April 7, 2006
Sandra Finley (contact info)
COMPLAINT TO COLLEGE OF PHYSICIANS & SURGEONS,
DR. DONNA MALCOLM
My Complaint:
The doctor’s assessment of my condition began prior to even seeing or talking with me. Her assessment does not correspond to any factual information.
I was forcibly confined from Saturday until Friday – 7 days. Drugs were put into my body forcibly and without my consent. One of the drugs caused complete memory loss of things I was doing and saying, and of things that were being done to me. It was an unjustified violation of my person and my civil rights.
The events:
WEDNESDAY EVENING: I went to the Walk-in Clinic (8th and Circle) because I knew the continuing sharp pains in my side required medical attention. (On the previous Saturday and Sunday I had remained in bed with what I thought was a flu bug – fever, aching muscles and joints. Those symptoms disappeared and were replaced by the pains in my side.) An X-ray showed a large amount of fluid on my lung. The doctor went over the X-ray with me, I understood the condition was serious. He advised me to come back and see one of two (named) doctors who would move my file forward. The booking clerk advised they would not be in until Friday at 10:00am. It was agreed that I would come in on Friday on a walk-in basis. I was not given any medical procedure to follow, just “come back the day after tomorrow”.
I went home and used the internet to find out about fluid on the lung, pleural effusion, thoracentesis , removal of fluid when the cause is not known. The information on various sites was pretty much consistent. A thoracentesis is used like amniocentesis to draw a sample of the fluid off for diagnostic purposes, complications may arise if the fluid is simply all drained off, and so on.
In my case the cause of the fluid was unknown at this point so I got information on one other symptom I had experienced prior to going to the Clinic. I looked it up under “skin discoluration” which was the best way I could think to describe it. I was by this time quite tired (sick) and so satisfied myself with what is probably quite common knowledge. A change in skin colour can be a signal that an organ of the body is not functioning properly. One example is the relationship between liver malfunction and yellowed skin.
THURSDAY: I advised my daughter who lives with me that I was seriously ill and must do everything possible to strengthen my immune system. I must get a lot of rest – that would have priority over work. And I must eat well. We talked about pesticide residues in food and how they place an extra workload on the body as it moves extra toxins out of the body. I told her that I needed to keep my muscles moving, so I would do some of the shopping at the organic Steep Hill Food Co-op, but only if I wasn’t too tired. Things which I would normally have pushed myself to do, I didn’t do, because I viewed my health to be in need of whatever assistance I could provide.
FRIDAY at 10:00am I was at the Walk-in Clinic. Dr. Lacny saw me. He said there was a blood test that should have been done on Wednesday. It was urgent to get it done because things start shutting down in the Labs on Friday afternoon. The blood was drawn and couriered to the Lab. I left and returned shortly after 1:00pm following a call from Dr. Lacny.
Dr. Lacny advised me to go immediately to Royal University Hospital Emergency and to take the x-ray with me. He told me that the doctor who saw me on Wednesday should have taken prompt action given the seriousness of fluid on the lung.
He told me that I should hurry because everything shuts down at the Hospital by 4:00pm Friday afternoon.
Friday afternoon: I checked into Emergency at RUH. I saw numerous different doctors and had different tests. RUH is a teaching hospital and so the number of doctors seen is more than at a non-teaching hospital.
I kept mental track of the doctors I saw, their names, and their area of expertise. At each stage I asked questions. For example, when I am told to go for an x-ray I asked: is the x-ray of my lung? Answer: yes. My response: there is an x-ray in my file, brought from the Walk-in Clinic. What is the purpose of another x-ray? Answer: (basically it turned out that another x-ray wasn’t necessary at that point and so I didn’t have it).
I asked questions for my own information but also because there were so many different doctors that saw me. Each doctor asks questions. If I don’t know WHAT has been done and WHY it has been done, I am in a poor position to provide the communication links between one doctor and the next, let alone understand myself what is going on. It allows you to pick up potential oversights or misunderstandings, in particular because not every doctor has time to read through the pile of paperwork accumulating in the file. I believe my attention to the details and concomitant ability to answer questions and provide input was helpful to some of the doctors. I found that the little I knew about fluid on the lungs from the Internet information, placed me in good stead to understand what the doctors were telling me. I did not require as much explanation as if I had come in “cold”.
