discipline summaries
of his attendance on this patient. Despite that, and also despite hearing two experts explain that the use of Diltiazem was contraindicated in this case, Dr. Kamermans maintained in his examination-in-chief that this medication was still part of his armamentarium for this problem. Dr. X said that this condition was a“ meat and potatoes” one in the ER, that is, fairly common. In the Committee’ s view, Dr. Kamermans knew he was out of his depth the day this patient came to the ER and the fact that he called the consultant confirms that. In the intervening three years, he has not taken the opportunity to learn from his deficiencies and augment his knowledge in this area, irrespective of whether there was a hearing about his deficiencies or not. At the hearing, Dr. Kamermans demonstrated that he did not learn from his experience that day in the ER, by reading the consultant’ s note or taking in the experts’ testimony. Both experts testified that because the patient had a pacemaker and an implanted defibrillator, it would be presumed the patient had impaired left ventricular function and using Diltiazem, as Dr. Kamermans did, would lead to complications, as it did in this patient. That his lack of knowledge persists three years later is of grave concern. It was also of concern to the Committee that Dr. Kamermans testified that the patient was on a monitor, intimating that there was somehow less risk when this patient was given a medication that had an adverse effect on his condition. Any comfort that monitoring would give is false. It indicates a lack of judgment and a cavalier attitude that gives pause when considering the urgency of the situation in this case. Clearly, Dr. Kamermans did not know what he was dealing with or how to manage it and he was fortunate that the consultant was available to come and assist. The Committee is not sure what the outcome would have been if the specialist had been unavailable to consult in this small town hospital when Dr. Kamermans needed him. Dr. Kamermans’ care and documentation for this patient fails to maintain the standard of practice. The Committee also finds that Dr. Kamermans showed a lack of knowledge and judgment that the evidence establishes persists to the present day.
Patient # 4 Patient # 4 was a child with respiratory distress, shortness of breath, a slightly dusky appearance and moderate to severe croup. Dr. Kamermans’ care of this patient failed to meet the standard of practice both in terms of documentation and treatment of this sick child. Dr. Kamermans used medication that was not helpful for croup and was not up to date with the current medication standards. This child was brought into the ER from a walk-in clinic and was in respiratory distress according to Dr. X. The child had a respiratory rate of 48 breaths per minute and the O2 Sat was 92-93 %. The acuity score was one, which indicated that the child needed to be seen immediately. The nurses’ notes indicated that the child was short of breath with significant indrawing with respirations and a slightly dusky appearance. In this case, Dr. Kamermans did chart that the child had indrawing, rhonchi and decreased air entry in his lungs. The croup score was six and following treatment with Atrovent, Ventolin and Pulmicort, as well as oral prednisolone syrup, the croup score was reduced to 2.5, although the charting of cough on the last assessment was missing and may have raised this score. Dr. X stated that the documentation for this patient was brief, incomplete, and provided only a cursory account of his clinical interaction with this patient. There is no documentation of the presenting illness, the past medical history, social history, developmental or vaccination history. The physical examination as charted is incomplete. There is no documented differential diagnosis given the other possibilities for co-existing pathologies and the management plan for the acutely ill child is lacking. Nor is there documentation with regard to the response to treatment by Dr. Kamermans. However, nurse’ s notes indicate that the doctor examined the patient on arrival and again about 15 minutes later, after treatment.
Treatment of Croup According to Dr. X, this child had severe croup on presentation to the ER, while Dr. Y and Dr. Kamermans called it moderate to severe. Dr. X said that marked retractions of the chest, severely decreased breath sounds, tachycardia and cyanosis( duskiness)
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Dialogue Issue 1, 2017