Two nurses have been punished for unprofessional behavior after they used forceps to insert oral medication into the rectum of an incompetent man detained at the RCMP in northeastern Alberta. Documents from a court hearing provide details of the October 2020 incident at Elk Point and how the Alberta College of Paramedics (ACP) fought for the discipline of Donald Hingley and Ryley Pals. Hingley and Phils have been fined and reprimanded and ordered to attend ethics training. They had also faced an eight-day suspension, but those sentences were overturned after a rare internal appeal. During a court hearing last July, Hingley and Pals admitted to incorrectly administering Keppra antiepileptic drug from the rectum, using large angle forceps. Hearing documents indicate that the patient was previously evaluated for symptoms at Frog Lake First Nation, but did not specify whether he is a member of the Cree community. The Frog Lake First Nation leadership could not be reached for comment.

The paramedic suggested that the patient was fake

According to an agreed statement, Hingley and the Pals worked at Medavie Health Services West-Prairie EMS, a private ambulance provider in Elk Point, 215 miles northeast of Edmonton. On October 7, 2020, they were sent to the local RCMP squad to help a man who appeared to have seizures. Hingley, an advanced care paramedic, supervised. Pulse was a primary care nurse. The patient – identified as “Patient A” in the hearing records – was unconscious in a detention cell when paramedics administered the drug. The court found that they administered the drug incorrectly and failed to conduct a proper evaluation on a non-responsive, vulnerable patient.

“Excellent, reckless”

Hingley was also sanctioned for his derogatory remarks implying that the patient was pretending to be symptomatic. In a patient care report, Hingley wrote that the man had previously been evaluated in the Frog Lake First Nation for “epileptic activity” which was in fact “more of a voluntary muscle contraction”. The patient did so so that he could spend time in a hospital room instead of being imprisoned by the RCMP, Hingley wrote. “The conduct of the audited members was outrageous, reckless and a significant deviation from the standards expected of an audited member,” court president Belle Clark wrote in a September 23, 2021 ruling. The decision noted that there are no current protocols that allow the correct administration of anticonvulsant drugs and that even if they existed, Keppra is not a drug that can be administered rectally. The use of forceps was declared unacceptable. “The combination of the invasive nature of the procedure and the inherent power imbalance created by the non-response of patient A is not tolerated,” the ruling said. Friends told a college researcher that if the patient was not going to take Keppra by mouth, then the drug could “go the other way,” he said. “[Hingley and Pals’s] “The apparent failure to consider other treatment options… is a sign of a significant lack of knowledge or blatantly deliberate behavior,” he said. Hingley, who described the patient as “very non-compliant”, allowed his previous interactions with the man to blur his judgment, the court found. The verdict stated that Hingley had stated in the patient care report that the man was pretending to be “on his way” and that he was “more interested in swallowing alcohol and drugs on the street” than in drugs. The court asked if the college had considered whether the case met the definition of sexual misconduct. A lawyer for ACP grievance director Jennifer Kirk said Kirk decided the behavior was not sexually motivated, but a mistake in judgment – and that Hingley and friends may have been motivated by the fact that the patient had previous interactions with paramedics and police officers. In an email to the CBC, Hingley declined to comment on his behavior, but said he had retired as a paramedic. Unable to communicate with friends.

‘It’s Personal’

Following the incident, an RCMP officer asked another Medavie nurse, Adam Nichols, to examine the monitoring material. Nichols, who is an advanced care paramedic, filed a formal complaint with the ACP after seeing the tape. Adam Nichols, an advanced care paramedic, filed a complaint with the college after watching a video of him being watched from the RCMP cell. (Google Meet / CBC)
The treatment the patient received was horrific, Nichols said in an interview with CBC News. “I could not imagine being treated the way they treated this person,” he said. Sanctions against Hingley and Phils are weak and set a “bad precedent” for the profession and patient care, Nichols said. “It was a violation [the patient’s] rights and violation of his basic human rights “.
In a ruling in September, the trial court said a harsh sentence was required for the case. A joint submission had proposed appropriate sanctions. the court deviated from the list by also issuing them an eight-day suspension. As recommended by the joint submission, Hingley and friends were contacted and each was ordered to pay a $ 500 fine plus $ 500 in expenses. They were instructed to complete a course on “ethics and boundaries” and were told that the college would publish details of the sanctions, along with their names. An additional condition was imposed on Hingley, who forbade him to supervise paramedical students for one year. “These are serious consequences that are consistent with a serious misconduct,” the court said in its ruling.

The suspensions were overturned

The eight-day suspensions were challenged by the college’s complaints director and then overturned during a March 30 appeal. The appeals panel found that the trial court had erred in law in issuing the suspensions. The appeal noted that Hingley and the Pals had no previous records of disciplinary matters, had regretted their actions and had cooperated with the investigation. “The Board of Appeal was not convinced that adding these additional sanctions to a carefully designed and agreed set of remedies would give any additional justice,” the Board of Appeal said in its decision. He also said that the members of the appeals committee were “seriously concerned” about the behavior of the two paramedics. In a statement to the CBC, Kirk said the ACP takes complaints against regulated members seriously and handles them under the Occupational Health Act. “The College’s commitment to this process, including the appeals process, serves to ensure that our members will continue to provide the highest quality care to Alberts,” Kirk said. Nichols said he did not know the patient, but hoped the man would find out the result. “This person should know that this is completely abnormal and unacceptable behavior – and most paramedics would stand by him and say it was blatant.”