St. Mary's ER doctor disputes CIUSSS reasons for dying patient's transfer
Patient with ruptured abdominal aortic aneurysm has 50-50 survival chance if surgery's swift, studies show
A veteran emergency room physician at St. Mary's Hospital in Montreal says the hospital administration's decision to revoke its only vascular surgeon's privileges to perform potentially life-saving surgery flies in the face of medical literature and training.
Last November, a patient with a ruptured abdominal aortic aneurysm — known in medical jargon as a "triple-A rupture" — died after he was transferred from St. Mary's emergency room to the MUHC Glen site for surgery.
St. Mary's emergency staff called in the hospital's vascular surgeon, Dr. Carl Emond, as soon as the patient was diagnosed.
However, another doctor told CBC News that Emond had to break it to his colleagues that his right to perform the time-sensitive operation had been taken away a few months earlier.
You don't transfer an unstable patient with a triple-A rupture if you can operate on them at your centre.- Veteran St. Mary's ER physician, Dr. Gerald van Gurp
"It must have killed him not to be able to operate on this patient," said Emond's longtime associate, Dr. Gerald van Gurp, who recently retired from active ER duty at St. Mary's but is still involved in patient care.
"Emond is a great surgeon. He's very conscientious."
'Minutes count'
Van Gurp worked in the hospital's emergency room for four decades, teaching generations of McGill medical residents what he calls the "tricky" work of diagnosing a triple-A rupture.
"It's one of the real big emergencies in emergency medicine," he said. "It's one of the reasons virtually all emergency physicians in North America have to learn to do bedside ultrasounds...so there is absolutely as little delay as possible getting the patient to the operating room."
"You don't transfer an unstable patient with a triple-A rupture if you can operate on them at your centre," van Gurp said. "Minutes count."
50-50 survival rate
In a news release Monday, 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) suggested the patient who died in November would have likely died anyway.
Hospital spokeswoman Claire Roy said in the statement that the medical literature shows the death rate from a triple-A rupture is 80 to 90 per cent, even if emergency surgery is performed.
"That's not true," said van Gurp. He cited a Dutch group's systematic review of all medical literature on triple-A ruptures which found that among patients who underwent surgery, the mortality rate was about 48 per cent.
Roy also said the decision to refer patients presenting with a triple-A rupture at St. Mary's to a tertiary level hospital "is a decision for quality and safety of care."
She said with only one vascular surgeon at St. Mary's, there was a risk that the surgeon would not be there whenever he was needed, and added that the hospital "does too few of the procedures annually to maintain the high standards of quality that can be found at university teaching hospitals offering tertiary and quaternary care."
Van Gurp said those guidelines might make sense on paper, but he claims the CIUSSS failed to use common sense and to look at what really goes on at St. Mary's Hospital.
"Why fix something that ain't broke?" he asked. "Emond is a dedicated old-school surgeon who doesn't live far from the hospital. I can't think of anytime he didn't come in, in an emergency."
"If you have an excellent surgeon who has done seven of these surgeries for 30 years, that's 210 operations," van Gurp said.
"I would trust myself under his knife anytime."
'Expert opinion' carries little weight
Van Gurp also challenged the CIUSSS's reference to a single independent expert opinion from a vascular surgeon working in the Gatineau region, Dr. Patrice Nault.
Roy said Nault had backed the "scientific foundation" of the CIUSSS's decision to revoke Emond's right to conduct the operation at St. Mary's.
"That's just one opinion," van Gurp said. "In the big scheme of evidence-based medicine, you don't make one expert opinion as your justification for anything."