HALIFAX - An external report warned more than a decade ago that a Nova Scotia hospital was "verging" on violating the basic rights of people with disabilities by forcing them to live in a locked-door psychiatric unit rather than in the community, a human rights inquiry heard Wednesday.
Yet, little changed for the people living at the Emerald Hall unit of the Nova Scotia Hospital, said a clinical social worker who testified at the inquiry about her effort to bring about change.
Jo-Anne Pushie, a veteran health worker who started working in the unit in 2011, said she heard of the study on the unit by Dorothy Griffiths — a Canadian expert on people with both intellectual disabilities and mental illness — and Dr. Chrissoula Stavrakaki, when she first came to the hospital as a part-time employee.
The April 2006 report on the unit's operations was tendered as evidence at the inquiry, and Pushie read its findings, after saying other staff at the hospital were aware of its existence.
"The individuals are being confined without justification because no community (housing) options are available for them within the system," said Pushie, reading from report.
"The delay of discharge at this time appears to be strangling the current unit ... and verging on violation of the rights and freedoms of the individuals long-time destined for release."
A copy of the report later obtained by The Canadian Press also says the detention of the residents of Emerald Hall violated the standards of care for patients with intellectual disabilities and mental health diagnoses.
"Moreover, this current situation clearly undermines the fundamental rights of these individuals," the document says. "The situation is clearly confinement without justification and cruel and unusual punishment for behaviours which have long since resided."
A provincial spokesman for the Department of Community Services told The Canadian Press that questions about the study should be sent to the Nova Scotia Health Authority. A spokeswoman was unable to provide immediate comment on who viewed it or what actions were taken in response.
Pushie said more than half of the 19 residents she cared for had no reason to be there, but languished for years without any place to go in the community due to shortages of smaller, supported housing units.
By 2014, with the backing of others on the unit frustrated by the situation, Pushie said she helped launch the human rights complaint that is now being heard in a Halifax hotel.
The inquiry is looking at whether Beth MacLean, a 46-year-old woman who used to live at the Nova Scotia Hospital and is now in a transition unit, and Joey Delaney, a 45-year-old man who is still at the hospital, should have the right to live in supported housing — meaning, in the community — rather than institutions and psychiatric facilities.
A third complainant in the case, Sheila Livingstone, died as the case wound its way through various delays, but her story will be told by family members and the complainants' lawyer.
During the hearing, Pushie was asked to recall what life was like for residents.
"The exit door is locked all the time. ... It's an institutional-style setting. Meals come on hot carts. People are expected to eat at regulated times," she told inquiry chair J. Walter Thompson and about 10 people sitting in the Halifax hotel room.
"Its a very restricted environment. It can be a very loud environment. ... There may be some people with complex issues that become very noisy."
Over time, she said she watched as the residents with the legal right to leave lost the ability to function in a community setting, forgetting how to make their own decisions, cook a meal or "do the simplest tasks" for themselves.
However, earlier in the day, a Nova Scotia government lawyer pressed an expert witness over the risks of shifting people with intellectual disabilities out of institutional settings into the community.
Michael Bach, a researcher and advocate for inclusion, had been called to testify by the Disability Rights Coalition, an advocacy group for people with disabilities that is a complainant in the proceeding.
Kevin Kindred, a Justice Department lawyer, asked Bach about problems that emerged in Ontario, Alberta and Newfoundland and Labrador after people who needed medical and personal care to live in the community didn't receive the necessary aid.
Bach concurred with Kindred that there have been examples of inadequate support and that some people with disabilities have ended up in psychiatric facilities and nursing homes.
However, he said that didn't change the need to aim for a model where people with disabilities could gain greater control over their own lives.
"It's 2018, we actually know what it takes and how it looks and what the models for support for people with very complex issues are," he said in an interview following his testimony.
The province has said it is working to improve its Disability Support Program and to create more small option homes.
Pushie has said she left the Nova Scotia Hospital for another job as a clinical social worker several months after the human rights complaint was launched.
She is expected to continue her testimony about the lives of residents at Emerald Hall on Tuesday.
Note to readers: This is a corrected story. An earlier version said the inquiry resumes on Thursday, rather than Tuesday.