discipline summaries and likely repeat lab work if appropriate . He said that the observation period should be at least six to eight hours and the two-hour observation period in this case does not meet the standard of care . Dr . X opined that Dr . Kamermans showed a lack of knowledge and judgment regarding the appropriate ER evaluation and management of this patient ’ s chief complaint and that there was a potential for harm for the patient . The Committee finds that Dr . Kamermans failed to maintain the standard of practice in this case of possible methanol ingestion . Dr . Kamermans was cavalier in the Committee ’ s view . He had the information he needed from the Poison Control Centre and he did not use it . It is the Committee ’ s view that Dr . Kamermans ’ knowledge and judgment deficiencies persist with respect to how properly to address the issue of the ingestion of antifreeze by a child . In his testimony , Dr . Kamermans said that he assumed that the child did not ingest much and certainly not enough to do any blood work that the Poison Control Centre recommended . However , Dr . Kamermans had no grounds for making that assumption . No one actually witnessed the child with the methanol .
Patient # 6 Patient # 6 was an elderly patient with dementia who presented to the Emergency Department after an unwitnessed fall . Dr . Kamermans failed to maintain the standard of practice in his investigation , evaluation and documentation . The Committee found Dr . Kamermans ’ investigation of the causal factors rudimentary . Although he said his physical examination of the heart would rule out some cardiac causes , he did not do an ECG , which would have been indicated . Similarly , he did not do further x-rays or a CT scan of the neck , which was indicated by Canadian standards . According to Dr . X ’ s summary in his report , the elderly patient presented to the ER after falling . She did not know where she was and could not remember the fall . Dr . X noted that this made her history of the event unreliable , given her dementia and the fact that the fall was unwitnessed . Dr . X noted the patient had a significant risk of both intracranial injury and cervical spine injury as a result of her fall .
Documentation is sparse on this ER chart . Dr . X points out that the physical examination is cursory and incomplete . Dr . Kamermans did not document his thought process regarding the evaluation and management of the patient and does not provide a differential diagnosis for why the patient fell . Dr . X commented in his report that a much more thorough evaluation should have been undertaken by Dr . Kamermans to rule out serious causal factors , such as syncope or near syncope of possible cardiac , neurogenic or neurologic origin .
Investigation of cervical spine injury One of Dr . X ’ s concerns as noted in his report was that the patient had no spinal precautions taken at any time , either by the paramedics transporting her or by the ER staff . Dr . X thought that there was a significant concern regarding a cervical injury and no neurological examination or assessment of the cervical spine was done . Although the fact that Dr . Kamermans did a CT scan of the head suggests that he clearly suspected that the patient had the potential for serious injury , Dr . X opined that Dr . Kamermans did not adequately assess the risk of a neck injury . Dr . X testified that no cervical spine studies were done and , given the patient ’ s advanced age , dementia and amnesia regarding the event , an injury to the cervical spine could not be ruled out by history and physical examination alone . Dr . X testified on Canadian standards and guidelines for when to order radiography in alert and stable trauma patients . In his view , this patient fit the category of patients who required follow-up assessment for neck injury because of her age and her Glasgow Coma score which was less than 15 . In his testimony , Dr . Y opined that since the patient was able to complain of a headache to the paramedics , she would likely have been able to complain of neck pain if she had it . Dr . Y thought pain would normally be elicited on palpation and if it was not , then a CT scan of the neck would not need to be ordered . Dr . Kamermans testified that he would have been
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Issue 1 , 2017 Dialogue 59