I found this online, I hope I don't offend anybody

[cjs]

I have an appeal with OHIP. Ontario Health Insurance Plan and was googling stuff and stumbled across this. If anybody on this forum is a member of this woman's family or a friend I hope you aren't offended. I think this woman is a hero. She must be very proud of her daughter. And give her a big hug for me.

Jill

 

 

File # 08-CRV-0447

HEALTH PROFESSIONS APPEAL AND REVIEW BOARD

PRESENT:

Stephen Kovanchak, Designated Board Member, Presiding

Christine Moss, Vice-Chair

Norma Grant, Board Member

The 6th day of July 2010 at Toronto, Ontario

IN THE MATTER OF A COMPLAINT REVIEW UNDER SECTION 29(1) of the Health

Professions Procedural Code, Schedule 2 to the Regulated Health Professions Act, 1991,

Statutes of Ontario, 1991, c.18, as amended

B E T W E E N:

K.O.

Applicant

and

E.G.D., MD AND H. S. S., MD

Respondents

Appearances:

The Applicant: K.O.

For the Applicant: S.O. (Applicant?s sister)

Maria Damiano, Counsel

The Respondents: E.G.D., M.D.

H.S.S., M.D.

For the Respondents: Ted Kalnins, Counsel

For the College of Physicians

and Surgeons of Ontario: Lindsay Lorkin (by teleconference)

DECISION AND REASONS

I. DECISION

1. It is the decision of the Health Professions Appeal and Review Board to confirm the

decision of the Complains Committee1 to issue counsels to Drs. E.G.D. and H.S.S. to

1. Since June 4, 2009, the Complaints Committee has been re-formed into the Inquiries, Complaints and Reports Committee.

2011 CanLII 14749 (ON H.P.A.R.B.)

2

ensure that they thoroughly document physical examinations, patient history, and

differential diagnoses pertaining to post-operative problems.

2. This decision arises from a request made by K.O. (the Applicant) and her sister, S.O., to the

Health Professions Appeal and Review Board (the Board) to review a decision of the

Complaints Committee (the Committee) of the College of Physicians and Surgeons of

Ontario (the College). The decision concerned a complaint made by the Applicant

regarding the care provided by Dr. E.G.D. and Dr. H.S.S. (the Respondents) to the

Applicant?s mother, Mrs. D.O. (the patient). The Committee investigated the Complaint

and decided to counsel both Respondents to ensure that they thoroughly document physical

examinations, patient history, and differential diagnoses pertaining to post-operative

problems.

II. BACKGROUND

3. The patient had previously undergone four transphenoidal resections of a pituitary tumour

and on September 6, 2007, underwent a fifth resection at the Trillium Health Centre in

Mississauga, Ontario. She was sixty-four years of age at that time.

4. The Respondent Dr. S. performed the operation and was assisted by the Respondent Dr. D..

5. The Applicant describes her mother as having deteriorated by September 8, being barely

responsive, and exhibiting low energy levels. Blood work was performed indicating a very

low cortisone level and Dr. S. ordered intravenous solucortef, which normalized the

cortisone level quite quickly.

6. The patient was discharged home September 13 and the Applicant stated that her mother

was still feeling unwell, her headaches continued and her condition generally worsened.

The patient was admitted to Hamilton General Hospital less than forty-eight hours after

having been discharged from the Trillium Health Centre. The patient was then diagnosed

2011 CanLII 14749 (ON H.P.A.R.B.)

3

with bacterial meningitis and was treated for same, but was left with a 40% hearing loss

and a cognitive deficit.

The Complaint

7. By letter, dated September 7, 2007, the Applicant filed a complaint with the College in

which she alleged that the Respondents failed to provide adequate care to her mother and

they:

? ignored the patient?s elevated temperature, headaches, and changes in her

mental and functional status;

? failed to perform a lumbar puncture and did not consider, investigate, or rule

out a possible differential diagnosis of meningitis;

? failed to properly assess the patient?s condition prior to discharge and

discharged her in an unstable state on September 13; and

? failed to return calls to the Hamilton General Hospital on September 15.

