MD disciplined over treatment of patient

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This article was published 17/01/2019 (2620 days ago), so information in it may no longer be current.

A Swan River doctor has been censured by the College of Physicians and Surgeons of Manitoba for failing to respond adequately to the needs of a personal-care home patient while on duty in a rural hospital emergency department nearly 21/2 years ago.

Last month, the regulatory body’s investigation committee found that Dr. Fayez Fouad Fahim Gouda had failed to meet his profession’s standard of care, conducted himself in an unprofessional manner and displayed a lack of judgment respecting the medical needs of the 62-year-old woman identified in a report only as “X.”

During the afternoon and evening of Aug. 8, 2016, X’s condition at the care home deteriorated. For several days, the woman, who had several chronic illnesses such as multiple sclerosis and diabetes, had been suffering from diarrhea. Her care had generally been managed by her family physician, who had ordered tests and prescribed antibiotics late that afternoon.

As the woman’s condition worsened, a care-home nurse called Gouda on his cellphone at 11:15 p.m., seeking to transfer the patient to hospital. Gouda, as the emergency department doctor on shift, also served as the on-call physician for the care home. He refused to authorize the patient transfer, even though the woman’s advanced-care planning status was Category 4, which includes full treatment and resuscitation.

According to the college report, Gouda got angry at the nurse and ordered that the woman be given “comfort care” and that her family doctor, who is not named in the report, be informed of the situation the following morning. The nurse tried to explain that the resident was becoming dehydrated and had not been eating and that her family sought advanced care, but Gouda still refused to OK her transfer to hospital.

The report also states that Gouda believed the family doctor should have been called first, although the unnamed regional health authority’s policy states that if nursing staff have concerns about a care-home patient outside normal office hours, they can call either the family doctor or the on-call hospital emergency physician.

After consulting with a care-home supervisor, the nurse tried contacting X’s family doctor, who did not answer his cellphone. A message was left on the second call. The health region’s protocol is that if a care-home nurse believes a resident requires urgent care and the on-call physician refuses to transfer the patient to hospital, there should be an attempt to contact another physician, usually the family doctor, and to keep the care home’s clinical manager informed.

At 4:45 the next morning, the resident’s daughter arrived at the care home. Seeing her mother’s condition, she asked the male nurse to telephone Gouda again, which he did. The MD still wouldn’t authorize the transfer, nor would he speak to the daughter, the report says.

Gouda told investigators that he believed it was protocol for the care-home nurse to call the patient’s doctor — referred to in the report as the “attending physician” — and for that doctor to arrange any transfer to hospital.

The six-page report does not name the hospital, the personal-care home or regional health authority involved. Swan River is located within the boundaries of western Manitoba’s Prairie Mountain Health region.

At 6:50 a.m., the nurse was finally able to reach the family doctor, who arranged a transfer to hospital. When she arrived at 8:21 a.m., another emergency room doctor assumed care for her. By then, she was unconscious and severely dehydrated, which adversely affected her blood-sugar levels and blood salts. She suffered acute renal failure.

The college committee said Gouda’s failure to address the care home’s concern over the resident’s condition contributed to her deterioration. It said it found the lack of action by the doctor in light of the nurse’s request for help “particularly egregious.”

In addition to being censured, Gouda had to pay the $9,727.50 cost of the investigation.

The MD did not return a request for comment on Wednesday. He continues to practise.

larry.kusch@freepress.mb.ca