INSTITUTIONAL BETRAYAL--HUMBER RIVER HOSPITAL STILL COVERS UP MEDICAL NEGLIGENCE(Dr. Laz Klein)-, CEO B. Collins

INSTITUTIONAL BETRAYAL—all were given the medical facts and expert opinions mentioned previously

Obviously, Dr. Klein has not changed since my daughter’s death. Before reading my story, take a look at excerpts from the following HPARB decision.   From an HPARB Review held on July12, 2017

As noted above, the Committee specifically considered the Respondent’s conduct history with the College. The Committee indicated that the Respondent’s “history with the College, which includes several complaints on a number of aspects of [the Respondent’s] care, raised some concern for the Committee”. The Board has reviewed the Respondent’s history with the College and finds that the Committee’s concern is reasonable.

The Committee noted that Dr. Klein has a significant history with the College, which include cases raising both clinical and record-keeping issues, for which he has received advice and been cautioned. The Committee agreed with the Board that the repetition of similar concerns in this case appears to indicate that the previous remediation attempts have not been successful. This, along with the Committee’s concern about Dr. Klein’s persistent lack of insight into his shortcomings in this case, suggested that a more significant disposition was required to adequately protect the public, as outlined above.

The Board notes that the Respondent’s conduct history with the College includes prior complaints involving the care of patients, including medication issues, that have previously been identified as concerns by the panels of Committee assigned to assess them and have resulted in advice being provided to the Respondent. The repetition of similar concerns highlighted in this case would appear to indicate that previous remediation attempts by the Committee have failed to yield the desired result. There is nothing within the Committee’s decision to indicate how the issuance of another advice in this matter will protect the public interest in light of the Respondent’s conduct history.

A PRIMER ON THE LAW OF DEFAMATION IN ONTARIO

"Defamation is comprised of two subcategories between libel (libel refers to written defamatory statements)and slander(broadcasting of spoken defamatory words)
Proving a Claim in Libel and/or Slander
"the statement must be false!"
Defences to Actions in Libel and Slander 

 
TRUTH--
"The first defence is the defence of truth. The defence can be made that the statement was truthful and therefor there was nothing false about the statement, meaning therefore, that the statement was not defamatory."

FAIR COMMENT--
"The second defence to an allegation of libelous statement is that the statements made were made as a fair comment. The defence of fair comment would be considered by the Court in situations where, by looking at the statement made, the facts and the situation, a conclusion can be made that the statements made were in actuality a fair commentary on the situation at hand and that the comments were fair and were not malicious."

QUALIFIED PRIVILEGE--
"The defence of qualified privilege arises normally in situations where the individual publishing these statements will escape any liability if it can be proven that the public good could be furthered in open debate.  --     especially considering the numerous deaths which occurred after my daughter's death and the one in Dec of 2012.  Who really knows the real total being concealed by all?

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HUMBER RIVER HOSPITAL STILL COVERS UP MEDICAL NEGLIGENCE(Dr. Laz Klein)-, CEO B. Collins

Memorial Plaque done by HRRH

Memorial Area done by HRRH

A very dangerous precedence has been set by the CPSO, HPARB, THE CCO, THE DIOC AND THE ONTARIO OMBUDSMAN by allowing the CPSO and HPARB decision to stand---- they can now use my case to substantiate other citizens’ complaints should any open surgery occur within Ontario without the mandatory antibiotic prophylaxis being administered, as well as  supporting the non-use of any antibiotics being administered to a patient who has undergone open abdominal surgery (all staples removed from the 8 inch incision) and developing an abdominal incision whereby test results indicated the presence of “many gram negative bacilli”.

SHAME

                                           

Failure of the Hospital:

They supposed are required to do a death investigation but when asked they told the Ombudsman's office, no records were actually kept and the hospital refused to give me a copy or summation of their supposed death investigation.  The Health Minister should be looking into this but of course her close friendship with Barb Collins, the CEO would prevent her from doing so.  --Breach of Trust.

As you can see from below, this hospital apparently did not do this, or else they covered up their  internal review of the patient's care.

issues are directly related to hospital quality of care. The Quality of Care Information Protection Act, 2004, which sets out in Section 1, the functions of quality reviews (emphasis added):

Definitions

1, In this Act, "quality of care committee" means a body of one or more individuals,

(a) that is established, appointed or approved,

(i) by a health facility,

(ii) by an entity that is prescribed by the regulations and that provides health care, or

(iii) by an entity that is prescribed by the regulations and that carries on activities for the purpose of improving or maintaining the quality of care provided by a health facility, a health care provider or a class of health facility

or health care provider,

(b) that meets the prescribed criteria, if any, and

(c) whose functions are to carry on activities for the purpose of studying, assessing or evaluating the provision of health care with a view to improving or maintaining the quality of the health care or the level of skill, knowledge and competence of the persons who provide the health care; ("comite de la qualite des soins).

In the Chief Coroner's refusal to conduct an inquest, the following is stated with regard to the above: (and to many of my recommendations contained within my submission to the CCO requesting an inquiry.)

Dr. Bert Lauwers

"The concerns raised by these potential recommendations properly belongs to the HRRH and a death review of Ms. Kilby's death"  

Apparently the did not do one or at least have a written report of it.  This also demonstrated the failure of the Hospital.--- keep in mind the Patient Ombudsman who at the time was Ms Elliott and her office rendered a completely useless report--    Cover-up!

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 Dear Mr. Kilby:  October 2, 2008

We received a series of questions from you through Dr. Hebert.

Yours truly,  Barbara E Collins

COO   Humber River Regional Hospital

4. ANTIBIOTICS

a. Was antibiotic surgical prophylaxis done at the proper time before time of the operation?.

Dr. Klein has advised that Terra was given the appropriate pre-     operative antibiotics.

AWKilby comment:  An obvious “lie” as proven by the hospital records.  How can the College accept anything Dr. Klein states

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From CPSO

“Although conversion to open surgery is always a possibility, his intention was that the
surgery would be performed laparoscopically to remove a mesenteric cyst. However,
during the surgery he determined it was necessary to immediately remove what he
suspected was more concerning than a simple mesenteric cyst. He could not rule out
sarcoma at that time, and it was not until after he converted to a laparotomy that it was clear that this cyst could not be removed without a bowel resection.”

AWKILBY’s Response:  The above is pure BS.  He knew before he converted to a laparotomy!!

