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Dr. Allon Reddoch:  The Grennan Case

Slandering a Patient’s Character In Lieu of Botulism Diagnosis

Stolen Files, Death of a Key Witness, and Political Pressure

Wednesday Sept 6: Simon Grennan smoked some fish he had caught and next day served it for lunch to himself, his 16-year old daughter Mary, and her boyfriend George Miller. All three fell ill early Friday morning. Simon was struck first, vomiting until he felt he ought to seek medical attention at Whitehorse General Hospital. Intending to enlist his daughter to drive him, he discovered she too had nausea. Both were driven to hospital and were seen by Dr. Kanachowski who diagnosed gastroenteritis. This can result from eating spoiled food.

After returning home, Simon improved slightly but Mary did not. At midnight Friday she returned to hospital where she told the duty physician, Dr. Galloway, that she had been vomiting all day, was feeling quite weak and had abdominal cramps. The diagnosis continued to be gastroenteritis. She was given IV fluids and sent home Saturday.

Dr. Reddoch: Stolen files, death of a key witness, political pressure from Yukon Medical Association, and conflict of interest among the judges of Yukon Court.

The mother did the driving because Simon and George were still unwell. Mum also contacted their GP Dr. Reddoch and explained that three people were ill from food poisoning. At the mother's insistence, Reddoch phoned the hospital and arranged to have Mary admitted.

The health status of George Miller is unclear as he died before trial in an accident and could not give evidence.

But the hospital chart did become evidence. Nurse McDonald set the tone with this entry: Sunday night Mary Grennan stated she was too weak to open her mouth or too weak to hold a water glass. Breathes normally when asleep but seems to hyperventilate and dramatize her illness when awake and has an audience. Nurse McDonald later explained that she ascribed some events as dramatizing because they would not otherwise fit the diagnosis of gastroenteritis.

Mary in fact had vomiting, stomach cramps, and was dehydrated – signs of food poisoning. She also had progressive weakness, difficulty swallowing, and labored breathing – signs that a primary neurological illness was afoot.

On Monday morning Dr. Reddoch saw his patient. He did not then (nor at any time) take a history and he shirked the physical examination. Reddoch opted for talk, discussing the recent death of Mary's grandmother. This conversation must have been one-sided, in view of the nurses' ongoing notes that Mary spoke in uncomprehensible whispers and displayed total dependency on others. Reddoch then charted his opinion: Globus hystericus. Throat clear. Chest clear. Discuss anxiety, etc. The term globus hystericus means a sensation of something in the throat, but without any organic cause.

Globus Hystericus: This diagnosis given to 16-year-old Mary Grennan was defamatory, patronizing and wrong. Insults such as uptight are more than a brush-off; they prove legal malice. A tranquilizer caused physical (respiratory) harm. Chart excerpt, right.

Mary's real condition? Botulism from food poisoning. Two other people visited the ER the same day, reporting identical symptoms from the same spoiled fish.

Later on Monday, Nurse McDonald wrote in the hospital chart: Ativan given for throat spasms re anxiety. Mother still at bedside and aware of Doctor Reddoch's diagnosis of throat spasms. To keep patient calm and breathing at a normal rate, it is important that she not hyperventilate and get uptight. Patient remains weak and will not assist with any movement like a rag doll.

However another nurse, Alan Macklon, did not see Mary act in an overtly anxious way. She did not seem emotionally distraught. Ativan is a tranquilizer used to treat anxiety; a side effect is that it decreases respiratory function.

And Mary worsened. Nurse McDonald continued to ridicule. On Monday night, McDonald wrote in the chart at 10.10 pm: Patient assisted back to bed by two staff, buckled at the knees and slid to floor stating she was too weak to walk. Very dramatic.

The same night at 10.30 pm a different nurse – Nurse White – instructed her Aide to test the blood oxygenation level. Checking blood oxygen was not routine, nor did Dr. Reddoch or any other physician suggest it, but was something the nurses were doing of their own volition. The Aide reported that the oxygenation level began at 84% then stabilized at 88%. This startled Nurse White who decided to recheck the reading. She did so after having Grennan breathe deeply; it now read 90%.

