Fredericton ER death compounds grief for mother who lost baby
Aimee Dunn says Chalmers Hospital promised more compassionate care
When Aimee Dunn heard that a patient died alone in the waiting room of a Fredericton emergency department less than four months after she lost her infant in the same ER, she felt grief and rage all over again.
"My baby looked perfect," said Dunn, who had to be delivered of a stillborn girl by C-section on March 23 at the Dr. Everett Chalmers Regional Hospital.
"They promised to do better. Now someone else is dead."
At the heart of Dunn's pain is why it took 12 hours for anyone to check on the health of her baby.
WATCH | Fredericton couple still in grief after losing child in ER
Dunn, who was 35 weeks pregnant, says her medical history should have prompted her pregnancy to be a top concern.
At 30, Dunn had already had one miscarriage and an ectopic pregnancy.
A diabetic from childhood, she came into the hospital wearing her insulin pump.
And her records showed she'd had lupus, an autoimmune disease that can raise the risk of pregnancy complications.
She said she'd been in the care of Dr. Erica Holloway, a maternal fetal specialist.
Dunn believed the maternity ward would take good care of her.
She knew its corners and its crannies, working there nights in housekeeping.
Her tasks include taking out the garbage, disinfecting equipment and cleaning up after women give birth in the labour and delivery unit.
"It can take up to an hour," Dunn said. "But none of this bothers me. I'm happy to do it. "
Something went wrong
On March 22, when Dunn was still excited that her day was coming — that soon she'd be a mother herself in labour and delivery, holding the baby girl she'd already decided to name Reia — she started feeling pain.
She began vomiting and heaving uncontrollably.
Her partner, Mitchell Waite, said he called labour and delivery and was told to bring Dunn in.
But when they got to the unit, they were turned away and instructed to go to the emergency department instead.
Dunn was admitted immediately at 5:43 p.m., according to the autopsy report.
Already, she had symptoms of preeclampsia, a known risk factor in maternal death and fetal death.
But Dr. Stephen Cashman in the ER seemed preoccupied with her cannabis use, Dunn said.
She had been diagnosed early in her pregnancy with hyperemesis, or severe nausea and vomiting. A cannabis user since age 15, she decided to keep using it during her pregnancy against the advice of her physicians. She said it helped reduce the nausea, but more important, it gave her an appetite.
In the ER, both Dunn and Waite felt dismissed by nursing staff and Cashman.
"He really didn't want to do anything else with us," Waite said. "He won't even talk to me, and I don't even smoke weed.
"Both him and the nurse were treating us just like poor people who were potheads."
Dunn's medical records indicate Cashman was planning to discharge Dunn, but she was reluctant to go and insisted on staying overnight.
She doesn't remember Waite leaving the hospital around 10 o'clock that night.
"I thought everything was handled at this point," Waite said. "She's in good hands. She's in a good place. She's going to get the care she needs."
"That wasn't the case at all."
No fetal heartbeat
According to an emergency room report written by Dr. Anthony Sarkisian, Cashman managed Dunn's care until she was handed over to Dr. Yogi Seghal, who then handed her over to Sarkisian at 1 a.m.
At that time, Dunn was described as stable with normal blood pressure. According to Sarkisian's report, Seghal had reported Dunn was assessed by labour and delivery, which felt her symptoms were not related to her pregnancy so directed her to the ER.
Dunn insists she wasn't seen in labour and delivery.
Just before 6 a.m., Sarkisian wrote, it was brought to his attention for the first time that Dunn had elevated blood pressure.
He reviewed her vitals and labs and realized she had consistently had high blood pressure since presenting to the ER.
"It was clear to me at that time that the patient was suffering from preeclampsia," he wrote.
He also noted that attempts were made to reach Dr. Sheri-Lee Samson, the obstetrician on call, but she and another doctor had been in the operating rooms, performing emergency caesarean sections.
He noted that Dunn was in diabetic ketoacidosis.
Soon thereafter, she had a seizure and was rushed to acute care for resuscitation.
