatient treatment, the at- tending psychiatrist could refer the patient to the Unit i aftercare program or to the 1-B or "basement" program or discharge the patient into the care of a physi. cian or program outside QSMHC. She agreed that it would have been necessary for a psychiatrist to continue to cover the patient if he had made a referral to the Unit I aftercare program, but not if he made a referral to the I-B program or discharged the patient. She acknowledged that she would not expect the institu- tion to order staff psychiatrists to make referrals to her program. She would not acknowledge, however, that the reluctance of Unit 1 psychiatrists to make refer- rals to her program or otherwise provide coverage to it might simply reflect their increased workload and consequent reluctance to carry too many outpatients as parg of that workload. She did acknowledge, however, that she had been told that the problem was one of scarce resources. The grievor was asked in cross-examination whether she attributed ii1 will to Dr. Gray. She replied that she had nothing to say about whether Dr. Grafs motives were bona fide or not. Ms. Kutty and Dr. Gray both testified ~hat outside consultants performed a study of QSMHC in 1980. Prior to the study, outpatients had been- receiving aftercare in the hospital setting. As a result of the stu~iy, the focus shifted to re- lying on community-based 9x~grams for aftercare. Unit 1 began referring more patients to outside agencies and programs in the community and less to after- care services provided by the hospital. Dr. Gray testified about his 1989 conversations with Dr. Jain concerning his workload. He said that at that time Dr. Jain had a higher workload than other psychiatrists in Unit 1. Dr. Jain asked Dr. Gray if he could reduce his out- patient workload. Dr. Gray testified that he believed they were talking about all outpatients, and that he told Dr. Jain he could discharge some outpatients in, consultation with their therapists if there were alternate outpatient services available to them. He later learned from Ms. Kutty that Dr. Jain had gone to the grievor and told her that Dr. Gray had directed him to discharge all of the pa- tients he had in her program. Dr. Gray said he had then spoken again to Dr. Jain and had explained to him that that had not been his intent. Ms. Kutty said the first discussion she remembered having with the grievor about problems with coverage was in 1989. The grievor told her that she was having trouble getting referrals of Unit i inpatients and felt tkis was due to the fact that there was no psychiatrist specifically assigned to provide coverage to the aftercare program. Ms. Kutty testified that she took the grievor~s concerns up with Dr. Gray, who later told her he had spoken to Dr. Malcolmson and had been told there was no possibility of having a psychiatrist assigned to the after- care program. She stated that she then conveyed that to tb.e grievor, and told her she should continue with the arrangement she had. Ms. Kutty testified that there was a subsequent meeting in which Dr. Gray told the grievor that there were no more resources available and that inpatient psychiatrists were focusing on inpatient care and were finding it too much work to provide coverage for af- tercare patients at the same time. Dr. Gray remembered the grievor making proposals involving sta£fing that he took to Dr. Malcolmson. He said Dr. Malcolmson told him that he did not have the resources and, furthermore, wanted to review the in-house outpatient programs generally. He remembered discussing with Dr. Malcolmson a proposal that the grievor could deal with patients for whom coverage was prpvided by psychiatrists outside of QSMHC. Dr. Malcolmson felt that outside psychiatrists would not necessarily perform to the institutions standards and would leave the grievor exposed, so that idea-~was not pursued. Dr. Gray testified that there was no attempt on his part to cut off or dis- courage re£errals to the aftercare program. He said that at staff meetings he told Unit 1 psychiatrists that the grievor felt underutilized and that they could make referrals to her. He could not order psychiatrists how to treat their patients, however; that was beyond his authority. The grievor described another incident, which she said occurred before the meeting with Dr. Gray in 1989. The teenage child of a patient in her program called to say that the patient had become very sick. The grievor felt the appro- priate response was for her and Dr. Jain, the covering psychiatrist for that pa- tient, to go out and see the patient to determine whether she should be readmit- ted on an involuntary basis, wkich required the involvement of a physician. Dr. Jain was not prepared to go out into the community in that way. The grievor then spoke to Ms. Kutty, who suggested that the patient's child seek the family doctor's assistance. The child reported that the family physician was not cooper- ating. Dr. Jain suggested an application to a Justice of the Peace, but that "didn't work." The grievor then spoke to a Dr. McRuley, who was the director of a "satellite" outpatient program connected with Q~MHC. Dr. McRuley accompa- nied her to see the patient, called an ambulance and signed the statutory com- mittal form to effect the patient's re-admission as an inpatient. The grievor res- tiffed that this was the sort of crisis an aftercare coordinator has, and that there was no psychiatrist in the hospital prepared to go out with her in such crises. She said that when she raised concerns about this she was "continually told" that the program had to remain the same or it would close. Ms. Kutty testified that the doctors in the crisis unit on Unit 1 were sup- posed to be available to provide coverage for the grievor in the event of a crisis. She said the grievor had not made her aware of'any occasion on which a doctor had refused to accompany her to see a patient in crisis in the community. She was aware that the grievor had sometimes had to look around to find a doctor to go with her, which was not unusual, but was not aware of any occasion when she could not find one. She said this had never been raised as a problem at any meetings she attended prior to the filing of the grievance. In cross-examination~_Dr, lGray denied the suggestion that there had been no provision made for emergencies in which a patient in the aftercare program needed immediate psychiatric intervention and the patient's covering psychia- trist was not available. He testified that the psychiatrists who provided coverage were frequently paired. When neither the covering psychiatrist nor the paired alternate was available, psychiatrists in the crisis unit were expected to deal with. emergencies during~?.egular hours, and this was the responsibility of the admitting department after hours. He said it was the responsibility of the cover- lng or attending psychiatrist to deal with attendances at off-site locations. He was not aware of any difficulties the grievor had getting attending physicians to attend off site. He said none had been raised with him. He noted that it was not unusual for in-house outpatient clinics to ask satellite program psychiatrists to make those off-site visits. Ms. Kutty recalled a conversation with the grievor about her difficulty in getting referrals, in which she suggested that the grievor should become more visible to the psychiatrists, and make thom aware of the services she provided, so as to enhance the prospect of referrals. She also said that if the