INSTITUTIONAL BETRAYAL===Health Professions Appeal and Review Board

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

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?

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

Health Professions Appeal and Review Board

 HPARB's Decisions Kilby vs Laz Klein.

http://www.canlii.org/en/on/onhparb/doc/2010/2010canlii44390/2010canlii44390.html First Decision

http://www.canlii.org/en/on/onhparb/doc/2012/2012canlii39837/2012canlii39837.html Second Decision.

http://www.canlii.org/en/on/onhparb/doc/2013/2013canlii46625/2013canlii46625.html Third Decision

Regarding the third decision; I PERSONALLY DO NOT BELIEVE THAT THE HPARB PANEL TRULY STUDIED MY SUBMISSION,

OR

THEY WERE FOLLOWING INSTRUCTIONS TO PUT AN END TO MY CONTINUED ATTEMPTS TO HOLD THE COLLEGE TO FULFILL ITS DUTY TO PROTECT PATENTS.

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

The past Liberal Health Ministers have fail in their duty to the public, are you going to do the same?

Our newly elected Conservative Government and the Health Minister must step in to correct this injustice!!!

From the College’s magazine “Dialogue”         April Issue 2009

“Either party can then make an application to HPARB following which HPARB can direct the ICRC to continue the investigation, make recommendations to the ICRC as HPARB sees appropriate, or take over the investigation.”   

This was denied and during the third review the panel appeared surprised that I had mentioned this and also appeared to be unaware of this procedure.

PHad they taken over the investigation and/or granted my request for Reconsideration the further deaths occurring and adverse events under this surgeon may well have been averted!

MY Request to HPARB for Reconsideration of their third decision with regard to Procedural Fairness and Principals of Natural Justice --- Denied by HPARB

Ms Vauthier

HPARB

From your letter dated, January 12, 2015

“With respect to the Board’s decision in the matter of 08-CRV-0097, the Board has reviewed your request and can find no basis upon which to reconsider its decision.  A reconsideration by the Board is discretionary and will only be undertaken in exceptionally circumstances that demonstrate the Board acted outside of its jurisdiction, did not consider an issue it was mandated to determine, or that its processes were in breach of natural justice or lacked procedural fairness.  In 08-CVR-0097 the Board returned your complaints to the Investigations, Complaints and Reports Committee of the College of Physicians and Surgeons of Ontario for further assessment.  The Board conducted its review in accordance with its legislated mandate and there is nothing to suggest its review was not carried out in accordance with the principals of natural justice or that is lacked procedural fairness.  As such, the Board will not be reconsidering its decision in the matter of 08-CVR-0097.”

NOW WITH REGARD TO PROCEDURAL FAIRNESS AND PRINCIPALS OF NATURAL JUSTICE:

THE BASIS FOR RECONSIDERATION IS CLEARLY STATED BELOW:

#1  Having the Chair for the third appeal, who pretty much control the entire proceedings from London, Ontario (Forest City Lawyers - London)  as is the College's Independent Opinion Provider, Dr. Brian Taylor.

No problem perhaps, but it certainly explains how this HPARB panel completely came up with their incredible decision and prevented me from giving my oral presentation.

I would have thought the Chair would have excused himself from this panel!

This was extremely unfair and the procedural process was definitely affected negatively.

#2  The contradictory CPSO's opinion with their own expert as well as the factual documentation within Terra's medical records!

This was extremely unfair and the procedural process was definitely affected negatively.

In response to a request for further information from the College, the IO provider also set out the following information:

*                     The standard of practice for open bowel resections is to provide antibiotic prophylaxis.
However, such administration would not reduce the risk of anastomotic leak.

*        The standard of practice would be to administer prophylactic antibiotics in connection with laparoscopic procedures if the bowel were involved; however, in this case, Dr. Klein believed he would be dealing with a cyst only and not opening the bowel, so the standard would not require administration of prophylactic antibiotics for the laparoscopic procedure.

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 chart I submitted for the third appeal.

Note the Procedure Desc. In the following chart:

“Laparoscopic Colon Resection Attempted For Mesenteric Mass”

The second Procedure Desc. indicates the laparotomy.

                                         

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.”

From Dr Klein’s own notes:

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

From Dr Klein’s letter to Terrra’s Family Doctor

So, he  has suspected this was a possibility Three  months prior to the operation

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  

Issue before the Committee

HPARB directed the Committee to reconsider this matter in light of the question of whether Dr. Klein met the standard of practice concerning the use of preoperative antibiotics.

Addendum Report from the IO Provider

The IO provider set out the following information in an addendum to the IO report:

*        The issue of antibiotic administration at the time of conversion to an open procedure is really not relevant to the outcome for this patient.

AWKILBY’s Response:  The outcome is not part of the complaint!          

*        Most general and colorectal surgeons administer antibiotics preoperatively prior to laparoscopic or open colorectal surgery, as they have been shown to reduce the incidence of wound infection. Antibiotics, however, have not been shown to decrease the incidence of anastomotic leak.

AWKILBY’s Response: Temporarily forget the anastomotic leak which was not in my complaint..  The above statement indicates the Standard of Care that was not followed by Dr. Klein.

#3   The complaint was about the Standard of Care not my daughter’s death.  Interesting to note the College always mentions the tragic outcome.  Stick to the Standards of Care not the Death.  HPARB got sidetracked away from Standard of Care and somehow interpreted the Standard of Care not resulting in the death.  This was not the complaint.

How can HPARB not focus on the actual wording from the Independent Opinion Provider and the College with respect to their statement contained within the Second and Third Decisions?

·        "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 Committee would suggest that Dr. Klein consider the routine use of antibiotics in such circumstances. Having said that, we do not consider this oversight to have contributed to the unfortunate outcome in this case."

         Neglected equals Negligence 

Notice how the College brings into the discussion my daughter's death from these example below:   reason to deflect away from the standards of care to the Terra's death

      "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 Committee would suggest that Dr. Klein consider the routine use of antibiotics in such circumstances. Having said that, we do not consider this oversight to have contributed to the unfortunate outcome in this case."  

       "The issue of antibiotic administration at the time of conversion to an open procedure is really not relevant to the outcome for this patient."

"He agrees with the IO provider that:    The issue of antibiotic administration had no bearing on the outcome of this case,”

 

   “The only benefit of pre-operative prophylactic antibiotics is to prevent a postoperative wound infection,   Preoperative antibiotics have no preventative or beneficial effect for an anastomotic leak."

