Court rejects son’s appeal over dying Nanaimo mom’s pain meds, backs doctor

An 80-year old double amputee, who spent her last months between a Nanaimo hospital and a nursing home, was in so much pain that a distinguished palliative care doctor was consulted on ways to make her daily wound care dressing changes more tolerable by using narcotics such as morphine.

Thomas William Sanders, the son of Arleane (also known as Eileen) Sanders, had a health-representation agreement on behalf of his mother but wouldn’t consent to heavy-duty pain medications for her. He later indicated in court documents that he thought the staff at Nanaimo Seniors Village only wanted to “overmedicate” her so she’d be in a vegetative state and hence, not a nuisance to caregivers.

Dr. Robin Love, an internationally recognized palliative care doctor, was brought in to see the patient. Love, who has been honoured with numerous awards, overruled Sanders and prescribed a fentanyl patch and other medications for his mother.

Eileen Sanders died on March 22, 2015. Her son had gotten the representation agreement the year before his mom died from complications of her peripheral vascular disease.

Sanders’ end-of-life experiences have played out in numerous legal hearings for three years because her son has filed complaints to every authority he could, starting with the College of Physicians and Surgeons of B.C., which dismissed his complaint about Love, finding that the doctor was diligent and attentive.

The same year the college dealt with the Sanders complaint, it awarded Love with an Excellence in Medical Practice award for his tireless advocacy and creation of a palliative care service in Nanaimo.

The Health Professionals Review Board did an investigation after a complaint from Sanders and found no fault with what the College decided.

Sanders also complained to the Vancouver Island Patient Care Quality Review Board, which concluded in 2016 that it might not have been right to override Sanders’ health-care representation agreement but medical professionals were “acting in your mother’s best interest.”

The hospital should have involved the Public Guardian and Trustee, the board recommended. The board also found that medical personnel need more training for dealing with end of life patients “to determine the appropriate protocols surrounding informed consent and revocation of a representation agreement.”

Still dissatisfied, Sanders took his complaint to the Supreme Court of B.C. in 2017, asking it to quash the Health Professionals Review Board decision that Love did not breach his obligations by overriding Sanders. The court reserved its decision after a three-day hearing last fall in Victoria but has now issued its decision, ruling against Sanders.

Noting that Sanders appeared to be a “dutiful” son who regularly visited his mother, Supreme Court Judge Michael Brundrett said Sanders’ contended that morphine medication caused his mother to have delirium and contributed to her lack of appetite.

Love met with Sanders and tried to explain that some of his mother’s confusion had to do with her progressive disease. In March 2015, the patient was admitted, for the final time, to Nanaimo Regional General Hospital.

She had a large, infected, gaping cavity in herperi-anal and rectal area because of an untreatable wound. The judge said nurses were “distressed and tearful” because they didn’t know how they could comfort Sanders given that her son would not consent to an increase or change in pain medications.

At that point, Love said he would try changing pain medications on a trial basis to see if Sanders’ mental clarity improved.

But on the morning of March 6, matters came to a head, the judge noted. Sanders was “yelling, crying and calling for help.”

Despite Love’s 24 years as a palliative care physician, he was as distressed as the nurses. He called Thomas Sanders to explain his mother was dying and needed better medications for her suffering but Sanders stuck to his position.

So Love said he would take the necessary steps to overrule him. Sanders indicated to Love that he would consult a lawyer.

At various legal hearings, Love said he consulted with a hospitalist, general surgeon, plastic surgeon and geriatric psychiatrist about the case. He also talked to various executives of the hospital, most notably the risk management department, which advised that he could override the representation agreement if it was in the patient’s best interests.

Sanders and Love had a meeting at the hospital. The physician told Sanders he could no longer watch what was happening, that nurses were traumatized by having to care for someone with such “unsurvivable” wounds and that his ethics and morals mandated that he provide proper pain medication which he went ahead and did. The patient died two days later.

What Love did not know is that an angry, frustrated Sanders had already filed a complaint with the College about Love’s care for his mother and overruling his wishes and instructions.

Judge Michael J. Brundrett said doctors aren’t held to a standard of perfection by the College when it handles complaints from the public. An inquiry committee must determine if appropriate standards of practice have been met. And they were in this case.

The judge avoided ruling on the legality of the physician overriding Sanders’ consent saying “this was not a clear situation in which a physician plainly acted illegally against the wishes of a representative acting in good faith in the patient’s interests.”

Jennifer Cameron, a lawyer with the Victoria firm that is representing Thomas Sanders, said a decision on whether to appeal the decision will be made soon.

“Our client remains concerned that his mother didn’t consent to the treatment provided to her and, despite the fact that she named her son as her representative, they unilaterally removed him as her representative.”

Cameron said the matter of revocation of representative agreements remains fuzzy and the current decision doesn’t clarify when doctors can override such agreements.

Sanders believed he was acting according to his mother’s wishes and in her best interests, she said.

Love could not be reached for comment.