Content may contain URLs that were valid when originally published, but now link to sites or pages that no longer exist.

According to the outpatient record at OP-54, the patient's recent head CT scan showed "NO METASTASIS", and her mediastinoscopy, samples of the cells and lymph nodes that had also been done on the same date were found to be "NEGATIVE".

Notably, mediastinoscopy is also used to stage lung cancer. From that record it seems clear that NO clinically detectable metastasis were found. The purpose of the mediastinoscopy is to show whether cancer or tumors have spread to the mediastinal nodes. Problems with damage to internal organs, infection, and bleeding are possible and can also be detected from the mediastinoscopy. What the family had found to be peculiar however, was the dramatic voice change following the mediastinoscopy that was done in Timmins on May 16th of 2000, what I assume to be vocal fold paralysis. However, the patient had began to regain her voice in the days prior to her .

The Outpatient Record at OP-53documents "pale-looking and lethargic". Lethargy is also associated with moderate to severe dehydration, including congestive heart failure. EMERGENCIES OF THE GASTROINTESTINAL SYSTEM

The same record documents a history of Tylenol and Aspirin, including "daughter states takes a lot" - suggests use of that can break the gastric barrier and damage the gastric mucosa, ie, aspirin, NSAIDs (non-steroidal anti-inflammatory drugs). Compare Salicylate Toxicity with dangers of acetaminophen.

Antibiotics may not cause side effects until they have built up in the body for several days, while an overdose of analgesics containing acetaminophen may cause damage within hours.

What I take to be the health management record from the Kirkland and District Hospital at A-21 of the medical record documents her cognitive perceptual pattern as "sedated", a sign of acute or late toxicity, such as seen in toxicity or medication overdosage.

Further findings suggest that an acutely ill, toxic appearance is a common feature in serious infections.

The same record documents what appears to be a "precaution for a resistant bacteria", as evidenced by a in the upper right hand corner of that document. The same precaution can be seen more visibly at N-9 of the nurses' notes under the subheading for "INFECTION CONTROL PRECAUTIONS".

From that information it seems clear that the healthcare providers who attended to Arlene Berry had been aware of a "gram-negative bacillus", what I believe to be a bacterium of low virulance associated with occasional infection, rash and disseminated disease that was likely to affect multiple organs in an immunocompromised patient but failed in their duty of care to closely monitor the patient's condition, or to take any precautionary measures whatsoever, marked by a complete abscence of orders or interventions. Further, details with respect to the offending organism were omitted from the record, withholding that information from the patient's family.

Notably, the same record at OP-53 is totally devoid of annotation with respect to the patient's bowel routine and urinary elimination pattern for toileting marked by a complete absence of nursing care plan as further evidenced at A-21 of the medical record.

The element of duty is straightforward and relatively easy to prove because once nurses undertake care for their patients they have a clear duty to provide care for that patient in a competent and reasonable manner.

There is absolutely nothing on record to suggest that any Supportive Care & Symptom Control Regimens were ever implemented. NO Complete Physical Exam to include an Abdominal Examination, Rectal Examination, NO PAP tests were performed. NO meaningful Nurses Diagnosis was made as per INTERNATIONAL CLASSIFICATION FOR NURSING PRACTICE.

What I take to be a continuation of A-21 of the same record seen at A-23 documents a "slurred" speech as evidenced by a √ in the upper left corner, also sign of iatrogenic drug induced intoxication in which dysarthria is a prominant finding in the setting of Portal-Systemic Encephalopathy or Dysarthria(chemically induced Dyskinesia). Dysarthria is caused by poor control of the speech muscles. Compare Ataxic Dysarthria Body

What I take to be the health management record from the Kirkland and District Hospital at A-21 of the medical record documents Arlene Berry's cognitive perceptual pattern as "sedated", a sign of acute or late toxicity, such as seen in medication overdosage.

Further findings suggest that an acutely ill, toxic appearance is a common feature in serious infections.

Further, dizziness, drowsiness, lethargy, ataxia, have all been cited with adverse events, including slurred speech, syncope, GI: constipation, nausea, vomiting, incontinence, and urinary retention. These are all findings associated with Toxic Myopathies in the setting of Drug-induced (iatrogenic) myopathies. Notes

Further findings suggest that Constipation actually gives rise to a process of self-poisoning. Thus, auto-intoxication is the process whereby the body literally poisons itself by maintaining a cesspool of decaying matter in its colon.

