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Surrey man's death prompts call for change

Peace Arch News - 12/11/2018

The death of a Surrey father at St. Paul's Hospital in Vancouver in 2016 has resulted in the coroner calling for change to the system.

Beds for patients admitted to hospital with acute medical and mental-health issues are lacking in the province, and were non-existent at St. Paul's at the time Spencer Walden fell to his death from one of the facility's seventh-storey windows, coroner Claire Thompson notes in a report that was issued to Walden's family Friday and released to Peace Arch News Monday morning.

St. Paul's officials are endeavouring to fill the gap in "necessary treatment," Thompson writes, but it's a step that should be more widespread.

"Throughout the investigation the challenge of balancing critically acute medical care of patients in conjunction with mental health support of decompensated patients was raised," she writes.

"Typically patients are admitted to a medical unit, with the ongoing support and following of psychiatric services, or vice versa. Currently there are very limited beds in the province of B.C. that are dedicated, with appropriately trained staff, to support patients who are both suffering from acute medical and mental health issues."

That Walden did not receive proper care and monitoring in his final weeks was a key concern of his wife, mother and siblings when they decided to go public with his story seven months after his death, as part of their efforts to reverse a classification that deemed Walden's death a suicide.

At that time, his widow Nicki said that the final straw was reading in PAN that a woman who had died on Highway 99 in August of that same year had been released from Peace Arch Hospital against her family's wishes not long before.

The similarities to Spencer's case hit home, they said, and they told PAN they were frustrated by what they felt was a lack of accountability by health officials.

"It's a mess," Walden's brother Brodie said at the time. "Surrey Memorial discharged him early when we asked them not to, Peace Arch gave him day passes when we asked them not to, St. Paul's didn't move him when we asked them to.

"Unfortunately, he paid the price."

Walden's family was not immediately available Monday for further comment, however, his sister Tara told PAN Friday that the report "includes a recommendation I want to fight for."

Walden, who was 32 when he died, had struggled with his mental health since he was a teenager, but as an adult, was high-functioning and lived a productive, happy life, his family had told PAN. Outside of those close to him, most people had no idea he lived with mental illness.

In Thompson's report – which ultimately maintains the suicide classification is appropriate – she notes Walden had strong support from his family and church community, and no known history of "suicidal ideation" or illicit-drug use.

He was diagnosed with schizophrenia at age 16, and further diagnosed with schizoaffective disorder in his adult years.

Walden had "approximately five" hospital psychiatric admissions prior to February 2016, and one to Colony Farm, a forensic psychiatric hospital, Thompson states.

Six weeks prior to his death, Walden was admitted to Surrey Memorial Hospital, but was discharged after two weeks despite his family's and his own concerns. A week later, his family contacted RCMP for assistance, as Walden's mental health had continued to deteriorate and they were concerned for his well-being.

Taken to Peace Arch Hospital, he was admitted under provisions of the Mental Health Act. Over the next three weeks, doctors tried to stabilize Walden with different medications, and cut back "privilege passes" for access to the community, the report notes.

The medical team determined Walden's deterioration was linked to him trying to taper off of an antipsychotic medication that had typically been effective, but which Thompson learned had side effects that Walden found "challenging."

On Feb. 14, 2016, Walden was granted 15-20 minute passes for smoking privileges at Peace Arch, following a conversation with a doctor about transferring back to the antipsychotic medication, which "reportedly created some positive forward thinking for Mr. Walden."

That same day, Walden left the hospital against medical advice, and police were later involved.

Early the next morning, Vancouver police located Walden while responding to a report of a distraught male "screaming in the street having a disagreement with security personnel of a building downtown."

Walden was transferred to St. Paul's "with an 'altered level of consciousness'" which health officials initially suspected to be associated with recreational drugs, Thompson's investigation found.

That cause was ruled out through lab tests.

Walden was also diagnosed with a liver injury, Thompson learned. He was physically restrained due to signs of paranoia – including hearing voices – and concerns he may try to leave.

Medical reports indicated Walden was initially to have a one-to-one "sitter" while on the medical ward. He was later transferred to a three-to-one support structure – a ratio deemed adequate at the time, as Walden had limited mobility; he was unable to bear weight on his right foot.

Thompson notes Walden began to stabilize at St. Paul's, but that his family continued to express concerns about his mental state.

A Feb. 18 note indicates he was to be placed on a wait list for transfer to Surrey Memorial's psychiatric services once he was medically cleared, she writes.

At approximately 9 p.m., St. Paul's medical staff observed Walden pacing and that he had a "flat affect." He was given a dose of the antipsychotic medication and stated, "I'm good," when asked about suicidal thoughts.

Just before 10 p.m., Walden entered another patient's room, grabbed an oxygen tank and began to smash the window.

"Medical staff attempted to physically and verbally stop Mr. Walden," Thompson writes.

"Security was contacted. Mr. Walden subsequently sat on the ledge of the broken window, with his back facing the open window, and was observed intentionally leaning back to go through the window. Mr. Walden landed in the courtyard below and a short time later was pronounced deceased."

While Walden's family had disputed a ruling that his death was a suicide, Thompson agreed with the classification.

"A classification of suicide includes deaths in people whose cognition may be impaired by acute psychosis, intoxication or impulsive acts," she states. "A key consideration is that the act is purposeful. Based on the findings above and the description of events surrounding Mr. Walden's death, I find the act of falling out of the window was purposeful."

Thompson's recommendation to assistant deputy minister of health Dr. Ian Rongve was that patients admitted to hospital with a dual diagnosis of medical and mental-health issues be "provided with the appropriate care for all acute conditions whether they are located on an acute medical unit or a mental health unit."