A man has filed a complaint with Winnipeg police over the death of his 95-year-old father last year at Seven Oaks Hospital, alleging his dad was inappropriately given a powerful opioid "for no good reason."
The elderly man was not in pain when the drug — hydromorphone — was administered, and the hospital broke protocol by failing to properly monitor his condition afterwards, his son says.
He also claims the size of the intravenous dose — one milligram — was far too large for a frail, elderly man with no history of taking opioids.
The Winnipeg Police Service confirmed this week that it received the complaint.
"There's a preliminary investigation, very preliminary," said WPS spokesman Const. Rob Carver. "We're not investigating a murder or a death. We've opened the file."
"There's a preliminary investigation, very preliminary. We're not investigating a murder or a death. We've opened the file." – WPS spokesman Const. Rob Carver
Scott Sime, director of communications with the Winnipeg Regional Health Authority, said officials will co-operate with any police investigation. He expressed his sympathies to the patient's family.
Sime said the WRHA could not share the results of an internal review of the man's care. However, the son showed the Free Press a letter from the WRHA that concluded — with a couple of qualifications — that his father's care had been "appropriate."
The man, who asked that his father not be named, told the Free Press he had several concerns about his dad's care after he was taken into the Seven Oaks emergency department on Nov. 25, 2018 to have fluid drained from his lungs, a procedure that he had done approximately every three months.
He balked at the hospital's decision to admit him in the first place — preferring that his father remain in the ER until a lung specialist could examine him. Once his dad was admitted, he disagreed with a decision to take him off solid food for a time.
At one point in the hospital stay, the son found his father lying flat on his back, in distress at not being able to raise himself, and disconnected from his oxygen. After that, the son paid for home-care attendants to be at his side around the clock.
But by Dec. 6, he said, his father was doing well and his lung specialist was to pay him a visit the next day to determine when he could be released.
In the early morning hours of Dec. 7, hospital records show, he was given a 1 mg dose of hydromorphone by a nurse after one of the home-care attendants alerted staff that he was breathing rapidly. Use of the opioid had been authorized by a physician a couple of days earlier.
The son said when he arrived to visit his father Dec. 7, his dad was "comatose." He died Dec. 9.
He alleges the hospital failed to monitor his father properly after administering the powerful drug.
At one point in the hospital stay, the son found his father lying flat on his back, in distress at not being able to raise himself, and disconnected from his oxygen. After that, the son paid for home–care attendants to be at his side around the clock.
He said he could potentially have been revived with the antidote naloxone, which hospitals, paramedics and police officers carry to treat opioid overdoses.
He faults a hospital doctor for failing to record in a "death summary" report that his father had been given hydromorphone.
The death summary says the elderly man was suffering from "end-stage heart failure." The man's son disputes any suggestion his father was on his death bed.
"He wasn't going to be on the Olympic team, but for a 95-year-old he was fine," the son said.
Hospital officials conducted a review into the man's care, which was summarized in a letter earlier this year to the son from Réal Cloutier, the WRHA's president and CEO.
"While recommendations for improvement were made," he wrote, "the WRHA is of the view that the care provided to your father was appropriate."
A one-page report accompanying Cloutier's letter said while the dose of hydromorphone given "was within the range commonly ordered for adults, the opportunity to consider a lower starting dose, based on (the man's) age and medical conditions, was not realized."
The report said hydromorphone had been administered to "provide comfort related to (the patient's) breathing." It acknowledged that "the opportunity to clearly document the indication for administration and the effect of the medication was not fully realized."
Dr. Vincent Taraska, the deceased patient's lung specialist, said in an interview he feels the hydromorphone dose was a higher than it should have been, given the man's age.
"There's a judgment call here. My judgment would have been probably a little less would have been better," he said.
Taraska describes his former patient as a frail, elderly man who suffered from congested heart failure and had recurrent pleural effusions (an unusual buildup of fluid around the lungs) that were related to his heart problems.
"Since he could not tolerate further heart medications, and they weren't particularly effective, we had adopted a plan to simply tap him (insert a tube) every once in a while to remove the fluids so he could breathe a little bit better," Taraska said this week.
Asked about the death summary report characterizing his former patient as having had end-stage heart failure, Taraska said he concurs — but with the following caveat: "He had quite severe heart disease, but end stage doesn't always mean imminent death."
Taraska said he's never given hydromorphone to a patient for reasons other than pain management but called it "an acceptable approach." He said it's used with people who are quite ill "just to help relax them and help them sleep and relieve general symptoms."
"The only question, then, is the circumstances of the patient at the time and the dose," he said.
Daniel Sitar, professor emeritus at the University of Manitoba's department of internal medicine (clinical pharmacology), said according to a list of medications the 95-year-old was taking (provided to him by the Free Press), he would have had chest pain "at least episodically."
"This drug list does not convince me that the dose of hydromorphone was unjustified," Sitar said in an email.
Larry Kusch didn’t know what he wanted to do with his life until he attended a high school newspaper editor’s workshop in Regina in the summer of 1969 and listened to a university student speak glowingly about the journalism program at Carleton University in Ottawa.