WARNING: This story contains distressing details.
Two paramedics have been disciplined for unprofessional conduct after using forceps to insert an oral drug into the rectum of an incapacitated man being held by RCMP in northeast Alberta.
Hearing court documents provide details of the October 2020 incident at Elk Point and how the Alberta College of Paramedics (ACP) wrestled with how Donald Hingley and Ryley Pals should be disciplined.
Hingley and Pals were fined and reprimanded and ordered to undergo ethics training.
They had also faced eight-day suspensions, but those sanctions were overturned after a rare internal appeal.
During a court hearing last July, Hingley and Pals admitted that they had misadministered the anti-epileptic drug Keppra rectally, using large angled forceps.
Hearing documents say the patient had previously been assessed for his symptoms on Frog Lake First Nation, but do not specify whether he is a member of the Cree community. Frog Lake First Nation leaders could not be reached for comment.
The paramedic suggested that the patient was faking
According to an agreed statement of facts, Hingley and Pals worked at Medavie Health Services West-Prairie EMS, a private ambulance provider in the town of Elk Point, 215 kilometers northeast of Edmonton.
On October 7, 2020, they were dispatched to the local RCMP detachment to assist a man who appeared to be having a seizure. Hingley, an advanced care paramedic, was supervising. Pals was a primary care paramedic.
The patient – identified as “Patient A” in court documents – was unconscious in a holding cell when paramedics administered the drug. The court found that they misadministered the drug and failed to carry out a proper assessment of a vulnerable and unconscious patient.
Hingley was also disciplined for derogatory comments he made suggesting the patient was faking his symptoms.
In a patient care report, Hingley wrote that the man had previously been assessed on Frog Lake First Nation for “grasping activity” that was actually “more voluntary muscle contraction.” The patient did this so he could spend time in a hospital room rather than being incarcerated by the RCMP, Hingley wrote.
“The conduct of the regulated members was egregious, reckless and materially deviated from the standards expected of a regulated member,” court chairwoman Belle Clark wrote in a decision dated September 23, 2021.
The ruling noted that there are no current protocols that allow rectal administration of antiepileptic drugs, and that even if there were, Keppra is not a drug that can be administered intravenously. rectal. The use of forceps was deemed unacceptable.
“The combination of the invasive nature of the procedure and the inherent power imbalance created by Patient A’s unresponsiveness cannot be tolerated,” the decision states.
Pals told a university investigator that if the patient wasn’t going to take Keppra orally, the drug could “go another way,” he said.
“[Hingley and Pals’s] the apparent inability to consider other treatment options … is evidence of a significant knowledge deficit or gross intentional conduct,” he said.
Hingley, who described the patient as “highly non-compliant,” let her previous interactions with the man cloud her judgement, the court found.
The ruling said Hingley said in the patient care report that the man was faking his symptoms “to get his way” and was “more interested in ingesting alcohol and illicit drugs” than by drugs.
The court asked if the college had considered whether the case met the definition of sexual misconduct.
A lawyer for the CPA’s complaints director, Jennifer Kirk, said Kirk determined the conduct was not sexually motivated but an error in judgment – and that Hingley and Pals may have been motivated by the that the patient had previous interactions with paramedics and police.
In an email to CBC, Hingley declined to comment on his conduct, but said he had retired as a paramedic. Friends could not be reached.
After the incident, an RCMP officer asked another Medavie paramedic, Adam Nichols, to look at surveillance footage. Nichols, who is an advanced care paramedic, filed a formal complaint with the CPA after viewing the tape.
The treatment the patient received was horrible, Nichols told CBC News in an interview.
“I couldn’t imagine being treated the way this person was treated,” he said.
The penalties against Hingley and Pals are weak and set a “bad precedent” for the profession and patient care, Nichols said. “It was a violation of [the patient’s] rights and a violation of his basic humanity.”
In its September ruling, the Hearing Tribunal said a strong penalty was required in the case. A joint communication had suggested appropriate sanctions; the court deviated from the list by giving them eight-day suspensions as well.
As recommended in the joint submission, Hingley and Pals were reprimanded and each ordered to pay a fine of $500 plus $500 in costs. They were ordered to take a course on “ethics and boundaries” and told that the college would release details of the penalties, along with their names.
An additional condition was imposed on Hingley, prohibiting him from supervising paramedic students for one year.
“These are serious consequences that are consistent with gross misconduct,” the court said in its decision.
The eight-day suspensions were challenged by the college’s complaints director, then overturned on an appeal heard on March 30. The appeal panel found that the original tribunal erred in law in granting the stays.
The appeal decision noted that Hingley and Pals had no previous record of disciplinary issues, were remorseful for their actions, and cooperated with the investigation.
“The appeal panel was not convinced that by adding these additional penalties to what was a set of carefully crafted and agreed-upon remedial orders that further justice would be done,” the appeal panel said in its statement. decision.
He also said members of the appeal committee were “seriously concerned” about the conduct of the two paramedics.
In a statement to CBC, Kirk said the CPA takes complaints against regulated members seriously and handles them in accordance with the Health Professions Act.
“The college’s commitment to this process, including the appeals process, serves to ensure that our members continue to provide the highest quality care to Albertans,” Kirk said.
Nichols said he does not know the patient but hopes the man will learn the result.
“This individual needs to know that this is completely abnormal and unacceptable behavior – and the majority of paramedics would support that and say it was egregious.”