Micheline Bouchard went to the emergency room at Trois-Rivières Regional Affiliated University Hospital Center last August because she was having trouble breathing. Twenty-two hours later, she collapsed without any treatment and was never able to stand again due to a pulmonary embolism. The 66-year-old woman was literally “forgotten” by her relatives in the emergency room and did not receive appropriate care.
Published at 1:27 am. Updated at 5:00 am.
“There was a real lack of support,” laments his brother Pierre Bouchard. “She was the victim of delays and lack of vigilance to her symptoms,” adds Guylaine Bouchard, who says “she has not yet gotten over the shock of losing” her sister.
Ms. Bouchard's case emerges as emergencies in Quebec have been under intense pressure for months. Two weeks ago, the CISSS de la Montérégie-Ouest confirmed that two investigations were underway following the deaths of two patients in the crowded emergency rooms of the Anna Laberge Hospital.
Last week, the Regroupement des chefs d'urgence du Québec wrote to Health Minister Christian Dubé describing a situation that was “out of control.”
Finally, on Tuesday, Minister Dubé acknowledged that the emergency situation was “extremely difficult” and called on the population to cooperate by avoiding travel if possible.
For Micheline Bouchard, emergencies were the only option, her brother Yves believes.
Long waiting
Single and childless, Micheline Bouchard enjoyed life. In recent months she had taken a trip to Egypt. Through the FADOQ network, she gave workshops for seniors on how to use electronic tablets. “She was an eternal optimist,” says Guylaine Bouchard.
At the end of July last year, Micheline Bouchard suffered a minor fracture to one foot while walking on a sidewalk. After consulting with the Trois-Rivières Regional Affiliated University Hospital Center (CHAUR), she had a “Samson boot” installed to keep her foot in place.
PHOTO STÉPHANE LESSARD, LE NOUVELLISTE ARCHIVE
The attached Trois-Rivières Regional University Hospital Center
But then she developed severe leg cramps after the incident. This pain subsides, but gives way to significant shortness of breath the same day. At around 5 p.m., Micheline Bouchard had such difficulty breathing that she lost her voice. His brother Yves took him to the CHAUR emergency room at 7 p.m., he says.
Micheline Bouchard was given a priority 3 triage rating, people close to her say. According to the Canadian Triage and Acuity Scale for Emergency Departments, a priority 3 patient should receive medical attention within 30 minutes.
Micheline Bouchard is placed in a wheelchair and led into the waiting room. She spent the night there without seeing a doctor. In text messages to her siblings, Micheline Bouchard wrote that a nurse told her around 2:30 a.m. that a doctor would not be available to see patients in the waiting room until 8 a.m. the next morning. Around that time, she saw a doctor who suspected possible phlebitis or a pulmonary embolism, according to text messages sent by Micheline Bouchard.
What is a pulmonary embolism?
“A pulmonary embolism occurs when a clot breaks away from one location and travels to the lungs,” we can read on the Quebec University Hospital website. “A pulmonary embolism can cause short- and long-term breathing problems and sometimes even death. »
The patient is informed that she must undergo an examination, a scintigraphy, to confirm the diagnosis. In the meantime, we'll put a heart monitor on her.
“We should have gone faster”
Guylaine Bouchard arrived at the hospital around 2 p.m. Her sister still hasn't taken her exam scheduled for 11:45 a.m. The exam will not take place until 4:00 p.m. “Why didn’t we prioritize them for the test?” “We should have gone faster,” said Guylaine Bouchard.
Back in the emergency room, a doctor explains to Micheline Bouchard that she has suffered a pulmonary embolism. That his results were “not pretty”. “He told him: It’s very serious. “You have a lot of blood clots in your lungs,” says Guylaine Bouchard.
His sister was quickly sent to another unit for treatment. But these will never begin. When she got up to go to the bathroom, Micheline Bouchard felt dizzy. She collapses to the ground in front of her sister. The patient is taken to the resuscitation room.
About thirty minutes later, a doctor told Guylaine Bouchard that her sister was really not feeling well. “I said to him: Are you telling me that my sister is going to die? He said yes,” she said. After several cardiac arrests and resuscitations, Micheline Bouchard was brought unconscious to the intensive care unit. She never regained consciousness and died there on August 28.
“We have a lot of questions about whether everything was done between the moment she was examined in triage and the moment she was transferred to the intensive care unit,” emphasizes Guylaine Bouchard. She no longer needed medication for 22 hours. »
Why has no one provided any information about the possible sequence of phlebitis and embolism? She was in the emergency room! It shouldn't have happened like that. My sister should still be alive today.
Guylaine Bouchard, sister of Micheline
“She never had the chance to start treatment. She's already collapsed once. There was a clinical dysfunction,” believes his brother Yves.
The family lodged a complaint with the local complaints commissioner.
No forensic examination
The CISSS de la Mauricie–Centre-du-Québec says they cannot answer specific questions about Micheline Bouchard's situation for confidentiality reasons, despite the family's consent.
However, we assure that “a doctor is present in the emergency room at all times at night” of the CHAUR and that after the initial triage of patients, “the emergency department staff assesses the situation in the waiting room in order to act quickly if a person's condition changes worsened. When a doctor examines a patient, “he requests additional examinations if necessary, indicating the degree of urgency according to the clinical portrait of the patient,” says the CIUSSS.
The facility emphasizes that CHAUR emergency room occupancy was at 100% on August 16, “with significant waiting room traffic that gradually decreased throughout the night.”
Because an internal assessment was conducted after each death in the emergency department. A forensic medical examination was not requested because the cause of death was known and “there were no criteria for requesting a forensic medical examination.”
A coroner's inquest can be opened in particular “when a death has occurred under violent or unclear circumstances or the death appears to be due to negligence”, we can read on the coroner's office website. And his sister's case resembles negligence, says Yves Bouchard.
PHOTO EDOUARD PLANTE-FRÉCHETTE, LA PRESSE ARCHIVE
Dr. Gilbert Boucher, president of the Association of Emergency Medicine Specialists of Quebec
The President of the Association of Emergency Medicine Specialists of Quebec, Dr. Gilbert Boucher, mentions that each patient case is unique and must be analyzed in detail before making a judgment. However, he believes that at first glance the delays “do not appear to have helped matters”.
The President of the Association of Emergency Physicians of Quebec, Dr. Judy Morris, recalls that Quebec emergency leaders wrote in their letter last week that the two deaths at Anna Laberge Hospital were “not just the tip of the iceberg.” “The mission of an emergency department is to identify, stabilize and care for patients in need of acute care. If we add waiting, we confuse that mission,” she says.
For the Bouchard clan, Micheline's death may not have been in vain. “The network must learn from this situation and improve its practices,” argues Pierre Bouchard.
Chronology of Micheline Bouchard's visit to the CHAUR emergency room in August 2023, according to the family history
August 16th
5 p.m.: After severe pain in her calf, Ms. Bouchard begins to have significant difficulty breathing.
7 p.m.: Arriving at the emergency room, she is examined in triage shortly afterwards. It is assigned a priority rating of 3.
August 17th
8 a.m.: She sees the first doctor in the emergency room. The latter suspects phlebitis or a pulmonary embolism. The patient must undergo an examination (scintigraphy).
4 p.m.: Micheline Bouchard is scanned.
4:30 p.m.: An emergency room doctor confirms the diagnosis of pulmonary embolism.
6 p.m.: Ms. Bouchard collapses and has to be taken to the resuscitation room. She is taken to the intensive care unit but never regains consciousness.
August 28th
Death of Ms. Bouchard in intensive care