Thursday, June 14, 2012

Victoria Island Health Authority: unchecked power, unchecked restraint

How does disagreeing with a nurse turn into a ban? When does a ban turn into a full psychological assessment? When does control become more important than care? When you are in Victoria.

Is this uncommon? Not even close, as within a week, two incidents in Victoria made national news. The first wass a 73 year old who traveled from South Africa to Victoria to see her son in the hospital found out when she ‘touched’ a nurse in order to indicate the need to be quiet (putting her finger to her lips). When the mother showed up the next day she found she was ‘banned from the hospital’. The Victoria Health Authority even says that the account given by the 73 year old mother is the same. When the mother wrote a letter of apology, Victoria Health Authority said it was not ‘heartfelt.’(http://news.nationalpost.com/2012/05/31/73-year-old-mother-banned-from-seriously-ill-sons-bedside-in-victoria-after-allegedly-tapping-nurse-on-the-head/).

The same Victoria Health Authority surprised me often by being aggressive and abusive for reasons I simply could not understand. Care or compassion seemed paramount at first, but over time, care was secondary to ‘not my inch’, ‘cover our ass’ and ‘do what I tell you.’

In December 2011, Linda was out of town doing work. We requested a nurse come to put on the Fentenyl patches. She came. We disagreed. She left without finishing putting on the patches. Part of the patches and Fentenyl coverings were found in the hallway of the building, where the VIHA nurse dropped them. This was reported by the next worker to come, as they found the articles in the hallway of the building where anyone could have come in contact with them, endangering themselves.

Linda, upon returning made a complaint to the health authority regarding the nurse sent, her behavior, her demanding that I provide her with additional medical equipment, and bullying until things were given to her, as well as her walking out.

Six months later, a few weeks ago, in relation to six questions that the Ombudsman Office wanted answering, the head of the Victoria section noted that yes, Linda had made a complaint but it had never been followed up or replied to. None of the six questions were answered (like ‘What is the name of the RN making the complaint?’ – as without the name, no ‘official’ complaint can be made through the oversight office monitoring VIHA).

But we did not know at the time that in BC with VIHA there is no complaint system, nor standards or oversights for dealing with complaints. VIHA has no requirement to act on complaints at all. And the arm of the health authority which gets the complaints most often simply gives the complaint to the person who the complaint is about. Particularily difficult as there is no protection against retaliation or reaction in the law or the complaint system. Which means each abuse often leads to more abuse. (http://focusonline.ca/?q=node/237

Soon after Linda makes the complaint, we are notified that there will be a meeting. Linda asks to be part of the ‘meeting.’ Instead we are notified that due to a complaint that I am ‘threatening’, much like the three stories in the last week from a single VIHA facility (one involved VIHA using police to handcuff the accompanying family member, the received compensation from the police AFTER a lawsuit). Why, in a small city, are there so many stories of RN’s and VIHA worker’s running rampant?

(http://www.timescolonist.com/news/Wife+wins+right+husband+hospital/6722282/story.html)

A Victoria retired cancer researched, Dr. Carol Hines, had to go to the supreme court because Victoria Island Health Authority, had involuntarily detained the husband, Prof Fred Oyster of Royal Roads, due to a brain injury. He was not able to live independently, but VIHA, within two weeks, took away all rights to visit from the spouse, nor allow her to have input into his care, or discharge him, so she took them to the Supreme court. VIHA said, “Haines had been banned because of questions from VIHA about her psychiatric health, her impact on her husband's health and the stress she placed on staff.”
The case from Dr. Hines was presented on the basis that “VIHA is making healthcare decisions without the patient's consent and against his wishes.” The Supreme Court Judge immediately gave her visitation. VIHA has her ‘escorted’ to and from him and VIHA spokesperson says, “As long as she complies with the rules, this will be okay.”
A Victoria Island Health Authority is saying they will ‘allow’ the Judge’s ruling to stand, if they choose to. I have often asked for the rules or regulations VIHA operates by in order to know what rights I have, what problems might occur. I have been told, “There is no document.”, “Nothing is in writing.”, and “it is something that you learn on the job.” But often seems to be whatever a worker wants it to be. Whether it is investigations, care plans, or saying ‘We will not come to your home’: nothing is ever given in writing.