Note the following:  This proves that Dr. Klein was going to attempt laparoscopically a colon resection for a mesenteric mass.  This was before he converted to a laparotomy!!!

Note the Procedure Desc. In the following chart:

“Laparoscopic Colon Resection Attempted For Mesenteric Mass”

The second Procedure Desc. indicates the laparotomy.

AWKILBY’s Response:  The College once again fails to thoroughly look at the Hospital Records.  OOPS or is it intentional---- My claim it is intentional--- three times they have studied the charts and still it is I who must point out the concerns substantiated by the records.  Dear HPARB panel, please don’t let them make cover up this neglect to the Standards of Care for a fourth time!

And from Dr. Taylors’(the College’s I.O)letter to Angela Bates May 8^th, 2011,

“During the surgery on July 11 2006, Dr. Klein realized that the mass was not separable from the colon or retroperitoneum and obtained consultation with a colleague and went ahead with an open right colectomy. This is well documented in the operative note on page 48.”

OPERATIVE PROCEDURE        I-/  Diagnostic laparascopy 

                                                     2-/ Open right hemicolectomy and excision of mesenteric cyst.              

PROCEDURE; 

At the time of laparoscopy, a large cyst could be seen in the mesentery of the right colon.  It was densely adherent to the bowel as well as densely adherent to the lateral abdominal wall.  It felt very solid and not at all in keeping with a simple mesenteric cyst.  We therefore made the decision to convert to an open procedure.

The fascia was divided.  The peritoneal cavity was entered under direct vision.  A 10 mm trocar was inserted.  Pneumoperitoneum was obtained.  A 5 mm subxiphoid and 5 mm suprapubic port were placed under direct vision.  We immediately could see the large mass in the right upper quadrant and the findings were as above.  We did not feel that this was at all easily accessible laparoscopically and could not separate the plane from the lateral abdominal wall as well as from the colon.  At this point, we made a decision to convert to a laparotomy. 

 AWKILBY’s Response:  So preceding information proves Dr. Klein knew prior to conducting open abdominal surgery that a colon resection had to be performed.  Why did he go ahead without ensuring my daughter received the mandatory antibiotic prophylaxis! 

 AWK Note:--- But when he discovered the mass could not be removed with the laparoscopic procedure, open abdominal surgery should not have gone ahead without the patient being properly prepared.  This was not an emergency surgery but day surgery!

I never saw the following letter but it does indicate that Dr. Klein knew that perhaps a colon resection may be possible through an open approach.  So, he should have been prepared and either rescheduled the operation or administered the mandatory antibiotic prophylaxis.

TELEPHONE (416)782-2616  960 LAWRENCE AVE WEST

FAX (416) 7*2-5899SUITE 504

TORONTO, ONTARIO M6A 3B5

LAZ V. KLEIN, M.D., M.Sc., F.R.C.S.(C) GENERAL AND LAPAROSCOPIC SURGEON   April 4,2006

Dr. Sandra Best 80 King St. East Brockville, ON  K6V 1B5

RE: Terra Kilby Dear Dr. Best,

Ms. Kilby has returned to my office today. I have had a chance to review her CAT scan. She likely has a mesenteric cyst or possibly a duplication cyst. It looks amenable to laparoscopic excision and appears to be separate from the bowel, kidney and ureter.

She continues to have symptoms and has a palpable mass in her right abdomen.

1 have therefore recommended a laparoscopic excision of the cystic mass. We discuss potential risks which include infection, bleeding, bowel injury, bladder injury. There is a risk of injury to any nearby organs such as her ureter or major blood vessels.

 There is also small risk that she may require a bowel resection.

Certainly, there is a risk that this will need to be done through an

open approach.

She would like to go ahead. I answer any question she had. Consent for surgery was obtained. I will take her to the operating room at the next available opportunity.

Sincerely,

               Laz V. Klein, MD, MSc, FRCS(C) LVK

TRANSCRIBED BY VOICE RECOGNITION TECHNOLOGY. DICTATED BUT NOT READ

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AS LONG AS THIS HOSPITAL'S CEO CONTINUES TO CONCEAL MEDICAL NEGLIGENCE AND GRANT HOSPITAL PRIVILEGES TO DR. LAZ KLEIN, ALL PATIENTS OF HRH ARE IN EXTREME RISK.

Humber River Hospital -North York, Toronto

My twelve year struggle resulting in failure to bring about the truth, protect Ontario citizens and open up true transparency and accountability.

Will the Patient Ombudsman's Office be another failed institution?? WELL, I WAS RIGHT--ANOTHER WASTE OF TIME.

SHOULD YOU OR A FAMILY MEMBER SUFFER AN ADVERSE EVENT IN AN ONTARIO HOSPITAL---THE TRUTH WILL NEVER BE REVEALED, INSTEAD NEGLIGENT MEDICAL CARE WILL BE COVERED UP BY ALL INSTITUTIONS UNDER THE AUTHORITY OF THE PRESENT LIBERAL GOVERNMENT.
THE NEWLY CREATED PATIENT OMBUDSMAN'S OFFICE IS A COMPLETE WASTE OF OUR TAX DOLLARS AND PORTRAYS A FALSEHOOD THAT A CITIZEN CAN TURN TO SHOULD THEY FEEL A HOSPITAL HAS MISTREATED THEM.
I DON'T BELIEVE THERE IS A PROVINCIAL PARTY, AT PRESENT, THAT WILL GO UP AGAINST THE CPSO AND CMP

Regardless of the friendship between Ms Elliott and Ms Collins, I feel she should be fully engaged in the investigation as this is far to important to disqualify herself! As the Patient Ombudsman, how can she investigate if she has friendships with the administrators of Ontario hospitals and disqualifies herself?

I met with the Patient Ombudsman, Christine Elliott, my MPP, Steve Clark and a patient ombudsman investigator, Marie-Claire Muamba with regard to HRH and Dr. Klein. This occurred several months ago, September 22/2016. I was told not to post anything until they had been in touch with HRH. This has occurred.

Marie, I am a little hesitant with regard to the coming phone call today, January 11, 2017, as I have had so many from so many investigators who merely want to inform me that there is nothing to be done! All these phone calls do is raise my blood pressure and anger me. They ignore the evidence and do a lame job of trying to explain why they find nothing to my concerns, which of course, is absolutely ludicrous!