grievor could find out from other programs a different way of providing her program and come up with a proposal, she would take the proposal to senior management. In the course of this discussion she told the grievor that if there were no referrals to the program, one option would be to close it. She testified that the griever "naturallf' became upset when she mentioned that option. She could not re- member discussing the possible closing of the program with the grievor prior to this conversation. In cross-examination, Ms. Kutty said that the prospect of closing the pro- gram did not mean the grievor would not have a job, because their policy was al- ways to find other positions for those involved in programs that are closed, that no-one had ever been laid off as a result of closing a program. That testimony was uncontradicted. Workplace Events of 1991 The grievor testified that she met with Ms. Kutty on September 12, 1991 to discuss what was happening in her program. She referred to her diminishing caseload and to the position_~ecification for her job. She testified that Ms. Kutty told her that her job specification had become obsolete, that she told Ms. Kutty that she felt she was under stress and had been harassed, and that Ms. Kutty told her that "harassed" was a strong word that she ought to look up. She also testified that Ms. Kutty told her she should have coffee with the psychiatrists in order to promote referrals, and that if the griever could not work with the pro- gram as it was she would recommend that it be closed. The griever described an incident involving an individual whe needed a prescription to continue her medication. She said the incident occurred on Sep- tember 10, 1991. Ms. Kutty testified that it occurred on September 16, 1991. In any event, it concerned a patient or former patient (it is not clear which) of Dr. Cava's whom the griever had followed in the aftercare program until the in- dividual left the country on an extended absence. This person had returned to Toronto ill, been readmitted and seen by Dr. Thuriarajah, given medication and sent home. This person then contacted the griever about-rejoining her program. The griever began seeking out coverage so that this person could participate in her program, because Dr. Cava was unwilling to continue with the patient. The griever had not yet solved the coverage problem when this individ- ual's medication ran out or was about to run out. Public transit workers were on strike and there was apparently no other means of travel this individual was willing or able to take to travel to QSMHC in order to get a fresh prescription. Dr. Cava would not write the individual a prescription. Dr. Krstich, who had told the griever she might be willing to provide coverage, was not then available nor, apparently, was Dr. Thuriarajah. The griever asked Dr. Gray if he would write a prescription for this person. He told her that he was not prepared to write pre- scriptions for other doctors' patients, a position which the griever acknowledged in cross-examination was not inappropriate. He suggested that she go back to Dr. Cava. She then went to Dr. Cava, who was. not prepared to write the pre- scription and refused her request that she call Dr. Gray about the matter. The griever then spoke to Ms. Kutty, who said she could not force doctors to write prescriptions, and told her she should document th~ incident. The griever testi- fied that she did not hear Ms. Kutty also say that she would speak to Dr. Gray about the matter. , After documenting the incident, the griever decided to go to the Patient Advocate for QSMHC about it. The Patient Advocate undertook to speak to Dr. Malcolmson. Soon thereafter, Dr. Malcolmson called the griever, found out what she thought was needed and wrote the prescription. A short while later, Ms. Kutty told the griever that she had spoken with Dr. Gray and, as a result, Dr. Cava would write the prescription if she could arrange to get the patient in to see her. The.griever rep!.i, ed that she had got Dr. Malcolmson to write the pre- scription. Ms. Kutty got upset with the griever for taking that action after being told that she would speak to Dr. Gray. In that context the griever testified that Ms. Kutty at one point said "I cannot work with you anymore," or words to that effect. The griever testified that she told Ms. Kutty that "the patient has her medicat'o , and added that that was the most important thing for her. With respect to this medication incident, Ms. Kutty testified that when she told the griever that she could not force doctors to write prescriptions and that the griever should document the incident she also t01d the griever that she would take the issue up with Dr. Gray. She did that. Dr. Gray told her he had asked the griever to go to Dr. Cava, whom he descr/bed as the attending physi- cian. Ms. Kutty then went to Dr. _Cava to find out why she had refused, since the griever had not said what reason Dr. Cava had given for her refusal. She testi- fied that Dr. Cava said she had not seen the patient since her discharge and was unwilling to prescribe medicine for her without seeing her. When Ms. Kutty went to speak about this to the griever, she learned that the griever had gone to the Patient Advocate in the meantime. She asked why the griever had not awaited the outcome of her discussion with Dr. Gray, The griever told her she had not heard her say she was going to speak to Dr. Gray. The griever testified that following this medication incident she gave Mort Mates, then the union's chief steward at QSMHC, a letter to Ms. Rainville, the head of the Nursing Department at QSMHC, about what had happened "and why I was at the end of my rope." Mort Mates and another steward, Barbara Break, sent the following memorandum dated September :LB, 1991 to Ms. Rainville and Dr. Malcolmson: Re: Lack of psychiatric back-up for the Unit ! Aftercare Co-ordinator We recently became aware of a situation invoking the lack of back-up ft~r the above-mentioned person. When psychiatric back-up, which had formerly been available, was den~'d, the Aftercare Co-ordinator was sent from one person to another and was still unable to obtain a prescription for her chent until the latter had run out of medication. This situation of back.up coverage for this person, and her long-term role within the Service, is still unresolved. Therefore, we are hereby formerly |sic] requesting a meeting with you, Mrs. Rainville and Dr. Malcolmson, Dr. Grey lsic], Mrs. Kutty, Mrs. Wilson and the writers. We wou]d very much.