Health Professions Appeal and Review Board's Second Decision re: Kilby vs Klein
Excerpts From Their Decision:
The second point that remains is of the greatest concern to the Board. That is so because the Record includes conflicting information concerning the standard of care concerning the use of preoperative antibiotics.
The routine use of antibiotics prior to bowel surgery is an important aspect of care that was neglected by [the Respondent] in this case. The Committee would suggest that [the Respondent] 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.
This passage appears to the Board to be contradictory. Although the Committee states that the "routine use" of antibiotics prior to surgery is an "important aspect of care" that was "neglected" by the Respondent, it does no more than "suggest" that the Respondent "consider the routine use" of preoperative antibiotics for future surgery. The Committee goes on to describe the Respondent's decision not to provide antibiotics prior to the patient's surgery as an "oversight", which suggests a failure of pre-operative care, regardless of whether the failure contributed to the outcome in the patient's case.
The second question related to whether perioperative antibiotics should have been prescribed. [The IOP] stated that he found no evidence in the record that any antibiotics had been prescribed perioperatively. He staled that it is the standard of practice with bowel surgery to administer antibiotics, either orally or intravenously, approximately 2 hours prior to surgery so that the drugs are circulating before the incision is made. While it makes intuitive sense to administer antibiotics postoperatively, [the IOP] indicated that studies show it is the preoperative dosage that is most important, while postoperative dosing has been found to be "icing on the cake", [emphasis added]
According to this information, the IOP advised the Committee that the standard of practice required the administration of preoperative antibiotics. This appears inconsistent with the statement he made in his written opinion that the patient's "preoperative care, operative care and post operative care seemed appropriate". The matter is further confused, because in answer to the question: "Could this omission [of preoperative antibiotics] be a contributing factor to the defect in the anastomosis seen at autopsy?", the IOP answered "No".
The Board is left in some doubt as to the nature of the IOP's opinion and the Committee's decision concerning the Respondent's decision not to provide preoperative antibiotics. The IOP does not specify whether the standard of care to which he referred included laparoscopic surgery or open surgery, or both. Nor is it clear how, if at all, the IOP's advice, that the omission of preoperative antibiotics was not relevant to the anastomosis, relates to his more general advice on the standard of practice.
In these circumstances, it is necessary to return the matter to Committee for further consideration and clarification of its decision on this aspect of the complaint.
The Board's only remaining concern is with the question whether the Respondent met the standard of practice concerning the use of preoperative antibiotics.
The matter is being returned to the Committee solely for further consideration and clarification of this important matter.
Pursuant to section 35(1) of the Health Professions Procedural Code, Schedule 2 to the Regulated Health Professions Act, 1991, the Board returns the decision to the Committee and requires it to further consider and clarify its decision concerning the use of preoperative antibiotics and the standard of practice. The Committee's decision to counsel the Respondent on timely documentation of discharge summaries and to take no further action on the other aspects of the complaint is confirmed.
There were 6 more deaths by the bariatric department of this hospital during 2009 and up to Feb. 2010 under similar circumstances— And this past year, a woman who had a hysterectomy bled out before they could get her to the OR. It is almost impossible for me to obtain the details but the Chief Coroner’s Office and the hospital would have them-----these deaths may have been prevented if my daughter’s death was thoroughly investigated the first time.
From someone who worked at the hospital.
“I forgot to let you know that last year a doctor from a university hospital was sent to HRRH to train surgeons for Bariatric surgeries, of course after people died of hemorrhages and they did not know what was happening in OR.”
re: death of daughter who bled to death 12 hours after being released from HRRH
Again, I support this site completely. But it is important for prospective patients to ask the questions that need to be asked.
The College doesn't even agree with its own expert: ie --- their expert stated that the surgeon neglected (this word is used as a verb, the noun would be negligence) to have anti-biotic prophylaxis delivered but the College ignores it
--the experts also states that the low protein count had to have occurred while Terra was hospitalized and the College ignores this ---their expert states that she should not have been released without a bowel movement and of course the College ignores this as well
From Surgeons outside of Canada --- two responses out of 99 and I only sent the the details today
Apparent lapses in care are: 1) Lack of peri-operative antibiotics . 2) Discharging your daughter with ongoing diarrhea of unexplained etiology, 3) Prolonged period of inadequate nutrition, 4) nursing records that appear to be at odds with the physician record of the abdominal exam, 5) failure to distinguish the intra-abdominal catastrophe from the wound infection.
It is self-evident that she was discharged prematurely or she would not have died outside the hospital of a devastating post-operative complication.
my review of the information
you sent me my opinion is that your daughter received suboptimal care
approaching malpractice-at least by US standards. I would have to
assume that Canadian standards are equivalent to US standards but from
the response I read perhaps they are not.
