ER was 'a zoo' when dying senior arrived, doctor testifies

The Saint John hospital emergency room was crowded and over capacity the day Lillian Mullin, 78, was sent home with the bowel problems that killed her 24 hours later, a doctor told a coroner's inquest on Thursday.

Dr. Tushar Pishe was on duty at the ER when Mullin arrived with abdominal pain and severe diarrhea in February 2005. He told the jury that "it was a zoo" in the emergency room, and in a situation the hospital calls Code Orange, which means no beds are available and patients are placed in the hallway.

Pishe was asked if Code Orange can affect his decision to admit or discharge a patient. He said he tries not to let it happen, but he said it can be a factor.

Pishe says he took Mullin's medical history, examined her, and diagnosed her with the flu. He gave her IV fluids to reduce her dehydration and Gravol to settle her stomach. He sent her home with advice to see her family doctor or come back if the condition worsened.

Mullin returned to the ER the following afternoon. It took six hours for a doctor to see her, and an hour after that, she was dead. A CT scan taken on the second day revealed a massive bowel infection.

Mullin's daughter, Shirley MacAulay told reporters she thinks Code Orange may have contributed to the decision to discharge her mother.

"Exactly what I was told was 'if we were to keep her she would have to be placed in the hallway because we have no beds available,' " she said.

MacAulay, who will spend Friday giving evidence to the jury, says hospital management has already told her that discharging her mother was the wrong move.

"Those were their words: 'We dropped the ball. She should have never been sent home the day before,' " she said.

However, Dr. Graham Bishop, a specialist called in on the second night Mullin was taken to emergency, also testified Thursday that the elderly woman had many other health problems and likely wouldn't have survived even had shebeen admitted the first night.

Bishop said Mullin had low blood pressure, her kidneys were not working properly, she had an irregular heartbeat and a low blood count. He said an ischemic bowel, which means the bowel has died and is not functioning, is the most likely cause of death.

A major point of contention in the inquest is whether Mullin was suffering from Clostridium difficile, an intestinal bacterial infection.

This coroner's inquest is not looking at who is to blame for Mullin's death, but was set up to develop recommendations for the hospital to ensure an infection such as C. difficile doesn't get misdiagnosed, and to create better systems in the hospital to investigate and manage stomach pain in seniors.

Mike Mullin said the family wants something positive to come out of his mother's death. "Our family misses our mom very much. And we just want the truth to be known," he said.

The inquest will hear evidence until Friday.