A 99-year-old resident of Pavillon des Cèdres in Rivière-du-Loup lost his life too early on July 19, 2023 after being unnecessarily sent to palliative care, reports coroner Dr. Renée Roussel.
The nonagenarian was sent to the emergency room at the Centre hospitalier du Grand-Portage (CHRGP) on July 9, 2023, following a fall at the seniors’ residence where she lived. While returning from a swing, she tripped over a garden hose that a volunteer was using to maintain the flowers. “There was a head impact, but no loss of consciousness,” the coroner’s report states.
A hematoma was visible on the right side of her forehead and around her eye. The eldest was still alert. However, “due to a certain decline in her general condition over the past few months, it was quickly agreed between the caregivers and the family not to proceed with a more complete assessment of her trauma. Thus, no craniocerebral or cervical spine imaging was prescribed,” relates Dr. Roussel.
The same day of her admission to the CHRGP, the patient was hospitalized and the objective of care shifted to D, i.e. palliative care, “everyone being convinced that there had been significant craniocerebral trauma”.
According to the report from Dr. Renée Roussel, in the hours that followed, the eldest became unwell and delirium set in. “Gradually, usual care was stopped […] [Elle] stopped eating and hydrating. She developed respiratory symptoms and then died 10 days later.
POORLY DOCUMENTED LESIONS
According to the report, an additional radiological assessment was ordered the day after the death since the injuries which led to the woman’s death were not sufficiently documented. The radiologist noted the absence of any traumatic lesion to the brain, skull or cervical spine. “The bleeding only occurred in the subcutaneous soft tissues of the forehead,” indicates the coroner.
“I find it hard to understand why no brain or cervical imaging was carried out even though we were in a hospital with a large radiology department and that, on the other hand, it was allowed to take X-rays of a shoulder and a knee. [durant l’hospitalisation]”There are probably good justifications, but this, seen from the outside, seems rather strange,” says Dr. Renée Roussel.
When the elder’s death was announced, the cause of death was unknown, but a brain hemorrhage from her trauma was suspected. “It was this presumed diagnosis that greatly influenced the family’s decision to allow caregivers to move to palliative care so quickly,” she says.
Regardless of the result, brain imaging would have greatly influenced the care provided to the elder, believes the coroner. “The absence of serious injuries would most likely have delayed the transition to palliative care or even the non-need to resort to it.”
SAME END
The expert nevertheless believes that the end would have been the same “because the physiological reserves at this age are very thin”.
However, she would like caregivers to think about the impact on a family of sending a loved one who led a good life before their accident so quickly to death, learning after the fact that no serious injury justified the decision. “The family was saddened and […] and feels guilty for having made such a decision so early, so quickly which ultimately was not made with full knowledge of the facts,” wrote Dr. Roussel.
No recommendations have been made regarding this aspect since “each case is different and it is not possible to establish fixed rules in such situations. Clinical judgment always remains necessary.”
However, Dr. Roussel advises the group that owns the Pavillon des Cèdres in Rivière-du-Loup to supervise the work on their land more safely to avoid another accident. A representative told him that maintenance would no longer be entrusted to volunteers, but a private company.