"Further to this clarification, the Committee notes that, as supported by the IO, the lack of antibiotics in this case did not influence the unfortunate outcome, given there was no evidence of sepsis at the time of the discharge from the hospital."

THE STANDARD OF CARE IS THE ADMINISTERING OF THE MANDATORY ANTIBIOTIC PROPHYLAXIS NOT THE OUTCOME! 

This was extremely unfair and the procedural process was definitely affected negatively.

#4   It appears this decision was made in record time: two months from the meeting in June my receiving the decision by mail on Aug. 1st.   

This was extremely unfair and the procedural process was definitely affected negatively. It makes one wonder whether HPARB had already decided well before, especially considering the following:

--HPARB appears to substantiate the College's opinion that Dr. Klein did not know that a colon resection was to take place until after he converted to an open abdominal surgery.   The HPARB panel totally disregarded the operation record that clearly stated that the first procedure attempted was:   "laprascopic surgery for colon resection."  This clearly indicates that he knew that a colon resection was to be performed before he opened her up.

--No antibiotics what so ever, even after an abdominal incision infection and the presence of "many gram negative bacilli".  Again, found in the hospital records.   Also, they ignored the letter from then Eastern Ontario Coroner which stated reasons for death also included "complicated by an infection

--Totally ignored my expert's opinions.

--Again, common sense.   Not an emergency situation, this was elective surgery supposedly well planned.  --- A surgeon is going to make an 9 inch incision in the abdomen, move around some internal organs, remove a tumor and perform a colon resection.----- without the mandatory antibiotic prophylaxis.

#5   The Third HPARB appeal panel had my submission on their laptops but they could not locate the sections I was referring to during my oral presentation.   They became so frustrated, the Chair, Thomas Kelly interrupted me and stated that I need not continue as they had read the submission.  BUT, I had my presentation prepared to highlight and point out the inconsistencies with regard to the College’s opinion and the medical facts contained within the hospital records and supporting documents.  This was extremely unfair and the procedural process was definitely affected negatively.

# 6  How could HPARB be sidetracked away from the "Standards Of Care" issues and be concentrating whether these issues to led to my daughter's death?   HPARB should have been dealing with whether the Standards of Care were held up to, or not!

This was extremely unfair and the procedural process was definitely affected negatively.

# 7  And Dr. Klein merely laughs off the College decision:   And this was in with the package the CPSO sent to HPARB.

From letter sent to the College by Dr. Klein

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 Kilbv - 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

AGAIN, WE ARE TALKING ABOUT STANDARD OF CARE NOT THE OUTCOME.
Oh, my God!!!!   Dr. Klein has not learned a thing from Terra's death and is obviously going to continue as he did!

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

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Health Minister:

According to Regulated Health Professions Act you do have the authority to look into the CPSO either personally or through the Advisory Council. You may consider this as possibly seen as interfering, but it is your responsibility to do so, and you are mandated to do so!
--matters concerning the quality assurance programs undertaken by Colleges; -- They are not placing patients and patient safety first; therefore they are completely ineffective when it comes to investigating complaints

-- each College’s patient relations program and its effectiveness; They are not placing patients and patient safety first therefor they are completely ineffective when it comes to investigating complaints

-- require the Council to do anything that, in the opinion of the Minister, is necessary or advisable to carry out the intent of this Act, the health profession Acts

AND question
--whether regulated professions should no longer be regulated;

Duty of Minister
3. It is the duty of the Minister to ensure that the health professions are regulated and coordinated in the public interest, that appropriate standards of practice are developed and maintained and that individuals have access to services provided by the health professions of their choice and that they are treated with sensitivity and respect in their dealings with health professionals, the Colleges and the Board. 1991, c. 18, s. 3.
Powers of Minister --“Council” means the Council of a College;

My daughter went through a colon resection and a tumor removed without the mandatory antibiotic prophylaxis, she also did not receive any antibiotics for the abdominal infection of the incision whereby all staples were removed.  As well, she did not receive any antibiotics for the presence of "many gram negative bacilli". 
  
NO ANTIBIOTICS WHATSOEVER DURING HER TIME IN THE HOSPITAL.   SHE BLED TO DEATH 12 HOURS AFTER DISCHARGE.   IS THE COLLEGE MAINTAINING THE APPROPRIATE STANDARDS?

5. (1) The Minister may,

(a) inquire into or require a Council to inquire into the state of practice of a health profession in a locality or institution;

(b) review a Council’s activities and require the Council to provide reports and information;

(c) require a Council to make, amend or revoke a regulation under a health profession Act, the Drug and Pharmacies Regulation Act or the Drug Interchangeability and Dispensing Fee Act;

(d) require a Council to do anything that, in the opinion of the Minister, is necessary or advisable to carry out the intent of this Act, the health profession Acts, the Drug and Pharmacies Regulation Act or the Drug Interchangeability and Dispensing Fee Act. 1991, c. 18, s. 5 (1); 2009, c. 26, s. 24 (1)

So again, would you please explain why the letters previously sent me states neither you nor your ministry can investigate my concerns??????
How can you possibly justify your inaction when within the Regulated Health Professions Act you do have the authority to step in?
If you would like the names of other Ontario citizens who feel the same, simply ask.

INQUIRIES, COMPLAINTS AND REPORTS COMMITTEE

DECISION AND REASONS

COMPLAINANT:         Mr. Arnold Kilby

PATIENT:                     Ms Terra Dawn Kilby

RESPONDENT:            Dr. Lazar Victor Klein (CPSO # 70489)

CPSOFILE#:              86981

INTRODUCTION

Mr. Kilby wrote to the College in June 2007. He expressed concern about the care his late daughter Ms Kilby received from general surgeon Dr. Klein, who performed her colorectal surgery at the Humber River Regional Hospital.

At the outset, the Committee wishes again to express its sincere condolences to Mr. Kilby on the loss of his daughter.

PROCEDURAL HISTORY

In January 2008, the Complaints Committee (the predecessor of the Inquiries, Complaints, and Reports Committee) considered Mr. Kilby's complaint and decided that the appropriate disposition was to take no further action.

Mr. Klein requested a review of the Committee's decision by the Health Professions Appeal and Review Board ("HPARB" or "the Board"). HPARB is an organization independent of the College, whose mandate includes reviewing decisions of health professions colleges when asked to do so by the person who brought the complaint, or by the health professional who was the subject of the complaint. Unless HPARB has specifically directed a disposition (which is not the case in the present matter), the Committee is free to come to any determination it feels is reasonable, after its reconsideration of the matter.

In March 2010, the Board returned the decision, as it did not agree that the Complaints Committee had addressed all of Mr. Kilby's concerns.

