discipline summaries
of his attendance on this patient . Despite that , and also despite hearing two experts explain that the use of Diltiazem was contraindicated in this case , Dr . Kamermans maintained in his examination-in-chief that this medication was still part of his armamentarium for this problem . Dr . X said that this condition was a “ meat and potatoes ” one in the ER , that is , fairly common . In the Committee ’ s view , Dr . Kamermans knew he was out of his depth the day this patient came to the ER and the fact that he called the consultant confirms that . In the intervening three years , he has not taken the opportunity to learn from his deficiencies and augment his knowledge in this area , irrespective of whether there was a hearing about his deficiencies or not . At the hearing , Dr . Kamermans demonstrated that he did not learn from his experience that day in the ER , by reading the consultant ’ s note or taking in the experts ’ testimony . Both experts testified that because the patient had a pacemaker and an implanted defibrillator , it would be presumed the patient had impaired left ventricular function and using Diltiazem , as Dr . Kamermans did , would lead to complications , as it did in this patient . That his lack of knowledge persists three years later is of grave concern . It was also of concern to the Committee that Dr . Kamermans testified that the patient was on a monitor , intimating that there was somehow less risk when this patient was given a medication that had an adverse effect on his condition . Any comfort that monitoring would give is false . It indicates a lack of judgment and a cavalier attitude that gives pause when considering the urgency of the situation in this case . Clearly , Dr . Kamermans did not know what he was dealing with or how to manage it and he was fortunate that the consultant was available to come and assist . The Committee is not sure what the outcome would have been if the specialist had been unavailable to consult in this small town hospital when Dr . Kamermans needed him . Dr . Kamermans ’ care and documentation for this patient fails to maintain the standard of practice . The Committee also finds that Dr . Kamermans showed a lack of knowledge and judgment that the evidence establishes persists to the present day .
Patient # 4 Patient # 4 was a child with respiratory distress , shortness of breath , a slightly dusky appearance and moderate to severe croup . Dr . Kamermans ’ care of this patient failed to meet the standard of practice both in terms of documentation and treatment of this sick child . Dr . Kamermans used medication that was not helpful for croup and was not up to date with the current medication standards . This child was brought into the ER from a walk-in clinic and was in respiratory distress according to Dr . X . The child had a respiratory rate of 48 breaths per minute and the O2 Sat was 92-93 %. The acuity score was one , which indicated that the child needed to be seen immediately . The nurses ’ notes indicated that the child was short of breath with significant indrawing with respirations and a slightly dusky appearance . In this case , Dr . Kamermans did chart that the child had indrawing , rhonchi and decreased air entry in his lungs . The croup score was six and following treatment with Atrovent , Ventolin and Pulmicort , as well as oral prednisolone syrup , the croup score was reduced to 2.5 , although the charting of cough on the last assessment was missing and may have raised this score . Dr . X stated that the documentation for this patient was brief , incomplete , and provided only a cursory account of his clinical interaction with this patient . There is no documentation of the presenting illness , the past medical history , social history , developmental or vaccination history . The physical examination as charted is incomplete . There is no documented differential diagnosis given the other possibilities for co-existing pathologies and the management plan for the acutely ill child is lacking . Nor is there documentation with regard to the response to treatment by Dr . Kamermans . However , nurse ’ s notes indicate that the doctor examined the patient on arrival and again about 15 minutes later , after treatment .
Treatment of Croup According to Dr . X , this child had severe croup on presentation to the ER , while Dr . Y and Dr . Kamermans called it moderate to severe . Dr . X said that marked retractions of the chest , severely decreased breath sounds , tachycardia and cyanosis ( duskiness )
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Dialogue Issue 1 , 2017