Emergency crisis | “Micheline should be alive today”

Micheline Bouchard went to the emergency room of the Trois-Rivières Regional Affiliated University Hospital Center last August because she was having trouble breathing. Twenty-two hours later, without any treatment having been undertaken, she collapsed, never to get up again, struck down by a pulmonary embolism. For her loved ones, the 66-year-old woman was literally “forgotten” in the emergency room and did not receive adequate care.

“There was a real lack of support,” laments his brother Pierre Bouchard. “She was the victim of delays, and the lack of vigilance over her symptoms,” adds Guylaine Bouchard, who says “she has not yet overcome the shock of the loss” of her sister.

The case of M^me Bouchard surfaces while emergencies have been under heavy pressure for months in Quebec. Two weeks ago, the CISSS de la Montérégie-Ouest confirmed that two investigations are underway after the death of two patients in the crowded emergency rooms of Anna-Laberge hospital.

Last week, the Regroupement des chefs d’urgence du Québec wrote to Health Minister Christian Dubé, describing a situation “out of control.”

Finally, on Tuesday, Minister Dubé recognized that the situation was “extremely difficult” in emergencies and asked the population to collaborate by avoiding going there if possible.

For Micheline Bouchard, emergencies were the only option, believes her brother Yves.

Long wait

Single and childless, Micheline Bouchard enjoyed life. In recent months, she had made a trip to Egypt. She gave workshops to seniors through the FADOQ network on the use of electronic tablets. “She was an eternal optimist,” says Guylaine Bouchard.

At the end of last July, Micheline Bouchard suffered a slight fracture to one of her feet while walking on a sidewalk. After consulting the Trois-Rivières Regional Affiliated University Hospital Center (CHAUR), she had a “Samson boot” installed to hold her foot in place.

But then, after the incident, she experienced violent cramps in her calf. This pain fades, but on the same day it gives way to significant shortness of breath. Around 5 p.m., Micheline Bouchard had such difficulty breathing that she lost her voice. His brother Yves takes him to the CHAUR emergency room at 7 p.m., he says.

In triage, Micheline Bouchard was given a priority 3 rating, say those close to her. According to the Canadian Triage and Acuity Scale for Emergency Departments, a priority 3 patient should obtain medical attention within 30 minutes.

Micheline Bouchard is placed in a wheelchair and directed to the waiting room. She spent the night there without consulting a doctor. In text messages sent to her siblings, Micheline Bouchard wrote that a nurse told her around 2:30 a.m. that no doctor was available to see patients in the waiting room before 8 a.m. the next morning. It was around this time that she saw a doctor, who suspected possible phlebitis or a pulmonary embolism, we can read in the text messages sent by Micheline Bouchard.

The patient is told that she will have to undergo an examination, a scintigraphy, to confirm the diagnosis. We’re putting her on a cardiac monitor in the meantime.

“We should have gone faster”

Around 2 p.m., Guylaine Bouchard arrived at the hospital. Her sister still hasn’t taken her exam, scheduled for 11:45 a.m. The exam won’t be done until 4 p.m. “Why didn’t we prioritize her for testing?” We should have gone faster,” said Guylaine Bouchard.

Back in the emergency room, a doctor explains to Micheline Bouchard that she has had a pulmonary embolism. That his results are “not pretty”. “He told him: it’s very serious. You have lots of clots in your lungs,” says Guylaine Bouchard.

His sister was quickly sent to another unit to undergo treatment. But these will never begin. When she got up to go to the bathroom, Micheline Bouchard felt dizzy. Before her sister’s eyes, she collapses to the ground. The patient is taken to the resuscitation room.

About thirty minutes later, a doctor told Guylaine Bouchard that her sister was really not doing well. “I said to him: are you telling me that my sister is going to die? He said yes,” she said. After several cardiac arrests and resuscitations, Micheline Bouchard was sent, unconscious, to intensive care. She never regained consciousness and died there on August 28.

“We ask ourselves a lot of questions about whether everything was done between the moment she was seen in triage and the moment she was transferred to intensive care,” emphasizes Guylaine Bouchard. She was off medication for 22 hours. »

“She never had the chance to start treatment. She collapsed before. There was a clinical dysfunction,” believes his brother Yves.

The family filed a complaint with the local Complaints Commissioner.

No coroner’s inquest

At the CISSS de la Mauricie–Centre-du-Québec, they say they cannot answer specific questions about Micheline Bouchard’s situation, despite the family’s agreement, for reasons of confidentiality.

However, we assure that a doctor “is present at all times during the night in the emergency room” of the CHAUR and that after the initial triage of patients, “the emergency staff assesses the situation in the waiting room in order to ‘Act quickly if a person’s condition deteriorates.’ When a doctor evaluates a patient, “he requests additional examinations when necessary, indicating the level of urgency according to the clinical portrait of the patient,” says the CIUSSS.

The establishment emphasizes that on August 16, the occupancy rate in the CHAUR emergency room was 100% “with significant traffic in the waiting room which gradually decreased during the night”.

As following any death occurring in the emergency room, an internal assessment was carried out. No coroner’s inquest was requested, as the cause of death was known and “no criteria were present to request a coroner’s inquest”.

A coroner’s investigation can be triggered in particular “when a death occurred in violent or obscure circumstances or which appears to have occurred as a result of negligence”, we can read on the Coroner’s Office website. And his sister’s case resembles negligence, believes Yves Bouchard.

President of the Association of Emergency Medicine Specialists of Quebec, Dr.^r Gilbert Boucher mentions that each patient case is unique and must be analyzed in detail before being able to make a judgment. However, he believes that at first glance, the delays do not seem “to have helped the cause”.

President of the Association of Emergency Physicians of Quebec, Dr.^D Judy Morris recalls that in their letter last week, Quebec’s emergency leaders wrote that the two deaths at Anna-Laberge hospital were “only the tip of the iceberg.” “The mission of an emergency room is to identify, stabilize and take care of patients who need acute care. When we add waiting, we confuse this mission,” she says.

For the Bouchard clan, Micheline’s death must not be in vain. “The network must learn from this situation and improve its practices,” argues Pierre Bouchard.