~ppreciate your early attention to this matter. As a result, a meeting was held in mid October 1991 at which these matters were discussed. During that meeting, Ms. Rainville and Dr. Malcolmson both said they recognized that coverage had been a problem. Dr. Malcolmson told the grievor that tI~e problem had been on his conscience for some time. Ms. Rainville said that the grievor had been working under' unfair and untenable conditions. Dr. Malcolmson undertook to speak to Dr. Gray and Ms. Kutty to see what could be done. There was then a meeting on November 6, 1991 attended by Dr. Gray, Ms. Kutty, the grievor and Ms. Break. The grievor testified that at this meeting Dr. Gray said she would be given coverage for her existing patients by Dr. Krstich, the psychiatrist in charge of Unit l's "I-B" or '~basement" outpatient program, that she could receive referrals from Dr. Krstich but could not go look- ing for referrals for her and that Dr. Krstich could only take 100 patients in total including hers and those in the I-B program. Ms. Kutty's understanding of the outcome of that meeting was later set out in this memo of November 21, 1991 to Dr. Gray, which was copied to the grievor and Ms. Break, among others: This is to confirm the discussion at the meeting of Wednesday, Nov. 6, 1991, which was attended by you, Ms. Fay Wilson, Aftercare Co.ordinator, accompanied by Ms. Barbara Break, Union Steward and myself. At the meeting the following plan was proposed and accepted by Ms. Wilson: - Ms. Fay Wilson will be linked with the Unit I~B program and Dr. Krstich will provide psychiatric coverage for the patients who will be admitted to the Aftercare program in the future. - The present psychiatric coverage for the patients who are on her Aftercare will continue with the same. However, when any of those patients get readmitted or discharged from the program and referred back to the program then the psychiatrist who w~s providing the coverage and Ms. Wilson could decide what woultl be the best for the patient, that is, to continue with the previous arrangement or refer the patient to Dr. Iirstic[~for the psychiatric coverage. - Ms. Wilson will receive referral through 1-B program or direct from other programs. But all referrals should be discussed with Dr. Krstich before accepting. - Dr. Krstich will provide psychiatric coverage for 100 patients between Unit I-B and Aftercare program. - You will discuss the above with Dr. Krstich and I will inform Jeries Qaqish, Head Nurse. - Dr. Krstich, Jeries Qaqish and Fay Wilson will meet to discuss operational issues. , The grievor testified that Ms. Kutty told her that the arrangement with Dr. Krstich was the best she could do; otherwise, they would have to close tlxe al- tercare program. After the meeting of November 6, 1991, the grievor went to meet with Dr. Krstich and Jeries Qaqish, the Head Nurse in the 1-B..program. We have only the grievor's account of this meeting. She stated that after hearing her describe her understanding of Dr. Gray's plan, Dr. Krstich told the grievor that that was not her understanding from Dr. Gray. According to the grievor, the particular points raised by Dr. Krstich with which she disagreed were that Dr. Krstich would not cover patients unless they were part of her program, and that the grievor was to be part of that program. In the course of the discussion, Dr. Krstich told the grievor that other staff members were angry because her taking on the patients from the aftercare program would cut off referrals to their programs. The grievor then asked the union to call another meeting. With reference to the failure of the proposal to link the aftercare program with the I-B program, Ms. Kutty testified that her understanding from the grievor was that Dr. Krstich wanted the two programs amalgamated and to have final say on all referrals, while the grievor did not want amalgamation and thought it was inappropriate for Dr. Krstich to have a final say on whether refer- rals were accepted or not. Ms. Kutty testified that concerns of other staff mem- bers had not been raised in meetings she attended,, nor in her discussions with the Head Nurse of the 1-B program. She acknowledged in cross-examination that the institution could have implemented the plan to join the 1-B and aftercare programs without the grievor's consent. She said the focus had been on finding a solution that was acceptab~l~to, all concerned, and that Dr. Krstich's conditions were not acceptable to the grievor. Mr, Mates then wrote the following memo dated November 13, 1991 to Ms. Rainville, Dr. Gray, Ms. Kutty and Dr. Malcolmson: Subject: Resolution oi~Outstanding Uncertainties Re Mrs. Faye Wilson -- The resolution of psychiatric coverage and attendant arrangements have fallen short of satisfying Mrs. Wilson, putting her at ease and allowing her to ~ get on with her job. Once again, her efforts to obtain answers from various managers have failed, due, at least in part, to managers' failure to coordinate effectively with one another. As a result, Mrs. Wilson has and is experiencing mounting stress and anxiety. [ hereby request another meeting at the earliest possible time to reach an acceptable and fair resolution which everyone can buy into. I expect that the final agreement would be put in writing, thereby elimina, ting the need for more meetings. Another meeting was held in December 1991. Ms. Kuttfs recollection was that the December meeting took place on December 13, 1991. Drs. Gray, Mal- colmson and Krstich, Ms. Kutty, Ms. Albrecht (another member of nursing man- agement) the grievor and a union representative attended. Difficulties with the proposed arrangement with Dr. Krstich were discussed...The grievor .testified that she told them Dr. Krstich had said she could not cover so many patients, and that Dr. Krstich then said she had agreed to provide coverage because she felt sorry for the grievor, but. she could not do it. Dr. Malcolmson asked the grievor what she wanted. She said she wanted coverage for existing patients and for new referrals without having to go from person to person. Dr. Malco]mson said he would get back to her in a week or two. The grievor testified that at this December meeting she also said that she had been through a lot, that it was too much for one person to take. Ms. Kutty testified that she did not hear the grievor make any such statement, In cross- examination, the grievor stated that she was told at ~this December meeting that there was a plan for realignment of outpatient services which would make the existing Unit 1 aftercare program redundant. ~ Ms. Kutty testified theft Ms. Albrecht mentioned during the meeting that Unit 4 was looking for additional resources in terms of aftercare and that there might be a solution there. Dr. Gray testified that he got a call from the Chief of Service of Unit 4 around this time, asking about the grievor and expressing en- thusiasm about having her join Unit 4, where he had a significant outpatient load and limited resources. The grievor stated-that after the December meeting she got a call from Dr. Duksta, the chief of Unit 4, saying he would like to offer her a position on his service. When she asked what the position would be and how it had come about~ he said he could not say exactly what the position would be, but that she should think about it and he would get back to her. The grievor testified that the problems of coverage and the meetings about them were stressful, and that she suffered from anxiety and, by January 1992, depression. She was asked in chief whether manage~ment was aware of her anxiety. She replied that Mr. Mates had written to Dr. Malc01mson about her anxiety in his memo of November 13, 1991 and that during the performance ap- praisal conducted at around the time of these meetings she had told Ms. Kutty how stressful it was not having coverage. Ms. Kutty testified that in the course of preparing the performance evaluation completed 'in December 1991, the grievor had told her that her pa- tient load was 35 in the "1990/91" period it covered. She put that figure in the appraisal, and the grievor took no issue with it when they~ discussed the ap- praisal. The performance appraisal document is dated December 16, 1991. In it, Ms. Kutty wrote that "Since she doesn't have a regular psychiatrist assigned to the program it is difficult for her to carry more clients which is rather frustrating for her." In the space provided for staff member comments, the grievor wrote This appraisal does not adequately reflect my .performance. In