Fatality inquiry judge says caregiver 'chose' not to do proper job
'It's almost impossible to come up with recommendations that would prevent criminal behaviour,' judge says
A caregiver who switched off a piece of medical equipment so she could sleep on the night her seven-year-old patient died clearly understood her duties, but decided not to perform them properly, says a judge hearing a fatality inquiry.
"It's very obvious what we have here is a caregiver who knew what to do, but chose not to do it," said provincial court Judge Lloyd Malin. "And it's almost impossible to come up with recommendations that would prevent criminal behaviour."
The fatality inquiry is gathering evidence about the death of Garrick Eng, a severely disabled boy who was quadriplegic and needed 24-hour nursing care.
The caregiver who switched off the machine in the early hours of Jan. 9, 2009, pleaded guilty to failing to provide the necessaries of life and in February 2012 was given a two-year conditional sentence that included house arrest.
On Tuesday afternoon, Vivian Chan gave testimony about her son and the care he was given in the months before his death.
She said health-care aide Renee Boudreau had been working in the family home for about four months.
Chan said she caught Boudreau sleeping during her night shifts perhaps four times during the first month she worked there.
'I had to retrain her'
During that first month, she said, she also noticed that Boudreau wasn't doing chest physiotherapy on her son in the mornings. That happened three or four mornings in a row, she said, before she talked to someone about it.
"So I basically had to retrain her to do that," said Chan, a nurse who spent 10 years in pediatrics at the University of Alberta Hospital.
After that first month, Chan said she had no further complaints about Boudreau's work.
Boudreau was there to cover night shifts, so Chan and her husband could sleep.
Chan said she sometimes heard "all the alarms" that went off on the machines that helped keep her son alive.
One of those machines was called a pulse oximeter. It constantly monitored the oxygen level in her son's blood stream.
If the level got too low, the alarm would sound. It was that monitor Boudreau switched off in the hours before Garrick Eng died.
Caregivers are required to keep charts that tracked medications and vital signs, and services performed.
Were the charts properly kept?
Chan said looking back, she now wonders if Boudreau kept honest charts.
"I'm wondering if she was actually doing everything she says she was. For all I know, she could have come in, charted her three lines, and then slept the rest of the night away."
Chan was asked, if she had concerns, could she have simply asked that Boudreau be replaced?
She said, yes, but whenever she raised concerns with Alberta Health Services, she got the impression that it would be difficult to get a new caregiver.
Boudreau worked for an agency called We Care, a company that provides home health services under contract with AHS.
Chan's husband, Rick Eng, asked his own questions at the inquiry.
At one point, he asked his wife how hard it was to find caregivers.
"It was quite difficult many, many times to find a caregiver," she said. "Especially when Gary was in the hospital. Because many times we'd lose the ones we had when he came out of hospital."
Her son was in hospital at least once a year, she said. Every time he was discharged, they family had to find a new caregiver and as time went on the little boy needed more care.
Family needed an LPN
By the end, the family needed a licensed practical nurse, Chan said.
"But we couldn't even find one who could give us as many hours as we needed. So we settled for a health-care aide, and even that was hard to find.
"I tried to phone as many agencies as I could. Most of them just didn't have any. I put posters up at the university."
Her son needed someone to brush his teeth and change his diapers. He was fed through a tube and had an IV line in his chest. He needed daily chest therapy and suctioning.
The family had what's called a hybrid care plan, Lois Dewar, Garrick's case manager, told the inquiry.
Part of his care was self-managed by the family and part was handled by caregivers hired by an agency under contract with AHS.
If there are problems, parents are told to take them first to a supervisor, then to AHS, Dewar said.
"Parents will often let us know if they have concerns about a caregiver. They're quite vocal."
Boudreau was taught how to use all the equipment needed to care for Garrick, Dewar said.
Charts entered as evidence at the inquiry show that Boudreau checked the sleeping boy's oxygen levels at 11 p.m. on the night of Jan. 8. She changed his diaper and checked again at 1 a.m., according to the charts.
Some time later she switched off the monitor and fell asleep
Garrick Eng was found dead in his bed early that morning.