Emergency Room Shenanigans: A Comedy in Tragedy
Ah, the emergency room—where time stands still, and you can witness the slowest game of triage imaginable. This brings us to the unfortunate tale of a lovely lady, Micheline Bouchard, who found herself waiting for a miracle in the regional hospital of Trois-Rivières. Unfortunately, the miracle machine appears to have been out of service that day, as she ended up waiting 22 hours to receive adequate care, and spoiler alert: a little too late for our 66-year-old heroine.
“We still believe it was a preventable death. If my sister had been taken care of more quickly, we think that today, she would still be alive. She should still be with us.”
— Yves Bouchard, brother of Micheline
The Triage Tango
Picture this: Micheline waltzes into triage at around 8 PM on August 16, 2023, gasping for breath. A charming nurse gives her a P3 rating—urgently urgent, which should mean a medical hug within 30 minutes because, you know, pulmonary embolisms aren’t exactly a “let’s take our time” kind of issue. But the next morning, after two reassessments and one regrettable cup of coffee, she was still waiting to be seen by a doctor! That’ll teach you to be a patient patient.
“Twenty-two hours, especially with a P3 rating, is unacceptable.”
The Sluggish Symphony of Healthcare
Now, let’s get into the nitty gritty, shall we? A coroner pointed out that the standard medical practices took a vacation that day. Anticoagulant therapy? Oh, that should’ve been a morning delight, not a late afternoon snack. You’d think they were waiting for the doctor on a three-martini lunch rather than dealing with a potential deadly condition!
But wait, there’s more! In a twist that only a poorly organized healthcare system could provide, the medications weren’t even present in the ER—nope, they were at the pharmacy! So, they had to wait for that cocktail of life-saving drugs to get validated by a pharmacist—a validation process that took even longer than deciding on a Netflix series to binge-watch.
Communication Breakdown
And let’s talk about communication—or lack thereof. Imagine being urgently reassessed and the nurse is too busy to answer a doctor’s call. It’s like trying to reach your mate at a loud concert: “Sorry, can’t hear you over the sound of chaos!”
“It seems to me that there is a difficulty in terms of communication…”
— Me Karine Spénard, coroner
Lessons Unlearnt
This tragic tale is not merely a freak occurrence—it’s a pattern. Just in case you thought the last 22-hour wait was just a glitch in the Matrix, a previous case from 2020 tells us that the ghost of pulmonary embolism had paid another unfortunate visit at the very same hospital. You’d think a memo would have been sent out, or at least a group chat started.
The Family’s Fight
The Bouchard family isn’t looking for revenge; no, they just want to make sure no one else has to suffer the same fate as their beloved Micheline. It’s about prevention, about ensuring that such fiascos become extinct like the dodo bird. They aim to get to the truth, and boy is it a wild goose chase!
In Conclusion
Like a bad comedy where the punchline just never lands, this incident shines a light on the urgent need for improvement in the emergency healthcare system. Perhaps they could install some timers on the waiting room walls—how about a countdown clock for every time someone lingers too long? Everyone loves a bit of friendly competition, right? “I beat your wait time by 2 hours!”
Micheline may be gone, but her family’s mission is clear: they’re standing up—armed with a sense of justice, a thirst for truth, and a hope that something will finally change.
Despite seeking immediate help at the emergency room, a 66-year-old woman from Trois-Rivières, Micheline Bouchard, tragically endured a harrowing wait of 22 hours before receiving any medical treatment. Sadly, by that time, it was already too late for her.
According to a medical examiner who analyzed the case, “the standard of practice had not been respected. […] Anticoagulation therapy should have been initiated as soon as the probability of pulmonary embolism was significant, around 10:20 a.m. on the morning of August 17, 2023,” stated the coroner.
Me Spénard pointed out that while there were clear lapses in care, this does not guarantee that Ms. Bouchard’s life could have been saved. “It is essential to stress that, even if anticoagulants had been administered sooner, we cannot definitively say that Ms. Bouchard’s condition would have improved,” he noted.
However, the family is convinced that better care would have changed the outcome of this tragic event. They emphasize that prompt medical intervention could have potentially altered the course of events that led to her untimely death.
“We firmly believe this was a preventable death. Had my sister received timely care, we are convinced she would still be with us today,” stated Yves Bouchard, Micheline’s brother.
The coroner’s investigation unveiled multiple issues, including ineffective communication, an examination that occurred seven hours post medical request, incomplete documentation, and the lack of available medication in the emergency room, leading to significant delays in critical treatment. Rectifications have since been initiated.
Me Spénard urged the Council of Physicians, Dentists, and Pharmacists of the CIUSSS MCQ to “critically review the care and support provided” to Ms. Bouchard and implement necessary changes to ensure that healthcare providers adhere to the highest treatment standards in such cases.
The Bouchard family is committed to ensuring that the recommendations from the coroner’s report are taken to heart by the establishment’s board. They are also considering taking further action, either legally or administratively, but they do not intend to direct their grievances toward specific individuals.
