17 December 2020

Response to Note to File from Doctor M, Respirology

 - Response to Note to File May 29/19     from Doctor SM, Respirology 

First, let me say, I do not wish Dr M or any other doctor including specialists, to begin by doing a bronchoscopy nor to do one at all. Nor do I want it done directly or indirectly - as last doctor available - to have it done under guidance and direction by Dr D. I would protocols to be followed, which indicate doing a sputum test, and preferably a 3-part sputum test, for the best chance. I was inserted into the middle of traditional TB protocols by not being offered a skin test, or sputum test first. And I was manipulated into having an ultrasound-guided endoscopy once I got into the patient area of the Procedure area that day.

Dr M suggests, in his first paragraph, page 2, in his version of my Medical Record, that I refused to follow up with further imaging. But that is not the case. I refused to follow up with him in having further imaging.  I have since had imaging, including a PET Scan organized by a different doctor, done on my lungs.  But I do object to radiologists like Dr G receiving too much direction as to what to write in the CT scan report. In his report dated Jan 23, 2019, he concludes, “Alteration in morphology of dominant lesion in the right upper lobe favours the possibility that it is related to the patient’s known history of atypical mycobacterial infection rather than malignancy.”  I objected formally, but organizations that support the LHSC, as well as THE LHSC, presume that all doctors speak from a position of professional integrity and good faith.

Furthermore, is Dr M inadvertently admitting to sending my lung culture to Toronto Public Health genome lab to be cultured and tested, in promoting his viewpoint on the state of my lung health in his Note to File. Or is he trying to undo a wrong which may be a little too late. In this offical Note, posted to my Medical Record in May, 2020, he claims the proper diagnosis of my condition is that I “have” non-TB mycobacterium. If he did not follow protocols (and he didn’t) when he submitted the sample/culture (deciding to go on no other basis than my not having TB after all), how can his word be trusted (ie, how can I, or we, have faith in his diagnosis?  How valuable is a professional opinion when it has not been confirmed, and even then, can that be trusted at this point, if the Dr’s colleagues are the ones confirming it?

Views of Radiologists

I have had just a few x-ray images as well as a CT scan taken  in the last 3 months, between taking various antibiotics, to determine how my lungs are, and what it looks like I have going on there. Some of the findings are repeated, but not the interpretation Dr M’s radiologist gave in his x-ray report made earlier, that served to uphold a questionably- acquired test result (called by Dr M a diagnosis). The results from different radiologists on those images in the last three months include aspiration pneumonia, pleural effusion, a primary nodule, bronchiectasis, an indication of hilum or hilar pneumonia, persistent left basilar opacities and interstitial pneumonia.

I implore readers of the Note to File, now on my medical record, not to blindly follow Dr M’s suggestions. He was not my Dr when he posted the Note to File and he had no right presenting his opinion in that manner. It was a test result, not a diagnosis. He is not my respirologist,  I will be sending this to FIPPA or the Privacy Office, and/or the President of LHSC Paul Woods, to have this Response placed alongside the Note to File.

Mycobacterium and TB

What Mr P (Dr Woods’ spokesperson, in his last letter) stated about mycobacterium, that it is a reportable disease, was factually incorrect. Tuberculosis is a mycobacterium, officially, but is reportable. But when the use of language comes into play, the way it is used is important. Language was created by humans, and can be changed by them, more likely if they have authority, to signify something else. Mr P doesn’t say where he gets his information, that all mycobacterium is reportable. If someone told him that mycobacterium is reportable, I would like to know who. If he discovered that incorrect fact himself, he made a grave error and should correct his misunderstanding.  I have implied before, if not stated outright, that someone sent my presumed sample/culture of mycobacterium (non-TB mycobacterium) up to Toronto without discussing the implications of it with me! And here Mr P is saying all mycobacterium, not just TB, was reportable and the testing needed to be done, for the sake of the community. And that my sample/culture, was sent up to Toronto to test further the TB aspect of it, I think he might have been saying, which was not true. The test for TB at the local lab came back clear. I did not have either active nor latent TB. That was decided and so someone sent it to Toronto. That would have been Dr M.  It was sent up to Toronto to investigate as a  a non-TB form of mycobacterium, which is non-reportable.

The Requisition

Furthermore, what they sent up to Toronto – what they – he – was looking for – was not done through a proper requisition.  Shouldn’t Dr M have known that? If not him, who authorized the requisition for further investigating of my culture in Toronto Public Health Lab.  The only requisition I have managed to gain access to was not signed and the title of the test or culture to be performed was altered.

The Consent Form - informed consent

The idea of informed consent is essential to hospital policy. But I was denied that when Dr D, who did the bronchoscopy, said I could not see the consent form until I got into the Procedure room, for the bronchoscopy. Now that so much time has elapsed, since 2018, no one will be able to remember anyway. But you can guarantee that if he did it once, he has, or will, try it again unless stopped!

I did not get to see the form until I had removed my glasses and had them put away, and was lying on my back on the stretcher. Then I got to see the form, while everyone bustled around with tubing and all that was required. I didn’t know what it meant that my sample/culture could be tested for research or whatever else it says, by the hospital.

“Clinical Symptoms”

Dr M didn’t seem to realize that up to this point, starting with the bronchoscopy, the symptoms written down as “clinical symptoms”  - cough and shortness of breath – were symptoms of me having emphysema. The mistake was passed to Dr P to Dr D, the morning of the bronchoscopy. Afterwards, somehow, the employee at LHSC managed to insert the same clinical symptoms into her SUSPECT form, indicating she thought I had new symptoms of coughing and a problem breathing, not symptoms attributable to emphysema but which had to be investigated as symptoms of Tuberculosis.  

