Isabel Palmeter prided herself on being healthy and active. At 85, she was a gym member, curled, golfed and was an avid traveller.
WINDSOR, N.S. — A Hants County physician has been reprimanded for his involvement in a case that nearly cost a healthy, active senior her life.
The College of Physicians and Surgeons of Nova Scotia issued the reprimand after investigating a complaint against Dr. Mark Kazimirski by the late Isabel Palmeter.
Dale Palmeter says his mother filed the grievance as a result of her care – or lack thereof – at the Hants Community Hospital in 2015. She spent several days being treated for constipation instead of being thoroughly checked for other possibilities. As a result, she went into septic shock and required emergency surgery.
“I think justice, in this case, is an acknowledgment that my mother's treatment was sub-par. I think that's what she wanted, she wanted that acknowledgment, and she didn't get to see it in her life,” said Dale Palmeter, who said his mother died in November 2016 due to an aggressive form of cancer.
Timeline of events
On Jan. 28, 2015, Isabel Palmeter saw her family doctor, complaining of abdominal pain. He ordered an x-ray, which was taken on Jan. 29. She was advised that she had a full bowel and was instructed to take laxatives.
By Jan. 31, she was taken by ambulance to the Hants Community Hospital where she was instructed by a different physician to take more laxatives and sent home.
On the night of Feb. 1, Isabel Palmeter returned to outpatients via ambulance, as the pain was worsening and her laxative treatment was not effective. She was seen by another doctor, who, according to the initial complaint letter, told her that “there was no blockage in the bowel.” She was, however, admitted overnight.
Kazimirski then took control of her care. Constipation was the ruling diagnosis and she continued to be treated with laxatives as her pains worsened.
She was taken to the QEII in Halifax for a CT scan, followed by immediate surgery, on Feb. 3.
“Her colon was removed. When she asked her surgeon about that, the surgeon said the colon died 48 hours before the surgery,” said Dale Palmeter. That meant she was laying in a bed in pain at the Windsor hospital when her colon died.
A cancerous tumour blocking the bowel was also discovered and she required additional surgery to remove her uterus, fallopian tubes and ovaries. She began cancer treatments on April 24, 2015.
“It caused her to lose faith in the care of that hospital,” Dale Palmeter said.
“At what point does a medical professional reflect on a diagnosis they have made of a patient when the treatment they have prescribed isn't working? At what point do you conclude that maybe your own diagnosis is incorrect?” he continued. “She felt that should have happened sometime well before she got to the point where she had gone into septic shock and was nearly dead.”
She filed a formal complaint in July 2015.
Dale Palmeter said his mother was an active 85-year-old when the incident occurred, and did everything to stay independent and healthy.
“My mother would have done everything that our health care system would want a person to do in order to stay healthy,” said Dale Palmeter.
“When she needed the health care system, I think it let her down.”
Isabel Palmeter loved to travel, golf and curl. She was a fierce competitor and had a gym membership. Just 10 months before her medical issues, she was walking on the Great Wall of China.
“As someone who taught nutrition in school, she was very aware of the role of diet and a healthy lifestyle,” said Dale Palmeter. “She was able to follow that in order to maintain a high quality of health that allowed her to do the things that she wanted to do as long as she could do them.”
College reviews complaint
The College of Physicians and Surgeons of Nova Scotia found that Kazimirski failed to meet the expected standard of care for his patient. The review led them to conclude that he failed to adequately conduct and document a physical examination; failed to take and document patient history; failed to appropriately address ongoing complaints of abdominal pain; failed to expedite a CT scan when there was a clear indication one was required; failed to document a detailed discharge summary and failed to communicate with the patient regarding her treatment and progress.
Kazimirski consented to the reprimand on July 7, 2017. He is required to make a contribution to the college for its costs related to the complainant. He's also required to pay for and successfully complete the next available medical record keeping course in Ontario. Further, he will be required to undergo an audit of his hospital practice about six months after the conclusion of the course. The cost for said audit will be paid for by Kazimirski.
Lawyer Brian Downie, Kazimirski's legal counsel, said in an email that the doctor was unable to discuss the matter due to the confidential medical nature.
“His duty of confidentiality is paramount,” said Downie.
“I will simply say that Dr. Kazimirski is (a) very good and caring physician who has given, and continues to give, his patients excellent care. About that fact, there is no doubt at all.”
Downie said that the doctor respects the jurisdiction of the College of Physicians and Surgeons of Nova Scotia and will not be commenting on the case any further.
Kazimirski has been licensed to practice in Nova Scotia since 1970.
A long-time patient of Kazimirski, Laurie Marsh, reached out to the newspaper to say how much the doctor has done to help her over 24 years.
“He has been my saving grace on more than one occasion. There were times when my health was at its lowest and he sent me for every medical test he could until he found out what was wrong,” she wrote in a message to the Journal.
“I think he deserves to be honoured for what he has done for me and my family. If not for him, my children may not have had their mother. I will remain his patient until he retires.”
While the college's decision keeps the complainant's identity confidential, the family hopes that by telling Isabel Palmeter's story it'll make people realize that they too can have their voices heard.
“This, for me, is about my mother,” said Dale Palmeter.
“I hope that it draws attention to the fact that users of the system have the right, if they don't feel they have been properly treated, to complain, that those complaints will be investigated, that there is a structure in place to consider the complaint of the patient, and that the system will be held accountable for the decisions that it makes,” he said.
“Humans aren't perfect, which means doctors aren't perfect. Mistakes can be made. What do you do in the health care system to try to minimize those mistakes?” he asked, before adding that physicians need to recognize the limitations of equipment at rural hospitals and put the patient's care first by sending them for more complete testing.