areas that meet standards e.g. pg. 2(e) (0 Pg. 3 (a))b) I am positive that my performance is well above standards given that I work independently with clients, their families, community agencies and I also carry a substantial caseload without adequate coverage. As Mrs. Kutty mentioned in her summary, I do not have a regular psychiatrist assigned to the program. This affects both the referral process and the number of clients assigned. , There is no mention that my performance is above standard in any of these areas. With this I disagree wholeheartedly. If one is measured according to standards, we have to look at the range from above to below. My job would be a lot easier ff the tools had been provided plus support and recognition. The entry identified here as "p. 3 (a)" states that the griever "has a caseload of 35 clients." The griever also added a two page addendum, in which she said she had demonstrated "exceptional ability" and described the lack of an assigned psychiatrist as a "handicap" despite which she had "independently and creatively accessed community resources for her clients and their family." What, ever the griever may have said to Ms. Kutty during the preparation of the ap- praisal, the comments she chose to append to it contained no complaint of stress, anxiety or depression. Ms. Kutty testified that as of December 1991 she did not know that the griever had a history of depression or was having difficulty of that sort at that time. It was put to her in cross-examination that she knew that the griever's shrinking caseload was causing her stress. She replied that she was not aware that the griever was under any more stress than anyone else at QSMHC. She said she knew that the medication incident and lack of coverage were frustrating for the griever, but that' frustrations and disagreements between doctors and nurses were features of health care, particularly in an institution such as theirs. Frustration was not the same. thing .as stress, she said. To a certain extent, she added, stress goes with the job in a psychiatric facility. She acknowledged the reference to anxiety in the memo of November 13, 1991, but said they had had a meeting to address the concerns raised. She had not seen in the griever any symptoms of stress or anxiety and had had no reason to believe she was suffering "mounting stress and anxiety" at that point. In about the third week of December 1991, less than a week after the De- cember meeting, the griever filled out the grievance which is now before us, gave it to Barbara Break and left on vacation. At that point the griever had not heard back from either Dr. Malcolmson or Dr. Duksta. The union filed the grievance early in the following week, while the griever was still away on vacation. The griever testified that she was depressed after filing the grievance, and saw her family physician about the symptoms of her depression starting in January 1992. She did not ~ that she had ever advised management of her de- pression before taking sick leave in September 1992. She did testify that her su- pervisor had said she looked depressed or asked if she was depressed at a meet- lng in January 1999.. Ms. Kutty testified that she might have said that the grievor looked "down", but would not have used a clinical term like "depressed" in a conversation of that sort. In any event, the grievor did not claim to have an- swered in the affirmative or otherwise advised the employer that she was suffer- lng from depression. More than once during the hearing, counsel for the employer suggested that at some time after she filed the grievance the grievor had been offered and turned down the position of aftercare coordinator in Unit 4. The grievor testified that she was not aware of any such offer. The employer presented no direct evi- dence that such an offer had been made to her or to the union. The Issue of Differential Treatment Of Aftercare Programs -- Dr. Gray testified at some length about the programs and staffing in Unit i and the differences between both the inpatient and the outpatient programs in Units 1 and 2 which affected the workload of the psychiatrists in those units. The thrust of his testimony was that Unit 1 had a proportionally greater inpatient load and that there had been no psychiatric resources available in Unit I to pro- vide increased coverage to its aftercare program without reducing the resources of some other Unit i program. It is unnecessary to recite his evidence in any greater detail because in closing argument the union abandoned its claim that differences in-the way coverage was provided to aftercare programs reflected a bad faith exercise of the employer's management rights. Role Expectations One of the themes of the grievor's testimony was that both her iob de- scription and her professional responsibilities as a nurse imposed on her obliga- tions which the employer's failure to provide more and better psychiatric cover- age made it difficult or impossible for her to fulfil. With respect to her professional responsibilities as a nurse, the grievor acknowledged that she had not consulted with the College of Nurses to deter- mine whether her difficulties~-'~ised concerns of that nature. With respect to coverage for new patients and her declining patient load, the grievor noted that her job description contemplated her acting as the pti- mary therapist for a patient group of "approximately 26 to 45 outpatients." She testified that her patient load had gone from 52 in 1982 to 18 in late 1991~ As we have already. noted, however, Ms. Kutty later testified that the patient load in- formation in the grievofs 1991 performance appraisal -- which indicated a pa- tient load of 35 -- had come from the grievor. Perhaps more importantly, that, appraisal stated that the grievor had met the employer's standard for her case load, as the grievor's own comment on the appraisal expressly noted. Recognizing that the end of the appraisal period may have been some months before Decem- bet 1991, we note that there is no specific evidence of a large number of patients having been discharged during the latter part of 1991. Although the contents of the appraisal were not put to the grievor in cross.examination, and first emerged during the subsequent testimony of Ms. Kutty, the grievor was not recalled to give any explanation of the apparent discrepancy. Ms. Kutty testified that prior appraisals of and annual reports by the grievor over the period April 1983 to 1991 show her patient load varying from a high of 46 in 1984-85 to a low of 31 in 1989. Dr. Gray testified that the number of patients in the grievor's program when it was disbanded in 1992 was greater than most other therapists handled. Ms. Kutty stated that once someone has been discharged and is no longer a patient, neither the hospital nor the aftercare coordinator has any legal or medical responsibility for him or her. When the aftercare coordinator receives a call for help from a former patient, she can ask him or her to come to the admit- ting department for an assessment. The admission process would then determine what type of help was needed and whether the former patient would be re- admitted. The decision whether to refer the person to the aftercare program would be made by a psychiatrist after admission. Ms. Kutty testified that the af- tercare coordinator was not responsible for finding' psychiatric coverage for a former patient who called her and asked for help. Dr. Gray confirmed that the employer had not considered the grievor obliged to find