On Allegations of Patient Abuse at St. Joseph’s

This story concerning alleged abuse of a senior at St. Joseph’s Health Care Centre (and yes, I know “alleged” is a weasel word) has been making the rounds in the Toronto media, including some blaring front pages in the Toronto Sun:

Ron Meredith claims two burly security guards at a west-end hospital manhandled him, dragged him to an empty room and shackled him to a bed like an animal.
The frail 79-year-old alleges he lay there unattended at St. Joseph’s — forced to wear a diaper — for seven hours until he was discovered by cleaning staff.
His only crime, he claims, is that he was sitting in a chair waiting patiently to be discharged.
“What they did to me was unbelievable,” Meredith said Monday, still in shock and covered in bruises two days after his ordeal.

Woken up by a noisy patient in the next bed, Meredith got dressed, went for coffee, and believing his discharge was imiment, sat down by the nurses station to wait. Unfortunately, the situation escalated.

He claims two security guards, “big guys,” approached shortly before 7 a.m.
“They accused me of trying to escape and told me to go back to my room,” Meredith recalled.
The senior explained he was waiting to be discharged but the guards again ordered him back to his room.
“I told them I was already dressed and I didn’t feel it was necessary to go back.”
After a third warning, he says the situation turned ugly.
“All of a sudden they pounced on me,” Meredith claims.
Both guards allegedly pulled him out of the chair, pinned his arms behind his back in a painful position and dragged him down the hall to an empty room.
“They threw me on the bed and I hurt my back on one of the rails,” Meredith said, adding the guards then cuffed his wrists and ankles to the bed.
“They really did a job on me,” he said. “And when that diaper was put on me I knew I was in for a long haul.”

Ugh. Nasty story. The thing is, as an old RN, I can immediately see suggestions there is much more to this story than meets the eye. The bruises, for example, on this poor patient’s arms are clearly old and related to IV starts or blood draws; they are particularly common in patients taking anticoagulants, which I strongly suspect this patient is on. They weren’t caused, in any case, by undue restraint. Further, one wonders if this patient refused a reasonable request to return to his room and wait for discharge; the patient then became increasingly angry and frustrated, and matters escalated from there.

On the other hand, as an old RN, I can clearly (and distressingly) understand how this story is completely plausible. Poor (or no) communication from the nurses on the inpatient unit to the patient and family on the care plan. Overreaction and assumptions made on the part of the nursing  staff. Stereotyping of the elderly as always confused and/or demented. Overuse of restraints. Underlying view of nurses that patients must be under control at all times. (Hospitals aren’t prisons!) Et cetera.

The point  is that there isn’t enough information to make an informed judgement one way or another, accusations made by the media notwithstanding. The problem is when health care horror stories — a favourite Canadian meme — appear in the press, it’s always a one-sided conversation. When hospital spokespeople say they cannot discuss the issue because of patient confidentiality, they aren’t being obfuscatory. Hospital administrators aren’t perpetuating a cover-up  By law, hospitals absolutely cannot make public patient information. This is to protect patients themselves. I mean, do you want information about you bum boil perianal abscess publicized?

The interesting thing for me is that the story, and how it is being played out in the media, suggests the public has a fundamental lack of trust in hospitals/health care and their ability to address complaints, and especially serious complaints like this one. This is precisely because there is a legislatively mandated lack of transparency. It’s not like hospitals want to treat patients shabbily, or think unethically (and possibly illegally) restraining patients is best practice, or don’t approach patient complaints with the necessary due weight. From experience, I can verify hospitals take all sentinel events extremely seriously, because we are, after all, in the business of making people better. I have no doubt that multiple various administrators at St. Joe’s are addressing the issue as I write. In short, time is needed for the appropriate investigations to be made.

I have to think, whatever the outcome, that this whole business was fundamentally a nursing issue. It could have been avoided. Basic Nursing 101: Avoid power struggles.  The nurses should have just let Mr. Meredith sit in his chair. Maybe that’s the ultimate takeaway.

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  1. #1 by Sarah on Saturday 24 September 2011 - 2047

    Ok so you looked at his bruises and thought ‘nice blood draw and IV sites’ too. I’m sure that there are two sides to this story but unfortunately the hospital/staff involved will never get the opportunity to share their side in the press. I’m always skeptical when people go running to the press without filing a formal complaint…

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