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Timmins, Ont., woman who had chiropractor treat her diabetes ends up in a coma Northern Ontario
Timmins, Ont., woman who had chiropractor treat her diabetes ends up in a coma
A professional health standards review committee is calling for a review of sanctions for a Timmins chiropractor whose patient ended up in a diabetic coma. (File) A professional health standards review committee is calling for a review of sanctions for a Timmins chiropractor whose patient ended up in a diabetic coma. (File)
A professional health standards review committee is calling for a review of sanctions for a Timmins chiropractor whose patient ended up in a diabetic coma.
An initial review of the case by the Inquiries, Complaints and Reports Committee ended with the chiropractor being issued advice to adhere to the scope of practice for chiropractors under Ontario law.
The transcript of the appeal said the female patient went to the chiropractor in October 2018 “to help understand diabetes.” The woman, who had type 1 diabetes, remained his patient until November 2019.
“During this period, the patient and the respondent exchanged numerous text messages, including messages regarding blood sugar, insulin and the patient’s insulin pump,” the transcript said.
On Nov. 10, 2019, she was feeling unwell and went to the chiropractor’s house, because the clinic wasn’t open.
“The patient provided information that during the Nov. 10 visit, she was at the respondent’s house for approximately one hour during which time he gave her vitamins, water and treated her with the activator,” the transcript said.
“She vomited three times during her visit ... the respondent assured the patient when she began vomiting that this was normal, advised that the vomiting was a good thing as it meant that the acidity was leaving the patient’s body, told the patient to continue drinking water and did not seem concerned.”
But on the morning of Nov. 11, she was unresponsive and hospitalized for severe ketoacidosis due to high blood sugar levels due to lack of insulin intake.
The initial review concluded that the chiropractor did not cause the diabetic coma, it was a malfunctioning insulin pump.
However, the appeals board concluded that the chiropractor was not taken to task for not recognizing the seriousness of his patient’s symptoms.
“There is no analysis in the decision regarding whether the respondent met the standard of care required of a chiropractor in failing to advise the patient to seek further medical attention on Nov. 10,” the appeals board said.
“The board finds that the information in the record supports that the patient informed the respondent that she was feeling very unwell on Nov. 10 before the visit, she continued to feel unwell during the visit vomiting several times, she was likely suffering from the early stages of ketoacidosis given her condition and hospitalization the following day, and the respondent did not advise the patient to seek medical attention.”
The board failed to address the standard-of-care issue in its first decision, the appeals body said, in particular the fact he didn’t “recognize the severity of the patient’s condition” and advise her to get medical care.
So it referred the issue back to the Inquiries, Complaints and Reports Committee to issue a new decision in the case.
Read the full transcript here.
https://www.canlii.org/en/on/onhparb/doc/2022/2022canlii111604/2022canlii111604.html[*/quote*]
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CanLII Logo Home › Ontario › Health Professions Appeal and Review Board › 2022 CanLII 111604 (ON HPARB)
Lemaire v Rafacz, 2022 CanLII 111604 (ON HPARB)
Document
History
Cited documents (1)
Treatment
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Date:
2022-11-25
File number:
21-CRV-0239
Citation:
Lemaire v Rafacz, 2022 CanLII 111604 (ON HPARB), <https://canlii.ca/t/jt67n>, retrieved on 2022-12-06
File # 21-CRV-0239
HEALTH PROFESSIONS APPEAL AND REVIEW BOARD
PRESENT:
Anna-Marie Castrodale, Designated Vice-Chair, Presiding
Sonia Gaal, Board Member
Mitchell Toker, Vice-Chair
Review held on April 7, 2022 in Ontario (by teleconference)
IN THE MATTER OF A COMPLAINT REVIEW UNDER SECTION 29(1) of the Health Professions Procedural Code, Schedule 2 to the Regulated Health Professions Act, 1991, Statutes of Ontario, 1991, c.18, as amended
B E T W E E N:
TERRY LEMAIRE
Applicant
and
WADE RAFACZ, DC
Respondent
Appearances:
The Applicant: Terry Lemaire
Support for the Applicant: Jessica Lemaire
For the Applicant Peter Denton, Counsel
For the Respondent: Heather J. Vaughan, Counsel
For the College of Chiropractors of Ontario: Tina Perryman, Representative
DECISION AND REASONS
I. DECISION
1. The Health Professions Appeal and Review Board returns the decision to the Inquiries, Complaints and Reports Committee of the College of Chiropractors of Ontario and requires it to reconsider this matter and to issue a further decision.