coverage for a-former patient or other person not currently a pa- tient of QSMHC. He observed that on humanitarian grounds she might choose to see what she could do and described several things she might do, but said none of those possible responses was a requirement of her position. He noted that before an individual could be treated as a patient, he or' she would have to go through the admitting department and be assessed to determine what treatment was needed. The Griever's Mental Health ~ Richard Wood is a clinical psychologist. He first began treating the griever in late 1983. He saw her once a week until early 1989, and intermittently there- after. The issues which he addressed with the griever in that period concerned her husband's health and other family issues as well as work place issues. Dr. Wood testified that the griever had been depressed intermittently during the period 1983 to i989, but not so severely as to be unable to-function. Dr. Wood began seeing the griever regularly again in August 1992. In Oc- tober 1992 he wrote ttxe following To Whom It May Concern report: Mrs. Faye Wilson has been a patient of mine over the course of the past. many years. During the last one and a half years she has maintained only .intermittent contact with me, but more recently, in August of this year, has called again to ask for help. During the course of my work with Mrs. Wilson I think she and I both felt she had come to manage many of the issues that had brought her to see me quite successfully. One issue, however, which remained unresolved and continued .to represent a source of frequently profound distress for her was her work. Mrs. Wilson feels that her problems at her job are long-standing ones, .having asserted themselves shortly after she arrived at Queen Street Mental Health Centre as an After Care Coordinator. She has discussed such problems throughout my treatment work with her and has, at times, so far as I can see, been subjected to considerable depression as a result of them. In spite of what looked to me to be determined and tenacious efforts to create a more favourable work environment for herself (and, she felt, for her patients), work problems only appeared to escalate as time passed. From my vantage point, I frankly do no [sic] understand how she bore some of the pressure and depreciation she felt was inherent in her job for as long as she did. She felt unwelcomed and devalued, and seemed to be at a loss to make things any better for herself, repeatedly reminded, as it were, of the helpless position she apparently maintained. As best I could tell (based on her account of events) s~e appears not ever to have been afforded accessible medical coverage for her patients. As events unfolded over the years, she saw that medication coverage not only became ~ . more inaccessible for h'er, but new admissions to her program were first reduced and then denied her as part of what she concluded was an effort to either shut her program down or drive her away. At various points in time, as already intimated, Mrs. Wilson became clinically depressed in response to work related distress described above. It was not surprising to me that it was work, once again, which induced her to return for help. My impression of her at present is that she is again quite depressed; her .self-esteem and her sense of efficacy have been badly damaged by a process which apparently has extended over nearly 10 years now of work imposed difficulty. I do not see Mrs. Wilson as being able to return to her present job at any point in the future ff doing so means working with the same individual she feels has visited so much devaluation upon her. In behaff of the current depressive episode, my preliminary estimate is that Mrs. Wilson ought not to return to work for at least two to three months, given that she is quite depressed now. My own strong feel/ng is that appropriate work alternatives at Queen Street Mental Health Centre commensurate with her skill, training and dedication to service must be provided her if she is to have some opportunity to repair damage her work place has seemingly inflicted upon her. In all fairness, however, the pain and depreciation she regards herself as having been subjected to in her work place will not likely simply ameliorate itself because she has been afforded a better and more appropriate job; such pain and depreciation will continue to invoke personal cost for her for some to come. I do not mean to suggest that, once having weathered another work related depressive episode, she would not be capable of demonstrating the high levels of commitment to her job and to service provision that I think she probably has in the past. What I am indicating, though, is that she will continue to live with some of the scars and the pain which her 10 year work experience looks to have created for her. Dr. Wood testified that the work difficulties discussed during the 1983 to 1989 period concerned her perception that she did not have coverage for patients she was able to care for, that attempts to bring this to the attention of others had not been successful, that she did not feel valued by others in the workplace and felt unwelcome as a member of Dr. Grafs team. He said his sense was that she was what he termed a "care-giver personality" who derived her sense of personal worth from her work. When she was not able to do her work she felt she was not valued. He felt that her difficulties about work remained unresolved when her regular attendances ceased in 1989. Dr. Wood further testified that when the grievor came back to him in August 1992 her primary concern was work, although, there were als0 concerns about her own physical health and her husband's health. She felt devalued. She reported that she could not ~cpeople around her to listen or appreciate how dif- ficult her circumstances were for her. She worried that she was being "forced out" of her position and was at a loss to understand why. She was, he said, profoundly depressed. Dr. Wood's understanding of the grievor's workplace concerns was that she had discovered she could no longer access referrals from boarding houses and that psychiatrists had been advised not to provide her with coverage, at least for new referrals. She told him that she had previously been able to take re- admissions from boarding houses, but that in 1990 Dr. Gray had told her she could only take patients from Unit #1. She told Dr. Wood that between 1956 and 1990 Dr. Gray had told other psychiatrists not to send patients to her because she had no coverage, that Dr. Gray had "kept coverage away from my program" so that her program could not grow. Dr. Wood's opinion was that the clinical depression from which the grievor was suffering when he began seeing her again in August 1992 was in the main a consequence of difficulties in the workplace. He further opined that if what she told him was correct, and if emotional pain was to be given the same weight as physical pain, then she had been exposed to a health hazard. Dr. Wood testified that having been in a position himself in which he needed psychiatric coverage in his work, he could appreciate how humiliating and devaluing it would be to have to "scrounge coverage," as he put it. He said he regarded the employer's failure to provide coverage as an "extraordinary indignity." In cross-examination, Dr. Wood said that from what the grievor had told · him, he had concluded that she was being denied the opportunity to do her work "for no good reason that she or I could identify." It was