‘CRUEL TREATMENT’
Family shocked as care-home worker’s 11 punches to senior caught on video
A personal care worker at a cityrun retirement residence delivered 11 punches to the face of an elderly, immobile and largely nonverbal dementia patient, a video obtained by the Citizen reveals.
The high-definition video camera that recorded the attack was installed by the patient’s family and wasn’t even a secret to staff at the Garry J. Armstrong long-term-care home on Island Lodge Road where the assault occurred.
Workers were made aware that the video system was being installed in the room of 89-year-old Georges Karam after the family grew increasingly concerned about the number of unexplained injuries he had suffered since moving into the residence two years ago.
The city scrambled to assure other residents and their families in the city-run long-term care home that “the safety and well-being of all of our residents is our number one priority,” after being contacted by the Citizen about the case. “We take our commitment to safety seriously,” wrote Janice Burelle, general manager of community and social services in a letter she sent to Mayor Jim Watson, council and city staff.
The video, which was provided to the Citizen by Karam’s family, shows the elderly man lying in bed as personal support worker Jie Xiao yanks him back and forth while removing his diaper. Karam suffers from Alzheimer’s and Parkinson’s diseases and needs a wheelchair to move around.
An agitated Karam took a pair of swipes with a crippled and shaking hand at Xiao during the diaper change.
It was after a third swipe that came closer to Xiao’s face that the 44-year-old care worker unleashed a series of rapid punches with his gloved hand to the side of Karam’s face on March 8.
Xiao frequently paused between the blows, delivering two or three punches at time with his left hand as his right hand took hold of Karam’s arm. The sound of the fist making contact with Karam’s face is clearly audible on the video.
In between the punches, Xiao frequently raised a closed fist next to Karam’s face. Before delivering the final punch, Xiao appears to be swearing at Karam. Karam then lets out a shout. The whole assault lasts about 28 seconds.
Xiao then briefly leaves the room, only to return 27 seconds later. He then stands next to the bed, pointing at Karam’s hand and his own face, before making a gesture as if Karam should try hitting him again. Xiao then made a fist and pointed at Karam’s face.
Xiao then pulls Karam’s blankets up, closes Karam’s eyelids with his fingers and pats Karam on the head.
Xiao then put a finger to his mouth in a shushing gesture before turning off the TV and the lights and leaving.
Last Tuesday, Xiao pleaded guilty to assault. A sentencing hearing is expected to be held later this year.
The assault took place at a time of growing concern about Ontario’s long-term-care system. Former nurse Elizabeth Wettlaufer was recently sentenced to life in prison for the murders of eight patients in long-term-care facilities. The province has announced a public inquiry, but NDP Leader Andrea Horwath wants that expanded to take a broader look at what she calls a broken system.
Karam’s grandson, Daniel Nassrallah, an Ottawa lawyer who set up the camera, said he couldn’t believe what he was seeing when he first viewed the video just after 10 p.m. on the day of the assault. Nassrallah had set up the camera — which is about the size of a baseball, lights up in the dark and had wires running from it — on the wall so he could watch the video remotely over the Internet.
“I literally stood up and fell down, my legs gave way because I didn’t know how to respond to this,” he said.
“We have a camera on him, and even that doesn’t deter him. To me, that’s mind-blowing.”
Nassrallah said after viewing the assault, he first called his uncle, who is the substitute decision maker for his grandfather, then his brothers. He then headed toward the home in his car, hoping to get there before the shift changed at 11 p.m. On the way, he dialed 911.
The police were already on his grandfather’s floor when he arrived; as he and his two brothers got into the elevator, one of them spotted Xiao leaving through the front door. Nassrallah approached him and asked him to come upstairs with them, which he did. Nassrallah then showed police the video. They arrested Xiao on the spot, handcuffed him and took him to the central cellblock.
Karam was taken to hospital by paramedics. A CT scan was performed but there were no serious injuries. He eventually returned to the home.
Ottawa police Det. Hilary Rao with the elder abuse unit said the video was “definitely disturbing.”
Burelle, the city’s head of community and social services, which oversees long-term-care homes, called the case “deeply troubling.” She outlined details of the incident and ongoing investigations in the letter to the mayor and members of city council.
“I deeply regret that one of our residents was subjected to this incident,” she wrote. “The actions of this worker are completely at odds with our mission and our commitment to the health and the wellbeing of our residents. Long-term care will not tolerate any form of abuse of residents. There can be no excuse for even a momentary lapse in the high standards that we, residents and their families expect of the people to whom we have entrusted the care of those who call our facilities home.”
The worker was immediately removed from the home once the allegations were made “and is no longer with the City of Ottawa.” Burelle said she is reaching out to other residents of the home and their families “who may have questions in light of the criminal code conviction.”
She also confirmed the city has received notice of intent to sue from a law firm acting on behalf of the resident’s family.
“I can also advise that staff are currently working with the ministry in response to other complaints relating to the same resident regarding his medical chart and care. This review is ongoing and does not relate to the personal support worker.”
Nassrallah said it was especially troubling to learn the employee who carried out the assault specialized in the treatment of dementia patients. He unleashed both a physical and verbal assault on a man who could neither defend himself nor speak out about his treatment, Nassrallah said.
Nassrallah’s grandfather speaks little English; when he does talk, it’s in Arabic.
‘THIS IS TORTURE’
“A person in a state of dementia reverts to childhood. It’s fight or flight. My grandfather can’t fly, he can’t run away, he can’t get away from the situation, he’s immobile. His hands are being held, he’s being demeaned, he’s being thrown around in some instances, he’s not being taken care of properly,” said Nassrallah. “This is torture, this is punishment, this is cruel treatment.”
