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Physicians must consult with family on end-of-life issues: college

A formal complaint about two doctors in a controversial end-of-life case that was considered three times by the province’s medical watchdog has ultimately resulted in the College of Physicians and Surgeons taking the position that it’s necessary for doctors to communicate with family members if they deem it’s necessary to change a patient’s status to “do not resuscitate,” says Toronto health lawyer Lonny Rosen.

“It appears as if the college’s Inquiries, Complaints and Reports Committee (ICRC) came to this decision reluctantly after having twice earlier refused to take action in these circumstances,” he tells AdvocateDaily.com. “It also seems that the ICRC was quite measured in its decision, finding that 'Dr. Chapman and Dr. Livingstone’s conduct was not completely appropriate, and some action is necessary.'"

Rosen, partner at Rosen Sunshine LLP, says he’s not aware of any other case where the Health Professions Appeal and Review Board (HPARB) found that the ICRC twice decided the same case unreasonably or in which after two reviews by HPARB, the ICRC changed its position.

He weighs in on the matter as the college issued a written caution against Drs. Martin Chapman and Donald Livingstone after it twice previously took no action in respect of  a formal complaint by the daughter of the man they treated, reports the Toronto Star

“In our view, Drs. Chapman and Livingstone failed to properly communicate with Ms. Wawrzyniak in this case when they made the decision that it was appropriate in the circumstances to change her father’s status," says the latest ruling by ICRC.

Joy Wawrzyniak launched the complaint and appeals against the two doctors after the death of her father, Douglas DeGuerre, at Sunnybrook Hospital on Sept. 22, 2008. She says the 88-year-old man had wanted a “full code” designation on his medical chart to be given every chance at life, says the article.  

Physicians changed his status to “do not resuscitate” just hours before he went into cardiac arrest, says The Star

Wawrzyniak filed a complaint with the college in 2009 and has also filed a $1-million civil suit against the doctors, says the newspaper. 

Rosen notes that the first time the ICRC reviewed this case, it took no action and Wawrzyniak asked HPARB to review that decision. HPARB, upon its review, found ICRC to be unreasonable in its assessment. ICRC then reviewed the case and again took no action. HPARB reviewed that decision once again and said that it was unreasonable. 

ICRC then looked at the case a third time, and this time it decided to issue written cautions to the two physicians. 

Rosen explains that the ICRC has the ability to respond to complaints in various ways – it can rule there’s no need to take any action, it can issue advice, a written or oral caution, which is a little more serious, and it can also refer the matter to the college’s disciplinary committee. 

He says HPARB has various options available to it as well  it can confirm the decision of the ICRC, it can substitute it's decision for that of the ICRC, or it can return the case to the ICRC with direction. HPARB can only take action in two circumstances: one, if it finds that the investigation by the ICRC was inadequate or if it finds the decision of the ICRC was unreasonable, he says. 

Meanwhile, this case doesn’t end here. The complainant has said she’s not satisfied with the cautions issued to the doctors.

Wawrzyniak has the option of requesting a review of the latest decision.

 

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