The College of Physicians and Surgeons of Ontario (CPSO) describes its mandate as follows: “To serve and protect the public interest by regulating the practice of the profession and governing in accordance with the Regulated Health Professions Act.”
Despite this, the CPSO has evolved so that its focus has become more about protecting physicians than patients. It is perhaps natural that doctors tend to believe that their colleagues always do the right thing. Sadly, not all doctors are careful and responsible all the time, and some doctors routinely act in ways that harm their patients. Sometimes, doctors cause extreme harm and death. The CPSO has shown itself ineffective in identifying and taking action against members in such cases. Consequently, we believe that the public is not being adequately protected, and we believe that the CPSO must be replaced as the body responsible for monitoring and taking disciplinary action where physicians are failing to meet safe practice standards.
CPSO Coalition for Physician and Surgeon Oversight 
ONTARIO, CANADA GRANTS SURGEONS/DOCTORS
“MEDICAL IMMUNITY”
The above title for this article is the absolute truth! After my seven plus year adventure searching for true transparency and accountability within Ontario’s health care system, I have come to accept this. The very institutions that supposedly protect patient safety are, in fact, covering up “adverse events” including deaths and harboring negligent surgeons and doctors. I am confident any Ontario citizen dealing with these institutions would agree.
To provide some brief background, my daughter Terra Dawn went to the hospital for a scheduled day surgery to remove a tumor from within her abdomen. Now the procedure was to be done in a minimally evasive manner. (Laparascopic Surgery). The surgeon discovered the tumor was attached to the colon. He decided to change the procedure to open abdominal surgery to remove the tumor and perform a colon resection. Unfortunately, for my daughter, he did so without administering the mandatory “antibiotic prophylaxis”. In fact, no antibiotics were administered at any time prior, during, or post operation even when the abdominal infection became very infected leading to all the staples being removed and test results indicating “many gram negative bacilli”. My daughter bled to death less than 12 hours after being released from this hospital as the colon resection broke down due to “necrosis of the tissue”.
The hospital took five months to provide me with the hospital records. I met with five administrators whereby they entered the room carrying only two blank scratch pads. They did not answer one single concern I addressed to them, except to defend their in-hospital mortality rate which was the second highest in all of Canada. After a three-year ongoing conversation, the COO of the hospital finally admitted there was no record of the antibiotic prophylaxis being administered. Of course, they would not provide any documentation I could use against the surgeon. They would not provide me with a copy of the internal hospital investigation. But, I do appreciate the hospital creating a memorial garden outside the main entrance with a plaque in Terra’s name. Thus, this is the first example of “medical immunity” given to the surgeon by a government funded (taxpayers’ dollar) institution.
The local investigating coroner informed me the Chief Coroner’s Office of Ontario had deemed the death unusual and was going go look into the matter further. I had looked forward to this until they rendered their decision. The motto for this office is “We Speak For the Dead To Protect The Living”. I would discover, after many years, this to be a fallacy. When it comes to investigating a death associated with medical care or lack there of, this Office will ignore the evidence even when pointed out to them.
This office denied my request for a public inquest, (they have never granted one involving a hospital), denied my request for my daughter’s death to go before the Patient Safety Death Panel, denied my request for an Eastern Ontario Regional Coroner’s Investigation, denied Mr. Robert Runciman my MPP, presently a Canadian Senator, to reconsider the public inquest, denied my request to assemble a Chief Coroner’s panel to look into Deputy Chief’s decisions, denied a request from the Ontario Ombudsman’s Office to meet with me and address my concerns and finally denied an Ontario Provincial Police Detective’s request to meet with me and address my concerns. No, instead they used their persuasive authority to contact the Toronto Metropolitan Police to investigate my e-mails. When the O.P.P. detective came to my home, he stated that the Chief Coroner’s Office had cut and pasted and taken my e-mails out of context. This was just an attempt to silence me! Did this stop my e-mailing and faxing? No! Behold, twice more I had to meet with this O.P.P. detective at the station for video taped interviews! Nothing even close to the laying of charges; it was merely a continued attempt to silence me. Gee, has this Office ever heard of “block sender” so they wouldn’t receive my e-mails? No, they wanted to continue to know what I might be up to. I found out later with the co-operation of the Chief Coroner’s Office this hospital department was shut down temporally in 2010 due to several (5 or 6) deaths similar to my daughter’s –bleeding to death. This is the second example of a government funded (taxpayers’ dollars) institution granting “medical immunity” to this surgeon.