put to him that the un- availability of coverage might reflect choices the institution had made about the allocation of scarce psychiatric resources. Dr. Wood's response was that he did not think the gr/evor was ever given a clear explanation. He said she had heard "through the grapevine" that the psychiatrist who was providing coverage for many of her old patients was being told to discontinue coverage, which meant her program was being shut down, but when she went to Dr. Gray he denied this. Dr. Wood said he understood that the grievor was being asked to do a job and then denied the tools needed to do it, that she was not being provided cover- age for persons who were "tF, r patients." He understood, he said, that it was part of the grievor's job responsibilities to deal with individuals referred to her by boarding houses. Dr. Wood stated that at times the grievor thought Dr. Gray had malevo- lent motives, that he was out to get her in some way. He mentioned that when she considered the poss. ib.!!ity of a position in Unit 4 she was concerned that a · number of Dr. Gray's friends were there, that as a result the unit would be hos- tile to her and that she might therefore lose the job after taking it. , Dr. Wood resisted any suggestion that by reason of her personality the grievor was more susceptible to a depressive reaction than others might have been in similar circumstances. He asserted that any therapist deprived of cover- age as the grievor had been would find it humiliating, and that her response was what he would have expected from any therapist in the circumstances. Because the grievor had put the cause of her 1992-93 depressive episode in issue, we granted the employer's request for an order that the grievor submit to examination by a psychiatrist selected by the employer. When that psychia- trist, Dr. Hy Bloom, later reported that he might have been assisted by psycho- logical testing to which the grievor had not consented, we ordered that the grievor submit to psychological tests administered by a psychologist in aid of the psychiatric examination. Our oral and later written reasons for ordering the psy- chiatric examination indicated that it was to address the nature and cause or causes of the depressive episode which formed the reason for the grievor's sick leave from roughly August 1992 to July 1993. The written report of the psychia- trist, Dr. Hy Bloom, did not directly opine on the causes of the depressive epi- sode. Instead, it focused on the related but rather different question "Why is this whole matter so important to her?", where the "whole matter" was her employ- ment difficulties at QSMHC. He stated that he 'put the question that way cause it was clear to him that the grievor had "endowed this situation with greater significance than it deserves on its face." Dr. Bloom's written report was prepared before psychological testing was ordered. It stated, and he testified, that in his view a "normal", "aVerage" or "reasonable" individual who experienced the suffering reported by the grievor would have done more thanz:~he appeared to have done to mitigate that suffer- ing, either by seeking a solution within the existing structure and its constraints or by changing her position or employment, and would not have allowed herself to have become so demoralized and immobilized by it. He noted and testified that the grievor had been more guarded in their meetings than he would nor- mally have expected, even taking into account the context in which they took place. He found no overt evidence of mental disorder, but felt there must have been something else in play which had not emerged in his discussions with the grievor. He hypothesized that some degree of passive-aggressive personality pa-~ thology might be involved and/or that the grievor might be displacing unacknow- ledged feelings of powerlessness and frustration about issues in her personal life onto her employment situation, leaving her feeling more ineffective in that situation than it would objectively warrant. He emphasized that these were merely hypotheses; he did not express a strong conviction that they were accu- rate. He was clear, however, that while the grievor was not mentally ill at the time he saw her, her reaction to the employment situation she described was not what he would have expected from an individual in the circumstances she de- scribed. The psychologist engaged pursuant to the second of our orders, Dr. Nathan Pollock, administered several standard psychological tests. The va- lidity indicators on one of the tests indicated extreme d, efensiveness. In Dr. Pollock's opinion this could not be accounted for solely by the circumstances in which the test was conducted. He concluded that it likely reflected an underly~ lng personality characteristic of the grievor. In his oral testimony Dr. Pollock emphasized that this defensiveness was not necessarily all conscious or deliber- ate. In his written report he stated that Similar validity configurations are usually obtained by individuals who are trying to present themselves in a positive light in an effort to avoid or deny unacceptable feelings, impulses and problems. Tl~ey are often psychologically naive, and tend to view the world in extremes. Pronounced use of denial and repression, poor insight and deliberate defensiveness are suggested. He testified that because there was this extreme defensiveness, the results of other test were ]argely unreliable. Based on the chronology of events, Dr. Pollock opined that the grievor's depressive reaction in 1991~8-was more directly attributable to the grievance procedure which she initiated than to her employment experiences at QSMHC. Argument As we have already noted, the union abandoned the claim that the differ- ential treatment of aftercare programs reflected a bad faith exercise of manage- ment rights. The union's closing argument rested on Article 18.1 of the parties' collective agreement. Union counsel submitted that Article 18.1 created a positive obligation on the employer to do whatever is reasonably necessary to protect the health and safety of employees, that the employer is required to anticipate dangers and take pro-active steps to prevent them and that a breach of this obligation may expose the employer to liability for damages, citing Leeanan, 1268/88 (Roberts), Mac- Lean et al., 1134/88 (Barrett), Gonneau, 227/81 (Teplitsky)'and Sim, 256/88 (Watters). He said this duty required the employer to protect employees from workplace stressors when exposure to those stressors could foreseeably cause psychological harm. He referred to two decisions of the Workers Compensation Appeals Tribunal which awarded compensation for work-related stress disorders: Decision No. I45/89 (1990), 14 W.C.A.T.R. 74 and Decision No. 636/91 (1992), 21 W.C.A.T.R. 277. He said the significance of those decisions for this case was that they show that work.related stress disorders are valid concerns and that they are therefore among the health risks against which the employer has an obligation to protect employees. Union counsel argued that the grievor had been exposed to a number of stressors in the workplace. Her inability to maintain and carry the caseload that she had had when she first took on the job was stressful for her, as was the need to search out coverage £or any individual she wished to take on as a patient. She also found it stressful to have to approach psychiatrists for coverage, only to have it refused. The primary stressor, he said, was her inability to get the institution