SUSPECT of having TB

Dr M knew, or should have known, that the symptoms I had which were used to declare me SUSPECT of TB by LHSC Department of Infection and Control were taken from my Medical File, but were symptoms of COPD (Emphysema) not current symptoms of a recent respiratory illness.  We both knew – or I thought we did – that this was a routine bronchoscopy and that I didn’t have symptoms to investigate. The procedure was to investigate infection, but any respirologist would have known that this patient was also being investigated for a possible malignant nodule. After all, it’s in my Medical Record.

Reportable vs Nonreportable

Presumably, Dr M did not know that, unlike Tuberculosis, which is a reportable disease, non-TB mycobacterium is non-reportable – not required to be reported to Public Health.  Yet he went ahead and presumably sent a requisition up to Toronto with the sample/culture, gained without my informed consent. Too many guesses and assumptions led to this situation happening and no one taking responsibility. Regardless of whether it turns out I had non-TB mycobacterium, Dr M has behaved abominably.

If by chance I have the condition, how can we know that it happened by chance. If someone can ignore the protocols at will, for any reason, what’s to stop them from ignoring other protocols. When a Dr speaks and sees himself  as having the right to make mistakes on his Note to File, or on my medical record when used as a guide for others involved in my care, just because he is a professional and apparently his opinions matter while mine don’t, it doesn’t mean that what he speaks is always the truth.

Finding a Doctor

I have difficulty finding and keeping a doctor, through having spoken out before when things went badly. Being single and older and living alone isn’t the way our own culture works, and it may be worse for those with more traditional views about older women, especially if they do so without having had a career. The education can be so easily discounted if one didn’t have a career, as can anything the patient says. So at this time I would value any input into this situation, especially coming  during the pandemic, as it is. I am seeking better health than I sometimes have received, as I still have research I would like to do.

Comments can be made on this blog entry, directly below. Several doctors already have access to relevant documents. I may add more later. I am asking here that Dr W, President, LHSC, and the Privacy Office, take steps to place my response alongside the Note to File by Dr M. 

The names here have been altered to protect the privacy of all. Contact me privately for more information.

 

Thank you

Susan McPherson

 London, ON.


15 November 2020

A birthday party, a car in the wrong space, and Mr "L”

This tells of the unresolved incident whereby a tenant parked her car in the parking space allocated to another in an apartment building parking lot in London, Ontario, and the resulting fabrications, false memories, and further offensive behaviour of Mr “L”.

The reason I am telling about this incident that took place 3 years ago is because I need to tell my side of the story, due to boss Mr “L” still saying, three years on, that I parked in the other tenant’s parking space, and that she, apparently, only then parked in mine.

The incident was never investigated, even though I reported it to Management as he had come quite nasty, blaming me and threatening to call a tow-truck if I parked in someone else’s parking space again (I had told him that day, when I went to ask him to ask the owner of the blue car to move, that when I saw someone in my spot, I parked in the next space to it).

I had arrived home at 2:30 in the afternoon, of Tuesday, July 4, 201 (a regular workday for Canadians as far as I know) after being out running errands with the car for a couple of hours or so.  When I realized someone else had parked in my parking space, I just pulled into the next space to that, which happened to be empty.  I was tired and did not realize it would cause such a problem to Mr “L” sense of logic, or to the dismay of some friendly residents in the building who were helping him celebrate his birthday, they said. 

I left my car in the next space while I went in to see if Mr “L” was around or someone who knew who had parked in my space.  As I walked by the lounge I saw Mr “L” sitting there with other residents as they commonly did, and went in, although this time they were eating cake and ice cream. Immediately, I was treated as though I was trespassing on a private party, although this was a working day and the middle of the afternoon. I was scorned for appearing thus, to ask him if he could call the owner of the blue car (the one usually parked beside mine) before I went up to my apartment.  

Mr “L” was more interested in where I had parked my car (because, well, wherever I parked it now it would not be in the space allocated to me.)  He turned against me, ,just as his group of old girls had, and threatened to have my car towed if I parked in someone  else’s space again, because I should have parked in the Visitor’s parking area.  He had the authority to have cars towed, he suggested, although the fact that this other woman had parked her car in my space while I was away didn’t seem to bother him. It was MY car that he threatened to have towed. He did finally go to call the owner of the blue car, after finishing his cake and ice cream.   Within a few minutes she came down, and we walked out together, for her to move hers into her own space, and me to move mine into my space.  She seemed a bit confused, as one would be if they had parked in the wrong space and not realized it.

The situation, however, was left with me being blamed, as Mr “L” decided to spin it, distorting what happened into it being me who parked in the blue car lady’s space so she had no choice but to park in mine, apparently.  However, Mr “L” wasn’t interested in calling the tow truck on her parking  mistake, only on me, for parking in the next empty space.  And blaming me was what he continued to do, it appears, during all the time I attempted to get the situation sorted out with Property Management.  I had been unable to pursue the matter farther due to other commitments.  2017 was a busy time, dealing with health issues and a doctor behaving about as nonsensically as Mr “L”.  I just didn’t have time to do it all.  

Having that erratic situation never being resolved, as Management was unable to deal with it effectively, was another burden I was forced to carry, through being blamed for yet another incident that was not my fault.  There is no Tenants’ Association for residents to go to, when such things happen. It is only people like Mr “L” and his inner circle, presumably, who get to say what’s what.

I just happened to mention the parking space incident one day, on my way through the parking lot, to Mr “L” as it happens, who is still the one in charge, although since Management had never conducted an investigation, apparently not even asking the errant lady herself how it came about, no guilt or innocence was ever decided upon. It was only stated by the higher-ups that the situation had been “addressed” thoroughly and it was time to drop it. It looked like the situation hadn’t been addressed at all – especially about the approach to the situation by Mr “L”.  

