Last spring, the death of Normand Meunier at the Saint-Jérôme hospital shook Quebec. The paraplegic man had developed a major wound during a hospitalization. His suffering was such that he requested, and received, medical assistance in dying. A public coroner’s inquiry into this case is expected in 2025.
This tragic case is far from unique, says Ariane Gauthier-Tremblay, community organizer at the organization Moelle épinière et motricité Québec.
“We don’t have official statistics. But our members tell us a lot about it: developing a pressure sore [communément appelée plaie de lit] “When they go to the hospital, it’s their dread. Many people delay their hospital visits or their tests because they’re afraid of that,” she says.
What is a pressure ulcer?
A pressure sore, or pressure ulcer in medical parlance, forms when sustained pressure is applied to an area of the body, usually a place where a bone protrudes from the body, such as the heels, buttocks, or hips. It is caused by the suppression of blood circulation to the affected area. Pressure sores are classified into four stages, depending on their severity.
The Press interviewed six spinal cord injury patients who, like Mr. Meunier, all developed very serious pressure ulcers following hospitalization, either after their initial injury or during a subsequent hospitalization. Three of them had attended the Montreal General Hospital (MGH), but many hospitals provide spinal cord injury patients with inadequate care, they denounce.
PHOTO HUGO-SÉBASTIEN AUBERT, THE PRESS
Antoine Laporte, who is paraplegic, woke up from his 13-day coma in hospital with a major wound to his coccyx.
After a motocross accident two years ago, Antoine Laporte, 27, became paraplegic, losing the use of his lower limbs. In addition to being deprived of the use of his lower limbs, he woke up from his 13-day coma at the MGH with a major wound to his coccyx.
I had an infection all the way to the bone. I had six months of antibiotics. It took a good eight months to heal.
Antoine Laporte, who is paraplegic
A similar scenario happened to Yowhan Lauzon. After an accident – a pressure drop on a balcony with a rotten railing – he ended up with fractured vertebrae and spent two months in a coma, then two months on the floors of the MGH.
It was four weeks after he arrived on the floors that the emergency services “turned on the light,” he says. He had a large wound the size of a tennis ball on his lower back. “You could see my sacrum.”
Injured people who “no longer feel their skin”
A person who suffers a spinal cord injury often loses the use and sensitivity of some of their limbs. “Since they no longer feel their skin, these people are not able to protect it. You and I, if we have been in the same position for 90 minutes, naturally, we will shrink to remove our pressure point because we feel it and we are able to do it. In spinal cord injuries, we remove both: they do not feel it and they cannot move themselves,” explains Gabrielle Limoges, clinical nurse in the trauma program at the Sacré-Cœur-de-Montréal hospital.
PHOTO ALAIN ROBERGE, THE PRESS
Anne-Marie Lagacé, clinical-administrative coordinator of the trauma program at the Sacré-Cœur-de-Montréal hospital, and Gabrielle Limoges, clinical nurse in the trauma program
Some pressure ulcers can be very large, to the point of exposing the bone. Developing a pressure ulcer can be very quick: it only takes two hours for the first redness to appear. “That’s why we have to rotate these patients every two hours,” explains Anne-Marie Lagacé, clinical-administrative coordinator of the trauma program at the Sacré-Cœur-de-Montréal hospital.
In addition to having to turn patients every two hours, they also often have to be provided with therapeutic mattresses and cushions to support the parts of the body most likely to suffer pressure ulcers: the shoulder blades, occiput, coccyx, ischial bones and heels. But this is far from being done everywhere, according to Ariane Gauthier-Tremblay. “Too often, hospitals are not organized to accommodate spinal cord injury patients while taking their needs into account,” she says.
An ordeal at the HGM
This is exactly what Sylvie Bard experienced at the Montreal General Hospital: a real ordeal. The woman became quadriplegic following a sudden fall down a flight of stairs in 2023. She therefore lost the use of its four limbs.
The paramedics transferred her to the Montreal General Hospital. She would spend a total of ten months there. “It was when they transferred me upstairs that I developed a nasty bedsore on my buttock. It was treated very poorly. They didn’t have time to change me from side to side when it should have been done every two hours. When I arrived at the rehabilitation centre, it was very hollow, very long, almost to the bone,” explains M.me Bard.
