Abusing Vulnerable People - How Wrong Is It?

Abusing vulnerable people - how wrong is it? Seems like a no brainer question. I think most people will agree that abusing vulnerable people is very, very wrong. If so, our system of consequences and deterrents doesn't reflect society's values. Please tell me if I've got it wrong.

Warning - there is a photograph of a pressure injury later in this post. It is disturbing. I included it because preventable and treatable suffering of vulnerable people is kept out of view, literally and figuratively. It kept me complacent. 

Background

You've read about my mother's abuse - days of intermittent screaming in pain and asking for help, badly cut legs from thrashing in pain and more. Staff closed her door so they wouldn't hear her as loudly and did nothing. They didn't call a doctor or call me and they didn't assess or treat her new pain. My complaint to Protection of Persons in Care was determined to be founded. 

Consequences and deterrents - The consequences are that her long term care facility was told to follow their existing policies related to the incident.

I’ve respectfully and repeatedly asked Truro Police Services to clarify why there isn’t a criminal investigation but I don’t get answers. 

In trying to understand our legal system’s tolerance for suffering among helpless people (after all it’s explicitly prohibited in the Animal Protection Act, but excludes humans) I’ve begun to look at other cases.  Unfortunately it isn’t difficult to find examples. Pressure injuries, as noted below,  are very painful and can lead to infection and even death. 

In the News - Pain Among Society's Most Vulnerable

CBC wrote an article in 2019 outlining a tragic pressure injury case. Here are excerpts from the article:

"Dorothy Dunnington wonders if anyone will ever be held accountable for a massive bone-deep pressure ulcer that became infected and led to her sister's death at the age of 40."

"Eight weeks prior to her death, she was rushed to hospital at her family's urging and treated for a bone infection as well as septic shock, pneumonia, a urinary tract infection and severe dehydration."

Consequences and deterrents - Halifax Regional Police found there was no criminal wrongdoing and they closed their investigation into whether there was negligence at Shannex's Parkstone Enhanced Care home in Halifax, where Chrissy Dunnington had lived. 

In case the Halifax Police findings weren't chilling enough regarding Chrissy Dunnington's experience at  Shannex's Parkstone, Medical examiner Matthew Bowes wrote in a letter to police that he found no evidence that her death was the result of circumstances that included negligence. Other medical experts seem to disagree, saying the type of wound she had was preventable.

Shannex's Parkstone, a for profit long term care facility has had 7 proven incidents of abuse from 2018, the year of the incident, to 2023 according to Protection of Persons in Care. Several of Shannex's other long term care facilities have multiple confirmed abuse cases in this time period. Many long term care facilities have no cases of abuse in this time period. 

A Reward? - Not only are there no legal consequences, Shannex received a $120 million sole-sourced contract from our provincial government for a care facility in Nova Scotia in June, 2024. Government contracts could be a powerful incentive and deterrent tool in reducing abuse. Hopefully the public will learn more about how this was the best use of our tax dollars.

The extreme pain of pressure injuries is a national problem. Here are some examples from other provinces:

1. A Quebec man who requested and received assisted suicide after developing a bone deep pressure injury (bedsore) in hospital in 2024 in Quebec is described here.

Consequences and deterrents - I didn't find any.

2. An Ontario man's terrible suffering and subsequent death in 2022 related to a preventable pressure injury (bedsore) is described here, including the very disturbing photograph below.

Consequences and deterrents - I didn't find any.

It's a Start

I'll note that in 2021 Nova Scotia did fund a pressure injury reduction strategy, approximately $665,000 per year (I'm unaware of the current budget), to provide staff training and wound management specialists. There has been a modest reduction in reported pressure injuries in Nova Scotia. You can view the data here. 

Closing Thoughts

Our legal system doesn't criminalize* even extreme pressure injuries in a long term care setting, despite the severe suffering and expert opinion that approximately 95% are preventable. (*I'm unable to find examples of criminal charges. There could be some.)

Unmanaged pain, pressure injuries and other abuses in long term care remain very hidden in our society. 

There were 43 confirmed abuse cases in long term care and hospitals in Nova Scotia in the 2022/2023 fiscal year. Did you know they were occurring at this frequency? I didn't. There are various factors that contribute to keeping abuse out of sight that I'll write about in a future post.

I haven't touched on the issues that many people blame for abuse, for example under staffing and lack of training. I'll leave those topics to others although I may touch on them in the future.

Resources

Find  Nova Scotia long term care and hospital abuse data by scrolling to the lower section of this page and clicking on the year you'd like to view.

Find the Nova Scotia College of Nurses complaints record page here. Click the 'Has Complaint Comment' box and then 'Search'.

Find your Nova Scotia MLA's email address and phone number here.

The information in this blog may have mistakes and reflects my opinion except as noted. I'm happy to correct any mistakes you may note. Thank you for reading.