NS Moms

ER Scenario 2: Inappropriate Discharge

Emergency Room complaint letter toolkit

Letters

Information and Instructions

This scenario can result in failure to do a capacity assessment when there is valid reason to do so, putting the patient and others at risk, lack of resolution of symptoms, continued instability in the community, cycling illness and return to ER or a more tragic incident.

Level 1, 2 and 3 letters for this scenario are sent to the position/person you complain to. Identify the appropriate person to send the complaint to at the links below. You may have to phone the hospital, as leadership positions vary from facility to facility.

Alphabetical Hospital Look Up:
https://www.nshealth.ca/locations-and-facilities

Executive Leadership if no CEO at Hospital:
https://physicians.nshealth.ca/physician-leadership-directory

In Nova Scotia, depending on the hospital, the various level positions will be different. For example, the QE II will have an ER Doctor, Chief of ER and a CEO, whereas a regional hospital may have an ER Doctor, Chief of Staff and a Nova Scotia Health Zone VP as the three levels.

Instructions: Review the sample completed letter as an example of specific details that may be similar in your situation. Fill in those details in the appropriate places in the associated “Fill In” Letter. It is important to have names of doctors and other health care professionals you interacted with, dates and times of the interactions, details of relevant history, dates of incidents related to lack of appropriate care, and details on any harm that came to your loved one or someone else due to the lack of care. Subsequent letters to higher levels should refer to the Level 1 complaint and may not require the same level of detail.

Tips for your Records

  • Keep a Copy: Ensure you save a digital and physical copy of this letter.
  • Method of Delivery: Consider sending this via registered mail or delivering it to the relevant hospital department to ensure there is a record of receipt.
  • Supporting Docs: If you have any previous discharge papers that list you as a contact, you may wish to mention that they were already on file from previous visits.

Level 1: Sample Completed Letter

Karen Sanders
15 Chestnut Drive
Hogginsville, NS

July 5, 2026

Dr. Patty Carruthers
Department of Emergency Medicine
Grace Hospital, Hogginsville, NS

Re: Bob Sanders, DOB: Sept 15 1993

Dear Dr. Carruthers,

I am writing to try to better understand why you did not admit my son, Bob, when he attended the Emergency Department on July 1, 2026, at approximately 2:30 PM.

While you did not meet with my husband and I while we were in the emergency room, we did speak to Jean Phillips, an emergency room nurse. We told Ms. Phillips that Bob had been refusing to take antipsychotic medication for the previous three months and that his illness had deteriorated in the previous two weeks. We specifically told Ms. Phillips that Bob had been responding to auditory hallucinations and that he had told us that he needed “to make a human sacrifice to protect the world from an invasion of aliens.”

You wrote a prescription for a different antipsychotic medication but clearly decided that Bob did not need admission to the psychiatric unit and our son was discharged back to our care at 9 p.m. that evening. On July 2, 2026, at 11:30 a.m., Bob threatened an elderly lady who was walking her dog. That incident led to his arrest and current incarceration at Corpington Jail.

It seems to me that my son met criteria for civil commitment under Nova Scotia’s Involuntary Psychiatric Treatment Act. I have copied the key criterion below, with bolding added, for your reference:

S.8 (a) the person, as a result of the mental disorder,
(i) is threatening or attempting to cause serious harm to himself or herself or has recently done so, has recently caused serious harm to himself or herself, is seriously harming or is threatening serious harm towards another person or has recently done so.

Bob had stopped outpatient treatment and was deteriorating. On July 2, 2026, his mental deterioration had reached a point where he was hearing voices, had paranoid delusions that the world was being invaded by aliens and was threatening to make a human sacrifice. We relayed to you through Ms. Phillips that Bob had told us that he needed to kill someone to prevent an alien invasion of earth.

Why did you not admit my son as an involuntary patient when you were given this information? It appears to me that the failure to admit Bob resulted in his threatening, and presumably traumatizing, an innocent woman. Clearly the outcome could have been worse.

I have copied the ER Chief, Dr. Dr. Stan Bernard, but am hoping that we can resolve this matter between us so we can better ensure the protection of health, safety and life in future cases.

I am happy to meet with you if that would be easier than writing to me, but either way I would like a response within the next two weeks.

