INSTITUTIONAL BETRAYAL—Death Investigation Oversight Council re: Dr. Bert Lauwers and Dr. Andrew McCallum
Death
Investigation Oversight Council re: Dr. Bert Lauwers and Dr. Andrew
McCallum--appointed by Liberal majority gov't
all were given the medical
facts and expert opinions mentioned previously
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!
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
Latest response from the DIOC-- they should be charged with Breach of
Trust.--- What a farce this institution is--- they merely cover up Ontario
complaints and present a false avenue for citizens to persue should they want
to make the Chief Coroner's Office more accountable and transparency, as well
as, more honest: -- they don't even have the guts to have a
real person signing this e-mail. Talk about transparency????From: DIOC (MCSCS) DIOC@ontario.ca
>Sent: March 23, 2016 10:23 AM
To: Arnold KilbySubject: Response
Dear Mr. Kilby:
As indicated in the DIOC Complaints Committee reporting letter sent to you on August 28, 2013, your file with the Death Investigation Oversight Council is closed.
A subsequent letter was sent to you on October 10, 2013 to thank you for taking the time to continue putting your concerns in writing.
E mails and any other correspondence between you and the Death Investigation Oversight Council will be included in your file.
Sincerely,
DIOC Secretariat
*********************************************************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 lawfirms. 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.
NO ONE APPEARS TO WANT TO PROVIDE THE TRUTH; THIS INCLUDES HUMBER RIVER HOSPITAL, THE COLLEGE OF PHYSICIANS AND SURGEONS AND THE CHIEF CORONERS OF ONTARIO.
From a recent Toronto Star Article
“We are not a public organization. . . Our accountability is to our members,” said the College’s executive director, Dr. Francine Lemire. CPSO
Keep in mind the Chief Coroner and many that work inside this Office are members of the CPSO
Dr. Huyer,
I believe the Patients Safety Review Committee contains the expertise of determining whether there were or were not systemic issue contributing to my daughter's death.
You, nor Dr. Lauwer's expert possess this expertise. (just look at what the expert did not notice or comment on)
I believe these experts are far more capable of determining if there appears to be system-based errors than YOU. This is when my daughter's death should have been sent by Dr. Lauwer's, Dr. McCallum.
I believe #7 from the Aims and Objectives of the PSRC applies in this case.
Annual Reports from the Coroner’s Office
"The complexity of cases involving patient safety issues, however, often requires specialized knowledge and expertise in order to fully understand the intricacies of the circumstances of the death. The PSRC develops recommendations aimed at preventing similar future deaths, which are sent to the relevant agencies and organizations by the Chief Coroner for Ontario."
The Patient Safety Review Committee (PSRC) was established in 2005 in order to address the need for specialized knowledge and expertise and to help expedite the review of coroners’ cases with actual or perceived systemic patient safety implications, and where possible, to make recommendations to prevent future similar deaths.
The aims and objectives of the PSRC are:
- To provide expert opinion about the cause and manner of death in healthcare-related cases where systems-based errors appear to be a major factor.
- To assist coroners to improve the investigation of deaths within, or arising from, the health care system in which systems-based errors appear to have occurred.
- To stimulate educational activities for professionals through identification of systemic problems, referral to appropriate agencies for action, collaboration with professional regulatory bodies and the dissemination of an annual report. Emphasis will be placed on speedy dissemination of information.
- To provide expert evidence at inquests on request.
- To conduct or promote research, where appropriate.
- To undertake random or directed reviews when requested by the chairperson.
- To help identify the presence or absence of systemic issues, problems, gaps, or shortcomings of each case to facilitate appropriate recommendations for prevention.
THE OFFICE THAT CONDUCTED MY DAUGHTER'S DEATH REFUSES TO ANSWER THE QUESTIONS POSED TO THEM IN A WRITTEN RESPONSE. WHY ONLY AN ORAL RESPONSE WITH NO PERMANENT RECORD OF THE MEETING?
ONTARIO CITIZENS--WAKE UP! AND SMELL THE ROSES.
DIOC Question -- Will these Members of
the DIOC conduct an unbiased, transparent, honest investigation or merely
support the corrupt, unjust decisions by the top men at the CCO??? Really,
are there any honest, ethical men and women in Ontario appointed to promote
accountability and transparency. My family and friends, along with
hundreds, if not thousands of others don't believe there are. But, let us
give these people a try.
