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Tuesday, May 16, 2000Woman sues doctors for not stopping her from killing
HAILEYBURY, Ont. - At first blush, it might appear Debora McNamara is the very embodiment of chutzpah.
After all, this woman with the curiously bland, pouchy-cheeked face almost a decade ago smothered her own nine-year-old daughter, Shauna, as she slept, and Ms. McNamara kept at it even after the young girl cried out, "Mommy, what are you doing?" and even after Shauna's feet had turned blue but she was still breathing.
Now, Ms. McNamara is suing in the Ontario Superior Court of Justice -- and for more than $20-million -- three doctors who were then treating her, alleging in essence that her violence early that morning in July, 1990, was both predictable and preventable, had the doctors only done their job properly.
Cut to the short strokes, and what Ms. McNamara's lawsuit says is that the doctors' alleged negligence cost her her little girl, and that they should pay through the nose to make up for the grief and loss she has suffered.
Nonsense, say the physicians -- Drs. Alexander Bell and Patricia Achiume, both psychiatrists at the North Bay Psychiatric Hospital about 150 kilometres to the south of this small former mining town on Lake Temiskaming, and Dr. Phyllis Hanley, Ms. McNamara's own family doctor here in Haileybury.
They say that Ms. McNamara was the sole architect first of her daughter's demise and ultimately of her own troubles, this by being an unco-operative, recalcitrant patient who didn't take her medication as prescribed, often cancelled appointments, wouldn't let those treating her share critical medical information and either minimized or lied about both her symptoms and state of mind.
Whatever else, the case is crystallizing in an unprecedented way the debate about who should bear responsibility for the kind of medical care a patient receives -- especially with mental illness, where much of a doctor's information may come from the patient herself -- and a patient's right to confidentiality and to refuse treatment.
Ms. McNamara may have put it best herself in evidence last week before Mr. Justice Norman Karam and a six-member jury when she said, of Shauna's death, "I blame myself, but I also blame that I was not myself. That I know I was sick. That I know I was going for help."
Now 49, she was found not guilty of first-degree murder by reason of insanity in March of 1991.
The verdict means she was deemed not capable in law of recognizing "the nature and quality" of her act -- legally insane.
She then spent about five years in two Ontario mental hospitals on what's called a Lieutenant-Governor's warrant before being released, a free woman, late in 1996 after an annual review.
She now lives and works in Hamilton, where she holds a "training position" as a clerk at a depression centre at Hamilton Psychiatric Hospital, and is on a disability pension.
The lawsuit was launched about the time of her preliminary hearing by Owen Smith, the local lawyer who represented her in the criminal case and who also represents her here in the civil suit.
The key issue for the jury appears not to be whether Ms. McNamara was seriously ill, but rather who of the myriad of those treating her professionally knew what, and when.
Certainly, it seems that the laymen in the Tri-town area -- it is composed of the three small towns of Cobalt, New Liskeard and Haileybury -- where Ms. McNamara was born and was living at the time knew something was terribly wrong.
Last week, the jury heard from some of those who worked with her at the New Liskeard pool and fitness centre, where she was a receptionist, and where in March of 1990, four months before Shauna's death, Ms. McNamara's bosses were so concerned about her deterioration they called a sort of tough-love crisis meeting, urging her to seek psychiatric help.
It was later that month that Ms. McNamara's own mother told a nurse at the local health unit, where Ms. McNamara had been going regularly for almost a year for help with insomnia and various phobias, to report that a few months before, "her daughter attempted to strangle her granddaughter."
The incident actually occurred on New Year's Eve of 1990, when Ms. McNamara found herself, inexplicably she says, pressing her thumb down on Shauna's throat.
The child wasn't injured, but the incident left both mother and daughter weeping, and Ms. McNamara had immediately phoned her mother to tell her and to arrange for Shauna to stay with friends. Nursing notes that are now an exhibit at trial show that the grandmother was "really concerned" about the incident, frantic almost, and that she was told "if she is concerned about [Shauna's] welfare, she should contact family and child services."
