Adult Protection Services left cognitively impaired woman in misery for four years, despite complaints

Adult Protection Services, a branch of the Nova Scotia Department of Health and Wellness, let an intellectually challenged woman live in horrific conditions for four years, despite two complaints about her conditions.

Screencapture from NS Health & Wellness website

News reports about the case have focused on a now retired physician, Jalal Hosein, who acted “Ms. X’s” family doctor while also acting with power of attorney and as executor of the patient’s father’s will responsible for dispersing funds set aside for her care.

In the event of the Ms. X’s death, residual funds were to go to the Hosein’s spouse. That’s obviously egregious professional and personal misbehavior, and the College of Physicians and Surgeons has disciplined the doctor.

The systemic failure rests with APS, which is responsible for protecting people like Ms. X, but failed to do so. That she did not receive the help APS is obliged to provide certainly prolonged her misery, and likely caused her mental capacity to deteriorate.

You can read the decision of the college here, and I hope you will. Its description of Ms. X’s living conditions is horrifying:

There was rodent feces throughout the apartment and sticky strips in every corner with approximately ten dead mice on them. [The informant] was a cleaner for a living and said that the apartment is the worst she had ever seen. The toilet was filthy; the tub stained dark, there were several tiles missing from the shower wall and insulation was showing through. Dried human feces covered Ms. X’s computer chair.

Ms. X told the Complainant she had not had a shower or bath in “a long long time”. She could not get into the bathtub because she was afraid of falling and could not sit down while having a shower. Ms. X also said that she had only one set of clothes to wear.

More horrifying is the fact Adult Protection Services received complaints about her condition in 2014 and 2016, but closed the file without action, apparently on the Hosein’s assurances that all was well. It’s unclear whether APS visited her apartment. It finally acted in 2018, and the woman was hospitalized pending an appropriate placement.

Ms. X had been referred to APS in 2014 and in 2016, both times with concerns about her living conditions. On both occasions, Dr. Hosein told APS that Ms. X did not lack capacity and that her living conditions were sufficient. APS closed its files in 2014 and 2016 without further action as they did not have enough evidence that Ms. X met the criteria for APS intervention.

The college decision does not disclose Ms. X’s medical condition, but it makes clear her living conditions negatively affected her cognitive abilities, which could have improved with proper care.

Ms. X has a significant medical condition and is cognitively delayed with intellectual disabilities. The medical condition, if untreated, including not adhering to a special diet, may result in deterioration of intellectual ability, seizures, behavioural problems and psychiatric disorders.

On December 3, 2017, the Clinic sent a follow-up letter to Dr. Hosein. The team met to discuss Ms. X after another member of the team reached out to Dr. Hosein to alert him about Ms. X’s overall welfare. Ms. X may have been heading for some sort of crisis, and unlike many patients with cognitive difficulties, there could be a potential improvement for her with active treatment and diet modification.

Mrs. X is a citizen, entitled to protection Nova Scotia law affords people with diminished capacity. APS was responsible for providing that protection, but failed to do so, despite warnings about her condition. That she did not receive the help APS is obliged to provide certainly prolonged her misery, and likely caused her mental capacity to deteriorate.

A spokesperson for the department told me she would probably be unable to provide any information about the case because of privacy rules. She promised to look into the matter and get back to me. I’ll let you know if she comes back with anything illuminating.

This is how governments often use privacy rules: not to protect anyone’s personal dignity, but to stonewall allegations of wrongdoing by bureaucrats.

[UPDATE] The department spokesperson got back to me with a statement in the familiar format, “We take [blah, blah, blah] very seriously,” language communications officers typically use in situations where their clients have been caught ignoring or flouting whatever [blah, blah, blah] entails. Here is what she wrote:

We take our role in the protection of Nova Scotia’s most vulnerable people very seriously. We cannot share information about individual cases due to privacy legislation. We can tell you,  the department investigates allegations of abuse or neglect, and there may be situations when we work with our policing partners and the medical community to ensure people are safe. If an individual has information about a person in need of assistance, they have a duty to report it. This is particularly true for members of the medical community for whom it is their responsibility to advocate based on the best interests of their patients.

A generous reading between the lines implies that they checked with Hosein, who assured them all was well, but who knows? I asked whether any case worker or supervisor will be held accountable for this lapse and the years of suffering it led to. The spokesperson said the department would have “no further comment.”