Even at this late date, nothing adds up or makes sense of the whole business of competency and confidentiality that went on at this time. From my post mortem review of Lee's Hospital record, I have come to the conclusion that the competency of a "Certified" patient to consent to either treatment, or to the release of "Confidential" information is apparently a "discretionary" call on the part of Hospital Staff. It very much depends on who wants it, is it in the best interests of the Hospital (the patients' interest being secondary), and is the party requesting information categorized as friend? or foe?. This is verified by the following:
1. As of the date of my meeting with Dr. Shore, Lee had been “Certified” 4 times. By Dr. Kitchen on Sept. 29, again on Oct.18 by Dr. Schick but was competent to enough while “certified” to agree to reverse a strongly held position and take AZT as part of his treatment. This was prescribed by Dr. De Wet who had previously been unable to convince him to take the medication while "Competent".
2. After two more “Certifications” on Nov. 12, I discovered that two days later Lee was competent to authorize release of his “Confidential” file to an outside third party, The Community Legal Assistance Society , who were somehow engaged to represent him at a Review hearing that was scheduled for November 29.
This apparently, had been troubling the hospital for on Nov. 18, Dr. Weiss notes in Lee’s competency assessment: “Pt wants to be discharged to a hotel vs parents wishes he remain in a locked facility. Certification issues. Ethical issues. Medical Legal issues.”
Dr. Weiss was again dealing with erroneous second hand information, the interpretation of our wishes as recorded by Hospital Staff . Lee’s parents did not wish him locked up, but, given: the distorted and inaccurate information they were spoon fed; the demonstrated inability of the Hospital to control his actions; the Normandy fiasco; his suicide and escape attempts, there was simply no other option available. Dr. Shore made this perfectly clear to me at our meeting on Nov.21.
Only one week prior to our meeting, Dr. Shore noted “nb. IV drug use” in Lee’s Medical Record, even though there was no prior history of drug abuse. As the Staff Psychiatrist in charge of Lee's treatment she was aware of the Certification, Ethical, and Medical Legal issues that concerned Dr. Weiss in his assessment. She had an opportunity at our meeting to verify or refute Lee's reported drug use; to explore our wishes re his future; to clarify our position relative to Dr. Weiss "issues". She apparently deemed this information “Confidential’ and the topic was not broached. Her statement that Lee could not release information was patently false. He had already done so while still "Certified" for the Community Legal Assistance Society. She was aware of the pending Review hearing and Lee’s need for Legal Representation but chose not to inform us. This was not confidential knowledge and we had a right to be informed about such matters.
It was only much later that this “labeling” of him as a junkie came to our knowledge. I firmly, to this day, believe that by allowing the label “IV Drug Abuser” to adhere to Lee for the balance of his treatment at St. Paul’s, Dr. Shore and Dr. De Wet were negligent, and that by allowing the error to stand in his Record they adversely affected his treatment while a patient in their care. Plans were made, actions taken, perceptions formed, by other Medical, Psychiatric, and Social Services staff who made their assessments of Lee based on an uncorrected error in his Record.
CLAS, the legal representation engaged for Lee, apparently were as unaware of our presence as parents as we were of theirs as our son’s new lawyer. They never contacted us for input or information, and apparently were unaware of our differences with the Hospital over his management. As a consequence we were denied the opportunity to engage Counsel for Lee who had a vested interest in his welfare and who could have provided advice that, given the sheer size of Lee’s file by this time, was not based on a cursory review of a file that was totally biased in the Hospital’s favor, and which labeled him an IV Drug Abuser.
I believe this was a conscious failure, by the Hospital, to disclose fully to Lee’s legal counsel any information that could be considered detrimental to their position, and was a violation of both Lee’s and our rights. To my request to St. Paul’s for the identities of the Panel members at that hearing and a transcript or summary of proceedings, no response has been received. A request to the Community Legal Assistance Society for information related to Lee was denied. I was informed by Mr. James Pozer, the Managing Director, that they were not even prepared to admit he was a client. Even if he was, they were not prepared to supply any information because this was a matter of Attorney / Client privilege and that privilege survives his death. How a "Certified" individual, mentally incompetent to handle his own affairs, is capable of entering into a legal association upon which his whole future depends is beyond me. A request for the identity of the party who engaged their services and to whom they were accountable, so that I might appeal their decision, was totally ignored. Apparently they are a "Star Chamber" appointed by God and accountable to no-one.