 AWKILBY’s Response:   Note the error above.  It was Mr Kilby requesting the reviews not Mr. Klein.

***************************************************************************************                                  QUALITY PROFESSIONALS / HEALTHY SYSTEM j PUBLIC TRUST

The Committee considered this matter again at its meeting of August 18, 2010 at which time it directed that an Independent Opinion (IO) from a colorectal surgeon be obtained. This IO was obtained, and the Committee considered it at its meeting of July 10, 2011, in addition to responses from Dr. Klein and Mr. Kilby. The Committee issued a counsel to Dr. Klein on timely documentation of discharge summaries, suggested that Dr. Klein may wish to consider the use of preoperative antibiotics for bowel surgery, and directed staff to omit the names of panel members on the decision.

Mr. Klein requested HPARB to review the Committee's July 2011 decision. In June 2012, the Board returned the matter to the ICRC, and noted the following in its decision:

 AWKILBY’s Response:   Note the error above.  It was Mr Kilby requesting the reviews not Mr. Klein.

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

•         The Committee's investigation of the complaint was adequate.

•         There were inconsistencies in the IO report regarding the standard of care and the use of
preoperative antibiotics.

•         The Committee's decision to counsel Dr. Klein on timely documentation of discharge
summaries and to take no further action on other aspects of the complaint is confirmed.

•         The Board's only remaining concern is the question of whether Dr. Klein met the
standard of practice concerning the use of preoperative antibiotics. The matter is returned to the Committee solely for further consideration and clarification of this important matter.

•         Although the Committee is not required under the Code to disclose the names of panel members, self-regulation carries with it an obligation of transparency and accountability, and the Committee's discretion to refuse to disclose the names of panel members should be exercised judiciously. In cases where the names of Committee members are not disclosed, the Committee should indicate the number of members of the panel and their qualifications to verify legislative compliance.

AWKILBY’s Response: The qualifications were not known before the HPARB meeting or during the HPARB meeting.   Somehow, they appeared in HPARB’s decision.  HOW---either the College or the panel were in contact with each other after the meeting which is not following procedure.

******************************************************************************                  A Surgical Panel of the Committee considered this matter at its meeting on September 14, 2012, and deferred its disposition in order to seek a response from Dr. Klein regarding additional information obtained from the IO provider on September 7 and 12, 2012. The Committee received Dr. Klein's response on October 3, 2012.

The Surgical Panel of the Committee considered this matter for a final time at its meeting on November 22, 2012.                                                                                                                                                             ROLE OF THE COMMITTEE

The College's complaints process provides a route for members of the public to raise concerns about a doctor's practice or conduct. The Regulated Health Professions Act requires the Committee to consider every complaint submitted to the College. The Committee, with the assistance of staff, conducts an investigation, then meets to review the written record of investigation and reach a decision.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                

The Committee cannot award financial compensation of any kind. Its process is not focussed on determining liability, or on punishing doctors. The Committee evaluates the investigative information available. It then determines what action, if any, is warranted, taking into account the seriousness and context of the concerns raised, the physician's insight into his or her practice, his or her capacity for remediation, and the physician's relevant College history, if any.

The Committee's role, broadly, is to protect the public by determining whether remedial action is necessary and, if so, what action would best enhance the quality of medical care of the particular physician, and the general quality of medical care in Ontario, by reinforcing the standards of practice.

The range of dispositions available to the Committee includes taking no further action, providing advice, cautioning a physician in writing or in person, or requiring a physician to complete a specified continuing education or remediation program.

In a small number of very serious cases, the Committee may refer a specified allegation of professional misconduct or incompetence to the College's Discipline Committee. The Committee will do this only where it believes that no alternative course of action could adequately protect the public interest, and that the available information has a reasonable chance of supporting a successful prosecution.

AWKILBY’s Response:  This only occurs if there is or has been a police investigation and usually after it goes to court!!

The Committee appreciates Mr. Kilby's action in bringing his concerns to the College's attention. Public engagement aids the College in protecting the public interest and improving the quality of physicians' care throughout the province. The Committee also acknowledges Dr. Klein for demonstrating professional accountability by providing a response.

ANALYSIS

The Committee always has before it applicable legislation and regulations, along with policies that the College has developed, which define the duties and responsibilities of physicians. Current versions of these documents are available on the College's website at www.cpso.on.ca, under the heading "Policies and Publications." If the Committee refers to a policy in its decision, a copy will be attached.

The Committee always has before it the physician's history with the College, if any. Investigative Information before the Committee

The information before the Committee included:

•    Original investigation record before the Committee in July 2011

•         Committee decision of July 2011

•         HPARP decision of June 2012

•         Addendum report from the IO, received September 10, 2012

•         Correspondence with the IO

•         Further Information from the IO, received September 12, 2012

•         Response from Dr. Klein via McCarthy Tetrault, received October 4, 2012

•         Additional information from Mr. Kilby

Issue before the Committee

HPARB directed the Committee to reconsider this matter in light of the question of whether Dr. Klein met the standard of practice concerning the use of preoperative antibiotics.

Addendum Report from the IO Provider

The IO provider set out the following information in an addendum to the IO report:

*                     The issue of antibiotic administration at the time of conversion to an open procedure is really not relevant to the outcome for this patient.

AWKILBY’s Response:  The outcome is not part of the complaint! ***************************************************************************   

*                     Most general and colorectal surgeons administer antibiotics preoperatively prior to laparoscopic or open colorectal surgery, as they have been shown to reduce the incidence of wound infection. Antibiotics, however, have not been shown to decrease the incidence of anastomotic leak.

AWKILBY’s Response: Temporarily forget the anastomotic leak.  The above statement indicates the Standard of Care that was not followed by Dr. Klein.

        In response to a request for further information from the College, the IO provider also set out the following information:

*                     The standard of practice would be to administer prophylactic antibiotics in connection with laparoscopic procedures if the bowel were involved; however, in this case, Dr. Klein believed he would be dealing with a cyst only and not opening the bowel, so the standard would not require administration of prophylactic antibiotics for the laparoscopic procedure.

 AWKILBY’s Response:  The above is pure BS except for the first line.  Gee, what changed from your thorough examination done for the second complaint and your findings then?   “Neglected”  & “Oversight”

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 chart I submitted for the third appeal. Note the Procedure Desc. In the following chart: “Laparoscopic Colon Resection Attempted For Mesenteric Mass”
The second Procedure Desc. indicates the laparotomy.

