Physician Disciplined for Poor End-of-Life Communication

Earlier this month, the Ontario Health Professions Appeal and Review Board affirmed a decision of the Inquiries, Complaints and Reports Committee of the College of Physicians and Surgeons of Ontario, counsel a physician to ensure that he has thorough discussions with patients and their families regarding care plans and end of life planning, and to document the same.

Here is the background.  On October 20, 2010, Dr. D.G.C. noted “DNR” (do not resuscitate) on
R.V.'s chart.  Three days later, on October 23, 2010, R.V.
died from a bilateral bronchopneumonia with coronary artery disease as a
contributing factor.  Nursing staff made
no attempts to resuscitate the patient when he was found with vital signs
absent.  

R.V.'s son, J.V., subsequently filed a
complaint with the Inquiries, Complaints and Reports Committee of the College
of Physicians and Surgeons of Ontario.  J.V. alleged that D.G.C. failed to accurately document DNR status, thereby preventing
resuscitation.



In response, D.G.C. explained that he had a conversation
with the family members on October 20, 2010 in which he explained that to offer
resuscitation to someone in the patient’s condition would not be “an honest
offer."  D.G.C. further explained that he documented a DNR order in the
patient’s chart following that discussion and that he was unable to explain J.V.'s differing point of view.  Finally, D.G.C. noted that resuscitation would not have
worked, given the patient’s accumulated burden of illness.

The Committee investigated the complaint and decided to counsel D.G.C. to ensure that he has thorough discussions with patients and their
families regarding care plans and end of life planning, and to document the
same.  Regarding the DNR status, the
Committee noted that entries in the chart were very brief and that it had
difficulty determining the content and context of the end of life discussion
between D.G.C. and the patient’s family. The Committee stated that it
would expect such discussions to be detailed and thoroughly documented and
decided to counsel D.G.C. regarding this aspect of his care.