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It's always hard to analyze these cases appropriately with incomplete information. Especially because the nature of doctor-patient confidentiality means that the aggrieved can make whatever true or fallacious allegations, knowing that the clinicians and institutions are gagged by privacy laws to counter.
In early February of 2024, a migraine kept Finlay home from school. His mother, Hazel, said this would sometimes happen if Finlay was getting sick. But his condition got worse, and Hazel decided to take him to
Oakville Trafalgar Memorial Hospital.
So based on a Chief Complaint of "bad headache", the differential diagnosis of worst case scenarios in triage is Meningitis or a Subarachnoid Hemorrhage (brain bleed). Both exceedingly rare. 99.5/100 times this is just a migraine that needs Advil, fluids & sleep. You can't also go by severity, because migraine sufferers & drug seekers (unlikely in a 16 y/o teen) will also tell you this is their "worst headache ever".
Fever + bad headache makes you more worried about meningitis in an adolescent male, but is also hard to tease out because every sniffle comes along with a headache. Vital signs also don't help to differentiate acuity, because the kid with the flu is also going to have a fever, fast hr and possible low BP.
Light sensitivity & bad vomiting could also point you to meningitis, but your average migraine also does this too.
A lot of the sick/not sick triage assessment really comes down to gestalt because you don't have great objective signs to decide who needs to be seen NOW. In these cases, some of this assessment really requires you to get the teen to lay down supine on a stretcher so you can get a good look at him, shining the scope light directly into his eyes to both check his pupillary response and see how much he actually recoils physically to direct light exposure. You also really need the patient to be lying down to properly do some maneuvers to reef on their neck and legs to see how much neck stiffness & pain you can elicit. The triage nurse is unlikely to have access to a proper gurney for this even if she knows how.
It's also notable that the teen was in Oakville. For cases like meningitis & aneurysms, the two tools you need are a CT scanner & a doc proficient in doing a spinal tap to look for blood & bacteria in the cerebrospinal fluid. Oakville is big enough to have ready access to a CT, unlike a lot of rural ERs in the north & cottage country. Another factor is that there is also inherent risk with sticking your average teen in a CT scan of their brain. It's a huge radiation dose that is likely to increase the risk of brain tumours decades down the road. So it's a tool that has to be used judiciously because it's harming everyone you stick in, but only helping few. A MRI of the brain has no radiation, but generally isn't used for emergent cases because MRI scanners are fewer, take longer in situations where minutes count, etc.
In reviewing the hospital records, Martin and Hillier lawyer, Meghan Walker, said, “Finlay was triaged at almost exactly 10:00. He wasn’t actually seen by a physician until 6:22 in the morning.”
This is pretty nutty. He wasn't seen for 20 hours. Triage should've reassessed him more frequently and his family should've kicked up more of a fuss to get him back to see a doc.
According to the statement of claim about what happened, when he was seen the following morning, the doctor said Finlay “was experiencing sepsis/pneumonia with hypoxia and he was at high risk for acute deterioration.”
His oxygens levels, which the lawyer said hospital records show had been dropping throughout the night, were also a concern.
This makes me think that the original Chief Complaint of a "bad headache" probably sent both myself & the triage nurse down the wrong diagnostic path. Presumably if he died of meningitis or a brain bleed, that would've been emphasized more.
The problem with the description of "sepsis/pneumonia with hypoxia" is that it's really to vague to properly speculate on the cause of what is happening. Definitely too vague to be picked out of a haystack by some overworked and underskilled triage nurse.
The sepsis part indicates there was some infectious blood poisoning going on likely. But again, this is a chicken & egg scenario where the source still isn't clear. The mention of pneumonia suggests this could've just been a bad respiratory infection, but that's not guaranteed either because the OG Chief Complaint doesn't mention anything respiratory. So this could simply be systemic decompensation.
Too bad though because it's possible that this kid could've been saved by a simple chest x-ray and shotgun guessing broad spectrum antibiotics instead of more esoteric stuff like CT scans and spinal taps.
Finlay eventually needed to be intubated. The decision was made to transfer him to SickKids hospital in Toronto. But before that could happen, he went into cardiac arrest. The statement of claim said “the contributing cause of arrest was listed as septic shock, pneumonia.”
Finlay arrived at SickKids and was taken to the ICU. He was in hypotensive shock and placed on ECMO, a life-support system that helps take over a patient’s heart and lung function.
Again, this stuff shows just how serious his condition got, not necessarily the cause.
One should also be suspicious of any ER diagnosis of "pneumonia". ER docs use "pneumonia" to document uncertainty when something has to be written down much like leftists throw around "racism". A radiological report declaring "pneumonia" is a lot more definitive. But also depends how far along into his illness the x-ray was taken.
“He was triaged as the second-highest level in triage. The guidelines say that 95 per cent of the time, they should be seen within 15 minutes.”
Takes some of the emphasis off the triage nurse. Though how did he wait around & not get reassessed for the next 19 hours by the nurses if his status should've been "15 mins to being seen" according to the lawyer? His triage status should've been that he was only behind awful stuff coming from the ambulances.
Furthermore, Dr. Ian Preyra has been onboarded as the new Vice President of Medical Affairs and Academics, and Dr. Prashant Phalpher is the new Chief of Emergency and Program Medical Director.
Oh good, Doc Prashant is looking into things.
