In May 2019, 81-year-old Robert McGregor received a phone call from London Hospital Sciences Centre (LHSC) requesting his attendance with Dr. Sami Omer, which he later learned was upon the petition of his children who were disturbed by his 'unusual' and ‘paranoid’ behaviour.
That his children did not initiate a meeting with the family physician to address their concerns is a conundrum to me. It would have been a kinder and much more respectful approach.
After leaving his perfectly groomed home and assisting his friends in his community with a few chores, McGregor went to LHSC and was assessed by psychiatrist, Dr. Sami Omer.
“Dr. Omer seemed to be annoyed with me as soon as I sat down. Within a few minutes of our meeting he said I was bipolar and then held up his arms as if to act as a corresponding visual aid. I really had no idea what he was doing," said McGregor.
"Dr. Omer said I need to be admitted to hospital."
“When I disagreed with Omer’s diagnosis, he threatened to take away my driver’s licence if I did not admit myself into the mental health unit,” added McGregor.
"Dr. Omer got my attention right away."
Why would a doctor resort to intimidation and threatening tactics on a patient?
It's important to note that McGregor's father and brother have been diagnosed with bipolar disorder, but McGregor was adopted and therefore, not genetically predisposed to this neurological disorder.
Fearing the loss of his much-needed transportation, McGregor was admitted to Victoria Hospital. Omer administered a 30-day time-released anti-psychotic inoculation to "calm him down" and McGregor was told that he would receive this inoculation every month.
Within a moment’s notice, McGregor’s human rights were violated and independence diminished.
Omer kept McGregor against his will at Victoria Hospital’s Mental Health Unit for thirteen days.
“The first night that I spent at Victoria Hospital was horrible,” says McGregor, adding that “people were coughing and hacking and yelling all night long.”
“When I woke up, I saw a man in the bed next to mine whose hands and feet were shackled to the bed frame.”
“A nurse approached me and asked me if I felt like I would hurt someone and I responded by saying: why would I want to do that?”
Ten days in and McGregor has seen more bouts of violence than he has experienced in his life.
“There were a lot of young men in the mental health unit and I felt bad for them. They were good people who desperately needed counselling – someone to talk to. Instead they were alone - quietly sitting in a room,” says McGregor.
On the eleventh day of McGregor’s stay at Victoria Hospital he received a head MRI (magnetic resonance imaging).
“On two occasions I asked Dr. Omer about the result of the MRI but he would not respond,” says McGregor.
McGregor was released from Victoria Hospital on the thirteenth day, given a prescription for Aripiprazole 5 mg, an antipsychotic drug, and ordered to “take all the medication.”
Omer presented McGregor with a medical document that states he has the “potential to be violent to himself and others” and that he is “incompetent to take care of himself.”
If McGregor did indeed have the potential to be violent to himself and others, as well as incompetent to take care of himself, it is a paradox why Omer released him from the Mental Health Unit on his own accord.
McGregor drove from London to Toronto seeking solace from his long time friends, who noticed immediately that he was walking with his torso skewed sideways and his speech was slurred.
“McGregor was just not himself,” says Andy Brisebois, a friend for over thirty years.
“He looked very tired and emotionally beaten down. He complained that his legs were very heavy, he had difficulty walking and his breathing was laboured. He works out three or four times a week. This is not the McGregor I know.”
McGregor stopped taking Aripiprazole and within a few days was back to feeling normal again - walking straight, clear-headed and his speech was no longer slurred.
McGregor had a follow-up meeting with Omer on Monday, June 17, 2019, but received a phone call from Omer’s office saying the appointment was cancelled; instead a nurse would be coming by his home the following day. McGregor did not trust this sudden change and came to the conclusion that anything that transpired during this visit would be his word against hers and she has the authority to have him placed in the mental health unit.
McGregor was conveniently unavailable for the nurse’s visit at his home.
A Lesson for Us All
It is a question for the judicial system to determine what authority McGregor’s children and the hospital possessed in requesting McGregor report to a Mental Health Unit for assessment. Then again, I don't understand why McGregor would consider attending an appointment without first questioning their authority. I can only conclude that McGregor was vulnerable and insecure – as well as shocked and hurt to know his children thought so little of him – and especially, with diminished capacity.
Speaking with McGregor it’s difficult to fathom how anyone could put this very kind and remarkable gentleman through such a horrific ‘thirteen-day mental health unit experience’. His kids, LHSC and Omer have all failed him terribly. McGregor is a fluid thinker and good conversationalist, although at times a bit loquacious, but with an amazing sense of repartee - and definitely not your typical 81-year-old.
