Woman with disabilities stuck in hospital, witness tells rights inquiry

Woman with disabilities stuck in hospital, witness tells rights inquiry

HALIFAX — A woman with intellectual disabilities was kept in a psychiatric hospital for years as government departments disagreed over which should change its ways to find her a home, a human rights inquiry heard Monday.

Denise MacDonald-Billard, a former senior manager at the Department of Community Services, said she wanted to help Beth MacLean move in the early 2000s, but there was no safe place to put her.

She said the Emerald Hall unit at the Nova Scotia Hospital had a practice of often keeping MacLean behind locked doors or occasionally using a "therapeutic quiet room" — a padded room.

"The Nova Scotia Hospital ... managed her behaviours by keeping her behind locked doors,'" MacDonald-Billard testified. 

The former Community Services manager — who now works in the Health Department — said she was urging the hospital to find approaches other than locking her in her room when she misbehaved.

She said the community facilities didn't have locked door systems or quiet rooms, and as a result MacLean stayed put.

"We tried to explain, 'Here's the level of support that can be provided safely in the community. Try and make sure that whatever care plan was being put in place is something that could be transitioned (to the community),'" she said.

The inquiry is considering whether the Department of Community Services violated the Human Rights Act by housing MacLean, 46, and Joseph Delaney, 46, in a hospital-like, institutional setting at the Emerald Hall psychiatric ward in Halifax for over a decade.

It also heard relatives tell the story of Sheila Livingstone, a woman with disabilities who died while the case wound its way through various delays. The Disability Rights Coalition is an intervenor in the process.

The human rights complaint, laid in 2014, argued they should have been provided housing in a "small options" home after psychiatrists medically discharged them.

Small-options homes are small housing units, usually with three or four residents, where day-to-day support is provided to people with intellectual disabilities to allow them to live in their community.

MacDonald-Billard, who is now a senior official in the Health Department, was the first witness the government called for its case. She was testifying after the first 18 days of the hearings focused on the complainants' witnesses.

The veteran public servant said when she was the manager of the Services for People with Disabilities division, she raised questions about Emerald Hall's methods.

However, she said the health authority "wanted Community Services to change how they provided care."

"But it's a licensed program. There are rules around how these homes are licensed and how they're staffed. We tried to explain, 'Here's the level of support that can be provided safely in the community,'" she testified.

Rachel Boehm, a manager in the central zone of the Nova Scotia Health Authority, said in a telephone interview she couldn't speak to what had happened in past years between the various departments involved.

However, she said in recent years the use of the locked doors and therapeutic quiet rooms have decreased and the hospital uses different methods to prepare patients at Emerald Hall for life in community homes.

"Our model of care has evolved since that time. So nowadays you have a lot more expertise on a unit," she said.

Boehm said since 2013-14, behavioural analysts have been hired to work with patients to intervene in cases of challenging behaviours, identify triggers and teach both patients and staff ways to reduce outbursts.

She said that improves their ability to move into community facilities, and has lessened the problem that Billard-MacDonald described from the earlier decade.

Billard-MacDonald also testified that during her tenure, an inter-departmental committee was created to try to work together for "complex cases," where the person with disabilities needed support from multiple departments.

However, the complainant's lawyer — Vince Calderhead — introduced a memo suggesting the committee lacked the resources to ensure the most difficult cases could be addressed.

Officials from the children's hospital, the health authority and the Department of Community Services pointed in the report to a lack of any special budget to fund special housing arrangements.

"Until the identified barriers are resolved, the complex case management team is powerless to advance or resolve existing and future complex cases," said the memo, in bold letters.

"Subsequently, the number of unresolved complex cases continues to increase."

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Michael Tutton, The Canadian Press