So imagine my surprise when I discovered, three years later and straight from the horse’s mouth himself, that I had parked in the blue-car-lady’s space first, whereupon she had parked her car in mine. He didn’t say whether she had mentioned that “fact” to him on July 4, 2017, before going up to her apartment after parking in my space, or whether she had simply decided that nature would take it’s own course.  He just said I had been the one at fault, parking first in her space, then she in mine. Nobody has mentioned that incident to me, in fact, other incidents have not been mentioned either, as though the girls in the know had learned what they should take as the truth.  Nothing seems to arrive at a resolution here. They are just left up in the air, and the girls in the inner circle would know what had been decided as the truth.

I still don’t know how that situation as described by Mr “L” could have come about – how did the blue car lady come to arrive home – and when – only to find I had apparently parked in her space.  I would like Mr “L” to be more specific, because of course the superintendent would know. But if I had already been in her parking space, (parking there earlier in the day, or the day before), at some point the evening before or on July 4, she had to have come home with her car, and parked it in my space because hers was taken.  If she had gone to Mr “L”, I’m sure he would have asked the lady J what time she arrived home and found her space taken.  After all, he would want the truth of the matter, wouldn’t he?   

I’d like to hear his story of how this incident happened, from notes he took about it.  I’d like to know what time she says she arrived home and, parking in my space instead (which Mr “L” and Management insists is a no-no), did she then attempt to contact Mr “L”? Did she leave a note for him, or a phone message, to get me to move my car?  How about some details on exactly how this situation came about, since they are claiming I was at fault for parking in the wrong space first.  I spoke to the lady once or twice after that, asking her to call Management and tell them what happened, but she said only that she thought the situation had been resolved. No, lady with the blue car. It hasn’t been resolved!

What was odd about this was that he seemed ready to place blame on me as soon as I walked in – his women, too - and was most certainly ready with the story that I had parked in the wrong space the day before. But if that were the case, that I had in the wrong space first, wouldn’t the other lady had gone to him about it on July 3; so why didn’t he telephone me that day and ask me to move my car. Or why didn’t he check during the day of July 4th, and realizing I had gone out in my car, which I had at about 12:30 pm, why didn’t he contact the lady who apparently had been obliged to put her car in my space, to ask her to move her car, now that I had gone? 

I was blamed, unjustly, for causing this incident. Now, three years later the lady in the blue car is still in her parking space, and I am in mine, beside hers.  I have explained here how this incident came about, and the result for me of trying to get it resolved. I have spoken my truth, and others have spoken their lies.  But I would still like them to speak up and admit they were wrong, and wrong to blame me.  If anyone can explain how this happened, in a different way than what I am stating, then explain, giving times of day, and who parked where, and to whom did they report it.

As well as getting the story straight, about the parking space, what’s been ignored altogether by Mr “L” and other staff, is his behaviour and that of his female companions.

 Part 2

 So what was it, you may be wondering, that started this up again, this situation that had been in limbo for 3 years?

On Tues Sept 15, 2020, I had gone out to the car, and stopped for a moment to ask a question of Mr “L”, about something for the apartments.  I happened to say something about living with the old parking space incident from 3 years ago, having to live with it not being settled and he responded in a manner I wasn’t expecting, saying that I was the one who parked in the other person’s parking space first, and so she parked in mine when she came home.  Well he caught me off guard, and I responded, telling him what I thought of him.  He wasn’t taking an approach that suggested it was a no-fault matter. He placed the blame squarely on me!  I told him off, indicating I did not accept his version of what happened and then left! Nothing had changed. He’s still the same old person.  (And as I have stated, I would like him to explain exactly how that incident happened the way he said it did, and why on earth the lady didn’t try to fix the problem instead of parking in my parking space and simply going home).

On Friday Oct 9, 2020, when I came back from getting groceries, a red pickup truck with a hook on a chain on it was parked in my parking space, no doubt from the site next door, although most park their vehicles away from the residents’ parking areas. 

Without entering the driveway into our lot, I stopped just as two guys in red vests went by, on their way to the construction site. I explained that there was a pickup truck in my parking space, and would they mind trying to locate him and have him move his vehicle (assuming he was from the site).  They did that, and a few minutes later the man came and got into his truck - without speaking to me - and moved it.  I didn’t get out of my car. I parked it and went home.

The next day, Saturday, October 10, the London Free Press had a special piece about Thanksgiving, so I wrote a comment about this incident for it, thanking the two workers who had been passing by just when I needed them – too tired to get out of the car to have to go looking for the owner of the red pickup myself, at the construction site!

The comments made by myself and one other following the article were later removed, but that doesn’t lessen the appreciation I have towards some people of this city who were so helpful to me at that time. In fact, it makes me appreciate the kindness I received even more.  I still have what I wrote in the comment I submitted:

Regarding a recent incident, I am grateful two workers in red vests who happened to be on the spot went to find the man who parked his red truck in my parking spot while he went to the construction site next door. I appreciated not having to try to find someone who could help in this matter without having it end up the same as it did 3 or 4 years ago when I was the one who got blamed for being the person who initially parked in the space next to mine. I am grateful for the opportunity to tell about that incident and the disregard, rudeness, and lies of the people involved. The London Free Press has provided readers with this opportunity to discuss local issues and happenings until recently (soon after the rope incident in the nature area, which offended some people), when commenting on articles was severely restricted. I don't like to see people with power using it to silence others! (WE ASKED LONDONERS: What are you most grateful for this year? https://lfpress.com/news/local-news/we-asked-londoners-what-are-you-most-grateful-for-this-year   Oct 10, 2020).  

Parking in another person’s parking space isn’t such a big deal. But it was, when Mr “L” and his buddies were in charge of such situations. 