***********************************************************I am well aware the DIOC does not deal with any aspect of a public inquest but there is so much more.
Firstly, the DIOC stated they could not investigate the medical aspects of my complaint.
One would think this would be the primary reason a complainant would have against the Chief Coroner.
Secondly, the DIOC accepted the Coroner's reasoning not to send my daughter's death to the Patient Safety Death Panel as his expert found no systemic issues or factors related to her death that this panel could investigate and make recommendations. Did the DIOC read this expert's report??
Did they really believe the medical issues I pointed out did not factor in the slightest way and contribute to her eventual death? Now, after the fact, we see more deaths by this same surgeon, we see the CCO secretly shut down this surgeon's department in 2010 due to deaths in 2009, and we have the death of Crystal Rose in 2012.
ISN'T HINDSIGHT A BITCH.--SADLY THESE DEATHS MAY VERY WELL HAVE BEEN PREVENTED.
But why not admit the error and do something --- like apologize first for many things-- my treatment, the inept death investigation, the continued concealment of the truth and grant my requests-- valid public recommendations can still be forthcoming.NOW, WILL THE DIOC TRULY SET THE RECORD STRAIGHT, AND PROTECT ONTARIO CITIZENS OR SIMPLY CONTINUE THE COVER-UP TO PROTECT THE FEW PRIVILEDGED, WELL PAID PUBLIC OFFICIALS.
But I am sure it can deal with the following as it relates to past Deputy Chief Coroner, past Chief Coroner and the probability that the Current Chief Coroner will not respond and should he, it will be a denial as the office continues to conceal the truth behind the death of my daughter by this surgeon which would be reveal if any of my request were to be granted.
Interesting to note the DIOC did actually begin their original investigation while my dealings with the CPSO and HPARB was still going on? What changed their thinking? Was it that the DIOC had waited until both Dr. Lauwers and Dr. McCalllum left the CCO? I think this was the case. You still have my original and it still applies as I am sorry but the previous panel demonstrated a lack of a real a deep investigation and that continues to affect other family members dealing with a death investigated by the CCO
I think with a more
thorough investigation the DIOC will see that no citizen in Ontario can expect
the CC to conduct a true investigation if it is related to a hospital or fellow
colleague and
member of the CPSO. Or will this investigation committee be composed of:
I guess we will all find out when and if they act? It
took two years for them to investigation the first time I asked. If that's
the case, I'll be dead and not know.member of the CPSO. Or will this investigation committee be composed of:
If the DIOC can actually make recommendations to the Premier and Minister, it should be that those working in the CCO should have not any affiliation with the CPSO or CMPA. It creates a conflict of interest and Ontario Citizens lose.
This office should change its motto. D'arcy McGee is flipping in his grave.
Dr. Lauwers, Dr. McCallum and Dr. Huyer do not Speak For the Dead to
Protect the Living. It should become "We Speak For The Dead to Protect the Living Only if We Can Protect Our Colleagues" This would be more truthful.
It should also be noted that many more deaths occurred at this Hospital by this same surgeon after the death of my daughter in 2006. In 2010, the CCO temporarily shut down this surgeon's department due to 5 or 6 deaths in 2010. They did so without public knowledge -- on the hush. Crystal Rose was another victim of Dr. Klein's in Dec of 2012.
It should be noted the previous DIOC probably contributed to these further deaths and the CCO definitely is responsible.
They continued with this so I had two video-taped interviews at the Brockville OPP station. After the last video-taped interview and no Charges, OPP Detective Seeley told me that he had talked to the two the week before and asked them why they would not just meet with me and answer my questions. They both respond to him "WE WILL NOT MEET WITH HIM AND WE WILL NOT ANSWER HIS QUESTIONS.
Gee and this office did the death investigation and the father is not allowed to question and get answers. The Ontario Ombudsman's Office asked the same question and go the same answer. Makes one wonder what they are afraid of revealing. Probably the fact they have been conducting inept death investigations for years. These two made a great salary paid by the taxpayer of Ontario but their allegience is to the CMPS and CPSO.