And from Dr. Taylors’(the College’s I.)letter to Angela Bates May 8th, 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.”
From Dr Klein’s own notes:
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                                                                                                                                                 

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

The standard of practice for open bowel resections is to provide antibiotic prophylaxis.
However, such administration would not reduce the risk of anastomotic leak.                      QUALITY PROFESSIONALS / HEALTHY SYSTEM / PUBLIC TRUST                                                                                                                          
 Information from Dr. Klein

Dr. Klein provided the following information in response to the addendum and subsequent information from the IO provider:      

He agrees with the IO provider that:

o   The issue of antibiotic administration had no bearing on the outcome of this case,

o   The only benefit of pre-operative prophylactic antibiotics is to prevent a postoperative wound infection,

o   Preoperative antibiotics have no preventative or beneficial effect for an anastomotic leak.

 AWKILBY’s Response:  But she did have a post-operative infection!   And what about the many negative bacillia seen?                                                                        

                                                                                                                       

 According to Hospital Records Terra had many gram-negative bacilli ---- Not Treated

*                     The administration of antibiotics after the conversion to the open surgery would likely have been of little benefit in terms of preventing a postoperative wound infection and would only have had the potential of causing side effects, which included C. difficile colitis.

*               AWKILBY’s Response: The conversion to open surgery should never have been done without antibiotic prophylaxis.  This surgery should have been postponed so that the patient could be properly prepared! 

*   Committee's Conclusion/Reasons

The Committee noted the following key points in reaching its decision:

•         The Board expressed concern with the Committee's suggestion to Dr. Klein to consider the use of peri-operative antibiotics, in particular in that the Committee noted:

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 Committee would suggest that Dr. Klein consider the routine use of antibiotics in such circumstances. Having said that, we do not consider this oversight to have contributed to the unfortunate outcome in this case.

 AWKILBY’s Response:  The outcome is not part of the complaint! *******************************************************************•        
The Board found this statement to be contradictory given that the Committee felt an important aspect of the care had been neglected, yet the decision did no more than suggest that Dr. Klein "may wish to consider the use of preoperative antibiotics for bowel surgery in future."

QUALITY PROFESSIONALS / HEALTHY SYSTEM / PUBLIC TRUST

In addition, the Board felt that the Committee's reason suggested that the use of preoperative antibiotics was entirely discretionary, but that such a view did not appear to be supported by the IO provider.

*        The Board also felt there were inconsistencies in the IO report. In particular, the IO provider indicated that the standard of practice with bowel surgery is to administer antibiotics, either orally or intravenously, approximately two hours prior to surgery sothat the drugs are circulating before the incision is made, but then concluded that the patient's "preoperative care, operative care and post-operative care seemed appropriate."

*        Given these concerns, the Board returned the decision to the Committee to clarify whether the administration of antibiotics at the time of conversion from a laparoscopic procedure to an open laparotomy would be required to meet the standard of practice.

*        The Board otherwise upheld the Committee's decision.

*        As part of its reconsideration of this matter, the Committee requested the IO provider to clarify whether the administration of prophylactic antibiotics at the time of conversion from a laparoscopic procedure to an open laparotomy would be required to meet the standard of practice.

*   The IO provider responded that antibiotics would not have been indicated at the time of the conversion in this case. He noted that antibiotics would have been indicated had the laparotomy procedure been scheduled from the start; however, Dr. Klein began with a laparoscopic procedure that would not have required antibiotics. In short, the IO provider noted that Dr. Klein believed he would be dealing with a cyst only, and as such, the administration of prophylactic antibiotics for the laparoscopic procedure would not be required to meet the standard of practice.

 AWKILBY’s Response:  The above is pure BS.  Gee, what changed from your thorough examination done for the second complaint and your findings then?   “Neglect”  & “Oversight”  And as previously noted  Dr. Klein started the laparoscopic procedure knowing full well that a colon resection was necessary to remove the tumor. ********************************************************************  

*        In addition to the IO provider's views, the Committee notes that at this time there is no consensus in the medical community based on available research to support that antibiotics should be administered at the time of conversion from a laparoscopic procedure to an open laparotomy. As such, the Committee agrees with the IO that the administration of antibiotics at the time of the conversion would not be required to meet the standard of practice.

 AWKILBY’s Response:  The above is pure BS.  Gee what changed from your thorough examination done for the second complaint and your findings then?   “Neglect”  & “Oversight” 

 Think about it,---a surgeon is going to make a 8 to 10 incision in your abdomen, spread it apart, move around some internal organs to get to the tumor, cut open a colon etc-----All done without antibiotic prophylaxis----I DON’T THINK THIS IS A STANDARD OF CARE AND IT CLEARLY INDICATES NEGLIGENCE!! ******************************************************************      

*      That said, there may eventually be developments in medical research that will provide definitive support for the use antibiotics at the time of conversion. Therefore, the Committee will take the opportunity to advise Dr. Klein to continue to consider the use of prophylactic antibiotics at the time of conversion from laparoscopic procedure to open laparotomy based on the evolving standard of practice.

*                       We acknowledge that Dr. Klein indicated he did appropriately consider the risks and benefits of administering antibiotics at the time of the conversion, and ultimately determined that the former outweighed the latter in this case.

 AWKILBY’s Response:  The above is pure BS. Dr. Klein misled (lied) to the CEO and COO when Dr. Philip Hebert on my behalf sent 10 questions to be answered by Dr. Klein.  In a telephone conversation I had with Ms B. Collins, COO, she stated that he still maintained that he administered the antibiotic prophylaxis.  She had to point out to him that he had not.  This phone call took place quite some time after I received the Hospital’s Response #4 below:

Dear Mr. Kilby:  October 2, 2008

We received a series of questions from you through Dr. Hebert. The purpose of this letter is to respond to your questions. In preparing this response, we have received input from Dr. Klein and we have reviewed the clinical notes and records available at HRRH relating to the treatment and care provided to your daughter, Terra.

The questions, as received from Dr. Hebert, are set in the attached document, along with our response.

We hope that these answers to your questions are of assistance. We would again like to express our sincere condolences for the loss of your daughter Terra.

Yours truly,  Barbara E Collins

COO  Humber River Regional Hospital                                                                                       

4. ANTIBIOTICS

  AWKILBY’s Response:  Was antibiotic surgical prophylaxis done at proper time  before time of the operation?. Dr. Klein has advised that Terra was given the appropriate pre-operative antibiotics

Further to this clarification, the Committee notes that, as supported by the IO, the lack of antibiotics in this case did not influence the unfortunate outcome, given there was no evidence of sepsis at the time of the discharge from the hospital.