16 June 2020

The Threat-sensitive Brain: a theory about animals applied to Gabriel Wortman

An analysis of
Seeking to explain Nova Scotia shootings: Inside the 'threat-sensitive brain'
https://www.cbc.ca/news/canada/nova-scotia/mass-killing-portapique-mental-health-1.5602698
'A threat-sensitive brain that is always looking for evidence to confirm the world is against them' by Michael MacDonald· The Canadian Press· Jun 08, 2020 7:25 AM AT | Last Updated: June 8

The Threat-sensitive Brain 
Can such a theory be applied to human beings or is it better off being applied to animals who survive on instinct? (revision of response to same article previously posted elsewhere).
This type of mental health explanation, as described in the article, ignores the reality of informal social networks or community ideals of conforming to the authority of those who have been granted power to control the lives of those living within their borders. Communities based on tradition or other cultural values may well result in the individual being punished discreetly and informally for breaking the rules of the hierarchy, which could be based on sexuality, or gender, wealth, or another kind of perceived status of members of the community.
Seeking to understand the behaviour of the individual presumably isolated within it, in relationships with fragile bases in which loyalty and trust have little place, means that injustices will build up, and if not resolved may eventually result in the individual attempting to break away from this insurmountable problem.
The idea of the 'threat-sensitive brain' must surely result in loud beeps in the brains of those reading about it, as though the individual has some kind of physical brain disorder (or animal-like brain where instinct is what counts) that results in the individual being unable to reason, to adapt, to be in a relationship, and to live a life of substantial success within the community and at a distance, doing work that has earned him compliments and security, doing sensitive, personal work with clients/patients seeking dental repair. If Gabriel Wortman were this kind of person, he probably wouldn't have been able to achieve all that he did.
The term 'injustice collector' is the creation of those who have lived at the top too long and has little understanding of what really happens in society, in communities that are encouraged and rewarded for demonstrating the collective value of family, sharing, and conformity and excluding those who don't quite measure up.
Referring to being an 'injustice-collector' as a way of seeing the world, as Tracy Vaillancourt (children's mental health and violence expert) does, according to this article, is only one possibility of a motivation for this tragic event. This expert in child bullying would do better spending more time on the subject of 'peer victimization' among adults.
Read ‘Dangerous Instincts’: FBI profiler explains the dangers of that ‘nice’ neighbor <https://www.washingtonpost.com/lifestyle/style/dangerous-instincts-fbi-profiler-explains-the-dangers-of-that-nice-neighbor/2011/10/17/gIQAkvNCDM_story.html> for information on the world-view of Mary Ellen O’Toole, a former FBI profiler who coined the term.
Michael Arntfield, criminologist turned armchair psychologist, who speaks of the 'injustice-collector' as someone who often feels "cheated or disrespected by others, even though there may be no evidence to support those beliefs." And that is most likely the problem. If a community does show disrespect in small ways, in an unrelenting manner, there may well be no “evidence” of the type that someone like Arntfield, a former police officer now working in a 'customized academic appointment' at Western University, would value (see Wikipedia, Michael Arntfield). Most of his work seems focused on the individual rather than the community, as most psychologists involved in extrapolating this theory of 'injustice-collecting' and the 'threat-sensitive brain' are.
I suggest a focus on the community, and I don't mean accepting their stories on Wortman as 'evidence' of his guilt or fitness-of-mind or not, but treating them, too, as though they might not be as credible as the investigators of this horrendous tragedy would like them to be. Liking should not translate to 'credibility'. Rather, investigators should attempt to be objective and to keep in mind that when such a tragedy happens, evidence of the sort that shows the killer in a good light may well be kept hidden. No one wants to support the bad guy at a time like this. Mr Wortman was known to be a caring and community-minded denturist in his working community and among those who knew him in that role. But community is often set apart from a person's work-life. It doesn't mean that Wortman should be labelled 'injustice-collector' because those in the business of psychology see him as such. 
A perspective taken from the discipline of Sociology might be better at undoing some of the falsehoods of this perspective, and the very one-sided blame on one man, similar, in fact, to the moral culpability of the tragedy of the Montreal massacre of 1989, during which killings were committed by Marc Lepine, for reasons that were distorted and attempted to be hidden from Canadians.

References:
Seeking to explain Nova Scotia shootings: Inside the 'threat-sensitive brain'  
by Michael MacDonald·
The Canadian Press·
Posted: Jun 08, 2020 7:25 AM AT | Last Updated: June 8
 https://www.cbc.ca/news/canada/nova-scotia/mass-killing-portapique-mental-health-1.5602698

 ‘Dangerous Instincts’: FBI profiler explains the dangers of that ‘nice’ neighbor
By Monica Hesse 
Style
October 24, 2011
https://www.washingtonpost.com/lifestyle/style/dangerous-instincts-fbi-profiler-explains-the-dangers-of-that-nice-neighbor/2011/10/17/gIQAkvNCDM_story.html

11 June 2020

HPARB Notice of Intention Not to Proceed with Review


2020 June 11 re Dr D                                                                         Susan McPherson
In Response to Notice of Intention not to Proceed with Review by HPARB

Following is the Response I submitted on June 11 to the Notice I received from HPARB  (Health Professions Appeal and Review Boardthat they were planning not to proceed with the Review of the CPSO complaint that I had asked them to do.  I was required to submit responses to HPARB within 30 days, which I did. the case is complex, and I could see that they hadn't really understood what I had said, so I tried again to explain.  In the following document, I have omitted the names of the parties involved and other extraneous information, such as titles of attachments and their job titles, etc.

