These requests were made in the first year following our mother’s death:

We believe that the best weapon against ‘bad medicine’ is public disclosure and awareness. What do we want? Certainly we want the RNABC and the College of Physicians and Surgeons to thoroughly investigate the events of February 20th through March 5th, 2000 and to consider the documented conduct of the named doctors against the accepted standards of professional practice and good medical judgment (See Letter to College)

We are not asking for the impossible. We understand the severe pressures on today’s medical system in terms of personnel and funding shortages. But we feel our requests are not about spending money: they are about exercising better judgment, demonstrating good sense in expediting changes to the system, and most important, having the intention to make things better.

Our Requests:

1. That the College of Physicians and Surgeons thoroughly review the actions of Drs. A.A. Suleman, D.M. Wickham, and A.R. Richmond to ascertain whether care was in conformity with standard practice.
2. That the Registered Nurses Association’s Professional Conduct Committee thoroughly reviews the actions of the nurses involved in the care of Esther Winckler to ascertain whether care was in conformity with standard practice.
3. That the role of Patient Advocate be clearly defined by the Health Region and their presence made known to families prior to a patient’s death. To ask our family to come out to Chilliwack after the death, in our opinion more interested in taking the temperature of our family vis-à-vis a lawsuit than sincere help, did not seem to be productive and was rather confusing.
4. That hospital charts have a clear area dedicated exclusively to the tracking of bowel movements of the patient.
5. That restraint policies of the Hospital be revisited and that the Hospital consider looking to the Ontario experience and the Report written by John Hurdis of the University of Waterloo for Health Canada. As well, that the Hospital look to the experience of Burnaby General Hospital who hired Clinical Nurse Specialist, Marsha Carr five years ago to examine hospital policy on restraints. The result is an innovative program and the existence of a ‘Least Restraint Committee’ that meets monthly and that comprises all hospitals in the Simon Fraser Health Region.
6. That medical personnel at Chilliwack General Hospital get further training in geriatric medicine – specifically the effects of certain drugs on seniors (i.e. Atavan) and also the signs to look for to differentiate post-op confusion in seniors from clinical distress. Given the demographic of Chilliwack General Hospital, it would seem sensible to pay more attention to the needs of this aging population.
7. That the Hospital re-look at the availability of medical personnel (on-site and on call) on weekends. (Note: It was impossible for family to get a doctor to come to Esther Winckler’s room through the critical last day of her life, despite her acute distress.)
8. That the Hospital Administration take a hard look at a culture that has developed internally which has nurses telling a family who is insisting on seeing a doctor that they aren’t encouraged to call the doctors on a weekend UNLESS there’s a good reason.
9. That families be given a brochure or some written explanation that clearly outlines what a DNR order means and what the ramifications will be once the family signs this form. Different medical personnel explain it differently to each family and this should be a standard.
10. That all hospital staff should be re-educated as to the importance of note-taking. Our mother’s chart had significant holes in levels of information. If not for the patient’s benefit, one would surely be moved by articles such as that in the Medical Post (Volume 37, No.07, February 20, 2001, “Not taking notes constitutes negligence”) whereby a recent Ontario ruling found that the failure to take notes was the central and not the side issue in a lawsuit.
11. That there be a system of checks and balances in place so that transfer from one ward to another does not result in complete absence of continuity of care. Bells should go off when it shows that in an entire 15 day hospital stay, the operating surgeon has only made one chart notation post-surgery, despite a later decline in the patient’s condition. As well, nurses mistaking a decline in health for senility should not be acceptable, one floor to the next.
12. That family members be brought into the process more effectively. That if there are shortages in staffing, the family is alerted so that they can make arrangements to sit by the patient as opposed to having long periods of restraints and an ‘out of sight, out of mind’ treatment mentality. As well, if the patient IS to have restraints, or has fallen, the family should be immediately notified.
13. That liquid and food intake be charted. The family noted that food workers came in and out taking the food without lifting the lid to see if anything had been ingested. No one appeared to be monitoring dehydration or nutrition levels.
14. That if an anesthetist or anyone attending the patient changes the gameplan regarding the surgery at the last minute (flying in the face of the pre-op consult, the understanding of the GP, and the family and patient), that at least one member of the care team is notified. This should not be an arbitrary decision by one person. Note: In Esther Winckler’s case, her GP, family and surgeon were not made aware of the change of plan re the general anesthetic vs. the epidural.

What We’d Like to See For the Future

In terms of what we’d love to see for the future – overwhelmingly we (and many others) would like to see an overhaul of the College of Physicians & Surgeons. Patients should have the right to view doctors’ records – not just the results that come from published disciplinary hearings, but the very fact of formal complaints as well. (After all, our mother’s case never made it to the Disciplinary Committee of the College and yet we know others would benefit by knowing more about the anesthetist and surgeons who we feel had a degree of complicity in the deficiencies in our mother’s care.

Massachusetts has a Physician Profiles Program that gives consumers the addresses and specialties of physicians, in addition to information about outstanding complaints or malpractice lawsuits. The profiles are available over the Internet. Why can we not have similar access to information?

In our mother’s case, we never got a chance to tell our side of the story to the College as meetings were ‘closed door’ to the family. And yet, final testimony from the doctors is in direct conflict with what we know to be true. Family, friends, pre-op anesthetist, and Esther’s own GP and hip surgeon knew she did not want general anesthetic the day of surgery given past surgical experience. Yet on the Sunday night before surgery, an anesthetist new to her case, someone unfamiliar with her rather long and complicated history, chose to change the agreed upon procedure the next day and administer a general. Worse, he testified that she wanted this change and agreed to it (although he has no supporting documentation). This DESPITE a recorded message following his visit from our mother to the family, full of anxiety that the “gameplan seems to have been changed and I don’t understand why and there’s not one of my doctors to talk to Sunday night.” (her words). Yet the College accepted Dr. Suleman’s recollection of the event and we had no imput.

Abraham Verghese, M.C., Director of the Center for Medical Humanities and Ethics at the University of Texas Health Science Center in San Antonia wrote something quite radical in the March 16, 2003 New York Times: “Solutions are desperately needed. I think we could start by sending all malpractice suits to regional panels of judges, physicians and consumer advocates to screen and eliminate those with no merit … and when we are patients, we could insist on being equal partners in our care. We might bring along family and friends when we interact with doctors and see that all our questions are answered and our expectations realistic. Medicine is fantastic in what it can accomplish, but there are real and clear risks.” He goes on to say, “Our efforts in medical schools to turn out skilled yet empathetic physicians who communicate clearly and who can put themselves in their patients’ shoes is critical to stemming the malpractice crisis. Patients sue when their feelings are ignored or when they are angered by lack of genuine concern for their welfare…”

Food for thought. Ultimately it points out the most important thing we’ve learned: Share information in your community and beyond. Learn how to advocate for your cause … and the greater cause. Understand when and how to get the media involved. And when to move beyond making your efforts about ‘retribution’ for the wrongful death of a loved one and more about making their life meaningful through advocating change.