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It is true that Arlene Berry was initially diagnosed with adenocarcinoma of the left lung for which she had a lung resection and prior to radiation therapy. However, there is NO evidence on record to suggest metastic Cancer.
Difficulty ambulating, a sign of poor ballance and uncoordinated movements is a common feature in toxic ataxia/toxic sedation which results in dizziness and drowsiness, but there were definite upper motor neuron signs in the legs causing this patient to pull to the right when walking, as evidenced by family and friends. The commonly observed deficit was one of weakness on one side of the body, such as seen in hemiparesis, vascular limb ischemia, unilateral limb ataxia, or limbic encephalitis, the result of CNS infection. Further, hemiparesis or unilateral limb ataxia is almost always an indicator of focal posterior fossa abnormality, such as infarct, demyelination, or abscess.
http://maritimes.indymedia.org/news/2005/05/10300.php
It seems clear that the coroner's expert (whose identity is omitted) assumptively considered a few cursory physical findings, but failed to take into account from the patient's medical history, ie. from the patient's belated bloodwork, particularly the Neutrophilia, including a documented CAUTION with respect to a "resistant bacteria", suggestive of an antibiotis resistant bacterial infection. Typically, the origin of the infection is indicative of its bacterial identity, at this point at least we know what to look for. Further, a progressive or increasingly severe headache concurrent with "nausea, vomiting, and drowsiness" can suggest clinical features of meningitis, cerebritis, or brain abscess that is consistent with a bacterial infection.
CAVEAT: Brain abscesses are life threatening due to systemic and local toxicity in early stages of cerebritis, and increased intracranial pressure during/after capsule formation.
You will note that N-9 of the record documents an INFECTION CONTROL PRECAUTIONS for a "resistant bacteria", evidenced by a check mark in the box . The particulars with respect to any bloodwork on the days before the patient's death (if done at all) are omitted. Apart from that caution , NO precautions are reported because NO precautions were taken. Supportive Care & Symptom Control Regimens are absent. Further, N-10 documents the patientŐs level of care as "routine", which showed little or NO concern for the safety of this patient. From these records it is clear that Arlene Berry was simply turned away at the door in the face of life threatening indicators - goes to evidence of gross negligence, and substandard care.
Submit, from the record there was every indication that Arlene Berry was about to suffer a catastrophic decline, at least from foreseable "dehydration" due to decreased oral/water intake and malnutritian from excessive vomiting over the previous week or more, which should have prompted immediate medical attention, but did not. Submit also that dehydration, which interupts blood flow and causes blood clots, cutting off the supply of oxygen to various parts of the body resulting in a toxic condition, the result of poor oxygen exchange as evidenced by a slurred speach, marked by a sedated and haggard appearance, and drowsiness together with constitutional symptoms documented on the record to include headache and vomiting with severe stomach pain, as evidenced by the "abdominal pain ongoing for 2 weeks" documented at A-5, and at A-8 of the medical record can constitute a "life-threatening medical emergency" on the face of the record.
According to the record, on May 23rd of 2000 "she returned" to the emergency department "with the very same complaints", as evidenced by the record at A-6. Submit that rapid evolution of illness or patient return within 24-48 hours suggests the severety of illness as to "mandate treatment in an intensive care unit". How could they realize she was sick knowing that and elect not to admit her to hospital at that time?
Submit that N-2 of the nurses' notes clearly document "attempts to pull away to painful stimuli" at 0400 hours, to rule out complete cessation of motor response at 0245 hours . From that record it is clear that Dr. Jordan lied. I was present at that time and had asked Arlene two times (in the presence of her foster brother) if she could hear me to wiggle her toes and she did, not once, but twice. In my opinion, Arlene appeared to be more paralyzed than anything, which may suggest one of two things, either chemical restraint, or meningitis.
Further, with meningitis, muscular power in the limbs is usually well preserved, muscular hypotonia occurs quite regularly, which may explain the "plantars responses". This may also explain why Arlene was able to wiggle her toes when I asked her to (not once, but twice), obviously she could still hear me at that time. It must have been a nightmare for her.