It should be noted that I had attempted to access information though the Freedom of Information Act. Since I had to send this to the Ministry of Corrections, I fully expected that I would get nothing. My MPP, Steve Clark whom I met last Friday when I was mentioning this to me, held up a blank white sheet of paper and asked if this is what my response looked like. Yep, it certainly did. I did tell Steve the first 50 pages were complete---- photo copied pages of bariatric surgery--- nothing to do with my request and my daughter did not have this surgery. All I had asked for was the number of deaths and dates of CCO death investigations after my daughter's death with Dr. Klein being the surgeon.--- no names of the patients. Even in one part where they mentioned investigations the one small 1 centimeter space that would have had a number was blackened out.
It should be noted I have the expert opinion of qualified surgeons from outside of Canada that puts Dr. Lauwer's so-called expert to shame. Pay close attention to what his expert says, but more importantly what he omits, on purpose.
It should be noted when I did meet with Dr. Huyer, he was very careful not to use the words "patient safety concerns" but use "patient care concerns" and they should be dealt with by the hospital and CPSO. He will be very hesitant to put anything in writing. I know what his response will be from his comments at this meeting. He didn't want to comment on the other two, only to say "they don't work here anymore" and I know how much he cares about the citizens of Ontario and respects the DIOC.
Only a complete idiot would swallow their opinion and Dr. Huyer's and agree my concerns I pointed out, in no way factored into the death of my daughter. You don't need to be a medical expert to discount their unsubstantiated reasoning.
I AM HOPEFUL DIFFERENT DIOC INVESTIGATORS WILL TAKE MY COMPLAINT MORE, I can't find the write word, AND DO A MORE THOROUGH INVESTIGATION INTO MY CONCERNS WITH DR. LAUWERS AND DR McCALLUM AND THE CURRENT CHIEF CORONER, DR HUYER WHO I KNOW WILL DENY MY REQUESTS.
I believe the DIOC should be contacting the OPP and demanding they investigate all three for "Breach of Trust by a Public Official"
I am formally requesting the Chief Coroner's Office send my daughter's death to the Patient Safety Death Panel
I am formally requesting the Chief Coroner's Officefor an Eastern Ontario Coroner's Review since Terra passed in Kingston
I am formally requesting you to initiate the Chief Coroner's Review Process with regard to all previous decisions made by the previous two mentioned above.
I am formally requesting a copy of the letter the Chief Coroner's Office sent to my expert and others at London Bridge Hospital, London, England which will reveal the past CCO people applying pressure on my expert to alter his written report so that it better reflects what the CCO wants.
Dr. Huyer and Ms Noonan, who appears to be the only one who in the past has contacted me with regard to my many e-mails ignored by Dr. Huyer, perhaps you can notify me if Dr. Huyer is afraid to comment on the record. Should you be responding by letter to my requests in the e-mail below, would you please notify me by e-mail as I am not presently at home and have only been in Lansdowne a couple days per month. I have my mail picked up by my neighbour.
************************************************
Chief Coroner of Ontario,
Dirk Huyer,
I WANT A WRITTEN RESPONSE. ASAP
Not once have you ever responded to me directly either by e-mail or letter. You have never gone on written record with regard to your opinions or statements. It is time to do so. As much as I appreciate Ms Noonan's responses, it is your responsibility to respond. One does not require a medical degree to ascertain the serious neglect by the surgeon and breach of trust by the CCO! You owe nothing to the previous two mentioned below but you certainly owe it those who died after Terra and to every single citizen in Ontario.
Since you did not wish to discuss the previous Chief Coroner, Dr. McCallum or Deputy Chief Coroner for Death Investigation at our meeting at the Coroner's Office building when we met, l would appreciate a written response from you ASAP. Your response was "they don't work here any more." When considering my requests please refresh your memory with Dr. Lauwers' medical expert's report which I will include in this e-mail. And then tell me there were no omission and commissions. As well, keep in mind the many deaths associated with my daughter's surgeon after Terra's death and the fact that your Office temporarily shut down Dr. Klein's department in 2010 due to numerous deaths which occurred during the 2009 up to February 2010. Also, keep in mind that you would not disclose how many deaths your office as investigated with regard to Dr. Klein and his patients.
