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Alberta Hospital Negligence

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May 1, 2000

The Honourable Judge P.G. Sully
Judges Chambers
Provincial Court of Alberta
Edmonton, Alberta

Your Honour:

RE: Nels Karstan Norregaard Inquiry

Please allow us to comment in regard to the available documentation which demands attention:

  1. April 22/87 Mr. Norregard was admitted to Alberta Hospital “against his will”, according to transcript of May 28/99, page 1, line 21 (Mr. Merryweather) However-
  2. The nurses’ admission notes state that he was admitted, “voluntarily”, the next day the same nurse, V. Hutt RPN states that Mr. Norregard is still, “disoriented as to time and place”.
  3. April 22/87, Consent For Diagnostic And Treatment Services – Voluntary Admission Form Dr Brahim had Mr. Norregard sign this form on admission. Page 2 states that the patient has been informed of his right to leave the hospital at any time.
    Paragraph 3 of page 2 has no entry which may indicate, Mr. Norregard may not have comprehended the document or that he was in a confusional state, as recorded in Dr. Brahim’s Discharge Summary.
    The signing of this form declared Mr. Norregard to be a voluntary patient. A voluntary patient cannot appeal for advocacy. In 1987, the Office of the Ombudsman had jurisdiction and since 1990, the Patient Mental Health Advocate has jurisdiction.
  4. The DISCHARGE SUMMARY authored by Dr. Asad Brahim dated 26/07/87 stated that 1) the “mode of admission was voluntary, 2) Mr. Norregard was in a “confusional state” P.2, Para 3, L. 4
  5. April 28/87,
    1. Mr. Norregard left the ward @ 9:30 AM and was brought back to the ward against his wishes. (Nurses notes) . What about the Voluntary Admission Form he signed on April 22/87 with Dr. Brahim stating that he could leave if he wanted (Page 2)?
    2. “He wanted to call his lawyer”. (Nurses notes)
  6. May 1/87 Mr. Norregard was certified by Mental Health certificates – Form II
    1. Dr. Brahim certified as follows:
      • “confused and disoriented to time and place” “total lack of judgement and insight”.
      • “patient is incapable of taking care of himself” “delusional and would need supervision” “incapable of taking care of himself” (repeated)
    2. Dr. Slavos Hontella certified as follows:
      • “moderately confused in time and even in place” “he wants to go home and sell the car and the home”
      • “progressive mental deterioration – becoming dangerous to himself and others (driving car)”
    3. Dr. Hontella also marked off on the form, “is in a condition presenting a danger to himself or others”.
  7. May 4/87 “Expressed desire to leave hospital.” (nurses notes)
  8. May 6/87 Schedule I, Form I signed by Dr. Assad Brahim – as follows:
    • “patient is incapable of looking after himself or making any reasonable decisions”
    • “confused, disoriented to time and place”
  9. May 12/87 Apparently, Mr. Norregard made Application to the Mental Health Review Panel, to have his Certificates reviewed and dismissed. We have not received a copy of this Application. It is not noted in the nurse’ notes.
  10. May 15/87 “Demanding to go to Bank of Montreal” (nurses notes)
  11. May 21/87 “Is disoriented at times”… “Will be discharged to a suitable setting in the community after further assessment…Presents no problem with elimination at this time. Total assessment complete and no new problems noted at present time.” (nurses notes)
  12. May 28/87 “Dr. Brahim was made aware of Pt’s absence from the unit before lunch (1130hr).” “Prior to leaving, Nels discussed his certificates with staff…” “She records his jacket as being “beige” when in fact it was green” (nurses notes) It would have been helpful if the nurse had recorded what Mr. Norregard stated concerning the certificates.
  13. May 28/87 4 page, Assessment of Decision Making signed by Dr. Assad Brahim, Terrence Chan, SW, Mona Marshall, RPN.
    Page 3, paragraph “G”. “He understood the reason for signing the appeal for his certification at AHE”.
    Page 4, paragraph “I” “He is capable of self care. He requires minimal supervision” (The former, contradicts all previous assessments of Mr. Norregard).
  14. Mona Marshall RPN, who was a signee of the 4 page, Assessment of Decision Making, fails to make mention of this document in the nurses’ notes. It is curious that three staff members would sit around and fill out this form when the 81 year old elder is missing from the facility.
  15. After supper, May 28/87, Form 8 is filled out by Dr. Brahim and senior staff are notified that Mr. Norregard is missing.
  16. On May 28/87, the weather was warm however there had been some precipitation with light winds.
    The next day, May 29/87, was mainly cloudy with thunder showers, winds west 25.
    Saturday, May 30/87, mainly sunny with scattered evening thunderstorms, winds south 20. Similar unsettled weather on May 31/87.
  17. The DISCHARGE SUMMARY of Dr. Assad Brahim dated 26/07/87 states:
    1. The “mode of admission” as voluntary.
    2. “….would eventually need some supervision” (diagnosis).
    3. Dr. Brahim regarded Mr. Norregard to be in a “confusional state”, P. 2, Para 3.
    4. Dr. Brahim does not record the signing of the Voluntary Admission Form, Consent For Diagnostic And Treatment Services
    5. Refers to Form 8 under the Mental Health Act
    6. Dr. Brahim stated on Page 2, paragraph 3:“By June 1, there was no word concerning the whereabouts of Mr. Norregard. The police had been looking for him and numerous media people had also been involved. Mr. Norregard’s certificates lapsed on June 1, 1987 and therefore his status was changed to voluntary after having gone out of the ward without permission”. (Not true. The police had not been looking for him prior to June 1/87.) “July 18, 1987…discharged from the hospital”
  18. How disturbing! When we fail to be able to account for our vulnerable patients, we simply declare their status as voluntary and then discharge them.
  19. We ask elderly persons to sign voluntary consent forms and them declare them to be “confusional” and “delusional”.
  20. If in fact he was confused, they failed to protect him. When the police were notified of his absence, they were informed that there was no urgency.
  21. The declared status of this elder was changed from, informal, to voluntary, to certified, and again to voluntary, all within a period of forty days. Then for no obvious reason, he was officially discharged.
  22. In summary, we believe that someone should have to give an account of the unusual and confusing process to which Mr. Norregard was subjected, preferably the provocator, Dr. Assad Brahim.

To date we have not received:

  1. a copy of the Application to the Mental Health Review Panel, requesting that his Certificates be reviewed and dismissed.
  2. a copy of the form 8 which would have been the form submitted to the Police.
  3. a copy of the Statement of Benefits Paid of the Alberta Health Statement as it relates to Mr. Norregard after he arrived in Alberta.

Respectfully submitted,

Elder Advocates of Alberta