The pending health system overhaul offers a golden opportunity to take action against those who would abuse the old and the sick.
By Joan Cohen
It seems to be more than coincidence that a bunch of entrenched and disturbing problems in our health system are gaining new public prominence, just at the time our political leaders are being called on to undertake a major overhaul in the system’s workings. From startling disclosures about hospital errors and unsanitary practices leading to some 60,000 potentially preventable misadventures annually in hospitals, to disclosures of mistreatment of our elders in hospitals and personal care homes, the incidents cry out for reforms in the system.
The overhaul, of course, springs from the fact that we can’t finance the projected cost increases of our health care operations as they’re now organized. On the positive side, though, is the fact that the pending overhaul offers a golden opportunity to bring discipline and a new set of standards to a system that appears much in need of them.
Let’s review for a moment, though, a few of the disturbing stories we’ve been hearing about abuse of the elderly in hospitals and patient care facilities:
- It will be the end of April before we get what should be the full story on the death of Anne Rostecki, 98, in Seven Oaks General Hospital on Aug.31, 2009. Rostecki had suffered a severe stroke 45 days earlier and, notably, her family was warned on her arrival at the hospital that she was certain to have a second stroke and it would kill her.
What followed was a series of shockers: unbeknownst to her daughter, Rostecki was given no food for the next 15 days, not even through a feeding tube; she was not bathed for 36 days after being admitted to her fifth floor hospital ward; when tube feeding was at last launched, Rostecki was left lying flat on her bed, despite requirements that the bed be elevated to 35 degrees to allow the food to go down. She developed black sores on her tailbone and blackened skin – one of many problems not reported to her family.
Her daughter Rozalynde suspects a second stroke killed her.
- Lillian Peck, 93, was living at the Sharon Home’s Saul and Claribel Simken Centre in October, 2010, when her skin became infected by her own feces and later ruptured. A health department report noted the nursing home had no documentation on the basic nursing care or assessment and treatment she received, and that neither she nor her daughter, Marsha Palansky, knew about the wound. The staff weren’t sure how to treat it.
When Peck’s health deteriorated, she was transferred to a hospital, where staff put out an alarm. “The skin was black,” her daughter later reported. “One of the doctors thought she might have a flesh-eating disease.” She died from renal and heart failure two days after arriving in the hospital.
- Heather Brenan, 69, had been sick for a month and unable to swallow, and for the last four days had been in Seven Oaks Hospital waiting for tests. She was sent to Victoria General Hospital Jan. 27 for a gastropscopy but doctors, finding her too weak to undergo the tests, returned her to Seven Oaks to get her strength up.
That same night, at 11 p.m., Seven Oaks discharged her, leaving a phone message for a friend that said she was being sent home in a cab. The friend got to Heather’s home first, just ahead of the taxi and just in time to see Brennan collapse on her doorstep. Paramedics returned her to Seven Oaks, where she died the next day.
Isolated cases? Not if you talk to people like Conservative health and seniors critic Myrna Driedger, whose office is “overwhelmed with calls” from elderly people or their families who face all too many problems of abuse and neglect in the health system, along with many other issues related to their health.
On his part, Jon Gerrard, the medical doctor who represents the Liberal party in the Manitoba legislature, reports he recently has had forums in River Heights, St. Norbert and Fort Rouge to discuss problems arising in the care of people in hospitals and personal care homes. “Quite a number of people” showed up with stories of their experiences. Dr. Gerrard is careful to note that some personal care homes are doing a good job, but where the problems occur they “tend to be ongoing and oft-repeated.”
In a set of worrisome if less than revealing tables, the health department’s Protection for Persons in Care office offers a taste of the abuse problem that exists in the Manitoba system. The 12-year old PPCO defines abuse as mistreatment that causes or is likely to cause death, serious harm or significant loss of property; its definition of abuse includes physical, sexual, mental, emotional and financial mistreatment.
The PPCO tables show that in each year from 2006-07 to 2010-11, it received between 1,220 and 1,509 reports of alleged cases of abuse at personal care homes — which in most or all cases would mean the elderly. This was approximately 90 per cent of all alleged abuses reported, except in 2007-08. Patients in acute care hospitals are counted in combination with patients at Selkirk Mental Health Centre, and in all but 2007-08 registered about 10 per cent of reported abuses.
A stunning fact emerges, as one studies the numbers for the five-year period. After the fiscal year 2006-07, while the number of incidents reported to the Protection for Persons in Care office remains roughly the same (though trending slowly upward), the number of cases actually investigated drops precipitously for the four remaining years: from 156 investigations that first year, to 55, 42, 35 and 37 in the succeeding years.
Interviews with both the Conservative and Liberal MLAs earlier had provided the tipoff. Both Myrna Driedger and Jon Gerrard had expressed concern regarding changes in the status of the PPCO a few years back. At that time, legislative changes transformed it from an independent, arms length operation and brought it under the control of the provincial health minister. The numbers laid out in the PPCO statistical tables leave no doubt about the year the change was made.
In its early period, says Jon Gerrard, the PPCO appeared to be effective in bringing forward cases of abuse, but then came the reorganization. “What seems to have happened,” he concluded, “is the ability to deal with abuses has been much less because of inadequately handled inspections and enforcement.
“A cynic would say they have reorganized things so they cover up problems rather than correct them.”
The Conservative health critic had the same concern: “After the minister of health took control of that office the number of founded complaints dropped dramatically,” she observes. “I became very concerned there was political interference going on with that office. We keep pushing the government to try to improve things.” In fact, the opposition critics say wryly, the health system here is set up to protect itself.
Driedger’s response to the many complaints she receives about abusive treatment is to suggest that the individuals put their concerns before the Protection for Persons in Care office. She occasionally writes the health minister herself. “The minister will just say the case has been looked at, but won’t talk about the outcome,” she laments. “We have to go back to the family to find out. We have no way of going further.
“People sometimes have to fight so hard to get the kind of care they should be getting automatically.” The one recourse for everyone nowadays, Driedger suggests, is to have some kind of advocate – whether family, a friend, or an official. However, the Anne Rostecki case at Seven Oaks Hospital shows damningly even that approach can fail.
For Dr. Gerrard, there are solutions to be found on many levels. One solution lies broadly in a global reform of the health system, whereby provincial health funding would be overhauled to become patient-focused. Rather than being paid out as block grants, funding would depend on the number of patients an institution serves and the quality of patient care it provides.
British Columbia began to adopt this approach some years ago. One result was that more surgical procedures are being carried out and wait times have been shortened. The cash-starved Ontario government has just announced its decision to overhaul health system funding on similar principles.
The Liberal leader’s immediate focus, however, is on repairing Manitoba’s malfunctioning method of dealing with patient abuse, and making the system more accountable and transparent. Where an abuse is alleged, standard inspection procedures would be followed, recommendations would be made and changes carried out. Today, issues aren’t resolved, and in some more delinquent personal care homes Dr. Gerrard says the same abuses occur again and again.
So today in Manitoba, as emerges from the stories that make it into our daily newspapers, the elderly can be subject to abuse and even abandonment, sometimes with their families standing helplessly by. Man’s sense of humanity toward his fellow man cannot be relied upon now to protect the elderly. The situation loudly cries out for reform.