Waiting-room death triggers review of Quebec private clinic rules

Quebec coroner Catherine Rudel-Tessier's report released today on the death of Jean-Jacques Sauvageau, who died January 11, 2008, in the waiting room of a private Montreal urgent-care clinic, demands that the Collège des médecins du Québec refine its regulations on such clinics to better protect patients.

Ms Rudel-Tessier said the 2007 Collège guidelines on private clinic administration should be "more precise" on certain points and must help administrators "offer a safe environment to their patients and permit them to adequately deal with emergencies."

The Collège's president and CEO, Dr Yves Lamontagne, said the guidelines would be either revised or replaced, depending on the results of the Collège's investigation of the incident. He said he expects two new measures will be incorporated into the guidelines. "One, every physician or nurse working in that type of clinic should follow a course on cardiopulmonary resuscitation. And two, all clinics should have equipment -- a defibrillator."

Ms Rudel-Tessier also recommended that the Collège investigate the doctor or doctors who attended to Mr Sauvageau.

Dr Jacques Chaoulli -- the same crusading Jacques Chaoulli whose high-profile 2005 Supreme Court case against the government of Quebec forced the province to overturn some of its restrictions on private health insurance -- examined Mr Sauvageau minutes after he stopped breathing and decided not to attempt resuscitation, instead leaving Mr Sauvageau's body in his waiting room seat until an ambulance arrived. An autopsy later revealed that Mr Sauvageau died of massive bilateral pulmonary embolisms and would not have been saved by resuscitation but Ms Rudel-Tessier concluded that Dr Chaoulli could not have known that at the time and should have tried to save Mr Sauvageau.

Dr Lamontagne told Canadian Medicine that an investigation into the circumstances surrounding the death of Mr Sauvageau is already underway. The results should be made public in a month or two, said Dr Lamontagne.

NB: To learn more about the private "network clinic" model used at the clinic where Mr Sauvageau died, see Canadian Medicine's earlier coverage here.

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