Protecting vulnerable person in care, Part II: Alberta nurses and the act

Ed had been a member of the cleaning staff on Unit 506 for 3 years. One day, Ed witnesses a registered nurse attempting to restrain Mrs. Anderson, an elderly patient with some cognitive impairment, in a geri-chair against her will. The RN gently forces a screaming and unco-operative Mrs. Anderson into the chair, and locks the chairs table (which serves the purpose of restricting Mrs. Anderson 's movement out of the chair) in place. It's lunchtime, and the nurse wants Mrs. Anderson in the chair so that she will sit still long enough to eat.

The day before, Ed attended an inservice presentation on the Protection for Persons in Care Act (PPCA). During the presentation, Ed learned that abuse included "intentionally causing emotional harm, including, but not limited to, threatening, intimidating, harassing, coercing or restricting from appropriate social contact" and that it was mandatory to report suspected abuse. A fine of $2, 000 could be imposed for not reporting.

Ed worried about Mrs. Anderson for the rest of the day, and thought about whether or not he should report the nurse. When he returned home late that afternoon, Ed called the 1888 number given in the brochure he received, and filed a report.

Since the Protection for Persons in Care Act (PPCA) came into effect on Jan. 5, 1998, there have been many stories circulating about how the act has affected caregivers. While the above story is fictional, it is typical of many of the cases reported to the PPCA toll-free reporting line.

When a report is received by the department of community development, it is written up and referred to the appropriate government department (either the minister of health, the minister of municipal affairs, or the minister of family and social services) to determine if the department has the legal authority to investigate the matter. If so, the minister must, as soon as possible, appoint a person to investigate the complaint.

From January to September 1998, numbers of reports of abuse increased with each reporting period:

Based on these numbers, it was reasonable to expect that as the act became better known, there would be a substantial increase in the next reporting period. However, the numbers went down: from Oct. 1 - Dec. 31 there were 150 reports of abuse.

There are several reasons to suggest why there was a decrease. First, from midway through the final quarter of 1998, reports of cognitively impaired abusers were not included, unless the incident involved serious injury or sexual abuse. Since the definition of abuse in the act includes the need for the abuse to be "intentional," a geriatric psychiatrist determined that a cognitively impaired person is not capable of forming intent to abuse. (Alberta Health, 1998). Since residents (47 per cent of all reports of abuse) were the most common alleged abusers in the first three reporting periods, leaving the cognitively impaired out of the reports would explain some decrease in the number of reports.

In addition, educational programs about the legislation may have become more effective, making it clearer to staff what abuse is and is not. Finally, fears of being reported may have prompted many individuals to review their techniques and care giving methods; some caregivers may have realized that some of their actions were unacceptable. As well, better communication with others about behavioral management and disease processes may have resulted in actions previously suspected as being abusive now being viewed as part of a plan of care.

Reports to Alberta Health

Since all of the reports under this legislation alleging abuse by nurses were referred to Alberta Health, it is of interest to look at the statistics on cases sent to the minister of health. (See TABLE 1) Of the 640 reports made in the first year to Alberta Health, approximately 80 per cent of the reports were "unfounded," in that abuse was not determined to have occurred, or there was insufficient evidence of abuse.

Edith Baraniecki, Alberta Health co-ordinator for the the PPCA, says that recent reports of cases show that five out of eight were not proven, and she estimates that this would be a closer estimate as unfounded cases in the future, about 62 per cent.

Callers who phone in sometimes wish to remain anonymous. They are told that they have the right not to give their name, but that they will then be unable to have input or receive feedback, and the investigation of the report may be difficult. Of the reports referred to the minister of health, less than two per cent have been anonymous.

So far no fines have been imposed. Fines have not been considered for any case referred to Alberta Health, but there have been several at the other two departments which are being reviewed by the Department of Justice to determine whether fines are appropriate.

In a case where abuse is determined, the agency and the relevant regional health authority are notified. The agency's response must be reported to the minister within 90 days. In most cases, this response is discipline of the alleged abuser, up to and including termination.