2. This decision arises from a request made to the Health Professions Appeal and Review Board (the Board) by Terry Lemaire (the Applicant) to review a decision of the Inquiries, Complaints and Reports Committee (the Committee or the ICRC) of the College of Chiropractors of Ontario (the College). The decision concerned a complaint regarding the conduct and actions of Wade Rafacz, DC (the Respondent). The Committee investigated the complaint and decided to issue advice to the Respondent to adhere to: Standard S-001: Chiropractic Scope of Practice; Standard S-002: Record Keeping, and Guideline G-001: Communication with Patients.
II. BACKGROUND
3. The Applicant’s spouse (the patient) suffers from type 1 diabetes.
4. In October 2018, the patient sought treatment from the Respondent, a chiropractor, “to help understand diabetes.” The Respondent treated the patient until November 2019.
5. During this period the patient and the Respondent exchanged numerous text messages, including messages regarding blood sugar, insulin, and the patient’s insulin pump.
6. On November 10, 2019, the patient was feeling unwell and sought treatment from the Respondent.
7. The Respondent treated the patient who vomited several times and still did not feel well. The Respondent did not advise the patient to seek further medical treatment.
8. On the morning of November 11, 2019, the patient was unresponsive in a diabetic coma and was hospitalized at the Timmins District Hospital (the hospital) for ketoacidosis.
The Complaint and the Response
The Complaint
9. The Applicant complained to the College as follows:
[The Respondent] was telling [the patient] that he could cure her type 1 Diabetes. And that her synthetic insulin was enabling her pancreas to secrete its own insulin. After hearing these statement [sic] [the patient] was asking if she should lower her insulin levels and [the Respondent] responded “if you feel comfortable doing so,” without telling her to talk to her physician. She began to lower in insulin [intake] on a daily basis because of statements and claims [the Respondent] had made. On November 10th 2019 she was not feeling well and I drove her to get treated, she began vomiting and [the Respondent] assured her this was normal it was the acidity leaving her body. On the morning of November 11th 2019 [the patient] was unresponsive and was hospitalized for severe ketoacidosis due to high blood sugar levels due to lack of insulin intake. This was not within his scope of practice to be encouraging this without seeking medical advise [sic] from a physician to lower prescribed insulin amounts which almost [cost] her life.
The Response
10. The Respondent provided a written response to the complaint in which he stated:
There was never any mention of type 1 diabetes.
It is against his professional conduct to make any statements with this regard.
Any decision for medication is up to the patient.
This was made clear at the first meeting as he does not treat medical conditions.
He supports and encourages people in their own decisions based on their health goals.
As far as providing services on November 10, he made himself available. After care, he requested an update in the patient’s condition as she had to drive home an hour and he received no response.
The complaint was a malicious attack.
11. The Respondent provided an additional response in which he indicated:
• On November 10, 2019, (Sunday) the clinic was not open as they were officially on holidays.
• The patient texted him as she and the Applicant arrived at the Cochrane office at his house.
• As soon as the patient entered and took off her boots, she had to vomit.
• The Respondent found her pulses were very fast and proceeded to correct Subluxation. Dysponesis was Compensation phase 4 Indican.
• The patient was not feeling well and the Respondent corrected the spinal dysfunction as indicated by leg length tests.
• Any supplements and/or water was provided.
• The patient proceeded to vomit again.
• When discussing why this had occurred, the patient stated that she once again had pickles and four meat patties to eat on the Friday.
• This had caused her stress before.
• After the Respondent had corrected subluxation, the patient still did not “feel well”.
• The Respondent told them that was all he could do, that he had not seen anything like this before and that doing more was making him feel uncomfortable.
• The Respondent still adjusted what could be found and the patient was still not feeling well.
