Patient Ombudsman Complaint Against Providence Healthcare
My mother, Irene Yu, has had a complex history with Providence Healthcare from when she was admitted to their long-term care facility – the Houses of Providence (HOP) – to when she was moved to the hospital side. I have had an equally challenging time dealing with the administrators in both facilities and have certainly pushed to ensure the best care for my mother as well as others at Providence. Consequently, I believe the recent treatment we’ve received has been a retaliation by Providence for my questioning of their practices and for pushing for better care for seniors in their care. It is my firm belief that they were unnecessarily more aggressive in the way they dealt with me and my requests regarding my mother’s care.
My mother, Irene Yu, is 83 years old, about 4’8” and barely weighs 90lb. She is diagnosed with Progressive Supranuclear Palsy and had been receiving care and treatment at Providence Healthcare. During this period of her life, I have acted as her power of attorney. As such I have taken every step to ensure my mother gets the best of the best.
During my mother’s stay at Providence, she has been under the care of Dr. Anjil Takhar. During this time, I have also interacted with Jacqueline Wiley, the Care Manager, Dave Langlois, the ethicist, whether together or separately.
Aside from random bruises with unexplained causes, Providence has caused both my mother and I strife and worry for the period my mother was under their care.
Baseless denial of osteopath and other physical exercise services.
My mother was admitted to, and released from, Michael Garron Hospital (MGH) about a year ago to return to Providence Healthcare. She was originally admitted for a fever along with a severe body rash and swelling of her extremities (her hands had swollen to the size to baseball mitts) which MGH said was likely due to an allergic reaction to medications she had been given by Providence. This reaction was sudden and came up after her primary care physician at the time, Dr. Anjil Takhar, insisted on administering high doses of acetaminophen (3000mg+) daily, some scopolamine and hydromorphone for pain they alleged my mother experienced. My mother was admitted for a month to MGH and was given only one dose of acetaminophen (650mg) and no other pain medication for the entire time she was there. They also said that they did not believe she had Complex Regional Pain Syndrome.
After being discharged from MGH, my mother was transferred to Providence. It was agreed that she will receive osteopathy treatment two to three times a week from our osteopath friend and had a PRN (as needed) of 500mg acetaminophen in her chart, which was never administered.
As a policy, Providence required that every outside care provider – i.e. osteopath – had to sign documents and had to be approved by the institution, which approval entailed a person supervising the session. The patient care manager, Jacqueline Wiley, was selected to supervise our selected osteopath. The care manager supervised from a seated position and at a distance. During the procedure, the care manager did not ask questions or seek any form of confirmation, yet surely, conclusions were made. The care manager claimed that she noted signs of pain in my mother during the procedure. However, the care manager’s recollection has been disputed by the osteopath as well as the caregivers. Following the said conclusion, the osteopath was denied further access to my mother, and as at January 2020, the osteopath was completely denied access to the premises and providence did not provide any osteopath or physiotherapy sessions of their own.
Forced administration of pain medication.
Following rejection of the osteopath services, I received an email seeking a meeting to discuss administering analgesics before an osteopathic session. The meeting was conducted between myself, Dr. Anjli Takhar, my mother’s primary care physician, Dave Langlois, the ethicist, and the care manager.
Again, due to misinterpretation and misunderstanding of my mother’s gestures, facial expressions and noises, Providence assumed my mother to be in great pain and sought to administer pain relief medication. It was during this meeting that I first heard of mention of mitigating my mother’s alleged pain with medication, specifically 3000mg of acetaminophen and dilaudid, which I later came to learn was hydromorphone. I was shocked by the proposal as the report by MGH was known to Providence. I strongly objected to the medication for reason that MGH believed it was hydromorphone that caused the allergic reaction that caused her to be transferred in the first place. In further response to their proposal, I informed Providence that I would be open to topical analgesics as I know my mother was never interested in taking a lot of pain relief medication and had always preferred ointments and a holistic approach.
I wrote the team a summary of the meeting and they sent me their notes which did not correspond entirely to mine. I engaged the Patient Relations Manager, Lynne Mycyk, at this point who was then copied on many of the emails throughout February. I asked in writing why no one ever gave my mother any of the PRN medication or contacted me if she was in such pain for the past 10 to 11 months. I asked about my wanting to see some sort of photos or video evidence of what the doctor claims were indications of pain. None were provided, and in fact, I was then sent an email about Providence’s policy of not allowing me or my mother’s caregivers to even take photos or recordings of my own. They then moved my mother from the wing she was in for 11 months – where many of the nurses knew her and with who I had been speaking about my mother’s condition and demeanour – to an entirely new wing in early March. This was shortly after I told Dr. Takhar and Jacqueline that many of the nurses I had spoken with do not feel my mother is in enough pain to merit a starting dose of 3000mg of acetaminophen per day. In fact, many of them said she was quite comfortable throughout the day as well as the evening.