Nurse White decided to make another blood oxygen check before alerting Dr. Reddoch. She returned to Grennan's room at 10:45 pm but found her sleeping and decided against disturbing her. At 11:07 pm she sent her Aide to redo the blood oxygenation test. The Aide returned immediately to report that Grennan was not breathing, and had no pulse.

Emergency resuscitation! Grennan was intubated and her heart function was restored, but without spontaneous respiration. On Tuesday she was transferred by air ambulance to St. Paul's Hospital in Vancouver. There a neurology specialist explained that botulism would cause pulmonary arrest, after which the heart will function briefly until the lack of blood oxygen arrests it. Emergency measures had restored Mary's heart function, and treatment later restored spontaneous breathing, but by then the brain was so damaged by prolonged absence of oxygen that she never regained consciousness.

Mary Grennan remained comatose from that day in 1995 until she died in April 1996 – on her seventeenth birthday.

Yukon Medical Council - Discipline of Dr. Reddoch

The Yukon Medical Council took action. Dr. Allon Reddoch was told: The Inquiry Committee will investigate your conduct or capability, or fitness to practise medicine in the Yukon with regard to the following charge, namely, that you from September 10 to September 11, 1995 failed to take appropriate steps in the management, treatment and care of Mary Grennan at Whitehorse General Hospital, in that you did not:

  • Record an adequate history of her present illness;
  • Carry out adequate physical examinations;
  • Make an adequate record of any physical examinations conducted;
  • Record your expected differential diagnosis and working diagnosis; and
  • Record a plan for the management of her illness.
  • In relation to the foregoing, you have been guilty of infamous or unprofessional conduct.

The Yukon Medical Council reached a unanimous conclusion that Dr. Reddoch was guilty of unprofessional conduct for these reasons:

  • Dr. Reddoch clearly failed to apply the requisite skill and knowledge to the care of Mary Grennan.
  • Dr. Reddoch failed in all respects to take the normal actions that one would expect of a physician to diagnose and treat a patient with a serious illness.
  • Dr. Reddoch relied too much on the focus and misadvice of other physicians and nursing staff.

Penalty imposed:  Dr. Allon Reddoch was fined $5000, was required to attend a clinical competency program, and faced a published reprimand.

Yukon Medical Council Disciplinary Decision / Excerpt

Defaming the Patient's Character

The spoiled fish harbored Clostridium botulinum which causes botulism, a rare form of food poisoning. This bacteria produces a neurotoxin directed at the neuromuscular junction. Symptoms are the gastric upset of any food poisoning plus double vision (diplopia), drooping eyelids (ptosis) and other neurologic signs.

Reddoch's guilt lay not in his failure to diagnose botulism specifically. His negligence lay in his rigid, lethal denial that the symptoms were real. Reddoch preferred instead to defame the patient's character – and this sealed his fate.

In plain terms: You don't give a psychogenic diagnosis to a patient with severe nausea and vomiting when two other people who ate the same fish had the same gastric symptoms. Mary ate more fish than anyone and developed difficulty breathing and swallowing, red flags for organic neurologic disease. You don't label primary neurologic symptoms as anxiety, then prescribe a tranquilizer which further erodes respiratory function.

Dr. Reddoch showed a blatant and cavalier disregard for this patient's health and well-being. What were those insults again? — whining, dramatizing, anxiety, uptight, hyperventilating to impress an audience, and globus hystericus. When an MD uses such defamatory language it points to an underlying hatred of the patients that he treats.

Dr. Paul Assad:  Expert Witness

In all legal venues, Dr. Allon Reddoch tried to block the expert witness Dr. Paul Assad, who testified to the standard of care expected in the Whitehorse region of Yukon Territory. Dr. Assad described the protocols of dealing with a patient that are established when you're in second year medicine. Any family physician has to do these things every day. The practice in noting down a patient's history and examination, and observations on reassessment, should be the same in a small, medium or large hospital.

The Court accepted Dr. Assad's testimony because it focused on the standards for a GP, not a specialist, and because it applied equally to populous and remote geographic regions. The evidence was damning: Dr. Reddoch did not even meet the standard of care taught in second year medical school.