The Committee?s Investigation and Decision

8. In the course of its investigation, the Committee reviewed the following information and

documents:

? the Applicant?s letter of complaint dated September 7, 2007;

? the Respondent Dr. S.?s letter of response dated November 21, 2007;

? the Respondent Dr. D.?s letter of response dated December 3, 2007;

? the Applicant?s further comments dated January 17, 2008;

? the medical records from the Trillium Health Centre, Mississauga; and

? the independent opinion of Dr. F. Gentili dated August 19, 2008.

2011 CanLII 14749 (ON H.P.A.R.B.)

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9. The Committee investigated the Complaint and requested an independent review of this

matter by Dr. F. Gentili who has the same Specialty Certification in Neurosurgery as the

Respondents.

10. The Committee reviewed the Applicant?s complaint with specific reference to information

obtained in the investigation.

11. The Committee relied upon the opinion provided by Dr. Gentili and took no action with

respect to the specific complaints of the Appellant, but did express concern respecting the

lack of detail in the charting and documentation. The Committee counseled both

Respondents to ensure that they thoroughly documented physical examinations, patient

history, and differential diagnoses pertaining to post-operative problems.

III. REQUEST FOR REVIEW

12. Dissatisfied with the decision of the Committee, in a letter dated December 19, 2008, the

Applicant and her sister requested that the Board review the Committee?s decision.

IV. POWERS OF THE BOARD

13. After conducting a review of a decision of the Committee, the Board may do one or more

of the following:

a) confirm all or part of the Committee?s decision;

make recommendations to the Committee;

c) require the Committee to exercise any of its powers other than to request a

Registrar?s investigation.

14. The Board cannot recommend or require the Committee to do things outside its

jurisdiction, such as make a finding of misconduct or incompetence against the member, or

refer allegations to a discipline hearing that would not, if proved, constitute either

professional misconduct or incompetence.

2011 CanLII 14749 (ON H.P.A.R.B.)

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V. ANALYSIS AND REASONS

15. Pursuant to section 33(1) of the Health Professions Procedural Code (the Code), being

Schedule 2 to the Regulated Health Professions Act, 1991, the mandate of the Board in a

complaint review is to consider either the adequacy of the Committee?s investigation, the

reasonableness of its decision, or both.

16. The Board reviewed all of the material considered by the Committee. At the Review,

Counsel for the Applicant and Counsel for the Respondents made oral submissions that

were of assistance to the Board in its deliberations.

Adequacy of the Investigation

Applicant?s Submissions

17. Counsel for the Applicant took issue with the adequacy of the Committee?s investigation.

She submitted that the investigation, as conducted by the Committee, did not go far

enough.

18. Essentially, the Applicant?s Counsel argued that the Respondents did not investigate the

Applicant?s complaints and did not consider a differential diagnosis of meningitis.

19. The Applicant?s Counsel reviewed the patient?s complaints, as set out by the patient?s

family, and indicated that the medical records were scanty and told a different story.

Counsel further argued that the records do not always reflect the complaints that were made

or what the family saw happening to the patient at the time.

20. Counsel for the Applicant submitted that the Committee should have considered the issue

of when the symptoms of meningitis manifested themselves. The Committee should have

investigated this issue and sought an opinion from an expert in infectious diseases rather

than an opinion from Dr. Gentili whose specialty is neurosurgery.

2011 CanLII 14749 (ON H.P.A.R.B.)

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21. Finally, Counsel for the Applicant acknowledged that if the Board disagreed with the

Applicant?s position that the investigation was inadequate, then it was conceded that the

decision of the Committee was reasonable on its face and the reasonableness of the

Committee?s decision would not be contested.

Respondents? Submissions

22. Counsel for the Respondents argued that the Committee?s investigation properly identified

the complaints, which were confirmed by the investigator by letter dated October 4, 2007.

He argued further that the Respondents provide detailed reply letters and that the Applicant

had an opportunity to clarify her concerns.