This is one of two responses I made about two doctors I had laid the complaint about to the CPSO, originally. The CPSO (College of Physicians and Surgeons), had decided not to go forward with the investigation, having saying that my complaint looked as though it was “frivolous, vexatious, made in bad faith, moot or otherwise an abuse of process.” They didn't say which. HPARB followed suit, the reason being that they do not conduct an investigation of the original complaint, only looking at the CPSO ICRC (the Committee) to see if they would have reached the same conclusion. They did, by making the same mistakes and relying on staff at LHSC to be able to explain this situation to them.

If viewers have questions, you are welcome to ask, or leave a comment. Please excuse the spelling errors. 

HPARB Notice of Intention Not to Proceed with Review
by Susan McPherson, Complainant
Dr D, Respondent
Case File: Dr D  HPARB   (CPSO, Complaint June 28, 2019)
Date:   June 11, 2020                                                
Sent by email to    
   

1.  The respondent, Dr D, was and possibly still is one of the health care custodians of reports and other documents about me that are related to this case; in fact, he was one of the main ones, being the person in authority, as submitter and receiver, responsible for the sending and receiving of documents from the lab he worked in at LHSC, and possibly providing authorization for some of them.

2.  I understand what HPARB is saying, that it was simply HIS name and hospital address that appeared on documents coming and going and that to him and the hospital it meant nothing. It wasn’t as though anyone was taking responsibility for what went out or was accepted in. I can see that. I already knew that. But I would like to know Dr D’s part in that, and whether he could have done better, and whether he should have been doing that job, and whether he did it to other patients, and more. Shouldn’t the hospital, and the College of Physicians and Surgeons, be accountable for their mistakes?   

3.  In the response I received from M, formerly of P   O LHSC, on May 31, 2019, she sent an explanation about the various documents that was not accurate.

4.  In the email bundle I received from HPARB on May 13, pages from M were listed under p 2, - -  that they used in determining the Decision on this case.   They are attached here.

5.  First of all (re Item 2 of the ROI) it wasn’t me who said that EMERG was involved in my path from Bronchoscopy to being TB Suspect. That information was on the Suspect form filled out by B, as well as other forms, such as the requisition form, and was an error. I don’t know how, except that almost everything she wrote on the form was incorrect. I didn’t have symptoms not able to be explained by emphysema, for instance. She just picked things up from my medical record and plopped them into the TB SUSPECT form. I state this because HPARB has accused me of being frivolous, and I don’t want them to think I just made things up out of the blue and asked M to find out about something that didn’t exist.

6.  M, P O, LHSC, thought that an “automatic notification” was “triggered” due to the “nature” of my visit to Dr M, and presumably did not involve any human action to be taken. Somebody has to put the piece of paper into the FAX machine, or lift up the telephone, or copy an email to God knows who. It doesn’t happen automatically, unless these people at LHSC are AI robots or in a daze and things get forwarded “automatically.”  Likewise with the requisition that was said not to have been sent by anyone. It simply exists, presumably and D was not responsible, you claim.  

7. Farther down on page 2 of her letter, M tried to tell me – and I am copying again for you - that “bacteria in the TB family was found during the exam.”  Actually, bacteria cannot be seen while the bronchoscopy is being carried out. It has to be discovered at the lab – presumably at the LHSC lab if possible, or if not at the Public Health lab locally or in Toronto.  Sounds like circular reasoning on her part – using the “find” as a reason to conduct tests on the sample to try to discover what it was, if anything, no matter how many labs they had to send it to.

8. HPARB and thus, CPSO, chose to refer to P O M’s response to me, received by me on May 31, 2019.  See pages 1 and 2 of her letter attached.   HPARB wrote in Section II,    of the Notice of Intention not to Proceed with Review (May 13, 20) how they understood the process, that “possible bacteria” of the TB family was present. However, it wasn’t possible for TB to be found until some reason was found for pursuing it – as with COVID-19 - such as having symptoms, or being in contact with someone who had it. In one assessment tool at MLHU that was written on, too, for no reason, the word “contact” was added.  It was thought I might have had an infection previously, but that could have been pneumonia or bronchitis. TB wasn’t suspected at the time of the bronchoscopy. If it was, no one told me, at least, not in a way that indicated what I might be up against, which was a lot more than most immigrants are. The doctor might have wondered to himself, but there was NO INDICATION that I had TB. Sure, you can say it was “possibly TB,” or possibly anything on the list of infectious diseases, or anything not infectious. It could have been - anything. But I didn’t fit the profile for TB and had no symptoms and I didn’t have close contacts so there was no reason to pursue that avenue.  

9.  It wasn’t until B filled out the form that anyone could seriously consider that I had TB, contradicting what you claim happened, that TB was suspected from the beginning. If she had filled out the form accurately, with more care, it would have been realized right away that I probably didn’t have TB and didn’t need to be tested. It is possible that once a test was done that indicated by the AFB test that TB was possible, B would have made out the inaccurate SUSPECT form, but it would take Dr D or someone to say how that test happened, and where, and when. And I don’t mean M saying she asked someone and they said this or that was a reasonable explanation. She was not a spokesperson for the LHSC and ought not be giving her word on how things happen there (and nor is Patient Relations, if that idea comes up). We are supposed to be able to put our trust in doctors, but how can people do that when things like this happen?

10. What I mean is that someone, such as Dr D, or whoever conducted the AFB test and signed the test result as being authentic and authorized by a requisition,  and received the lab report back, should be investigated by HPARB as the person being investigated should be. If CPSO did not do this, then it can be said that in this matter, the investigation they conducted was not adequate.

11. I realize that the inadequacy of the CPSO investigation of my complaint is one of the reasons I was able to request a review.  The other part was whether or not the Decision of the Investigating Committee of the CPSO was reasonable. And it was not. I cannot state what their final conclusion was because they don’t exactly say – either I was being “frivolous” or I was “abusing the process”. What was it? HPARB says the same thing, which isn’t really anything unless it was something.