to change the arrangement in some way such that she would have coverage. An- other significant stressor was her inability to get psychiatric support in crisis situations, as evidenced by the medication incident i~volving Dr. Cava and the occasion when she eventua~e.nlisted the support of Dr. McRuley to.go out and pick up a patient. He also referred in this connection to the occasion when Dr. Jain told the grievor that Dr. Gray had told him to discharge the patients he was covering in her aftercare program. Union counsel said that failure or inability to find a solution to her cover- age problems was also a stressor for the grievor. He gave as an example the fact that the linking of the grievor's program with Dr. Krsti'ch proposed in the fall of 1991 had not come about. On the basis of Dr. Wood's testimony, union counsel submitted that even before the grievor said anything to management about her mental state, it was foreseeable to the employer that these stressors could cause the grievor psycho- logical harm. He argued that the grievor had informed the employer of the el- feets on her of these stressors during in her meeting of September 12, 1991 with Ms. Kutty, when she said she felt under stress and harassed, in the union's memo to the employer of November 13, 1991, which described the grievor as be- lng under mounting stress and anxiety, and in the grievor's statement at the De- cember 1991 meeting that she had been through a lot and that it was too much for one person to take. He noted also Ms. Kutty's recognition that her suggestion of closing the program had upset the grievor, and the statements at the October 1991 meeting by Dr. Malcolmson, who said the grievor's circumstances had been on his conscience for some time, and by Ms. Rainville, who said the grievor had been working under unfair and untenable conditions. Counsel said that while the union was not asserting that any member of management deliberately set out to cause the grievor psychological harm, it did accuse her managers of being reckless in their management of the situation. He said it was inappropriate for management to have left the difficulties unresolved for so long after it became aware of them. He said that the employer ought to have ensured that the coverage necessary to do the job she had been hired to do was available, or made efforts in cooperation with the union to arrive at a solu- tion that would remove the grievor from the stressful situation. Employer counsel argued that · the remedy claimed' had been impermissibly expanded beyond what had been sought in the grievance filed; ~,~- · this grievance was essentially a claim for damages for a workplace in- jury, which could not be advanced otherwise than as a claim for work- ers compensation benefits having regard to the provisions of the Work- ers' Compensation Act and this Board's decisions in Lister, 340/89 (Samuels) and Johnston, 1225/91 (Tacon); · - 'Article i8.1 merely codifies in the collective agreement the employer's obligations under the Occupational Health and Safety Act, which are concerned only with the physical work environment and not with mai- ters of the sort raised here; and · in any event, on the facts before us there had been no breach of Article 18.1. It is unnecessary to deal with or further describe the first three of tt~ese submis- sions (or the union's submissions on damages) because we accept the employer's submission that even if a workplace injury to mental health may properly be the subject of this or any grievance based on Article 18.1, no breac]~ of that article has been established. Decision In Re Crown In Right of Ontario (Ministry of Correctional Services) and Ontario Public Service Employees Union (1986), 27 L.A.C. (3d) 233 (Roberts), the board observed (at pp. 237-8) that The law relating to the application of art. 18.01 of the collective agreement to health and safety issues was set forth by the board in two awards: Re Gonr~ea~ and Ministry of Att~oraey-General (1982), G.S.B. No. 227/81 -.~ (Teplitsky), upheld by the Ontario Divisional Court [unreported] in March, 1983; and Re OPSEU (Union Grievance) and Ministry of Correctional Services (1984), G.S.B. No. 69/84 (Samuels). In Gonneau, the board concluded that art. 18.01 was more than a mere declaration of intention, that it "imposes an obligation on the employeF, supra, at p. 6. In the Samuels award, the nature of this obligation was expressed as follows at pp. 6-7: Article 18.01 speaks of "reasonable provisionS" [emphasis added) for the safety and health of the employees. And this is echoed in s. 14(2)(g) of the Occupational Health arid Safety Act, R.S.O. 1980, c. 321, which 4 , imposes a duty on an employer to "take every precaution reasonable in the circumstances for the protection of a worker" [emphasis added]. . There is no oblige-inn to guarantee an employee's safety against every possible risk, no matter how remote the possibility that it will occur. The collective agreement and the legislation contemplate "reasonable" precaution ... -27 - It was concluded that art. I8.01 did not obligate the ministry to guarantee an employee against risk of injury, no matter how remote, but only to take reasonable precautions for protection. What constituted a reasonable precaution, the board added, had to be assessed upon an objective review of the relevant circumstances, which balanced "the safety of the employees against the need for care and custody of the inmates and the purposes of the institution", at pp. 7-8. ~ The board then applied those considerations in the matter before .it. The safety risks with which the Board was concerned in that case and the cases cited in it were risks of physical injury. We are inclined to think that the word "health" in Article 18.01 includes mental as well as physical health, but it is unnecessary for us to decide the point in this case. If "health" includes mental health, the above-quoted observations apply equally to the employeFs obligations with respect to risks of injury to men- tal health. Determining whether the employer has taken "reasonable provisions" in respect of a particular risk requires an objective review of the relevant circum- stances, including the remoteness of the alleged risk and the nature of the work and workplace in which it arises. Publicly funded health care institutions do not have unlimited resources. They must make choices about how their limited resources are allocated. As a result of those choices, some things that might otherwise have usefully been done will not be done. Some health care resources, human and physical, will be un. derutilized because other resources needed to support their functions are in short supply. The ability of individual health care providers to provide the health care they are capable of providing to those who would benefit from it will sometimes, perhaps often, be limited by factors beyond their control. This will be a source of frustration and stress for them. Stress does not necessarily impair mental health, and some stress is unavoidable. In this context, Article 18.01 is not a guarantee of stress-free work. It is apparent, particularly from Dr. Wood's evidence, that the way the grievor saw her work experiences was at variance with the reality portrayed by evidence put before us. She~eelieved that Dr. Gray was deliberately withholding from her something to which she was entitled, and that there was no plausible reason for this other than that he was perhaps out to get her or intended to drive her out of her job. She thought Dr. Gray