Ironically, every worker who comes, as well as every VIHA worker sees a series of notes online which have been added and amended. These are notes about the client, me, which I am not allowed to see, but every worker, whether it is one of the ones trained for six weeks or with a 9 month certificate can see. They may be accurate, or based on complaints that workers have made which I have never been told about. For example, mine used to say: ‘Do not ever speak to the client, be aware she has a BLOG’, now part of what I can’t see says, ‘Only wash 1 spoon, 1 fork and 1 knife, and ensure that no dishes Linda uses are washed.” So a worker this week refused to wash any dishes, and simply sat for over an hour, and when I pointed out that the dishes were ‘built up’ and could only be used by me, she asked if I didn’t have someone who could have washed them the day before. My understanding of food and time means as time goes forward and I eat meals, including after a worker has been there, dishes will accumulate.

All we knew from calls to VIHA was that no health agency, RN or connected workers will come to the home, nor will they pursue any forms of care which do not require coming to the home. Palliative was supposed to cover midnight to 8 am, but when requested four times, they would not send the emergency nurse either, nor pursue any services. We would be told that the director of X program would call the next day…the call would never come. So, for the six months during which I was and am going in and out of two day light comas, and renal slowing, stopping along with kidneys failing, as I lie there, no urination, no processing out the toxins in the body (and as I don’t sweat, none come out without going to the bathroom). During this the body shuts down, going from overheating to a state of shock, unable to be warmed. I am, based on the medical evidence, palliative, and entered into the palliative program so I can die at home with care. Only the home nursing care won’t come, nor will the palliative nursing care. Even unconscious, am I ‘threatening?’

No one at Victoria Health Authority has asked what happened, beyond the RN, who walked out. And we are told she didn’t say that . Linda is told that I did not touch the nurse, I did not throw or threaten to throw or touch the nurse but that I am just ‘threatening.’ No one would explain what that means, and turn down hearing the other side of the story. From several sources, those who disagree with some Victoria Health Authority workers find themselves labeled either ‘mentally incompetent’ or ‘emotionally unstable’. And those who ask for clarification or help are ‘disruptive’ or ‘malicious’ (Ironically, the word to describe VIHA’s actions, in an assessment of my care).

With VIHA acting so….odd, it seemed, I asked, and put in writing to add to my official file that my doctor, my GP, not to give confidential medical information to the agency unless it is cleared with us, as is my choice and right. This action was due to a problem with medical confidentiality we have found with the health authority and the female RN’s who are managers. When I started to receive care, I was told that information would be shared by members of the Victoria Health Authority, but only in regards to care, and only for those working directly with me, on issues that were directly relevant.

In practice, however, this is not what has occurred. My meeting with my current RN, which occurred a few years ago, and is the only meeting with her, she did not face me, did not talk to me, and stated she had looked up records on the system, including gyno records, and notes from anesthesiologists before surgeries. She never make clear what that had to do with home care. Other incidents actual have information shared to people I have never met, are not on my care group, which becomes in essence a ‘whisper campaign’.

Several months later we were told that the Victoria Island Health Authority had a meeting, we were not invited, but my GP, who works with the health authority regularly, had, despite orders in writing, had been giving them information from visits and my complete health file. He stated when I repeated he had been not to do so that it was a ‘ridiculous request.’ A patient’s concern over medical confidentiality, after individuals start taking it and using it against them, may not be important to the doctor, but as the doctor is work for the health and confidentiality concerns of the patient, it isn’t ridiculous. Nor, do I think would the same GP want his full health records, and his GP to start give information to a person or party who might want to limit his life, livelihood or reputation, simply because his GP didn’t think it important. I have found people who find other’s concerns or rights negligible, still feel their own should be protected. (In the same way the police told us that when we assaulted it was ‘low priority’ and never took action: if assaulted themselves, they tend to view it with greater interest)

There is a difference between accessing the database of information by workers and trained RN’s to give care, and to request, or demand information from the personal files of a person’s GP, without them being notified.