 AWKILBY’s Response:  The outcome is not part of the complaint! *********************************************************************************      

*                             The Board was also concerned by the prior Committee's failure to provide the names of its panel members on the earlier decision. The prior Committee noted that it chose to omit the names of panel members in this case out of concern for their privacy. In its reconsideration of this case, the Committee decided to provide the names of the members of this panel on this decision in the interest of transparency, public trust, and accountability.

Based on all of the above, the Committee has determined that the appropriate disposition is to advise Dr. Klein to individualize the use of pre-operative prophylactic antibiotics for patients where it is warranted based on the evolving standard of practice. This is an educational disposition, designed to assist the physician in improving future practice.

In its July 2011 decision, the Committee issued a counsel to Dr. Klein on the timely documentation of discharge summaries, which the Board accepted as reasonable in its June 2012 decision. The Committee, therefore, includes this counsel to Dr. Klein as part of the current decision. A counsel [predecessor of the Advice disposition] is an educative disposition designed to guide a physician's future practice.

 AWKILBY’s Response:  So, counseling Dr. Klein keeps Dr. Klein’s record absolutely clear as far as the public is concerned and this decision is not transparent and accountable to the Citizens of Ontario!   When a complaint has been justified then it should be made public!  Even HPARB’s own decision when placed in the public domain only shows the initials of both parties.   

SUMMARY OF DISPOSITION

For the reasons set out above, the Committee advises Dr. Klein to continue to consider the use of prophylactic antibiotics at the time of conversion from laparoscopic procedure to open laparotomy based on the evolving standard of practice.

 AWKILBY’s Response:  This decision is BS --- “consider the use of…”. Prospective Patients should be able to look up the Surgeon’s Record and be able to access decisions made concerning complaints against this Surgeon!  If HPARB accepts this, the College could hide further or past complaints against this Doctor and Ontario citizens would never know.

What also concerns me is a statement Dr. Klein made when a nurse asked him if antibiotics should be prescribed for the infected incision after all the staples had been removed.   His response was “The Body Will Heal Itself.”  I think this explains a lot about his belief in using antibiotic prophylaxis and post operative antibiotics.  It would be extremely interesting to study the records of all patients undergoing surgery by Dr. Klein to see whether he has failed to use antibiotic prophylaxis and post operative antibiotics  when the standards clearly indicate so, and what the results are with respect to infections and perhaps deaths!!! *****************************************************************************      

PANEL MEMBERS: November 22, 2012

J. WILSON, MD - Chair, ICR Committee

B. BYRICK, MD

R. HOLLENBERG, MD

Mr. R, PRATT - Public Member

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

AWKilby’s Conclusion:

Page 6 of College’s Second 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 Committee would suggest that Dr. Klein consider the routine use of antibiotics in such circumstances. Having said that, we do not consider this oversight to have contributed to the unfortunate outcome in this case.”

Page 5 of College’s Third 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 Committee would suggest that Dr. Klein consider the routine use of antibiotics in such circumstances. Having said that, we do not consider this oversight to have contributed to the unfortunate outcome in this case.”

 The College had it correct with above statements without qualifying these statements with regard to the outcome.  Plain and simple, the use of antibiotic prophylaxis (& since this was not done) and the use of post antibiotics for the infected incision and the presence of many gram negative bacilli constitutes a failure to provide the Standard of Care! 

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 chart I submitted for the third appeal. Note the Procedure Desc. In the following chart: “Laparoscopic Colon Resection Attempted For Mesenteric Mass”
The second Procedure Desc. indicates the laparotomy.

And from Dr. Taylors’(the College’s I.)letter to Angela Bates May 8th, 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.”
From Dr Klein’s own notes:
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

                                                                                                                                                      

Professional negligence by act or omission by a health care provider in which care provided deviates from accepted standards of practice in the medical community.

 It is truly unfortunate that the Second HPARB panel were “hood wicked” into dismissing the other concerns which did clearly indicate more examples of neglect.  The College looked at each singularly and dismissed them instead of looking at them as a whole.

 If all of my concerns were medically address then yes the tragic outcome could have been prevented.

ORDER REQUESTED by Mr. Kilby

Having heard the submission here today, I ask that the Board: 

a) determine that the investigations conducted by the College into the complaints made by Mr Kilby be found to be inadequate, and returned  to the Complaints Committee for a forth decision but because of failure to thoroughly and honestly investigate, a letter from HPARB to be sent strongly stating this failure; 

b) determine that the decisions made regarding the complaints of Mr. Kilby be found to be unreasonable, and a direction be made to the Complaints Committee to refer these complaints, to be heard by the Discipline Committee, involving pre and post operative neglect regarding the Standard of Care of providing pre and post antibiotics. 

c)  submit a letter to the Health Minister, Premier of Ontario and the President of the OCPS  outlining the unreasonable and inadequate decision arrived at (via a non-thorough & biased investigation) by the Ontario College of Physicians and Surgeons' Complaint Committee and requesting that this College's right to self-regulation be looked into by the present day government.(of course the President was on this last College panel)

d) I make request to HPARB to take over the investigation.

From the College’s magazine “Dialogue”         April Issue 2009
“Either party can then make an application to HPARB following which HPARB can direct the ICRC to continue the investigation, make recommendations to the ICRC as HPARB sees appropriate, or take over the investigation.”

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

Ministry of Community Safety and Correctional Services

Office of the Regional Supervising Coroner - Eastern Region

366 King Street East, Suite 440

Kingston. ON   K7K6Y3
Telephone:     613-544-1596

Facsimile:        613-544-3473

Mlnistere de la Securite communautaire et des Services correctionnels

Bureau du Coroner Superviseur Regional - Region de 1'Est

366, rue King Est, Bureau 440
Kingston, ON  K7K6Y3
Telephone:     613-544-1596

Telecopieun     613-544-3473                    September 14,2007

Ms. Sandra Keough

Investigator

Investigations and Resolutions

The College of Physicians & Surgeons of Ontario

80 College Street

Toronto, ON M5G2E2

Dear Ms. Keough:

Re: Kilby, Terra Dawn

Death Pronounced: 21 July 2006

Our File No.: 2006-11425

The investigation into this death has now been completed. In response to your original request to the Office of the Chief Coroner, which was forwarded to my office, please find enclosed the following documents:

1.                                Coroner's Investigation Statement

2.               Report of Postmortem Examination

1 trust this information will be of some assistance to you. Yours sincerely,

Andrew McCallum, MD, FRCPC

Regional Supervising Coroner for Eastern Ontario

AM/lr

cc       Dr. James T. Cairns, Deputy Chief Coroner for Ontario                                                                     

This is the first time that I have seen this letter that was sent as part of the package from the College to HPARB for the third review.  I wonder what else I have not seen?  AWK

I have now only copied the pertinent information from this letter to the College from

Dr. McCallum, Eastern Ontario Coroner, at that time.