The third institution is not funded by the Ontario government but is supposed to be overseen by the Ministry of Health. C.T.V.’s “W-5” and the Toronto Star have in the past exposed the failings of the Ontario College of Physicians and Surgeons. They have been granted self-regulation and Ontario citizens are to go to them if they have a complaint against a doctor/surgeon. I did and they appeared very sincere and helpful, but only to make my complaint weaker. They suggested I rewrite my complaint so it would be more concise and actually did it for me and asked me to consent to the rewrite. What a mistake that was, easier for them to dismiss, but fortunately when I appeal it, I include my original. This College rendered its first decision after seven months. I appealed it and the decision was sent back. It then took more than 400 days to receive the second decision that I immediately appealed. The third decision was done in record time and of course I appealed this. At this time it should be noted that no Canadian doctor/surgeon would offer up an opinion with regard to the care of another Canadian doctor/surgeon. So, to prepare for all of my appeals, I sent more than 3,000 e-mails to surgeons throughout the world. I received more than 100 responses providing me with valuable expert opinions. This was a complete waste of my time as all institutions ignored these opinions. It should be noted that the College and their own expert stated in the second decision with regard to the mandatory antibiotic prophylaxis that the surgeon “neglected” this and that this was an “oversight”. Being a teacher, I am quite aware the noun form of neglected is “negligence” which is exactly what I was maintaining. If one goes to the College website, the surgeon’s record would be spotless, not even the lesser punitive warnings will show up. The College only acts if there is a police investigation involved, just look at their decisions over the years. (sexual impropriety, selling or using illegal drugs, defrauding the government and oh yes, I did discover that a doctor was severely reprimanded for prescribing drugs to his neighbour’s dog. Of course the complainant for this was the College of Veterinarians)
Now, we have the third institution entrusted to protect patient safety opting to protect a surgeon’s reputation and grant this surgeon “medical immunity”
One may expect, as I continue my quest for transparency and accountability, I could depend upon two institutions funded by the Ontario government (taxpayer’s dollars) and created to give citizens another avenue to pursue should he or she feel the College of Physicians and Surgeons had erred and/or the Chief Coroner’s Office had erred.
These accountable institutions are, in fact, created to give the illusion that an Ontario citizen will not really recognize the mirage until they have closely examined it.
The Health Professions Appeal and Review Board is what I turned to next. Their mandate is to look into College decisions when a complainant submits a request within 30 days of receiving the College’s decision. I have made three requests and submissions to this board and had moderate success with the first two appeals and was totally bewildered by the third appeal decision. This Board can only examine to see if the College’s decisions are “adequate” and “reasonable”. I somehow expected the College’s decisions would be held to a higher degree! This Board totally ignored my expert’s opinions, the irrefutable facts contained within the hospital records, and documentation from medical books, journals, articles etc. and the panel without question accepted the College Of Physicians and Surgeons’ unsupported opinions. Oh yes, it should be noted that a College representative is not required to appear before this H.P.A.R.B. panel and they do not! Their attendance is via a telephone conference call even though the College’s Offices are within walking distance to the H.P.A.R.B. office building. I traveled over 300 kilometers to be present. This panel and the Board lack plain common sense. If H.P.A.R.B. felt they couldn’t do an “adequate” and “reasonable” job, it should be asking the Ontario Government through legislation to give them more authority. After all, all they can judge the College is on adequacy and reasonability! The fourth institution within Ontario to grant a surgeon/doctor “medical immunity”!
The fifth institution is the Death Investigative Oversight Council created to handle complaint against the Chief Coroner’s Office. Its own mandate states when an Ontario citizen submits a complaint against the Chief Coroner it is to be handled immediately.
Well, two years after my initial submission, they started to investigate.
It should be noted they failed immediately with respect to transparency and accountability as they meet behind closed doors and the complainant and the public is prevented from attending. Now there is an excellent start to a citizen’s complaint! When I received their decision approximately two and a half years after my submission, I was shocked to see they can not comment on the medical aspects of my daughter’s care!
So, why were they created as an avenue for one to pursue? Of course, any complaint against the Chief Coroner would have to be about a death investigation, and of course, it would have medical aspects related to the case. Again, we have another government funded (taxpayers’ dollars) institution within Ontario that has granted “medical immunity” to a surgeon by not challenging the effectiveness of a death investigation by the Chief Coroner’s Office of Ontario.
