Doctor who missed hepatitis diagnosis reprimanded
Patient died the week after Dr. Justin Clark discontinued antibiotics, sent her home
A Nova Scotia emergency doctor who sent a patient home after missing a hepatitis diagnosis has been reprimanded for incompetence.
"It's simply a sad case where the care was below our standard and the outcome was tragic," said Dr. Gus Grant, registrar and CEO of the College of Physicians and Surgeons of Nova Scotia.
According to the college's decision against Dr. Justin Dale Clark, the elderly female patient arrived by ambulance at the Colchester East Hants Health Centre in early 2017, complaining of weakness and feeling unwell.
Blood work came back 'good'
She was in declining health with a recent history of urinary tract infections.
Clark, a family doctor with an additional emergency certification, ordered a chest X-ray and blood tests. After telling the family the blood work came back "good," Clark discontinued the patient's antibiotics and sent her home.
The next day, the woman's family doctor noticed troubling signs in her blood tests and ordered her back to the emergency department.
She was admitted with acute hepatitis, and died in hospital the following week.
Grant said these are painful circumstances for the woman's family.
"The family was left in their grief to struggle with whether the care their mother or grandmother received was appropriate. Grief is hard enough. But grief complicated by 'What if?' makes it harder," he said.
Clerical error suspected
According to the report, Clark doesn't know how he missed the warning signs, but he suspects a clerical error.
"He is unsure whether another patient's results were placed on the chart in error or if he reviewed the wrong report online," the report stated.
The investigation committee found additional concerns with Clark's practice.
They include a lack of documentation of the case, a failure to take a history and physically examine the patient, and an inappropriate discussion with the family around palliative care without a clear diagnosis.
'I feel terrible'
During an interview with the college's investigation committee, Clark apologized to the family.
"I feel terrible about missing the blood work and especially how they felt I was dismissive of their loved one's complaints," the report quotes him as saying.
"I will use this experience to improve my care moving forward," Clark said.
During the interview, Clark noted that "not infrequently, blood work is printed and placed on the wrong chart" in the Colchester East Hants emergency department.
The investigation committee said Clark had multiple chances to catch the error by either checking the test results online, or cross-checking the printed copy against the patient's identification band.
Clark agreed with the investigation committee's findings of incompetence.
He agreed to three reprimands, one for failing to perform and document an appropriate history and physical examination, the second for failing to properly review lab reports, and a third for giving the family palliative care advice with limited knowledge of the patient.
'A very serious matter'
The reprimand "will form part of Dr. Clark's professional record for as long as he's in the career," said Grant. "That's a very serious matter, and it's taken very seriously by physicians."
According to the website of the College of Physicians and Surgeons of Nova Scotia, Clark studied medicine at Saba University School of Medicine in the tiny Dutch island of Saba in the Caribbean, graduating in 2013.
Clark received training at Dalhousie University in family medicine in 2015 and family emergency medicine in 2016. He has been fully licensed by the college since July 7, 2016.
The investigation report says Clark agreed to contribute an undisclosed amount toward the college's costs of the investigation.
In an email, the Nova Scotia Health Authority acknowledged it is aware of the decision.
"Dr. Clark is an active physician at Colchester East Hants Health Centre's emergency department," said spokesperson Kristen Lipscombe.