discipline summaries and likely repeat lab work if appropriate. He said that the observation period should be at least six to eight hours and the two-hour observation period in this case does not meet the standard of care. Dr. X opined that Dr. Kamermans showed a lack of knowledge and judgment regarding the appropriate ER evaluation and management of this patient’ s chief complaint and that there was a potential for harm for the patient. The Committee finds that Dr. Kamermans failed to maintain the standard of practice in this case of possible methanol ingestion. Dr. Kamermans was cavalier in the Committee’ s view. He had the information he needed from the Poison Control Centre and he did not use it. It is the Committee’ s view that Dr. Kamermans’ knowledge and judgment deficiencies persist with respect to how properly to address the issue of the ingestion of antifreeze by a child. In his testimony, Dr. Kamermans said that he assumed that the child did not ingest much and certainly not enough to do any blood work that the Poison Control Centre recommended. However, Dr. Kamermans had no grounds for making that assumption. No one actually witnessed the child with the methanol.
Patient # 6 Patient # 6 was an elderly patient with dementia who presented to the Emergency Department after an unwitnessed fall. Dr. Kamermans failed to maintain the standard of practice in his investigation, evaluation and documentation. The Committee found Dr. Kamermans’ investigation of the causal factors rudimentary. Although he said his physical examination of the heart would rule out some cardiac causes, he did not do an ECG, which would have been indicated. Similarly, he did not do further x-rays or a CT scan of the neck, which was indicated by Canadian standards. According to Dr. X’ s summary in his report, the elderly patient presented to the ER after falling. She did not know where she was and could not remember the fall. Dr. X noted that this made her history of the event unreliable, given her dementia and the fact that the fall was unwitnessed. Dr. X noted the patient had a significant risk of both intracranial injury and cervical spine injury as a result of her fall.
Documentation is sparse on this ER chart. Dr. X points out that the physical examination is cursory and incomplete. Dr. Kamermans did not document his thought process regarding the evaluation and management of the patient and does not provide a differential diagnosis for why the patient fell. Dr. X commented in his report that a much more thorough evaluation should have been undertaken by Dr. Kamermans to rule out serious causal factors, such as syncope or near syncope of possible cardiac, neurogenic or neurologic origin.
Investigation of cervical spine injury One of Dr. X’ s concerns as noted in his report was that the patient had no spinal precautions taken at any time, either by the paramedics transporting her or by the ER staff. Dr. X thought that there was a significant concern regarding a cervical injury and no neurological examination or assessment of the cervical spine was done. Although the fact that Dr. Kamermans did a CT scan of the head suggests that he clearly suspected that the patient had the potential for serious injury, Dr. X opined that Dr. Kamermans did not adequately assess the risk of a neck injury. Dr. X testified that no cervical spine studies were done and, given the patient’ s advanced age, dementia and amnesia regarding the event, an injury to the cervical spine could not be ruled out by history and physical examination alone. Dr. X testified on Canadian standards and guidelines for when to order radiography in alert and stable trauma patients. In his view, this patient fit the category of patients who required follow-up assessment for neck injury because of her age and her Glasgow Coma score which was less than 15. In his testimony, Dr. Y opined that since the patient was able to complain of a headache to the paramedics, she would likely have been able to complain of neck pain if she had it. Dr. Y thought pain would normally be elicited on palpation and if it was not, then a CT scan of the neck would not need to be ordered. Dr. Kamermans testified that he would have been
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Issue 1, 2017 Dialogue 59