23. The Respondents? Counsel took the position that the investigator obtained all relevant

information and that the Committee properly obtained an independent expert opinion from

Dr. Gentili, a specialist in neurosurgery. Counsel stated that Dr. Gentili summarized the

main issue as follows:

whether the care provided to the patient, Ms. D. O. by Dr. S. and D. met the

standard of practice of the profession.

24. Finally, the Respondents? Counsel noted that Dr. Gentili found no indication in the medical

record that the patient showed or had signs or symptoms of meningitis. He argued that it

was not necessary for the Committee to have retained an expert in infectious diseases and

that a neurosurgeon would have been the most likely and most relevant to consult in this

situation. He further argued that adequacy does not require an investigation that is

exhaustive of every possibility, but need only be enough to allow the Committee to fulfill

its function.

2011 CanLII 14749 (ON H.P.A.R.B.)

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Analysis

25. An adequate investigation does not need to be exhaustive. Rather, the Committee must seek

to obtain the essential information relevant to making an informed decision with respect to

the issues complained about.

26. The Board agrees that the issues for investigation were all properly identified, including the

main issue raised by the Applicant that the Respondents did not consider, investigate, or

rule out a possible differential diagnosis of meningitis.

27. The Committee had before it the Applicant?s letter of complaint, the Respondents?

responses, a lengthy reply from the Applicant in response to the replies of the Respondents,

the medical records, and an independent expert opinion from Dr. Gentili.

28. Regarding the allegation relating to the Respondents? failure to deal with the patient?s

persistent fever after September 8, the Respondents acknowledge that the patient had an

elevated temperature on September 8, 11, and 12, but in each case, it returned to normal

and was not sustained. The Committee noted that Dr. Gentili commented that there

appeared to be some discrepancy in the medical records regarding the dates and frequency

of temperature elevation; but nonetheless, he concluded that he did not see in the patient?s

record that she had any signs or symptoms of meningitis. The Committee agreed with the

opinion of Dr. Gentili. The Board finds the Committee?s reliance on the opinion of the

independent expert reasonable in this regard. .

29. Regarding the allegation that the Respondents ignored the patient?s persistent postoperative

headaches, the Committee concluded that, based on the record that was before it,

they were unable to find that the Respondents should have been aware of persistent

headaches. In addition, the Committee concluded that, based upon the medical record

before them, they were unable to make a finding that the Respondents dismissed out of

hand the patient?s symptoms of lethargy, loss of appetite, and changes in mental and

functional status. Further, the Committee agreed with the opinion provided by Dr. Gentili

2011 CanLII 14749 (ON H.P.A.R.B.)

8

that, based upon the medical records, there was no compelling reason to do a lumbar

puncture prior to discharging the patient. The Board finds the Committee?s conclusion

reasonable.

30. Finally, the Committee found that there was insufficient information to confirm or indicate

that the discharge of the patient was premature or that the Respondent, Dr. D., should have

performed another assessment on September 13, prior to discharging the patient. Based

upon the record available to the Committee, the Board finds the Committee?s conclusion in

this regard reasonable.

31. The Committee accepted explanations from both Respondents with respect to why they did

not respond to the phone calls from Hamilton General Emergency Department on

September 15. It found the explanations to be reasonable and took no action with respect to

this allegation. The Board finds the Committee?s disposition of this issue reasonable.

32. The Board notes that in this instance, it was appropriate for the Committee to request an

independent expert opinion from Dr. Gentili, whose expertise is in neurosurgery, the same

area of specialty as the Respondents. The Board finds support for this view in Branco v.

Sunnybrook & Women?s College Health Sciences Centre, [2003] OJ No. 3287, where the

Court stated,

A Physician is negligent only if the Physician fails to apply that degree of skill,

care and learning ordinarily possessed and exercised by other Physicians in

similar circumstances?To establish breach of the standard of care, the Plaintiff

must lead expert evidence of a Physician practising in the same field as the

Defendant Physician attesting to his or her failure in that regard.

Although it is acknowledged that this was a medical negligence case, the Board is of the

opinion that the same principle should be applied in the matter before it.