12. Still looking at Item 4 of the HPARB Notice, it is stated that TB is a mycobacterium. Tuberculosis most certainly is a contagious disease on the list of reportable diseases to Public Health. However, non-TB Mycobacterium, the query that someone had in order to have sent up a sample culture to Toronto to be identified as such, is not reportable - meaning, it is not reportable to Public Health as a public health concern and need not be investigated in samples submitted by any patient, or immigrant from countries where it is most likely to occur in large numbers. Most often, the two diseases are separated, into TB and non-TB mycobacterium. The kind that was presumably found in a test culture in (date), 2018, in a sample that was taken from me during the bronchoscopy in August, ened up being non-TB mycobacterium.  It was an unusual investigation, as most immigrants do not even have the test done upon arrival in this country.  They just have a regular TB test, perhaps a sputum test, which I did not have in the first place. I was sent straith through to having the full TB mycobacterium and non-TB mycobacterium investigated.

13. Speaking of TB mycobacterium and non-TB mycobacterium as though they are in the same family – as the HPARB Notice does - may or may not be correct, legally, but they are not talked about – nor investigated – nor in the same risk category  -  in medicine.  And it distorts the issue to write about it in that manner. Where in the Notice it is written “That testing revealed the bacteria was not one that causes tuberculosis,” (Item 4, Notice . . Dr D) that is another error. It was already known by that time that the bacteria I had, if I really did have any worth mentioning, or a conclusive test result, was not TB. The sample culture was sent to Toronto to discover whether is was a non-TB mycobacterium,  not to check whether it was not one that causes TB. And I don’t even know whether proper submitting protocols for the sample were carried out.  Based on the looks of the requisition I managed to get and the lab test result that came back with no clear dates or results, nor names of authorizing doctor, and B’s methods, one would have to question whether the lab even followed proper travel protocols of the sample. 

14. And of course, as I have said, the test result of that single test was positive, and remains unconfirmed because Dr M didn’t follow standard guidelines for the testing for TB. If it was Dr M who authorized the requisition for further testing, or Dr D2, or Dr D, I would like to know. So far, it is only Dr D’s name on the requisition, as Submitter, And he was the receiver of the finished lab result. At least, for this investigation, I would like to hear from Dr D himself, what his job description is and did he not think he was supposed to check important documents like requisitions from his department before they were sent out, with the sample culture?

15. I have included the original handwritten Dr D Requisition form here so it can be compared with the typed-up data on the lab information forms located in the bundle of documents sent to me. Both those are OLIS data, with information jumbled together not making much sense unless one already had a good grasp on the details of the lab testing, etc. But both had Dr D’s name on them, one even stating that Dr D was the “Ordering physician”. The other one refers to him as the “Provider,” while the original requisition uses the term “Submitter.”   The original requisition was not obtained through M at LHSC, although one would have thought they would have saved a copy, since it was proof that the testing done in Toronto was legitimately authorized and not simply pushed through.   There is no clinician named on that original requisition order, nor a Doctor’s name to forward the results to. It all went from Dr D back to Dr D after being carried out.  The two lab reports are attached here.

16. But I do know that the requisition with Dr D’s name on it was scribbled on, after striking out the words Final AFB (a different test, done locally) and inserting the word mycobacterium, whereas if it were going to be tested for TB, then it would say TB – the title given on the back of the form to identify the test required. I imagine TB had already been cancelled out, because I didn’t have it. And so, someone came along and put  “mycobacterium” on it, so it could be sent to Toronto, without a new requisition having to be made out and having to have someone take responsibility for adding on this extra testing, which I was not informed was going to happen, nor why, preventing me from knowing what was going on. So it wasn’t meant as this being a test for TB and “mycobacterium.” It was a meant to be for a non-TB mycobacterium. so in those Item numbers where this is discussed, eg Item 4 and Item 9 in the HPARB Notice.

17. I have attached a blank general test requisition, of the kind Dr D permitted to leave his department unchecked by him, including the back of it. If you look, you can see where TB is listed, as being mycobacterium. There is no category for non-TB mycobacterium, whether because there is a different requisition form for it, or I don’t know why. I am not a doctor and it is difficult for me to get answers from OLIS or any lab on these matters because they only answer questions from doctors, they say, about procedures. Or perhaps lawyers.

18. To be accurate, the term non-TB mycobacterium probably should have been put on the requisition at that point, and someone should have signed it, or initialed it, instead of leaving it such a difficult-to-understand document.  It makes it difficult, too, because people who access it and change it, etc, don’t put dates on it, or initial it, so no one knows for sure where it was nor when, nor who.

19. I understand the CPSO does not deal with administration, but it does deal with rules about how doctors should act if they have custody of a patient’s medical record or other important documents, and this is one of them – and Dr D had the document in his office, for it to have been stamped with his name. And it deals with ethical issues – issues of accountability. That’s why I am asking.

20. If Dr D was the only person who had access to that requisition, and if he did not instruct his staff on how to deal with them (eg, read the document and if there is anything unusual about it, such as if it is an unsigned requisition, hold it for me, he could have said). Who signed the original requisition? So whose responsibility is it if his staff did not know how to deal with it?

21. The report referred to in Item 4 was the SUSPECT form, by B. I don’t know how it got to MLHU. It got there, whether by Dr D or someone else. That should have been caught, too. The name Mrs N,  B’s boss, was on the list of witnesses to interview, in the Application, but CPSO did not bother.

22. TB WAS ruled out, by the way (Item 4 of your Notice says it was NOT ruled out). This is the problem I have been telling you about, and CPSO. I did not have TB. And then someone decided to send a requisition up to Toronto so they could look into non-TB mycobacterium. I don’t think people who have TB have to have their samples checked by LHSC lab, and MLHU lab and then by Toronto’s genome lab. Someone went out of their way to have my culture sample sent up to Toronto. But non-TB Mycobacterium is not on the Reportable Diseases list of Public Health.