HRH has an opportunity to bring forth the truth after concealing it for over ten years. The patients of Humber River Hospital should have the assurance that should an adverse event occur, this hospital will not conceal the truth by remaining silent. I and all of whom are aware of Terra Dawn's hospitalization and death would certainly not go to this hospital nor recommend Humber River Hospital to anyone. The problem is most Ontario citizens are completely unaware!

Ms Collins, knowing that my complaints with regard to Terra's care or lack thereof has been ongoing for ten plus years, one would feel compelled to reopen my file when the Excellent Care For All came it effect.

Keep in mind, I met with five HRRH administrators in May of 2008 whereby they didn't respond to a single question/concern of mine. This was before I actually had the hospital records. Once studying the records, I often sent my new concerns to Ms. Collins.

Excellent Care For All 

1. Have practices in place for handling patient complaints as part of the organization's overall patient relations process. As part of these practices, health care organizations are be required to:

have processes in place for reviewing and resolving complaints made by patients and caregivers record, monitor, and analyze key information about each complaint, including the name of the person who made the complaint (except in the case of an anonymous complaint), the date the complaint was made, the subject matter, whether the complaint was resolved, and if so, when and how the complaint was resolved

inform the person who made the complaint of its review status, within five days of the date the complaint was made and whenever the person who made the complaint reasonably requests further information

Public Hospital Act 
 Remember this is after Terra's death--considering this surgeon has multiple deaths, and the fact that his department was temporarily shut down due to multiple deaths in 2009 up to Feb of 2010, the CEO and COO should have realized there was a serious problem present. Let's not forget the death of Crystal Rose in Dec of 2012. Perhaps, HRH's lack of action led to these deaths and continue to do so.

Duty where serious problem exists      CEO and COO were well aware of a serious problem! But ignored it for the years.

(3) If an officer of the medical staff who is responsible under subsection (1) or (2) becomes aware that, in his or her opinion a serious problem exists in the diagnosis, care or treatment of a patient, the officer shall forthwith discuss the condition, diagnosis, care and treatment of the patient with the attending physician. 2006, c. 4, s. 52 (12).

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Should they not, the Ontario Citizens should be able to access a public document from the Patient Ombudsman's Office indicating HRH's lack of transparency and accountability and their excuse to hide behind the "Excellent Care Act" and conceal the truth with regard to a surgeon's negligence which resulted in many more deaths after Terra Dawn Kilby.
Also: If the phone call has to do with what I want from HRH. l doubt they will do the following.. They will not want to put anything on record.
For example-- a written response to some of the following questions. There are many more questions!     

The Patient Ombudsman’s Office cannot get answers to any of the questions posed below.

1. Is it hospital policy and the standard of care for Humber River Hospital and its Surgeon to change to an open abdominal surgery to perform a colon resection and removal of a tumor after attempting a colon resection laparascopically without administering the mandatory antibiotic prophylaxis???
2. Is it hospital policy and the standard of care for Humber River Hospital and its Surgeon not  provide the patient with antibiotics when the abdominal incision became so infected that all staples had to be removed, considering the patient did not receive the mandatory antibiotic prophylaxis at the time of surgery???
3. Is it hospital policy and the standard of care for Humber River Hospital and its Surgeon not  provide antibiotics to the patient when test results indicated the "presence of many gram negative bacilli" considering the patient had not received any antibiotics whatsoever???
4. Is it hospital policy and the standard of care for Humber River Hospital and its Surgeon not  provide supplemental nutrition after five days of the patient only receiving a liquid diet and where records indicate the patient was not tolerating current diet???
5. Is it hospital policy and the standard of care for Humber River Hospital and its Surgeon to keep a patient on a liquid diet for nine days without nutritional supplementation??
6.  Is it hospital policy and the standard of care for Humber River Hospital and its Surgeon to ensure the patient had a solid bowel movement after consuming her only two solid meals just prior to discharge??
7. Is it hospital policy and the standard of care for Humber River Hospital and its Surgeon to see the patient the day of discharge??
8.  Is it hospital policy and the standard of care for Humber River Hospital take over two years to substantiate my assertion that the mandatory antibiotic prophylaxis was not administered even though the surgeon kept telling the COO that he had done so???? And this was only done so during a phone call I had with Ms Collins. 
9.Would HRH not consider all of the above to be negligence on the part of the surgeon and perhaps the hospital???

PLUS SO MANY MORE QUESTIONS WHICH HRH CAN EASILY SEE BY STUDYING THE HOSPITAL RECORDS.                                                                                  

CPSO's Decision “The routine use of antibiotics prior to bowel surgery is an important aspect of care that was NEGLECTED by Dr. (Laz) Klein in this case.” The CPSO issued a secret written caution to Dr. Klein and stated that PERHAPS he MIGHT want to CONSIDER administering the mandatory antibiotic prophylaxis in THE FUTURE when converting from minimal evasive to open surgery! 

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Ms Deborah Dennie, e-mail send to Ms Dennie with no response.

Director of Education, Quality Support and Risk Management. HRH

‎My MPP and I will be meeting with the new Patient Ombudsman.
I know you will undoubted run to the new CEO about this, however I am hopeful you will bring forth the truth after it has been conceal for such a long time.
Ms Dennie

I understand you conduct in-hospital deaths without consulting with nursing or medical staff who were involved in that incident. And then, quite often, you would go to the program director and get some information from her or him to prepare your report. It is now time to bring forth the truth!

Did you and another party investigate the death of Terra Dawn Kilby when she passed away on July 21st, 2006 less than 12 hours after being discharged by HRRH, Finch Street Site.
What was the date of this investigation?
Who else was involved in this death investigation?
Were copious notes kept of this investigation?
What was the result of this investigation? Scott Jarritt stated at a meeting you found no concerns!! I would love to put you on the stand before a Judge/Jury to have you commit purgery!
How many times have you investigated an in-hospital death of one of Dr. Laz Klein's patients? He must have kept you very busy!

Newsflash!    Dr. Devlin, Congratulations upon your upcoming retirement from HRH as its CEO.  A FEW MONTHS BACK, RUMOUR HAD IT THE MINISTRY OF HEALTH WAS FORCING RETIREMENT ON YOU. 

 Perhaps, it is time to come forth with the truth with regard to the negligent care received by Dr. Laz Klein and provide me with a copy of the supposed in-hospital death investigation which you have continued to refuse to grant me.

I am deeply sorry to think this but the run around the hospital have been giving me over the years,  I can’t help thinking this as a truth!

