Judge refuses MUHC plan to move, forcibly medicate 'abusive' 80-year-old patient

A Quebec Superior Court judge has rejected a treatment plan proposed by the McGill University Health Centre for an 80-year-old female patient described by one doctor as "impatient, irritable, irascible, anxious, unpleasant, verbally and physically aggressive, and confrontational."

Among other allegations, hospital staff said the woman would frequently and intentionally run into other patients and staff with her electric wheelchair.

On one occasion, a staff member was injured, and police were called.

The woman's family said the alleged abuse was exaggerated, and the hospital's proposed treatment plan was designed to make life easier for staff, not to improve the patient's care.

Planned transfer to Douglas, forced medication

The court decision released this week protects the woman's identity.

The patient has several health problems, including chronic obstructive pulmonary disease. She's been living in various hospitals since 2009, and at the Lachine Hospital since 2015.

The MUHC suggested that the woman may also have mental health problems, including major neurological, behavioural or personality disorders. 

Doctors proposed allowing staff to forcibly medicate the woman when necessary, and to transfer her to the Douglas Mental Health University Institute for psychiatric evaluation.

The woman and her family were dead set against the transfer, as well as to allowing staff to force the patient to take medication when she was being difficult. 

In a decision which he acknowledged was a "difficult task," Justice Sylvain Lussier sided with the woman and her family.

Family says MUHC exaggerated woman's behaviour

The court decision shows the patient and her family have had a tense relationship with doctors and staff at the hospital for years.

The MUHC alleged the woman regularly asked to be prioritized over other residents.  

It said she hit staff while receiving care, hollered at them and refused necessary care.

The MUHC also said the woman often ran into staff, other patients and furniture with her electric wheelchair, which  prompted them to confiscate it.

The woman's lawyer, Patrick Martin-Ménard, told CBC the claims of abuse were greatly exaggerated. 

The family installed a video camera in the woman's room and presented some of the videos as evidence in court.

"Some things which were alleged to be physical aggression or very severe incidents of violence or aggression were, in fact, very minor things," Martin-Ménard said.

Martin-Ménard said, for example, sometimes the woman would grab an orderly's arm while receiving care to get his attention, and the orderly would immediately accuse the woman of hitting her and leave the room.

Martin-Ménard said the woman was unfairly labelled as a "difficult" patient.

"It depend on how you define difficult," he said. "For example, repetitive demands for basic things are considered to be problematic behaviour."

'Her hospital room is her home'

In his decision, Lussier concluded the patient was indeed demanding.

"She is impatient and insists on receiving immediate attention. Her requests can become exasperating, and the personnel has indeed grown exasperated," Lussier said.

However, he concluded, the patient does not present a danger to herself or others.

He also concluded that the woman was not "categorically" refusing medication, as the MUHC alleged, nothing that she agreed to take some drugs but refused others because they caused her stomach pain.

As for the transfer to the Douglas Hospital for psychiatric evaluation, Lussier concluded this would do more harm than good.

"The Court comes to the conclusion that the distrust the patient and her family manifest towards the Douglas Hospital is bound to lead to failure," Lussier said.

"Her hospital room is her home. Displacing her for a long period of time in what she perceives as a hostile environment can only increase her anxiety," he said.

Lussier acknowledged he believed the MUHC was acting in good faith but that its proposed solution was wrong.

"The Court can also understand the family's fear that the proposed treatment is an easy way to sedate their mother, to make the staff's life easier, even if the Court does not think that this is the case."

Case reveals systemic problems: patient's lawyer

Martin-Ménard said the case touches on broader systemic issues in long-term care facilities.

"It's not acceptable to ask the court for an authorization to forcibly medicate a vulnerable elderly person simply based on the fact that the reality of the system does not allow us to give this person the life quality to which she is entitled," he said.

Lussier acknowledged the systemic problems in his ruling, saying they made it harder to find a solution.

"The court has no remedies for staff shortages and aging of the Quebec population. It has no remedies to find alternative resources," he wrote.

"It can only encourage the parties to be more flexible and creative, and to continue their dialogue, failing which they will have to continue to bear each other in the unpleasant present situation."

Martin-Ménard said his client and her family are prepared to do that.

"They'd like to rebuild a relationship of trust and confidence on both sides. Hopefully, there will be a way forward for all the parties to work together and improve the situation," he said.

The MUHC refused to comment on the case.