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Hospital mum on reasons for woman’s death after a dental abscess

Posted: November 4, 2014

(October 31, 2014)

Pamela Minocha was a healthy, smart, vibrant 33-year-old woman who unexpectedly died in a Toronto hospital in May 2013, apparently from an allergic reaction to a medication. Her family still don't know what happened in the hours before she died.

Pamela Minocha, 33, died in a Toronto hospital after a toothache. Because of a provincial secrecy loophole, her family doesn’t know why.

Her parents don’t know if her unexpected death could have been prevented, because what happened is a secret shielded by the sweeping Quality of Care Information Protection Act (QCIPA).

Invoking the act is discretionary, and critics say some hospitals interpret the act to mean they don’t have to share how an incident happened or what’s being done to prevent it from happening again.

QCIPA can trump all other legislation, including freedom-of-information law, and allow Ontario hospitals to hide the results of critical care investigations from families, the public and even coroners.

Toronto medical malpractice lawyer Paul Harte said the act has created “ongoing problems with the openness and transparency of our entire health care system.”

“It’s very common for a hospital to first of all hide behind a QCIPA shield and secondly to be very inaccurate and sloppy in their quality-control investigations because of it,” Harte said.

In September, Ontario Health and Long-Term Care Minister Dr. Eric Hoskins launched a review of QCIPA to improve the legislation after a Star investigation.

The series included a family unable to get answers after their 20-year-old son committed suicide under psychiatric care, and a hospital that refused to release any information about how a newborn baby was wrongly declared dead. Hoskins’ review is due to be completed in mid-December.

QCIPA was created to allow health-care workers to freely share mistakes in a confidential environment in an effort to prevent future errors.

Minocha’s death was the subject of one of 12 critical-care investigations held at St. Joseph’s Health Centre in the past three years, the Star has found.

St. Joseph’s chose to place all 12 incidents under the protection of QCIPA — making it one of only two health centres in Toronto that keeps all critical investigations secret.

In contrast, Toronto East General hasn’t used the controversial act in more than five years.

The discrepancy “underlines the problem in having important public policy left to the discretion of individual hospitals to such an extent,” Natalie Mehra, executive director of the Ontario Health Coalition, previously told the Star.

“It should not be up to hospitals to so widely interpret what the public can and can’t have access to.”

Minocha was a healthy, vibrant MBA student at Wilfrid Laurier University who was admitted to St. Joseph’s with a swollen face last May, according to medical records obtained by the Star.

A day earlier she had been diagnosed with a dental abscess and prescribed Clindamycin, an antibiotic for serious infections, by a dentist. Minocha began to feel unwell and started vomiting after taking the medication, her medical records show.

Her brother, Arvin Minocha, told the Star that after she was admitted to hospital, doctors spoke to her Calgary-based parents over the phone and said she was alert, stable and going to be “fine.”

Her parents boarded a four-hour flight to Toronto. Minocha died before they touched down.

A preliminary autopsy report lists her cause of death as hypersensitivity myocarditis — an allergic reaction to the drug she took that attacks the heart.

In May this year, Minocha’s family received a short letter from the hospital on the findings of the review.

The letter contains only nine sentences and said Minocha received “intensive and appropriate treatment.”

It offers no other details about her care.

When family asked for more information, St. Joseph’s said the review was complete and it would “not respond to further communications about this matter,” according to a follow-up letter from the hospital.

In an emailed statement to the Star, St. Joseph’s chief of staff, Dr. Ted Rogovein, said a quality of care review into Minocha’s death was “protected under QCIPA.”

Rogovein, who was not made available for an interview, said the legislation had not prohibited the hospital from sharing the facts of the review with the family, including a follow-up phone call and Minocha’s patient chart.

Last Friday, after the Minocha family’s fight for information was highlighted by CTV News, St. Joseph chief executive Elizabeth Buller and other hospital leaders called the family to discuss their concerns, Rogovein said.

The family has not been given a copy of the quality of care review and has no idea what it covered. They still don’t know what happened in the hours leading up to Minocha’s death, or if it could have been prevented.

What answers the family has been able to glean from St. Joseph’s over the past year and a half have been contradictory, they say.

“Anyone can imagine how painful it would be to receive a five-sentence letter from a hospital containing no information at all about the death of your child,” Mehra, of the Ontario Health Coalition, said.

QCIPA was a “giant secrecy loophole” that gave hospitals the discretion to decide what they would and would not tell families in critical situations such as this, she said.

The unanswered questions and inconsistencies in information surrounding Minocha’s death have stolen her family’s time of mourning, Arvin Minocha said.

He described his sister as a selfless individual who loved life. She volunteered to feed the homeless during holiday seasons and had dreams to one day get married and have five children.

“Rather than celebrate the person my sister was and grieve this tragic loss, we are still at a loss for how a system could lack such transparency and ownership,” he said.

“We were told she was going to be fine, and then her heart just stopped. We are still waiting to know whether something more could have been done.”

NDP federal health critic France Gelinas said the case raises more questions about the act itself.

“This law is in need of clarification,” she told the Star.

A coroner’s investigation into Minocha’s death continues.

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