Contributing Factors:

Narrative

This 28 year old woman underwent abdominal surgery on the bowei 10 days ago and was

discharged home on July 19th to her parent's home to recover. She had had a bowel

tumor removed and the operation was complicated by a post op wound infection. At

discharge, her vitals and bloodwork were normal, though there was some foul smelling

discharge from the incision She was feeling well upon arrival to her parents' home but

suddenly felt unwell in the bathroom that evening and collapsed. She was rushed to hospital

 by ambulance but died in emergency respite resuscitation.

Regional Supervising Coroner's Note: the cause of death as determined at autopsy was intra-                                                                                                             

abdorninal hemorrhage on a background of coagulopathy A 2cm defect was noted at the

line of anastomosis (the  point of joining) of the terminal ileum and transverse colon.

This defect was oozing blood, but (he pathologist could not determine if this was the

point where hemorrhage occurred The Regional Supervising Coroner for Toronto West

has reviewed this case with the hospital. A meelng has been held with Ms. Kilby's parents

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

When HPARB and the CPSO have definitely abused the citizens of Ontario via this particular case, it is incumbent for the Health Minister and the Ministry to get involved. They do have the justification and the authority to do so, to ensure these institutions are not doing the same to other citizens who have brought complaints before them.

Norm Miller

MEMBER OF PROVINCIAL PARLIAMENT PARRY SOUND-MUSKOKA

October 24, 2008

Dalton McGunity, Premier Legislative Building Queen's Park Toronto, ON M7A 1A1

Dear Premier:

I am writing on behalf of Arnold Kilby. Enclosed is a copy of his e-mail, which is self-explanatory.

Mr. Kilby's 28-year-old daughter passed away soon after being released from hospital on July 21^st, 2006. While she was in the hospital, her family had several concerns not the least of which was the lack of care she received. You will note the family is very upset with the circumstances and are seeking answers. At a meeting May 15, 2008, they still did not have their concerns answered.

Premier, I have frequent complaints about the College of Physicians and Surgeons and their handling of complaints.

I look forward to receiving a timely response.

Sincerely,   Norm Miller, MPP Parry Sound Muskoka

NM/klstg

cc: Arnold Kilby -

JAN  2010

Mr. Arnold Kilby 888  County Road 2 Landsdowne ON KOE1LO

Dear Mr. Kilby:

Thank you for your correspondence regarding various aspects of the amended Coroners Act.

As you correctly indicate, section 8.4 (1) does not include complaints against the Chief Coroner and Chief Forensic Pathologist. However, section 8.4 (6) of the act governs complaints against these individuals, as follows:

"Complaints about Chiefs

(6) Subject to subsection (8), the complaints committee shall review every complaint made about the Chief Coroner or the Chief Forensic Pathologist. 2009, c. 15,s.4."

Section 22 and its companion section 23 of the Coroners Act were repealed after very careful consideration, which included submissions from several parties during standing committee hearings in the spring of 2009. Until its repeal, section 22 had only been invoked once in the history of Ontario. That is because my predecessors recognized that physicians, as medical experts, have the requisite knowledge and expertise to adequately weigh the many issues that must be considered when determining whether or not to hold an inquest. They are therefore better suited to make such determinations than a minister, who may not be a physician.

This change was also made in an effort to avoid the potential for political interference. Inquests are conducted in the public interest, as opposed to private interests. It would be grievously inappropriate for a Minister of the Crown to be perceived as politically interfering in a non-partisan decision-making process under this or any other circumstance — and that would be an injustice to the people of Ontario.

Mr. Arnold Kilby Page two

With respect to your dissatisfaction with Dr. McCallum's position regarding an inquest into Terra's death, you may appeal his decision by accessing the justice system and seeking a judicial review.

Once again, please accept my deepest condolences for your loss.  Sincerely, Rick Bartolucci, MPP, Sudbury Minister

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

March 9, 2010

Mr. Arnold Kilby 888 County Road 2 Lansdowne ON KOE 1LO

Thank you for your letters and e-mail messages regarding Terra's medical treatment at Number River Regional Hospital. I'm deeply saddened to hear about your loss. I realize how difficult this must be for you and I appreciate the time you've taken to share your thoughts.

Over the past three years, you've written many letters to the Ministry of Health and Long-Term Care, and I understand that you've also been in touch with the Ministry of Community Safety and Correctional Services, responsible for the Chief Coroner's office. We've also received many copies of letters that you've sent to other organizations as well regarding your concerns.

I want to assure you that we've carefully reviewed every letter that we've received from you to date, and we've done everything we can to clearly and accurately address your concerns in our many replies to you.

I'm always interested in hearing about Ontarians' experiences with the health care system. Should you wish to share your thoughts with us in the future, well be more than happy to hear from you. While your comments are valuable to us, we can only respond should there be any new issues to address.

Once again, allow me to personally extend my deepest condolences to you and your family.

Sincerely,

Deb Matthews, Minister

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

Ms. Matthews has done absolutely nothing.

APR 2010

MC-2008-2359

Mr. Arnold W. Kilby 888 County Road 2 LansdowneON KOE 1LO

Dear Mr. Kilby:

Thank you for your e-mail message regarding your daughter's experiences at Humber River Regional Hospital. Please accept my deepest sympathies on her passing.

Although the Ministry of Health and Long-Term Care funds public hospitals, they are independent corporations run by their own boards of directors. This is set out under the provisions of the Public Hospitals Act and other legislation. While it is important for the ministry to receive feedback about the health care system, the boards are directly responsible for the day-to-day management of their hospitals, including the quality of care provided to their patients. This involves clinical decisions, and my ministry does not intervene. The hospital administration is in the best position to respond, and I note that you have been in contact with a patient representative.

I note that you have also lodged complaints with the College of Physicians and Surgeons of Ontario and the Ontario College of Nurses. These organizations are responsible ensuring that their members provide health services in a professional and ethical manner.

I encourage you to continue your dialogue with the hospital administration and professional colleges so that your concerns can be addressed.

The Office of the Chief Coroner of Ontario falls under the jurisdiction of the Honourable Rick Bartolucci, Minister of Community Safety and Correctional Services. I have provided Minister Bartolucci with a copy of your letter for his consideration.