Update: Feb. 24, 2016 Subject: Re: Formal Requests to the Chief Coroner
From: Huyer, Dirk (MCSCS) Dirk.Huyer@ontario.ca
> Sent: February 24, 2016 11:21 AM
To: Arnold Kilby Cc: Noonan, Julia (MCSCS)
Subject: RE: Formal Requests
Dear Mr. Kilby,
I am writing as a reminder of how we concluded the meeting between you, your family members, Ms. Noonan and I on June 26, 2014.
You requested the meeting so that you could present your questions to me and I provided responses based on my review of the information.
At the meeting I told you that I would not be responding to future dialogue about the death investigation of your daughter, her medical treatment or the decision not to hold an inquest as our investigation is complete.
You acknowledged my position at the June 26th meeting and in a subsequent e-mail on July 3, 2014.
Respectfully, Dirk
Dirk Huyer, MD Chief Coroner for Ontario 25 Morton Shulman Avenue Toronto, Ontario M3M 0B1 647-329-1814
**********************************************************
DR. HUYER
Congratulations on this being your very first e-mail sent to me from the many, many e-mails sent to you from me. Your wife and co-workers must be extremely please with your progress and joining the computer age. A bit of a slow learner, though.
It should be noted you will not comment with a detailed written statement with regard to my other requests.
You have cleverly used the meeting which was oral and no records kept for others to review:
IN ORDER CONCEAL NEGLIGENCE CONTRIBUTING TO MY DAUGHTER'S DEATH TO PROTECT THE SURGEON.
YOU CONTINUE TO CONCEAL THE DEATHS OF OTHER CITIZENS BY THIS SAME SURGEON.
YOU WOULD NOT COMMENT ON THE TEMPORARY CLOSURE OF HIS DEPARTMENT IN 2010 DUE TO MORE DEATHS.
YOU FAILED AT THAT MEETING TO DISCUSS THE ISSUES SURROUNDING THE PAST DEPUTY CHIEF CORONER AND PAST CHIEF CORONER AS YOUR ORAL STATEMENT WAS "THEY DON'T WORK HERE ANYMORE".
ARE YOU PREPARING FOR YOU OWN DEPARTURE FROM THIS OFFICE TO ESCAPE ACCOUNTABILITY AND TRANSPARENCY?
E-MAIL RECEIVED TODAY, FEB 24, 2016 "At the meeting I told you that I would not be responding to future dialogue about the death investigation of your daughter, her medical treatment or the decision not to hold an inquest as our investigation is complete.
You acknowledged my position at the June 26th meeting and in a subsequent e-mail on July 3, 2014."
**************************
IF YOU TRULY BELIEVE WHAT YOU SAID DURING THE MEETING, WHY NOT PUT IT ON PAPER??????
Do I have a written statement from you with regard to what you state above??? No, and not once did you respond to the e-mails your referred to above. Why? --Again, to avoid a paper trail. And does my e-mails to you agree with what was discussed at our meeting? Of course not.
YOU CONTINUE TO SHOW YOU MAY BE IN "BREACH OF TRUST BY A PUBLIC OFFICIAL"
I would like a written response to my other requests. Could you provide my MPP with written reasons as to why you will not respond in print to me.
DO YOU HAVE THE "BALLS" TO RESPOND AND ADDRESS MY CONCERNS SPECIFICALLY OR CONTINUE TO COMMENT WTHOUT SAYING ANYTHING AS YOU HAVE DONE TO OTHERS YOU HAVE MET WITH ie-- Charlotte in Northern Ontario, Michael west of Hamilton --do you require the names of others?
I forgot castration was mandatory in accepting the job of Chief Coroner. Perhaps, this explains your wife's excitement when you informed her of accepting the position.
And, when will the people who have the authority to act, ACT?
****************************************************I submitted my DIO complaint in February of 2011, That's two years ago. Apparently, mine is next in line--I have heard this before.
1) So, could someone explain to me why the above was not applied? NOW OVER TWO YEARS!
2) Was it delayed so that the Chief Coroner, Dr. Andrew McCallum, had a chance to vacate this position, which he did, to become the CEO of Ornge?
3) Are you waiting for Dr. Bert Lauwers to vacate his position, as well? HE DID BEFORE THE DIOC STARTED.
4) Do you actually have my submission and all the extras sent to the DIOC over the past two years?