At the meeting, it was ‘decided’ that I should have a full evaluation psychologically. This was told to my GP, as well as who they wanted to do it, at the local Mental Health authority or hospital. Not just Victoria Health Authority has numerous complaints of using the health authority to deem patients who are not as co-operative as they would wish ‘mentally ill’ in order to proceed as they wish without permission, but the entire province abuses this. “BC’s draconian Patients Property Act. Under this law, doctors can conduct a five-minute mental “examination,” declare people “incapable,” and then take away from them absolutely all control over every aspect of their lives—and deaths.” (http://focusonline.ca/?q=node/69 )

The problems with abuses of medication and mental health drugs or labels to control is documented in the ongoing dispute between what is legal and what is currently done as standard practice by the Victoria Health Authority by the British Columbia Ombudsperson, along with 178 recommendations, in the 2011-2012 review (seen at the ombudsman webpage, under downloads). This includes the laws passed 15 years ago, but never put into practice.

I asked my counselor if they could do an assessment, or could recommend someone as I have found assessments to often be skewed by the information given the person giving the assessment which is rarely given to the person being assessed. Also the amount of time for a ‘professional opinion’ can vary from six minutes to three days depending on who is doing the assessing. If there was something wrong, or dangerous with me, I wanted to know from an independent party (otherwise known as, “Am I paranoid doc, or are they really out to get me?”).

For me, I could not quite understand how one complaint, from one RN, to an unnamed group of other Victoria Health Authority workers could lead to them directing the care of my GP. And all this done without my being part of the process or having consent and leading to a nurse administrator telling a GP to tell a specialist what to do, what to assess and how to do it, and yet not leaving the decision to the specialist. The results were to go to the RN’s, and only they would decide what if anything would be done. And it was to be done in ten days.

As a person dependant on healthcare, it is a poor position to be in if blackmail or coercion were to occur. And as the list of standard illegal practices by Victoria Island Health Authority as noted by the ombudsman’s office seemed quite long, and advocates seemed quite silent, I was concerned.

The reason I had to have the assessment, and have it so quickly, was because VIHA felt that ‘they may not have given all the care I need.’ Puzzling, no? As I have had only three visits from a nurse for my health in four years, and no follow ups. “What care?” was the assessment. However that phrase is oft used by VIHA to validate the administration of anti-psychotics, either due to dementia, personality disorder or other reason. And this would be implemented against my will, and if Linda did not comply, they would remove Linda as guardian. And then, all the complaints and blogs from 715 Vancouver street would stop.

That hardly seems realistic right? Except that currently Victoria at 52%+ has the highest percentage of people under care taking anti-psychotics in all of North America, and twice that of the average the other provinces of B.C. Interviewed RN’s, LPN’s and other caregivers actually thought the percentage was higher, closer to 80%. “Antipsychotics are a regular part of the medication routine,” says one LPN. “It’s almost an admission requirement.”
VIHA’s (representative doctor) Bailey is cautious. “It would be a fair statement to say that we would like to see fewer people on them,” he says. “But when you look at many [situations in which antipsychotics are being given] they may well, at least in the short term, be justifiable. In fact, it is my guess that the majority are.” 52% justifiable? Yikes. (http://focusonline.ca/?q=node/237)

However, anti-psychotics cause heart problems, particularly in the elderly, and over 100 will die in Victoria in the next six months according to Award Winning writer for Focus, due to this ‘solution’ to VIHA care problems. “..none of the long-term care staff I spoke to were even aware that Health Canada had issued warnings against seniors taking antipsychotics.”

So how can they keep prescribing it when a chemical restraint is supposed to be illegal? Because “there’s a gaping loophole. The policy defines a chemical restraint as any drug used to tranquillize a person’s behaviour and that “is not needed to treat medical or psychiatric symptoms.” Dementia-related behaviours, of course, are virtually always considered to be both medical and psychiatric symptoms...If [an antipsychotic] was prescribed as part of a regular care plan,” confirms Peters, VIHA’s Long Term Care contract manager, “it may not be considered to be a restraint.”” (http://focusonline.ca/?q=node/237)

Scared yet? I was.

