Concerned and Alarmed Doctor Speaks Out

The following is a copy of letter written by Dr. Daniel Carver, MD, FRCPC reprinted with permission:


Sent: Wednesday, May 30, 2007 6:49 PM
Subject: Helena Munroe
Dear Mr. MacKay,

As a doctor specialising in the care of older adults at the Queen Elizabeth II Health Sciences Centre in Halifax I am concerned and alarmed about the Helena Munroe situation. I have been closely involved in Mrs. Munroe's medical care since 2005 when I was asked to assess her in my professional capacity as a Geriatrician. The following medical information is released to you with the permission of her husband Sandy Munroe who has enduring power of attorney.

As you know, from press reports and documents forwarded to your office the facts are as follows: 1. Mrs. Munroe arranged for an enduring power of attorney for health care and finances, 2. Subsequently, she developed a serious progressive brain illness - Alzheimer disease, 3. Unfortunately, this illness significantly impaired her decision making to an extent that, in my opinion, she became incompetent for personal care, health and financial decisions, (this was also the opinion of other doctors involved in her care), 4. Her husband Sandy Munroe, was advised to enact the enduring power of attorney. 5. Later, without the knowledge or agreement of her husband, Mrs. Munroe was accompanied to the UK by her brother - who claims this was her decision. (In my opinion, Mrs. Munroe was not fit to consent to travel to the UK - she did not understand the risks or benefits of travel to the UK. Mrs. Munroe had told me, in my clinic, approximately 6 months before she went to the UK that she did not want to visit her family in the UK because of the stress involved.) 6. Mrs. Munroe is presently a resident of a private care facility in the UK (Billingham Grange) 7.This facility claims to be providing good care to Mrs. Munroe but refuses to consider her return to Canada despite the wishes of her enduring power of attorney. In my opinion, the staff at this institution demonstrate a paternalistic attitude. They also lack information about the situation and appear uninterested in more information. In my opinion, the care she is receiving at this institution is suboptimal as it does not involve family or friends. (A cardinal principle of caring for an individual with Alzheimer disease is involvement of family and a familiar environment - neither available to Mrs. Munroe presently.)

Despite much effort the NS crown will not prosecute this case, in part, because she was not declared incompetent by the courts prior to her move to the UK. (I understand that no one is truly "incompetent" until declared so by a judge -who often relies on medical opinion - but taking this step before the enduring power of attorney is "enacted" is rarely necessary and in almost all situations would be an unnecessary expensive step.) In my opinion, the NS crown appears to 1. lack understanding about the common illness dementia and how it affects judgement and 2. lacks initiative in pursuing this tragic situation.

In my opinion, the government of Canada must act to protect vulnerable older adults who lack adequate decision making capability. I strongly urge the government of Canada to work to return Mrs. Munroe to her husband in NS. I am upset and dismayed by the lack of government action to protect a vulnerable older adult.

Respectfully,

Daniel Carver, MD, FRCPC
Camp Hill Veteran's Memorial Building
QEIIHSC