THE CONTEXT of my behaviour (essential to understanding whether or not my actions at the Hospital were “manic” (I believe that is the justification used by the doctor to forcibly confine me for 7 days, and to give me an injection that gave me permanent amnesia of what happened for a number of hours.):
Notations are of course made in patient files. After reading the remarks in my file one doctor said “You don’t believe in western medicine.” I responded in good humour that if I didn’t I wouldn’t be at the hospital, would I? I told him that you can’t beat western or allopathic medicine when it comes to diagnostic ability and things like operations that repair broken bones or detached retinas (with which I have experience). However, “the western hemisphere” doesn’t have a corner on ALL there is to know. Western medicine is poor at addressing the CAUSES of illness; it directs its energies to the SYMPTOMS. It also underestimates the ability of the human body to heal itself, under the right conditions. Alternative therapies fill a gap. So I support and pursue a combination of western and other knowledge bases, and give my body a chance to do its remedial work.
I believe it is narrow-minded for doctors to dismiss the experience of patients, and to place a label on them (stereotyping) should they raise questions and fail to follow orders, especially when the doctor’s information about the patient is limited to an interview that lasts a few minutes. Does the body self-heal? (This is the context – my personal experience – that causes me to act in a certain way.) A couple of years ago in September I was told by a Saskatoon doctor that I had pre-cancerous cells in my reproductive tract and vaginosis. She wrote out a prescription for me and I was to see a gynecologist who would then decide whether an operation was in order to remove the pre-cancerous cells. I explained to the doctor that I would like to try other approaches first. She emphatically read out loud to me as she wrote in my file “Patient … declines … treatment”. I was nervous and had a lot of doubts, especially when the doctor was so clearly displeased, but I persisted. I made changes to my diet and took other steps. I returned to the doctor 5 months later, in February. Tests showed that I no longer had vaginosis nor the pre-cancerous cells. So my experience tells me that my body has the capability to right itself if I work with it.
The last test of the day (Friday) was a CT scan prescribed by a doctor from Internal Medicine; it was explained to me what would happen. Later, when I arrived in radiology I found I was to take a liquid first for the purpose of definition in the scan (the I.M. doctor had not mentioned this). When putting substances into my body I want to know what’s going in, why, and whether there are alternatives. (Under special circumstances I might, but normally I do not use medications because of experience in my twenties – without exception they have made me sicker than the ailment I had. A muscle relaxant for a pulled muscle – once I knew the pain wasn’t anything other than a pulled muscle (which would have healed itself in time), I should have left the doctor’s office. But I didn’t do my own thinking: I relied on him and waited while he wrote out a prescription. It laid me out sick on the bed for 3 days – until a friend pointed out that maybe it was the pills. It hadn’t dawned on me to question the prescription given to me. When I had bad allergies I was prescribed seldane – it has now been taken off the market because it is not safe. Along with VIOXX, etc. etc, etc. I know that the priority of many of the pharmaceutical companies (who own the chemical companies who together are the biotechnology companies) is how much money they make. They have a long history of buying research (the IBT Laboratory scandals in the U.S. in the 1980’s are just one example). There are almost no studies of the long term effects of the drugs, in spite of the fact that they are known to have many side effects in the short term. …. It seems ultimately reasonable to me that I should avoid the prescriptions of the pharmaceutical companies whenever possible and certainly if there is no clear need at a particular point in time. I eat almost entirely organic food; I treat my body quite well!! ) The radiologist came out to explain the reason for the liquid. I mulled over his information and was not satisfied; I declined the test, knowing I could return and have it later, if further information indicated it should be done.
I returned to the doctor from Internal Medicine and the resident doctor working under her. We had a thorough conversation. I listened to them, they listened to me. In the end I signed a waiver form to absolve them of any responsibility should my departure from the Hospital bring about harm to myself. They were concerned to be sure, but respected my explanation. They were quick to ensure that I knew I could return to the Hospital at any time. (Which I took for granted, but appreciated the articulation nonetheless.)
I live not far from the Hospital and returned home.
Friday night: I sent an email into my email network – there are people who are doctors in this network. If there was someone who had experience, perhaps they could supply information that would be helpful to my understanding.
Saturday morning: No information came in. Shortly after 8:00am I decided to go back to the Hospital for more information. I knew that my liver or my kidneys had been tested on Friday and had a clean bill of health, but I didn’t know for sure which one it was. Because of the skin discolouration I had experienced prior to the pains in my side, I had a particular interest in the functioning of my organs. Also, I wanted to understand more about how it comes about that fluid will accumulate in the pleura. What are the possible causes? It seemed to me the best way to be able to make informed decisions about medical procedures was to understand as much as I could.
