An Island psychiatrist who was accused of abusing a patient by using behaviour modification therapy has been cleared of all allegations by the governing body for doctors on P.E.I.
The 50-page ruling by the hearing committee of the P.E.I. College of Physicians and Surgeons instead finds fault with a member of the patient’s family. It also examines the struggle faced in finding appropriate long-term care for the patient, Laurel Hurst.
The Aug. 17 ruling, a copy of which was obtained by CBC News, followed hearings conducted earlier this year in which 19 people testified, including Dr. Arvind Singh.
“The evidence around this allegation involving ‘restrictive behaviour modification’ was perplexing at best,” wrote the three members of the hearing committee.
“The phrases ‘restrictive behaviour modification’ or ‘behaviour modification therapy’ do not appear in over 8,400 pages of Laurel’s medical chart.”
“Dr. Singh testified extensively about Laurel’s medical and psychiatric conditions … this committee finds no unfitness or incompetence … Accordingly, all of the allegations against Dr. Singh are dismissed.”
Patient needed specialized care
Laurel Hurst, 40, is living with late-stage Huntington’s Disease. It’s a genetic neurological disorder with symptoms that can include physical disability, dementia-like behaviours and emotional outbursts.
Hurst was admitted to the mental health unit of Prince County Hospital in January 2017, after she was picked up by Summerside Police following an incident of erratic behaviour in the driveway of a private home.
Hurst remained at PCH for more than a year, under the care of Dr. Singh, while staff tried to find long-term care and relations with the Hurst family deteriorated.
“Huntington’s patients require specialized care … this type of care is unfortunately not available on P.E.I.,” the ruling states. “Significantly, virtually no one working in the [mental health unit of PCH] had any experience or training in dealing with an HD patient.”
“There was unanimous agreement amongst everyone — caregiver and family alike — that Laurel did not belong in a mental health unit in an acute care hospital … improved management of her behaviour was seen as critical to her being able to relocate to [long-term care].”
The ruling also noted the “torturous process” encountered by staff trying to find an appropriate long-term placement for Hurst. In May of 2018 she was transferred to Wedgewood Manor in Summerside.
Expert testimony discounted
Much of the testimony heard by the committee focused on the attempts by Singh and hospital staff to manage Laurel Hurst’s behaviour. Staff testified Hurst displayed hoarding tendencies, and would accumulate dozens of food items, toiletry articles and pieces of clothing in her room, often taking them from common areas and from the rooms of other patients.
On at least two occasions, Hurst was placed in the “high-risk room” on the mental health ward of PCH.
Prosecutors had argued use of the high-risk room, an empty space with a locked door and a bare mattress, constituted “behaviour modification therapy.” They argued that was inappropriate because Huntington’s patients are incapable of being taught to change their behaviour.
The hearing committee agreed with Singh’s defence that the high-risk room was used to protect the patient and others from possible harm, noting it was also used by other patients and that the two occasions in which Hurst was placed in the room took place more than a year apart. The committee ruled it was evident such infrequent use of the room showed there was no intention to try to “teach” the patient anything.
The committee noted that Singh’s four-page written protocol, intended to help staff manage Laurel Hurst’s behaviour, was developed in collaboration with the Huntington’s Disease Society of Halifax, and Hurst’s parents, among others.
Thanks to all the staff who had the courage to speak the truth and our clients, community and colleagues for their support.— Dr. Harminder Dhillon, wife of Dr. Arvind Singh
Meanwhile, the committee said there was no clear evidence another document — a one-page protocol outlining restrictions on visitations, phone calls, clothing, meals and other items — had actually been used to guide Hurst’s care.
On that basis, the committee decided to discount much of the testimony from an expert medical witness, Dr. Serge Lessard, who asserted Singh had failed to maintain required professional standards of care.
The committee also ruled as inadmissible an independent investigation commissioned by Health P.E.I., concluding that testimony gathered by the committee itself provided a fuller understanding of context and details.
Harsh words for patient’s father
The hearing committee had harsh words for Stephen Hurst, father of the patient — finding fault with his testimony at the hearings and with his “shocking and inexcusable behaviour” at Prince County Hospital while his daughter was there.
According to the committee, on one occasion in April 2018 following use of the high-risk room, Stephen Hurst confronted staff over his daughter’s care and “banged his fist” on the nurse’s counter for about 45 minutes. This incident was recorded by Singh in his case notes and confirmed by others who testified.
Under cross-examination at the committee hearing, Stephen Hurst testified he had “no recollection” of the fist-banging incident.
The complaints against Singh were originally made to Health P.E.I. by Stephen Hurst. Those complaints were independently investigated by a third-party expert on behalf of Health P.E.I. — the investigation ruled inadmissible by the college.
Dr. Heather Keizer, then head of mental health services, reported the allegations to the College of Physicians and Surgeons. The college convened the hearing committee, with a lawyer acting as prosecutor for the college.
Singh family thankful, Hurst family ‘disappointed’
In a statement to CBC News, the wife of Dr. Arvind Singh expressed relief in the hearing committee’s rulings.
“We want to thank all committee members and our lawyers for their hard work. Thanks to all the staff who had the courage to speak the truth and our clients, community and colleagues for their support,” wrote Dr. Harminder Dhillon, who is also a psychiatrist.
Reached by telephone Friday, Stephen Hurst said he was “quite stunned” and “deeply disappointed” but needed more time to read and digest the document.
The College of Physicians and Surgeons has said the full text of the ruling will be published on its website after the appeals period has ended.