How did a Penticton woman come to be held in a residential-care facility, against her will, for two years? It was frighteningly simple. Nancy Varcoe, a 60-year-old registered nurse, had suffered a series of strokes. While she was being treated in hospital, staff became concerned she could no longer care for herself.
Eventually, the Interior Health Authority arranged for her involuntary detention in a long-term care facility. Thus began a two-year ordeal that her husband likened to being taken hostage.
It must be said that there are circumstances in which patients should be confined. Yet Varcoe鈥檚 experience raises troubling issues. The legislation used to detain her 鈥� the Mental Health Act 鈥� is shockingly casual.
All it takes to confine someone initially is a written assessment by a physician. Any physician.
After 48 hours, the detention can be extended for one month if a second physician agrees. Following that, the detention can be prolonged indefinitely at the discretion of staff. The laxity of these provisions invites abuse.
Then there is the long reach of confinement. An example: Varcoe sometimes spent weekends at home with her husband. On one occasion, when she elected to remain at home, the care facility dispatched an ambulance with an RCMP escort to bring her back.
Last, there is a problematic arrangement over money matters.
Under the Mental Health Act, a health authority cannot gain control of a patient鈥檚 finances. However, the authority can ask the Public Guardian鈥檚 office to appoint a trustee, who does have that power.
This is problematic in two respects. First, the guardian鈥檚 office makes no assessment of the patient鈥檚 state of mind. It simply takes the health authority鈥檚 word for it.
Second, health authorities are not a disinterested party in this transaction. They have a financial interest.
Interior Health asked that a trustee be appointed to manage Varcoe鈥檚 finances. The authority then drew $25,000 from Varcoe鈥檚 pension, to cover her residence fees, in whole or part with the assistance of that trustee.
The authority was entitled to be paid. Yet it is also a fact that, had the authority granted Varcoe鈥檚 wish to be released, the trusteeship might have ended and those fees might not have been paid. This is a clear conflict of interest.
After pleading his wife鈥檚 case, Varcoe鈥檚 husband鈥檚 approached the provincial ombudsperson. That office conducted an investigation, and last month issued a scathing report.
Among the findings: The health authority detained Varcoe for over two years, against her wishes, without legal authority. In addition, the authority engineered the appointment of a public trustee without advising Varcoe of her right to legal counsel. The care facility might also have misrepresented its authority to detain Varcoe.
The outcome was swift. Varcoe was released, the health authority refunded her $25,000 and issued a written apology. But how many more such cases are there across the province?
The reality is that patients held in involuntary confinement often have fewer rights than prisoners in a penal facility. No doubt the great majority receive good care. But the exceptional vulnerability of these patients demands legislative protections far stronger than those in place.
After the initial period of confinement, subsequent reviews should be carried out by an external panel, not by facility staff.
To avoid the conflict over financial interests, a third-party assessment of the patient鈥檚 state of health should be obligatory before a trustee is appointed.
And the Mental Health Act should be redrafted to clarify roles and duties. In particular, physician assessments should only be carried out by doctors who have prior knowledge of the patient.
Nothing less will suffice, if we are to avoid a repeat of Nancy Varcoe鈥檚 ordeal.
