The emergency department doctor being sued by the family of Allison Holthoff has filed a statement in his defence.
Holthoff died in the emergency department in Cumberland Regional Health Care Centre on Dec. 31 after waiting for more than seven hours to see a doctor.
Dr. John Atia denies claims made by Holthoff’s husband, Gunter, and three children he was in any way negligent in providing adequate emergency care to the 37-year-old woman.
Her husband carried Holthoff into the hospital that morning because she was too weak to stand and complaining of severe pain in her left abdomen. Holthoff’s condition continued to worsen, and she died at about 11:30pm. The Holthoff family also alleged negligence against Nova Scotia Health, which employs nurses at the Cumberland Regional Health Care Centre.
“The Deceased’s condition quickly deteriorated within the first hour of waiting in the hospital’s waiting room,” reads the statement of claim lawyer Michael Dull filed on behalf of Gunter Holthoff and Holthoff’s three children.
“She was in extreme pain and nauseous. She was vomiting bile. She was unable to sit straight in her wheelchair and remained slumped in the fetal position to one side. She was no longer effectively able to verbalize sentences. The Deceased’s husband, along with witnesses in the waiting room, continued to report the Deceased’s urgent condition to the Defendant’s nursing staff.”
The claims made against Atia, a family physician who has practiced in Amherst for more than 10 years and is credentialled to practice emergency medicine, state he breached his duty of care to the patient by:
- failing to respond to the pleas of nursing staff to see the deceased in a timely manner;
- failing to work his shift in the emergency room in the urgent manner expected of emergency room physicians;
- failing to order diagnostic testing in a timely manner and/or overlooked important findings on that testing which was performed;
- failing to consider a possible splenic artery aneurysm as being causative of the deceased’s symptoms and order appropriate imaging tests.
Atia’s statement of defence
The statement of defence filed for Atia said he learned of Allison Holthoff’s arrival at the emergency department at approximately 11:45am as he attended to other patients. At that time, Holthoff had a triage score of three and “recognizing that the limited space and resources in the Emergency Department might cause a lengthy wait,” Atia ordered bloodwork, a urinalysis, a pregnancy test, and an electrocardiogram.
Here’s part of his statement of defence filed Thursday by lawyer Joseph Herschorn:
From the time of Mrs. Holthoff’s presentation to the Emergency Department to 6 p.m., Dr. Atia worked tirelessly, without a break, as the lone emergency medicine physician on duty. Among other responsibilities over that time, Dr. Atia was occupied with four critical psychiatric emergency cases and four critical cases of pediatric illness, including a case of pediatric stroke, which required considerable effort to arrange Life Flight service to the IWK Health Centre. Each of these cases was time-consuming. The stroke case, for example, occupied Dr. Atia most of the time between 4 p.m. and 6 p.m.
From approximately 11:45 a.m. until 6 p.m., Dr.Atia was not told of Mrs. Holthoff’s condition. At or just about 6 p.m., Dr. Atia was told for the first time of Mrs. Holthoff’s deterioration, including that her blood pressure had dropped precipitously. Dr. Atia immediately went to assess her. Among other things, he immediately ordered interventions to promote hemodynamic stability.
Because of the clinical and diagnostic uncertainty and the relatively broad differential diagnosis, Dr. Atia began arranging CT imaging of the chest, abdomen, and pelvis. Without on-site radiology service after 4 p.m., Dr. Atia was required to seek approval from Diagnostic Radiology and arrange for the imaging study to be done by a radiologist in Halifax”.
Atia’s statement of defence then goes on to describe a dramatic series of events. While Allison Holthoff was being X-rayed and Atia was briefing the emergency doctor due to start his shift at 7pm, the patient went into cardiac arrest. According to the defence, the two doctors worked to resuscitate Holthoff while calls were placed to an internal medicine specialist and surgeon who soon arrived at Cumberland Regional Health Care Centre. The internist assumed responsibility for her care and once stabilized, she was taken for the CT scan arranged by Atia.
Atia denies that the doctor received any pleas from nurses to see the patient before 6pm. (The statement of claim filed by the Holthoff family said Allison’s husband and other bystanders repeatedly asked nurses for assistance as she lay on the floor in a fetal position groaning in pain until she was moved into a private area at 3pm.)
Atia also denies he breached any standard of care and claims he did not rule out the potential diagnosis of a splenic artery rupture, which is the reason he ordered the CT scan “to try to identify the cause of Allison Holthoff’s deterioration and inform clinical decisions including about possible surgery.”
At the time the lawsuit was filed, the Holthoff family had not received a formal autopsy report from the medical examiner’s office, but understood from conversations with the office that an aneurysm may have led to her death.
What Nova Scotia Health has said
In its statement of defence filed with the court on Feb. 28, Nova Scotia Health denies any claim of negligence. It states:
“… any injury, loss or damage sustained by the plaintiff was not caused by negligence on the part of the defendant health authority or anyone for whom the defendant health authority would be responsible at law…any care provided by them to Allison Holthoff was provided reasonably, appropriately and in a manner consistent with the applicable standard of care in the circumstances”
None of the allegations have been tested in court. Nova Scotia Health is asking that the case be dismissed, and the legal costs charged to the Holthoff family.
Meanwhile, it’s unclear whether the family or the public will ever get to see the contents of the patient quality review undertaken by Nova Scotia Health into the circumstances surrounding Holthoff’s death.
In a scrum with reporters on Jan. 19, Premier Tim Houston committed to providing the family with the full report from the patient review and “the recommendations, at a minimum, to the public.” But that assurance to the family from Houston runs contrary to the message being provided by Nova Scotia Health.
In an email on Thursday from Nova Scotia Health, senior communications advisor Brendan Elliott said, “We have committed to sharing recommendations with the family when they are available.”
Elliott was unable to share a timeline for when that might occur. The review committee normally has three months to submit its findings.