At this point, a reader may ponder, “Why did Mr. Kilby not pursue a malpractice suit?” Three law firms stated that the expense would be great, as would the amount of time that would go by. Should I win, the judgment would be between $45,000 and $135,000. This is not the United States of America. This was never about money, but the truth, transparency and accountability. As well, the Canadian Medical Protection Association (the medical insurer for all Canadian doctors) has of this date a Three Billion Dollar Reserve Fund to be used to provide legal council and to settle malpractice suit that would be the last thing they would do, and only after years of exhausting delays to a trial. Every trick in the book would be used with the intent of draining you financially, emotionally and physically. One must wonder why our own Ontario Government pays 85% of the surgeons/doctors membership fees (insurance) to the C.M.P.A.?
The final institution to grant “medical immunity” to Ontario surgeons and doctors is our Liberal Provincial Government, and unfortunately all MPP’s within Ontario whose salaries are paid for by Ontario taxpayers. I have sent e-mails, and faxes continuously throughout the years pleading for the Premier, his Ministers and his Caucus to look into my substantial and very serious concerns and have been totally ignored. Unfortunately, the Conservative and New Democratic Party have failed not only me but also all the citizens of Ontario. So they have become the final party to grant “medical immunity” to all surgeons/doctors within Ontario.
It is so wrong to think this, but I am convinced. In a hospital setting a surgeon/doctor could actually commit a murder and get away with it. They are getting away with negligence contributing to adverse events and deaths taking place in hospitals with no fear of being reprimanded or held accountable. The record of Terra’s surgeon remains spotless although there are more deaths associated with him, and there is no way for citizens to be aware of his past. This is the reality within Ontario.
I would propose the Ontario Government abolish the H.P.A.R.B.’s and the D.I.O.C.’s authority to investigate complaints submitted by Ontario citizens and use this financial savings to allow the Ontario Ombudsman to expand their role. (Ontario is the only province/territory whereby he does not have the authority to investigate Health Institutions or those related to it)
This article is dedicated to my daughter, Terra Dawn Kilby, An Angel In Our Lives and to all citizens of Ontario who have been abused by the non-transparency and un accountability in this province and those that will encounter the same in the future.
My love, prayers and best wishes go out to you all.
A.W. Kilby 888 Country Rd 2 Lansdowne, Ontario K0E 1L0 1-613-659-2906
TEARS BEFORE WE SLEEP
As we lie within our beds,
Streaming tears are always shed.
This occurs each evening and night,
Waiting for dawn’s first light.
Thoughts of you are all around,
With many restless nights abound.
Awaking each morning I still dread,
Wishing and hoping, I was dead.
Your sister and you were very tight;
Continuing on is quite a fight.
Loneliness, emptiness brings us down,
No peace as yet— have we found?
Teardrops fall upon the pillowcase,
With memories of you, a beautiful face.
A mother’s love forever there,
A heart weighted down with such despair.
Terra, we see you most every day,
In our minds and hearts to forever stay.
Four family hearts in full embrace,
Will eventually meet in a higher place.
People pass by us — so unaware–,
It’s like we are playing solitaire.
Our tearful lives in such disarray,
But loving you won’t fade away.
Love Always,
DAD
Why did woman die after routine surgery?
Terra Dawn Kilby died at age 28 — and no one is to blame?
By Alan Shanoff ,Toronto Sun
First posted: Saturday, October 12, 2013 06:32 PM EDT
Arnold Kilby wants answers. He wants to know why his daughter, Terra Dawn, died at the age of 28 after routine surgery to remove a noncancerous tumour from her abdomen.
The operation took place in July, 2006 at Humber River Regional Hospital. Shortly after commencing the operation in a minimally invasive laparoscopic manner, the surgeon converted the surgery to an open operation.
The surgery was said to have been “uneventful,” in other words successful.
Terra was discharged on July 20. She was dead within hours of arriving at home and Kilby has been searching for answers ever since.
Among his questions: Why was Terra discharged when, according to a decision by the Health Professions Appeal and Review Board, there were “consistent observations in the nursing charts of a foul odour and an oozing incision with large purulent discharge — commencing July 15 and continuing to the date of his daughter’s discharge”?
Why was she released when her abdomen was distended, at a time when she hadn’t had a normal bowel movement?
Why had the surgery taken place without the prior administration of antibiotics?
Kilby didn’t sue. He didn’t want money; he wanted an apology, an acknowledgment of error and a commitment to fix things.
So in 2007, he filed a complaint with the College of Physicians and Surgeons of Ontario complaints committee.