I wonder if Dr. Devlin's religious commonality with Dr. Klein prevented the truth from coming out concerning the death of a common Gentile? One must also wonder if Terra's care would have been far superior that it was had she been Jewish?  I believe should the Hospital and the CPSO compared patient hospital charts for those of different faith, they would certainly discover a tremendous difference with respect to post operative care provided by Dr. Klein!       bcollins@hrh.ca   rdevlin@hrh.ca

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Be Forewarned --If the CEO and COO covers up negligence, should you or a loved one consider going to the newly built hospital. THINK HARD.

Sadly, a deceased woman is less valued than one who remains alive in a vegetative state-- one reason why a malpractice suit is rejected by law firms. But in this case, besides the Surgeon, Dr. Klein, I believe a suit could be filed against all who supposedly looked into this death--- Humber River Regional Hospital, Chief Coroners Office of Ontario, the Death Investigation Oversight Council, the Ontario Ombudsman's Office, the Ministry of Health, the Ministry of Community Safety and Corrections, the Health Professions Appeal and Review Board. A knowledgeable Law Firm would know the exact reasoning for a suit against the above publicly funded institutions But "Breach Of Trust" would not in the least bit be difficult to prove.

Message from beyond:
"I want you all to know how much I love you and miss you. But I am content and watching over all of you. Until we meet again, please remember all of the good experiences we shared and the fun times we had together as a family."
“ Continue the fight, Dad, so changes are made to protect others”

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College’s Decision “The routine use of antibiotics prior to bowel surgery is an important aspect of care that was NEGLECTED by Dr. Klein in this case.”

The College recommended to the surgeon that perhaps "he might consider the use of antibiotic prophylaxis in the future when converting to open surgery" HE MIGHT CONSIDER???????

The Chief Coroner's Office, the College of Physicians and Surgeons of Ontario, the Health Professions Appeal and Review Board, the Death Investigative Oversight Council, the Liberal government and Liberal Health Ministers and Premier Wynne apparently agree that it is perfectly within the accepted Standard of Care to:
--have open abdominal surgery without the mandatory antibiotic prophylaxis
--having not had the above, accepted that there was no need for antibiotics when the abdominal incision was oozing purulent liquid and was so infected that all staples were removed  An example of something purulent is an open wound that's not healing properly.
--when test results showed "many gram negative bacilli", still it was quite acceptable to provide no antibiotics

A VERY DANGEROUS PRECEDENCE HAS BEEN SET BY ALL OF THE ABOVE AS THIS DECISION CAN NOW BE USED TO JUSTIFY SIMILAR COMPLAINTS. EVEN THOUGH, IT WAS AN OBVIOUSLY WRONG DECISION.        
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From: Arnold Kilby awkilby@hotmail.com> Sent: September 15, 2009 11:49 AM To: barbara collins Subject: Dear Ms Collins, I am still requesting a copy of ...

Dear Ms Collins,I am still requesting a copy of the internal investigation to my complaints which I ask for in a letter sent around Oct 22 of 2008.  I would also suggest that you review your internal investigation as it would appear that it was not very thorough, even though I have not seen it. I presented a very strong case to the HPARB panel this week.                               
 With respect, Arnold W Kilby
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Subject: FW: Terra Dawn Kilby's Death HRRH    From: Arnold Kilby awkilby@hotmail.com
>Sent: July 5, 2010 12:14 PM
To: barbara collins; rdevlin@hrrh.on.ca; steve clark; a horwath; andre marin; bentley; central health integrated network; Christina Blizzard; Collette Gooden; d matthews; dmcguinty.mpp.co@liberal.ola.org; domonique Pierre; Elizabeth Witmer; rbartolucci.mpp@liberal.ola.org; Rick Bartolucci; Talia Talaga; Tim Hudak; Toronto Star; w 5; laz Klein

Dr Devlin & Ms Collins Just wondering whether you are following your lawyers advice not to communicate with me again?  There is no lawsuit so I'm not sure why the lack of transparency on the hospital's part? I will be distributing Terra Dawn's flyers shortly after the fourth anniversary of Terra's death.  Still waiting patiently for a response. I would still, after several attempts made to you, request a copy of your internal investigation which took place in the 2008 year. I believe I am entitled to this as it pertains to my complaints I submitted to you, and tried to address during the May 2008 interview with your five administrators who sat by deaf and muted.  I am re-sending the previous e-mail as I did not receive a response.

Respectfully yours, Arnold W Kilby

From: Arnold Kilby awkilby@hotmail.com>  Sent: June 26, 2013 10:02 PM     To: barbara collins

If there is no cover-up then could I have a copy of the internal death review that was done after Terra's death, which I have asked for on numerous occasions. And how can a patient, regardless of it changing from laparoscopic to open, for removal of tumour and a colon resection be done with no antibiotic given at all, at any time --prior, during and after.  I still remember that meeting when it was said that the hospital found no issues????  How in depth was this investigation? Certainly this aspect should be noted in the review as a concern. It is very difficult to believe that the hospital feels Dr. Klein acted in a knowledgeable, professional, ethical etc manner with respect to all aspects of Terra's care, prior, during and after her operation.
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Twelve Attempts made with no response: 
a letter sent around Oct 22 of 2008                     September 15, 2009 11:49 AM
Sat 2015-12-12 6:28 PM          June 26, 2013 10:02 PM 
Sat 2016-01-02 9:03 PM           Mon 2016-01-11 4:45 PM
Thu 2016-01-21 9:52 AM        Fri 2016-02-05 3:15 PM
Wed 2016-02-10 11:14 PM      February 11, 2016 6:25 PM
Feb 23, 2016               March 4, 2016 

--- MS COLLINS AND MR DEVLIN IT IS NOW FEBRUARY 23, 2016. PERHAPS YOU THOUGHT OF CRYSTAL ROSE YESTERDAY, AS IT WAS HER BIRTHDAY. PERHAPS, I WILL GET A RESPONSE BEFORE TERRA'S BIRTHDAY, APRIL 22 --- WHICH IS EARTH DAY AND WE NAMED HER TERRA DAWN NOT KNOWING ABOUT EARTH DAY.
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Oh, and I forgot the Ombudsman's Office inquired and yes I know they did so not officially since they do not have the authority and the answer was HRH did one but will not reveal it to them.