5) I know there is no time limit set when you actually begin to look at my complaint and come up with a final decision BUT can I expect it in less than TWO YEARS?
As an advisory body, the purpose of the complaints committee is to consider complaints with a goal of improving Ontario’s death investigation system. The committee is not an investigative body and it is not within its mandate to review or assess medical conclusions or opinions with respect to a cause or manner of death. In reviewing a complaint, the committee will consider the procedures undertaken during the course of a death investigation. If you are unable to find suggestions to improving Ontario's death investigation system after looking through my complaint I would be happy to point them out to.
**********************************************************************
Dear Mr. Kilby, Thank you for your email.
I can confirm that your complaint is next to be reviewed by the Complaints Committee. The Complaints Committee will begin to review your complaint once the review they are currently undertaking is finalized. As the amount of time required to review a complaint varies from case to case, we are unable to provide you with a set completion date. We will, however, provide you with a bi-weekly update on the status of your complaint. We may also contact you if the Complaints Committee requires any further information or clarification. Please note the purpose of the Complaints Committee is to review complaints with a goal of providing advice in order to help improve Ontario’s death investigation system. As an advisory body, it is generally not within the committee’s mandate to review or otherwise assess substantive medical conclusions or opinions with respect to the cause or manner of death. Consequently, and to the extent that your complaint before the DIOC may raise such issues, these aspects of your complaint may be outside the authority of the committee to consider.
Should you have any questions on the complaints process or the role and mandate of the organization, please email us or call 416-212-8443 or toll free 1-855-240-3414.
Thank you, DIOC Secretariat
***************************************
February 21st 2012
Mr. Arnold Kilby 888 County Road 2 Lansdowne, Ontario KOE1LO
Dear Mr. Kilby:
Thank you for your response to the request for information that was sent to you on behalf of the Death Investigation Oversight Council's (the "DIOC") complaints committee (the "committee"). I am writing to you on behalf of the Chair of the committee in regards to your complaint file.
Based on its legislative mandate, the purpose of the complaints committee is to review complaints with a goal of providing advice and recommendations in order to help improve Ontario's death investigation system. As an advisory body, it is not within the committee's mandate to review or otherwise assess substantive medical conclusions or opinions with respect to the cause or manner of death. Consequently, and to the extent that your complaint before the DIOC may raise such issues, these aspects of your complaint may be outside the authority of the committee to consider.
In addition, the materials you recently provided regarding your complaint, that is currently before The College of Physicians and Surgeons of Ontario ("CPSO") and the Health Professions Appeal and Review Board ("HPARB"), have been reviewed. Please be advised that it is the policy of the committee to avoid the risk of collateral proceedings by deferring the review of a complaint matter where similar issues may be raised in another proceeding, such as your matter that is before the CPSO or HPARB.
Once your proceedings before the CPSO and/or HPARB have concluded, the committee would appreciate a copy of the results of those proceedings, and at that time, the committee can then begin to undertake a formal initial consideration of your complaint matter to determine what, if any, aspects of your complaint may fall within the mandate of the committee for review.
Sincerely, Ali Veshkini Manager Death Investigation Oversite Committee **********************************************************************
DIOC Chairman,
You committee has missed the point. My complaint with the College of Physicians and Surgeons being reviewed by the Health Professions Appeal and Review Board concerns the pre and post- operative care provided to my daughter by the surgeons, Dr. L. Klein. Why wait for HPARB's decision. I won the first time, I will win the second time and the College will then get a third attempt to get it right???? The above is not the same as my complaint against Dr. Lauwers.
My complaint against Dr. Lauwers is that he failed to effectively investigate my daughter's death by using a medical opinion that omitted numerous facts found within my daughter's hospital records and he failed to act upon my documented concerns. This inaction very well may have contributed to at least 5 more deaths at this same hospital under the same medical department. Two completely different complaints.
Yes, of course they are related. Both complaints are valid and provide evidence to support them. We now have two institutions protecting the reputation of doctors/surgeon rather than protecting patient safety!
*****************
Dear Mr. Kilby:
Thank you for your recent correspondences to the Death Investigation Oversight Council (the "DIOC").
This letter is to acknowledge receipt of your recent email correspondences that are listed in Appendix A, which have been added to your complaint file.