Lee, of course, simply took it as a minor ripple in his suicide plans:
Lee’s Journal Entry: Nov 22, 1995
if I had a gun i’d blow my brains out
this morning I saw dr. shore. she said they have been looking for accommodations for me in a locked place. i’d be locked up !!
these past days my mind has been filled with images of the burrard station and me killing myself.
if I could get out of here i’d do it right now. before when i thought of jumping in front of the train i’d feel somewhat scared and a feeling of not wanting to do it. it just seemed too gruesome. now i feel more relaxed about . what i’ll do is walk in the tunnel part, lay down on the track and wait for the train.
tomorrow i’ll hang out by the front door and try to sneak out. i shall do this everyday until i’m out.
the suicide is a bit sooner than i’ve thought of, but with the
position i’m in, the depression and now this.
this afternoon i stood by the front door for about an hour,
hoping to dart through the door.
the staff were telling me to move away from the door as they knew i was going to try to escape. after some talking i thought it was useless to try to escape when they’re all there.
i may try tonight when the man takes away the meals cart. and i’ll try tomorrow when they take the cart. whenever i escape this place it will be the day i suicide.
it weird thinking about it-
maybe tomorrow or next week i’ll be dead.
Lee's Journal Entry: Nov. 23,1995
shit, fuck, shit, fuck, shit!
i made it out the front door, people were chasing after me, i made it across burrard st. when 2 security guards stopped me.
i can’t even suicide
if these security guards never caught me i’d be sitting in a bar now getting drunk before my suicide
***
630 and i wish i could sleep. i love to sleep. that’s all i want to do these days is sleep. right now I want to go to sleep but i can’t.
i’m just pissed off that i ran into these security guards.
I have come to the conclusion after reading all of his files, that after his readmission from Normandy, his subsequent escape attempts, Lee was effectively written off with regard to his medical problems, He was perceived as a terminally ill HIV +ve drug abuser who was beyond medical help, and who’s mental problems and erratic behavior made him a “Management” problem. His treatment for the balance of his stay at St. Paul’s consisted of administering various and sundry psychiatric drugs in massive doses with the sole focus of modifying his behavior and rendering him “manageable”. His medical treatment was confined to maintenance of drugs to prevent opportunistic infection and any medical organic reason for his continuing deterioration was totally ignored, and no follow up studies were made. Lee’s admission to St. Paul’s was the result of an encephalitic infection of undetermined nature. Spinal tap, CAT scan, and MRI showed only diffuse atrophy but no causal agent was ever identified. An EEG showed abnormal patterning but all these tests were run in his first two weeks in hospital and were never repeated to determine if there had been changes of an organic nature. No other tests were ordered, no neurological consults were called for. Whether the damage to his system was progressive or self-limiting, and nature of the causal agent was will never be known.
Lee had severely limited Short Term Memory and judgment, but no quantitative Psychometric tests were ever administered to try to quantify the actual degree of impairment. All treatment was the result of subjective impressions of Dr. Shore and her staff of the behavior displayed by Lee, and his responses to verbal stimuli in one-on-one conversations. Any conclusions drawn from such sessions were almost totally without merit since no attempt had ever been made to gather a data base re his personality, behavior, or mental status before his admission. After five years of treatment, his own personal physician admitted he did not know Lee very well and conceded he was a very private person. Dr. Shore and her staff however, with their all-knowing and omnipotent cognition and intuition felt totally secure in deciding what was “normal” and acceptable to both Lee and ourselves. They possessed no personal knowledge of either Lee or ourselves, of our belief structures and value systems, of our personal principles and ethics, yet they felt free to stand in judgment of both him and us. Their conceit and arrogance should be cited in textbooks as how not to handle a situation.
Lee spent 4 more weeks on 2 East and he never adjusted to the routine or accepted the control placed on him by the Hospital. He got up in the morning for the first of an almost endless series of coffee’s and cigarettes. He sat in the smoking room and watched for escape opportunities. He dreamed elaborate suicide plans, He ignored his fellow patients because they were all nuts. He tried out dozens of reasons on the staff for day pass excuses because of the better escape opportunities they afforded, but most of the time he sat like a caged tiger, watching television and bristling under the restraints of his surroundings.
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