St. Mary's Hospital in crisis mode as ethical debate rages over dying patient's transfer

Montreal's St. Mary's Hospital is in crisis mode, as debate in Quebec's medical and legal circles rages over whether the hospital's only vascular surgeon, Dr. Carl Emond, should have ignored administrators' orders and performed potentially life-saving surgery on a patient last Nov. 2.

• St. Mary's ER doctor disputes CIUSSS reasons for dying patient's transfer
• St. Mary's Hospital administration defends decision to revoke surgeon's privileges

Mark Blandford, 73, died after he was transferred from St. Mary's emergency room to the MUHC Glen site, before he could undergo surgery for an abdominal aortic aneurysm – or "triple-A" – rupture.

"A doctor can never put hospital rules ahead of his ethical obligations," said Jean-Pierre Ménard, a Montreal lawyer specializing in patients' rights. "The obligation is to help someone whose life is in peril."

A hospital and doctors are under obligation to do what they can, with what they have, - Patients' rights lawyer Jean-Pierre Ménard

A triple-A rupture "is a critical condition," Ménard underscored – one in which surgical intervention must take place within the hour. "The law provides that every patient with a life-threatening condition has the right to receive services."

Under that kind of life-and-death situation, Ménard said, "a hospital and doctors are under the obligation to do what they can, with what they have."

Emergency 'trumps all'

Many of Emond's colleagues at St. Mary's have rallied around him, suggesting the 30-year veteran of the teaching hospital had no choice but to transfer the patient, having been told repeatedly since last summer that he was no longer entitled to do triple-A rupture surgeries as part of the reorganization of the hospital's services.

However, outside St. Mary's, some surgeons are less than certain Emond did the right thing.

"An emergency situation trumps all other considerations," said one surgeon on condition of anonymity.

Call for coroner's inquest

Ménard said he hopes a coroner's inquest will be called into Blandford's death, to investigate all the circumstances publicly.

He said it must be made absolutely clear, both to patients and to health care providers, that even in a case where a hospital administration has decided to restrict a doctor's privileges, exceptions can be made.

It should be explicitly stated to a doctor, "for the future, you won't be authorized to do such-and-such an operation, except in an emergency situation," Ménard said.

For now, there is no plan by senior administrators to change the directive to transfer any patient with a triple-A rupture from St. Mary's to the MUHC or the Jewish General Hospital.

• St. Mary's doctors in a fight against change, health agency head says

If someone else walks into St. Mary's with that condition, "that person will be quickly sent to the tertiary-care environment," a senior administrator, Benoit Morin, told CBC on Tuesday.

Morin, president and CEO of the Montreal West Island Integrated University Health and Social Services Centre (known by its French acronym CIUSSS de l'Ouest-de-l'Île-de-Montréal), also said the events surrounding Blandford's death are under review by Quebec's College of Physicians and Surgeons.

However, College spokeswoman Leslie Labranche said Thursday it had only learned of the situation through media reports. Labranche said the College's investigation arm is now seeking out the facts that led to the patient's death to see if further investigation is warranted.

Senior administrators at the CIUSSS de l'Ouest-de-l'Île-de-Montréal were to hold an emergency meeting of departmental heads of St. Mary's on Thursday night.

Claire Roy, a spokeswoman for the CIUSSS, said in a brief email message earlier Thursday that the administration is offering no further media comment on the situation while "the evaluation is underway."