But the CPSO dismissed the complaint. In doing so, it couldn’t come up with any reason why Terra died.
Not satisfied, Kilby requested a review of the decision by the Health Professions Appeal and Review Board.
The HPARB concluded the CPSO decision was unreasonable and sent the case back to the CPSO, directing it to address Kilby’s questions.
The second CPSO decision wasn’t much better.
There were answers of a sort, but the CPSO still wasn’t certain of what occurred. The direct cause of death could not be ascertained.
Yet the CPSO was clear no one was to blame and there were no grounds for a disciplinary hearing against the surgeon.
But the CPSO did caution the surgeon over his five-month delay in completing Dawn’s discharge summary and stated “the routine use of antibiotics prior to bowel surgery is an important aspect of care that was neglected by (the surgeon) in this case. The Committee would suggest that (the surgeon) consider the routine use of antibiotics in such circumstances. Having said that, we do not consider this oversight to have contributed to the unfortunate outcome in this case.” The surgeon was told he “may wish to consider” the use of preoperative antibiotics in future cases.
Of course Kilby sought review of the second CPSO decision. If the routine use of antibiotics prior to bowel surgery is “important” then why was the surgeon merely told to “consider” its use? How can we be sure the surgeon’s “oversight” did not contribute to Terra’s death?
The HPARB agreed and sent the case back to the CPSO.
The third CPSO decision didn’t advance the situation much further. There was still no answer as to the reason for Terra’s death. Kilby sought review by the HPARB for a third time.
But this time the HPARB decided to uphold the CPSO decision. It’s almost as if the HPARB threw up its arms and said, “we’re sorry, we tried to help you but we are up against a brick wall.” So, six years after the initial complaint, with three CPSO investigations and three HPARB reviews, no one seems to know why Terra died.
Barring any formal inquest, and Kilby has been denied his request to hold one, he still has no answers.
He only has the fact of his daughter’s death, which apparently occurred for no reason. No one is to blame. No one was at fault. No one has apologized.
But the hospital did create a memorial garden with a plaque in Terra’s name.
***************************************************
Please respond to Mr Shanoff and ask for more articles delving into the cover-up of Terra Dawn’s death.
alan.shanoff@sunmedia.ca
Arnold Kilby
Terra Dawn Kilby
“An Angel In Our Lives”
April 22/78 to July 21/06
http://anangelinourlives-awk.blogspot.ca/
No Accountability or Transparency in Ontario
RESPONSES FROM SUN READERS ON LINE.
Suchstuff
Such a sad story made worse by the lack of closure for the family. There’s something really wrong with physician oversight that puts the interests of paying members before the interests of the public whom they have promised to protect. How can the hospital or physician learn from their mistakes if they won’t even acknowledge them? Oversight in name only from the College and again from our government’s HPARB – if they haven’t got any teeth – what’s the point of being there? This man has waited 7 years for an answer – shame on our health care system (and the fake oversight that goes with it) for ignoring and avoiding his questions.
***************************************
bafflegab
Anybody who has ever complained to the CPSO quickly discovers it is a waste of time. I know from experience. The CPSO let the public down with respect to the Dr.Charles Smith debacle – the Wia Ping butchery – and countless other public scandals. In every case we discover long after that the College had provided covered for the doctors rather than protected the public. And now this. The CPSO is not to be trusted. The CPSO promises to protect the public but in fact poses a danger to the public. The CPSO needs to be shut down and its cover-up artists (employees) need to move on to some other line of work. Something more honest. Put simply, everything you need to know about the CPSO (its investigators, its administrators and its executive) is clear from reading Mr. Shanoff’s accounting of it pathetic behaviour in this sad case.
******************************************
John Kyndesen
Like most so called “professional” review boards they sure circle the wagons in time of troubles. Eventually people get worn out or run out of money battering against the wall of silence that greets them and then it’s business as usual.
******************************************************
Dachshunds
My condolences Mr.Kilby, how truly tragic and unnecessary your daughters death must be, I hope you get the answers and apologies you so rightfully deserve. May your “Angel” rest in peace and may this never happen again to another family as the results from her unfortunate passing. I will hug my daughter a little closer today and hope something positive comes from all these inquiries and examinations of this “uneventful and successful” surgical procedure. My heart goes out to you and yours and I hope you can somehow find closure in this mess. You are a better man than I, Mr.Kilby and your daughter was very lucky to have a father such as yourself, its too bad she didn’t have a better surgeon. Bless you Mr.Kilby, and bless you Terra, lest your passing be in vain…David Clarke.