33. Despite the lack of detailed charting in the medical records noted by the Committee, the

Board finds that the documentation obtained through the Committee?s investigation

covered the period complained about, and was sufficient for it to address the concerns that

2011 CanLII 14749 (ON H.P.A.R.B.)

9

the Applicant expressed in her complaint, and to render a decision. Accordingly, the Board

finds that the Committee?s investigation was adequate.

Reasonableness of the Decision

34. In considering the reasonableness of the Committee?s decision, the question for the Board

is not whether it would arrive at the same decision as the Committee, but whether the

Committee?s decision can reasonably be supported by the information before it and can

withstand probing examination. In doing so, the Board considers whether the decision falls

within a range of possible, acceptable outcomes that are defensible in respect of the facts

and the law.

35. As noted, the Applicant has conceded that if the Board found the Committee?s

investigation to be adequate, then on the face of it, the decision of the Committee is

acknowledged to be reasonable and there was no argument with respect to that issue.

36. The Board notes that the Committee reviewed in detail and reasonably relied on the

information in the Record of Investigation (the Record) to support its conclusions regarding

the issues raised by the Applicant in her complaint. No information was provided to the

Board to support a finding that the Committee did not reasonably assess the issues raised

by the Applicant based upon the Record before it.

37. The Board has already noted that the Committee?s choice of Dr. Gentili to provide an

independent expert?s opinion was appropriate. Although Dr. Gentili noted a certain lack of

detail in charting in the medical records, he found the records to be sufficient for him to

provide his opinion that the Respondents met the standard of care required.

38. The Board finds that the Committee addressed the issues, properly relied upon the

independent expert?s opinion and based its review and conclusions on the information

contained in the Record; its decision is therefore reasonable.

2011 CanLII 14749 (ON H.P.A.R.B.)

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39. The Board notes that the Committee issues counsels in situations where it has identified an

area of practice, which might be improved upon. In this case, the Committee identified the

necessity for the Respondents to thoroughly document physical examinations, patient

history, and differential diagnoses pertaining to post-operative problems. In the Board?s

view, such a disposition both recognizes that the Committee took seriously the Applicant?s

concerns and has constructed an educative disposition that services the public interest

should a similar situation arise. The Board acknowledges that such a disposition is not

insignificant to the Respondents. Taking into account all of the circumstances of this

matter, and in particular, the analysis of the Committee of the various concerns of the

Applicant, the decision to issue counsels to the Respondents, was, in our view, reasonable.

VI. DECISION

40. Pursuant to section 35(1) of the Health Professions Procedural Code, Schedule 2 to the

Regulated Health Professions Act, 1991, the Board confirms the decision of the Committee

to issue counsels to the Respondents to ensure that they thoroughly document physical

examinations, patient history, and differential diagnoses pertaining to post-operative

problems.

DATED at Toronto this 22nd day of March 2011

____________________________

Stephen Kovanchak

____________________________

Christine Moss

____________________________

Norma Grant

2011 CanLII 14749 (ON H.P.A.R.B.)

[Tofu]

For some reason, trying to read this made my eye cross. So I didn't make it through the whole thing... but still I feel compelled to say FIVE pit surgeries?! Holy cow. How did she even have any gland left for surgery number 5?

[cjs]

For me it was like watching a car accident, I couldn't stop reading.

 

The short version is after 5 failed pit surgeries this 64 year old woman was totally dismissed by the Ontario Medical Board. The Drs were given a slap on the wrist for discharging her with menningitis

[Shaw]

For me it was like watching a car accident, I couldn't stop reading.

 

The short version is after 5 failed pit surgeries this 64 year old woman was totally dismissed by the Ontario Medical Board. The Drs were given a slap on the wrist for discharging her with menningitis

 

Not to sure how I feel about Dr. G now. He was the only one who could have spoken up for the women. In Ontario you are judged by your peers and it's their opinion that the Board heavily relies on in making their decision. To win, they would have needed another neurosurgeon that agreed with the patient, clearly Dr. G didn't. Unreal, it is more than obvious she shouldn't have been discharged. Poor family!