• The patient stated that she would contact him when she got home, “if she was not feeling well, would recommend going to hospital.”
Additional information from the Applicant
12. The Committee investigator shared the Respondent’s response with the Applicant. The Applicant replied and included the following information:
• The statements made by the Respondent were false and he did in fact say that he would cure the patient’s type 1 diabetes by resetting her pancreas so it could secrete insulin again.
• They referred to the “dump the pump” goal set out in the Respondent’s notes.
• The Respondent told the patient that “Dump the Pump” would be the title of his book when he cured her type 1 diabetes.
• They were at the Respondent’s Cochrane office at his house approximately an hour and a half to two hours on November 10 and not once during this time did the Respondent say he felt uncomfortable treating the patient.
• The Respondent just continued to try things like supplements, different chiropractic techniques and told the patient to keep drinking lots of water.
• Not once did the Respondent recommend going to see another medical professional or to go to the hospital. He just said to call him back and follow up with him on Monday (November 11).
• That night and going into the next morning, the patient went into ketoacidosis.
13. The Applicant and the patient included text messages exchanged between the patient and the Respondent from September 17, 2019 to November 12, 2019 as well as an image of the Respondent making a “rude” gesture towards the patient’s insulin pump from July 26, 2019.
The Committee’s Decision
14. The Committee investigated the complaint and decided to issue advice as noted above.
III. REQUEST FOR REVIEW
15. In a letter dated April 29, 2021, the Applicant requested that the Board review the Committee’s decision.
IV. POWERS OF THE BOARD
16. After conducting a review of a decision of the Committee, the Board may do one or more of the following:
a) confirm all or part of the Committee’s decision;
b) make recommendations to the Committee;
c) require the Committee to exercise any of its powers other than to request a Registrar’s investigation.
17. The Board cannot recommend or require the Committee to do things outside its jurisdiction, such as make a finding of misconduct or incompetence against the member or require the referral of specified allegations to the Discipline Committee that would not, if proved, constitute either professional misconduct or incompetence.
V. THE PARTIES’ POSITIONS
18. Counsel for the Applicant made extensive submissions in advance of the review, and both parties’ Counsel made oral submissions at the Review, all of which have been considered by the Board.
Applicant’s written submissions prior to the Review
19. In the request for review, Applicant’s Counsel submitted that the Respondent breached the duty set out in section 30 of the Regulated Health Professions Act (RHPA) regarding members being restricted from treating or advising outside the scope of chiropractic practice, in that he treated the patient for diabetes, encouraging her to “dump the [Insulin] pump,” and he attempted to treat the patient with chiropractic techniques when she required emergency medical care for diabetic ketoacidosis.
20. Counsel referred to the Record in support of his submissions, including the text messages, photographs and information in the Respondent’s chiropractic records identified by the Committee, which he submitted relate to the Respondent’s treatment of the patient’s diabetes and insulin use, and getting the patient to discontinue the use of insulin, and are outside the scope of his practice.
21. Counsel submitted that during the interview with the investigator, the Respondent’s memory was self-serving and unreliable. For example, the Respondent could not recall if he advised the patient that adjusting her spine could improve her diabetes, he stated that chiropractic care could co-manage her diabetes and he stated that he may have told the patient that adjustments would lower her blood sugar, as he had seen this in other people.
22. Counsel noted that there are no notes to say that the Respondent was not treating the patient for diabetes or that he encouraged her to address her diabetes insulin use with a medical doctor as this was outside the scope of his practice.
23. Counsel argued that it was difficult to understand the Respondent’s “level of ignorance” regarding diabetes and in particular ketoacidosis, from a chiropractor who stated that chiropractic treatments can co-manage diabetes and used adjustments to lower blood sugars.
24. With respect to the visit of November 10, 2019, Counsel argued that the Respondent failed to appreciate that the patient was in an emergency situation, failed to appreciate that her care was beyond his level of skill, failed to plan for the worst-case scenario, failed to make use of a differential diagnosis when coming to the diagnosis of “dysponesis”, did not explain why he preferred that over more severe possibilities, failed to consider alternate diagnoses and rule out the most dangerous, did not recognize the signs and symptoms of diabetic ketoacidosis, which needed to be addressed by a medical doctor, and admitted that he did not advise the patient to seek medical care.