In Grennan v Reddoch et al 2000 YKSC 25 the judge ruled: It was reasonable for the Inquiry Committee (of the Yukon Medical Council) to accept Dr. Assad's evidence. I am not persuaded that Dr. Assad should be barred from giving opinion evidence to this Court.

Dr. Allon Reddoch Legal Timeline

1995 – Medical Neglect

Mary Grennan ate tainted fish, developed botulism, was admitted to Whitehorse General Hospital under the care of Dr. Reddoch, and within two days went into a coma.

1996 – Death

Mary Grennan never emerged from her coma. She died on her seventeenth birthday.

1998 – Disciplinary Decision

The Yukon Medical Council investigated Dr. Allon Reddoch and found him guilty of unprofessional conduct.

1998 – CMA President

Just when the Yukon Medical Council was finding him guilty, Reddoch applied to become president of the Canadian Medical Association (CMA). On his application form, Reddoch lied and avowed there were no disciplinary judgments against him. That lie was uncovered; Reddoch was elected president of the CMA anyway.

1999 – Disciplinary Decision Upheld

Dr. Reddoch appealed his disciplinary decision to the Yukon Superior Court, but lost. The Court upheld the verdict of unprofessional conduct. Reddoch then resigned as president of the Canadian Medical Association.

2000 February – Grennan Civil Claim

The Grennan family filed a malpractice suit against Dr. Reddoch. A year later, after a nine-day trial in Yukon Superior Court, Ed Grennan won $143,850 in damages for the death of his daughter Mary. A judge from Alberta presided at trial because all of the Yukon Superior Court justices were forced to withdraw due to conflict of interest when the media learned that each knew one or more of the parties involved.

2000 February – Reddoch File

To prepare for his Court appeals, Reddoch requested his disciplinary file from the Yukon Medical Council. In reply, the YM Council disclosed everything except 4 internal letters sent from their legal counsel to the Discipline Committee which investigated Reddoch. The letters were protected by attorney-client privilege. Heedless, Reddoch pursued them anyway. The wrangle was resolved by the Yukon Court of Appeal which denied access, saying: Reddoch was on a fishing expedition, and had no evidentiary basis to demand the final records.

2000 March – Theft of the Reddoch File

The Reddoch disciplinary file vanished and was never found. It happened in March 2000 when the Registrar of the Yukon Medical Council traveled to Vancouver to discuss the case with their YMC lawyer. During the trip, the Registrar stored the Reddoch file in her suitcase, locked in the trunk of her car. Between March 17 and 19, the Reddoch file was stolen from that vehicle. The entire suitcase was lost and never recovered. Afterward, Reddoch broadcast defamatory accusations: he said the Council had something to hide, and he implied the suitcase was lost to prevent a review of the file.

However, it is unlikely the Registrar – who owned the suitcase – would sacrifice her clothing and other property to get rid of a file folder. If ruse it was, there are simpler ways.

And the Yukon Medical Council, as an organization, would not purloin their own file. This file had been read into evidence at two venues – the YMC Disciplinary Inquiry, and the Yukon lower court. Both times, the file served to convict Reddoch of unprofessional conduct, which was the Council's goal. The file vanished on the eve of the final round in Yukon Appeal Court (the upper court). Reddoch was the only person with a motive to get rid of the file.

A parallel case offers insight: In New Brunswick, a lady doctor whose license was suspended by the College of Physicians and Surgeons (for arson) was later found not guilty in criminal court when prosecutors learned that documents vital to the case had been destroyed. That MD benefited (she escaped conviction) due to lost evidence.

Reddoch had a similar destiny. After his disciplinary file was stolen, the legal process turned abruptly 180°, and judicial decisions now came down in this Yukon doctor's favor.

2001 August – Reddoch found his niche

Reddoch closed his family practice in Whitehorse, and became a medical advisor with the Yukon Worker's Compensation Board.

2001 November – Political Pressure

The Medical Profession Act confers authority on the Yukon Medical Council (YMC) to govern and investigate MDs. The YMC is the counterpart of the College of Physicians and Surgeons in other regions. Up to 2001, the YMC was run by the Justice Department of the Yukon Government.

