Woman with Huntington’s disease called ‘manipulative’ in psychiatrist’s notes

A Summerside psychiatrist called a patient with Huntington’s disease 'manipulative' in his notes on the case and restricted her access to the telephone at the Prince County Hospital, a disciplinary hearing was told on Tuesday.

Panel members who will decide on fine or discipline get chance to question Dr. Arvind Singh

A Summerside, P.E.I., psychiatrist called a patient with Huntington's disease "manipulative" in his notes on the case and restricted her access to the telephone at the Prince County Hospital, a disciplinary hearing was told on Tuesday.

But Dr. Arvind Singh continued to defend his treatment plan under cross-examination from a lawyer for the College of Physicians and Surgeons, saying everything he did was in Laurel Hurst's best interest.

Hurst and her parents were both anxious to have her leave the psychiatric ward of the hospital and be accepted as a resident in a long-term care home, Singh told prosecuting lawyer Doug Drysdale.

"Wedgewood Manor told us if her behaviour was not stable, they would not be able to receive her," he said.

"It was done in goodwill, to get her out of hospital as quickly as possible.… Being discharged and then coming back would have been even more hurtful."

Singh is accused of failing to meet accepted professional standards, not co-operating with a patient's family, prescribing drugs or therapies in a manner "not consistent with generally accepted professional standards and procedures," and abusing a patient verbally or physically.

Hurst's parents have said Singh used behavioural modification therapy with their daughter, trying to change her actions with a regime of punishments and rewards – even though her degenerative disease had left her cognitively impaired and unable to link actions with consequences.

"Patient continues to be manipulative," Singh wrote in a set of patient notes brought up at the hearing Tuesday. "It may be necessary to place her in seclusion if her behaviour does not improve."

Another set of notes kept by hospital staff cited by Drysdale contained this comment: "Parents would like phone restrictions lifted. Doctor does not agree to this."

She was making statements like "Staff is just sitting around collecting paycheques." The family would react without discussing it with staff. The decision was made to restrict phone access.

– Dr. Arvind Singh

Singh explained those comments by saying that Laurel Hurst was going into the rooms of other patients, without permission, and phoning her family to complain about how she was being treated at the hospital.

"She was making statements like 'Staff is just sitting around collecting paycheques,'" he told Drysdale. "The family would react without discussing it with staff. The decision was made to restrict phone access."

Panelists question psychiatrist

A three-person panel will make a decision at the end of the hearing process that could see Singh fined or operating his practice with restrictions in place.

On Tuesday, members of the panel were able to directly question Singh for the first time.

John Hennessey wanted to know how long the average patient stayed on the ward, compared to Hurst's 17-month stay.

Singh said the usual patient is admitted for one to two weeks, but long-term care patients who have to receive hospital psychiatric treatment can end up staying for months. Hurst was "one of my longest in-patient admissions," he confirmed.

He also acknowledged that Hurst was "distressed" by the fact she wasn't getting released.

"She'd see other patients coming and going. She blamed her parents. We started giving her passes.… Nobody was coming to take her out. She expected her family to be more available."

Notes questioned

Dr. Rosemary Henderson, the chair of the panel and medical director for the provincial government, asked Singh about a patient note that he had written saying, "No memory issues to be concerned about."

Singh said he can't remember why he would have written that, since Hurst had been declared incompetent because of her declining brain function.

Henderson went on to say: "We heard staff felt demeaned and ridiculed in front of others by yourself. Are you aware that people felt that way?"

Singh replied, "I know we have different sensitivities but I did not have a sense I was hurting anyone."

Another panel member, Dr. Randy MacKinnon, addressed the communications breakdown between Singh and Hurst's father, Stephen, her legal guardian. He was the one who officially complained about his daughter's treatment at Singh's hands, after she was released from hospital in June 2018.

"I got the feeling the breakdown in communications between you and the Hurst family sometimes put staff in a difficult situation," MacKinnon said to Singh.

"Correct," the doctor answered.

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