However, her daughter and the physiotherapist who was treating her had demanded that the staff provide her with a mattress adapted to her condition and regularly change her position.
My daughter saw that I had a wound. She was trying to get them to do something.
Sylvie Bard, who is quadriplegic
The hospital staff clearly did not know what to do with such a wound, M.me Bard. It was only when she was transferred to a rehabilitation center that things improved. There, they disinfected the wounds, used creams, bandages, and above all, they made her move constantly in bed and sat her down regularly in a chair. Sylvie Bard spent six months at the rehabilitation center. “And it was only at the end that we managed to make everything go away.”
The McGill University Health Centre, which operates the MGH, declined to comment on the specific cases raised in our story. But spokesperson Bianca Ledoux-Cancilla said the hospital’s expertise in trauma – which includes spinal cord injuries – is recognized worldwide.
“From the emergency room to the intensive care units and the wards, the multidisciplinary team at the MGH is trained and skilled to provide the appropriate continuum of care to patients with spinal cord injuries and their families. These patients require special care, such as frequent mobilization, regular positioning, skin care, specialized mattress, pressure points, respiratory therapy. The psychological and physical adaptation to spinal cord injuries can be lengthy.”
At Moelle épinière et motricité Québec, however, we advocate that spinal cord injured patients be sent to the two centres of expertise dedicated to them, namely the Sacré-Cœur hospital in Montreal (see other text) and the CHU de Québec.
Mme Lagacé points out that there are few spinal cord injuries in the network (130 to 140 new cases per year in Quebec). Health care workers are therefore not very exposed to this clientele and may not always know how to intervene.
This is what causes the bad practices observed at the Montreal General Hospital to be reproduced in many establishments, underlines Mr.me Bard. She recently had to be hospitalized for a urinary tract infection. “When I left, I had a big red patch on my buttocks. If I had stayed longer, it would have definitely ended badly, because I was lying down all the time.”
In the emergency room, Sylvie Bard was lying on a simple stretcher. Her daughter asked for a specialized mattress. “If my daughter hadn’t spoken, I would have stayed on a stretcher. It’s like they don’t know how to take care of us!”
A wound “as big as an apple”
Simon Plamondon makes the same diagnosis. In 2011, he became a quadriplegic at the age of 25, following a scooter accident. However, he manages to maintain a certain autonomy because he still has the use of several arm muscles.
PHOTO EDOUARD PLANTE-FRÉCHETTE, THE PRESS
Simon Plamondon, who became quadriplegic following a road accident, experienced an ordeal due to a pressure ulcer that appeared during a stay in hospital.
Seven years after his accident, he entered the Saint-Sacrement Hospital in Quebec City with pneumonia. The problems arose from the first day, he says. “There is no protocol in place for spinal cord injuries in hospitals.”
Soon, a white spot appears on the left buttock. This initial wound quickly evolves into a major wound of almost two centimeters in diameter. The wound becomes necrotic, infected. “It was as big as an apple.”
After months of suffering and operations to drain the pus from the wound, it was plastic surgeon Geneviève Mercier-Couture who finally got the better of it.
I wouldn’t be able to go through another several weeks in the hospital. Once you’ve had a major wound, it becomes really anxiety-provoking.
Simon Plamondon, who is quadriplegic
Over the course of his stays in different hospitals, Simon Plamondon observed that practices really differed from one establishment to another. At the Hôpital de l’Enfant-Jésus, his mattress was ready for him upon his arrival. But not at the Hôpital du Saint-Sacrement or the Centre hospitalier de l’Université Laval (CHUL), where he never had access to a therapeutic surface. Same scenario at the Hôpital Saint-François d’Assise, where he asked several times to have access to a specialized mattress, without success. “I have never suffered so much!”
The Ministry of Health and Social Services (MSSS) says it has given presentations in recent months to “raise awareness among emergency personnel about the importance of wounds and the elements to monitor when dealing with a person with a spinal cord injury.” A conference emphasizing “the importance of collaboration with the patient” will also be given shortly.