23. The information you give in Item 9 has fragments of truth bu in it essence is inaccurate. Non-TB Mycobacterium is not a reportable disease. I can give you lists, but it’s not on them, because there are only lists of reportable diseases, like TB, not of non-reportable ones. I gave that information to the CPSO.

24. A sample was taken from the bronchial lavage I had (and signed a consent form that enabled them to do whatever research they wanted on it.). I asked Dr D2 if I could sign the consent form and he said wait until you are in the Procedure room. By the time I got there I was lying flat on my back with my reading glasses safely tucked away. I signed under pressure! Uniformed consent. I had not realized I would be tested in ways no other patient would ordinarily be tested, not even recent immigrants who, according to their profiles, probably came came from the major continents where their ancestors were raised in mud huts and ate off the ground and thus were more susceptible to the kind of diseases these doctors and staff were investigating me for, I allege, so that they had a guinea pig they could test these poisonous drugs on.

25.  M makes it up as she goes along, in her letter of response. She couldn’t find the requisition, she didn’t know how things got from one place to another, and she says in Item 3, p 2, that the “culturing process has to be referred out  by LHSC.”  By L H S C – by the *hospital,* by magic, because no one fills out the form and no one signs it. It is all automatic!

26. Generally, people start off this process that I went through by having symptoms they go to a doctor for. I didn’t have symptoms that could [not] be explained away. I already was short of breath due to emphysema, and had a cough that went with it. Yet B of LHSC wrote on the form that I had clinical symptoms of TB.  People at LHSC say different things about the process. M says, “the reportable disease notification was sent automatically to the Middlesex Health Unit as part of our standard protocol (which adheres to legislation).”  I am explaining again because I think it takes hearing it more than once to sink in. She knew only a small part of what this was about and the most important parts she got wrong anyway. Someone was responsible. It didn’t happen “automatically.” 

27. The College didn’t conduct an investigation prior to making a Decision. In their first paragraph in their Analysis they quoted from the CPSO’s rules on reporting and left it at that, stopping at the point of the supposedly necessary TB SUSPECT report. Non-TB Mycobacterium is not a reportable disease. I can give you lists, but it’s not on them, because there are only lists of reportable diseases, like TB, not of non-reportable ones. I gave that information to the CPSO but they must have presented it to you incorrectly.  That’s why this situation was so unjust – I was subjected to this testing, which so many others do not have to have done, even though from foreign countries where it is more known. I was subjected to it, and people hid it from me, and hid the part they played in allowing it to happen.

28. The second paragraph of the CPSO Analysis  focused on lab protocols, incomplete forms, and health policies, for the most part irrelevant. The third and final paragraph was completely false. Dr D was meant to be working under the supervision of Dr C at the time this situation took place, and only to be given tasks to do that he was capable of doing satisfactorily – or complaints would be made, which I did, while he was still uder restrictions.  

29. The CPSO’s final Decision was that they would take no action with respect to the complaint. Instead, they decided that my complaint looked as though it was “frivolous, vexatious, made in bad faith, moot or otherwise an abuse of process.” They don’t say which.

30. My presence (in writing) and complaints, may leave you feeling vexatious, or show how I was feeling, but they are relevant in today’s health care system, and as far as I know, were not an abuse of process, but if they were, were made in good faith.  I put much work into this, provided extra material for the ICRC, and kept the Board up to date on the lack of attention by the CPSO to what is going on in hospital settings.

31. Doctors or not, we all know from the coronavirus pandemic that there is always some concern over patients who have symptoms and who test negative, or those who test positive and yet are asymptomatic. I only had one test and the doctor started talking about it as though I had bee diagnosed with this non-TB mycobacterium. And then other residents would mention it, as though I actually “had” it and had not simply had one unconfirmed test result. No symptoms, did not fit the profile, no contacts. Nothing! Just one test, and we don’t know whether protocols were carried out in sending it to Toronto.

32. I would like to get this matter dealt with, as it is part of a larger whole. Each piece is complex enough, so doing them all together would be impossible. I still have other people I believe need to be questioned about this. It may seem frivolous to you now, or an abuse of process, but these questions need to be asked of Dr D and others mentioned in the application, so that when I file a complaint about another doctor, you will know what has been covered. If D doesn’t respond to questions about his part in this – such as about his job description – then no one will know whether he is the one (along with Dr C) who should take responsibility and how the LHSC can become more accountable in its hiring and supervision, with the cooperation of the CPSO.

33. I am attaching what appears to be the original requisition *submitted* to PHO labs by Dr D, it states, complete with one part crossed (AFB Final) out and the word Mycobacterium written in, with no signature nor date to indicate whether it was Dr D who made the change or someone else.   No reason for the test is given. Under clinical symptoms, “respiratory symptoms” has again been listed, falsely. The patient setting was given as ER – not true. Dr D is clearly listed as the Submitter, although apparently, M may be right, No one person needs to be identified as requesting the test, or authorizing it, as a health care provider or custodian, it being a mysterious process at the best of times.

34. And who does that leave as health care custodian in this situation of documents coming to the lab and going out, if not Dr D, the one who “submitted “ the requisition to have the test in Toronto, the test that didn’t need to be done and that I was not informed about in advance! I have attached the requisition, and a copy of a blank requisition,  as well as a copy of the Fact sheet on Health care providers, since this last item, the status of Dr D, as provider, was mentioned in the responses of CPSO and HPARB to my complaint.  

