St. Mary's ER doctor disputes CIUSSS reasons for dying patient's transfer

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.

• St. Mary's Hospital administration defends decision to revoke surgeon's privileges

Last November, apatient with a ruptured abdominal aortic aneurysm known in medical jargonas a "triple-Arupture"died after he wastransferred from St. Mary's emergency room to the MUHC Glen site for surgery.

St. Mary's emergency staff called in the hospital'svascular surgeon, Dr. Carl Emond, as soon as the patient was diagnosed.

However,another doctor told CBC News thatEmondhad to breakit to his colleaguesthat his right to perform the time-sensitive operation had been taken awaya 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.

"Emondis a great surgeon. He's very conscientious."

'Minutes count'

VanGurpworked in the hospital's emergency room for four decades, teaching generations of McGill medical residents what he callsthe "tricky" work of diagnosing a triple-A rupture.

He said itisoften misdiagnosed as kidney stones or some other noncriticalailment.

"It's one of the real big emergencies in emergency medicine," he said. "It'sone 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, CIUSSSde l'Ouest-de-l'le-de-Montral) suggested the patient who died in November would have likelydied anyway.

Hospital spokeswoman Claire Roy said in the statement thatthe medical literature shows the death rate from a triple-A rupture is 80 to 90 per cent, even if emergencysurgery is performed.

"That's not true," said van Gurp. He citeda Dutch group's systematic review of all medical literature on triple-A ruptures which found that amongpatients whounderwent surgery, the mortality rate was about 48 per cent.

Roy alsosaid the decision to referpatients presenting with atriple-A rupture at St. Mary's to atertiary 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 addedthat thehospital"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 claimsthe CIUSSSfailedto 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," vanGurpsaid.

"I would trust myself under his knife anytime."

'Expert opinion' carries little weight

Van Gurp also challenged the CIUSSS'sreference to a singleindependentexpertopinion from a vascular surgeon working in the Gatineau region, Dr. Patrice Nault.

Roy saidNaulthad backed the "scientific foundation" of the CIUSSS'sdecision 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 oneexpert opinion as your justification for anything."