Sincerely,

__________________
Karen Sanders

Copy: ER Chief, Dr. Stan Bernard

Level 1: Fill In the Details Letter

[Your Name]
[Your Address]

[Date of letter]

[Physician Name]
Department of Emergency Medicine
[Hospital Name and Address]

Re: [Patient Name], DOB: [Patient Date of Birth]

Dear [Physician Name],

I am writing to try to better understand why you did not admit my [relationship, e.g., son/daughter/spouse], [Patient Name], when [he/she] attended the Emergency Department on [Date of ER Visit], at approximately [Time of Arrival].

While you did not meet with [me/us] while we were in the emergency room, we did speak to [Staff Name], an emergency room nurse. We told [Staff Name] that [Patient Name] had been [describe recent medication/treatment non-compliance, e.g., refusing to take antipsychotic medication for the previous three months] and that [his/her] illness had deteriorated in the previous [timeframe]. We specifically told [staff name] that [Patient Name] had been [describe specific clinical symptoms and relevant statements patient made].

You wrote a prescription for [medication/treatment details] but clearly decided that [Patient Name] did not need admission to the psychiatric unit and our [relationship, e.g., son] was discharged back to our care at [Time of Discharge] that evening. On [Date of Post-Discharge Incident], at [Time of Incident], [Patient Name] [describe the incident/behavior that occurred after discharge]. That incident led to [his/her] [consequence, e.g., arrest and current incarceration at Facility Name / re-hospitalization].

It seems to me that my [relationship, e.g., son] met criteria for civil commitment under [Name of Governing Legislation/Act, e.g., Nova Scotia’s Involuntary Psychiatric Treatment Act]. I have copied the key criterion below, with bolding added, for your reference:

S.8 (a) the person, as a result of the mental disorder,
(i) is threatening or attempting to cause serious harm to himself or herself or has recently done so, has recently caused serious harm to himself or herself, is seriously harming or is threatening serious harm towards another person or has recently done so.

[Patient Name] had stopped outpatient treatment and was deteriorating. On [Date of ER Visit], [his/her] mental deterioration had reached a point where [he/she] was [summarize major clinical symptoms present during the ER visit]. Why did you not admit my [relationship] as an involuntary patient when you were given this information? It appears to me that the failure to admit [Patient Name] resulted in [summarize the negative outcome/impact on the patient or community]. Clearly the outcome could have been worse.

I have copied the ER Chief, [ER Chief Name], but am hoping that we can resolve this matter between us so we can better ensure the protection of health, safety and life in future cases.

I am happy to meet with you if that would be easier than writing to me, but either way I would like a response within the next [timeframe, e.g., two weeks].

Sincerely,

[Your Name]

Copy: ER Chief, [ER Chief Name]

Level 2: Sample Completed Letter

Karen Sanders
15 Chestnut Drive
Hogginsville, NS

Dr. Stan Bernard, Chief of ER
Grace Hospital
150 Main Blvd.
Hogginsville, NS
B3H 4R2

July 20, 2026

RE: Patient: Bob Sanders
DOB: September 15 1993
Date of Incident: July 1, 2026

Dear Dr. Bernard,

I am writing to you as Chief of the ER, regarding the discharge of my son, Bob at the Emergency Department on July 1, 2026, at approximately 2:30 PM. I wrote to Dr. Carruthers, the attending physician, on July 5 and copied you. I have not received a response from Dr. Carruthers.

Dr. Carruthers did not meet with my husband and I while we were in the emergency room but we spoke to Jean Phillips, an emergency room nurse. We told Ms. Phillips that Bob had been refusing to take antipsychotic medication for the previous three months and that his illness had deteriorated in the previous two weeks. We specifically told Ms. Phillips that Bob had been responding to auditory hallucinations and that he had told us that he needed “to make a human sacrifice to protect the world from an invasion of aliens.”

Dr. Carruthers wrote a prescription for a different antipsychotic medication but clearly decided that Bob did not need admission to the psychiatric unit and our son was discharged back to our care at 9 p.m. that evening. On July 2, 2026, at 11:30 a.m., Bob threatened an elderly lady who was walking her dog. That incident led to his arrest and current incarceration at Corpington Jail.

It seems to me that my son met criteria for civil commitment under Nova Scotia’s Involuntary Psychiatric Treatment Act. I have copied the key criterion below, with bolding added, for your reference:

S.8 (a) the person, as a result of the mental disorder,
(i) is threatening or attempting to cause serious harm to himself or herself or has recently done so, has recently caused serious harm to himself or herself, is seriously harming or is threatening serious harm towards another person or has recently done so.