had told staff psychiatrists not to give her coverage for new patients. She told us, and presumably Dr. Wood, that she understood he had given this direction to five doctors. Curiously, there is no evi- dence that she approached Ms. Kutty or Dr. Gray about this, as she had with re- spect to her belief that Dr. Gray had told Dr. Jain to discharge patients she was following. When she raised the matter of Dr. Jain in 1959, Dr. Gray told her that Dr. Jain was mistaken, that v/hile he had suggest that Dr. Jain reduce his out- patient load, he had not ordered or suggested that he do so by discharging the patients she was following. He then spoke with Dr. Jain to eliminate the misun- derstanding, with the result that Dr. Jain did not discharge any of those pa- tients. Nevertheless, the grievor persisted in her belief that Dr. Gray was un- dermining her and acting out of malevolence toward her. Indeed, from the way Dr. Wood described her report of this to him, it appears that her belief may have been heightened by Dr. Gray's denial of something which she continued to be- lieve was true. We accept as true Dr. Gray's uncontradicted testimony that he did not tell psychiatrists that they were not to provide the grievor with coverage, nor that they should target her patients for discharge. We also accept his testimony that the grievor's periodic requests that a psychiatrist be specifically assigned to pro- vide coverage for any patients admitted to the aftercare program could not have been granted without taking psychiatric resources away from some other pro- gram. Although she led Dr. Wood to believe the contrary, we are persuaded that plausible explanations consistent with the absence of malice were provided to the grievor when and to the extent she actually sought them. It is not apparent to us that there was any reason for management to foresee that coverage arrangements for the Unit 1 aftercare program posed any particular risk to the grievor's mental health before' the fall of 1991, when she first complained about stress and anxiety. The argument that it should have done so depended on Dr. Wood's opinion that the mental health of any therapist treated as he understood the grievor had been treated would have been injured as a result. His understan ~d~-~g!' however, was that coverage, which could have been given was deliberately withheld for no good reason and without explana- tion. We have concluded that the grievor was not treated as Dr. Wood under- stood. His opinion cannot support the union's argument in the circumstances as we find them. We do not accept that therapist depression is a foreseeable conse- quence of allocating limited psychiatric resources in such a way that a particular program gets coverage for fewer patients than the therapist in it can handle, in the absence of the sort of malicious motivation that the grievor apparently read into her situation. The Unit 1 aftercare program had been functioning without an assigned psychiatrist since the grievor took the coordinator position in 1982. Management knew the grievor wished that she could carry a larger patient load, but it had not told her it expected her to carry more patients than she appeared to manage- ment to have. While it is apparent that the grievor did not get the tools to do the job she wanted to do, we do not accept the union's assertion that the grievor was denied or deprived of tools she needed to do the lob that the employer expected her to do. The employer did not know of the grievor~s episodes of depression during the 1980's. During the period in question -- that is, up to the filing of the griev- ance -- it had no reason to suppose that the grievor entertained the belief that Dr. Gray was out to get her. Before the fall of 1991 it had no reason to suppose that the grievor could not cope or was not coping adequately either with the workplace frustrations she had identified from time to time or with the stresses and conflicts inherent in her position. On the evidence before us, the first time the grievor told management that she felt under stress in relation to the problem of coverage was in her con- versation with Ms. Kutty in September 1991. This was coupled with the asser- tion she was feeling "harassed," a term not particularly apt to describe anything revealed by the evidence before us. It was said in the context of a renewed at- tempt by the grievor to secure what she seems to have considered an entitlement flowing from her having been given the coordinator position in 1982. It was fol- lowed shortly thereafter by the union's request for a meeting to discuss both the grievor's need for "backup" ~d her "long-term role within the Service." In closing argument, the union acknowledged that giving the grievor what she wanted was not the only reasonable precaution the employer could have taken upon foreseeing that her mental health was endangered by her existing job arrangements. It argued that alternatively the employer should have made el- forts in cooperation with the union to arrive at a solution that would remove the grievor from the stressful situation. In the period of less than 15 weeks from the grievor's first reference to stress on September 12, 1991 to the filing of the griev-, ance, the employer did precisely that. It made efforts in cooperation with the union to arrive at a solution satisfactory to the grievor. The fact that those ef- forts had not achieved success by the time the union filed the grievance does not suggest to us that it was unreasonable of the employer to make the attempt, nor that the employer's efforts in that period were inadequate when assessed against the "reasonable provision" standard. The grievance was filed while efforts to find the grievor an alternate position satisfactory to her were ongoing and before the grfevor had heard again from Dr. Duksta about the position he wished to offer her in Unit 4. It is not apparent why that opportunity did not ultimately afford an acceptable solution, apart from what one might infer from Dr. Wood's testi- mony about the grievor's fears concerning the motives of Dr. Gray and his influ- ence over Unit 4. When stress and anxiety were first mentioned in September and Novem- ber 1991, respectively, there was no accompanying complaint that there was a mental health danger so immediate that the grievor should be removed from the sources of stress and anxiety on an interim basis pending a more permanent so- lution. We are not persuaded that the employer should have heard such a com- plaint in anything the grievor said at the December meeting, nor in any com- munication made by or on her behalf at any time relevant to this grievance. Given what the employer knew or could reasonably be expected to have known at the time, it could fairly have expected to be criticized for overreaction and worse if it had responded to the mention of stress and anxiety by unilaterally relieving the grievor of her responsibilities for the aftercare program before the process of consultation and search for alternatives which the union had sought on her be- half had run its course. In our view, the discussions it entered into at the union's request in the last three moths.of 1991 were an entirely reasonable response to the concerns presented to it at the time. In all the circumstances, we are not persuaded that the employer failed to make reasonable provisions for the grievor's mental health. Accordingly, this grie. vance is dismissed. Dated at Toronto this 23rd day of May, 1996, Owen V. Gray, Vice-Ch~)~ D. Montrose, Member Member