When "obstetrics" saw Dunn at 6:30 a.m. on March 23, no fetal heartbeat could be identified, the autopsy report said.
'Doesn't sound good'
Waite, a mechanic, said he was getting ready for work when he got the call to come back to the hospital.
"They said I had to go to L and D [labour and delivery] right away, and I was like, OK, this doesn't sound good," said Waite.
"So I'm in L and D and they're explaining what's going on, and they told me about the seizures. They weren't upfront about Reia dying.
"They're like, 'It's possible she may have passed away.' So I was left there, not quite understanding the whole concept."
Dr. Erica Schollenberg, with the department of pathology at the IWK Hospital in Halifax, wrote in her autopsy report that the fetus was anatomically normal and likely died in the overnight hours.
"Specific mechanism of fetal demise in maternal eclampsia is not well understood but is likely asphyxial due to acute insufficiency of vascular supply from the uterus to the placenta," she wrote.
By the time Dunn had her seizure, Schollenberg said, she had laboratory features of both eclampsia and diabetic ketoacidosis.
Dunn said it took her a while to find the strength to ask for her medical records.
When she got them, she felt sick all over again.
She wrote a detailed complaint describing what happened to Horizon patient representative Gillian Gillies, who set a meeting for May 31.
Also present were Nicole Tupper, the hospital's executive director, Dr. Erica Frecker, head of obstetrics, and Dr. Krishna Pulchan, head of emergency medicine.
"They basically apologized for what happened," Waite said.
Dunn said she was touched by Pulchan's kindness.
"He was a really quiet man, and when he ended up having his turn, he spoke very softly," she recalled.
She said Pulchan offered his deepest condolences and told her tears had come to his eyes when he read the complaint.
"He couldn't believe how out of all that happened that night, if one person would have given any type of compassion that this result could have possibly been changed," Dunn said.
"Yeah that was the problem," Waite said. "Nobody really cared enough that night."
Neither Dunn nor Waite took notes of what was said in the meeting. They said they were told there were not enough emergency specialists to staff the ER, so family doctors were filling the gap.
They also said the hospital was working on plans to add critical triage care to the labour and delivery unit. The emergency department would be making changes to better monitor patients in the ER waiting room.
CBC News requested interviews with any of the physicians who were present at the May 31 meeting and a copy of any action plan that resulted from the review.
No interviews or details were provided.
Instead, Horizon forwarded a written statement from Margaret Melanson, the interim president and CEO.
"Horizon has a thorough quality review process in place which ensures concerns expressed by a patient about the care they receive in our facilities are followed up on. Results — as well as any recommendations or mitigating actions — that may come from the review are shared openly and transparently with the patient and their loved ones," wrote Melanson.
Complaint filed with college
Dunn said she filed a complaint with the College of Physicians and Surgeons of New Brunswick. The college did confirm it's reviewing her complaint filed against Dr. Stephen Cashman of Vancouver.
Outgoing president Dr. Ed Schollenberg said Cashman will be given an opportunity to respond before the college decides next steps.
The college could decide to conduct a disciplinary hearing.
Schollenberg said it all takes time and he wondered if this case would end up under the scrutiny of a coroner's inquest.
"I would think this would be eligible," he said.
Dunn and Waite are still grieving the loss of their first child.
The hospital let Dunn hold Reia for a while. She was also given a plaster cast of Reia's tiny feet and hands and a handprint.
Dunn said what she really wants, since she'll never get her baby back, is to have the hospital follow through on what it promised.
Another death in ER
On July 12, a man described as a senior sitting in a wheelchair died alone while waiting to be seen in the Chalmers ER.
Dunn was shocked. She'd been told staff would get "compassion training" and improvements were already in the works.
"They said they had a new plan to make sure that patients in the waiting room would be seen by someone and would get some kind of treatment while they were waiting. Even if it's just Gravol for nausea."
She doesn't want to hear about people not getting proper care in the emergency room.
"At this point we're determined to keep fighting for change," Dunn said.