McGregor has an indomitable, entrepreneurial spirit providing all listeners with an abundance of wisdom that in his heyday paved a way to his lucrative and successful career. He is a geographical adventurer travelling around the world visiting over 80 countries. McGregor has always been there for his kids in celebration of good times and a shoulder to lean on in bad times. Through trials and tribulations – through hopeful days and emotional nights taking care of his wife whose body was riddled with cancer until her untimely demise, he has demonstrated strength, compassion, love and steadfastness. McGregor has given his children more than $800,000.00 and created trust funds towards his grandchildren’s education.
These actions do not resemble a man with a violent predisposition, diminished capacity and incompetence; rather a father who would do anything for his kids and grandkids and a man who loves life and all the adventures it will allow.
We have all been forgetful, a little paranoid or nuts and yes at times, given the right circumstances, frayed at the edges – but it’s no reason to call the loony bin. We haven’t given up on you; why on earth would you give up on us?
LHSC: 10,000 People Flagged as ‘Potentially Violent’
From April 2018 to 2019, over 10,000 people were flagged as ‘violent’ or ‘potentially violent' under London Hospital Sciences Centre’s (LHSC) new ‘Behaviour Assessment Screening’ policy.
156 patients have appealed their 'violent' classification of which 22 were successful.
ARCH Disability Law Centre is currently 'counsel on record' representing a number of applicants before the Human Rights Tribunal of Ontario in the matter related to the “purple armband” and the LHSC.
‘Purple Armband’ Policy Violates Human Rights
The risk assessment tool used for the screening profile casts a much broader net of typical or conventional emotions outside its periphery, i.e. irritability, agitation, anxiety, nervousness, depression and confusion. These emotions do not pose threats nor are they representative of the person’s psyche – but perhaps a response to the medical event that has occurred. Then again, these emotions can be experienced anywhere within any industry on any given day.
Going to an Emergency department for medical assistance, you are already under duress and depending on the severity of injury to yourself or someone close to you – the experience can be unnerving and upsetting. We all handle stress differently. That you are expected to be calm, cool and collected during a medical ordeal is an overreach under the best of circumstances.
All inpatients, emergency department patients and mental health service patients are screened by a triage nurse at LHSC for violence risk - a professional assessment customarily provided by a psychiatric team. Should you show signs of anxiety, confusion, irritability, boisterousness, nervousness, agitation, paranoia, depression or anger, the triage nurse has the authority to place an electronic marker on your medical record. This marker tells everyone in the medical industry that you have the potential to be violent towards yourself and others.
LHSC then calls you in for an assessment with a psychiatrist at their Mental Health Unit. Even when you have been assessed for the second or third time and display no signs of mental anguish or illness, LHSC will not remove the electronic marker on your medical record.
If a person receives a score of moderate or higher on the risk assessment, he/she is asked to wear a purple armband. If a person refuses to wear an armband, a sign with a large exclamation mark is adhered to the door or curtain of the patient's room to warn staff of the potential risk. If a patient in the Outpatient Mental Health Unit refuses to wear an armband, he/she will be escorted by staff wherever they venture. If a patient refuses the escort, he/she will be denied treatment that day.
Public Services Health and Safety Association
According to Public Services Health and Safety Association – Ontario,
Examples of violent behaviour include: choking, punching, hitting, shoving, pushing, biting, spitting, shouting, swearing, verbal threats, groping, pinching, kicking, throwing objects, shaking fists, and threatening assault and,
Examples of early signs of violent behaviour include: changes in autonomic nervous system, e.g., sweating, flushed face, changes in pupil size, increased muscle tension, and rapid, loud or profane speech.
“Electronic flags appear on the computer screen as abbreviations and/or symbols; however, their presentation and effectiveness may vary according to software and type of flag:
Active flags are displayed as pop-ups each time the file is opened. They require staff to acknowledge they’ve seen the flag before workflow can continue.
Passive flags are visible at all times in a prominent place on the screen, and do not require staff acknowledgement.”
In November 2018, London Free Press published an article that states LHSC is not the only hospital that has a violence prevention policy that distributes purple armbands to ‘potentially’ violent or ‘high-risk patients. Chatham-Kent Health Alliance and St. Joseph’s Health Care use purple armbands as well. Since 2014, Bluewater Health in Sarnia, Ontario has utilized bracelets for physically aggressive patients and Huron Perth Healthcare Alliance is considering the implementation of armbands or bracelets.