25. Counsel argued that the Respondent’s advice and reassurances allowed a dangerous and life-threatening situation, diabetic ketoacidosis, to progress leading to the patient going into a diabetic coma and that as a health professional he was required to tell the patient that she needed immediate medical attention.
26. Counsel submitted that the Committee’s decision not to refer this matter to the Discipline Committee, because it found there was no information that the ketoacidosis was caused by the Respondent’s advice, demonstrated a poor understanding of the progressive nature of diabetic ketoacidosis.
27. Counsel submitted that the investigation erred in finding that the patient’s insulin pump was defective and that this absolved the Respondent. He argued that the investigation was inadequate as there was no evidence of a literature review regarding diabetic ketoacidosis or the treatment of diabetes through chiropractic means, and no expert evidence from a chiropractor or medical doctor on the signs and risks of diabetic ketoacidosis. Finally, he argued that the patient and the Applicant were also not given an opportunity to respond to the arguments of the Respondent’s Counsel concerning the insulin pump.
28. Counsel concluded that the Committee’s decision not to refer the matter for discipline was not reasonable. The seriousness of the consequences of a chiropractor attempting to treat diabetes, discouraging the use of insulin pumps, and, in particular, failure to recognize an emergency situation like diabetic ketoacidosis warranted a more appropriate disposition beyond advice. He requested that the decision of the Committee be reviewed, and it be recommended that the matter be referred to the discipline committee.
Submissions at the Review
29. At the Review, Counsel for the Applicant re-iterated and expanded on his written submissions. He further submitted that:
The Committee failed to appreciate the significance of the Respondent’s misconduct.
The Applicant was not afforded the opportunity to respond to information which the Respondent’s Counsel gave to the Committee regarding the pump, in violation of the rule in Browne v Dunn[1] which renders the whole decision unreasonable and the investigation inadequate.
30. The Respondent’s Counsel submitted that the investigation was adequate and the decision reasonable and referred the Board to the Record in support of her submissions. Counsel’s submissions included the following:
• The Board’s powers are limited to reviewing adequacy and reasonableness.
• The Committee is not required to leave no stone unturned, nor is it required to retain experts. The Committee obtained sufficient information to decide this matter including hiring an independent investigator who conducted interviews of the patient, the Applicant and the Respondent, and secured hospital records, chiropractic records and text messages.
• Additional information was adduced and new issues have been raised which were not before the Committee. The Board must review the Record of Investigation (the Record) and consider the information in the Record rather than new information which is not relevant.
• The rule in Browne v Dunn has no application in this case.
• The Committee reviewed the information in the Record and noted that the patient and the Respondent provided consistent evidence that the Respondent never told the patient he could cure her type 1 diabetes.
• The references in the Record to blood sugar do not mean that the Respondent was treating her diabetes or that he told her he could treat her diabetes. Based on the text messages, it is illogical to believe that the Respondent was purportedly treating the patient’s type 1 diabetes, nor does it mean that the Respondent told the patient that she could come off her insulin. The Respondent thought that the patient wanted to get off the pump but not necessarily the insulin.
• Regarding the pump, information about the pump is not evidence that is before anyone and the hospital records indicated that they looked at the pump, that the patient was inputting carbohydrates and that it had no blood glucose information.
• The Respondent did indicate that he could co-manage her diabetes from a chiropractic standpoint but that does not mean curing diabetes.
• A review of the Record confirms that there were some communication issues and it was reasonable for the Committee to determine that the remedy was advice regarding clearer communications and clearer documentation.
• This decision will remain on the Respondent’s file.
VI. ANALYSIS AND REASONS
31. Pursuant to section 33(1) of the Health Professions Procedural Code (the Code), being Schedule 2 to the RHPA, the mandate of the Board in a complaint review is to consider either the adequacy of the Committee’s investigation, the reasonableness of its decision, or both.
32. The Board has considered the submissions of the parties, examined the Record of Investigation, and reviewed the Committee’s decision.
