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Specialists argue patients at risk
PUBLICATION: The Ottawa Citizen
DATE: 2005.11.07
EDITION: Final
SECTION: City
PAGE: C1 / Front
BYLINE: Ian Sutton
Senior medical professionals, including two retired psychologists who have spent their careers
caring for developmentally disabled Ontarians, have expressed serious concern about the risks
involved in an Ontario government plan to move residents from three provincial institutions into
small community facilities.
The head of the Canadian Mental Health Association branch in Ottawa, meanwhile, questions whether
radical changes involved in moving residents out of Rideau Regional Centre at Smiths Falls and two
facilities in central and southwestern Ontario are a humane course of action.
Dr. Joseph Molino and Dr. Bruce McCreary have filed affidavits with the Ontario Superior Court of
Justice in support of about 150 families of residents at Rideau Regional Centre who had been
seeking an injunction against moving their relatives out of the facilities into the community.
Rideau Regional Centre continues to be a supportive community for the men and women who reside
there, Dr. Molino said in his affidavit.
But residents still living there, he said, lack the cognitive and legal capacity to provide the informed
consent required by law for their transfer from the centre.
"These men and women have developed longstanding bonds with staff and their peers and have
enjoyed tremendous freedom of movement and security because of the size and opportunities
presented by the therapeutic community," his affidavit states.
While Dr. Molino supports group homes and other community−based residences, which he agrees
have provided a positive move for those who wish to live in "properly supported settings," he does
not agree that group homes are the best solution for every developmentally−disabled person.
"My experience supports my opinion that for some individuals the cost of transferring out of RRC to
a group home would be too high."
Superior Court Justice Robert Smith ruled on Sept. 30 that none of about 430 residents remaining at
the Smiths Falls facility should be relocated pending a judicial review of the impact on their quality of
life.
As well, a class action suit was launched last summer by families of residents at Rideau Regional
Centre in a constitutional challenge under the Charter of Rights and Freedoms. A similar action has
been filed by families of residents at the Huronia Regional Centre in Orillia.
About 1,000 residents in total, many in their 60s, 70s and 80s, are housed at the three institutions,
including the Southwestern Ontario Regional Centre in Chatham. The average age of the residents at
the Smiths Falls centre is 53, many of whom have lived there since the facility opened in the
mid−1950s.
Lawyers for the family groups and for the Ontario Ministry of Community and Social Services will
present arguments Dec. 12 and 13 during Divisional Court hearings on the judicial review in Ottawa.
Before retiring, Dr. McCreary was on staff at both the Huronia Centre and Rideau Regional, where he
still serves as a consulting psychiatrist. He expresses similar concerns to Dr. Molino's about the
legal requirement for informed consent of residents for their relocation. Family members who are
expressing concerns about the need to assess risks and benefits to their loves ones "would be
acting reasonably," he says.
"Group homes can offer an alternative to institutions," Dr. McCreary agrees.
"However, the Ontario group home system is significantly under−resourced at present, relative to
the needs of those residents." In addition, he says, "it will take time to develop resources in the
community for the remaining residents, who generally have high needs −− I have seen some former
residents of institutions who have done well in group home settings. I have seen others whose
health has declined, and who have done poorly, relative to their time in an institutional setting."
Paul Doig, a spokesman for the ministry, declined to comment on the expert affidavits filed late last
month, since the matter is before the courts.
Residents still housed at Rideau Regional Centre and the other facilities are "clearly the most
severely disabled and probably the most difficult to care for," says Dr. Walter Rosser, chief of family
medicine at Queen's University, where many physicians who provide medical care to developmentally
disabled patients obtain their specialized training.
"Although I don't have clear numbers, it certainly seems that generally it will be more expensive to
care for these people in small group homes where there are six or eight people, than in a larger
institution, where one would expect economy of scale," he said.
"When I talk to the physicians there, they always talk about the staff being absolutely critical in
determining if someone is not doing well," Dr. Rosser said.
"Administering medical care to this group is very difficult because these people aren't capable of
giving a history or saying, 'I don't feel well' or 'I have a pain in my chest.' It's very difficult to recruit
physicians into this facility because there are very few doctors with the interest or the skills −− this
kind of medicine requires a very specific set of skills."
Marion Wright, executive director of the Ottawa branch of the Canadian Mental Health Association,
agrees that locating younger residents with development disabilities into community facilities −−
rather than large institutions −− makes sense.
"What we did 20 years ago, we don't think is the best thing for people to do now," she acknowledges.
"But we still have a belief that there are some individuals who require institutionalized care for a
period of time because of the characteristics of their disorder."
Residents still living at the Rideau Regional Centre have severe mental health disabilities −− many of
them with dual diagnoses, including Alzheimer's −− from which they will not recover, Ms. Wright says.
"The question is, can you mirror what the big institutions did in a community setting −− providing
safety, security and 24/7 care and, if so, what would then be the benefits to everybody?" she asks.
"The question remains that we have institutionalized people; we've added institutional issues on top
of a large cocktail of other issues they have to deal with and is it really humane for someone who is
in their 40s or 50s or 60s to make such a radical change at this point? Therein is the dilemma."
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