35. In responding to HPARB’s decision, I would first say that there were several errors and distortions in the CPSO’s investigation, repeated in your response, to address each one in detail. I have already made this case once to the CPSO, and your making a case against me, based on what they claim I said and what they choose to believe, doesn’t do justice to my request for a review. I realize this is how a Review by the Board is undertaken, but it still doesn’t make sense. If PHARB is not analyzing the original documents from my Complaint and seeing if they come up with the same conclusion, instead of looking at CPSO’s interpretation of the Complaint, and seeing what’s wrong with it, to what purpose is having a Review?

36. An excerpt taken from my request for review, in Item 13 of the Notice, is what the HPARB has decided to hold against me, as the essence of what I am asking them to do and the reason for not proceeding with the Review. However, going back to the original Complaint I made, which presumably is what the CPSO used to base their investigation on, would be more appropriate. See attachments.  Here you will find my concerns, the start of a description, and the names of two persons who could offer more information. My concerns are not as you describe in Item 13, but this, from p 3 of my CPSO Complaint about Dr D and Dr C, which surely the CPSO used as the basis for their interpretation of my Complaint? :

37.      1. Dr D was involved in submitting information about me to MLHU in September or October 2018, that resulted in the Health Unit screening me for Tuberculosis.  After it was discovered I did not have TB, the lung sample  was sent to Toronto for further testing. I question, first, the basis on which I was deemed to be suspect for having TB, and the process by which the report was approved and sent to MLHU. Secondly, did Dr D also approve the requisition for the lungsample sent to Toronto?
             2.  My concern is that Dr D wasn’t doing his job well, and that errors were made in having my information submitted to MLHU. CPSO public information about Dr D indicates that he may practise medicine only in a setting that is approved by the Chair.  Dr C  is the Chair. I question whether he, too, was not doing his job effectively.
              3. It was the responsibility of Dr D, and thus indirectly of Dr C, to ensure that the documents sent (and received) to and from MLHU and other labs were valid and completed with accuracy. This didn’t happen with the form that was submitted by LHSC to MLHU, nor with other documents related to this situation.  If Dr D's work was not to be trusted, why was my health care entrusted to him, with no one overseeing it?

38.  As I said above, on its own, this case is not the entire story of what happened to me. This entire situation, of Drs D and C, is connected to others including Dr M, LHSC, who I have alleged mistreated me and manipulated me, with the compliance of staff and doctors including Dr D2, LHSC) employee B, Drs D and C, Ms B MLHU, and others; that said, if the participation of the various employees and physicians wasn’t done out of compliance, then it had to be out of ignorance.

39. On its own, one might see D’s actions as trivial, but connected as they are to the wider issue, of the supposed chance occurance of a patient being lied to, misrepresented, and dragged through the system to a conclusion not out of her (my) informed consent, one can see that what they did was essential to this effort by Dr M and colleagues to inveigle me into being their research subject.

40. In Item 15 of the HPARB’s Decision May /20, Dr D’s role is referred to, that HPARB is saying means he was not involved in this situation. But that is his title and address as it appears on his documents. He does do clinical work, and practical research. He has Hospital privileges at all the hosptals under LHSC. He may even have had something to do with speaking with the referring doctor (Dr M) or Dr D2, about what lab testing did they want done.

41. No, there was no doctor/patient relationship between Dr D and myself, as you suggest in Item 15 of the Notice.  I am saying he was a hac – a health care custodian. He had personal data on me (some of it incorrect) and he was the person in that environment, of the clinical lab, not as academic, who sent and received reports including requisitions, and perhaps even consulted on what kinds of lab tests could be done. He wasn’t an administrator per se. \

42.  Many professionals in hospitals have numerous titles, sometimes, as heads of Committees, and so on. Regardless of his title, whichever one it is, look at the form, reports, lab requisitions and so on. All the ones to do with me have his name on them. And the question is, regardless of whether he was away that day (see Item 15 again) should he had been a little more careful of what was happening with patients’ requisitions and lab results that had inaccurate medical information on them. It surely was his job. And of course, it was Dr C that was also at fault. I have included D’s CPSO profile as it was before it was updated.

43. Re Item 16. I am not talking about protocols in this case. I gave the CPSO the background information to my complaint. How otherwise would they have been able to comprehend what the issues were with Dr D. It wasn’t just about him. Somebody or some persons were involved in manipulating me from start to finish. If not that, then the professionals at LHSC are incompetent. And yes, again, I have given you the information on the limitations requested on Dr D on his file, before July 1. So while you are correct in what you say, “there is no persuasive information that the Respondent’s licence is restricted due to competency issues,” what you say is not correct as far as this complaint is concerned. He has a different profile now. The restrictions I was referring to were lifted.

44. On June 28, 2019, I emailed my Complaint to CPSO about Dr D and Dr C.  It was not acknowledged until Tuesday July 2, due to the long weekend.  I submitted the application before I knew what changes would be made to the restrictions on Dr D’s CPSO file but I had wanted it to be there before the file was altered and so that the CPSO and others at LHSC knew that this had happened while Dr C was supposed to be supervising him and that my Complaint was submitted before that restriction came to an end. I submitted my complaint before the restrcition was lifted. It is up to HPARB when they decide to follow up on it.

45. The damage had been done while Dr D was still under supervision, despite what HPARB believe about there not being restrictions due to his ability. He may have been competent within himself, but the question is, was he capable of overseeing incoming and outgoing documents (or even authorizing requisitions) whose existence and careless use might well have dire consequences for someone caught up in the incompetence or manipulative behaviour of others. Lacking experience, he might have been a risk being in that position.  

Thank you for taking the time to examine my response to your Notice Not to Proceed with Review. The Decision made by the board about my case against Dr D was inadequate, and was also unreasonable.


Susan McPherson    

17 Attachments follow