A central Newfoundland family whose wife and mother died after she was released from hospital say an external review backs up their belief that a physician missed critical details about her condition.
Musgrave Harbour resident June Abbott, 69, went to the emergency room in Gander in May 2010 with a complaint of pain in her shoulders, only to be sent home by a physician who did not order tests. Abbott died of a heart attack just hours later.
"She was a beautiful person, sir, a kind-hearted woman. She loved everybody," said her husband Ches Abbott.
The family contends that the physician who saw her, Dr. Esmail Abej, should have done more to treat June Abbott when she sought help at James Paton Memorial Hospital. Their complaint has been dealt with by the College of Physicians and Surgeons, which has produced a report that is critical of how Abej handled the case but which does not recommend disciplinary action.
The mother of seven, who was also a grandmother and great-grandmother, had been complaining that she was "under the weather," and had had shoulder pain.
Abbott told a triage nurse that the pain was radiating down her arm. The nurse did not check her blood pressure.
The family waited for three hours to see a physician, and by then Abbott said she was feeling much better. Abej did not pick up on notes that the nurse had written on the chart about pain in Abbott's arm.
Abbott told Abej that she had been moving furniture in her home a few days before. Abej decided that Abbott was sore from that activity, and sent her home with instructions to see her family doctor.
Decision not to run tests questioned
Her daughter, Kelly Croucher, questioned the decision not to run medical tests when her mother said it was time to go.
"I said, 'Well, how does he know that? Did he run any tests? Did he do blood work or anything?' 'No,' she said. I said, 'How does he know it's not your heart?' She said, 'I asked him if it was my heart and he said no. Tylenol wouldn't take away a heart attack.'"
Croucher and her relatives believe her mother had been misdiagnosed.
"How do you not run tests and then diagnose someone in three minutes? He could've [saved] her life," she said in an interview.
"If he had known my mom's history, he would have thought right away, 'Well, this lady could have been having a heart attack.'"
Within an hour of arriving home and going to bed, Abbott was dead. An autopsy showed she died of a heart attack.
For the last two years, the Abbott family has fought with health authorities to get the truth of what happened to June Abbott.
In March, vindication of a sort arrived when a committee of the College of Physicians and Surgeons filed a report of its review.
"There are reasonable grounds to believe Dr. Abej should have been more suspicious of a potential cardiac cause for Mrs. Abbott's symptoms," the report said.
Suspicions should have been raised: report
The investigation found that Abbott's age and health conditions — including a history of diabetes, high blood pressure and the presentation of atypical chest pain — should have "raised the index of suspicion that Mrs. Abbott may have been experiencing a cardiac-related problem."
The committee found that Abej ought to have recorded Abbott's blood pressure, pulse rate and rhythm, and ordered both an electrocardiogram and a blood test.
"Dr. Abej should have given greater consideration to the triage note indicating upper left arm pain earlier that day, in light of Mrs. Abbott's risk factors noted above," the college's committee determined.
However, the college ruled that one wrong judgment did not constitute incompetence.
The "issues and concerns" cited in the review "did not rise to reasonable grounds to believe that Dr. Abej engaged in conduct deserving of sanction," the committee said.
'Back to Square 1 again'
That conclusion has not been sitting well with the family.
"It felt good when I was reading the letter," said Croucher. "Then, when I realized they weren't doing anything about it, [it was]
right back to Square 1 again."
Tracy Abbott, her sister, said the finding was hard to accept.
"I'm mad because this doctor should not be seeing anyone else," she said.
"It's like any job in the world. If I'm working on the oilfield and I mess up, I'm going home. I'm going home, especially if I killed somebody.… I don't care which way the world looks at this, to me it's murder."
Contacted by CBC News, Abej declined to comment. He is currently working at a hospital in Winnipeg where he is working on a specialty in internal medicine.
Central Health, meanwhile, had all of the emergency room staff at Gander's hospital take a refresher course in procedures.
"People make mistakes. People make errors — that happens all the time," said Central Health CEO Karen McGrath.
"The problem is if we don't learn from them, and we do learn from them."
Abbott's family have never been able to find a lawyer who'll sue the hospital and the doctor in civil court. The family say the College of Physicians and Surgeons letter, though, may give them the ammunition they need.