The Ontario Health Professions Appeal and Review Board has rejected an appeal claim by a Northern Ontario family that a doctor at Health Sciences North failed to properly examine, provide treatment and admit an adult male referred to as R.G.
The complaint followed the death of the patient who suffered a cardiac arrest the day after he was sent home from emergency for a pinched nerve complaint.
The review board investigated the complaint regarding the conduct and actions of Dr. Renee-Anne Pierrette Montpellier, MD, who was an attending physician at the HSN Emergency Department in January 2022.
The review board has just released its decision on the appeal and decided that after investigating the complaint, no further action was required.
The case goes back to Dec. 28, 2021, when R.G. attended at the Emergency Department (ED) at HSN Sudbury "concerned about a one-month history of right neck, shoulder, upper back and arm pain. He further reported occasional pain across his anterior chest," said the written statement from the review board.
"Following normal results from an ECG and troponin test, the patient was diagnosed as having right arm radiculopathy, provided medication and referrals for follow-up care, an MRI, physiotherapy and a referral to the Chest Pain Clinic) and then discharged," said the statement.
A few days later, on Jan. 1, 2022, the patient returned to the HSN emergency room.
The physician, Dr. Montpellier, was on duty in the emergency room.
Montpellier examined the patient, diagnosed right arm radiculopathy, ordered a further course of medication to treat his pain and then discharged him.
"Sadly, the patient passed away the next day following a sudden cardiac arrest," said the review board transcript.
A family member for R.G. subsequently complained and said the physician "failed to examine, admit and treat the patient,” her brother.
The transcript said the family member "believed that the Respondent (Montpellier) relied too heavily on the diagnosis from the Dec. 28, 2021 visit to the ED and should have administered a CT angiogram.
"The Applicant believed that had a CT angiogram or other tests been administered, the cardiac issues would have been identified and her brother R.G. would not have died of a cardiac arrest," said the transcript.
The issue was first considered in 2022. At that time, the board decided the complaint was not reasonable. The complaint was dismissed.
R.G.’s family member, the applicant, disagreed with the decision.
In a letter dated Sept. 19, 2022, the applicant requested that the board review the decision of the first committee.
The transcript reported that the first review committee took note of several issues:
- The Committee’s review of the medical records from the patient’s December 2021 ED visit indicated that in response to the patient’s report of occasional chest pain a cardiac work-up was ordered, including troponin and ECG tests, which returned normal.
- The patient was also referred to the Rapid Access Chest Pain Clinic.
- Based on the patient’s report of right neck, shoulder, arm, and upper back pain and upon examination revealing pain and tenderness in those areas, a clinical diagnosis of cervical pain with radiculopathy was made.
- The patient was prescribed further medication to treat these symptoms.
- He was referred for an MRI of the cervical and thoracic spine, and physiotherapy was recommended.
- The Committee’s review of the medical records from the January 2022 ED visit indicated that the patient presented with increased right arm, right shoulder, neck and upper back pain.
- The patient was noted to have stable vital signs.
- The medical records did not indicate that the patient reported any chest pain during this visit.
- Dr. Montpellier advised, and the medical records supported, that she performed her own physical examination of the patient which revealed normal breath sounds, normal heart rhythm, normal heart sounds, tenderness and reproducible pain in his upper body and some sensation changes in his right little finger.
- Dr. Montpellier also noted her diagnosis to be right radiculopathy.
- Dr. Montpellier further advised, and the medical records supported, that she also obtained the patient’s history from him and reviewed his hospital chart from his December 2021 visit.
- Dr. Montpellier noted in the chart from this ED visit (Jan.1) that the previous ED physician had ordered an MRI and made a referral to the Chest Pain Clinic.
- Dr. Montpellier ordered pain management for the patient in the ED and prescribed further medication to treat his pain symptoms upon discharge; and
- Dr. Montpellier advised the Committee that she had concluded that the most appropriate course of action was to continue with the outpatient management already put in place at the patient’s previous ED visit, with the addition of some further pain management options.
In the final remarks in the transcript, the review board wrote the following:
The committee’s decision demonstrates a coherent and rational connection between the relevant facts, the outcome of the decision and the reasoning process that led it to that outcome, and its decision as a whole is transparent, intelligible and justified.
“The board notes that the Applicant’s complaint and the Committee’s disposition in this matter will remain on the Respondent’s permanent (although private) record with the College and will be considered should another complaint arise in the future.
“The board expresses its condolences to the applicant.
“The board confirms the committee’s decision to take no further action.”
The full text of the decision, published on July 28, can be found here.
Len Gillis covers health care and mining for Sudbury.com.
