Complaint about Dr. Van Walraven

 

Dr. Carl Van Walraven's first contact with Mr. Spindler, his patient, was in December 2011, in the AMA (acute monitoring area) of the Ottawa General Hospital in Canada, when he replaced the physician in charge for just a few days. The first thing he did was to prescribe the wrong antibiotic for his patient, the one of two antibiotics on the list of six antibiotics tested that the patient was resistant to. I had to ask the nurse to page the on-call resident and change the order to replace the prescribed antibiotic that my father was resistant to with an antibiotic he was sensitive to. Interestingly, when Dr. Van Walraven called to inform me that he had put my father on antibiotics, when I asked if it was the correct antibiotic for his bacteria, the doctor started yelling at me, completely out of control, and did not answer my question.

Next, he was put in charge of this patient in March of 2012. In April of 2012 he started to withhold the patient's active medical treatment including highly needed antibiotic treatment without consent and without advising anyone. Oddly enough there was no medical team assigned but he operated alone and he would only see his patient a few minutes, once a week. Because he did not treat his patient for eight full weeks, from May7th, till July 4th 2012, despite the fact that the patient was suffering from a rampant pneumonia he compromised the patient's lungs, heart and respiratory system to such an extent that the patient could no longer breeze and died asphyxiated over many long hours and in agonizing pain.

Shortly after his admission into the Ottawa General Hospital, my father was infected with a strong and dangerous bacteria, E-Coli, in his lungs. A discriminatory policy of minimal treatment was applied to him from the start, because of his age and injury. The staff and the doctors were expecting the patient to expire. This policy of minimal treatment and sustained low level illness caused the infection to never be cured entirely and provoked a long streak of consecutive septic shocks, uremic shock and heart attacks that were all a direct result of the neglect to treat the patient's infections adequately and responsibly. My father’s infections were both preventable and curable but the doctor never showed an intention to fully cure it. After having been allowed to go into euremic and septic shocks, after having had pain inflicted on him, pain that was never medically managed until the last eight weeks of his hospitalization, after he was handled so carelessly and so roughly that he was turned into a paraplegic and then into a quadriplegic several months after his arrival in the Hospital, after having been placed in a shared isolation room with patients who were contagious and infected with Hepatitis or MRSA when he had no contagious disease, the doctor applied to the Consent and Capacity Board to terminate his life. 

The minute the doctor became aware that the patient had a clause in his Power of Attorney Document saying that if "terminally ill. irreversibly comatose or persistently vegetative" he did not wish to be kept on artificial life support, the doctor immediately prepared an application to the Consent and Capacity Board of Ontario, had it approved, signed and filed in less than 72 hours total. Never had this doctor acted that fast when the patient was ill and needed treatment or when the patient's daughter called him or needed him to answer one of the written notes she had left for the doctor. In fact, he absolutely never talked with the daughter, he never informed or discussed the application he made to the board with her, nor the alleged “new proposed plan of treatment”, never returned any of her calls or replied to any of her written notes. The patient was not terminally ill, he was not persistently vegetative or irreversibly comatose. He was wide awake, in a wheelchair at times, responding & communicating with his daughter & her children. 

The Power of Attorney document was a standard legal document that he signed against his will, only on a temporary basis, as a gap measure, just in case...He signed it late in the day, on a day when he was rushed, and he agreed with the lawyer he would return to correct this particular clause because he did not want it. The patient did not want that paragraph, not at all, and was going to remove it but unfortunately, a couple of weeks after having signed it, he fell, broke his hip, had surgery, and as soon as he recovered, on his first trip out of Montreal to Ottawa, to see his daughter, he had the car accident that landed him in the Ottawa Hospital and eventually under Dr. Carl Van Walraven's care, who made him sick enough to be able to apply that clause and have him terminated. He was squashed like as bug.


As soon as the doctor read this document, he set out to impose it on his patient, although, neither the patient nor his family wanted this provision of the document to exist or to be applied. The doctor wanted to impose his own power over that of the patient's daughter, who had the patient's legally appointed power of attorney, in order to "let the patient die". The doctor substituted his own wish to that of his patient’s and of his family’s and attorney’s, wish that had always been to live and to prolong life as much as possible.

The Board Hearing was held two months after the application was filed by the doctor.

During the 6 weeks leading to the Hearing, Dr. Van Walraven stopped the patient's medical treatment along with the antibiotics required desperately in order to treat the patient's rampant pneumonia. This allowed enough time to induce a new septicemia. While no antibiotics were administered, the patient was given pain killers that contributed to the patient's lethargic state and inability to keep his eyes open or to communicate. In his testimony, Dr. Van Walraven said that the patient "met the clinical criteria for a persistent vegetative state", thereby strongly implying that the patient was indeed in a persistent vegetative state. He declared that although he himself was not a specialist, he knew how to diagnose the clinical criteria for this particular condition because he had read an article in a medical journal, article that he named but did not produce during his testimony. He stated that he had become aware of the clinical criteria for a persistent vegetative state that same morning, the morning before the Hearing, after he read the article and went to consult his patient for about ten minutes.

