Psychiatrist's behaviour left Summerside hospital staff concerned, hearing told

Some Prince County Hospital staff members did not agree with how psychiatrist Dr. Arvind Singh was treating a patient with advanced Huntington's disease, a hearing into misconduct allegations heard Tuesday.

Singh's treatment plan, and his conduct toward patient Laurel Hurst and her family, are at the heart of a College of Physicians and Surgeons of P.E.I. board of inquiry taking place in Charlottetown. 

Psychiatric expert Dr. Serge Lessard told the board he had received and reviewed 8,415 pages of hospital records after being asked to evaluate Singh's treatment plan.

By the time she was hospitalized in early 2017, Hurst was in her mid-30s and had lived with Huntington's disease for many years. During that time her brain function declined to the point that her father said she had the comprehension of a four-year-old, and was prone to emotional outbursts. 

To try to curb bad behaviour, Singh locked her in a room and removed most of its contents, as well as instructing staff to offer her small rewards for good behaviour.

"It only causes distress … It never had the desired impact," hospital staff wrote in the notes reviewed by Lessard.

"It provoked distress and provoked undesirable behaviour," was how Lessard summed up the punitive actions Singh ordered at the PCH psychiatric ward. 

The main issue at the hearing is whether Singh's treatment plan amounted to what's called behavioural modification therapy.

In its simplest form, Lessard testified, it's what parents do with children as they grow. They reward good behaviour, and punish the bad.

"When police pull you over and give you a speeding ticket, that's behaviour modification," Lessard said.

But Hurst had been declared mentally incompetent, and was incapable of grasping why she was being punished, her family insisted earlier in the hearing. She was also being treated for alcohol and opiate addiction, and was receiving methadone treatments.

Her undesirable behaviours included theft from other patients, hoarding items in her hospital room and highly emotional, aggressive outbursts at staff and others.

"The patient must have the ability to understand consequences" in order for behavioural modification therapy to work, Lessard said. 

Yet, after going through the hospital records, he said: "I have clinical notes, signed by Dr. Singh, referring specifically to behavioural modification therapy."