King Edward VII Memorial Hospital- The Influence Of Lawyers And Insurers On Medical Practice.

Email Of March 12, 2005-

To: jonathan.brewin@bermudahospitals.bm
CC: judy.richardson@bermudahospitals.bm
Subject: Re: xxx/Apology For Negligence

Dear Jonathan,

Although I've been liaising with Judy Richardson regarding my long
awaited Apology For Negligence, seeing as how this matter seems to be
becoming a rather drawn out affair, I thought I should remind you about
it. I must admit that given how long this process seems to be taking, I
am trying quite hard to avoid taking the view that the powers that
be in the hospital are just taking their time hoping that I will go
away. This latter is simply not going to happen so I would respectfully
suggest that everybody get on with it. I will also take this
opportunity to remind you of what I consider to be a few key points:

1. It would be outrageous to suggest that anything other than
negligence occurred and in fairness nobody in KEMH has pretended
otherwise. However, the very fact that I am even having to ask
for an apology suggests to me that at KEMH, there is a culture of
expediency rather than principle- and of course the patient
suffers as a result.
2. It is this culture and ethos that has me particularly perturbed.
I sense a distinct lack of willingness to take responsibility. I
do not see the welfare of the patient coming first and foremost
until openness, forthrightness and complete honesty prevail. These
things start at the top of any organisation, not in the basement,
as I am sure you are aware. I believe that not only am I due an
apology, the very act of giving it will actually help to make KEMH
a better place, starting from the top down.
3. It has never been my intention to seek a legal remedy to this
situation as it would probably only contribute to continuing what
I perceive to be the existing culture and realities at KEMH. If
the BHB, their lawyers and their insurers are unable to grasp
this, my conclusion is that they are the fundamental problem
within KEMH.
4. As a member of this community who has the resources, credibility,
and of course good reason to help address and correct matters, it
would be wrong for me to let this matter go. I think it would be
in everybody's best interest (including the public's) that we work
together, but I would be remiss not to mention that I believe I
have the integrity and ability to get results in other ways. So
far I have not taken offence that an apology has not been
forthcoming but it would be a mistake to misuse my patience and
goodwill.
5. The longer this matter continues, the more serious it will become-
I assure you the only way it can be resolved is through complete
transparency and honesty, starting with an apology.

Sincerely,
xxx


Authors Note: As of May 27, 2005- no apology has been forthcoming. I have been told off the record by "powers that be" in King Edward and the Bermuda Hospitals Board that they have been informed by their insurer (handled by Kitsons, I am informed by these same sources) and by their lawyers (Alan Doughty at Trott & Duncan) that if an apology is issued, King Edward Memorial Hospital's insurance will be cancelled.

Hospital Accreditation- is it worth the paper it is printed on?

8^th June, 2004

The Canadian Council on Health

Services Accreditation

1730 St. Laurent Boulevard

Suite 100

Ottawa, Ontario K1G 5L1

Canada.

Dear Sirs,

Re: The King Edward VII Memorial Hospital Bermuda (KEMH)

We write to you as the accreditation body of the above-noted hospital, on the instructions of our client, Mr. X.

Our said client has instructed us to bring to your attention a serious systemic breakdown at the hospital which not only adversely affected him, but which could be life threatening to other patients of the hospital.

On May 19^th, 2003, at approximately 9:00 p.m., our client was admitted to the hospital as an emergency patient, having been diagnosed as suffering form appendicitis. About midnight, an appendectomy was performed upon our client. The appendix was sent to the Department of Pathology. We attach a copy of the pathology report which indicates that it was “reported” on June 13^th, 2003, and states inter alia, that the findings include “Mucin Producing Adenocarcinoma Nests Present In Muscularis Of Appendix”, namely that the appendix was malignant.