This wasn’t the first troubling incident involving Karam at the long-term care home, Nassrallah alleges.
He said they have filed complaints with the Ottawa police and the Ministry of Health and Long-Term Care after the family discovered that a registered nurse had signed a Do Not Resuscitate order for their grandfather without their knowledge or consent.
Nassrallah said it is entirely contrary to the express wishes of the family and the wishes made by Karam in a power of attorney he signed before deteriorating to his current state.
Nassrallah said the family only learned about the DNR order by accident on June 17 after they were contacted by the home after his grandfather fell from his bed. Nassrallah said when they arrived they discovered his grandfather had suffered injuries to his head; however, they later found out the injuries were not caused by the fall. They were then given a copy of his medical file. Nassrallah said they were told that the DNR was a “mistake.”
The nurse “would have signed my grandfather’s death sentence against his express wishes,” Nassrallah said.
He said the family found evidence of supposed meetings with the facility’s doctor, which were dated before his grandfather had even moved to the home.
Nassrallah said the camera has also caught incidents, both before and after the assault, of another resident entering his grandfather’s room and going through his belongings. Another personal support worker was also recorded by the camera taunting his grandfather. In one video, he loudly calls him “Mr. George” and “my boss,” changing him in front of an open door. The worker also hit his bed and then repeatedly said “inshallah,” an Arabic expression meaning God willing, or if God wills. Karam is Lebanese.
In the second video, recorded just days after the assault by Xiao, the same worker stands next to Karam’s head, repeatedly saying inshallah. He later dances out of the room, repeating the word over and over as he leaves.
Nassrallah said they were told the worker was suspended for two months and assigned to a different floor after they complained.
The video also caught Xiao making a sound that mimicked a squeal made by another resident with health problems on the same day he assaulted Karam, Nassrallah said. Prior to the assault, Xiao failed to properly prop Karam up when he put him to bed to prevent a bedsore from getting worse, and tossed dirty towels he had used to clean Karam’s genitals on the bed, Nassrallah said.
“Everyone should have a camera in the room,” Nassrallah said. “Most substitute decision makers are not here essentially as peeping Toms to watch an elderly individual change. That’s not their purpose. It’s oversight over your loved one.”
Nassrallah said the family made the decision to install the camera in February after their grandfather suffered a cut to his neck. They later discovered a support worker had tried shaving him with disposable razors and cut him, even though the family had provided them electric razors to prevent injury.
“We thought that something was not right,” Nassrallah said. “Over the past six or seven months prior to February 2017, there were several incidents in the home that were unexplained. There would be cuts and bruises to my grandfather, they would claim that he had fallen out of bed. There was a laceration to the top of his forehead. We never had a satisfactory answer given, it was always unexplained facts. That was not satisfactory to us.”
They installed the camera to monitor their grandfather’s care but also to act as a deterrent, he said.
The management “had full knowledge of the camera, and actually approved of the camera being in place,” Nassrallah said.
Burelle said cameras have been installed in the rooms of two residents at the home. “Residents and their families are free to place cameras in their rooms, and that is a choice that some residents/ families make for their own personal reasons,” she said.
Nassrallah said his grandfather fled to Canada from Lebanon’s bloody civil war in the early 1980s. In Lebanon, Karam had been in the military. He later became a staff sergeant in the traffic and circulation division.
He’s a widower now. His wife died in 1993 as a result of the tainted-blood scandal.
“My grandfather was tough as nails,” Nasrallah said. Now, he’s just fearful. “He begs us to protect him. Literally the translation is: ‘I beg you, I beg at your feet, please don’t leave me, please protect me, something ’s not right,’ ” Nassrallah said.
But despite what’s happened, Nassrallah said the family has been reluctant to move him out of Garry J. Armstrong home, fearing what might happen to him if he leaves.
“The only reason he’s still there is because you are stuck between a rock and a hard place. An individual in that mental and physical state, he’s accustomed to his surroundings. He’s accustomed to the people who work at the home, he’s accustomed to the food, he’s accustomed to his bed, he’s accustomed to waking up with routine at the home. He’s accustomed to his life at the home,” Nassrallah said. “Removing him at this stage would be extremely detrimental to his health and well-being, both physical and mental.”
In Ottawa and the surrounding area, about 7,500 people are in long-term-care beds and another 3,500 are on waiting lists. More than 700 residents are in city-run long-term-care homes.
The city says it received 26 complaints related to services at Garry J. Armstrong in 2016, mostly about the home’s services, including housekeeping, response time and food. There was also one confirmed incident of verbal abuse.
The city works with the province to make sure remedial action happens quickly, Burelle said. She noted that all long-termcare homes are subject to regular and random inspections by the ministry and are assessed by independent auditors every four years to make sure standards are being met. City homes, including Garry J. Armstrong, had an overall rating of 95 per cent satisfaction as places to live by residents and families in 2016, she said.
He begs us to protect him. Literally the translation is: ‘I beg you, I beg at your feet, please don’t leave me, please protect me, something’s not right.’
ADDITIONAL TRAINING
All staff provide proof of education and undergo police checks and are provided with “comprehensive orientation” before they begin work. Annual mandatory training includes abuse prevention.
She said staff are now getting additional training on the city’s abuse policy, which will be completed by September.
The assault has left Karam’s family questioning whether other residents may have been victimized.
“I dread to think what happens to other families who don’t have the same resources and capabilities that our family does,” Nassrallah said. “With another patient or another resident who doesn’t have a voice, doesn’t have a family or oversight, that individual is left alone to suffer, because of that; that is what drives me in this.
“I want change and I’m not going to stop until we get change,” Nassrallah said. “The system is broken and it needs change.”