Ms. Collins told me the following about your request for a copy of "the report":
- you are asking for a copy of their "internal investigation report"
- you were told that the hospital investigates all deaths in the hospital and that they do a complete review of each case 
- she has been in communication with you since a week after your daughter died
- they have provided you with all of the information that they can provide to you - everybody has tried to be understanding but there is nothing more that she can give you
- you have the entire health record - you cannot have all of their internal documents as you are asking for private and confidential information
- there is NO REPORT, she emphasized, but only internal notes and documents
- you have appealed to the Privacy Commissioner to get all of the information from the hospital and the Privacy Commissioner is currently investigating
- the Privacy Commissioner will decide if you can get any further information This is the information that was provided to me.
The last two comments above are incorrect, what I went for dealt with the Chief Coroner's Office, not the hospital.

I appreciate your comments about our lack of jurisdiction over the hospital sector and, I think you know, our Ombudsman is working very hard to try to get his jurisdiction expanded to include the hospital sector as well as the other sectors which our province does not allow him to oversee. I share your optimism that this will be "coming sooner than later" but, sadly, it is not in place now. Unfortunately there is nothing further that I can do to assist you with this issue. I think it is good news that you have taken your concerns to the Privacy Commissioner and given that she is investigating your complaint at this time perhaps you will be satisfied when she has finished her review and can report back to you. I am going to close your complaint on this issue to our office as there is nothing further that I can do. Having said that you know that you can contact me again, directly, at any time, if there is anything you want to discuss.

Fran Cappe Investigator Office of the Ombudsman of Ontario 

COO Ms B. COLLINS AND CEO, DR. DEVLIN OF HUMBER RIVER HOSPITAL IN TORONTO.  bcollins@hrh.ca   rdevlin@hrh.ca

It is now February 18, 2016 and still no response.  This will prove to be beneficial in the future.
I, once again, am requesting a copy of HRRH's internal death investigation of Terra Dawn Kilby. I am the father; I deserve this report. We all know who the surgeon is so you can omit his name for privacy reasons. But the facts must become public, for the interest of patient safety, accountability and transparency! 

I am still asking for a copy of the supposed internal death investigation done after Terra's death.  I kind of suspect that you don't have one. Actually I know you didn't at the time but may have come up with one several years after the fact. I would like to see that one.
I'm sure your death investigation would have dealt with these concerns even though for two years you maintained Terra had received the mandatory antibiotic prophylaxis prior to surgery simply because you asked Dr. Klein and he said yes. Two years to finally look at the records to discover he lied! Remember, I have Dr. Phillip Hebert's questions that were answered by HRRH in the fall of 2008.
 The following is the answer to the first question:

Dr Hebert's first question:  a. Was antibiotic surgical prophylaxis done at the proper time before time of operation?
HRRH's Response: Dr. Klein has advised that Terra was given the appropriate pre- operative antibiotics.

Why didn't you look at the operation chart to see he attempted a colon resection without the mandatory antibiotic prophylaxis being administered? Then he lied and said he didn't know he had to do a colon resection until after he converted. The operational chart shows the opposite--- Look at the first Procedure. Why do you continue to cover up negligence when this surgeon is responsible for so many deaths? WHICH WAS A COMPLETE LIE TO YOU AND TO EVERYONE

 It is so wrong to think this, but I am convinced in a hospital setting a surgeon/doctor could actually commit a murder and get away with it. They are getting away with negligence contributing to adverse events and deaths taking place in hospitals with no fear of being reprimanded or held accountable. The record of Terra’s surgeon remains spotless although there are more deaths associated with him, and there is no way for citizens to be aware of his past. This is the reality within Ontario. Humber River Hospital by concealing the truth contributes to the above.

 HRH has never addressed any of the medical concerns I have sent to you via numerous e-mails in the past. All of which dealt with Terra's pre and post care! 

If you recall, often you had mentioned that we could meet, and I had said that unless some measure of acknowledgement that Terra's care should have been better then there was no point in meeting. You never commented on this. Considering the numerous unquestionable issues this was not an unreasonable request. If you recall I met with five administrators in May of 2008 whereby not a single issue was address by Dr. Barkin. So really, how does one expect that a meeting with HRRH would be any different?

The first meeting assessment written by Terra's Aunt who attending this meeting:

HRRH’s Communication Efforts?

 “The general attitude of senior staff at HRRH (we met five senior staff members, including Dr Jack Barkin, Chief of Staff, at our meeting of May 15, 2008) appears to be one of complete haplessness: as they have been cleared (by the College of Physicians/Surgeons) of not meeting standards in Terra’s post-operative care, they have expressed a lack of interest in further discussion and have given us the impression that they consider Terra’s death to be a fluke/bad luck/ “just one of those things” / a medical mishap for which there is no explanation and show absolutely no inclination to conduct their own inquiry.

Their truculence to say anything at all, indicates to us that any discussion initiated by them may be taken as an admission of culpability. Is it not incumbent upon hospitals, when these types of totally unexpected deaths occurs, to conduct an investigation, to shed some light on the situation (in Terra’s case, the cause of death was DIC) as some measure of solace to relatives, and also to educate other medical professionals and to advance the body of knowledge on the subject - in other words, perform a public service?

Our family expected HRRH would provide this kind of service to us - that they would tell us what happened/may/could have happened. On the contrary, we have had to conduct our own research, much of it via the internet, via journals, but it can be accessed only by subscribing and paying a fee.

This state of affairs should be unthinkable in our province. Our family knows the CAUSE of Terra’s death - what should be investigated are connections between the events of Terra’s hospital stay and their connections to the onset of DIC. This is the heart of the matter. Terra’s father, has done a meticulous job, researching medical records, organizing documents etc. while at the same coping with his overwhelming grief. He deserves credit for this.”
“It is common knowledge that on very rare occasions, a patient, even a young healthy patient dies after surgery. However, until every detail of the surgery/post-operative period in HRRH have been examined by specialists in the field, we are not prepared to accept the fact that Terra’s death has no explanation.”

Note: Terra's Colon Resection broke down and she bled to death. We had been told that she had DIC which the Chief Coroner later retracted.
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As well, when the parents of another of Dr. Klein's patient (who died in Dec of 2012, Crystal Rose), requested a meeting with the hospital, HRRH agreed to meet. HRRH asked Mr & Mrs Rose to submit the questions/concerns they wanted addressed at the meeting.  Then, upon receiving Mr Rose's questions/concerns, HRRH cancelled the meeting! But later in 2016 they met and nothing was resolved.

