How Could Florence Girard Starve to Death in a CLBC Home Share?

Florence Girard, a woman with Down syndrome, starved to death in the care of a British Columbia government-funded home share provider.

A coroner’s inquest that began Monday is examining her death and looking for ways to avoid future tragedies.

Girard was a social, fun person who wanted to hug people when she first met them, loved to shop and go to 7-Eleven for Slurpees and swam in the Special Olympics, her sister Sharon Bursey testified.

“It breaks my heart that she’s gone,” said Bursey. “She was a joker. She was boy crazy. She loved my family and loved my kids.”

Presiding coroner Donita Kuzma opened the inquest by describing its primary functions: to determine the facts related to the death, to make recommendations on how to avoid similar deaths in the future and to assure the community that the death was not overlooked or ignored.

Five jurors were present in Burnaby for the proceedings, along with lawyers for the provincial government, Community Living BC, Kinsight Community Society, the family and the advocacy group Down Syndrome BC.

Girard was 54 when she died in 2018.

Unable to look after her own needs, she was a longtime client of Community Living BC, the provincial Crown corporation responsible for supporting adults with developmental disabilities.

She lived in group homes for many years before moving in 2010 into the Port Coquitlam home of Astrid Dahl, a home share funded by CLBC and provided through the local agency Simon Fraser Community Living, which has since changed its name to Kinsight Community Society.

Dahl, who is scheduled to testify today and Wednesday, was found guilty in the B.C. Supreme Court in 2022 of failing to provide the “necessaries of life” to Girard, but was found not guilty of criminal negligence.

The court gave Dahl a 12-month conditional sentence, which meant she avoided jail time.

The B.C. Court of Appeal later raised the sentence to 15 months in jail. But Dahl did not need to spend time in jail as she had already served the bulk of her sentence.

According to documents from Dahl’s criminal trial, the roughly five-foot-tall Girard was “significantly overweight” when she started living with Dahl. She dropped to 120 pounds by 2013, a period during which she was monitored through doctor’s appointments.

But around 2014, Dahl stopped taking Girard to doctor or dentist appointments, despite entering care agreements with the agency saying she would. Even as Girard lost dangerous amounts of weight in the months ahead of her 2018 death, Dahl failed to seek medical attention.

Girard weighed just 50 pounds when she died.

In his reasons for judgment, Justice David Crossin said Dahl had shown a “breathtaking lack of judgment” that demonstrated a “marked departure” from what a reasonably prudent person would have done in the circumstances.

“The accused knew or clearly suspected that by the last week of Ms. Girard’s life, Ms. Girard was dying,” he said. “Yet, the accused decided not to seek medical attention. By then, Ms. Girard had completely, or almost completely, stopped taking food and fluids as well as stopped communicating.”

At the time of Dahl’s trial, advocates said there was a need to also hold CLBC and Kinsight accountable for their failures and to make changes to how home shares are monitored and how people like Girard are supported.

The Crown had previously charged Kinsight in relation to Girard’s death but stayed those charges in 2020. The BC Prosecution Service approves or continues charges only in situations where Crown counsel believes there is a substantial likelihood of conviction and a prosecution is required in the public interest.

Some 4,200 adults with developmental disabilities in B.C. are living in home shares contracted through local agencies. While CLBC presents shared living as having many benefits that can enhance the quality of life for a person with a disability, some providers say the job is often stressful and poorly supported.

Bursey said that at first Dahl’s home seemed to be a good place for Girard to be. “For the first probably five years it was great,” she said. “She loved being there. She lost weight, but she looked healthy.”

At some point, however, Dahl and Girard moved and the care deteriorated. Girard stopped going to day programs and was in her room endlessly rewatching the movie Titanic, Bursey said. “The last four years of her life were awful,” she said. “It’s like being in a prison camp and thrown in the hole without food.”

Juliyana Romey, a family physician in Coquitlam, testified by video about Girard’s medical history and said their last visit was in 2014. “Based on my chart notes and what I can recall, she looked well,” Romey said. “She did not look unwell.”

It is normally the responsibility of patients and their caregivers to make appointments, and there was no further contact regarding Girard’s care, she said. “That is very unusual.”

Robin Friedlander, a neuropsychiatrist at BC Children’s Hospital, testified about Down syndrome and care for people with the condition.

Various witnesses are scheduled to testify during the eight days of the inquest, including from CLBC, Kinsight and Down Syndrome BC.

In 2022 a representative of CLBC said it had introduced new standards for agencies “that outline requirements for oversight of services, health and safety, and regular monitoring.” CLBC expects agencies to conduct on-site monitoring at least four times a year, he said, and requires people living in home shares to visit the doctor and dentist at least once a year.

Bursey last saw her sister in April 2018, about six months before she died. “She was thin,” Bursey said. “In hindsight I wish I’d done something.... I thought she was just aging.”

Communication with Dahl had become so difficult that she complained to a Kinsight official, Bursey said. Records of that interaction were read during the inquest.

“It got impossible,” she said, “then Astrid [Dahl] just blocked me so I couldn’t get a hold of her at all.”

There needs to be better communication, such as through quarterly meetings, between the agency, the caregiver and family members, said Bursey, who along with a brother was Girard’s substitute decision-maker for health matters and had power of attorney for financial matters.

Bursey said she would have liked to look after her sister in her own home, but the B.C. government doesn’t provide financial support to family caregivers. “I would have quit my job to have her living with me if I could afford to.”

Since Girard’s story became public, Bursey said, she has heard many similarly horrific stories from people who have gotten in touch with her.

“I can’t believe this happens in Canada,” she said. “I’m so scared this will happen again. I’m really afraid it will.”