I arrived in Emergency not long after 8:00am. It did not appear to be busy. There was one fellow in the waiting room, waiting for someone who was in a cubicle. No one else. I went to the registration desk and inquired if by chance one of the two doctors from Internal Medicine who had seen me the previous day (I named them) might be in. They weren’t. I explained that I had come just to see if I could get more information, I probably didn’t need to see a doctor through the Emergency procedure. I told the clerk that I had spent all of the previous afternoon at the Hospital and had left after signing a waiver form. She went to get my file. Based on the comment made by the one doctor on Friday after reading my file (that I didn’t believe in western medicine), I was aware and embarrassed that the admissions clerk would probably find notations in the file that indicated I was a bit of a kook. I tried to explain. Eventually I was shown to a cubicle.
A male nurse came in. I was restless (and fevered) with nothing to do. I told him that I had just come to the Hospital to obtain information. Perhaps he could help me – maybe I didn’t need the expertise of a doctor. Could he look in my chart and see whether it was my liver or my kidneys that had been tested the previous day and had tested out okay? Also, I would like to know more about the flow of the cardiovascular system (the flow of blood through the lungs, over to the heart, – where the liver and kidneys fit in – etc.). He said he couldn’t provide the information but offered to bring a book, – terrific! I gladly accepted and he came back with a book. I went to the index – there wasn’t an entry for the cardiovascular system and so when he returned I asked if there might be another book. He again obliged, this time with a book that had terrific coloured pictures of the parts of the system, but unfortunately there was nothing that showed the pieces when they are fit together. So I went out to the nursing station and asked whether I might have a look at the books they had – maybe I could find for myself what I was looking for. I had the impression that my request was unusual and that they were now beginning to look at me as someone who was weird. I asked for a pen and paper and was obliged.
The nurse could not supply information. The particular books I was given were not helpful. I thought I would try to write down just what it was I wanted to know and ended up just doodling the time away. I put down the lungs, the heart, and lower down a note re the kidneys and liver so I wouldn’t forget to ask the doctor just what had been tested.
The nurse returned and told me I was to go for an EEG or an ECG (I forget which). I became annoyed: how is it that a doctor is sending me for a test and he or she hasn’t even seen me? That seemed highly unprofessional. I had a pain in my side: the doctors from Internal Medicine the day before had not suggested an ECG/EEG. As far as I knew I had had every test they wanted me to have, with the exception of the Cat scan. Who was this now that was sending me for this new test without even having seen me? The nurse knew I was now upset and hastened to calm me down with reassurance that the doctor would be in shortly. I was thinking that I should just go home and see whether there had been any email replies to my request for information. I felt that I was wasting time here. By this time I had been waiting for more than 2 hours, I was hot and feverish.
The doctor, Donna Malcolm, came into the cubicle. She asked 3 questions in an extremely condescending tone. The first question I forget. The second: “Oh, I see that you like to draw pictures. Will you tell me about them?”. The third question was “Now tell me, what makes you think you have fluid on your lungs?”.
Then I knew for sure that I was wasting my time, and I became quite angry. I was sick and here was a psychologist or psychiatrist speaking to me like I was a child. I could see that she didn’t have my file in her hand. I pulled open the curtain of the cubicle, strode across the aisle to the nurses’ station, looked about for patient files, then pointed down and said (not calmly) “Look in my file. There is an x-ray in it. THAT is why I think I have fluid on my lung! I am wasting my time here.”. And I headed down the hallway toward the exit.
The doctor called the security guards and told them to stop me. I was surprised, I had no idea that I was not free to leave the Hospital. Each of the guards took me by one of my arms. I told them to let me go, I fought to free myself of them. They put me in a closed cell that had a cot in it. When they determined that I had calmed down, Donna Malcolm came to the cell. Her opening question was “Now, what seems to be the problem?”. You will understand that I was without any control over my being. Physically I had been overpowered. I was locked up. And so I responded with the only tool available to me, a put-down, my attempt to gain some power (which I understand in retrospect). I surprised myself by assertively stating to Donna Malcolm, “Either you have a very short memory, or you are a little short on brain power. Less than 10 minutes ago I directed you to my file and the x-ray which shows I have fluid on my lung. THAT is the problem.” This kind of statement (a put-down) is not characteristic of my behaviour.
I asked for a waiver form to sign, so I could leave the hospital. The doctor seemed to agree with the request and left. I waited and waited. No forms were forthcoming. I moved out of the cell into the corridor with the 2 security guards, and chatted with them. Waited some more. Finally, I interrupted a passing nurse and explained that I was waiting for a waiver form, would she mind seeing what had happened to it. Donna Malcolm returned to the area from time to time. Assertively and firmly I told her that I had been given a waiver form the previous day, and the same option would be available to me now. Nothing. Later I told her that what was happening was not right. I asked for access to a telephone so I could call my lawyer. Nothing happened. Finally Donna said that the Hospital had its own lawyer who she would call. I could not speak with my lawyer.
