Changing protocols

Man dying of cancer languished for six hours in ER

A Nova Scotia hospital has rewritten waiting time rules and end-of-life protocols in response to the disturbing story of how a 68-year-old man dying from pancreatic cancer languished for six hours in an ER hallway.

A report on the death of Jack Webb says that as of July 1, the Halifax Infirmary requires internal medicine specialists to meet their patients within two hours when transferred to the hospital after being seen by another facility.

Webb’s widow, Kim D’Arcy, provided the internal report to The Canadian Press.

It outlines changes made by the Nova Scotia Health Authority after the saga of his treatment emerged in late April.

The review that followed a public outcry over his case has also brought changes to training of medical students and some procedures for treating dying patients.

It also says that “unstable” patients in ER are to be admitted to the hospital “after a direct conversation” between emergency and the senior internist.

Webb was supposed to have been seen by an internal medicine specialist upon arrival at the Infirmary when he was transferred there from a suburban ER.

Instead, nobody was waiting and he lay shivering in a crowded emergency room hallway lineup with his paramedics.

D’Arcy says after his wait, Webb spent time in ER with an intravenous that couldn’t pump fluid, and he was later bumped from his private room by another dying patient into a medical teaching unit.

He was also repeatedly asked by various staff if he would agree to a do-not-resuscitate order, even though he hadn’t been given any clear information on how long he had to live.

On the last day of his life, after being sent for a scope test, Webb lay in a recovery room and overheard staff yell, “If he stops breathing, don’t resuscitate,” D’Arcy said.

Under the changes, medical students will be guided in simulated conversations on how to talk to dying patients like Webb about their prognosis.

In addition, a written “goals of care” form is being introduced that documents the varying types of care patients with terminal diseases want to receive.

Jason MacLean, the president of the Nova Scotia Government and General Employees Union, said the reforms are useful steps, but added: “Wouldn’t you think that’s the way it should be? ... They are telling you something that should have been (in place).”

Public records indicate the underlying issues of crowded ERs and proposed solutions have been raised for years before Webb’s case highlighted the problems.

For example, the former provincial adviser on emergency care, Dr. John Ross, said in a 2010 report that, “the emergency department CANNOT be used for ... holding areas for inpatients transferred from other hospitals.”

This is precisely what occurred in Webb’s case.

There were also recommendations at the time, accepted by the medical advisory committee of the health authority, that specialists take over care of ER patients within two hours of a consultation showing they needed to be admitted.

Still, D’Arcy said she’s pleased some measures are being taken as a result of her husband’s death.

“They’re putting it in writing and they have people assigned to it now ... so now someone’s accountable,” she said.