Bob had stopped outpatient treatment and was deteriorating. On July 2, 2026, his mental deterioration had reached a point where he was hearing voices, had paranoid delusions that the world was being invaded by aliens and was threatening to make a human sacrifice. We relayed to Dr. Carruthers through Ms. Phillips that Bob had told us that he needed to kill someone to prevent an alien invasion of earth.

Can you explain to me why Dr. Carruthers decided not to admit my son as an involuntary patient considering the information she had? It appears to me that the failure to admit Bob resulted in his threatening, and presumably traumatizing, an innocent woman. The outcome could have been worse.

I am hoping that we can resolve this matter so we can better protect patients and others in future cases and that I don’t have to bring my concerns to the hospital’s senior administration.

Sincerely,

__________________
Karen Sanders

Copy: The hospital CEO could possibly be copied or left off

Level 2: Fill in the Blanks Letter

[Sender Name and Address]

[Recipient Name and Title]
[Address]

[Date of Letter]

RE: Patient: [Patient Full Name]
DOB: [Patient Date of Birth]
Date of Incident: [Date]

Dear [Recipient Name],

I am writing to you as [Title], regarding the discharge of my [Relationship, and name] at the [Department /Hospital] on [Date], at approximately [Time]. I wrote to [Attending Physician Name], the attending physician, on [Date of Previous Letter] and copied you. I have not received a response from [Attending Physician Name].

[Attending Physician Name] did not meet with [name(s)] while we were in the ER but we spoke to [Staff Name and position]. We told [Staff name] [Patient Name] had been [Description of Patient's Behavioral/Medical History]. We specifically told [Staff Name] that [Patient Name] had been [Detailed Description of Patient's Severe Symptoms/Threats, etc].

[Attending Physician] wrote a prescription for [medication name] but clearly decided that [Patient Name] did not need admission to the psychiatric unit and was discharged back to our care at [Discharge Time] that evening. On [Date of Post-Discharge Incident], at [Time of Post-Discharge Incident], [Patient First Name] [Description of Subsequent Incident/Behavior]. That incident led to [his/her] arrest and current incarceration at [Facility Name].

It seems to me that my [Relationship] met criteria for civil commitment under Nova Scotia’s Involuntary Psychiatric Treatment Act. I have copied the key criterion below, with bolding added, for your reference:

S.8 (a) the person, as a result of the mental disorder,
(i) is threatening or attempting to cause serious harm to himself or herself or has recently done so, has recently caused serious harm to himself or herself, is seriously harming or is threatening serious harm towards another person or has recently done so.

We relayed through [Staff Name] to [Attending Physician Name] the details [particulars on patients statements and behaviors]. Can you explain to me why [Attending Physician Name] decided not to admit my [Relationship] as an involuntary patient considering the information [he/she] had? It appears to me that the failure to admit [Patient Name] resulted in [Summary of Negative Outcome/Consequence]. The outcome could have been worse.

I am hoping that we can resolve this matter so we can better protect patients and others in future cases and that I don’t have to bring my concerns to the hospital’s senior administration.

Sincerely,

[Your Name]

Copy: [Optional: Name/Title of Hospital CEO or Administration]

Level 3: Sample Completed Letter

Karen Sanders
15 Chestnut Drive
Hogginsville, NS
B3H 4R2

Dr. Kerry Lynn Baker
CEO/Zone VP
Nova Scotia Health
Hogginsville, NS
B3H 4R2

August 4 2026

RE: Patient: Bob Sanders
DOB: September 15 1993

Dear Dr. Baker,

I am writing to you as Zone VP, responsible for Grace Hospital, regarding the discharge of my son, Bob at the Grace Hospital Emergency Department on July 1, 2026, at approximately 2:30 PM. I wrote to Dr. Carruthers, the attending physician, on July 5th and Chief of the ER on July 20 and the have not received a response from either.

On July 1st, Dr. Carruthers did not meet with my husband and I while we were in the emergency room but we spoke to Jean Phillips, an emergency room nurse. We told Ms. Phillips that Bob had been refusing to take antipsychotic medication for the previous three months and that his illness had deteriorated in the previous two weeks. We specifically told Ms. Phillips that Bob had been responding to auditory hallucinations and that he had told us that he needed “to make a human sacrifice to protect the world from an invasion of aliens.”