 

The clinical criteria that Dr. Van Walraven had diagnosed as vegetative in the morning just before the Hearing were the patient's inability to track, to communicate and to interact with his environment. These were in fact symptoms that were very likely all criteria for a clinical diagnosis of the severe infection and septicaemia induced in this patient by not treating the pneumonia for such a long period of time. This would have been a better clinical diagnosis because it was also in line with the WBC count that showed twice the normal value on the day the doctor discontinued the antibiotics and withdrew medical treatment from this patient. So, six weeks later when the Board Hearing was held, it was more than natural for the patient to be unable to track, communicate or interface with his environment in any significant way. Furthermore, in those six weeks, for the first time ever since he arrived in the Hospital he was on regularly administered pain killers prescribed by the doctor himself. It is a side-effect of the pain killers to render the patient less responsive and more lethargic especially if he is physically ill with pneumonia!

 

The fact that the doctor cited an article he did not produce it in the Hearing while he was cross-examined made it impossible to put into evidence and therefore he made it possible to leave out a few essential elements in that article, for example the fact that the article recommended caution when diagnosing the patient clinically and the period of observation of the patient was not shorter than a couple of months or at least several weeks which obviously did not happen in this case. The article also stated that it was highly indicated that the clinical diagnosis be supported by the physiological presentation of a disconnection of the cortex through scientific testing such as EEGs, CT scans or MRIs. Scientifically tested evidence was required to confirm the clinical diagnosis but this fact was completely left out of the doctor’s testimony.

Moreover, the patient had never been diagnosed as persistently vegetative before the day on which the doctor had filed the application to the Consent and Capacity Board asking to get approval for a new plan of treatment that entailed the withdrawal of all medical treatments such as preventive, diagnostic and active and then to withdraw the feeding tube in order to let the patient dehydrate and starve to death. He had never been diagnosed terminally ill or irreversibly comatose either.

 

Despite being cross-examined to that effect, the doctor never explained to the Board why he had filed the application when he did, two months prior to clinically diagnosing the patient in a “persistent vegetative state”.  The only explanation he gave, was the fact that he became aware of the Power of Attorney document and of the patient's wish in Section 4.3 of this POA document BUT did not explain how he was able to predict that on the day of the Hearing, eight weeks after the application was filed, the patient would "meet the clinical criteria of a persistent vegetative state" at that time. What incredible foresight and outstanding planning skills!

 

Also, while he was asked many times, the doctor never explained why would a clinical appearance of meeting criteria of a "vegetative state" (because one could never argue the "persistent" component seen that he was only assessed for ten minutes on the day of the Hearing) be enough to propose a plan of treatment to withhold medication and withdraw artificial life support if no medical tests or scientific evidence can prove/confirm that this clinical appearance was in fact a medical truth?

 

The patient's power of attorney document never said that the patient wished not to be maintained on artificial life support if he merely "met the clinical criteria of a persistent vegetative state", when that state was not verified, not supported by any medical tests, not proven with any scientific evidence, when no differential diagnosis was ever conducted and when no specialist's opinion was obtained. Furthermore, his document stated nowhere that the patient wished not to receive appropriate medication when his condition required it, such as antibiotics for pneumonia. The doctor twisted the content of the document to suit his purpose. His proposed plan of treatment included the removal of the feeding tube and letting the patient starve and dehydrate to death which is particularly cruel and against the patient's religion as well. 

In cross-examination, when Dr. Van Walraven was asked if any neurological tests were conducted to verify the clinical diagnosis he made, he answered emphatically with an angry and annoyed voice that he had already testified that this was “strictly a clinical diagnosis”, implying that no tests had been conducted. In reality, there had been neurological tests conducted, many tests. One of them, an EEG of the brain, was conducted only one month prior to the filing of the application, and that EEG, along with all the other neurological tests conducted throughout the patient's stay in the Hospital were not supportive of the diagnosis of a persistent vegetative state. The doctor had to be aware of these tests since they were in the patient's chart.

 

Despite the fact that there was no scientific proof of a persistent vegetative state, despite the fact that all neurological tests conducted throughout the duration of the hospitalization never showed any indication that the patient was in a persistent vegetative state and despite the fact that the patient had been left with rampant pneumonia for six weeks prior to the Hearing without any treatment or medication except for regular pain killers which, combined, were clearly going to produce the very same clinical criteria that could be interpreted as vegetative,  the doctor strongly and repeatedly implied to the Board that the patient was vegetative, based on the clinical criteria he had diagnosed, and asked permission to "let the patient die with dignity", which showed the deliberate intent to cause death.

