June 19, 1925 - August 6, 2008
One of the reasons we moved from British Columbia to Ontario was to be near to my Dad. We had seen him at Christmas and I returned in January to help my sister and brothers with the miserable task of moving him into a nursing home. I didn't think anything could make me sadder than that. On Wednesday, August 6th, he died in palliative care in the local hospital and we all learned a new lesson in heartbreak.
Dad suffered from Alzheimer's, complicated by Aphasia. It was difficult to communicate with him, but he enjoyed our visits and a joke, a pretty girl or a child could still make him smile. He liked to be pushed in his wheelchair around the neighbourhood and seemed to appreciate any talk about visiting England.
Here, in my sister Kim's words, is what happened. This is from her excellent letter to the Ontario Ministry of Health and Long Term Care:
During a visit with Dad on July 20, along with my Mother, it was obvious to us that Dad was uncomfortable and experiencing some pain. He had recently been treated for a diaper rash and the nursing staff and Personal Support Workers (PSWs) assured us that this issue had been cleared up. I relayed information to the PSWs on July 20, that Dad was experiencing discomfort and judging from his behaviour thought he might have a bladder infection.
My Mother was in every day thereafter and repeatedly made requests for a urine sample to be taken. She spoke to the Charge Nurse in Dad’s unit, as well as to the PSW staff. She also spoke to the Director of Nursing. While the Director of Nursing was most accommodating, the urine sample was still not taken. My understanding is that the staff tried on numerous occasions to obtain a sample but were unsuccessful. Repeat requests by my Mother were met with cavalier unconcern and in fact, she felt very much as if she was being patronized. Dad’s discomfort grew during the week but by the 24th and 25th he seemed very sleepy and it was difficult to even feed him. They were, apparently, able to get a urine sample on Friday, July 25th – however we have no idea whether they processed the sample or not.
We were out of town on Saturday but received a call early Sunday, August 27th from S. Park to advise that Dad had been taken to [the local] Civic Hospital. The charge nurse from S Park informed me that Dad had been very agitated on Saturday night and they administered extra Atavan to calm him down. At approximately 5 a.m. on Sunday they discovered that Dad’s “level of consciousness was very low.’
Upon admission to Emergency, Dad was in severe pain. He was diagnosed with acute renal failure, caused by an untreated, acute urinary tract infection. He was also suffering from a low-level pneumonia, which, in the Doctor’s opinion, was likely caused by food aspiration. He was very dehydrated and in absolute agony. The catheter was full of pus and blood. He was unable to do anything except repeatedly pull his legs up to his chest and scream in pain. Except that you couldn’t really hear him scream as he had aspirated on food and required frequent suction to clear out his throat. Dad was unable to swallow and repeated attempts to insert an NG tube were unsuccessful. He was admitted to the Palliative Care wing of [the local] Civic Hospital on Saturday, August 2nd. He died on Wednesday, August 6th at approximately 5:15 p.m.
By copy of this letter and on behalf of my family, I wish to lodge a formal complaint against the nursing and PSW staff of the S. Unit at The Village of S. Park. The specific issues are these:
• Lack of care and timely response to our concerns. A blatant disregard for the fact that we TOLD them Dad was in pain and we ASKED them to run a urine sample a full week before he was admitted to the hospital.
• They were the care givers and the health care professionals. Where was the compassion – they were the ones who were entrusted with the care and well-being of our father – why didn’t they take us seriously? If they had difficulty obtaining a urine sample by putting him on the toilet, why didn’t they order a catheter? In fact, why didn’t they have the staff doctor take a look at him?
• In conversation with the General Manager, J.S., of S. Park on Monday, July 28, we were informed that Dad’s file contained a standing order to administer Atavan every 8 hours (3x daily) as well as on an as needed basis. This was contrary to the instructions I issued during the family health care conference on May 28, in which I requested they administer Atavan on an as needed basis ONLY. In fact, Jennifer Simpson admitted surprise at the standing order as she was in attendance at the conference and recalled the conversation.
• Despite being told that Dad was in discomfort they CHOSE to label his pain as agitation. So what did they do? They over-medicated him with an ANTI-PSYCHOTIC drug – despite everything we told them. They administered a significant amount of Atavan all week, to the point where he was non-responsive – enough to mask his agony. Remember – pus and blood in the catheter when he was admitted on the 27th – which lasted a week. How long did he suffer with this before he was admitted?
• Aspiration and Urinary Track Infections are very common in the elderly. Where was the quick response time to nip a potentially life threatening condition in the bud?
• When admitted to Emergency, his teeth were covered in food. No wonder he aspirated on food which subsequently lead to his low-level pneumonia. Where was the concern for his oral health and respiration?
We are shocked at the events leading up to Dad’s death and we are broken-hearted about his untimely demise. It is our opinion that his death was precipitated by S. Park’s gross negligence. Had they responded in a timely manner, diagnosed the problem and prescribed antibiotics, this may have been avoided. Shame on them.
The whole family stayed with him in palliative care, and took turns spending the night with him. Mom and I were there at the end, and I hope it gave him some comfort. It still seems very unreal, and we're all a loose ends without nursing home visits to make.
My father and I were not very close, since I spent the last 20 years on the other side of the country. Dad was smart, articulate, charming—and stubborn. Like me, he was an atheist, but was so conservative in his viewpoint that he once argued for prayer in school during a disagreement we had. But he was always very generous and so clearly loved us all. We all ache for him and we will never be the same.