***************************************************
Deepwell
The college of physicians and surgeons is having a consultation on their transparency when it comes to complaints about their members. It’s an issue that affects all patients who have a right to know whether the doctor who treats them has a bad track record. Right now there is no transparency as Mr. Kilby has found out – the CPSO is all about protecting their members and nothing about protecting the public from bad doctoring like this. Consumers should let the college and our government know that we won’t tolerate abuse of the public in this way and that their lack of action to protect the vulnerable should result in charges against those who are contributing to wrongful deaths. If the CPSO isn’t part of the solution then they are part of the problem. Look up ‘draft transparency principals’ on the CPSO website – and let the cpso know that their oversight is worse than none at all – it is facilitating bad doctoring. Thank you Mr. Kilby (and Mr. Shanoff) for exposing this often fatal flaw of the lack of physician oversight in Ontario and my sincere sympathy for the loss of a loved one.
*******************************************
Ruledbythemoon
They are scared of a lawsuit so nobody is going to put down anything concrete in writing that could be used later. Makes you wonder why we even have a review board?
I had similar surgery at NYGH a couple years ago and they would not discharge me till I had pooped. Not easy when you are on a liquid diet but that was their rule.
******************************************
InScarborough55*
My sincerest condolences Mr. Kilby to you and your family. It is just so sad that someone is allowed to die because the supposed expert is incompetent. And then to have the board, supposedly put in place to oversee these experts and root out the bad ones, just defends them is beyond irrational.
********************************************
G_Goon
Don’t stop Mr. Kilby my wife works in the health care system all sorts of mistakes made that never see the light of day .So sorry for your loss stay strong stay focused.
*************************************
Z71guy
I too was in a relationship with a critical care nurse who routinely told me of unreported medical errors committed by both doctors and nursing staff. I would wager that more lives are lost unnecessarily to medical treatment errors than impaired drivers. But where is the uprising of MADD – mothers against dumb doctors?? You’ll never see it because of coverups, lack of reporting and oh yeah, they bury their mistakes……unfortunately literally in cases such as Ms. Kilby’s.
No SIU type agency to hold doctors to a higher standard, how long overdue is this? A doctor shortage? Pfffft….please. This is an internally controlled monopoly controlled by the college of physicians to keep supply low and their demand and earnings high. This province has many highly qualified medical applicants kept from becoming practicing doctors for made up conditions to control the supply of services. The numbers relegated to veterinary school or dentistry , qualified foreign doctors refused to be recognized just to control supply – absolutely criminal. The recent expansion of nurse practitioners needs to continue.. For logic sake there are medical apps available for iphones that can make many medical tests simpler and almost instantaneous. Doctors are not gods but unfortunately many feel they are. Keep the pressure on Mr. Kilby
***************************************************
kickyourproblemstothecurb
sir I saw the web page and am shocked that there was no inquest given the circumstances. I presume you have a COMPLETE copy of her chart.
go through it with a very fine tooth comb. check for phone calls made to ANY doctor re the condition of the wound and any abnormal lab results or vital signs. after all, if they are documenting the bad condition of the wound before discharge, then they must of called a doctor to come and see it. and then the doctor called is responsible to act appropriately.frankly, wonder how she got discharged with a surgical wound in that condition. did the doctor who did the operation write the discharge orders?
ps check the labs if any done the week of her discharge in particular the INR. and look at the medications she was on just before discharge. if she had a high INR then the doctor would have been called and a medication change order written.
ps application called pocket lab values available for iphones, ipods through the apple web site. very easy to use and very informative.
very sorry for the loss of your loved one. and i hope you get the answers you want. hope I’ve been of some help. we went looking for answers ourselves after losing a loved one years ago.
OMG and he never ordered any anitbiotics? i am so sorry and frankly don’t understand how this happened.
god bless you because you have the courage and strength to try to make sure this doesn’t happen to anyone else.