Adequacy of the Investigation
33. An adequate investigation does not need to be exhaustive. Rather, the Committee must seek to obtain the essential information relevant to making an informed decision regarding the issues raised in the complaint.
34. The Board finds the Committee’s investigation to be adequate.
35. The Committee obtained the following documents:
• the complaint and subsequent communications from the patient and the Applicant;
• the Respondent’s written responses;
• the Respondent’s chiropractic records regarding the patient;
• text messages between the patient and the Respondent;
• the patient’s records from the hospital; and
• summaries of interviews of the patient, the Applicant and the Respondent.
36. The Board finds the Committee’s investigation covered the events in question and that it obtained relevant information to make an informed decision regarding the issues raised in the complaint. The parties were offered opportunities to submit information to the Committee. Both parties did so. The Applicant and the patient had the opportunity clarify their concerns in writing and in telephone conversation with the Committee investigator. The Applicant and the patient provided copies of text messages exchanged between the patient and the Respondent. The Respondent provided his response and his records. The Committee obtained hospital records and interview summaries from the patient, the Applicant and the Respondent.
37. The Applicant submitted that the Committee ought to have obtained information from the patient and the Applicant about the patient’s insulin pump. The Board observes that while the Committee could have obtained more information about the patient’s insulin pump, the Record reflects that the investigation obtained the essential information for the Committee to make an informed decision. The Board finds that the condition of the patient’s pump is not essential information to a determination of the Applicant’s complaint. Accordingly, the Board does not find that it was necessary for the Committee to obtain information regarding the insulin pump from the Applicant or the patient.
38. The Board finds the Committee’s investigation covered the events in question, and that it obtained relevant information to make an informed decision regarding the issues raised in the complaint. There is no indication of additional information that, if obtained, might reasonably be expected to have affected the Committee’s decision.
Reasonableness of the Decision
39. In determining the reasonableness of the Committee’s decision, the question for the Board is not whether it would arrive at the same decision as the Committee. Rather, the Board considers the outcome of the Committee’s decision in light of the underlying rationale for the decision, to ensure that the decision as a whole is transparent, intelligible and justified. That is, in considering whether a decision is reasonable, the Board is concerned with both the outcome of the decision and the reasoning process that led to that outcome. It considers whether the Committee based its decision on a chain of analysis that is coherent and rational and is justified in relation to the relevant facts and the laws applicable to the decision-making process.
40. The Board finds the Committee’s decision to be unreasonable.
41. The Committee determined to issue advice to the Respondent on chiropractic scope of practice, record keeping and communications with patients.
42. The Committee summarized the patient’s concerns as follows:
• the Respondent purported to treat the patient’s type 1 diabetes;
• the Respondent encouraged her to lower her insulin dosages; and
• the Respondent failed to address the patient’s symptoms of emerging ketoacidosis by referring her to a more appropriate provider of health care.
43. The Board notes that the Committee reviewed the complaint, responses and reply from the parties, including text messages and the interview summaries of the parties, and set out much of this information in its decision.
44. The Committee noted that the Respondent treated the patient within the chiropractic scope of practice in that he performed conventional tests for musculoskeletal complaints, diagnosed vertical subluxation complex and used conventional chiropractic techniques, including adjustments. The Committee further noted that chiropractors are allowed to provide adjunctive services such as nutritional counselling so long as it is related to the chiropractic scope of practice. The Committee reviewed Standard S-001: Chiropractic Scope of Practice and quoted sections from it, including the following:
A member is restricted from treating or advising outside the chiropractic scope of practice by s.30 of the RHPA…
In responding to general health related questions by patients or the public that relate to controlled acts outside the chiropractic scope of practice … a member must:
• Advise the patient … that the performance of the act is outside the chiropractic scope of practice and the patient requires the care or would be more appropriately treated by a health care professional who has the act within their scope of practice.
45. The Committee specifically noted as follows:
• the text messages and photographs could suggest that the Respondent encouraged the patient in her hopes that she could “dump the pump” but do not explicitly say that the Respondent was treating her diabetes.
• There is some information suggesting that the patient thought the Respondent was treating her diabetes.
• There is no clear documentation from the Respondent that he was not treating her diabetes.