This report was sent to our client’s physician, however our client was not informed by his then physician of the pathological findings. In August, 2003, Mr. X changed physicians. In November, 2003, our client’s new physician, upon examining our client’s medical records noted the pathological findings, but did not advise our client of those findings and merely reported the matter to an internist to whom our client was being referred for chest pains. That consultant did not advise our client of the pathological findings, although the referral letter to him stated that “I did not tell Mr. X of the histology”.

It was only in December, 2003, some 7 months after the pathological findings that, by accident, our client noted the aforesaid comment by his then physician in her referral letter, which he coincidentally saw.

In January, 2004, our client attended at the New York Presbyterian Hospital, where a review of the KEMH slides confirmed a tumor passing through the serosa into the pericolonic fat. An ileo-hemicolectomy was performed. Fortunately, it appears as if there was no further evidence of cancer and that the regional lymph nodes were negative.

Our client must undergo six months of chemotherapy, which has already commenced, and is to be tested every year for the next five years to determine whether or not the cancer has spread.

Our client’s concerns, in view of the foregoing include, inter alia, the following:

1) If the purpose of sending surgical samples to the pathology lab is to ascertain amongst other things, if there is evidence of cancer, why was it only “reported” on June 13^th, 2003, a month after surgery?

2) Why was the report sent to our client’s G.P. and not the operating surgeon?

3) Why is there no follow up by the pathology department, where clear evidence of cancer was disclosed, to ensure that the matter was dealt with by either the surgeon or the G.P.?

4) Why no steps were taken by anyone to ensure that the pathological findings were brought to the attention of our client, to ensure that he was aware of the problem and had it attended to?

Although our client’s prognosis appears to be good, in similar circumstances, the systemic failures identified above could very well be fatal.

As the KEMH is the only hospital in Bermuda (aside form the psychiatric hospital) it is imperative that its systems and procedures be such that near catastrophic events such as that experienced by our client, do not arise in the future and thereby adversely affect any other member of the public.

We would appreciate your consideration of the foregoing and advise us what if anything you as the accreditation body propose to alleviate the problem.

If we can provide you with any further information, please do not hesitate to contact the writer.

We look forward to hearing from you.

Yours faithfully,

Barristers & Attorneys XXX

Attention: Executive Director

Dr. Roger Wong

Point Finger Road Medical Center

16 Point Finger Road

Paget, DV 04.

Dr. Terrence Elliott

“Ralmar”

15 Point Finger Road

Paget DV 04.

Dr. Anna Neilson

The Family Practice Group

7 The Lane

Paget PG 05.

An Example Of How Medicine Is Practiced In Bermuda

Chronology Of Events: Bermudian Male, Early Forties.

2002:

Mid/Late December- I go to bed with a pain on my right side, when I wake up in the morning it has become very severe. I call my GP, Dr. Roger Wong and see him sometime shortly after 9am. I ask him if he thinks the pain is my appendix and he states that it is definitely not, “it is up too high”. He gives me an injection of antibiotic in his office, a prescription for the painkiller oxycodon and orders a blood test and ultrasound of my kidney area. I visit him the following week and am informed by him that I had a kidney infection and that no kidney stones were present.

2003:

May 19- Around 4pm I start to feel unwell and begin feeling pain on the right side of my belly. The pain gets progressively worse and around 7pm I lie down and take a rest. The pain continues to worsen and around 9pm my wife takes me to the Emergency Room of King Edward. The ER doctor diagnoses an appendicitis and brings in the surgeon on duty, Dr. Terrence Elliott, who concurs. The decision is made that immediate surgery is necessary and the operation takes place around midnight.

May 20- Dr. Elliott visits me on the ward.

May 21- I am discharged from King Edward by Dr. Elliott and told to visit him in his office approximately 10 days later for a follow up.

Follow Up (I do not remember date but it will be in Dr. Elliott’s records and also with Argus Insurance)- Dr. Elliott examines scar area and informs me that all is well and I leave his office.