Photo: This Thanksgiving as you spend this day with your loved ones===cherish this moment to the fullest. Why did woman die after routine surgery? Terra Dawn Kilby died at age 28 — and no one is to blame? By Alan Shanoff ,Toronto Sun First posted: Saturday, October 12, 2013 06:32 PM EDT Arnold Kilby wants answers. He wants to know why his daughter, Terra Dawn, died at the age of 28 after routine surgery to remove a noncancerous tumour from her abdomen. The operation took place in July, 2006 at Humber River Regional Hospital. Shortly after commencing the operation in a minimally invasive laparoscopic manner, the surgeon converted the surgery to an open operation. The surgery was said to have been “uneventful,” in other words successful. Terra was discharged on July 20. She was dead within hours of arriving at home and Kilby has been searching for answers ever since. Among his questions: Why was Terra discharged when, according to a decision by the Health Professions Appeal and Review Board, there were “consistent observations in the nursing charts of a foul odour and an oozing incision with large purulent discharge — commencing July 15 and continuing to the date of his daughter’s discharge”? Why was she released when her abdomen was distended, at a time when she hadn’t had a normal bowel movement? Why had the surgery taken place without the prior administration of antibiotics? Kilby didn’t sue. He didn’t want money; he wanted an apology, an acknowledgment of error and a commitment to fix things. So in 2007, he filed a complaint with the College of Physicians and Surgeons of Ontario complaints committee. But the CPSO dismissed the complaint. In doing so, it couldn’t come up with any reason why Terra died. Not satisfied, Kilby requested a review of the decision by the Health Professions Appeal and Review Board. The HPARB concluded the CPSO decision was unreasonable and sent the case back to the CPSO, directing it to address Kilby’s questions. The second CPSO decision wasn’t much better. There were answers of a sort, but the CPSO still wasn’t certain of what occurred. The direct cause of death could not be ascertained. Yet the CPSO was clear no one was to blame and there were no grounds for a disciplinary hearing against the surgeon. But the CPSO did caution the surgeon over his five-month delay in completing Dawn’s discharge summary and stated “the routine use of antibiotics prior to bowel surgery is an important aspect of care that was neglected by (the surgeon) in this case. The Committee would suggest that (the surgeon) consider the routine use of antibiotics in such circumstances. Having said that, we do not consider this oversight to have contributed to the unfortunate outcome in this case.” The surgeon was told he “may wish to consider” the use of preoperative antibiotics in future cases. Of course Kilby sought review of the second CPSO decision. If the routine use of antibiotics prior to bowel surgery is “important” then why was the surgeon merely told to “consider” its use? How can we be sure the surgeon’s “oversight” did not contribute to Terra’s death? The HPARB agreed and sent the case back to the CPSO. The third CPSO decision didn’t advance the situation much further. There was still no answer as to the reason for Terra’s death. Kilby sought review by the HPARB for a third time. But this time the HPARB decided to uphold the CPSO decision. It’s almost as if the HPARB threw up its arms and said, “we’re sorry, we tried to help you but we are up against a brick wall.” So, six years after the initial complaint, with three CPSO investigations and three HPARB reviews, no one seems to know why Terra died. Barring any formal inquest, and Kilby has been denied his request to hold one, he still has no answers. He only has the fact of his daughter’s death, which apparently occurred for no reason. No one is to blame. No one was at fault. No one has apologized. But the hospital did create a memorial garden with a plaque in Terra’s name. *************************************************** Please respond to Mr Shanoff and ask for more articles delving into the cover-up of Terra Dawn’s death. alan.shanoff@sunmedia.ca Arnold Kilby Terra Dawn Kilby “An Angel In Our Lives” April 22/78 to July 21/06 http://anangelinourlives-awk.blogspot.ca/ No Accountability or Transparency in Ontario RESPONSES FROM SUN READERS ON LINE. Suchstuff Such a sad story made worse by the lack of closure for the family. There’s something really wrong with physician oversight that puts the interests of paying members before the interests of the public whom they have promised to protect. How can the hospital or physician learn from their mistakes if they won’t even acknowledge them? Oversight in name only from the College and again from our government’s HPARB – if they haven’t got any teeth – what’s the point of being there? This man has waited 7 years for an answer – shame on our health care system (and the fake oversight that goes with it) for ignoring and avoiding his questions. *************************************** bafflegab Anybody who has ever complained to the CPSO quickly discovers it is a waste of time. I know from experience. The CPSO let the public down with respect to the Dr.Charles Smith debacle – the Wia Ping butchery – and countless other public scandals. In every case we discover long after that the College had provided covered for the doctors rather than protected the public. And now this. The CPSO is not to be trusted. The CPSO promises to protect the public but in fact poses a danger to the public. The CPSO needs to be shut down and its cover-up artists (employees) need to move on to some other line of work. Something more honest. Put simply, everything you need to know about the CPSO (its investigators, its administrators and its executive) is clear from reading Mr. Shanoff’s accounting of it pathetic behaviour in this sad case. ****************************************** John Kyndesen Like most so called “professional” review boards