The report has been made. It says that I am not a threat. I was to assessed for ‘Borderline Personality Disorder.’ I don’t have that. I was to be assessed for PTSD. The only PTSD which they saw occurring was due to the type of ‘powerless and exploited’ situations that I was being put in by Victoria Health Authority. The report is in, but I still have no medical home care.

Who guards these 'guardians' of the vulnerable.

11 comments:

GirlWithTheCane said...

Can you get access to a lawyer, Beth?

Someone has got to hold these people accountable for these...awful things... :(

Baba Yaga said...

My goodness, Beth. That's an extraordinary piece of writing.

2 things jump out at me which I can put into words - more which need digesting, I think.

One, that the approach and tactics (right up to the lack of respect for confidentiality, and systematic withholding of information) closely mirror what I experienced in the psychiatric system; which after all, remains based on coercion and a presumption of incompetence.

(As far as I can make out, most shrinks are decent and enlightened sorts, in the abstract, and at least partly aware that the system is wonky, if they mostly haven't worked out the extent to which their own practice is infected. In the concrete, the old origins of the system are very evident, especially when one has the wrong sort of diagnosis, or the wrong sort of needs, or the wrong level of ability to communicate in terms they recognise as legitimate, or all three.)

It makes sense that the psychiatric system retains that basis: it's wrong, but it makes sense that it's wrong.

It makes no sense at all, except from a perspective of unfettered power, that that approach, and active suppression of what doesn't even amount to dissent, should be applied to the entire population of people with illnesses in need of care - which is to say, the entire population, sooner or later. If only some *happen* to be abused or neglected, that doesn't mean the potential isn't there for the rest.

It's insane. Nothing in writing? It is something that you learn on the job? Good grief, surely in this age no-one responsible for policy-making can be unaware that that's a recipe for the evolution of an abusive system? O.K., some proportion of administrators probably don't know, and may not realise it's incumbent on them to care; but politicians are mandated to care, and to find out! How can it not be a legal requirement that there be written policies, available to all?

(OK. my comment's too long: will split it in two.)

Baba Yaga said...

Two: "the administration of anti-psychotics, either due to dementia, personality disorder..."

Both inappropriate uses of neuroleptics! (Most are, in fact.) Particularly so in Lewy Body dementia: if there's any suggestion of your being put on them, please ask my colleague (via me, if you want) for an expert's statement on that.

Justifiability, of course, is defined by those with power. Neuroleptics make people tractable, and that's very convenient for 'professionals': it's often confused by even the quite good ones with 'mental health'.

& if neuroleptics make one crazy (or just crazier), that's seldom recognised as iatrogenic (even when agitation shows up precisely 20 minutes after their administration, in full sight of the staff who administered them - I remain cross about that!), and therefore is likely to be treated with more antipsychotics. Neuroleptic-induced compliance doesn't necessarily think to question that.

On that topic, a comment which might interest you: "In a newspaper article in April this year, the UK's chief pharmacist was quoted as saying that 94 per cent of patients on neuroleptics receive no benefit from them." (James Mackie - I think an MSP at the time -, in evidence to Scottish Parliament Public Petitions Committee, Tuesday 19 November 2002.) - Link just in case anyone wants to verify. (I haven't been able to trace the newspaper artile: research was never one of my skills.)

The misuse of psychiatric assessments... I'd be scared silly, in your shoes. Even with the best intentions, shrinks are easily swayed to see people as incompetent - it's almost an occupational injury -, and to think fellow 'professionals' must be accurate in their assessments. (I've seen my psychiatric notes: they're riddled with inconsistencies, untruth, and wild extrapolations from preconception. It's rather alarming to think that for years I believed that my shrinks knew what they were doing! I actually thought, because they told me so, that they understood me better than I did: most of them understood someone who was not actually me - a different someone for every other shrink - better than I did.) Is there any way you can get an independent assessment?

If you were in Scotland, I might be able to actually help. Argh!

Christianne said...

