Tuesday, January 25, 2005

Bond's job is to get facts on Nelson hospital case

VICTORIA - Health Minister Shirley Bond has two choices - order an independent review of a controversial death at Nelson's hospital, or pick up the phone and ask the coroner's office for some information.
The second choice is the simplest, most sensible option.
Edward Morritt died last March after a series of events that heightened Nelson residents' concerns about the quality of available medical care.
Morritt was 75, and suffered from health problems that could be expected at that age. He fell while working in his yard, made his way into his house, and waited three hours until he could reach a family member. He arrived at Kootenay Lake General Hospital in Nelson by ambulance at 6:18 p.m. Doctors feared internal bleeding. His condition meant x-rays weren't practical. The hospital had ultrasound equipment, but technicians weren't on call after hours.
By 8 p.m., doctors wanted to move him to Kootenay Boundary Regional Hospital in Trail for a CT scan, admission to the Intensive Care Unit and surgical care.
But they couldn't connect with the surgeon, and were told no bed was available. The situation was eventually straightened out, but the result was that Morritt didn't arrive at the hospital until 10:40 p.m. He died less than three hours later. The cause of death was internal bleeding from a ruptured spleen.
People die every day, despite the best care we're able to provide. Perhaps Morritt, who was taking blood thinning medication, was just one of those people who received too serious an injury to allow effective treatment.
But his family, and others in the community, have raised questions about the reduced level of care in the Nelson hospital. They want to know if he could have been saved if more options had been available in his hometown. And they had hoped that a coroner's inquest would provide some answers.
It didn't. Coroner Jeff Dolan ruled the death accidental and made no recommendations.
Perhaps that could have ended the issue.
But CBC News learned that the investigator who reviewed the death for the coroner did make recommendations, which weren't included in the final report. The coroner's agent, Jim Draper, wouldn't reveal specifics but said three important recommendations related to questions about how the health care system may have failed Morritt.
So why weren't the recommendations included? Dolan says he can't answer that question. Lisa Lapointe, speaking for the coroner's office, says she can't discuss specifics, but adds that coroners rarely tell health authorities what to do. (raising the question, why not?)
The result leaves questions about whether service reductions in Nelson were a factor in Morritt's death.
Bond was quick to point to the coroner's report as an indication that everything was fine in Nelson. (The Interior Health Authority made the same claim.)
But Bond says she's content with final report, and doesn't want to compromise the independence of the coroner's office by asking questions about the abandoned recommendations.
That's a bad answer. The medical staff at Nelson's hospital have expressed concerns over the effect of cuts on Morritt and other patients, and the lack of recommendations in the coroner's report. The issue is important to the people of the region. The health minister should want answers.
All Bond has to do is call the coroner's office and ask for the draft recommendations. If the chief coroner says no, she would have to consider next steps, but any effective health minister would ask for the information.
If she is unwilling to do that, Bond should order an independent, public inquiry. It does not need to be involved, or costly. A review of the existing record should suffice. (The health authority hired an Alberta doctor to review the case, but hasn't released its findings.)
Major questions remain about Morritt's death. The health minister's should want to get the answers.
Footnote: Hospital medical staff say Morritt would have been able to get an ultrasound in Nelson before the cuts to services; the IHA says that's not true. The community needs a definitive answer to that and other questions. Restructuring health care is a huge undertaking, with significant risks and benefits. We need to look at the consequences and learn, instead of shying away from the facts.

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