 So, things have not really changed at all!!! REAL CLOSURE WILL NEVER COME ABOUT FOR US AS LONG THE TRUTH CONTINUES TO BE CONCEALED.

HOW RESPONSIBLE IS DR. LAZ KLEIN FOR TERRA'S DEATH AND THIS HOSPITAL FOR CONCEALING THE TRUTH? DR. KLEIN CAN ANSWER THIS.

Dr.John Hagen, Dr. Klein's partner in MIS surgery operating out of Humber River Regional Hospital, delivered this presentation during May 2010 in Montreal as part of a symposium on diabetes.            

                                                                                                                                                                               

IN 2010, "With the help of the Coroner's Office, the program was shut down while an external review was done by a well-known expert." (according to this power point display which mentions 5 deaths within 30 days of operation of patients) My sources say it is higher. 

 From Dr. Hagen’s Power Point

¡  First 880 cases done with acceptable results

¡  Over a 6 month period September 2009-February 2010 there were 5 deaths within 30 days of surgery

¡  With the help of the coroner’s office, the program was shut down while an external review was done by a well known expert

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From letter sent to the College by Dr. Klein which I had not previously seen.
July 13, 2011
Ms. Angela Bates Manager,                                                                                                                                           Committee Support Area Investigations and Resolutions                                                                                                  
College of Physicians and Surgeons of Ontario 80 College St. Toronto ON M5G2E2
RE: Ms. Terra Dawn Kilby - Your File #77429

 Antibiotics                                                                                                           
 "The independent assessor is correct that Ms. Kilby did not receive preoperative antibiotics. I agree with the independent assessor's opinion in response to your subsequent letter that preoperative antibiotics would not have been a contributing factor to the anastomotic leak. Antibiotics are used to prevent or treat an infection. They have no preventative or beneficial effect for an anastomotic leak."

"Furthermore, it is not my practice to prescribe antibiotics for a planned laparoscopic surgery with possibility of conversion to an open procedure."
"As I have explained in my initial response, Ms. Kilby did develop a superficial wound infection postoperatively that was treated appropriately. I do not feel that the wound infection 'was in any way related to the outcome of this case."

L Klein
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Oh, my God!!!!  Dr. Klein has not learned a thing from Terra's death and is obviously going to continue as he did!    

One, antibiotic antibiotic prophylaxis is a standard of care and yes, Terra had an abdominal infection as noted by the nurses and the lab test results indicating the presence of ‘many gram negative bacilli’ 

Dr. Klein’s own words contradict himself
“Antibiotics are used to prevent or treat an infection”
“Ms. Kilby did develop a superficial wound infection postoperatively that was treated appropriately”

So superficial that all staples had to be removed???
 But the College, HPARB, CORONER’S OFFICE fail to consider this and is distracted only with Terra’s anastomotic leak resulting in death.

This is detrimental to the safety of patients that are under his care!!!!!!

I have not seen this prior to receiving this from HPARB and Humber River Hospital refuse to comment on the concerns I point out regarding Dr. Klein's letter to the CPSO.  I have included my comment within to address concerns

Dr. Klein’s letter to the College:
July 9, 2010
Ms. Sandra Keough Investigator
College of Physicians and Surgeons of Ontario
80 College St. Toronto ON M5G 2E2
Dear Ms. Keough:
Re: Dr. Lazar Klein
Your File No. 08-CRV-0097

“I understand that this matter has been referred by the Health Professions Appeal and Review Board ("HPARB") back to the Inquiries, Complaints and Reports Committee ("ICRC") for further consideration and the issuance of a new decision. I write to clarify my response to Mr. Kilby's initial complaint and to address the specific aspects of the HPARB decision.:

Committee's Findings
The Committee had found that:
“Ms Kilby's cause of death was determined to be intra-abdominal haemmorrhage with coagulopathy [i.e. DIC]. It is very odd that Ms Kilby had no signs of coagulopathy while in hospital, and that it affected her so suddenly and fatally. Overall, Ms Kilby's case is an extremely unusual one, and the Committee could find no information in the hospital chart or other medical records to predict the horrific outcome, nor any information to suggest that there were flaws in surgery performed by me or the care that I provided that directly or indirectly resulted in Ms Kilby's untimely death. It is an unfortunate fact that the delivery of appropriate and adequate medical care does not guarantee positive results, and that sometimes it is not possible to avoid a tragic outcome, particularly when an unpredictable clinical presentation occurs and when a patient's symptoms do not coincide with the underlying pathology.”

With respect to the postoperative care, the Committee found that:
“Dr Klein's account of the visits paid to Ms Kilby and attention to her wound are supported by information in the hospital chart, which contains my post-operative notes, documenting that Ms Kilby was seen daily. While the Committee cannot tell from the chart whether Ms Kilby's wound was assessed daily, the record does contain my diagnosis and treatment of a minor wound infection that developed post-operatively.”

 AWKILBY’s Response: Take a good look at Dr. Klein’s notes, lacking thorough examination on various issues. Also, important to note, the College does not require the length of time to be noted, for obvious reasons. So, a ten second visit counts-----how on earth can one truly care for a patient in ten seconds, and the Wednesday prior to her release she was asleep when he was in the room? On one other occasion I waited in the TV room four doors down from Terra’s room, counted “ten steamboats” and then went to my daughter’s room. Dr. Klein was not only gone from the room but also the floor, as I had asked the nurse to locate him. She couldn’t find him.

Because the CPSO could not read his daily notes, he was asked to transcribe them.   There still is very little information contained within.  Look for what is not said--- test results and scores, abdomen size and oozing incision.  There is no way that this surgeon’s notes are copiously done,

Many of my experts concluded Dr. Klein’s notes are barely acceptable and conclude they                     

should have been more detailed.

 “Dr Klein had some very brief progress notes in the chart but not, in our doctor’s opinion adequate to describe what was happening with the abdominal wound.  (Dr Hebert also mentioned the progress notes as lacking at the meeting on July 4, 2008)   The medical consultant noted that the wound was treated by cleansing but no antibiotics were given and no further cultures were done.” “It is his comment that it would appear Terra’s death was due to lack of attention to any discharge procedure.”