I do not recall what prompted the next event. There was no altercation. I was taken out of the corridor back into the cell, and placed face-down on the cot. The top of my slacks was pulled back and a needle injected into my hip area.
The next thing I knew I was in a hospital room with my parents at bed-side. I was confused: they live two and a half hours from Saskatoon. I didn’t know how long they had been at the Hospital or how they had gotten there. We were in the middle of a conversation.
Later I learned that I had spoken with the Hospital’s lawyer. I have no recollection of her or of the conversation. And so I understand that a person who has received the injection can carry on conversations but when they come out from the influence of the drug, have no recollection of anything that has happened. So I was given access to a lawyer, but it was meaningless access.
Soon enough I discovered that I had been “committed” to the psychiatric ward. I objected and was told of an appeal procedure. I filled out the form; the appeal was scheduled for Thursday morning.
While in the ward, I made a point of asking, when speaking with a doctor from a different ward (for example, Internal Medicine), “Doctor, where should I be placed in order for you to deal most effectively with the fluid on my lung? Should I be here, or should I be in Internal Medicine?”. I was told I should be in I. M. I asked if they could initiate paper work that would transfer me out of this Ward to where I should be. It was awkward because there were no clear lines of authority. I asked the question directly: “who has the authority to initiate the paperwork to transfer me?”. There was no definitive answer. I then surmised that because Donna Malcolm had committed me, she maintained power.
When confronted with medications, I asked the reason why I should be taking them. The reasons given were inadequate and I stated why I did not wish to have them. I had no need for mood altering drugs. I was forced to take Epival, 500 mg twice a day and Risperidone, 1 mg twice a day. Have you ever taken these drugs? They deaden your brain. Try as I might, there were routine pieces of information I simply could not bring to mind. I knew I knew them, but I couldn’t find them in my memory. You become monotone, dull, rather numb to stimulation, lacking in vitality.
Dr. Stuart Houston, retired radiologist from the University Hospital, came to visit me. His comment, when he heard what had happened, “This is something one would expect in the 1950’s. Not in today’s world.” Dr. Houston volunteered to come to the Appeal Hearing and speak on my behalf. Later, by telephone, he advised me that he had collected pieces of my work which he has at his house, to present as evidence to the Hearing.
A friend was in attendance one afternoon when an employee of the Department came into my room with pills for me to take. I asked what they were. One was warfarin, a blood thinner. I advised the employee that the drug had not been prescribed to me (I had absolutely no knowledge of any doctor having prescribed this drug for me) , and that I didn’t wish to take it. My friend explained her experience with warfarin (it was not good) to the employee and said that warfarin should only be used if it was known what it was being used for, and only if it was absolutely necessary. The employee was satisfied and left. (I knew the reason someone would be administering warfarin from the previous day’s discussion with medical personnel. It would be as a precautionary measure in case there was an embullism that would travel from my lung to my heart and be lethal.)
My friend left, it was late afternoon or early evening: 5 people came to my room, three nurse-type people and 2 guards as back-up. They came with pills in hand – the warfarin and 2 mood-altering drugs. I told them that I had no need of the drugs. They told me I had a choice: either I could take the pills or they would give me an (another) injection. I took the pills.
My parents were very upset by what was happening. My brother from Vancouver Island became party to the information. He was unable to get any satisfaction by telephone and finally flew out here to Saskatoon. (He has young children and work to look after at home.)
I had been “committed” on a Saturday. At the end of the work-day on Wednesday Donna Malcolm came to tell me that I had progressed so well under her care (the mood-altering drugs) that I could be released. Oh, and by the way, she had given instructions, someone would call and cancel the Appeal Hearing – it obviously wouldn’t be necessary since I was no longer certified. I do not recall whether Donna knew that Dr. Houston would be presenting information on my behalf to the Appeal Hearing.
I asked when I would be transferred to Internal Medicine. It would be the next day (Thursday).
During the objections to the warfarin I learned that I had been started on the warfarin (and probably the mood-altering drugs) while I was “out” from the injection. As mentioned I have no memory of anything that happened during that time.
On Thursday I let the nurses know that I was to be transferred, and I asked of every doctor I encountered, “Have the papers been processed to transfer me to Internal Medicine?”. I asked when I would get out, given that the decision had been made the previous day. I didn’t get out. My brother arrived and went to work on it. On Friday, first thing in the morning we were both at work on it, I mindful that if I didn’t get out by the end of the day, I would remain in the psych ward until Monday because nothing happens on the weekend. I finally got out late in the day Friday.