Dr. Takhar’s pain relief suggestions and recommendations were erratic, and she refused listening to anyone that had hands-on experience with my mother, including me. I wrote to Patient Relations directly explaining that Dr. Takhar had upset me after one Friday conversation. She was not listening to me, and I could barely work from feeling overwhelmed by her comments about my mother being in pain. I was calling nurses from the hospital that weekend to see how my mother was doing and was specifically told she was not in pain. No one responded to my email other than to say my questions were clinical and should be answered in a meeting.
On March 12th there was another phone meeting. Dr. Takhar told me that she and the nurses felt my mother worsened in the week and a half since she was moved, and believed my mother was in more pain. I stressed that I had copious notes from caregivers about my mother’s reactions and facial expressions and that she, in fact, had improved and opened her eyes more recently despite the recent move. Dr. Takhar had the nurses only write when my mother makes faces/frowns or sounds, which they interpret as pain. I spoke with the nurses over the weekend and none of them said my mother had worsened. The day nurse said she didn’t really know my mother yet, as she had only been with her for less than 2 weeks. Her old nurse said that even if she didn’t think it was pain, she could not, and would not challenge Dr. Takhar. Yet again these expressions, gestures, and mannerisms were always there, and Dr. Takhar insisted on the nurses writing everything down once I disagreed that my mother was in pain. The notes on her expressions started in early February and later that month I mentioned she breathes slightly faster when annoyed or anxious. They again told me it was from pain, despite my mother’s caregivers and I explaining that she has always done this in the past.
I continued to visit my mother at least twice a week and she didn’t look any worse. When meeting with Dr. Takhar, I learned my mother wasn’t receiving osteopathic treatment until I agree to give her 1000mg of acetaminophen prior to. I am told the clinical team has the right to up the dosage or stop the osteopathy. My mother’s neurologist (who is an expert on PSP) recently examined her and explained that PSP sufferers often grimace, squint and have jerky movements that don’t necessarily mean pain. He also sent a letter that said that he didn’t see why a lower dose of acetaminophen couldn’t be used to gauge its effect if they are discussing analgesics. This was discussed in front of caregivers when my mother was brought to him; we talked about a low dose of 325mg. He suggested trying different times for the low dose Tylenol and slowly increasing it. He didn’t think 3000mg to start throughout the day was necessary at this point. Does Providence not have to at least give some credence to specialists who have been following my mother’s progress?
Considering what was written by the neurologist recently and what happened last year, I asked again why the starting dose would need to be at least 3000mg of acetaminophen. Dr. Takhar insisted hydromorphone is fine for my mother, and she said my mother was nearing the end of her life and should have dignity. The ethicist again explained that I was supposed to be looking out for the best interests of my mother and that they may have to take me to the Consent and Capacity Board.
I know my mother’s wishes, and she never liked to take much medication (especially Western medicine) – much less a medication she didn’t need. These facial expressions and small gestures are her new language and those who know her best are able to understand them. She used to scratch and kick when she had more movement to indicate she didn’t like something and made even more faces especially once she lost the ability to speak. Her facial expressions and gestures could be signalling discomfort, something much different from pain. PSP patients also cannot control their expressions or even some movements (sometimes jerky) which are again, not always indicative of pain.
Lack of Communication
I had subsequent conversations with Dr. Takhar after the first meeting where Dr. Takhar told me she had her colleagues examine my mother; it was only then I discovered that the neurologist from Providence, Dr. Ramanathan, had seen her at least twice and a physiatrist, Dr. Joseph, had seen her without my consent or knowledge. I emailed the Patient Care Manager (copying patient relations) to ask when this happened (apparently, in early February), what the notes were, and why I was not informed. No one responded or sent me any paperwork.
