Patients
Douglas Davis Harris
On April 18, 1974, Douglas Davis Harris, a twenty-three-year-old man, described as suffering from “mental retardation,” which was a consequence of an accident causing brain damage back in 1956, was checked into the Lakeshore Psychiatric Hospital by the police. He had been missing from his North York home, which he shared with his mother, Rosemary Dalton, since April 17, 1974, at approximately 11:00 am or 12:00 pm.
Douglas headed to New Toronto, to the neighbourhood of the Lakeshore Psychiatric Hospital, where he had previously been a patient. He went to the Capitol Restaurant, located at 2811 Lakeshore Boulevard West, sometime around 11:00 am. He ordered a hot sandwich, for which he was unable to pay. The waitress became alarmed, as she noticed that Douglas put a table knife into his pocket. Quickly, she notified the owner of the restaurant and they called the police, while Douglas was peacefully sitting at the table, waiting for them. Shortly, two police officers arrived from the twenty-first division: John Dunning and Robert Hobbs. They asked Douglas why he had a knife in his pocket. He replied that he wanted to cut someone’s throat, but when the officers asked whom, he did not know. Dunning and Hobbs proceeded to ask more questions and together they gathered that once Douglas had been a patient at Lakeshore in the past. Together they decided to take him there. It was noted that Douglas was co-operative and did not show any signs of resistance.
Upon the admission to the hospital he was directed to the crisis ward. Despite this fact, his mother was not informed of his whereabouts, either by the hospital or the police, until April 19th. Meanwhile, Douglas was examined by a psychiatrist, who eventually decided not to prescribe any treatment due to the fact that the past medical records of Douglas could not be made available immediately. As a result, the doctors decided to prescribe a sedative, and order the nurse on duty to administer if it was needed.
During the following morning at breakfast, on April 20th, Douglas threatened the nurse, Janet Lynn Bell, and other patients, with a butter knife. As Bell later explained later at the hearing, she felt that the patient was merely seeking attention from others and that he did not intend to harm anybody. In order to calm him down, he was given the sedative prescribed the night before, and he confessed that he wanted to die. As The Advertiser, a local newspaper, reported, he was given a “special treatment” in order to supposedly prevent a possible suicide attempt. The sedative drug had a profound and effective influence on Douglas, as he was sedated until the following day on April 21st.
On that day, Nurse Bell came to the ward where Douglas was staying at about 5:00 pm. From her observation, she concluded that his pulse was normal and that sleep would benefit him, as she decided not to wake him up for the supper. Nurse Bell came back three hours later, at 8:00 pm. She checked Douglas’s pulse again and noted that it was normal. She also noticed that he had also turned from his side to his back. There was no blood or other signs of any injury. At 11:15 pm, Nurse Bell finished her shift. On the following day, she learned that the patient died during the night due to injuries to his head. At the inquest, she confessed that the patient was not injured during the second check up. The time of his death was listed between 10:00 pm, April 20 and 7:00 am April 23rd.
It is interesting to note several elements of this sad and strange story. The original article published in the now defunct Advertiser is biased towards the patient, Douglas Davis Harris, as it describes his “sad history of mental retardation.” However, the article was not published until July 10, 1974, almost two months after the accident, due to the ongoing investigation. In addition, it is interesting that the police officers decided to take Douglas to Lakeshore, instead of not first informing his mother of the whereabouts of her son because leaving Douglas to the responsibility of the hospital was easier than locating his mother. Furthermore, most importantly of all, during his admission to the hospital, he was quickly transferred to the crisis unit and soon administered a sedative drug, but there is no indication in the article that the psychiatrist even bothered to talk to the highly troubled, suicidal patient. Since Douglas was admitted to the crisis ward, why wasn’t he under constant observation after he had shown signs of a possible suicide attempt? And, why did he decide to go to the neighbourhood surrounding the psychiatric hospital in the first place?
Rapport, a bi-monthly newsletter of the hospital, reported on the inquest under a staff committee. It revealed that Douglas died “accidentally” and of “injuries received by his own actions.” The staff committee was referred by the coroner A. E. Noble, who was instructed to follow the hospital policy. They had been investigating the death of the patient since he was found dead beside his hospital bed at 6:00 am on the morning of April 22. The official inquest began on July 8, 1974, when a pathologist examined the body of the patient. He testified that Douglas died from a fluid in his lungs, which was caused by a blow to the side of his head. In turn, this injury had fractured his skull. Prior to his death, it was also found, Douglas was in a coma. The inquiry also revealed that only one male nurse was in the male observation area. When he left to answer the nursing office phone, he returned and found Douglas lying on the floor next to his bed. He later confessed that he did not notice any signs of injury and put the patient back to bed. However, the same pathologist, who examined the body of the patient reported that the injury was “very difficult” to detect. Even the doctor, who was originally pronounced Douglas dead only testified that there was “no evidence of head injury” and “no blood on the patient or his bed.” The only unusual thing he noticed was a few drops of liquid coming out of the patient’s nose.
In the end of the investigation, the jury signed the verdict recommending that the Ministry of Health ought to review salaries of the nursing staff. In addition, the coroner congratulated the staff for their “dedication” and “attentiveness.” He is quoted as saying, “I have been very impressed with the quality of the hospital staff who has given evidence.”
References:
“Accidental Death: Inquest.” Rapport: 1, 3.
Lethbridge, Gene. “Please Let me Die, Man Begs Nurse.”
The Advertiser. July 10, 1974.
All primary sources retrieved from the Archives for the History of Canadian Psychiatry and Mental Health Services, January 30 and April 21–22, 2005.
