Thursday, October 22, 2009

Nurse: MD’s note didn’t look official

An article published in today's edition of The Chronicle Herald:
No psychiatric exam had been set up for Hyde; man didn’t show acute symptoms, woman says

By Michael MacDonald, The Canadian Press

The nurse who admitted a man to a Nova Scotia jail where he later died knew about a doctor’s note requiring the inmate to receive a psychiatric exam, but the nurse told an inquiry Wednesday she didn’t consider it an official physician’s order.

Sandra McLeod was the nurse in charge at the Central Nova Scotia Correctional Facility [pictured] when Howard Hyde — under arrest for an alleged assault — was dropped off there by deputy sheriffs on Nov. 21, 2007.

Hyde, a 45-year-old musician with a long history of mental illness and run-ins with the law, died the next morning as he struggled with guards, yelling there were "demons" in the jail.

McLeod told the inquiry she knew Hyde had not refilled his prescription for an anti-psychotic drug for about four months, and that he had been Tasered by police after his arrest and later sent to a hospital for treatment.

As well, McLeod confirmed she had read a handwritten note on Hyde’s health information transfer form, written by Dr. Janet MacIntyre, that said he had to be returned to hospital if he did not receive a court-ordered psychiatric assessment.

McLeod testified that when she read the note from the emergency room doctor, she called the Mentally Ill Offender Unit to determine if they were expecting Hyde for a court-ordered psychiatric assessment. But she was told nothing had been scheduled.

The form also said Hyde required ongoing treatment for schizophrenia and psychosis. As well, it said he had demonstrated aggression towards others and the potential to hurt himself.

The nurse said she saw no reason to send Hyde back to the hospital because he wasn’t displaying any acute symptoms.

"He wasn’t disoriented, he wasn’t agitated, he wasn’t hallucinating and he was following direction," she testified during her second day in the witness box.

McLeod said MacIntyre’s note did not constitute a physician’s order because it was written on a form she was unfamiliar with and lacked instructions on a specific time and place for an appointment.

"This isn’t the same kind of form that we follow through on," she said.

Still, McLeod said she asked one of the jail’s support clerks, Maureen Walford, to contact the hospital to make sure Hyde had been medically cleared.

Walford, who also testified Wednesday, confirmed Hyde had been cleared and said she also asked the hospital about MacIntyre’s note.

Recalling the conversation, Walford told the inquiry: "(A hospital administrator) just said, "No, he doesn’t have to come back. I have nothing here.’ "

McLeod said she would have contacted an on-call doctor had Hyde started displaying psychotic behaviour.

She also testified that she was not made aware that Hyde had been given an anti-psychotic drug when he was at the hospital.

However, Hyde did not have any prescriptions with him when he arrived at the jail, which McLeod did not find unusual.

Hyde was placed in a health-care cell, which meant guards would check on him every 15 minutes, but McLeod confirmed the guards were not told to watch for anything unusual.

Most of the guards who have testified at the inquiry have said they had little or no training on how to deal with the mentally ill.

The inquiry, which began in July under the direction of provincial court Judge Anne Derrick, is trying to determine why Hyde didn’t get the psychiatric help he needed, and what can be done to prevent similar tragedies in the future.

Earlier in the inquiry, MacIntyre testified that she would not have discharged Hyde if she had known he would be sent to a jail cell rather than a psychiatric hospital. She said police had assured her Hyde would receive a court-ordered assessment.

The inquiry has also heard that the Halifax police officers working on Hyde’s case knew they did not have the authority to follow the doctor’s instructions once he entered the court system.

The deputy sheriffs escorting Hyde to court did not hand the health form to lawyers handling the case because legislation at the time forbade them from sharing such information with anyone but health-care providers, such as McLeod.

Bold plus italic emphasis is mine.

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