New chief nursing officer was an activist before taking on federal role
By Laura Eggertson
August 24, 2022
Editor’s note: Leigh Chapman is Canada’s new federal chief nursing officer and, in this position, will be charged with leading and supporting nurses during a national nursing shortage. Here's a glimpse into her career before she took on this new role, which was recently reinstated by the federal government.
The day the brother of Canada's new chief nursing officer overdosed on opioids — just 400 metres from a harm reduction clinic that could have saved his life — marked the shift in Leigh Chapman’s nursing career towards caring for people experiencing homelessness and using substances.
Brad Chapman, 43, died in hospital in August 2015, a week after a security guard found him slumped in an alley. He had overdosed and his head had fallen forward, blocking his airway.
Although they are first responders, the police officers on the scene did not move Brad to relieve that airway, the family’s lawyer testified at a coroner’s inquest. One of the jury’s recommendations was to improve overdose training for police officers and to have them carry naloxone, used to restore breathing when people have taken opioids.
“The police stood over him and did nothing,” Leigh says. “I firmly believe that if Brad had looked differently, smelled differently, or was dressed differently it would have been a different response.”
A week later, Brad died in hospital, with his siblings and children at his side. But he almost died alone. For nearly a week, hospital staff classified him as a John Doe. His identification languished in a police evidence locker.
Sought answers from officials
In the months and years following Brad’s death, Leigh probed for answers from police and hospital officials. She needed to know what happened to her brother.
Just weeks before his death, he’d left jail. He’d begged a judge not to release him in the inner city, but to get him the help he needed. Instead, he was released right back into the environment he was trying to avoid.
“I was struck by — how does this happen, that people fall through these gaping holes in the system?” Leigh asked.
Driven to action, Leigh spoke at city hall and other public forums about the need for adequate housing and supervised injection sites.
“I essentially told Brad’s story to anyone and everyone who would listen,” she says. “I was publicly grieving and unabashedly sharing my family’s worst nightmare in public.”
Brad’s death turned Leigh from an intensive care nurse and an academic specializing in competency assessment, into an activist. As she investigated Brad’s death, she learned from the harm reduction community about the extent of the opioid crisis in Canada.
In August 2017, Leigh was among members of the Toronto Overdose Prevention Society who opened an unsanctioned supervised injection site in tents in Moss Park in the city’s east end. Three other supervised injection sites had been approved, but hadn’t yet opened.
‘We had to create a new type of model for people who aren’t able to access traditional health care.’
With people dying from opioid overdoses, Leigh and her colleagues believed they couldn’t wait for the other sites to open.
“I feel like that’s when I crossed the line from being an advocate to an activist,” she says. “We were essentially delivering health-care services in a park.”
The Moss Park injection site operated for 11 months, forcing changes in the City of Toronto’s drug policy. It eventually became a sanctioned bricks-and-mortar site, associated with the South Riverdale Community Health Centre.
Her transition to a nurse activist took Leigh by surprise.
“I never would have thought that I would be supervising people using drugs after my brother died of an overdose,” she says. “But I can say without a doubt it’s been the most rewarding part of my 19-year nursing career to date. Because it is life-changing work.”
Safe places needed
Leigh, 48, recently finished a two-year-stint as the inaugural director of clinical services with Inner City Health Associates, a group of 200 doctors and nurses who provide health care to people living on the streets and in shelters and encampments in Toronto.
Leigh’s job was to lead the establishment of 24/7 COVID-19 isolation and recovery facilities for people experiencing homelessness during the early days of the global pandemic.
Vaccines had not yet been developed. People experiencing homelessness could not follow public health directives to wash their hands regularly, self-isolate when sick, or stay two metres apart.
“Many folks who were at that time in congregate shelters did not have single occupancy rooms,” Leigh explains. “If they acquired COVID, they needed a place to self-isolate.”
People experiencing homelessness not only needed safe spaces to await test results, they also needed compassionate treatment and care if they tested positive.
In just 19 days, from March 20 to April 7, 2020, Leigh and her colleagues procured supplies, hired nurses and managers, and set up procedures and policies to care for and treat people at a 200-room isolation centre and a separate 400-person recovery centre for people awaiting COVID-19 test results. Both were based at hotels converted to meet these new needs.