 

The Board decided on a start date of two weeks from the Hearing despite the undisclosed fact that doctor Van Walraven had in effect started his "proposed new plan of treatment" six weeks prior to the Hearing and he was already "letting this patient die" by not treating him when the patient desperately needed it. For two months, effective the date of the application, April 18th, until the Hearing, on June 18, and especially for the six weeks prior to the Board Hearing, all patient's medical records were painstakingly hidden to cover up the withholding of treatment, all communication with the Hospital staff was forbidden, emails would be caught and re-directed, calls were not returned, questions regarding the patient’s condition or treatment were never answered and all notes left for Dr. Van Walraven were never replied to. In fact, a security guard was posted by the patient’s bedside to write everything down during the daughter’s visits and this intimidated all staff to the point that they would systemically refuse to give any information even very elementary such as the patient’s vitals that day.

 

Dr. Van Walraven also refused to allow for an independent consult which had been ordered by the Board in order to have a second opinion. He disallowed all access to the medical records to everybody including the patient's cardiologist of seventeen years. While he was left to wait 5 hours at the patient’s Hospital door until he was told that Dr. Van Walraven forbids the consult, the cardiologist asked to be allowed to consult my father’s medical records but was denied access to them also. Dr. Van Walraven also banned access to the patient and to the patient’s chart to all other Ottawa Hospital doctors and residents on his team, the care team that my father was allocated to while in the Hospital. 

During the six weeks preceding the Hearing, all the medical records were made totally inaccessible to the patient's family or power of attorney despite the order of the Board for complete disclosure, order that stipulated that complete copies of all the Hospital records for this patient were to be supplied to the patient’s daughter. The doctor did not answer calls or written messages left by the daughter to inquire about her father. He gave strict orders and instructions to all Hospital staff not to talk to the daughter or to give out any information regarding the patient's treatment or medical condition. For that purpose, he placed a security guard next to the patient's bed to take notes of everything that was being said during visitation hours, that were strictly enforced. This was designed to ensure that no Hospital staff would tip the daughter about the change in treatment, change that was in direct breach of a prior decision of the Board, where the doctor was ordered to continue the patient on the same treatment, at the same level of care as before, until the final Hearing. The withholding of treatment & the denial of medical care were only found out accidentally, through the slip of the tongue of the assistant, during the Hearing.

After the decision of the Board was released, the daughter transferred the patient to the Montreal Jewish General Hospital where he was looked after and treated for his condition. After only three days of antibiotic treatment, the pneumonia disappeared completely but the damaged respiratory system and the lungs were too weak to continue to function so only a few days after he was moved, Mr. Spindler died.

In conclusion, from the very start, the doctor prescribed the wrong medication, an antibiotic the patient was resistant to. Once he became the primary care physician, the doctor never healed, nor tried to heal his patient. Instead, contrary to the order of the Board, he withheld antibiotic treatment from the patient when the patient needed it in order to survive. Hence, numerous times he showed reckless disregard for his patient’s life. Also, he moved the patient out of a private room into a semi-private one, where the patient was forced to share the room with contagious patients while he, himself was not contagious and he had insurance for a private room. Some of these contagious patients had Herpatitis and others had the super-bugs. Hence, the doctor placed his patient’s life at risk over and over again.

Dr. Van Walraven never discussed or even showed the patient’s daughter (who was also his attorney) the “new proposed plan of treatment”. He went directly to the Board with the allegation that the daughter did not comply with her responsibility as a substitute decision maker. What the doctor meant, was that the daughter did not give him consent to change the plan of treatment. Since the doctor had never discussed and had never shown his new plan of treatment to the daughter, she was not in a position to give consent because according to the Consent Act of Ontario, the consent has to be informed. It was the doctor’s obligation to inform the family and the power of attorney of what the new plan was as well as of all the risks and benefits related to the new plan. Since this was never done, the daughter could neither consent or dissent. Therefore, the doctor’s allegations of the daughter not complying with the Act were false. Furthermore, the plan consisted of denial of care,  withdrawal of treatment when treatment was required and withdrawal of feeding tube when it was required for the patient to stay alive. There was no explanation on how this would benefit the patient other than the “persistent vegetative” clinical diagnosis but since the diagnosis was made two months after the filing of the application to the Board, it appears that the application was unfounded and the new plan of treatment was entirely wrong because the patient’s best interest was not respected by this new plan of treatment, neither medically, nor from a personal values and religious beliefs point of view.

However, in order to make his allegations more credible for the Board, the doctor made libellous comments in his plan of treatment, stating that the daughter was being investigated for fraud by the patient’s bank. This was an invention and an outright lie. In reality, what had happened is the bank was told by the daughter that the patient was in the Hospital and they called to confirm the information. The bank simply wanted to verify.  In lying, the doctor acted immorally & in breach of his own code of ethics, as well as in breach of the law. In writing it into his proposed plan of treatment proves that he would use anything to attain his goal because the truth would not accomplish that.

Overall, Dr. Van Walraven invested an unimaginable amount of time, effort and Hospital money in legal action, in order to terminate his patient. For that purpose, he misrepresented the condition of the patient during the Board Hearing. He hid documents, had no interaction with the patient's family except to intimidate or scare the family and he ultimately was responsible for causing the death of a human being who did not want to die and who had trusted him to be his healer. In doing so, he also caused the family members such as the wife of 65 years, the daughter and the grandchildren an outstanding amount of distress and suffering.