KJIPUKTUK (Halifax) – Bad things can happen when you believe that the characters in a taped Christmas show are real, and you start yelling at them.
Things might escalate and you could end up dead.
That is what happened to a resident of Valley View Villa, a long term care facility in Riverton, a small community near New Glasgow.
“Not knowing his diagnosis, but from what I read, it sounds to me like a very inappropriate placement. More thought should have been put into his support needs, it doesn’t sound like that happened.”
Cindy Carruthers, People First Nova Scotia
In late 2014 the obese man died of a heart attack while in a scuffle with a RCMP police officer. The officer was assisting Emergency Health Services (EHS) staff in moving the man to a nearby hospital after Valley View management decided he posed a risk to staff and residents.
The fatal scuffle was the last in a series that day. Earlier there were altercations with a caregiver and a security person at the Villa. But things appeared to have settled down again.
He had arrived at the facility only five days earlier.
So what happened?
The Nova Scotia Advocate talked to all the parties involved – Valley View management, the investigator who reviewed the officer’s action on that day, the Department of Health, and the Nova Scotia Health Authority.
What we were told is that it was nobody’s fault.
But the questions remain.
One thing leads to another
The Serious Incident Response Team (SIRT) is the independent agency that’s called in to review any major incident involving police in Nova Scotia. Three weeks ago SIRT released its report on the Valley View tragedy.
We learn that the unfortunate resident was a large man, weighing close to 300 pounds. He was a man living with mental illness who could at times become aggressive and physically violent. He used a walker. He was 49 years old.
After he started yelling loudly at the television, a caregiver told him she would take the DVD away if he didn’t quiet down. He apologized twice, but twice he resumed his yelling shortly after.
When the female care worker next removed the DVD the man grabbed her uniform by the neck and threatened to kill her. When a security guard told him to let go, he obeyed.
Next a struggle ensued in the hallway with the same security guard. In an effort to calm the man down the DVD was returned to him, at which point he retreated to his room, while continuing to curse loudly.
After the man had lunch and received medication, it was felt he had calmed down.
Meanwhile, management had decided that he should be moved to the Aberdeen Hospital.
When told that he would be moved the man became enraged all over again. As a result the police officer told him he was being placed into custody under the provisions of the Involuntary Psychiatric Treatment Act (IPTA).
Another struggle, and, with the help of a maintenance staff person, the man was handcuffed.
“At that point Officer 1 noted the affected person (AP) was unconscious and no longer moving. EHS personnel who were present attempted resuscitation efforts. […] AP was pronounced deceased at that point,” states the SIRT report.
It sounds to me like a very inappropriate placement
Cindy Carruthers, a coordinator with the self-advocacy group People First Nova Scotia, raises several questions.
She doubts that the man belonged in River View Villa, a institution that according to its web site mostly targets senior citizens.
“Not knowing his diagnosis, but from what I read, it sounds to me like a very inappropriate placement,” says Carruthers. “More thought should have been put into his support needs, it doesn’t sound like that happened.”
Carruthers also wonders why it was necessary for the police to intervene. After lunch things had quieted down, it doesn’t sound like the risk the man posed to himself or others was immediate.
And are police really the appropriate people to deal with people who are facing some kind of mental health crisis?
“It would seem that there was no need to have the police there, it was more a medical issue, or an appropriate support issue, as opposed to a justice issue. The police are being utilized in a way that they aren’t trained for. Mental health is not their area of expertise,” Carruthers says.
The officer did exactly what he was supposed to do
Ron MacDonald, director of SIRT, is confident that the RCMP police officer did nothing wrong.
“(The officer) did exactly what he is supposed to do, protecting other people’s safety,” MacDonald tells the Nova Scotia Advocate.
“The officer’s actions were justified under the Involuntary Psychiatric Treatment Act. He could also have arrested him under the criminal code. His intent was only to arrest him so that he was able to be brought back to the Aberdeen Hospital for treatment without causing injury to anybody,” MacDonald says.
The police officer was very restrained in his actions, says MacDonald.
“Although the police officer is still around he really didn’t have too much to do with the man, he is in the background. Then when staff attempt to move in again the man becomes very aggressive and violent, and now he is effectively, or at least technically, assaulting people and threatening to assault many people. Now he is out of control,” MacDonald says.
Whether the timing was right for the decision to move the man to the hospital, after things seemingly quieted down, is a question for the administration, MacDonald suggests.
“The officer was originally called to the home late that morning. The man had already assaulted a staff person and threatened to kill several of them. Staff was very upset about that, in fact the administrator of the home wanted the man arrested,” MacDonald says.
Then MacDonald offers up this information.
“What is not in my report is that the administrator of the home felt the man should not have been there in the first place. There was some disagreement whether the health agency should have placed him there.”
It’s not easy to make the decision that you need help
So was Valley View Villa the proper place for this man?
The home appears to be a loving place, with a caring, well-trained and dedicated staff. But is it the right place for a person who struggles with acute and severe mental health issues?
During a phone call with the Nova Scotia Advocate, Emily McEachern, administrator of the facility, is guarded in her response.
“That is beyond my control. We can refuse residents, and that judgement can be overturned,” says McEachern. We can’t be discriminating towards folks that have violent behaviours, but we also must feel safe.”
She believes the events that day could not have been defused, and calling the cops was warranted.
Once the man was warned that the DVD would be removed unless he stops yelling, there was no turning back, says McEachern.
“So on two occasions our care worker warned him, and each time the resident apologized for his behaviour and calmed down. But then he became obnoxious and disruptive again. With this type of client you have to mean what you say,” says McEachern.
If anything, McEachern believes that staff are typically reluctant to take a drastic step like calling police.
“This is a care facility and staff want to care for our residents. It’s not easy to make the decision that you need help because somebody is exhibiting violent behaviour, because it’s not the norm,” she says.
The government’s response: we just follow the rules
The Department of Health and Wellness regulates and monitors the long term care facilities in the province.
Questions are referred back to the the Nova Scotia Health Authority (NSHA), which is responsible for the placement of patients.
The NSHA simply followed the rules, writes spokesperson Everton McLean
“Our care coordinators assess each applicant to determine the appropriate care level. We follow the Department of Health and Wellness (DHW) legislation, regulations, policies and standards regarding nursing-home-level care,” writes McLean.
“You will note someone with a mental illness that is not stabilized is not eligible for placement. If a resident’s condition worsens or becomes unstable, whether it is a mental illness or not, it is the facility’s responsibility to ensure the person is seen by the appropriate primary health care practitioner and/or sent to the hospital for assessment,” McLean writes.
The questions are answered, yet the questions remain
A man yelled loudly at the television in the morning, things escalate, and by mid-afternoon he is dead.
It’s not our fault, we followed all the rules, say the police, the government, and the administration of Valley View Villa in unison.
In a narrow sense they may be right, but for Carruthers and others the broader question remains.
“I can’t believe that they accepted him in the first place. They should never have accepted him,” Carruthers insists.