I am glad to see that VIHA's horrible behavior is finally getting some attention from the press. I would not presume to write on your behalf without your permission, but I noticed an email address for the woman who wrote the Times-Colonist article about this on June 3rd (ceharnett@timescolonist.com). One would think any journalist who's covered the topic would be interested in your ongoing experience...if you are interested in pursuing this, I am sure we (your friends) would be happy to do what we could to help.
Lots of love to you and Linda!

darkninja said...

I tried Googling a little and there seems to be some possibility of free legal aid. It's damn hard doing this for a different country than your own, maybe someone from BC can help you?
http://www.cba.org/bc/public_media/lawyers/430.aspx - broad list of legal aid, some free possibilities.


http://www.clasbc.net/ - seems to offer some free aid.


Other than that your one option seems to be to involve the media, and that can be even harder than simply doing without the help altogether :/

I hope for the best. I really hope justice prevails in the end.

darkninja said...

Whoops, thought my screen name was a different one. It's Lise from Denmark here :)

Neil said...

Note to self: NEVER move to Victoria.

Beth, VIA does have written rules; I've just found some of them online by searching for "VIHA standards of practice."I don't have time to search the results though, since I'm supposed to be cleaning the bathroom, not commenting on blogs. And we're going out to a medieval event this afternoon.

I undertand that seeking legal advice takes more time and energy - and coherence - than you have available.

But VIHA sounds like it's totally out of control, and some brave soul is going to have to do something about it. And it doesn't sound like your Premier or provincial minister of health particularly cares to do anything.

I wish SO mush that I could help you two, but even in the same country, we're too far away. :(

If you're at a low enough income, could you qualify for social assistance? That would at least allow you to qualify for disability recognition.

I wish you less pain, better sleep, and kidneys that work as they're suppposed to.

How's Linda's leg doing?

Love and zen hugs,
Neil

Elizabeth McClung said...

Neil: Neither I nor Cheryl have been able to find a standard practice for VIHA - what does come up are the job competancies (sic) for the jobs like LPN must be able to: give an IV, etc - these are what people must be able to do FOR VIHA, not what VIHA is required to do under law for others in care. I did go check it out in hopes they had provided some sort of written or published standards - the pages they do have, on dementia and others have tags on them saying that they are put out by VIHA but that VIHA is not responsible for them, and they do not represent the care standard or diagnostic standard or anything definitive or representing VIHA outlook or guidelines.

Hope you have a great weekend.

Kate J said...

Hi Beth, I'm as appalled as all your other friends. No suggestions to offer... because none of us know the VIHA system as well as you and Linda do - sadly. I did draw your blog to the attention of a cousin of mine, who has worked as a nurse in Victoria and now working in Alberta, not in nursing but I think in mental health advocacy.

She says:
'It sounds like your friend needs someone to advocate for her, relentlessly because what is happening to her isn't right nor is it necessary and that is what it takes to get anywhere. I know she should be entitled to home care and funding for it and especially for the meds. If her partner is out of work and loses her job for medical reasons she can apply for medical Ei which is federal if she doesn't have private coverage. It is a matter of fighting which I can easily imagine they are too exhausted to do...

I know it's been a nightmare for my nephew (nb. he has ALS) but relentlessly contacting everyone you can and getting someone ie her MLA involved is important.

I am so sorry for their situation. I can do some digging and find out more re Victoria. What all does she need to have in place re care? If you let me know I will try to find some resources."


Beth, I don't know whether you'd like my cousin to get involved, and I doubt she's able to add to anything you're already doing, but I thought you'd like to see the perspective of someone who has worked in Canadian healthcare...

Love and peace

Audrey Jane Laferriere said...

Beth, suggest you tell VIHA that you are going to sue them for causing you post traumatic stress. That might get their attention. I am having my issues with Vancouver Coastal Health and all they want me to do is confess (confessing to their abusing sounds like spousal abuse)so there is a win win solution after the fact that the situation was of their making. I am the only advocate for a quad who cannot talk or write and they keep lessening his standard of care because he has the right to refuse treatment.

Anonymous said...

VIHA psyc doctors have a god complex and will break the laws. You should ask for help from "seniors at risk" sar.coalition@gmail.com