At the peak of operations, Leigh was responsible for more than 200 nurses. Most were working casually, contributing a day or more a week to the centres after working other jobs. She oversaw “crash on-boarding” — rapidly hiring and training nurses, many of them embarking on their first experiences working with people who were homeless or people experiencing mental health and addiction challenges.
The clients also included refugee families and people fleeing intimate partner violence.
“COVID was new to all of us, caring for people in hotels was new to the majority, and caring for people experiencing homelessness was also new for the majority (of nurses),” Leigh says.
“We had to create a new type of model for people who aren’t able to access traditional health care because of homelessness. It was a really unique experience, because rarely in health care can you innovate that quickly,” she adds.
Many new challenges
The nursing challenges came fast and furious.
With each wave of COVID-19, Leigh had to guide the nursing staff to be alert to different symptoms.
They also dealt with sicker patients as the pandemic progressed. During the first wave, the patients were not initially as ill as they were during the second, third and fourth waves, Leigh says.
During those later waves, caused by new variants of the virus, people arrived very sick, but were reluctant to go to hospital. The nurses couldn’t provide intravenous medication or run oxygen continuously for people who were severely ill in a hotel-based setting. They had to get those patients to hospital.
The nurses also responded to mental health crises, seizures, difficulty breathing, cardiovascular events, and overdoses, a not-infrequent occurrence that was difficult to prevent or monitor because people were in private rooms.
Alongside the COVID pandemic, the nursing team worked closely with peer support and harm reduction workers to continue to respond to the opioid epidemic, made more deadly by a toxic drug supply.
Eventually, the partners created overdose prevention sites at the recovery centre, rooms where people could use drugs under supervision.
The nurses functioned as discharge planners, liaised with pharmacies to get patients the medication they needed, and helped people access primary care they had been missing for months or years.
Once vaccines became available, they also coordinated and administered vaccines. In 2021 alone, the recovery centres housed more than 6,000 people and helped provide more than 5,000 people with vaccines.
The staff also had to manage their own COVID exposures.
In the midst of all the clinical crises, Leigh and her team also coped with changing protocols surrounding personal protective equipment and isolation rules.
Once public health officials acknowledged that COVID is airborne, which happened during the arrival of the Omicron variant, people who tested positive and their close contacts were not the only ones who had to go to recovery centres. If someone in a congregate shelter tested positive, the entire shelter had been exposed. It was not feasible for all the residents to move to the isolation and recovery sites, so the team needed to develop isolation protocols.
Nurse-led program ‘very successful’
For Leigh, the initial challenges meant 15- or 16-hour days, seven days a week. She worked on site and remotely from home, while also caring for her 12-year-old son, Liam. The program eventually opened nurse-led clinics at 10 shelter hotels and created a team to visit makeshift encampments.
Leigh set up a home gym to cope with the stress. She held monthly town hall meetings with her nurses to hear suggestions about how to improve care at the recovery site or shelter hotels.
“The nurses co-developed the program with us,” Leigh says. “They were co-writing and defining policies and procedures as we went. It was very successful.”
The chief success, she says, lay in the partnerships the program built among the Inner City Health nurses and doctors, shelter providers, hospitals, harm reduction and peer support workers, and City of Toronto staff and public health officials.
“We were trying to piece together a very broken system,” Leigh says. “Essentially, shelter and home care — they don’t talk to each other. We were able to bring them together.”
The funding for Leigh’s position at the recovery and isolation centres ended two years after the program began. Such programs that work with clients rely on building trusting relationships, she says. Those are the same kind of relationships her brother Brad relied upon when he was living on the streets.
Leigh came to her focus on those experiencing homelessness and using substances through her brother’s life and death. She continued to work in the field because of her deep commitment to health equity and the social determinants of health.
“They are the patients with the richest stories, if you care to listen, with the most compelling lives,” she says. “They are under-served and the most deserving of our care and compassion.”
Laura Eggertson is a freelance journalist based in Wolfville, N.S.