A separate organization, the Yukon Medical Association, is a push-back organization run by doctors which aggressively promotes doctors' interests. In November 2001 this Association passed a non-confidence vote in the Yukon Government, and made 7 recommendations for reforming the YMC. Main points: The Association wanted the YMC Registrar to be a doctor (instead of a Justice employee) and wanted the YMC run at arm's length from government. The Association strongly supported the notion of self-regulation of MDs because protecting the reputation of doctors was paramount.

2001 December – Disciplinary Decision Reversed

The Yukon Appeal Court overturned the finding of unprofessional conduct originally made against Dr. Reddoch by the Yukon Medical Council.

Reddoch v. The Yukon Medical Council 2001 YKCA 13

2002 December – Grennan Damage Award Reversed

The Yukon Appeal Court canceled the $143,850 damage award to the Grennans.

Grennan (Estate of) v. Reddoch 2002 YKCA 17

Negligence versus Criminal Conduct

When a doctor commits an injury, he or she cannot walk away blithe and blameless just because the adverse outcome wasn't intentional. There are two levels of harm:

  • Accidental Harm – Negligence
    The law defines negligence as failure to use reasonable care, resulting in damage or injury to another. Negligence is actionable in civil court.
  • Deliberate Harm – Malice
    Synonyms for malice include vindictiveness, hostility, hatred, enmity. Malice requires the desire to harm someone. Such intentional injury is actionable in criminal court.

When a Medical Council or College investigates a complaint, the frame of reference is negligence. The prevailing viewpoint is that the medical injury was not intentional. This view is shared by patient and lawyers all. If the harm were deliberate, the doctor would face more than a reprimand, retraining, and fine – he would be in jail.

The public readily grasps that carelessness, poor judgment, or lack of skill differ entirely from the case when a physician uses his profession for an improper purpose, for example to make someone more ill or cause death. The Yukon Appeal Court, however, refused to make that distinction.

That disquieting posture, indelible, on record, appears in a ruling by Yukon Appeal Court on the conduct of Dr. Allon Reddoch. That ruling overturned the disciplinary decision of the Yukon Medical Council. Note the disciplinary hearings were separate from the lawsuit filed by the Grennan family. Follow the ethical decline:

Yukon Medical Council

Hearing: August 19, 1998
Document: 35-Page Disciplinary Decision / Excerpt

When responding to a complaint, a Medical Council or College always compares the MD to what is expected of an average (not a perfect) doctor in the same specialty. The Yukon Medical Council investigated Dr. Allon Reddoch in this manner and found him guilty of infamous or unprofessional conduct.

That was an umbrella phrase common to medical regulatory bodies. Translate it to specifics in this case: The YMC deemed Dr. Reddoch deficient in knowledge and skill on eight tangible points, covered in a written decision 35 pages long. Reddoch was fined $5000 and ordered to upgrade his clinical competency.

The YMC disciplinary decision was a consent judgment – effectively a guilty plea. The evidence was so strong that the YMC did not adjourn to deliberate, but reached an immediate conclusion. Reddoch accepted the criticism as a recognition of the inevitable, and made genuine expressions of remorse. He did so after reflection and in consultation with his lawyer.

Yukon Superior Court

Hearing: August 18, 1999
Document: Reddoch v Yukon Medical Council (1999), 17 Admin.L.R.(3d) 241

Dr. Reddoch challenged his disciplinary decision at the next judicial level. He lost: Yukon Superior Court upheld the YMC findings based up a consistent, solid body of evidence. What happened to Reddoch's initial expressions of remorse? They served to soften the penalty imposed by the YMC, after which they vanished.

Yukon Appeal Court

Hearing: December 11, 2001
Document: Yukon (Medical Council) v Reddoch 2001 YKCA 13

The YMC Bylaws uses the term unprofessional conduct as an umbrella over more specific counts. This term is used worldwide when physicians seriously err.

Yet at the Yukon Appeal Court, the three judges (Southin, Ryan, and Braidwood) ignored the entire body of evidence in Reddoch's 35-page disciplinary decision, and instead argued semantics. The Appeal Court said unless a doctor acts with blatancy or cavalier disregard then he can never be disciplined – can never be reprimanded, fined, lose his licence, or even be retrained.