“We are not seeking to blame anyone. […] Our primary goal is prevention. We want to ensure that the issues identified are rectified and that individuals experiencing similar health crises receive the urgent care they require,” Yves Bouchard articulated.
Hours of waiting
On the evening of August 16, 2023, Micheline Bouchard sought immediate medical attention at the emergency department of the Regional Affiliated University Hospital Center (CHAUR) in Trois-Rivières. Upon arrival, during her triage at 8:08 p.m., she reported severe breathing difficulties along with pain in her calf.
The nurse assessed her condition as priority 3, indicating an urgent need for attention within 30 minutes, as outlined by the Canadian Triage and Severity Scale for emergency situations.
During the night, her condition was reassessed twice by a nursing staff member. Despite her escalating breathing difficulties, she didn’t receive a doctor’s evaluation until 8:55 a.m., nearly 13 hours after her initial assessment, raising immediate concern for potential pulmonary embolism. Following this, blood tests and a imaging study were ordered, but the imaging took an additional seven hours to be conducted.
The scintigraphy results later revealed embolisms in both lungs, prompting a prescription for anticoagulants around 5:10 p.m., which was not validated by a pharmacist until 6:08 p.m.
By 6:48 p.m., Ms. Bouchard experienced a cardiopulmonary arrest and ultimately succumbed to her condition on August 28 after never regaining consciousness. According to her family, by the time of her collapse, she still had not received any treatment for her severe condition. The coroner determined her death was due to natural causes stemming from bilateral pulmonary embolisms.
Nursing
The CIUSSS MCQ conducted a comprehensive analysis of the incident. The findings suggested Ms. Bouchard’s triage and reassessment align with expected protocols. Nevertheless, it was revealed that she had sustained a foot injury two weeks prior, which significantly increased her risk of developing an embolism; however, this vital piece of information was not documented during her triage.
Medical procedures
The coroner noted, “It is not uncommon for anticoagulants to be administered before a formal diagnosis has been established through imaging or lab results.”
The attending physician opted to wait for the test results, believing they would arrive promptly. She later mentioned that she had attempted to follow up on Ms. Bouchard a few times during the afternoon but struggled to connect with a nurse who was overwhelmed with duties.
Imaging and medication
Ms. Bouchard was registered for a scan at 11:45 a.m. but did not undergo the procedure until 4 p.m. The hospital’s protocols for medical imaging vary greatly depending on whether patients are on stretchers or ambulatory. At the time of the examination request, she was not on a stretcher, though she was when the imaging occurred.
“It remains unclear why she missed her examination, as no call appears to have been made to summon her. This highlights apparent communication issues. A recommendation for improving these processes has already been made at the establishment to promote clarity and efficiency,” concluded Me Karine Spénard.
Regarding the anticoagulants, they were unavailable in the emergency room and had to be sourced from the pharmacy, necessitating a prescription that was issued at 5:10 p.m. but not confirmed by the pharmacist until 6:08 p.m.
Reaction of the CIUSSS
The CIUSSS MCQ stated that a comprehensive internal review of the situation was conducted.
Consequently, nurses were reminded of their duty to meticulously document all relevant data during triage, the internal protocols for medical imaging were revised, and medication is now accessible at certain emergency points prior to pharmacist validation, which may happen afterwards if required.
Julie Michaud, the CIUSSS MCQ’s information officer, confirmed via email: “As recommended in the report, the Council of Physicians, Dentists, and Pharmacists is diligently evaluating the medical care processes. We are committed to following up directly with the coroner’s office on the issued recommendations.”
“The heart of our family”
Ms. Bouchard’s vitality was evident throughout her life, marked by her recent fulfilling trip to Egypt and her plans to travel to Tunisia. A retired individual, she dedicated her time to various volunteer endeavors.
“She had a vibrant personality and a contagious enthusiasm for life. My sister was truly the heart of our family,” Yves Bouchard shared, reflecting on her significance in their lives.
The family remains devastated by this sudden loss. “To this day, it is difficult for us. As a family, we made it our mission to find the truth in memory of our beloved sister.”
Another case
This incident is not the first of its kind, as previous coroner recommendations have been issued to the CIUSSS MCQ regarding similar deaths caused by pulmonary embolisms.
In December 2020, a 40-year-old woman from Trois-Rivières died from a pulmonary embolism after visiting the emergency room twice and consulting a local clinic in the preceding weeks.
Has been actively engaged in reviewing the care protocols and communication processes within the establishment. Our top priority is to ensure that all patients receive timely and effective treatment, and we are committed to implementing the necessary changes outlined in the coroner’s report to prevent similar incidents from occurring in the future.”
The Bouchard family remains determined to advocate for systemic changes in order to honor Micheline’s memory and ensure that no other families have to experience a similar tragedy. “We are hopeful that with the appropriate measures put in place, future patients will receive the urgent care they rightfully deserve without delay,” Yves Bouchard remarked, reflecting the family’s dedication to seeking improvements in healthcare systems.
As the investigation continues, both the healthcare community and the Bouchard family stress the utmost importance of swift medical action during emergencies, which they believe can drastically change outcomes and save lives.
