2023-05-13 05:32:28
No malpractice, but obvious organizational problems. Andrée Simard, the widow of Robert Bourassa, died last year in pain and distress because she did not have access to the palliative care normally given to a patient in her situation.
What there is to know
- Andrée Simard, widow of former Prime Minister Robert Bourassa, died at St. Mary’s Hospital Center on November 28, 2022.
- In January, his daughter Michelle Bourassa reveals that Mme Simard died after three days of suffering and distress; she did not receive palliative care.
- The College of Physicians launched an investigation in February.
- According to the College, there were no “ethical breaches by the medical team”. However, the survey raises flaws in the “organization of care”.
Walking on eggshells, the College of Physicians has just published its investigation report into the events surrounding the death of Mme Simard, at St. Mary’s Hospital Center on November 28, 2022. The investigation carried out by a doctor and former executive of the health network “did not reveal any ethical breaches by the medical team”, observes d First of all the College, which however notes “problems of communication between the family and the care team” as well as flaws in the “organization of care and services” for terminally ill patients.
M’s daughterme Simard, Michelle Bourassa, said in an interview that she was “deeply disappointed” with the College’s conclusions. “I was able to see the opacity that reigns within this professional order. The College evokes the friction between the members of the family and the care team as well as the lack of clarity of the relatives as to the level of sedation desired for the patient. “A doctor threatened to expel me from the establishment because he alleged that I had broken the bond of trust with the nursing staff. This is, for me, not only a flagrant lack of judgment, but a deficient ethical practice, ”launches the daughter of the late Prime Minister.
The state of Mme Simard had deteriorated rapidly at the start of the weekend. For the president of the College of Physicians, Dr.r Mauril Gaudreault, “the conditions were in place for a perfect storm”. “A 90-year-old patient, whose condition deteriorates very quickly, in a few hours. It happened at the weekend, when there was a change of doctor, change of resident, change of team,” he explains.
There was no breach of ethics, but there were clearly organizational problems, problems with the provision of care, both by the medical nursing staff and the other professionals. We can conclude that Mme Simard could have had access to better organized palliative care.
The Dr Mauril Gaudreault, President of the College of Physicians
The College conducts its investigations “not to find a culprit, but to improve the situation, in this hospital center and for the entire network. It is certain that it did not suit Mr.me Bourassa when we sent him our conclusions,” he adds.
New measures
At the CIUSSS de l’Ouest-de-l’Île-de-Montréal, the Deputy President and CEO, Najia Hachimi-Idrissi, points out that since then, measures have been taken to review the provision of palliative care.
Nearly 80% of nursing staff have since received training in this type of care, a specialized multidisciplinary team has been set up to ensure that the needs of patients and the wishes of families are met more sensitively, “to detect more quickly signs of distress.
The CIUSSS has also prepared standardized protocols on the procedure to be followed by doctors and nurses in similar situations.
The limited resources, the lack of personnel also contributed to the slippage: “The weekend is a difficult context, sometimes the link between the teams is a problem. The family was in distress, they would have benefited from psychosocial support, which was not deployed in time, the social worker was absent at the time,” explains Ms.me Hachimi-Idrissi.
Was Michelle Bourassa right to be indignant? “A patient who is going through a difficult experience is always right. What the person is experiencing is an important aspect, it must be taken seriously, ”says Mme Hachimi-Idrissi.
Access to palliative care
Andrée Simard’s daughter points out that she insisted that her mother be given palliative care to relieve her pain. Gold, M.me Simard had contracted COVID-19, and the hospital did not want to transfer her to the palliative care unit because it was feared she could infect oncology patients.
An old building, St. Mary’s Hospital Center has many rooms with multiple patients, and oncology and palliative care are in the same unit. “We cannot admit someone who has COVID-19 to this unit,” explains Ms.me Hachimi-Idrissi. The new specialized team can travel to provide palliative care in other units.
When The Press had reported the drama crossed by Mme Simard and his family, the CIUSSS de l’Ouest-de-l’Île-de-Montréal immediately announced changes to this practice and specified that palliative care was normally available in other care units.
In its report, the College of Physicians makes the same observation. This file “highlights the difficulties faced by care settings, in particular the difficulty of access to accompaniment and support outside the unit dedicated to palliative care”.
For the College, it is necessary to question the situation throughout the CIUSSS, “which raises concerns about access to palliative and end-of-life care throughout the network”. It is necessary, according to the College, “to question the sufficiency and the organization of the resources […] in order to truly guarantee equitable access to quality palliative and end-of-life care, at home, in accommodation and in hospitals”.
Corrigendum
A modification was made after publication of this article to clarify that the doctor who carried out the survey is not retired, as initially mentioned by the College of Physicians. He is an active doctor and ex-executive of the health network.
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