With respect to the occular, eyes mid sized and fixed gaze is a common feature of adverse reaction to phenothiazine type drugs., and you will note from the record that she was given Stemetil. Further, in "acute bacterial meningitis" the pupils may become dilated and fixed, with papilledema (late) as the disease progresses. With meningitis, any of the ocular muscles may become paralyzed - most frequently one or both, hence mid-sized with fixed gaze.
The lession in the region of the occipital lobe that measures less than 1 cm seen on the first CT that was done in Timmins is consistent in appearance with an old hemorrhage, or early stage cerebritis during/after capsule formation in the early stage of abscess development (capsules can rupture resulting in the formation of multiple abscesses), or perhaps even an abscess secondary to an occipital dermoid cyst. Rupture of a dermoid and leakage of a cyst contents into a ventricle or subarachnoid space may produce an epidymitis or meningitis respectively.
CAVEAT: Brain abscess in a previous hemorrhage or infarction area as a complication of systemic infection, or untreated bacteremic spread is reported in the literature.. A systemic bacterial infection can effect all organ systems, and the brain is no exception.
The record clearly documents NO METASTASIS and a NEGATIVE mediastinoscopy.
As you are aware, the occipital lobes interpret vision. Brain tumors are more solid/dense and therefore are usually associated with multi-focal deficits; tumors of the occipital lobe usually produce homonymous hemianopia or partial visual field deficits.. A tumor in the occipital lobe can cause loss of vision on the side of an occipital neoplasm which, in addition to loss of vision in half of each visual field may also cause hallucinations, and seizures. Arlene Berry had no such deficits.
Had this lesion been a recent tumor, there would have been onset visual misperception in half of one or both visual fields, with visual impairment and subsequent loss of vision with evolution. With a soft tissue infection the expanding lesion would have been assymptomatic. Even multiple brain abscesses may not cause focal deficit to suggest their presence.
Further, the blood chemistry at A-19 of the hospital record documents a Neutrophil count of 92.0 H, with an Absolute NeutŐs of 20.6 H. An increase in the neutrophil count suggests neutrophil emegration (the normal range is 1.3 - 6.7). Emigration of neutrophils, together with tissue destruction is the hallmark of abscess formation. These lesions are commonly produced by a group of microorganisms known as the pyogenic (pus-producing) bacteria). The staphylococci are a group of bacteria possessing pyogenic properties. particularly Staphyloccocal. meningitis, or variants thereof..
Staph meningitis is an infection caused by the bacterium Staphylococcus aureus, also known as S. epidermidis, which causes an inflammation of the membranes surrounding the brain and spinal cord, which can rapidly result in paralysis. Some of the symptoms of meningitis are similar to brain tumors. Patients with Staph. meningitis may have high levels of neutrophil in the CSF, marked by Neutrophilia. Acute bacterial infection is a common cause of neutrophilia, especially with pyogenic bacteria. CAVEAT: Leukocytosis (especially neutrophilia) is a hallmark of systemic infection. Systemic infection is marked by widespread tissue destruction. The record clearly documents an elevated WBC count, marked by neutrophilia, that is, to confirm leukocytosis, and further submit that the record speaks for itself.
With meningitis, intracranial infection can result in cerebral abscesses which can lead to brain herniation and shift of midline structures. ICP itself can be responsible for further damage to the CNS by decreasing blood flow to the brain causing the brain to herniate (push through) the opening in the back of the skull where the spinal cord is attached. Once bacteria have established a foothold on the membranes surrounding the brain, they trigger inflammation severe enough to cut off the blood supply resulting in decreased cerebral perfusion and cause swelling in the brain. The decreased attenuation throughout the cereberal hemispheres may result in stroke symptoms that include paralysis, which if left untreated can result in herniation or massive hemorrhage into brain substance.
With meningitis, CT of the brain often shows obliteration of the cisternae surrounding the midbrain and of the subarachnoid space over the cerebral hemispheres and is reported in the literature. With meningitis intracranial infection can result in cerebral abscesses which can lead to brain herniation and shift of midline structures. ICP itself can be responsible for further damage to the CNS by decreasing blood flow to the brain causing the brain to herniate (push through) the opening in the back of the skull where the spinal cord is attached .