With COVID-19, no one is able to be with my mother and can’t even move her a bit. I had arranged with one nurse to call in when she was doing my mother’s care and she agreed to answer her phone. However, then Jacqueline, the patient care manager, on Monday, March 23rd, said that she instructed all of them not to answer the phone in my mother’s room anymore. She also asked me not to call the nurses’ station. She said she would update me daily and that’s when I asked if I could speak with my mother at that time. She said she would be able to make a call about 4pm during the week. I had emailed over the weekend in answer to her email that no one would be allowed to visit. I had asked if someone could help my mother with a bit of movement since that’s what my mother’s caregivers would do. I had asked if I could speak with my mother at least twice a day and perhaps Skype with her. At this point, no one can help move my mother and I’m not sure she is even getting in the wheelchair twice a day. I was also told that a recreational therapist would try to see if a weekly Skype could be arranged. Nothing has happened yet, and I am not sure if I will be able to even speak with my mother on weekends.
Now I rely on Jacqueline to call and had to reach out to Patient Relations once last week when she wrote to say she couldn’t call in the afternoon. In the end, she said she’d call around 6pm which turned out to be 6:20pm. I asked a question about my mother and she said she’d call me back to give me an answer. When I asked if my mother seemed comfortable, she said she didn’t think so as my mother was grimacing and trying to pull her legs to her chest (which she has never been able to do in her condition) plus she said my mother was grinding her teeth which she often did before. Then she proceeded to tell me that the nurses wrote down other indications of pain including grimacing and trying to move her hands and stiffness (which is a part of PSP), but I explained that this was my mother’s personality. When she could speak, she was bothered by people trying to do her daily care and she would try to scratch and kick those she didn’t like. She would get annoyed and her breathing would speed up and get louder because she was angry. Sometimes she even made sounds out of frustration.
Jacqueline didn’t want to hear it and said if this kept happening – my telling her these things – then she wouldn’t call me anymore. Then, perhaps she thought better of it, and said she wouldn’t update me and would just have me speak with my mother. I told her that’d be fine as long as I could get information on anything that was different or a sudden change. I haven’t been notified of any significant changes thus far.
Threat of CCB Proceedings & Refusal to discharge
On May 19th, I went to Providence with my Power of Attorney forms to take my mother home. The doctor refused to let me take her home but kept me waiting downstairs in the lobby for almost 3 hours. Then I was told by Patient Relations they could set up a meeting to discuss taking my mother home even though I told them I would do it AMA, if necessary. Given that I had everything planned out, provided details and am my mother’s POA and still couldn’t take her home, it made me wonder if I ever would have her back with me. I got on a conference call with the doctor, the patient care manager and a VP of Care from Providence along with two friends of mine and my mother’s. On that call, I was told my mother could come home and that it had nothing to do with my needing to agree to morphine or other narcotics or pain relief medication. I was told it was because Dr. Takhar wanted my mother assessed by physio first and monitored for baclofen side effects (as we started it then) even though I had been asking for my mother to be allowed some sort of exercise or movement since they banned the osteopath months ago. Suddenly, this became a condition of her being allowed to leave even though this assessment could have been done at home as could monitoring any side effects.
I then received an email saying that Dr. Takhar had filed a Form G to take me to the Consent and Capacity Board unless I agreed to her treatment for my mother’s perceived pain. She wanted me to consent to 3000mg of Tylenol per day and also to morphine. It was subsequently amended to morphine and fentanyl in less than a few weeks.
Then the date she was supposed to be released home was changed to May 26th and of course, the CCB hearing was happening that week. I questioned why it was still happening since I was told my mother didn’t require the morphine or fentanyl to leave. During the hearing, the board and I were told otherwise. In fact, Dr. Takhar testified that my mother was in a lot of pain and questioned why I wouldn’t give her these opioids. Again, I re-iterated I questioned her clinical judgement and also knew my mother didn’t like to take such strong medication without trying alternatives – some of which the expert on PSP had suggested and Dr. Takhar dismissed. I also said Dr. Takhar was unable to see anything other than pain as the reason my mother might grimace. I said she had influenced the others to skew everything my mother might still be able to do (sometimes make a face or sound which was rarer after all of the medication she was on and the lack of movement or stimulation) to pain without considering anything else. Dr. Takhar kept referring to a “constellation of symptoms” which I explained often mirrored what happens when my mother needs to have a bowel movement. I pointed out these incidents/symptoms in the written progress reports even (showing they were followed by a BM), but Dr. Takhar refused to even entertain she might be wrong. She insisted my mother was deteriorating due to PSP and required morphine. Yet she didn’t want to try the suggestions of the PSP expert.