This Yukon Court literally turned unprofessional conduct into ho-hum, all in a day's work for a doctor. An excerpt from the ruling:

[56] The critical issue on this appeal is whether the words unprofessional conduct encompass Dr. Reddoch's acts of omission which, on the findings of the Yukon Medical Council, can be summed up as a failure to exercise reasonable care and skill.

[60] When the issue is one of a failure of reasonable care, the conduct of the physician, in order to constitute unprofessional conduct, must have about it some quality of blatancy – some cavalier disregard for the patient and the patient's well being.

The Appeal Court made jurisdictional error. Their mandate was to evaluate the physical evidence. They were blind to it, and evaluated only Reddoch's state of mind when he caused the patient's death. The framework of the YMC decision was negligence (good intentions, lack of skill) – the most benign state of mind possible. A higher court need only visit the MD's state of mind if deliberate factors emerged which would increase the penalty.

The Appeal Court desired blatancy which means done openly and unashamedly. In other words, done deliberately. If that were Reddoch's state of mind, he would have been investigated by Police, not the Medical Council. Reddoch would have faced charges of felony endangerment, manslaughter, or frankly murder. He would be shackled, wearing an orange jumpsuit, indicted in criminal court, not wearing a business suit calmly attending civil court.

What Caused the Court Reversals?

  • Missing evidence: The Reddoch disciplinary file was stolen in 2000. These were original documents belonging to the Yukon Medical Council, containing the full record of their investigation into Dr. Allon Reddoch.
  • Death of a key witness: George Miller ate a small quantity of fish, suffered mild food poisoning, and intimately knew the symptoms. After Mary was hospitalized, Miller visited her many hours each day, and he witnessed first-hand her status and the actions of the health-care providers. Ultimately Miller did not testify – he died in an accident before trial.
  • Political pressure gutted the Yukon Medical Council: Traditionally, the YMC was run by a Registrar and other employees on loan from the Justice Department. In 2001, they were shunted aside when the 43 doctors of the Yukon decreed that only MDs could fill Council positions. The Yukon medical profession was now entirely self-regulated. Unbiased oversight was extinct.
  • Conflict of interest may have quietly emerged. When proceedings opened at the Superior Court level in Whitehorse, a judge from Alberta was engaged because all the local justices in this small community declared a conflict of interest due to knowing the parties involved.
  • Within a year, the Yukon Appeal Court heard both branches of this case – the Grennan lawsuit, and the YMC disciplinary decision. Each appeal was set before a panel of three judges. But there was cross-pollination: the panels were almost identical. That does not inspire confidence that the rulings were disinterested.
  • YMC Disciplinary Decision
    This Appeal was heard by Justices Ryan Madam Justice Catherine A. Ryan
    B.C. Court of Appeal
    Retired from bench 2013
    , Braidwood Justice Thomas R. Braidwood
    B.C. Court of Appeal
    Retired from bench 2005, and rejoined his life-long law firm, currently named
    MacKenzie Fujisawa LLP, Vancouver
    , Southin Madam Justice M.F. Southin
    B.C. Court of Appeal
    Retired from bench 2006
  • Grennan Damage Award
    This Appeal was heard by Justices Ryan Madam Justice Catherine A. Ryan
    B.C. Court of Appeal
    Retired from bench 2013
    , Braidwood Justice Thomas R. Braidwood
    B.C. Court of Appeal
    Retired from bench 2005, and rejoined his life-long law firm, currently named
    MacKenzie Fujisawa LLP, Vancouver
    , Hall Justice John E. Hall
    B.C. Court of Appeal
    Retired from bench 2014
    Former law firm:
    DuMoulin Black, Vancouver
  • Tuum Est's investigative journalism found a near-certain conflict of interest more subtle, more devastating than neighborhood relations. This was never declared, never nullified. Its shape: At least one Appeal judge (Braidwood) has a lifelong connection to the Canadian Medical Protective Association (CMPA), the litigation arm of the medical profession in Canada. The CMPA retains a cadre of lawyers who defend MDs in medico-legal actions in any venue (tribunal, civil court, and criminal court). Other judges censure the CMPA scorched-earth tactics.
  • Justice Thomas R. Braidwood was common to both appeals. His profile:
    • In 1957 Braidwood was called to the bar. From 1990-2005 he was a judge in British Columbia, sometimes on loan to the Yukon. Before and after that period, Braidwood worked at MacKenzie Fujisawa LLP (the law firm name has changed slightly over time). His partnership was lifelong.
    • Among other areas of law, MacKenzie Fujisawa specializes in Professional Liability and Regulation. Their own description: In our role as counsel for professionals, we assist with … defending against claims of professional misconduct. We advise clients on complaints and disciplinary hearings. Our litigators have a deep knowledge of professional negligence matters at all levels of court. We represent regulatory bodies and individuals facing regulatory action.
    • Insight: MacKenzie Fujisawa is a CMPA Law Firm. Their attorneys in the Professional Liability area, under contract to the CMPA, adopt its fervid battle plan. Such attorneys seldom shed their CMPA loyalty when elevated to the bench. Au contraire: The CMPA aims to stack the judicial bench. The CMPA was incorporated in 1913. Its Annual Report for that year contains this chilling language: Our success is in the silent influence we sway over litigants. Malpractice cases are strangled at their inception, and disappear like dew off the grass.