they sure circle the wagons in time of troubles. Eventually people get worn out or run out of money battering against the wall of silence that greets them and then it’s business as usual. ****************************************************** Dachshunds My condolences Mr.Kilby, how truly tragic and unnecessary your daughters death must be, I hope you get the answers and apologies you so rightfully deserve. May your “Angel” rest in peace and may this never happen again to another family as the results from her unfortunate passing. I will hug my daughter a little closer today and hope something positive comes from all these inquiries and examinations of this “uneventful and successful” surgical procedure. My heart goes out to you and yours and I hope you can somehow find closure in this mess. You are a better man than I, Mr.Kilby and your daughter was very lucky to have a father such as yourself, its too bad she didn’t have a better surgeon. Bless you Mr.Kilby, and bless you Terra, lest your passing be in vain…David Clarke. *************************************************** Deepwell The college of physicians and surgeons is having a consultation on their transparency when it comes to complaints about their members. It’s an issue that affects all patients who have a right to know whether the doctor who treats them has a bad track record. Right now there is no transparency as Mr. Kilby has found out – the CPSO is all about protecting their members and nothing about protecting the public from bad doctoring like this. Consumers should let the college and our government know that we won’t tolerate abuse of the public in this way and that their lack of action to protect the vulnerable should result in charges against those who are contributing to wrongful deaths. If the CPSO isn’t part of the solution then they are part of the problem. Look up ‘draft transparency principals’ on the CPSO website – and let the cpso know that their oversight is worse than none at all – it is facilitating bad doctoring. Thank you Mr. Kilby (and Mr. Shanoff) for exposing this often fatal flaw of the lack of physician oversight in Ontario and my sincere sympathy for the loss of a loved one. ******************************************* Ruledbythemoon They are scared of a lawsuit so nobody is going to put down anything concrete in writing that could be used later. Makes you wonder why we even have a review board? I had similar surgery at NYGH a couple years ago and they would not discharge me till I had pooped. Not easy when you are on a liquid diet but that was their rule. ****************************************** InScarborough55* My sincerest condolences Mr. Kilby to you and your family. It is just so sad that someone is allowed to die because the supposed expert is incompetent. And then to have the board, supposedly put in place to oversee these experts and root out the bad ones, just defends them is beyond irrational. ******************************************** G_Goon Don’t stop Mr. Kilby my wife works in the health care system all sorts of mistakes made that never see the light of day .So sorry for your loss stay strong stay focused. ************************************* Z71guy I too was in a relationship with a critical care nurse who routinely told me of unreported medical errors committed by both doctors and nursing staff. I would wager that more lives are lost unnecessarily to medical treatment errors than impaired drivers. But where is the uprising of MADD – mothers against dumb doctors?? You’ll never see it because of coverups, lack of reporting and oh yeah, they bury their mistakes……unfortunately literally in cases such as Ms. Kilby’s. No SIU type agency to hold doctors to a higher standard, how long overdue is this? A doctor shortage? Pfffft….please. This is an internally controlled monopoly controlled by the college of physicians to keep supply low and their demand and earnings high. This province has many highly qualified medical applicants kept from becoming practicing doctors for made up conditions to control the supply of services. The numbers relegated to veterinary school or dentistry , qualified foreign doctors refused to be recognized just to control supply – absolutely criminal. The recent expansion of nurse practitioners needs to continue.. For logic sake there are medical apps available for iphones that can make many medical tests simpler and almost instantaneous. Doctors are not gods but unfortunately many feel they are. Keep the pressure on Mr. Kilby *************************************************** kickyourproblemstothecurb sir I saw the web page and am shocked that there was no inquest given the circumstances. I presume you have a COMPLETE copy of her chart. go through it with a very fine tooth comb. check for phone calls made to ANY doctor re the condition of the wound and any abnormal lab results or vital signs. after all, if they are documenting the bad condition of the wound before discharge, then they must of called a doctor to come and see it. and then the doctor called is responsible to act appropriately.frankly, wonder how she got discharged with a surgical wound in that condition. did the doctor who did the operation write the discharge orders? ps check the labs if any done the week of her discharge in particular the INR. and look at the medications she was on just before discharge. if she had a high INR then the doctor would have been called and a medication change order written. ps application called pocket lab values available for iphones, ipods through the apple web site. very easy to use and very informative. very sorry for the loss of your loved one. and i hope you get the answers you want. hope I’ve been of some help. we went looking for answers ourselves after losing a loved one years ago. OMG and he never ordered any anitbiotics? i am so sorry and frankly don’t understand how this happened. god bless you because you have the courage and strength to try to make sure this doesn’t happen to anyone else.