August 12- I visit the The Family Practice and meet Dr. Anna Neilson. She agrees to become my GP and sets an appointment for a check up on September 17. Either during this initial interview or else during the September 17 check up, Dr. Neilson directly asks me if I have ever had cancer. I answer that I have never had cancer. ( I believe that Dr. Neilson noted this down and it should appear in my records).

September 9- I visit Dr. Roger Wong’s office and inform the secretary/nurse (Mrs. Wendy Johnson) that I am switching practices and would like all my notes transferred to Dr. Anna Neilson at The Family Practice. Mrs. Johnson gives me a form to fill out and sign which I do and I give the form back to her.

September 17- I visit Dr. Anna Neilson for a check up. She informs me that she has not yet received the notes from Dr. Wong’s office but that when she does she will review them. During the check up, the decision is made that my heart should be more thoroughly checked due to left side chest pain that I had been experiencing. Later that morning, I visit King Edward for an ECG.

Approximately one week later, I receive a letter from Dr. Neilson. I am informed in the letter that my ECG indicates that I may have had a mild heart attack. That same day, I see Dr. Neilson in King Edward and undergo a cardiac stress test with her.

September/October- I make visits for heart investigations to Drs. John Doherty and Shane Marshal. I am informed by Dr. Doherty as regards my ECG that my Q wave is outside of normal variances but is probably not a heart attack. The various other tests are negative.

Early October- Mrs. Wendy Johnson calls me from Dr. Wong’s office to let me know that the notes have been transferred to Dr. Neilson.

Late November- I have not heard from Dr. Neilson regarding all the tests that were done and I remain very concerned that I am still experiencing chest pains. I make an appointment to see her on November 21 and my wife comes with me. She refers me to Dr. Wilbur Warner for further investigations and appointment is made by her office for December 11, which I later switch to December 23.

December 22- Visit Dr. Neilson for a sore throat. She asks me if I have seen Dr. Warner yet and I reply that the appointment is the next day. No mention of anything else is made.

December 23- Visit Dr. Warner and he diagnoses the chest pain as costocondritis. He writes a prescripton and hands me a file to give back to his nurse/secretary. I read the file before handing it back and in particular I read a letter from Dr. Neilson to Dr. Warner. The letter is mainly about my chest pain but in one of the final paragraphs which begins with the word ‘incidentally’, I learned that my appendix had been examined by the pathologist in King Edward and that it contained nests of Mucinous Adeno Carcinoma (cancer). I asked Dr. Warner’s nurse/secretary if I could see him again and I asked him what it was I was looking at. He informed me that it was a diagnosis of cancer and he appeared to be somewhat astonished and confused that I did not already know this. He arranged for a series of tests to undertaken. Later that day Dr. Neilson spoke to my wife at home and I duly returned her call. I found her explanation to me of what had occurred somewhat obscure but I think she was saying that she had assumed that I had known about the diagnosis. She also stated that she had (just?) spoken with Dr. James ( I am assuming her colleague Dr. V. James but possibly the King Edward pathologist Dr. K. James) who was of the opinion that “waiting and seeing what happened” was a reasonable option and that she (Dr. Neilson) had assumed that this was what had been decided. I decided during this conversation that Dr. Neilson’s answers did not sit well with me and I made the decision during the conversation to contact a personal friend of mine who practices medicine in New York and is associated with Cornell University’s New York Presbyterian Hospital. I informed Dr. Neilson of this during the conversation and she agreed to send the pathology report to my friend in New York. Following my conversation with Dr. Neilson, I called (my friend) Dr. Arnold Weg’s office in New York and booked an appointment for January 6).

Late December/Early January- I contact my wife’s friend Dr. Marion Watlington and tell her my story. I specifically did this because I was aware that Marion is an oncologist and that her advice would be helpful- (her advice in fact turned out to be invaluable). She was of course shocked to hear what had happened and basically told me to get to a specialist as quickly as possible and take as much information with me as I possibly could- in particular the slides of my appendix as these would need to be examined again to confirm the diagnosis. (i.e- the sending of the slides to Dr. Weg was my initiative and not Dr. Neilson’s- in fact I had to badger her to get this done).

