Woman with Huntington’s disease called ‘manipulative’ in psychiatrist’s notes

A Summerside, PEI psychiatrist called a Huntington’s disease patient ‘manipulative’ in his case notes and restricted her phone access at the county hospital of Prince, a disciplinary hearing announced on Tuesday.

But Dr Arvind Singh continued to defend his treatment plan under cross-examination by a College of Physicians and Surgeons lawyer, saying everything he was doing was in the best interest of Laurel Hurst.

Hurst and her parents were both eager to get her off the hospital’s psychiatric ward and be accepted as a resident in a long-term care home, Singh told attorney Doug Drysdale.

“Wedgewood Manor told us that if her behavior was not stable, they could not receive her,” he said.

“It was done out of goodwill, to get her out of the hospital as quickly as possible. … Being discharged and then coming back would have been even more hurtful.”

Singh is accused of 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 verbally or physically abusing a patient.

Laurel Hurst, now 40, is the patient at the center of malpractice allegations against psychiatrist Dr Arvind Singh. (Sent by Wedgewood Manor)

Hurst’s parents say Singh used behavior modification therapy with their daughter, trying to change her actions with a regime of punishment and reward – even though her degenerative disease left her cognitively and unable to link actions to consequences.

“The patient continues to be manipulative,” Singh wrote in a series of patient notes presented during Tuesday’s hearing. “It may be necessary to place her in solitary confinement if her behavior does not improve.”

Another set of notes kept by hospital staff quoted by Drysdale contained this comment: “Parents would like to see phone restrictions lifted. Doctor disagrees with this.”

She was making statements like “Staff are just sitting around collecting paychecks.” The family would react without discussing it with the staff. The decision was made to restrict access to the telephone.-Dr. Arvind Singh

Singh explained the comments by saying that Laurel Hurst entered other patients’ rooms, without permission, and called her family to complain about the way she was being treated at the hospital.

“She was making statements like, ‘Staff are just sitting around collecting paychecks,'” he told Drysdale. “The family would react without discussing it with the staff. The decision has been made to restrict access to the telephone.”

Panelists interview the psychiatrist

A three-person panel will make a decision at the end of the hearing process that could see Singh fined or operate his practice with restrictions in place.

On Tuesday, panel members were able to question Singh directly for the first time.

John Hennessey wanted to know how long the average patient stayed on the ward, compared to Hurst’s 17-month stay.

Laurel Hurst was a patient in the psychiatric ward at Prince County Hospital for 17 months, from January 2017 to June 2018. She now lives at Wedgewood Manor in Summerside. (Tom Steepe/CBC)

Singh said the usual patient is admitted for one to two weeks, but long-term care patients who need to receive inpatient psychiatric treatment can end up staying for months. Hurst was “one of my longest hospital stays,” he confirmed.

He also acknowledged that Hurst was “distressed” that she was not released.

“She was seeing other patients coming in and out. She blamed her parents. We started giving her passes. … No one was coming to take her out. She expected her family to be more available.”

Remarks questioned

Dr. Rosemary Henderson, chair of the committee and chief medical officer for the provincial government, asked Singh about a patient note he had written saying, “No memory problems to worry about.”

Singh said he could not recall why he would have written this, since Hurst had been declared incompetent due to deteriorating brain function.

Henderson went on to say, “We heard staff felt belittled and ridiculed in front of others by yourself. Do you know people felt that way?”

Singh replied, “I know we have different sensibilities but I didn’t feel like I was hurting anyone.”

Another panel member, Dr. Randy MacKinnon, addressed the breakdown in communications between Singh and Hurst’s father, Stephen, his legal guardian. He was the one who officially complained about his daughter’s treatment at the hands of Singh, after she was released from hospital in June 2018.

“I felt that the breakdown in communications between you and the Hurst family sometimes put the staff in a difficult position,” MacKinnon told Singh.

“Correct,” replied the doctor.