Internal Medicine was like dying and going to heaven. I was cold during the first night and asked for a blanket. The nurse returned with a blanket that she had warmed in the dryer. I was almost moved to tears, her kindness was in such sharp contrast with what I had experienced since arrival in the Hospital.
There were significant differences in care. I had a thoracentesis (drawing of fluid from the pleura) done while I was in Psych and again later when I was in Internal Medicine. In the Psych ward the care was no different than if I had returned from an x-ray. You return to your room, use the bathroom if you have to, do whatever needs to be done. No one tells you anything different. In Internal Medicine, you are monitored in case the thoracentesis needle might have punctured the lung. You are confined to bed, if you have to go to the bathroom they want to bring a bed pan; readings of your vital signs are taken every 15 minutes.
I was 2 weeks in Hospital altogether, a week in each ward. The Psychiatric Ward, in addition to the removal of my civil rights, made a serious attack on my health at a time when I was very sick physically. I can handle the attack on my health. As a responsible citizen, and on behalf of other citizens, I cannot stand by and do nothing when persons in positions of authority abuse the civil rights of others. More than anyone else in the medical profession, a psychologist or psychiatrist should understand and have developed the tools to deal effectively with interpersonal communications. Instead, at the doctor’s direction I was overcome by physical force, and literally locked up for 7 days. I was given an injection which efectively made me unconscious – gave me permanent amnesia of the time. Drugs were forced upon me. There was no justification.
I believe I am not an isolated case. Fortunately I have the ability to seek redress. Others do not.
Changes are required.
Three weeks following release from Hospital (April 1, 2005) it was confirmed that I had tuberculosis – in the pleura, not inside the lung. Diagnosed early. Not contagious. It is with the consent of Dr. Hoeppner at the TB Control Centre that I am using his diagnostic capabilities and expertise, in conjunction with a well-credentialled and recommended naturopathic doctor. I did not take the 8-month drug protocol normally assigned.
It is not because I think I am smarter than “the doctors” that I do this. It is because
1) I have faith in the ability of my body to heal itself, provided I do my part which is to get lots of rest, fresh air, sunshine, good food and live peacefully, in balance.
2) My Grandmother-in-law had TB. She conquered it through the programme at the Sanitorium in the Qu’Appelle Valley back in the forties. So I know the disease can be overcome without the use of drugs.
3) Nature evolves. We know this from the Centre for Disease Control that warns about the development of “super bugs”. In Africa and in Eastern Europe in particular, TB has evolved to be resistant to the drug protocol we have so far been able to use here in Canada. I try to live according to what I believe. I try to do my part. If I can overcome the disease by improving my immune system and removing that which is weakening it, that is the best way to go. I do not contribute in any way to the development of resistant organisms. Resistant organisms are an extremely serious long term problem. “Problem” is not even the right word to be using. We are contributing to the development of organisms against which we will eventually have no defence.
4) The drugs have side effects while you are taking them. No one studies the long term effects of the drugs.
5) I would rather be tired as I work on the TB, than nauseated for 8 or 9 months from the drugs.
6) I am fortunate to have been diagnosed early. There is time to experiment. If I can’t beat it the way I propose, the drug option is still available.
The naturopathic doctor asks “Why was your immune system not functioning very well? Lots of people carry inactive TB organisms. Their immune system is strong enough to keep the bugs at bay. What is weakening your immune system?” That approach makes sense to me.
It is one-year later and I am returned to health. Last month I cross-country skiied for 3 hours non-stop, uphill and down dale in the forested area north of Duck Lake.
In conclusion, I ask you: did the doctor’s assessment of my condition began prior to even seeing or talking with me? Does her assessment correspond to any factual information? Was there an unjustified and serious violation of my person and my civil rights? If so, changes are in order to prevent more of the same from happening.
Dr. Hoeppner (TB Control) made a remark about the medical system. I laughed and said, “Don’t go there. Not with me.”. I briefly told him of my experience with being locked up by the system. He didn’t laugh in return. He said, “That could have been me.”
Respectfully submitted, Sandra Finley
Please check out the relationship between Donna Malcolm and the young woman doctor who provided the second opinion on Donna’s diagnosis. Was it an objective, independent second opinion? Was that even possible, given the relationship?
(INSERT: the second opinion came from a student doctor who was dependent upon Donna Malcolm’s assessment of her work.)