WARNING: This story contains distressing details.
Two paramedics have been sanctioned for unprofessional conduct after using forceps to insert an oral drug into the rectum of an incapacitated man in RCMP custody in northeastern Alberta.
Documents from a hearing tribunal provide details on the October 2020 incident in Elk Point, and how the Alberta College of Paramedics (ACP) wrestled over how Donald Hingley and Ryley Pals should be disciplined.
Hingley and Pals have been fined and reprimanded and ordered to take ethics training.
They had also faced eight-day suspensions but those penalties were overturned after a rare internal appeal.
During a hearing tribunal last July, Hingley and Pals admitted that they incorrectly administered the anti-epilepsy drug Keppra rectally, using large angular forceps.
The hearing documents indicate the patient had been previously assessed for his symptoms on the Frog Lake First Nation but do not clarify if he is a member of the Cree community. Frog Lake First Nation leadership could not be reached for comment.
Paramedic suggested patient was faking
According to an agreed statement of facts, Hingley and Pals were working at Medavie Health Services West-Prairie EMS, a private ambulance provider in the town of Elk Point, 215 kilometres northeast of Edmonton.
On Oct. 7, 2020, they were dispatched to the local RCMP detachment to assist a man who appeared to be having seizures. Hingley, an advanced care paramedic, was supervising. Pals was a primary care paramedic.
The patient — identified as “Patient A” in the hearing documents — was unconscious in a holding cell when the paramedics administered the drug. The tribunal found they incorrectly administered the medication and failed to conduct a proper assessment on an unresponsive, vulnerable patient.
Hingley was also sanctioned for derogatory comments he made suggesting the patient was faking his symptoms.
In a patient care report, Hingley wrote that the man had been previously assessed on Frog Lake First Nation for “seizure activity” that was actually “more of a voluntary muscle twitching.” The patient did that so he could spend time in a hospital room rather than being incarcerated by the RCMP, Hingley wrote.
“The conduct of the regulated members was egregious, reckless and was a significant departure from the standards expected of a regulated member,” tribunal chair Belle Clark wrote in a decision dated Sept. 23, 2021.
The decision noted that there are no current protocols that allow for the rectal administration of anti-seizure medications, and that even if there were, Keppra is not a drug that can be administered rectally. The use of forceps was described as unacceptable.
“The combination of the invasive nature of the procedure and the inherent power imbalance created by Patient A’s non-responsiveness cannot be tolerated,” the decision said.
Pals told an investigator for the college that if the patient was not going to take Keppra orally then the medication could “go in another way,” it said.
“[Hingley and Pals’s] apparent failure to consider other treatment options … is evidence of a significant knowledge deficit or egregious intentional conduct,” it said.
Hingley, who described the patient as “very non-compliant,” allowed his previous interactions with the man to cloud his judgment, the tribunal found.
The decision said that Hingley had stated in the patient care report that the man was faking his symptoms “to get his way” and that he was “more interested in alcohol and street drug ingestion” than medication.
The tribunal asked whether the college had considered if the case met the definition of sexual misconduct.
A lawyer for ACP complaints director Jennifer Kirk said Kirk determined the conduct was not sexually motivated but an error in judgment — and that Hingley and Pals may have been motivated by the fact that the patient had previous interactions with paramedics and police.
In an email to CBC, Hingley declined to comment on his conduct but said he has retired as a paramedic. Pals could not be reached.
After the incident, an RCMP officer asked another Medavie paramedic, Adam Nichols, to look at surveillance footage. Nichols, who is an advanced care paramedic, filed an official complaint with the ACP after viewing the tape.
The treatment the patient received was horrific, Nichols told CBC News in an interview.
“I couldn’t imagine being treated in the way that this person was treated,” he said.
The sanctions against Hingley and Pals are weak and set a “bad precedent” for the profession and patient care, Nichols said. “This was a violation of [the patient’s] rights and a violation of his basic humanity.”
In its September decision, the hearing tribunal said a strong penalty was required in the case. A joint submission had suggested appropriate penalties; the tribunal deviated from the list by also issuing them eight-day suspensions.
As the joint submission had recommended, Hingley and Pals were reprimanded and each ordered to pay a $500 fine plus $500 in costs. They were ordered to complete a course on “ethics and boundaries” and told that the college would publish details of the sanctions, along with their names.
An extra condition was placed on Hingley, prohibiting him from supervising student paramedics for one year.
“These are serious consequences which are consistent with serious misconduct,” the tribunal said in its decision.
The eight-day suspensions were contested by the college’s complaints director and then overturned during an appeal heard on March 30. The appeal panel found the original tribunal made a legal error in issuing the suspensions.
The appeal decision noted that Hingley and Pals had no previous records of disciplinary issues, were remorseful for their actions and had co-operated with the investigation.
“The appeal committee was not persuaded that by adding these additional penalties to what was a carefully crafted and agreed-upon set of remedial orders, any additional justice would be served,” the appeal panel said in its decision.
It also said the appeal panel members were “gravely concerned” about the conduct of the two paramedics.
In a statement to CBC, Kirk said the ACP takes complaints against regulated members seriously and manages them according to the Health Professions Act.
“The college’s commitment to this process, including the appeals process, serves to ensure that our members continue to provide the highest quality of care to Albertans,” Kirk said.
Nichols said he doesn’t know the patient but hopes the man learns of the outcome.
“This individual needs to know that this is completely abnormal and unacceptable conduct — and the majority of paramedics would stand by him and say that this was egregious.”