• The patient’s intake form notes that she was there to “Help understand Diabetes”.
• The Respondent’s notes contain references to understanding her sugar control, the “DAWN Phenomenon”, “WD insulin”, “Dump the Pump”, “insulin=blow torch”, “Think outside the pump” and “Sugar Demon”.
• The Respondent’s records do not tell the story of this patient as required by Standard S-002: Record Keeping.
46. The Committee noted that it would have been helpful if there were clear written information that the Respondent was not purporting to treat type 1 diabetes, that he should have been clearer with this patient about the scope of practice of chiropractic and the limits of his care and that they would have expected the Respondent to keep thorough notes about the events of November 10 and 11, 2019. The Committee noted that the Respondent’s texts conveyed clinical information in an informal way. The Committee concluded on these issues as follows:
Therefore the ICRC advises [the Respondent] to adhere to Standard S-001: Chiropractic Scope of Practice, Standard S-002: Recording Keeping and Guideline G-001: Communication with Patients
47. The Board finds that it is not apparent from the Committee’s decision whether it determined that some of the Respondent’s actions amounted to acting outside the chiropractic scope of practice. For example, the Committee set out the circumstances in which chiropractors are allowed to provide adjunctive services but did not consider or address whether the actions complained of by the Applicant amounted to adjunctive services or were outside the chiropractic scope of practice.
48. Accordingly, the Board finds that it is not clear whether the Committee’s decision to advise the Respondent to adhere to the College’s standard on scope of practice was based in part on a determination that he acted outside the scope of practice, or whether it was based solely on a determination that his communications and record keeping did not specifically say that he was not treating the patient for diabetes and did not set out the scope of chiropractic treatment and the limits of his care.
49. The Board finds that the issue of whether the Respondent acted outside the chiropractic scope of practice is central to a consideration of the Applicant’s complaint. The Board notes that there is information in the Record which the Committee thought could support a determination that the Respondent was encouraging the patient in her hopes to discontinue use of her insulin pump. The Board notes that there is also information that the patient thought the Respondent was treating her diabetes, repeated references to diabetes, insulin, sugar control and the patient’s insulin pump in the chiropractic records, as well as references to sugar control and the patient’s insulin pump in the text messages. The Board finds that it was unreasonable for the Committee to arrive at a disposition in this matter without specifically and clearly addressing this scope of practice issue. The Board does not find that there is a logical and rational line of analysis from the information contained in the Record to the Committee’s disposition.
50. Regarding the concern that the Respondent failed to address the patient’s emerging ketoacidosis by failing to refer her to a more appropriate health care provider, the Committee quoted in detail from the consultation report of a physician at the hospital dated November 11, 2019 which included the following information.
• [The patient] has not been very adherent to her insulin pumps.
• She never enters any blood glucose for correction in her pump.
• She …. since Saturday has been using the pump to input her carbohydrates.
• on Saturday around 10, her blood sugars went up to 20.
• She had not been wearing her pump for the week prior to Saturday.
• It seems that, to me, she had been wearing her old infusion set on Saturday that had been changed the week before but had not been worn.
• The pump looks to be in poor condition and apparently there was water that got to the pump.
51. The Committee noted that the diagnosis in hospital was “diabetic ketoacidosis, poorly controlled type 1 diabetes secondary to non-compliance.”
52. The Committee further noted that the ambulance report stated that the patient was wearing an insulin pump that should be delivering a dose every hour.
53. The Committee considered information from the Respondent’s Counsel, given during the Respondent’s interview, that there was evidence online that the patient was posting about a pump malfunction with respect to her hospitalization.
54. The Committee considered that the patient may not have inputted data that would allow the pump to monitor her condition.
55. The Committee decided “not to refer this matter to discipline because there is no information that the ketoacidosis was caused by [the Respondent’s] advice. It appears the device was defective. There is no information that [the Respondent] told [the patient] not to program the pump.”