As we drew closer to the 26th, there was always some reason that made my mother “unstable” to go home. Even throughout the hearing, Dr. Takhar would say my mother’s blood pressure was too high or she felt the baclofen wasn’t working and was causing side effects (hence her reduction of it to a tiny 2.5mg dose from 15mg). She would say keeping her from going home had nothing to do with pain, but then she insisted that my mother needed the morphine and inevitably, the fentanyl patch, and wanted to continue with the hearing.
Ultimately, I had to sign an agreement that I would give my mother morphine before Dr. Takhar would sign off on my being able to take my mother home which wasn’t until May 28th. And I had to agree to give my mother morphine for at least one week or else she would continue the CCB hearing and not withdraw the Form G. I felt I had no other choice but to sign or never get my mother home. Even up until the morning I was taking my mother home, Dr. Takhar wrote me an email to say my mother moaned, was in pain and needed morphine which she, of course, gave her that early morning.
Dr. Takhar also called the Office of the Public Guardian and Trustee saying she thought I want my mother in pain because I disagreed with her diagnosis. The investigator has since called my mother’s new doctors, the palliative care coordinator as well as the daily nurse who monitors my mother. No one has questioned the care she is receiving, the fact that she isn’t in such pain and all of them understand how much I love my mother. They have questioned Dr. Takhar’s clinical judgement though and what goes on at Providence Healthcare especially with seniors who have no voice and no one to advocate for them.
Conclusion
I have no doubt that if I didn’t speak up for my mother, she would not be with me now. My mother is more alert and certainly more aware now that she is on barely any pain relief medications (cut by over half). The new doctors also took her off of morphine less than a week after she got home even though Dr. Takhar called up my mother’s current physician to check up on what she was doing. Again, I believe Dr. Takhar has some sort of issue with control and doesn’t like to be questioned. I believe she has hastened my mother’s decline by insisting on all of the pain medication which made my mother become dozy and by Providence withholding any sort of exercise (they didn’t allow the osteopath and didn’t replace him with anyone or any other movement therapy), my mother stiffened up quicker. At one point, Dr. Ramanathan and Dr. Takhar testified that my mother was not even aware of what was happening around her and couldn’t move at all.
My mother is not completely stiff (as Dr. Takhar told me) thankfully and can still move a bit, does passive exercise, and has improved with the baclofen too even though Dr. Takhar felt it would have no benefit for her. In fact, my mother – God willing – seems to be improving at home. She is not as dire as I was led to believe and certainly, she is not in unbearable, chronic pain that requires morphine.
Dr. Takhar has cost me and my mother quality time because she insisted on giving my mother so much medication that it kept her dulled and barely aware. She wouldn’t allow my mother to go to a long-term care facility nor come home sooner and suggested my mother only had less than three months to live. She wanted to give my mother hydromorphone even though my mother not only didn’t need it, she might be allergic to it. Yet Dr. Takhar still insisted at the hearing she didn’t believe that to be the case and wanted to “try it” since she could monitor my mother at Providence. She even questioned keeping my mother’s feeding tube in and my mother’s wishes even though I explained we had clearly discussed them when she was able to speak.
I had to endure a CCB hearing and a Public Guardian and Trustee investigation (which may be ongoing still for all I know) because this “doctor” didn’t like to be questioned. She would prefer to cast aspersions on my character and not even consider our concerns putting my mother’s life at risk by insisting on morphine (which can cause respiratory depression) and hastening her decline. Before no one was allowed in due to Covid, my mother was still opening her eyes easily. After no one was allowed in and her medications were increased, she started keeping her eyes closed more often. This “doctor” blocked me from taking my mother home when I had the legal paper work to do so and I know my mother would not have wanted to be kept from me. She robbed us of precious time and negatively impacted my mother’s quality of life.
I went through an emotional rollercoaster and developed anxiety, and my mother suffered further (from depression and loneliness) as a result of Dr. Takhar’s poor judgement, God complex and non-existent bedside manner. I also spent tens of thousands on lawyers (a debt I am still paying off) because of a CCB hearing that never should have happened in the first place. Plus I lost 20 lbs – not a “diet” I would ever have chosen – because of constant worry about my mother and an inability to contact her, be with her or get any answers from Dr. Takhar or Jacqueline Wiley. It was a needless nightmare for both me and my mother.
Meanwhile the staff at Providence can and probably have caused an early death of a vulnerable senior who didn’t have anyone asking questions and demanding answers. Providence, Jacqueline Wiley and Dr. Takhar should be held accountable and at the very least, investigated thoroughly about their practices.
I plead you take this letter and its contents into consideration for your further action. Thanking you in advance for your continued service.
Yours faithfully,
Kim Yu.
APPENDIX
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