FURTHER READING

The Grennan Case

Negligence versus Criminal Culpability

Georgena S. Sil
Saskatoon, Canada
Physicist & Technical Writer
Alumnus: University of British Columbia
TuumEstContact@protonmail.com
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Dr. Allon Reddoch

Dr. Allon Reddoch, Yukon

Touches of barbarism in his contours.

Thomas Hardy (1891)

DR. REDDOCH PROFILE

Yukon Medical Licence
#1829-2-66

Medical School
University of Western Ontario (1973)

Area of Practice
Family Physician

Additional Competencies
None

Source
Medical (Family Doctor) Register
Yukon Medical Council

DUTY TO DIAGNOSE

In law the duty to diagnose was established long ago. The precedent Wade v. Nayernouri 1978 ONHC established that:

An erroneous diagnosis does not alone determine a physician's liability. But if the doctor, as an aid to diagnosis, does not avail himself of the scientific means and facilities open to him for the collection of the best factual data upon which to arrive at his diagnosis, does not accurately obtain the patient's history, does not avail himself of referrals to specialists – then the net result is not an error in judgment but constitutes negligence.

A thorough history, physical examination, tests, and consultation with colleagues and specialists, are basic to a proper diagnosis. A reasonable doctor should also heed a patient's complaints during treatment for they may be harbingers of change in condition.

DIAGNOSING UNCOMMON DISEASES

When you hear hoofbeats, think of horses, not zebras

This phrase is used to teach medical students to anticipate common diseases rather than very rare ones.

But rare diseases do exist. When the clinical picture is puzzling, a competent MD must think of zebras before resorting to blaming patients for causing their own symptoms. The disease is difficult, not the patient or the person.

Cavalier dismissal of neurological symptoms is particularly risky: Weakness, dizziness, labored breathing, difficulty swallowing, aphasic speech, lack of coordination – these are serious signs and should not be labeled psycho-social stress unless it is a diagnosis of exclusion — and probably not even then.

A diagnosis of exclusion means a diagnosis to be used only if no organic disorder is suggested by the symptoms. But this presumes an MD is familiar with the symptoms of every disease, whether common or rare, whether known or yet unknown to medical science. In decades past, such arrogance did prevail among doctors trained never to admit I don't know.

But today via the web, most patients absorb medical knowledge to a level of sophistication never before seen in human history. Patients also acquire a copy of their own clinical chart: the MD's opinion no longer circulates only among his colleagues.

Today, if a doctor unsuited to science decides to label perplexing symptoms psychogenic accompanied by a scatter-gun list of terms that reads like the index of a psychiatry textbook — then that MD may not only get sued for civil negligence, but also face criminal charges for libel, slander, or defamation.

Copyright © 2008-2019 Georgena Sil. All Rights Reserved.