New Brunswick·CBC Investigates

Vitalité turns over new records about patient's death, after saying it didn't have them

The province’s French-language health authority has turned over new records about the suicide death of a patient at the troubled Restigouche Hospital Centre, after a lengthy access to information battle.

CBC’s access to information complaint was delayed for nine months before health authority turned over records

Martin Michaud, shown right, died Feb. 9, 2019, at the Restigouche Hospital Centre in Campbellton. His family questions whether his death could have been prevented. (Radio-Canada)

The province's French-language health authority has turned over new records about the suicide death of a patient at the troubled Restigouche Hospital Centre, after a lengthy access to information battle.

Vitalité Health Network claimed it had only two records, amounting to less than three pages' worth of information, about the investigation into Martin Michaud's February 2019 death.

But that wasn't true.

In fact, Vitalité had several other records about Michaud's death, including a timeline of events and an email sent by a vice-president of the organization to other members of senior management.

The health authority kept those records from both CBC News and ombud Charles Murray for nearly nine months, delaying Murray's investigation and the public's access to the information.

"In future complaint investigations with Vitalité, I am hopeful that this office will receive better co-operation with respect to the production of relevant records to an investigation in a timely manner," Murray wrote in his March 2020 report about CBC's complaint.

Murray's investigation also found that an internal Vitalité committee that reviewed Michaud's death didn't write down their findings and only delivered the report orally.

Murray suggested this was on purpose.

"They are trying to avoid creating a record, which they think might be used against them in a legal process," Murray said in an interview.

Michaud, 38, died on the morning of Feb. 9, 2019, just two days after Murray delivered a scathing report that warned of mistreatment and inadequate care of patients at the psychiatric hospital, stemming from chronic understaffing.

Unanswered questions 

Vitalité has maintained that the hospital is safe for patients, but many questions about Michaud's death remain unanswered.

That includes questions around a three-hour gap between when someone last checked on Michaud and when his body was discovered, a gap that members of Michaud's family say they didn't learn about until they read a coroner's report.

None of the records released to CBC News explain what happened during that gap of time.

In September, Vitalité CEO Gilles Lanteigne said the health authority made changes at the hospital following Michaud's death, including revising its system to ensure routine checks are done. He said staff would have to confirm they've seen the patient breathing, write down the time of the check and have their rounds validated by a supervisor.

No one from Vitalité was made available for an interview for this story.

"In this said file, everything that needed to be done has been done, including certain modifications to our internal processes," Lanteigne wrote in an emailed statement.

"This subject has already been broadcast many times by the media and the network has already spoken out several times on the matter in 2019 and 2020. At this point, no additional comments will be made by the network."

He did not answer specific questions posed by email about why Vitalité didn't document its work or why it withheld records from the ombud.

"It is not uncommon for the organization to question a Request to Information (RTI) that could potentially result in obstructing the Personal Health Information Privacy and Access Act," Lanteigne wrote.

A nine-month delay

When CBC first asked Vitalité for information about Michaud's death, the health authority declined to provide any information at all, saying it would be an unreasonable invasion of privacy.

CBC appealed that decision and several months later, Vitalité produced two records.

They included the text of two recommendations stemming from Michaud's death: for staff to make sure they're doing hourly checks and verifying the patient's condition on those rounds, and to continue recruiting staff at the hospital.

It also included a redacted incident report.

Vitalité released this incident report that was written after Michaud's death. (Vitalité Health Network)

But Vitalité maintained it didn't have anything else and CBC requested a formal investigation.

Murray said he didn't buy the explanation that Vitalité didn't have any other records, including anything would explain how it came to those two recommendations.

"This notion that at the end of this entire review, we have a couple of these single-page-or-less documents, it's not a particularly credible situation," Murray said in an interview.

It wasn't until Murray began a formal investigation into the complaint that Vitalité revealed it had more information.

In some cases, Murray said, small organizations that aren't used to answering right to information requests can make honest mistakes.

But he doesn't believe that applies to Vitalité.

"The notion that its errors are unintended or inadvertent is much less credible to me than it would be if it were a small municipality, for example, with only one part-time staffer who is doing this work."

Problems with documentation

It's not the first time Murray has highlighted a problem with proper note-taking and documentation at the Restigouche Hospital Centre.

In his Failure to Protect report, Murray detailed "a pattern of notes being poorly documented" in the file of a Patient A, who died in custody of the hospital. He concluded this made it difficult to determine the chronology of events and what was done.

"This may be another example of that and would not be surprising if that were true," Murray said about the lack of documentation in Michaud's case.

Provincial ombud Charles Murray saw his investigation into CBC's complaint delayed for nearly nine months, until Vitalité turned over new records. (CBC)

Earlier this year, Michaud's father told Radio-Canada he was frustrated because he expected to know more about what happened to his son.

Michaud's family has previously described him as an avid reader who was curious about the world around him but struggled with social phobia. They hoped he would find help at the Restigouche Hospital Centre.

"It was their job to take care of him and unfortunately the care failed," Marie-Hélène Michaud, Martin's sister, said in an interview last summer.

"He just felt despair and lost hope."

ABOUT THE AUTHOR

Karissa Donkin is a journalist in CBC's Atlantic investigative unit. Do you have a story you want us to investigate? Send your tips to NBInvestigates@CBC.ca.

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