A Summerside psychiatrist charged with malpractice had the opportunity to defend his actions Monday before a Board of Inquiry from the College of Physicians and Surgeons of PEI.
The complaints against Dr. Arvind Singh include failing to adhere to accepted professional standards, failing to cooperate with a patient’s family, prescribing medications or therapies in a manner “not in accordance with generally accepted professional standards and procedures” and verbal or physical abuse of a patient.
The case involves Laurel Hurst, who was admitted to the psychiatric ward at Prince County Hospital in early 2017 and remained there in Singh’s custody until June 2018. She had been diagnosed more than a decade earlier. early with Huntington’s disease, a degenerative nerve disease that damaged his cognitive ability and physical health.
Singh testified Monday that the system of rules he put in place was designed to protect both Hurst and hospital staff from harm.
“We had a consistent program with routine and structure, which a Huntington patient would benefit from,” Singh said. “She had her ups and downs.”
Singh wiped tears from his eyes at one point as he described efforts to deal with ongoing complaints from Hurst’s father, Stephen.
“I asked him what he thought was the problem.”
“‘Staff need to improve,’ was his response.”
“I think my response was, ‘Your attitude sucks.'”
Singh went on to wish he hadn’t used that word in Hurst, since Laurel’s father wrote it down in a notebook and brought it up a year later in another conversation.
Among other things, the family was upset that Laurel was sometimes locked in the ward’s secure room and was sometimes denied access to her own belongings.
Singh said he never saw any of the measures he put in place with Laurel as punishment.
She was moved to the high-risk area of the ward at one point because she was kicking her steel bed and they feared she might hurt herself, he said.
He testified that his patient’s condition worsened during her hospital stay. She wasn’t responding to medication, so he increased some, hoping to improve her behavior, reduce hoarding, and prepare her for transfer to a long-term care facility. He also reduced his dose of methadone, which he felt was too high.
The medication changes were designed to “target anger and agitation”, he testified.
“The comments from my team were that she was getting more and more aggressive…more physically aggressive towards the staff….Other patients were threatening to hurt her if she came into their room or took anything from them.”
Nurses testify about the family
Earlier Monday, two Prince County Hospital staff testifying on Singh’s behalf described Stephen Hurst as someone who confronted nurses about his daughter’s care and hammered at the nursing station office nurses for an extended period on one occasion in April 2018.
“A lot of staff were intimidated by them, and I was the one interacting with them,” charge nurse Kelly Walsh said of Hurst and his wife Janet-Rose Hurst, who is the stepmother. by Laurel. “They had a hard time understanding why we were doing the things we were doing.
“I remember he was upset, really mad at the nurses office.…I let the dad vent.…He wanted things to change. My main concern was Laurel’s safety.”
Walsh testified that the regular schedule and structure Singh created for Laurel was helpful in keeping her calm.
“Her care was excellent,” nurse Susan Simpson said of Laurel. As for her father and mother-in-law, “They were difficult from the start…always picky. They were very arrogant with the staff.”
Simpson said the safe room was only used for “extreme events” involving Laurel – “maybe running amok, trying to kick you, or throwing things, like hot tea.”
Simpson testifies that she was surprised by the parents’ complaint against Singh, after Laurel was released from the hospital.
“She was treated with great care. … She had some ability to control herself,” she said.
Treatment plan questioned
One of the main questions the hearing explores is whether Singh’s treatment plan amounted to what is called behavior modification therapy. The Hursts say the treatment was inappropriate given the nature of Laurel’s condition.
Singh testified that the phrase was never used in his notes, even though that is how others have described his treatment plan.
Dr. Serge Lessard testified earlier in the proceedings that behavior modification therapy is tantamount to treatment in which good behavior is rewarded and bad behavior is punished.
Hurst had been declared mentally incompetent, her father acting as her guardian, and her illness had progressed to the point that she could not understand why she was being punished. She was also being treated for alcohol and opiate addiction.
We were rooting for her. I deny any punitive action against her.– Dr Arvind Singh
“Each person with Huntington’s disease may present differently,” Singh said Monday. “I leaned on my team for a lot of feedback. We created a plan…
“We were supporting her,” he said, describing his efforts to get Laurel admitted to long-term care.
“I deny any punitive action against her.”
If the three-member panel finds Hurst’s family’s complaints justified, Singh could face a fine and/or restrictions on his practice.