I totally support you but a MIS surgeon failed my daughter. L Klein was the surgeon. Negligence
Please read my blog at:
http://anangelinourlives-awk.blogspot.com/ No Accountability or Transparency in Ontario
My daughter bled to death 12 hours after being released from this hospital.
When I first met Dr. Klein I found him to be very open, upfront, and easy to talk to. He took his time and listened to what I had to say and didn't make me feel rushed at all. At my follow up before surgery he took the time to answer my list of questions and explained everything to me in easy to understand terms which you don't often get.
Day of surgery he was awesome very reassuring and kind as I was a upset and sooo nervous, and I found his bedside manner great also.
Post op follow up at his office I had been having trouble and he took time to listen to my concerns and put the appropriate action into place for follow up as I had a stricture.
His office staff are very friendly and helpful. I would highly reccommended him to others that are thinking of having the same surgery....I defiantely felt like and still do that I am in great hands and being well taken care of.
dr klein is very good, he is a nice surgeon he is very thorough and even comes and sees u while u are in the hospital, yes he has good aftercare, i had a really great expieriance with him as i am sure i will with my aftercare i am 6 weeks post op now and have seen him at my one month follow up. i was very glad i have a great surgeon and a great surgery!!Aug. 17, 2011
After 17 months from when I started looking into this, I had my first visit with Dr Starr, quite a wait though, so expect to be there awhile. Good thing you don't have to pay for parking He was very nice and personable, unlike a lot of doctors i've seen over the years.
This week has been hell. I've been transferred to Dr Hagen on top of everything - I'm thrilled about Dr Hagen doing my surgery. At least now I know it won't be until at least January.
Dr. Klein seems really knowledgeable. He is an assistant Prof at U.of T. and was one of the key factors in getting Laproscopic surgery at the bariatric program at Humber River Regional Hospital.
He has answered all of my questions(including the stupid ones - without cracking a smile)and I feel really comfortable with him.
Another fantastic point is that he has great staff, and his office runs on time!!
Overall I am really pleased with Dr. Klein, and I will update more after surgery.
My first impression wasn't a good one he seemed rushed and cold like ice, i though t he was some sort of work out buff. Over time i realizeed that he was a man with compassion and wanted to help me he is truly a nice man. His staff is extremly friendly and nice. I least liked the wait times at the office sometimes i had to wait an hour later than my sceduled appointment. Dr.Klien cares about each and every one of his patients. He prefers for you to stay the whole duration in the hospital. I would rate him a 10. Both surgical competence and bedside manner are equally important.Jan. 18, 2010
he was very up front and i will addmit i was scared of him at first cuz every dr i'd been to always said you need to lose weight and every problem i had in live was my weight. dr klien listened to me and didn't judge me it was like he could read my mine with all the hurt and pain my weight has caused me. and it was nice to see that someone understood how i was feeling and not push me away. i would recommend him to anyoneApril 28, 2009
My first impression of Dr. Klein was that he looked very young....and was super good looking...My impression has not changed, I now realize what an amazing and compassionate man he is. His office staff are also amazing. I guess if I had to say the thing I liked least about him, it is that he is so busy...but then again if he wasn't I would be worried. Future patients should know that you will wait a long time everytime you visit, however, he will give you the best care you could ask for....and will always return your calls....or get on the phone with you immediately...He definately lets you know how important follow up is....He was quite honest with me about risks involved, but we did not discuss the issues of vitamin/minerals later in life...this was dissappointing, but then again...without surgery how much..later life could we expect...Overall I rate him as one amazing individual....no complaints here..I think competence is better...but bedside manner is always good. rnMy only concern was the cleanliness of the hospital, the nursing staff, and one dietician in particular....The hospital staff was lacking what the surgeon made up for...Guess no surgery can be perfect...Feb. 22, 2009
i thought hi was very cold at first.then after meating him a couple of times he was very nice.very nice.Feb. 20, 2009
AT FIRST I DID NT FIND HIM TO BE VERY FRIENDLY BUT AFTER WARDS HE WARMED UP TO ME.THEY WHERE VERY HELPFUL.I LIKED EVERYTHING ABOUT HIM.THEY SHOULD KNOW THAT HE CAN BE VERY COLD AT FIRST.YES THEY DO HAVE A VERY STRUCTERED PROGRAM AFTER.HE SHOWS YOU BOTH PICTUYRES OF SUREGRY AND DISCRIBES WHAT COULD HAPPEN AFTER SURGERY. I WOULD GIVE HIM A 10 HE IS EXCELLENT DR.I THINK THAT SURGICAL COMPETENCE BEDSIDE MANNER ARE BOTHE GREAT.Jan. 11, 2009