In addition, thank you for a copy of the Health Professions Appeal and Review Board ("HPARB") decision dated June 7th 2012 (File # ll-CRV-0401) relating to your complaint matter that is before the College of Physicians and Surgeons of Ontario ("CPSO").
It appears that at this time your matter is complete or substantially complete in regards to your complaint with the HPARB and the CPSO. Your complaint file with the DIOC may be finalized in preparation for its initial review by the DIOC complaints committee in order to determine if your complaint, or aspects of your complaint, are within the mandate of the Council.
Based on DIOC's legislative mandate, the purpose of the complaints committee is to review complaints with a goal of providing advice in order to help improve Ontario's death investigation system. As an advisory body, it is generally not within the committee's mandate to review or otherwise assess substantive medical conclusions or opinions with respect to the cause or manner of death. Consequently, and to the extent that your complaint before the DIOC may raise such issues, these aspects of your complaint may be outside the authority of the committee to consider.
The committee is currently conducting a review of a complaint and once this review is concluded, the initial assessment of your complaint matter may begin. In addition to notification with respect to the status of your complaint, the complaints committee may also contact you if they require any further information or clarification.
Sincerely AV Manager Death Investigation Oversight Council
***
I RECEIVED NO REPLY TO THIS LETTER I SENT
Ms. Emily Musing
Dec. 17, 2014
Chair of the
Complaints Committee
Death Investigation
Oversight Council
Ms Musing
With regard to Issue 1, I look forward to the DIOC providing
me with additional information and a decision when the Council has the
authority to do so.
The second issue with
regard to the Patient Safety Review Committee, I find very frustrating and
highly questionable. Perhaps the COO
does not identify system issues because they didn’t want to find them. The antibiotic concern is one major system
issue! If they didn’t see this, it
proves they didn’t want to find any! I
WOULD LIKE A DETAILED EXPLANATION SUPPORTED BY DOCUMENTED FACT AS TO WHY MY
DAUGHTER’S DEATH DID NOT MERIT GOING TO THE PSRC. It is not sufficient to merely say so but to
give precise, accurate and responsible statements.
Yes, I did meet with Mr. Huyer last June. I might add that this meeting only came about
by my numerous requests. Mr. Huyer at
this meeting stated that the OCC lawyers had recommended to him not to do
so? At that meeting he dismissed all of
my concerns with this was a patient safety issue best dealt with by the College
and/or the Hospital. His unsupported
opinion was they did not directly result in Terra’ death. This may be true in part but to say they had no role or factor is an incredibly ridiculous and
false assertion.
The OCC has used these lines ever since they conducted the
death investigation and I began questioning the validity of this. For the DIOC to accept the CCO’s opinions
unsubstantiated with medical fact is absurd.
We have the same “cover-up” continuing by Dr. Huyer, the new Chief
Coroner to basically keep the truth from coming forth and to protect those in
the past. HOW CAN THE DIOC ALLOW THIS TO
CONTINUE?
I won’t go in to every issue but I would like a response to
some:
1. Please tell me why
the DIOC would not question an elective
open surgery for the removal of a tumor and a colon resection being performed
occurring without the mandatory antibiotic prophylaxis. The autopsy stated there was necrosis of the
tissue surrounding the colon resection.
What caused the tissue to die? No
one from the COO has answered this question as well as the College. Don’t tell me that this did not play some
factor into the colon resection breakdown, even if was a small role. The COO discounts this completely.
2. Since the
mandatory antibiotic prophylaxis was not done, why were there no antibiotics given to treat the abdominal
infection (see medical records for description of incision) and all had to
be removed? Don’t tell me that this did
not play some factor into the patient’s overall condition, even if was a small
role. The COO discounts this completely.
3. Since neither of
the above occurred, could you tell me why my daughter did not receive antibiotics for the presence of “many gram negative
bacilli” (same category as C Dificile).
Don’t tell me that this did not play some factor into the patient’s
overall condition, even if was a small role.
The COO discounts this completely.
4. From a letter to
the College from Dr. McCallum when he was the Eastern Ontario Coroner stated “the operation was complicated by an
infection”. Gee, and no antibiotics
given???? But the COO still maintains
the infection was nothing!
5. The COO temporarily shut down the same hospital department including my daughter’s
surgeon in 2010 due to 5 – 6 deaths and had an expert brought in to evaluate
the program and make recommendations.
