Neurologist alleges malpractice by Ottawa Hospital
A former Ottawa neurologist says a botched procedure at The Ottawa Hospital led to a life-threatening case of septic shock, a sevenmonth hospital stay — and lasting injuries that have robbed her of a once-promising medical career.
Dr. Inge Loy-English, the former director of the memory program at Élisabeth Bruyère Hospital, is now disabled and can no longer work as a neurologist.
She’s suing The Ottawa Hospital, along with a handful of doctors and nurses, alleging negligence and malpractice.
Loy-English, an expert in the treatment of dementia, is seeking more than $2.6 million in damages.
The case is highly unusual in that it pits one doctor against another in a malpractice suit.
In her statement of claim, LoyEnglish alleges that Dr. Harinder Dhaliwal, a gastroenterologist — or another doctor acting under his supervision — performed an endoscopic procedure on Jan. 8, 2013.
Loy-English had suffered abdominal pain for several years when she went to day surgery for the procedure known as endoscopic retrograde cholangiopancreatography (ERCP). It allows doctors to examine the ducts that drain the liver and pancreas.
During the procedure, doctors also planned to cut into the muscle that surrounds the area where the ducts open to enlarge it and, hopefully, relieve some of Loy-English’s pain.
The treatment is called a sphincterotomy. It is performed using a long, thin, flexible and lighted instrument known as a duodenoscope, which is threaded down the back of the throat, through the stomach and into the top of the small intestine.
The procedure is less invasive than traditional, open surgery.
During the procedure, LoyEnglish suffered a rare but serious complication when her small intestine was perforated. Material from her bowel leaked into her abdominal cavity. (A 2007 Mayo Clinic study that examined the records of more than 12,000 ERCP patients found that fewer than one per cent suffered perforations.)
According to her statement of claim, Loy-English awoke from the anesthetic and complained of severe abdominal pain. She had trouble walking.
As a result, she was sent for an abdominal X-ray, which revealed the presence of “free gas” in the lining of her abdomen.
The claim contends that the finding was consistent with a perforated bowel and should have triggered more investigation. Instead, it alleges, Loy-English was discharged from hospital and told she could go home.
But Loy-English was in so much pain that she immediately went to the emergency department, where she waited several hours to see another doctor. An emergency physician ordered a second X-ray, then a CT scan, which revealed a bowel perforation.
Loy-English began a course of antibiotics and was admitted to hospital. In the ensuing days, however, her condition deteriorated. She slipped into a coma and suffered an episode of “cerebral hypoxia,” during which her brain was starved of oxygen.
Loy-English developed a widespread infection that threatened her life, the statement of claim says, and on the afternoon of Jan. 12 she went into septic shock. The condition, marked by a dangerous drop in blood pressure, can quickly lead to organ failure.
During emergency surgery, doctors confirmed that Loy-English had a perforated bowel. Surgeons cleaned her abdominal cavity, then tried to close the wound in a second operation three days later.
“The surgical team was unable to repair the perforated bowel because the infection was extensive and severe, and the bowel was severely compromised,” the statement reads.
Loy-English was moved to the intensive care unit but her bowel continued to leak, so in April surgeons removed a large section of her colon. She remained in hospital until late August, then spent more than a month in rehabilitation.
Loy-English has not been able to return to work. According to the statement of claim, “(She) suffers from nausea, diarrhea, malnutrition, muscle weakness, depression, fatigue and various cognitive deficits as a result of the infection, hypoxia and ileostomy,” a procedure that redirects the small intestine outside the body.
Loy-English had been unable to practise neurology since 2010 because of what doctors believed was recurrent pancreatitis. She was hoping the procedure in January 2013 would allow her to resume her medical career.
The lawsuit contends that the doctor who performed the initial procedure failed to exercise reasonable care and did not adequately investigate the cause of her post-surgical pain. What’s more, Loy-English says, she should have received antibiotics as a prophylactic measure and medical staff should have been quicker to identify her diminished state of consciousness in the emergency department.
The allegations made in the statement of claim have not been proven in court.
Lawyers for Dhaliwal and The Ottawa Hospital have indicated they intend to defend themselves against the lawsuit.
The hospital denies there was any negligence on its part, or on the part of anyone working for it. What’s more, the hospital argues that it’s not liable for the actions of Dhaliwal, an independent medical practitioner who holds privileges at the hospital.
Dhaliwal and his lawyers did not respond to a request for comment.