I WOULDN’T TAKE MY DOG TO CAMBRIDGE MEMORIAL HOSPITAL, MY MOTHER WAS BROUGHT IN THERE HAN 14/05 AND WAS GONE BY JAN 24/05. I BELIEVE THE HOSP IS RESPONSIBLE FOR HER UNTIMELY DEATH. SHE HAD NO FEELING WHAT SO EVER IN HER LOWER LEGS, THEY WERE COLD AND BLUE YET THEY KEPT HER IN A HALF RAIL BED AND WERE GIVING HER LAXATIVES BUT SHE WASN’T EATING. NURSES WERE FEW AND FAR BETWEEN. THE NIGHT BEFORE SHE PASSED MY MOM FELL OUT OF BED I AM GUESSING SHE TRIED TO GET UP BUT FELL TO THE FLOOR. THE LADY IN HER ROOM BUZZED FOR A NURSE SEVERAL TIMES BEFORE ONE CAME. I GOT A CALL LONG AFTER SHE WAS CLEANED UP AND BACK IN BED. SHE HAD A BANDAGE WRAPPED AROUND HER HEAD FROM THE FALL. I TRIED TALKING TO HER BUT SHE WAS DELERIOUS. SHE DIDN’T KNOW WHO I WAS. THE NEXT MORNING WE GOT THAT FATAL CALL, MY MOM WAS GONE. WHEN WE GOT THERE WE WERE GIVEN TIME TO BE WITH HER ALONE. MY BROTHER NOTICED SHE HAD BLOOD IN HER MOUTH, THIS INDICATES TO ME THERE WAS INTERNAL BLEEDING BUT THEY DIDN’T DETECT THAT. I AM SO SORRY FOR THE LOSS OF YOUR SON. BUT I WOULD MAKE IT VERY CLEAR TO ANYONE WHO IS SICK AND IN CAMBRIDGE, DON’T GO TO THIS HOSPITAL IF YOU WANT TO LIVE.
You should get her records and make a complaint to the hospital. I could help you if you like.
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See my blog, Sue’s Views on the News, and the piece specifically on what is currently happening with me (Aug/Sept, 2014) as I seek justice through the complaints process at the CPSO. See
CPSO complaints against Ontario doctors, July 30, 2014
http://suemcpherson.blogspot.ca/2014/07/cpso-complaints-against-ontario-doctors.html
For those who have had brain surgery for epilepsy, with no beneficial outcome, may want to check out the following eye-opener. Medical records and X-ray at http://www.thewhyfiles.net/mkultra4.htm#update discloses unauthorized lobotomy and brain implant experimentation, (Dec. 9,1969 & Jan. 27,1972, at 14 & 16 years of age) without informed consent, nor parental knowledge, while under the guise of treating epilepsy. (ie-“scar tissue removal”) This information not only correlates with Manchurian Candidate developmental research, according to The Mind Stealers by Samuel Chavkin, and The Mind Manipulators by Alan Scheflin, it also correlates with the CIA MK-ULTRA project of psychosurgical and brain implant research upon unwitting subjects. Those subjects being myself, and other unwitting children who suffer epilepsy at the Toronto Hospital for Sick Children. Butcher Neurosurgeon Dr. Harold Joseph Hoffman is noted for having 15,741 children under his care between 1964-1998. It would be fair to suggest that anywhere between 20-75% have been subjected to unauthorized brain surgical research (3-10,000 children) Despite my complaints to the College and HPB, in 1981, this child abuse was neglected and concealed, by the College and Board, while Hoffman continued to impose unauthorized lobotomies upon epileptic children.(ie-Patient D.L. 1991) It should be recognized as most cruel, sadistic, evil, mean, repugnant, and extremely inhumane as to impose lobotomy upon a minor who suffers seizure disorder, when the historical research of lobotomy upon psychiatric patients demonstrate adverse effects of “seizures and cerebral hemmorrahaging”. No parent should be deprived informed consent, when the risks outweigh any benefit for the interests of their child. Anyone effected by Hoffman are welcome to contact me. Terry Parker Jr @ sympatico.ca http://www.thewhyfiles.net/mkultra4.htm#update