Sandra Keough Investigator  NOV 29 2007

Investigations and Resolutions  CPSO

Dear Ms. Keough,

The office notes from March 22,2006 and April 2006 have corresponding dictated notes attached previously. As a routine, I dictate all office visits including initial consultations and follow-up visits. I do this to ensure that there are no legibility issues with any office charting. At the hospital I dictate all consultation notes that I write. Only daily progress notes do not have a corresponding dictation, I do endeavor to print these notes to make them legible.

The chart notes continue as follows:

July 11,2006:

OR Note:

Proc: Lap - open Right hemicolectomy and excision of large mesenreric cyst

Surg: Klein, Esser, Shedletsky

GA: Zadic

No comp.

July 12,2006

VSS afeb No gas Abdo soft Comfortable

July 13, 2006

HR: 100, Temp 38.1 Feels better today No gas Wound: ok Abdo soft Hungry                                                   D /C Foley IV bolus

July 14, 2006

Temp: 36.0 (Max 38.1)

HR:80

-I- gas (passing gas)

abdo still tender

incision okay

WBC: N (normal)

Con't clears (fluids)

July 15, 2006

VSS, afeb

Wound infection -> opened

+ gas

Con't as is

July 16, 2006 (This note was written by the clinical fellow)

AVSS (afcbrile, vital signs stable) c/o nausea, no vomiting wound packed incisional pain

I/P (impression/plan): stable, blood work July 17,2006

Some diarrhea, otherwise well Plan: home 1-2 days

July 18,2006

afeb

well, eating well

Plan: home 2 days

July 19, 2006

VSS, afeb

Well

Decreased pain, decreased diarrhea, C. diff. negative

Plan: home in AM.                                       

I hope this is satisfactory. I appreciate your efforts in this matter , Sincerely aLaz V. Klein, MD, MSc, FRCS(C) LVK

AWKILBY’s Response:  So none of the following are a concern????

Did Dr. Klein look at the nursing records and test results or even talk with    the nurses??

THE INCISION    from July 15 to release from hospital, incision was infected 

ABDOMINAL SWELLING    from July 13 to release from hospital  With significant nausea, vomiting, or abdominal distension, x-rays of the abdomen should be obtained.

MANY GRAM NEGATIVE BACILLI SEEN     as stated in hospital records

MANY PMN’S Polymorphonuclear Neutophils greater than 15/LPF as stated in hospital records

Pulse Rates         34/38 of Terra’s recorded pulse rates were above 90 during her stay 

Temperatures       23 out 38 recorded temperatures were not in the normal range 

Breathing    It should be noted that Terra’s breathing to the most part indicated concern.   (see hospital records)

All Five Hemoglobin test scores below normal range.

All Five Hematocrit test scores below normal range.

Red Blood Cell Count test scores---one at lowest of normal and other four below

All five Absolute Lymphocytes well below normal range.

All four UREA   Blood Urea scores well below normal range.

Issues Raised by Mr. Kilby

The HPARB panel noted that the Committee did not specifically address in its Reasons certain concerns of Mr. Kilby related to his daughter's postoperative wound infection that he believed to be relevant to his complaint. In particular, Mr. Kilby:

• pointed to observations in the nursing notes regarding the odour and oozing from Ms. Kilby's wound, as well as abdominal distension;
• questioned whether Ms. Kilby should have been ordered antibiotics;
• queried whether her wound infection may have been related to DIC; and
• questioned whether a CAT scan would have been warranted in the circumstances.
As I stated in my initial response letter, Ms. Kilby did have a superficial wound infection postoperatively.

“Postoperative wound infections such as the one experienced by Ms. Kilby are common after bowel surgery. I treated Ms. Kilby's infection promptly by opening the wound and draining the fluid on the fourth postoperative day. As this was a superficial wound infection, antibiotics would not have been necessary. Further, there would have been no need to perform a CAT scan since Ms. Kilby did not have any signs of a systemic infection. As stated in my response letter, she had no fever, no tachycardia, no elevated white blood cell count and normal bowel function”.

AWKILBY’s Response: It was on Saturday, Day five after the surgery not Day 4 and the infection spread to the entire incision by Tuesday. Thus, her entire incision was now opened up. Since she was given no antibiotic prophylaxis, wouldn’t one think that for this incision infection, an antibiotic would be warranted? Also, what about the gram negative bacilli—left untreated. Gee, an enlarged abdomen doesn’t warrant a cat scan or further investigation? Also when the nurse asked about antibiotics Dr. Klein’s response was “The Body Will Heal Itself” --- Well just maybe, Terra’s body needed a little help.

(Pulse Rates >90) (tachycardia) Please go back and see Terra’s pulse rates. Again, I believe this is proof the Dr. Klein paid no attention to the nursing records.

34/38 of Terra’s recorded pulse rates were above 90 during her stay

Please refer back to comments made by the surgeons I contacted with regard to the incision.
Concerns of abdominal distension were not communicated to me at any time during my daily assessments of Ms. Kilby. As I stated in my response letter, Ms. Kilby continued to recover well after surgery, and the time of discharge she was feeling well and had no complaints. In any event, abdominal distension is not uncommon after abdominal surgery and in my view, would not have given any indication of DIC.

AWKILBY’s Response: Again, did Dr. Klein not look at the nursing records or talk to the nurses? See description of abdomen. As well, how on earth can a nurse communicate with Dr. Klein when his visits are timed in seconds. Who knows whether the nurse was present in the room while Dr. Klein was temporarily there or not.

As I stated in my initial response letter, Ms. Kilby did not show any signs that would have alerted to me to any cause for concern. Her death was extremely unusual and tragic.

AWKILBY’s Response: So none of the following are a concern requiring further investigation????

Did Dr. Klein look at the nursing records and test results??

THE INCISION from July 15 to release from hospital, incision was infected

ABDOMINAL SWELLING from July 13 to release from hospital With significant nausea, vomiting, or abdominal distension, x-rays of the abdomen should be obtained.

MANY GRAM NEGATIVE BACILLI SEEN as stated in hospital records

MANY PMN’S Polymorphonuclear Neutophils greater than 15/LPF as stated in hospital records

Pulse Rates 34/38 of Terra’s recorded pulse rates were above 90 during her stay

Temperatures 23 out 38 recorded temperatures were not in the normal range

Breathing It should be noted that Terra’s breathing to the most part indicated concern. (see hospital records)

All Five Hemoglobin test scores below normal range.

All Five Hematocrit test scores below normal range.

Red Blood Cell Count test scores---one at lowest of normal and other four below

All five Absolute Lymphocytes well below normal range.