Further, when Dr. Jordan finally showed up in the small hours of May 24th of 2000, precious moments that followed were not taken up with measures to save this patient's life, but rather ways to accellerate her demise, that is, he proposed a DNR. A decision was made to intubate the patient and you will note from the record that during the intubation procedure the patient's HR soared to 174 bpm that is consistent with trauma, or injury caused suddenly. Further, the ET was malpositioned for one full hour before the error was discovered by one of the duty nurses and further submit that any negligence of the patients airway can result in a decreased or no cerebral perfusion and that is exactly what happened here, which goes to evidence of negligence and substandard care. Any negligence of the patient's airway or throat secretions can trigger an inflamatory response.
From the record it seems clear that Dr. Jordan did not support the use of agressive intervention to keep alive someone he had already injured, for to give treatment to remedy a wrong would result in the fact that mistakes were made and there is nothing on record to suggest that the patient was adequately oxygenated prior to intubation. From the record it seems clear that Dr. Jordon had done too little too late by reason of his failure to attend, and from the record it is clear that nothing was done by any of the other healthcare providers in his absence.
Clinical presentation of brain abscess is usually similar to other intracranial space occupying lesions but the symptoms of an abscess(s) tend to be more rapidly progressive than those associated with neoplasm. Microorganisms can be spread by the blood during a systemic infection. In this case bacteria are carried to the site of abscess from a distant source. Under these circumstances there is not a solitary abscess but rather multiple abscesses in the brain. Brain abscesses. can produce "purulent meningitis" associated with signs of neurologic damage or brainstem malfunction.There is nothing on record to suggest metastatic CA of the brain, indeed there is nothing to suggest other than "purulent meningitis", with evidence of sepsis, including neuroleptic drug involvement.
The evolution of abscess is characterized by four stages: early cerebritis, late cerebritis, early capsule formation, and late capsule formation. Most patients receive this diagnosis when the abscess is in the stage of late cerebritis or mature formation. The period that is required for the formation of a mature abscess varies, ranging from 2 weeks to several months. Arlene Berry developed flu-like symptoms 2 weeks following radiation therapy. 10 days later she is dead. Spontaneous meningitis can kill in 24 hours if left untreated. The infection may mimic space occupying lesions of the CNS. Some of the symptoms are similar to brain tumors. Even when the imaging characteristics are very suggestive of tumor, a biopsy is the only way a precise diagnosis can be made. It seems clear that the opiniated expert failed miserably in postulating his opinion.
Staph meningitis is an infection caused by the bacterium Staphylococcus aureus, also known as S. epidermidis, which causes an inflammation of the membranes surrounding the brain and spinal cord. In the very early stages of meningitis, it can appear like the flu. The record at OP-54 clearly documents "2 weeks had the flu".
Further, with multiple abscesses the meninges typically show a purulent exudate that obscures the sulci making radiographic appearance of microabscesses less visible,. hence they are not well opacified. In severe meningitis, the basal cisterns may become completely obliterated and that is what happened here.
Morbidity due to a brain abscess generally results from brain herniation due to mass effect, in this case the result of iatrogenic neglect.
Further, rapid deterioration is an invariable accompaniment of an untreated condition, in this case pyogenic bacterial infection.. However, rapid progress of the disease may actually be displaying a pronounced "blood-brain barrier breach", chracterized clinically by an abrupt and "rapid evolution", the result of a certain medications, ie. the Stemetil.
Although it is clear that the patient was transferred to Sudbury with ventillatory support, and although Dr. Jordan was aware of the need for emergency care and life support, after ordering it, he cancelled it, without family consent, and waited for this patient's death. From the record it seems clear that this is a medical homicide.
Arlene H. Berry died suddenly and unexpectedly at the age of 41 less than 24 hours after being admitted to the Kirkland & District hospital. She presented initially with flu-like symptoms that have since been thoroughly researched.