Thank you again for writing. Yours truly, George Smitherman Deputy Premier, Minister

c: Hon. Rick Bartolucci, Minister

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

Third HPARB   DECISION AND           

I.         DECISION

1.         It is the decision of the Health Professions Appeal and Review Board to confirm the decision of the Inquiries, Complaints and Reports Committee of the College of Physicians and Surgeons of Ontario to:

(i) advise Lazar Victor Klein, MD, to continue to consider the use of prophylactic antibiotics at the time of conversion from laparoscopic procedure to open laparotomy based on the evolving standard of practice;

(ii) advise Lazar Victor Klein, MD, to individualize the use of pre-operative

prophylactic antibiotics for patients where it is warranted based on the evolving standard of practice; and

(iii) counsel Lazar Victor Klein, MD, on the timely documentation of discharge summaries

From your correspondence dated:  August 10th, 2015 

 "The CPSO and all other health regulatory colleges that govern Ontario's health professions are independent from me, as minister, and the staff of my ministry. Neither I nor ministry staff can intervene or become involved in individual cases, as this may be interpreted as breaching the independence and integrity of the legislated complaints and  disciplinary processes administered by the CPSO."   

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

Wed 2017-01-25 7:01 AM

Mr Hoskins,  Minister of Health
One year from today, I sent this to you-- with no response.  So, let us try again.
I asked the Minister of Health to address my concerns with regard to the CPSO and HPARB
Mr Hoskin's response was basically to say he had no authority to intervene or question the process and decisions by both the CPSO and HPARB.   -----COMPLETE BULLSHIT OF A RESPONSE!
This is a lie as you will see, but I will shorten it.
The following excerpt comes from your letter to the College Presidents and Registrars/Executive Directors as seen below:

"My hope is that we can work collaboratively to implement these steps as we work together to maintain the public’s trust in our health care system. However, as Ontario's Minister of Health and Long-Term Care, my ultimate responsibility is to the people of Ontario. I reserve the right to take any and all necessary measures to ensure that the public interest remains paramount, including exercising the powers reserved to me under subsection 5(1) of the RHPA including the ability to require Councils to do anything that, in my opinion, is necessary or advisable to carry out the intent of the RHPA and the health profession Acts."
AND
According to Regulated Health Professions Act you do have the authority to look into the CPSO either personally or through the Advisory Council. You may consider this as possibly seen as interfering, but it is your responsibility to do so, and you are mandated to do so!
--matters concerning the quality assurance programs undertaken by Colleges; -- They are not placing patients and patient safety first; therefore they are completely ineffective when it comes to investigating complaints
-- each College’s patient relations program and its effectiveness; They are not placing patients and patient safety first therefor they are completely ineffective when it comes to investigating complaints
-- require the Council to do anything that, in the opinion of the Minister, is necessary or advisable to carry out the intent of this Act, the health profession Acts
AND question
--whether regulated professions should no longer be regulated;
Duty of Minister
3. It is the duty of the Minister to ensure that the health professions are regulated and coordinated in the public interest, that appropriate standards of practice are developed and maintained and that individuals have access to services provided by the health professions of their choice and that they are treated with sensitivity and respect in their dealings with health professionals, the Colleges and the Board. 1991, c. 18, s. 3.
Powers of Minister --“Council” means the Council of a College;

My daughter went through a colon resection and a tumor removed without the mandatory antibiotic prophylaxis, she also did not receive any antibiotics for the abdominal infection of the incision whereby all staples were removed.  As well, she did not receive any antibiotics for the presence of "many gram negative bacilli".   NO ANTIBIOTICS WHATSOEVER DURING HER TIME IN THE HOSPITAL.   SHE BLED TO DEATH 12 HOURS AFTER DISCHARGE.   IS THE COLLEGE MAINTAINING THE APPROPRIATE STANDARDS?
5. (1) The Minister may,
(a) inquire into or require a Council to inquire into the state of practice of a health profession in a locality or institution;
(b) review a Council’s activities and require the Council to provide reports and information;
(c) require a Council to make, amend or revoke a regulation under a health profession Act, the Drug and Pharmacies Regulation Act or the Drug Interchangeability and Dispensing Fee Act;
(d) require a Council to do anything that, in the opinion of the Minister, is necessary or advisable to carry out the intent of this Act, the health profession Acts, the Drug and Pharmacies Regulation Act or the Drug Interchangeability and Dispensing Fee Act. 1991, c. 18, s. 5 (1); 2009, c. 26, s. 24 (1)
So again, would you please explain why the letter you had previously sent me states neither you nor your ministry can investigate my concerns?????? If you would like the names of other Ontario citizens who feel the same, simply ask. Since you don't seem to want to answer me, perhaps you could send your response to my MPP Steve Clark.
A great injustice has taken place. This case exemplifies the very reason why Bill 29 must be passed and the importance of the Minister of Health acting on my concerns. Just imagine if this happened to me, what other citizens have gone through??

      Arnold Kilby

                              Terra Dawn Kilby
                        "An Angel In Our Lives"
                                       April 22/78 to July 21/06
  http://anangelinourlives-awk.blogspot.ca/ 

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

ONCE AGAIN AN E-MAIL FOR YOU TO DISREGARD??? as you have done with e-mails sent December 6th, NOVEMBER 12, Sat 2015-10-17, 2015,2 Sep 2015,

Minister of Health, Dr. Hoskins;    A RESPONSE WOULD BE GREATLY APPRECIATED.

The following excerpt comes from your (Dr. Hoskins) letter to the College Presidents and Registrars/Executive Directors as seen below:

"My hope is that we can work collaboratively to implement these steps as we work together to maintain the public’s trust in our health care system. However, as Ontario's Minister of Health and Long-Term Care, my ultimate responsibility is to the people of Ontario. I reserve the right to take any and all necessary measures to ensure that the public interest remains paramount, including exercising the powers reserved to me under subsection 5(1) of the RHPA including the ability to require Councils to do anything that, in my opinion, is necessary or advisable to carry out the intent of the RHPA and the health profession Acts."

According to Regulated Health Professions Act you do have the authority to look into the CPSO either personally or through the Advisory Council.  You may consider this as possibly seen as interfering but it is your responsibility to do so and you are mandated to do so!