All four UREA Blood Urea scores well below normal range.

AWKILBY’s Response: From my research

 

What Complications Can Occur with a Colon Resection?

These complications include:

• Bleeding
• Infection
• A leak where the colon was connected back together.
• Injury to adjacent organs such as the small intestine, ureter, or bladder
• Blood clots in deep veins in your legs that may travel to your lungs.

It is important for you to recognize the early signs of possible complications. Contact your surgeon if you notice severe abdominal pain, fevers, chills, or rectal bleeding.

When to Call Your Doctor

Be sure to call your physician or surgeon if you develop any of the following:

• Persistent fever over 101 degrees F (39 C)
• Bleeding from the rectum
• Increasing abdominal swelling  YES
• Pain that is not relieved by your medications YES
• Persistent nausea or vomiting  YES
• Chills YES
• Persistent cough or shortness of breath YES
• Purulent drainage (pus) from any incision YES
• Redness surrounding any of your incisions that is worsening or getting bigger YES

Gee, why did Dr. Klein discharge her?

• You are unable to eat or drink liquids YES

            *****************

“In summary, I reiterate that I feel that I provided appropriate care to Ms. Kilby. I am confident that Ms. Kilby's infection was no more than a superficial wound infection, which I treated appropriately and that it had no effect on her tragic death. I again express my deepest condolences to Mr. Kilby and his family “. Yours very truly,
Lazar Klein
************************************************

From July 11th after her operation up to July 20th lunch, Terra was on a liquid diet with no nutritional supplementation. A liquid diet should not go more than five days. As well, records show she was not tolerating current diet. Her dinner on the 20th and breakfast on the 21st were regular meals. So, this was the first time she ate regular food. She did not have a bowel movement prior to discharge at noon on the 21st. 
Gee, one would probably think that the colon resection should have been tested to see if she could pass a solid bowel movement. But not this hospital. She was not seen by any doctor on the day of her discharge. The day prior to her discharge she was seen my Dr. Klein while she was sleeping???? So really, the last time Dr. Klein spoke to her was on two day prior on the 19th when I though my hissy fit about the infected incision. It took quite some time to locate him that day.

Nurses:    Angella Y Miller     Betty Traynor   Cheryl Byrnes                       Gylanne Allen    Jennifer Celio         Jennifer Dyce    Kalpana Mohammed  Linda Lane          Paul Pangilinan      Claudia Herod  Allan Gylanne              Ingrid Nattras     Julie Lazzaro           Kwabena Omane-Badu              Marlene Sutherland

Dr. Laz Klein    SEE THE SIMILARITY TO THIS PATIENT AND TERRA’S REGARDING INFECTION   --STILL OPERATING THE SAME AFTER TERRA’S DEATH??????    WHY DOES THE HOSPITAL AND ALL CONTINUE TO COVER UP HIS NEGLIGENT CARE WHICH HAS LEAD TO DEATHS

?

Submitted April 5, 2017

Very difficult to communicate with in a disrespectful way, walks away when you are talking to him, even my 5 yr old knows it's rude and disrespectful to walk away from someone when they are talking to you. It makes it impossible to to ask questions about your situation. And I have every right to know what's wrong with me, what my options are, etc. This man's salary is coming from my tax dollars, he does not get to decide whether or not he'll communicate with a patient, once you are being paid for your services by my tax dollars you have an obligation to communicate with me. He contradicts himself multiple times, and tells you one thing but writes something completely different in the chart. He sent me home from hospital with an infection even after I complained numerous times about puss coming out of the wound and my entire abdomen being swollen and hot to touch and redness spreading everywhere. I had to be admitted to another hospital to get i.v. antibiotics and get the wound opened up again by another surgeon because of internal infection. It could have all been prevented had he listened when I was telling him in hospital that my belly was very hot to touch and there was puss coming out and that my belly was very swollen, and that the redness around the wound was spreading, etc. He just kept saying, that's all normal, you've just recently had surgery. I have had many surgeries and I know what's normal and what isn't, puss from a wound is not normal, severe redness around a wound that is spreading is not normal, a belly that is extremely hot to touch is not normal. These are all signs of infection and just because I didn't have a fever he assumed there couldn't possibly be an infection anywhere. The new surgeon at the other hospital who took care of me said not all infections will show with a fever. Maybe he couldn't have prevented the infection, I know it's a risk with any surgery, BUT he could have sent me home with antibiotics therefore preventing another hospitalization and the wound having to be opened up again. He could make his own job so much easier and could have far less problems for himself if he just learned how to listen. Just because someone is sick doesn't mean they're stupid.

*********************

Submitted , 2016

Dr. Klein it's the MOST unreliable surgeon there is , believe what you read about him!!! He does NOT care about his patients , I had my gbp 4 months ago and since then it's been a night mare I been in an out of the ER with strange symptoms that nobody knows and I never suffer from before every time I go to Humber river Hospital he is never available!! They page him and he never responds to his page... I have been trying to get an appt with him and I haven't able too , it's been 3week I been vomiting blood and he thinks it's not important. Before my surgery I saw him 2 times in his office for 5 min each times. I did not see him before nor after my surgery. PLEASE PEOPLE IF UR FP MAKES A REFERRAL FOR THIS DR. PLEASE TRY ANOTHER OPTION STAY AWAY FROM THIS "SURGEON" .

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http://thepatientfactor.com/canadian-health-care-stories/the-unholy-alliance-between-organized-medicine-and-government-a-fathers-quest-for-truth-and-justice-in-public-health-care/
http://www.torontosun.com/2013/10/11/why-did-woman-die-after-routine-surgeryhttp://www.torontosun.com/2013/10/18/secret-medical-cautions

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Should you wish to send your MPP your concerns please do so.

My own MPP sold his soul for a Cabinet Position and to get his daughter a $100,000 plus job in Ford’s Government!

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STEVE CLAKE, GRENVILLE--THOUSAND ISLANDS AND RIDEAU LAKES

steve.clark@pc.ola.org

Ministry office

Ministry of Municipal Affairs and Housing
17th Floor
777 Bay St.

Toronto, ON M5G 2E5

Tel.: 416-585-7000

Fax: 416-585-6470

Constituency office

Suite 101
100 Strowger Blvd.

Brockville, ON K6V 5J9

Tel.: 613-342-9522

Fax: 613-342-2501

Toll Free: 1-800-267-4408

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