These deaths apparently had similarities. It’s hard to get details but a nurse at the
Hospital told me “bleeding to death” which occurred with my daughter!
6. Please tell me that all of the following
would not have been a concern that may have led to further investigation by the
surgeon and possibly prevented my daughter’s death. The COO and College like to discount every
one separately as if they were a single issue by itself and refused to evaluate
them together. I am certain the Patient
Safety Review Committee would find these to be a concern and would definitely
be able to make the appropriate recommendations.
THE INCISION from July 15 to release
from hospital, incision was infected See
hospital RecordsABDOMINAL SWELLING from July 13 to release from hospital With significant nausea, vomiting, or abdominal distension, x-rays of the abdomen should be obtained. See hospital Records
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 See hospital Records
Temperatures
23 out 38 recorded temperatures were not in the normal range See hospital Records
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. See hospital Records
All Five Hematocrit test
scores below normal range. See
hospital Records
Red Blood Cell Count test
scores---one at lowest of normal and other four below See hospital Records
All five Absolute Lymphocytes well below normal range. See hospital Records
All four UREA Blood Urea scores well below normal range.
See hospital
Records
Terra was on a liquid diet of juice, jello, brothe and
tea for 8 ½ days. (last two meals were
regular) This
diet should not be used for a long period of time unless vitamins, iron, or
liquid nutritional supplements are added.
Terra received no nutritional supplements. She was receiving only 687 calories per day that
equates to a starvation diet.
With no nutritional supplementation!!!!!
I PROVIDED ALL THE
NUTRITIONAL INFORMATION WITH THIS LETTER.
NUTRITION DOES
PLAY A MAJOR ROLE IN HEALING AND FOR THE COO TO REFUTE THIS IS AN UTTER LIE!
7. This doesn’t pertain to my case except that the COO
is operating as is with many others in the past year. That is, meeting with numerous complainants
trying to explain why the COO does act when it comes to deaths associated with
hospital/surgeon care? All of which are
completely dissatisfied with Dr. Huyer.
8. This
same surgeon has quite a few deaths associated with him—difficult to ascertain
as the F O I, cleverly blacks out my simple request which did not ask for names
only the number of deaths associated with Dr. Klein. Crystal Rose, a 27 year old young lady died
at his hands in December of 2012!
If the COO sent Terra’s
death to the Patient Safety Review Committee long ago, Crystal above and some
other death may well have been avoided.
And for the DIOC to not
send this to the PSRC, more deaths will certainly occur as the COO continues to
shield the surgeons/hospital and place Ontario citizens last.
This Office certainly
makes their motto very questionable. “We
Speak For the Dead to Protect the Living”
The DIOC has a role to
play to ensure the COO honours their motto.
Arnold W Kilby
CC: Steve
Clark, MPP Leeds and Grenville
Christine Elliott MPP
A.
Marin,
Ontario Ombudsman
Alan Shanoff – Sun
Columnist
And to many other
families who have dealt with the COO
*****************************************************************************
The
Devil’s Advocates Exists Within Ontario’s Health Care System
One wonders who does
the Devil’s work?
Within the system they
do lurk!
The CPSO, Satan’s prime disciple!
The entire executive is
unaccountable.
Exhibiting evil and
committing lies,
Protecting negligence,
not saving lives!
The Chief Coroner is Satan’s kingpin!
Covering up deaths; Lauwer’s prevalent sin!
McCallum and
Huyer disbursed the devil’s tolls.
Satan quite pleased
with all three roles!
Premier
McGuinty and Premier
Wynne,
Have also committed a
demonic health care sin!
Health
Ministers Hoskins and Matthews,
Execute Satan’s
mission; thus paying their dues.
Let us not forget the Liberal MPP’s,
Following blindly
unable to see!
How is Satan collecting
your membership fee?
An afterlife in Heaven
will not be!
There are others
fulfilling the Devil’s quest,
HPARB,
Ombudsman Dube, DIOC; and the rest.
To Heaven, our loved ones journeys’ end,
To Hell for those; the Lord will send!
Fleeting time to change your story,
Or spend eternity in purgatory!
Terra
Dawn Kilby April
22/78 – July 21/06
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