I am requesting that you, Mr Hoskins, as Minister of Health

To refer the following issues to the Advisory Council in writing, seeking its advice with respect to:

--matters concerning the quality assurance programs undertaken by Colleges;  they are not placing patients and patient safety first; therefor they are completely ineffective when it comes to investigating complaints

-- each College’s patient relations program and its effectiveness;   they are not placing patients and patient safety first therefor  they are completely ineffective when it comes to investigating complaints

-- require the Council to do anything that, in the opinion of the Minister, is necessary or advisable to carry out the intent of this Act, the health profession Acts    in particular, the absolutely biased, prejudice and error filled investigation into my complaint given to them where by CPSO admitted that the Surgeon neglected to administer the mandatory antibiotic prophylaxis required for open abdominal surgery to remove a tumor and perform a colon resection.   In their third decision they attempted to qualify the above by stating the surgeon did not know that he had to do a colon resection.  But the medical records clearing indicated that he attempted a laproscopic colon resection prior to converting as well as a letter sent to my daughter's physicians stating that this was a possibility.      THEREFOR, THE CPSO IS COVERING UP NEGLECT!

AND question

--whether regulated professions should no longer be regulated;  if you look at their decisions that actually went on to the disciplinary panel since 1993, it is very obvious that the only complaints by citizens that go to this panel are ones which:

a: are or will be under police investigation

b: dealing with abuse of drug prescriptions and/or use of drugs

c: defrauding the government

d: professional misconduct   (does not involve negligent complaints)

Any complaints dealing medical negligence appears to be covered up via unscrupulous investigations.

I am requesting that you investigate

HPARB'S absolutely absurd decision on the third appeal. 

The CPSO on their third attempt to justify this negligence stated the surgeon did not know he had to perform a colon resection while removing the tumor until he converted to open surgery.  LIE--- Operation record clearly indicates the attempt to perform a resection prior to converting plus a letter to my daughter's doctor indicating that a resection was a possibility.  

AND HPARB DID NOT QUESTION THIS, AND MY REQUEST FOR RECONSIDERATION WAS DENIED.  HOW, WHEN MY CONCERN IS FACTUALLY SUPPORTED BY THE MEDICAL RECORDS SUPPORTED BY MY OWN NUMEROUS QUALIFIED SURGEONS' OPINIONS AND MY FACTUAL RESEARCH MATERIAL.   ALL THE CPSO SUBMITS TO HPARB IS OPINION UNSUPPORTED AS WELL AS THE CPSO HAS BEEN CAUGHT FABRICATING THE EVIDENCE.

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

MY HEART WAS WOUNDED

No one “Speaks for the Dead to Protect the Living”

My heart was wounded the day you did die,Not given a chance to say my final good-bye.

The CCO pierces the dagger deep into my chest,

Twisting it deeper; concealing the truth from the rest.

The CPSO endorses my heart and soul to bleed,

Negligence must be protected to mask the ill deed.

HPARB crushes the breath from my lungs,

 To silence the truth released from my tongue.

The DIOC’s job is merely to quash,

 Search for accountability and my life to squash.

The Ombudsman’s Office tightens my restraints,

Inflicting more pain their decisions do paint.

 

MPPs’ impale my body with total indifference,

Rendering me lifeless with no “just” forgiveness.

Terra, my heart was wounded the day you did die,

Not given a chance to say my final good-bye.

No closure for family, continuing to ask why?

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

There is not one single institution with the courage to bring about transparency and accountability to Ontario’s Health Care System.

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

College of Physicians & Surgeon’s Disciplinary Decisions since 1993 to end of 2009

I did this to prepare for HPARB.  I am sure the trend continues to the present.

Since  1.09 % of all complaints received actually goes to a disciplinary panel.

Approximately 21,458 complaints have been made to the Ontario College of Physicians and Surgeons since 1993 to end of 2009.  That’s seventeen years!!

Only 377 complaints  have been brought before the disciplinary body and found guilty to one or more accusations.

College Decisions                            Interesting to note:  

approximately                  .0159 of the 1% found guilty of not maintaining the standards of care.

The statistical probability of all complaints pertaining to                                             standards of care would indicate the above percent to be highly unlikely and far too low.                             

2.917 of the 1% found guilty of sexual impropriety and/or professional misconduct

.0291 of the 1% found guilty of abuse or inappropriate prescribing drugs

 .0186  of the 1% found guilty of falsifying records

             .0663 of the 1% found incompetent

                .4589 of the 1% found guilty of professional conduct

.0875 of the 1% found guilty of not maintain the standards of the                                                                  profession

.0318 of the 1% found guilty of other

I maintain the CPSO only takes serious the complaints from the public which  are under or will be under police investigation. All other complaints are handled with oral or written cautions which are not made public.

Ontario College of Physicians and Surgeons Disciplinary Decisions since 1994          

 377 out of 21,458 complaints

My complaint deals with pre & post-operative care.

For each year the alphabetical letter indicates if the same physician/surgeon was found guilty on more than one offence

Year	stand of care	sexual impropriety	inapprop prescrib  drugs	falsifying records	Incompetent	professional Misconduct	stand of profes	Other	Total # of MD’s
1993	4	16	4	1	4	1	0	1	31
1994	0	9	Dr. a	1 +  Dr. a	1 + Dr. b	4 + Drs. a & b	0	1	21
1995	0	6	0	Dr a	0	5 + Dr a	1	1	15
1996	0	7 + Dr c	0	0	Dr b & c	2 + Drs a & b	3 +Dr a	0	18
1997	Dr a	3	Dr a	0	Dr a & b	6 + Dr b	2	0	16
1998	0	1	Dr a	0	0	2 + Dr a	1	0	6
1999	0	2	Dr a	0	Dr b	1 +Drs a,b	0	2	9
2000	0	0	Dr a	0	1 + Dr a	9 + Drs a, b, c,d,e	Drs b,c,d,e	1	22
2001	0	6 + Drs a, b,  d, & e	0	0	Drs c & e	2 + Drs a, b, c, d, & e	Dr a	3	23
2002	0	4 + Drs b & c	Drs a & b	1	Drs b & d	7 +  Drs b, c & e	2 + Drs a, c,d & e	0	27
2003	0	9	0	0	Dr a	11 +Dr a	5	0	26
2004	1	9	0	0	1 + Dr a	21 + Drs a & b	1 + Dr b	0	37
2005	0	16 + Dr a	0	0	2 + Dr a & b	27 + Drs a & b	1	0	51
2006	0	3	0	Dr a	0	19 + Dr a	0	0	24
2007	0	1	0	0	0	12	0	1	14
2008	0	3	0	0	0	1	0	2	6
2009	0	7	0	1	Dr a	14 + Dr a	6	0	30
TOTALS	6	110	11	7	25	173	33	12	377

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