Dr. Carruthers wrote a prescription for a different antipsychotic medication but clearly decided that Bob did not need admission to the psychiatric unit and our son was discharged back to our care at 9 p.m. that evening. On July 2, 2026, at 11:30 a.m., Bob threatened an elderly lady who was walking her dog. That incident led to his arrest and current incarceration at Corpington Jail.

It seems to me that my son met criteria for civil commitment under Nova Scotia’s Involuntary Psychiatric Treatment Act. I have copied the key criterion below, with bolding added, for your reference:

S.8 (a) the person, as a result of the mental disorder,
(i) is threatening or attempting to cause serious harm to himself or herself or has recently done so, has recently caused serious harm to himself or herself, is seriously harming or is threatening serious harm towards another person or has recently done so.

Bob had stopped outpatient treatment and was deteriorating. On July 2, 2026, his mental decline had reached a point where he was hearing voices, had paranoid delusions that the world was being invaded by aliens and was threatening to make a human sacrifice. We relayed to Dr. Carruthers through Nurse Phillips that Bob had told us that he needed to kill someone to prevent an alien invasion of earth.

As neither Dr. Carruthers nor Dr. Bernard have replied to my question can you explain to me why Dr. Carruthers did not admit my son as an involuntary patient considering the information she had? It appears to me that the failure to admit Bob resulted in his threatening, and presumably traumatizing, an innocent woman. The outcome could have been worse.

I am highly discouraged by the lack of response to my letters to date and ask that you respond to this question within two weeks. My hope is to resolve this issue within the hospital rather than having to approach government officials.

Sincerely,

__________________
Karen Sanders

Level 3: Fill in the Blanks Letter

[Your Name and Address]

[Recipient Name/Title and Address]

[Date of Letter]

RE: Patient: [Patient Full Name]
DOB: [Patient Date of Birth]

Dear [Recipient Name],

I am writing to you as [Recipient Title/Role], responsible for [Facility Name], regarding the discharge of my [Relationship], [Patient Name] at the [Facility/Department] on [Date of Incident], at approximately [Time of Incident]. I wrote to [Attending Physician Name], on [Date of First Letter] and [Name of Second Recipient,] on [Date of Second Letter] and have not received a response from either.

On [Date of Incident], [Attending Physician Name] did not meet with [family member name(s)] while we were in the ER but we spoke to [Staff name]. We told [Staff name] that [Patient Name] had been [Description of Recent Medical/Behavioral History and effect on illness and related timeline]. We specifically told [Staff Name] that [Patient Name] had been [Detailed Description of Patient's Clinical Presentation/Symptoms/Statements].

[Attending Physician Name] wrote a prescription for [Treatment/Medication Change] but clearly decided that [Patient Name] did not need admission to the psychiatric unit and our [Relationship e.g. son] was discharged back to our care at [Discharge Time]. On [Date of Subsequent Incident], at [Time of Subsequent Incident], [Patient First Name] [Description of Escalated Behavior/Incident]. That incident led to his [Outcome, e.g., arrest, harm to others, incarceration, etc].

It seems to me that my [Relationship] met criteria for civil commitment under Nova Scotia’s Involuntary Psychiatric Treatment Act. I have copied the key criterion below, with bolding added, for your reference:

S.8 (a) the person, as a result of the mental disorder,
(i) is threatening or attempting to cause serious harm to himself or herself or has recently done so, has recently caused serious harm to himself or herself, is seriously harming or is threatening serious harm towards another person or has recently done so.

[Patient Name] had [Summary of Clinical Decline]. On [Date], his mental decline had reached a point where he was [Summary of Specific Severe Symptoms]. At the ER we relayed to [Attending Physician Name] through [Staff Name] Title and Last Name] that [Patient Name] had [Reiteration of Safety Risk/Threats].

As neither [Attending Physician Name] nor [Other Unresponsive Official Name] have replied to my question, can you explain to me why [Attending Physician Name] did not admit my [Relationship] as an involuntary patient considering the information [he/she] had? It appears to me that the failure to admit [Patient Name] resulted in [Description of Negative Outcome/Consequences]. The outcome could have been worse.

I am highly discouraged by the lack of response to my letters to date and ask that you respond to this question within [Timeline for Response, e.g., two weeks]. My hope is to resolve this issue within the hospital rather than having to approach government officials.

Sincerely,

__________________
[Your Name]