Ex-Nunavut health director doubts internal review done on accused nurse

A former Nunavut government nursing director is questioning whether the health department ever carried out a promised internal review of a nurse facing a slew of complaints, including that she refused to see an ill infant who later died.

"There were no changes made anywhere, so what the inquiry consisted of, I can't speak to that," said Elise Van Schaik, who worked as the director of health programs for the southern Baffin region.

In that role, she oversaw health centres in five communities, including Cape Dorset, the hamlet where a three-month-old boy, Makibi Timilak, died in 2012 after an on-call nurse allegedly refused to see him.

• Nunavut put community's health at risk by mishandling nurse
• Government orders health-care review following CBC investigation

A CBC News investigation found that the nurse, Debbie McKeown, faces nearly 20 allegations, including that she refused to see other patients and misdiagnosed some as well. An investigation is underway. McKeown's licence is currently suspended in Nunavut.

She was also found guilty by the government of harassing co-workers in two separate incidents. Yet, the government continued to employ her and promoted her at one point.

In response to the CBC News story on Nov. 7, Nunavut Health Minister Monica Ell ordered an independent review. She also stated that an internal review had already been conducted.

However, Van Schaik says she doubts whether that happened because nothing seemed to come out of it.

Van Schaik was part of a four-member team from the Baffin regional office assembled to take a look at McKeown's case after the acting deputy minister asked them to review a letter of complaint about the nurse. The team concluded that the mishandling of McKeown had put the health of the community of Cape Dorset "at risk" and recommended certain actions be taken to protect the public.

Among their recommendations were that an internal investigation be done on "the way management dealt with this matter" and that McKeown be "terminated immediately" or suspended until an investigation was done, if the deputy minister preferred.

"This is recommended for risk management, quality assurance and transparency reasons," said the internal emails from early January obtained by CBC News.

Patients dying from 'incompetent care'

Van Schaik says when she asked for an update about the investigation in late January, officials told her the Iqaluit office had taken over the process.

Nunavut's health department did not respond to CBC's request for comment, nor have they provided any details about the planned external review.

Van Schaik, a nurse practitioner, began working in Nunavut in 2008 in nursing contracts. In mid-2013, she was hired as acting director of health programs for Baffin South, then was offered the position on a permanent basis last February. She was dismissed in May. She says it was likely because she filed a harassment grievance against her boss and because she also went "against status quo."

After her dismissal, the nurse practitioner sent an email to Health Minister Monica Ell on May 7 expressing her concerns with how the health department was being managed. 

"Patients are dying from incompetent care," wrote Van Schaik. "Health Centres have never been audited. We are not able to build a sustainable and quality health care system if these are not being addressed."

"I had begun the work of addressing these serious concerns," she added. She says she never heard back.

In an interview with CBC News from Ottawa, Van Schaik described the health department as lacking accountability and transparency.

"Issues get swept under the rug," said Van Schaik.

The former health department employee says some health-care professionals feared speaking up about problems they witnessed, which prevents positive changes from happening.

"I've seen good nurses kicked out of Nunavut ... because they speak up," she said.

In the case of Makibi, the baby who died, a casual nurse, Gwen Slade, had filed complaints about McKeown months before the child's death. Slade says she felt her complaints were ignored by the government and that she was blacklisted from working in the territory.

Resumes waiting for months

The government refused to comment on McKeown's case, citing employee confidentiality. However, the health department did address accusations by some nurses who told CBC News the government rarely fired nurses due to severe shortages.

In an email, the government said that nursing shortages are felt across the country.

Though Van Schaik agreed with that, she also placed blame on the territory's sluggish bureaucracy.

"You may have resumes sitting on someone's desk for six months, so by the time that they actually get back to looking at those resumes, people go elsewhere," said Van Schaik.

In the future, the nurse practitioner says she'd like to see the health department do a better job of embracing the key tenets of traditional Inuit culture that the territory was founded on — that of consensus building and consultation.

"I see people at the community level who have no say in their health care, a government … that governs itself," said Van Schaik. "And I think it's set up for failure in that respect."

"Things could be so much better," added Van Schaik.

• Nunavut put community's health at risk by mishandling nurse