Public trustee's office investigates Riverview case

Pamela Fayerman
Vancouver Sun

April 17, 2002

The Public Guardian and Trustee's office of B.C. is investigating the case of an elderly Riverview Hospital patient who has received more than 130 electric shock treatments over the past three years, sometimes as often as every few days.

Riverview psychiatrists have declared that the patient, 71-year-old Michael Dennis Matthews, is unable to give consent to the shock treatment because of his mental state. So, as with many geriatric patients, they are administering electroconvulsive therapy (ECT) to him on an involuntary basis.

During a recent interview outside Riverview, where he said he has been confined for the past four decades, Matthews told the Vancouver Sun he fears the shock treatments more than anything else.

"I'm braver now, but I don't like it. They hurt, I don't want it," said Matthews, who recalled he was admitted to Coquitlam's Riverview Hospital 39 years ago -- for what reason, he cannot remember or cannot disclose.

Billing records shown to The Sun (dating from 1998 to February of this year) show that Matthews received about 135 ECT treatments, and they have continued in the past few months, but with less frequency. This is well above the average number of ECT treatments of between six and 12. Doctors normally expect improvement within 15 treatments.

He has a terrible forehead gash, sustained, he said, after he fell over in a dizzy state following a recent shock treatment session.

Matthews said he was born in Cranbrook, although he remembers living for a time in Creston. Matthews does not appear to have any contact with relatives or people from his Kootenay past.

The public trustee's office, which has jurisdiction over Matthews' financial and legal affairs, was made aware of his ECT situation by Julie Butler, who appears to be Matthews' only visitor at Riverview. Matthews has an affectionate regard for Butler, and during the interview with The Vancouver Sun, he kissed her hand and hugged her when asked if he enjoys her visits.

Butler is director of the B.C. chapter of the Citizens Commission on Human Rights, a Church of Scientology affiliate.

The commission lobbies around the world against psychiatric "abuses and violations of human rights."

Butler, who wants doctors to halt Matthews' ECT sessions, said she became aware of Matthews when she read about him on a Web site and began visiting him several months ago.

On the Internet, an anonymous, former caregiver at Riverview participated in a forum, complaining about the relentless frequency of the shock treatments Matthews was receiving and the increasing adverse effects she perceived as stemming from them -- agitation and confusion among them.

Catherine Romanko, deputy public guardian and trustee, said although her office's authority does not extend to Matthews' personal or health-care matters, she feels that it is important to nevertheless "make inquiries into the situation because of circumstances which we have been made aware of.

"So if, for example, it appears that medical opinions are not in support of this treatment, or there are reasons to review it -- and I'm not sure what our inquiry will turn up -- then there are avenues of recourse we can consider on behalf of him," Romanko said, referring to independent medical opinions and even litigation if it came to that.

She acknowledged that the Public Trustee is stretching the boundaries of its jurisdiction somewhat by delving into matters that are not strictly confined to authority over his legal and financial affairs.

The trustee has a committee of estate protective role over the financial and legal affairs of many other patients at Riverview. "Clearly, we deal with them all the time," Romanko said, referring to some patients and administrators at the hospital.

Because of the close contact between the trustee and the hospital, there is an awareness of the scrutiny the hospital faced last year after the former provincial government appointed an external review panel to investigate ECT practices at Riverview.

The Vancouver Sun reported on the sharp increase in the number of ECT procedures, beginning in 1997, when doctors were allowed to bill MSP for each ECT treatment. Some questioned if the increase was tied to a financial incentive and in late 2000, the then-health minister, Corky Evans, said he wanted an external review of the hospital's ECT program to find out why treatments on elderly patients had more than doubled.

The report never offered a conclusion on the question because, as it stated, the lack of a detailed database "makes examination of the Riverview practice of ECT with respect to patient selection and outcome virtually impossible."

The external review report noted that the average number of ECT treatments is normally between six and 12, but more may be needed. Dr. Martha Donnelly, a Vancouver Hospital geriatric psychiatrist and member of a team that has just delivered a report to the minister of health on recommended guidelines for ECT delivery, said doctors hope that patients improve within 15 treatments.

Sometimes, they will continue ECT on a "maintenance" program which could mean once a week, bi-monthly, or monthly.