An Edmonton woman says her father was neglected and not given enough pain medication at an Alberta hospital until his family was told he was close to death.
Bridget Stirling’s 71-year-old father, Ian Stirling, died on July 21 in the general medicine unit of Edmonton’s Royal Alexandra Hospital, where he had been admitted 16 days earlier.
His family would later learn that the cancer had spread from his lungs to his liver. A mass on his chest, below his collarbone, had grown to the size of a fist.
The family wasn’t told her father’s condition was terminal until two days before his death, she says. Her father was robbed of his dignity while his family lost precious time to share a meaningful farewell.
We’ve lost that time and we’ll never get it back.- Bridget Stirling
“No one told us that he had advanced cancer and that his liver and kidneys had failed and that he had days to live,” she said.
“We lost that time and we will never get it back.
Sterling said her father’s time in the hospital was a nightmare of miscommunication. It fell through the cracks of a health care system in crisis, she said.
She said it shouldn’t take weeks for a family to get their loved one adequate care or clear answers about the prognosis.
She filed a formal complaint with Alberta Health Services, detailing how her father’s debilitating pain was treated for days with only Tylenol and how he was found in soiled sheets.
Medical experts say Sterling’s complaint is an example of the continued pressure of the COVID-19 pandemic on Alberta hospitals, the lack of access to timely end-of-life care and the need for improved training to ensure medical staff are informed patients and their families when death is near.
Sterling said one morning after her father was no longer able to walk without assistance, the family found him lying dirty in a hospital bed. He had not been able to get to the toilet during the night and appeared to have been in that condition for hours, she said.
“It was like no one was checking on him,” she said.
“I just want to know why no one told us and why my father was left in such pain.”
An AHS spokesperson would not comment on the specifics of this case due to patient confidentiality, but said staff would meet with the Sterling family and the complaint would be “followed up and managed as appropriate.”
Ian Stirling, pictured above in this family photo, died on July 21. His end-of-life care is now being reviewed by Alberta Health Services following a complaint from his daughter. (Travis McEwan/CBC)
Sterling’s father, who lived alone and worked full-time at a local graphics firm, was admitted to the hospital on July 5 after visiting the emergency room at Strathcona Community Hospital in Sherwood Park.
After an initial CT scan showed spots on his lungs and possible liver tumors, he was transferred to the Royal Alex, where an MRI and biopsy were performed, Sterling said.
She said a doctor told the family that once the results came back – within five to 10 business days – her father would be referred to the Cross Cancer Institute for treatment.
He writhed on his bed and moaned and cried and begged. I will never be able to stop hearing it.- Bridget Stirling
His condition was deteriorating rapidly, Sterling said. He stopped eating and developed jaundice, which turned his skin and eyes yellow.
Her father was moaning in pain and was no longer conscious, but was only given Tylenol until Sterling asked a nurse to give him something stronger, she said.
He was given morphine on July 10, but it was given inconsistently for four days, she said.
“He was writhing on his bed and moaning and crying and begging. I’ll never be able to stop hearing it.”
On July 15, a hospital pharmacist spoke with Sterling about the medications he would need once he returned home.
Four days later, Sterling said the family had an initial consultation with a palliative care physician. Then they understand that her father’s death is inevitable.
He died two days later in a hospital emergency room.
Until hours before his death, hospital staff tried to get him to sit up in bed to eat, even though it was causing him great pain, she said.
The doctor who previously treated her father did not tell the family that his illness was terminal, Sterling said.
“We kept asking about [the biopsy] and the doctor kept saying, “It’s all right, we’ll just wait and it’ll be all right.”
Rules for disclosure of information to patients
Alberta Health Services protocols say patients should be well informed about their diagnosis to ensure they can make informed decisions about treatment. The AHS said that even without the patient’s consent, doctors can inform families of a prognosis.
“It is important to recognize that some diseases are difficult and challenging to predict, and at the end of life, a patient’s disease trajectory can change rapidly,” the AHS said.
AHS protocols also recommend that all patients be checked at least once every two hours, more often if the patient’s condition warrants.
In the general medicine wards at the Royal Alex, patients are checked at least every four hours through “comfort rounds” which address the patient’s “pain, position, toilet and belongings”, the AHS said.
“Pain assessments are performed at all routine patient examinations, during comfort rounds, after administration of analgesics, and when patients report pain.”
Comfort rounds are in addition to patient check-ins during routine medical rounds, scheduled medication administration, meal deliveries or room cleaning, AHS notes.
AHS said each area has designated palliative and end-of-life care beds; waiting lists for hospice beds vary based on patient demand.
People who die in large, busy hospitals often don’t tend to have excellent end-of-life care.- Donna Wilson
Sterling’s case is a sign that Alberta hospitals remain “in shock” from the pandemic, said Donna Wilson, a professor in the University of Alberta’s faculty of nursing.
“People who die in large, busy hospitals often don’t tend to have excellent end-of-life care,” Wilson said.
“I think it’s probably worse now than it’s been in a couple of years because of COVID.”
Leaving a patient in soiled sheets is unacceptable and is a “warning bell” for possible staffing issues, Wilson said. Sterling said the staff at her father’s ward seemed very busy and exhausted.
Wilson said hourly patient checks should be standard in every hospital.
She said the case highlights the lack of access to end-of-life care in Alberta, along with the chronic challenges urgent care departments face in meeting the needs of all patients.
“Dying people, for several decades, have not done well in the big acute care hospitals because, again, the whole emphasis there is on diagnosis, treatment and cure.”
Wilson said when a patient’s death is near, lack of communication with families is all too common.
Information is sometimes withheld due to privacy rules or withheld due to the time it takes to reach a diagnosis. Other times, information isn’t shared because of a “lack of responsible doctors” willing to take the time to have difficult conversations, she said.
Preserving dignity
Sterling’s case also points to the need for improved training in palliative care, said Dr. Harvey Chochinov, a professor of psychiatry at the University of Manitoba and senior scientist at the CancerCare Manitoba Research Institute.
Chochinov, who held Canada’s first research chair in palliative care, said every health worker should have training in caring for dying patients, especially pain management.
Difficult conversations are necessary, and a doctor’s personal discomfort should never get in the way of preserving a patient’s dignity, he said.
“There will never be enough palliative care beds to accommodate all the patients who have a life-threatening or life-limiting condition,” Chochinov said.
“Therefore, all of us who practice medicine must become well-versed in the palliative approach. … And in the face of impending death, patients and families need to be informed.”
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