January 6- I see Dr. Arnold Weg in New York who makes an appointment for me to see an oncologist Dr. Robert Gelfand the next morning and he sets up three cat scans (chest, pelvis, abdomen) for the next afternoon. Whilst in his office, he performs a complete physical evaluation including ECG. I inform him of the previous ECG findings in Bermuda and he informs me that he can see nothing the matter with my Q wave.

January 7- I see Dr. Robert Gelfand and tell him my story. He is absolutely shocked and states to me that “in this country we call that malpractice” and that what has happened to me is “outrageous and preposterous”. He also states that King Edward pathology report is so specific that he is inclined to believe it. I gave him my pathology slides which he immediately sent to the lab at NY Presbyterian. He arranged for me to have a pet scan of the colon as well as the cat scans that afternoon. He arranged for Dr. Weg to do a colonoscopy exam on me the following day. Blood was drawn in his office for testing. Finally, he informed me that was calling his associate the Director Of Surgical Oncology at NY Presbyterian Dr. Michael Lieberman for advice. He called Dr. Lieberman in front of me and Dr. Lieberman informed him in the strongest possible terms that as far as he was concerned and even if there were no signs of cancer, cancer of the appendix is cancer of the colon and must be treated accordingly. Dr. Gelfand made an appointment for me to see Dr. Lieberman on January 9. I left Dr. Gelfand’s office and proceeded to my various tests.

January 8- I see Dr. Weg again. He informs me that my various tests (cat scan, pet and blood) were all negative. He also informs me that surgery will be necessary (hemicolonectomy) as cat and pet scans of the colon are notoriously inaccurate and the only way to be absolutely sure that there has been no spread of the cancer from the appendix into the colon is to remove the section of the colon that the appendix was attached to (approximately 1 ft). He also informs me that is standard, normal treatment which should have been performed shortly after my appendix had been removed. He performs a colonoscopy and removes two polyps which he informs me look benign and which he will send to the lab to confirm.

January 9- I see Dr. Michael Lieberman and his associate Dr. Garrett Nash. Dr. Lieberman informs me that as far as he is concerned, surgery is critical in this instance and that he would like to operate on me on January 13. I agree. Dr. Lieberman sends me to NY Presbyterian’s clinic for preoperative testing immediately following my appointment with him. I receive another complete physical including ECG and am interviewed by an anesthesiologist. I ask him to take a look at my Q wave on the ECG and tell him that a doctor in Bermuda had told me that I may have had a mild heart attack. He replied that he saw nothing to indicate this diagnosis.

January 13- I am operated on.

January 18- I am released from NY Presbyterian.

January 22- I visit Dr. Robert Gelfand who informs me that he wants me to undertake a course of chemotherapy- (5FU weekly for six weeks followed by a week off for four courses- i.e 24 treatments of Chemptherpay in total). Dr. Gelfand also informs me that thirty two nodes of the section of colon that was removed were tested for cancer and they all tested negative. Dr. Gelfand informs me that I should be tested for cancer every year for the next five years. Dr. Gelfand arranges for my first chemotherapy treatment to take place in his office on February 2 with the rest to follow in Bermuda.

January 23- I visit Dr. Michael Lieberman and Dr. Garrett Nash. Dr. Nash removes the staples from my belly and I am examined by Dr. Lieberman. Dr. Lieberman informs me that he would like to see me in four to five months for another look. I ask Dr.Lieberman what I should do if I encounter any difficulties in Bermuda- he tells me to get on a plane and see him immediately (I take it that he too had serious concerns with the previous work done on my body at King Edward although he did not say as much directly)..

February 2- I receive chemotherapy treatment at Dr. Robert Gelfand’s office in New York.

February 4- I return home to Bermuda.