56. The Board notes the following information in the Record:
• Before the patient’s attendance with the Respondent on November 10, she sent him a text containing the following:
… I have been feeling so horrible! My body went into extreme acidity since Friday and I’ve … drinking O much Alka powder I can’t take a step away without bending over and regurgitating it. Another words I feel like you need to adjust to me and I feel so helpless. Do you have any suggestions? I have formula G here at the house door do you think that’ll help? I’m so desperate right now for help Bedridden for 2 …heart is beating out of my body, body is overheating … I just take a few steps and my heart is ready to explode…
• The patient provided information that during the November 10 visit, she was at the Respondent’s house for approximately one hour during which time he gave her vitamins, water and treated her with the activator. She stated that the Respondent indicated he was thrown off by her symptoms as they were new to him and he did not seem concerned. She vomited three times during her visit. She noted that he sent her home with advice to follow up with him in his clinic the following day if symptoms persisted and he did not recommend she go to the emergency department or follow up with a physician.
• The Applicant provided information that during the November 10 visit the Respondent assured the patient when she began vomiting that this was normal, advised that the vomiting was a good thing as it meant that the acidity was leaving the patient’s body, told the patient to continue drinking water and did not seem concerned. The morning of November 11 the patient was unresponsive and hospitalized for severe ketoacidosis due to high blood sugar levels due to lack of insulin intake.
• The Respondent made no notes of the November 10 visit.
• During his interview with the investigator, the Respondent stated in part as follows:
o He did not advise the patient to go to a hospital or follow up with a physician.
o He believed she would follow up with him following her car ride home, at which point further decisions could be made.
o Ketoacidosis is not something that he is familiar with as a chiropractor, and as such he would not have been able to pick up on this from her symptoms.
o Regarding whether her vomiting is a good thing, he would have believed that the body was getting rid of toxicity.
o It was the patient’s decision to eat pickles which led to her dysponesis.
o People who do not follow his advice can and have ended up in the hospital.
o During treatment he noted that the patient’s dysponesis was “indicant” which means she was experiencing neurological distress from undigested protein because she had eaten four hamburgers and pickles and that he had told her not to eat read meat and had to correct her nervous dysfunction from this in the past.
• The hospital records include a consultation report dated November 11, 2019, which noted that the patient was brought to hospital in a diabetic coma and that she was in a very critical condition in the intensive care unit. The history of her present illness indicated that the previous day the patient was feeling achy and had some flu-like symptoms and some nausea, she had been to see her “chiropractor and naturopath” and had a multivitamin shot and drank lots of Alka Powder. The day of her admission, the Applicant was unable to wake the patient and brought her to the emergency room.
57. The Board notes that the Committee considered whether the Respondent caused the patient’s ketoacidosis, but there is no analysis in the decision regarding whether the Respondent met the standard of care required of a chiropractor in failing to advise the patient to seek further medical attention on November 10.
58. The Board finds that the information in the Record supports that the patient informed the Respondent that she was feeling very unwell on November 10 before the visit, she continued to feel unwell during the visit vomiting several times, she was likely suffering from the early stages of ketoacidosis given her condition and hospitalization the following day, and the Respondent did not advise the patient to seek medical attention. In this regard, the Board notes the information from the Respondent that he was co-managing the patient’s diabetes, and that he was not familiar with ketoacidosis. The Committee did not address whether the Respondent met the chiropractic standard of care in failing to recognize the severity of the patient’s condition and in failing to advise her to seek medical care. The Board finds that it was unreasonable for the Committee to fail to address the appropriate standard of care in this situation and whether the Respondent met it.
59. The Board finds the Committee’s decision unreasonable for the reasons set out above. The Board returns the matter to the Committee and requires it to reconsider this matter, including conducting any further investigation it deems necessary for such reconsideration.
VII. DECISION
60. Pursuant to section 35(1) of the Code, the Board returns the decision to the Committee and requires it to reconsider this matter and issue a further decision.
ISSUED November 25, 2022
“Anna-Marie Castrodale”
___________________________
Anna-Marie Castrodale
“Sonia Gaal”
___________________________
Sonia Gaal
“Mitchell Toker”
__________________________
Mitchell Toker
Cette décision est aussi disponible en français. Pour obtenir la version de la décision en français, veuillez contacter hparb@ontario.ca
[1] 1893 CanLII 65 (FOREP), 6 R. 67, H.L.
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