Neglectful hospital care robbed Edmonton cancer patient of dignified death, daughter says

An Edmonton woman says her father was neglected and given insufficient medication for his pain in an Alberta hospital, while his family was not informed that he was near death.

Bridget Stirling's 71-year-old father, Ian Stirling, died on July 21 in a general medicine ward of the Edmonton's Royal Alexandra Hospital where he'd been admitted 16 days earlier.

His family would later learn that cancer had spread from his lungs into his liver.  A mass on his chest, beneath his collarbone, had grown to the size of a fist.

The family wasn't told that her father's condition was terminal until two days before his death, she says. Her father was robbed of his dignity while his family lost precious time to share a meaningful goodbye.

We lost that time and we will never get it back.- Bridget Stirling

"Nobody told us he was with advanced cancer and that his liver and kidneys had failed and that he had days left to live," she said.

"We lost that time and we will never get it back."

Stirling said her father's time in hospital was a nightmare of failed communication. He fell through the cracks of a health-care system in crisis, she said.

She said it shouldn't take a family weeks to get their loved one adequate care or clear answers about a prognosis. 

She has filed an official complaint with Alberta Health Services detailing how her father's debilitating pain was treated for days with only Tylenol, and how he was found in soiled sheets. 

Medical experts say Stirling's complaint is an example of the lingering pressures of the COVID-19 pandemic on Alberta hospitals, the lack of access to timely end-of-life care and for the need for improved training to ensure medical staff inform patients and their families when death is near.

Stirling said one morning, after her father could no longer walk without help, the family found him lying dirty in his hospital bed. He had been unable to get to the washroom during the night, and it appeared he had been in that state for hours, she said.

"It was like no one was checking on him," she said.  

"I just want to know why nobody told us and why my dad got left in that kind of pain." 

An AHS spokesman would not comment on the specifics of this case due to patient privacy but said staff will meet with the Stirling family and the complaint will be "followed up on and managed as appropriate."

Stirling's father, who lived alone and worked full-time at a local graphics firm, was admitted to hospital on July 5 after visiting the emergency department at the Strathcona Community Hospital in Sherwood Park.

After an initial CT scan showed spots on his lungs and probable liver tumours, he was transferred to the Royal Alex where an MRI and a biopsy were performed, Stirling said. 

She said a doctor told the family that after the results came back — within five to 10 business days — her father would be referred to the Cross Cancer Institute for treatment.

He was writhing on his bed and moaning and crying and begging. I'll never be able to stop hearing that.- Bridget Stirling

His condition deteriorated quickly, Stirling said. He stopped eating and developed jaundice, which turned his skin and eyes yellow.

Her father was moaning in pain and no longer lucid but was only given Tylenol until Stirling begged a nurse to get him something stronger, she said.

He got morphine on July 10 but it was given inconsistently over four days, she said. 

"He was writhing on his bed and moaning and crying and begging. I'll never be able to stop hearing that." 

On July 15, a hospital pharmacist spoke to Stirling about the medications he would need after returning home.

Four days later, Stirling said the family had an initial consultation with a palliative-care physician. That's when they learned her father's death was imminent.

He died two days later in shared room in a hospital acute-care ward.

Up until hours before his death, hospital staff were trying to make him sit up in bed to eat even though it was causing him severe pain, she said.

The doctor previously treating her father had not told the family his illness was terminal, Stirling said.

"We kept asking about [the biopsy] and the doctor kept saying, 'It's OK, we'll just wait and everything will be fine.'"

Rules around patient disclosure

Alberta Health Services protocols say patients need to be well-informed of their diagnosis, to ensure they can make informed decisions about treatment. AHS said even without the patient's consent, doctors can inform their families about a prognosis. 

"It is important to recognize that some diseases are difficult and challenging to prognosticate and at the end of life, a patient's disease trajectory can change quickly," AHS said. 

AHS protocols also recommend that all patients be checked at least once every two hours, more frequently if the patient's condition requires.

On general medicine units at the Royal Alex, patients are checked at least every four hours through "comfort rounds," which address a patient's "pain, position, toileting and possessions," AHS said.

"Pain assessments occur with all routine patient assessments, during comfort rounds, following administration of analgesics and when patients report pain."

Comfort rounds are in addition to patient check-ins during routine medical rounds, scheduled drug administration, meal deliveries or room cleanings, AHS noted.

AHS said each zone has designated palliative and end-of-life care beds; waitlists for hospice beds vary based on patient demand.

People who pass away in big, busy hospitals often don't tend to have excellent end-of-life care.​​​​​​- Donna Wilson

Stirling's case is a sign that Alberta hospitals remain "in shock" from the pandemic, said Donna Wilson, a professor in the nursing faculty at the University of Alberta.  

"People who pass away in big, busy hospitals often don't tend to have excellent end-of-life care," Wilson said.

"I think, probably, it's now worse than it's been in a number of years because of COVID." 

Leaving a patient in soiled sheets is unacceptable and a "warning bell" about possible staffing issues, Wilson said. Stirling said staff in her father's ward seemed very busy and burned out.

Wilson said hourly patient checks should be the standard in any hospital.

She said the case highlights a lack of access to end-of-life care in Alberta, along with the chronic challenges faced by acute-care wards in meeting the needs of all patients. 

"Dying people, for a number of decades, have not fared well in large acute-care hospitals, because, again, the whole emphasis there is to diagnose, treat and cure."

Wilson said that when a patient's death is near, lack of communication with families is far too common.

Information is sometimes withheld because of confidentiality rules or held back due to the time needed to reach a diagnosis. Other times, information isn't shared due to "a lack of responsible physicians" willing to make time for difficult conversations, she said.

Maintaining dignity

Stirling's case also points to a need for improved training in palliative care, said Dr. Harvey Chochinov, a professor of psychiatry at University of Manitoba and senior scientist at the CancerCare Manitoba Research Institute.

Chochinov, who served as Canada's first research chair in palliative care, said every medical worker should have training in caring for dying patients, particularly in pain management.

Difficult conversations are necessary and a physician's personal discomfort should never get in the way of maintaining a patient's dignity, he said.

"There's never going to be enough palliative-care beds to accommodate all patients who have a life-threatening or life-limiting condition," Chochinov said.

"Therefore, all of us who practise medicine need to become well-versed in a palliative approach. … And in the face of approaching death, patients and families need to be provided information."