Ms. McNamara admitted in cross-examination yesterday by Paul Millican, lawyer for the three doctors, that she didn't tell anyone but one of the nurses about putting her thumb on Shauna's throat until, as Mr. Millican put it, "after Shauna was dead."
When Mr. Millican suggested she had withheld this information from the psychiatrists -- and the fact that she had allegedly tried to strangle herself with a pair of long shoelaces afterwards -- because she was afraid she might be deemed an unfit mother and lose Shauna, Ms. McNamara snapped, bizarre in the circumstances, "I know I was a fit mother."
What is clear is that at the local health unit, Ms. McNamara was both known as a difficult, non-compliant patient who resisted the nurses' repeated pleas that she seek a psychiatrist, and that she was spiralling downwards.
The nursing notes detail her many complaints, among them a persistent fear that she had AIDS or another sexually transmitted disease (though repeated tests showed she did not) and an unshakeable belief she would soon die, haunting nightmares in which headless bodies pursued her, chronic sleeplessness and wild mood swings that saw her buoyant and reasonably happy one week, especially if there was a new man in her life, listless and seriously depressed the next.
By the time she finally agreed to see Dr. Douglas Cooper, a North Bay pyschologist who was a health clinic consultant who saw Tri-town patients on weekends in the fall of 1989, he found her "very disturbed" with "a profile not dissimiliar from schizophrenia."
Dr. Cooper, who testified yesterday, described her as a very difficult patient whose mix of "restlessness, an overbearing attitude, paranoia and a preoccupation with health or sex concerns" and a series of defence mechanisms, made getting information from her like pulling teeth.
She also admitted, he said, "to having a violent disposition though it was under very tight control."
One of his case notes records that he believed "Any breakthrough of her extraordinarily strong defences could have catastrophic effects," but he said yesterday what he feared was that she might harm herself, not that he ever imagined she would hurt anyone else.
He saw her only four times, the last time in December of 1989, and came up with a tentative diagnosis of a "borderline personality disorder," meaning that though she seemed normal, she could "cross the threshold into psychosis."
Toward the end of March the following year, he was alarmed to learn that instead of being admitted as an in-patient at the North Bay hospital, Ms. McNamara was going to be seen by Dr. Bell as an outpatient.
"She was far more severe than anyone I'd seen either at the health unit or in private practice," he said, and he felt so strongly she was being "shortchanged" that he spoke to Dr. Achiume, who with Dr. Bell had made the decision Ms. McNamara would be seen as an outpatient, to complain about the treatment plan.
Dr. Achiume, he said, told him "the die was cast", and that that was how Ms. McNamara would be treated.
Dr. Bell also saw her only four times, the last in May of 1990. According to Ms. McNamara, the visits were only about 15 or 20 minutes each, and all she got out of them was a relaxation tape to help her sleep and a prescription for Prozac, an anti-depressant. She admitted yesterday that she never told him that she had been having thoughts of suicide, of throwing herself downstairs or lying in the snow and dying and that, in fact, at her last visit, she had told him she was feeling better -- well enough, in fact, to return to work.
"Wasn't it important for him to know that?" Mr. Millican asked.
"Yes," Ms. McNamara said in her flat way.
"You should have told him?"
"Patients have responsibility in their own care, don't they?" Mr. Millican asked.
"Yes," said Ms. McNamara.
Were the doctors denied the tools that might have saved her, and her daughter? Is it that, as Mr. Millican's assistant, lawyer Wayne Bryneart, put it, she didn't have the stomach for the pain and work that regular therapy requires?
Or was it, rather, as Dr. Cooper suggested yesterday, that while the paperwork before the court may show she was being treated, in reality, "It seems as though she was seeing someone, but not seeing someone" -- as though she wasn't getting the right solutions for her "troubled mind and her troubled spirit."
Shauna McNamara is buried in nearby New Liskeard. She would have turned 20 July 24.
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