Manitoba doctor disciplined after questionable care of 2 infants
Professional judgment of pediatrician Dr. Emmett Joseph Elves called into question
A Brandon pediatrician has been censured for his care of two infants, one who died and another who needed a life-saving liver transplant.
The committee found Dr. Elves failed to recognize his limitations and did not promptly consult colleagues for help with each of the infants.
In the most recent case, Dr. Elves saw a boy born last February and interpreted an x-ray as showing signs of a higher bowel obstruction, the censure report said.
The report said Dr. Elves’ plan was to monitor the infant’s condition and observe any changes.
When another doctor came on shift, there was a consultation with a neonatologist and later that day the baby was sent from Brandon to Winnipeg for care.
By the time the infant arrived in Winnipeg, the baby “had complete and irreversible intestinal necrosis and died at day four,” the report said.
“In retrospect, although he believed the obstruction was functional, he ought to have called the NICU [neonatal intensive care unit] and further investigated the cause of the obstruction. He regrets his delay in referral,” the report said of Dr. Elves.
The diagnosis was “intestinal malrotation with volvulus,” and the report said a timely diagnosis may have resulted in a greater chance of salvaging the baby’s bowel.
Dr. Elves is still practising in Brandon but was required to pay the College’s investigation costs of $2,472.50.
Second case of questionable infant care
The second case involved a baby girl born in February 2011, referred to Dr. Elves by another doctor in May 2011 for jaundice.
[The baby] was so ill that she was immediately transferred to Toronto where she was listed for life-saving liver transplantation.
The report said Dr. Elves ordered an urgent ultrasound and other tests, and then, after his assessment, transferred care of the baby back to the referring physician.
Doctor Elves saw the baby again in the months that followed. In November 2011, the report said, Dr. Elves noted the baby “needed a biopsy and a liver scan and that he attempted to contact the pediatric gastroenterology service by telephone on Nov. 2, 2011 and afterwards, but was unsuccessful.”
A few days later, a different physician saw the baby for respiratory concerns and referred her to Winnipeg for further investigations.
In Winnipeg, the report noted, the baby was “so jaundiced that she was literally green in colour, with florid cirrhosis and portal hypertension.”
A pediatric gastroenterologist gave a diagnosis of biliary atresia — a condition that comes from inflammation within the bile ducts around the time of birth.
At that point, the baby “was so ill that she was immediately transferred to Toronto where she was listed for life-saving liver transplantation.”
The report said Dr. Elves acknowledged “his follow-up plan should have been more explicit rather than relying upon the parents to monitor [the infant].”
He told the investigation committee he has changed his practice for investigating jaundice in infants, including earlier consultation with specialists.
The report concluded timely diagnosis may have avoided the necessity of a liver transplant.
Doctor not suspended during investigation
Dr. Bill Pope, registrar for the college, told CBC News Dr. Elves had no prior discipline history and he was not suspended during the course of the investigation.
College records show Dr. Elves graduated from the University of Manitoba in 1975 and has lectured at the U of M in the department of pediatrics and family practice.
A call to his office at the Brandon Clinic was not returned Wednesday.