Doctor censured for 'egregious' failure to care for woman, 62

A doctor in Swan River has been censured for failing to properly care for a woman in a personal care home in 2016.

Dr. Fayez Fouad Fahim Gouda also had to pay $9,727.50 for the costs of the investigation by the College of Physicians and Surgeons of Manitoba.

Gouda was the on-call doctor for the emergency department in the western Manitoba town on Aug. 8-9, 2016, when the 62-year-old woman's condition began to deteriorate.

Nurses from the care home where she lived repeatedly called Gouda after 11 p.m. on Aug. 8, requesting that the woman, who suffered from several chronic illnesses, be transferred to the hospital.

He refused and got mad at the nurses, telling them to give her comfort care and talk to the family doctor in the morning, says the report on the censuring decision by the college, handed down in December.

The nurses explained the woman was getting dehydrated, suffering from diarrhea, and should be given IV therapy. Gouda still refused, the report says. The nurses described him as being disrespectful and not listening to their concerns.

Refused to speak to family

According to the regional health authority's chief medical officer, if a nurse at a care home believes a resident requires urgent care and the on-call physician refuses to transfer the patient to hospital, an attempt should be made to contact another physician, preferably the patient's family doctor, the report says.

Calls were made to the woman's family doctor but there was no answer.

On-call physicians are crucial to the provision of good care within our health-care system and, consequently, the responsibilities that come with assuming the role as an on-call physician are great- College of Physicians and Surgeons report

One of the nurses then called the local hospital's emergency department, asking whether there was anything else that could be done. The nurse was told that without the doctor's approval, the patient could not be transferred.

The woman's daughter, who also had been called by the nurses, arrived at the care home around 4:45 a.m. on Aug. 9 and asked the nurses to call Gouda again.

He would not speak with her directly and told the nurse to call the patient's doctor after 8 a.m., the report says.

Just before 7 a.m., the nurses were finally able to reach the woman's family doctor, who arranged a transfer to the hospital. It was full, however, and the doctor was advised the woman could not be admitted until 10 a.m.

By 8 a.m., the woman was unresponsive and she was rushed to the hospital. Lab work revealed she had severe metabolic acidosis, hyperglycemia, hypernatremia and acute renal failure, the report says.

It called Gouda's lack of action "particularly egregious."

Gouda was cited for failing to respond to what was an urgent medical situation, displaying a lack of judgment and failing to conduct himself in a professional manner

"On-call physicians are crucial to the provision of good care within our health-care system and, consequently, the responsibilities that come with assuming the role as an on-call physician are great," the report states. 

The censure will go in Gouda's disciplinary record, which could then be considered in any future investigations or hearings.

Gouda has not returned calls from CBC for comment.

Swan River is about 400 kilometres northwest of Winnipeg, near the Manitoba–Saskatchewan border