‘Stop the Stigma’
Psychiatrists at Victoria Hospital and LHSC employees have been wearing ‘Stop the Stigma’ bracelets to protest against the new screening policy introduced in May 2018, which unfairly targets people with mental illness.
Psychiatrists Resign at LHSC
In an article dated May 9, 2018, Kate Dubinski, reporter for CBC News stated that Dr. Paul Woods, CEO of LHSC, released a memo addressed to all psychiatrists asking them to work extra shifts, cover for colleagues on holidays and continue to be the primary psychiatrist for patients admitted into hospital. The memo also asked psychiatrists to be watchful for recent graduates and community psychiatrists who wanted to work temporarily while LHSC administrators actively search for new psychiatrists for the inpatient unit.
In March 2019, 5 psychiatrists resigned from their positions at LHSC due to ongoing poor leadership and mismanagement. The immense increase of patients and inadequate outpatient services at LHSC has positioned psychiatrist’s workload beyond capacity.
LHSC ‘Policy on Patient Information’
“LHSC's first priority is patients. Information about our patients is private and confidential, unless it has been authorized to be released to the media by the patient, the patient's family, or the patient's substitute decision maker.
The hospital will not provide any patient information when doing so:
- violates or appears to violate a law;
- is likely to have an adverse effect on the patient in the judgment of a physician, or other health-care professional involved in the direct care of the patient.”
Is LHSC breaking their own policy by asking patients to wear a purple armband – a labelling mechanism that visibly divulges a patient’s private and confidential information?
Ombudsman
Patients who are anxious about the ambiguous outcome or delay in their armband appeal, are invited to call Ombudsman at 1-800-263-1830 (toll free) or 416-586-3300 (outside Ontario), or you can Fill an online complaint form with Ombudsman.
Conclusion
Flagging people with little or no substantiated, medical evidence or prior history of violence is discriminatory and violates human rights.
Legal advocates and renowned psychiatrists state repeatedly that the purple armband is a labelling mechanism that stigmatizes, victimizes and hurts people. This undignified approach disparages the patient’s relationship with the family, medical environment and general public.
People seeking treatment for mental illness at LHSC are suffering and continue to face unjustified stigma having to wear the purple armband. Aren’t they going through enough?
Surely, medical professionals and corporate management can come up with a better solution that does not compromise a patient’s privacy and dignity.
The criteria used to determine a patient’s potential for violence is different in every hospital. The right thing to do is find a province-wide, principled solution that would protect staff, the public and the patient.
For anyone in the hospital industry who does not understand just how undignified the purple armband is, let me paint you a scenario. All medical personnel who have had negligence or malpractice charges placed against them, regardless of evidence and outcome, must wear a red armband. If you have been reprimanded for insubordination, medical ethics and practice or uninformed consent, regardless of evidence, you must wear a red armband.
So that the public can make their own decision as to who they receive medical assistance from, and so that medical staff can choose who they work with and for, you must wear a red armband - for an undetermined amount of time.
I heard someone once say, “When everything seems to be lacking in integrity, you find it in yourself.”
Everyone recognizes that staff, patients and the public need to be protected from acts of violence. We get it. We’re with you all the way. You’re just going to have to find a dignified and professional way to do it.
Resources
For additional information, Diligencia Investigative Reporting recommends the following articles:
https://www.cbc.ca/news/canada/london/lhsc-facing-at-least-a-dozen-human-rights-complaints-1.5034281
https://www.cbc.ca/news/canada/london/lhsc-purple-armband-10000-patients-1.5160439
https://www.cbc.ca/news/canada/london/london-ontario-lhsc-psychiatrists-resigned-1.5073633
https://www.cbc.ca/news/canada/london/camh-largest-psychiatric-hospital-violent-patients-1.5000723
Public Services Health and Safety Association - https://www.pshsa.ca/wp-content/uploads/2017/04/VWVMNAEN0616-Communicating-Risk-of-Violence-Flagging-Prevention-Program-V1.1-2017.04.21.pdf
ARCH Disability Law Centre – is a specialty legal clinic that practices exclusively in disability rights law. Since incorporation in 1979, ARCH has been a leader in disability rights advocacy and test case litigation. ARCH is dedicated to defending and advancing the equality rights, entitlements, fundamental freedoms and inclusion of persons with disabilities with low income in Ontario. ARCH is primarily funded by Legal Aid Ontario.
Additional Resources
Diligencia Investigative Reporting recommends the following articles:
Diligencia Investigative Reporting - Mental Health Costs and Burden: Canada and the United States
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