During fasting, the concentration of toxins expunged from the body and appearing in the blood can increase ten times above normal concentrations. The released toxins can either exacerbate the symptoms being treated or create their own symptoms such as headaches, body ache, joint pain, dizziness, sweating, general malaise, sore throat, nausea and/or flu-like symptoms.

The record at OP-54 dated May 22nd of 2000 documents a "haggard appearance" including "large blood trace leukocytes". Notably also, leukocytes (WBC's) are elevated with dehydration, hyperviscosity secondary to dehydration, and infection.

The same record documents a question mark (?) with respect to possible morphine allergies, and that for "2 weeks" she had the "flu". The same record documents bloody bowel movements for 4 days, a sign of possible diverticulitis, a condition associated with constipation with abnormal increase in the white blood cell count (indicative of infection), mucous, and blood (concealed hemorrhage) in the stool or passage of bloody stool.

It seems clear that the healthcare providers in this case did not take into account the many other medications prescribed or administered by the patient's Oncologist, Dr. Hugh Prichard over the course of her radiation therapy, between March and the end of April of 2000. i.e. Senokot for constipation, side effects of which include "severe stomache pain", and unusual change in color of urine, i.e, "tinged-urine".

Further, she had also been prescribed sodium phosphate, a hyperosmotic laxative that has many precautions which had not been disclosed to this patient, and is prescribed for constipation caused by other medicines. Compare Sennosides.

A-12 of the medical record documents a BP of 163/117 at 03:20 hours that by 03:45 hours had dropped to 85/58, and again to 85/52 by 3:52 hours, over a span of 7 minutes, as evidenced at N-2

N-10 of the Nurses' Notes document the patient's level of care as "routine", which shows very little concern.

What I take to be a continuation of the same record at N-11 documents "vomiting, lung CA". There are NO further entries on that two-page assessment.

From the RECORD it seems clear that there was every indication that Arlene Berry was about to suffer a catastrophic decline, at least from foreseeable dehydration due to decreased oral/water intake and excessive vomiting over the previous week or more which ought to have prompted immediate medical attention but did NOT.

Dr. Jordan's "discharge note" at A-1 documents that she was "afebrile" (without fever), while the record at A-26 documents a body temperature above 37.0°C. Further submit that a patient can be "afebrile" (without fever) and still have Toxic Shock Symdrome. The same record at A-26 documents a BP of 162/80 at 0220 hours that by 0235 hours had dropped to 78/70.

In the upper right hand corner of the same report D. Jordan documents 3 sets of numbers which I have traced to "anorexia, joint pain, and urinary tract infection". Note the hand scripted numerical notations from the ICD (International Classification of Disease) Code, i.e. 784.0 =Headache, 787.3 Gas/bloating , and 599.7 Hematuria . Findings are non-specific due to variations in the published literature.

The same record seen at A-1 documents "plantars upgoing bilaterally". Submit that upgoing plantar responses are associated with hepatic encephalopathy, including Status epilepticus and is also associated with intracranial infection, ie. meningitis which can result in brain herniation, meningoencephalitis, or cerebral abscess which can result in shift of midline structures. Compare Google Search

The same record documents Dr. Jordan's "I was called in later that night because she had become obtunded", (also a sign of severe dehydration) while N-6 of the nurses' notes documents obtundation as evidenced by the "no response to verbal or physical stimulation" as early as 0030 hours on May 23rd of 2000, a considerable passage of time from when he was called in and eventually showed up. Further, there is a complete abscence of documentation with respect to the patients BP between 18:45 hours on May 23rd, and 00:40 hours on May 24th, which shows very little concern, as evidenced at N-6, and N-5 of the record.

A-8 of the related record documents "patient was unconscious with respirations of approximately 30 and laboured", that is consistent with dyspnea - difficult or labored respiration. Dyspnea is breathlessness due to high filling pressures and pulmonary congestion/edema, i.e. shortness of breath, a smothering feeling, inability to get enough air, and suffocation.

Cardiac asthma which is dyspnea with wheezing, a non productive cough, and loud gurgling sounds are suggestive of pulmonary edema (Thelan, et al.1996). Compare Incidence and characteristics of preventable iatrogenic cardiac arrests.

Dyspnea can be caused by a variety of conditions, including metabolic, allergic, psychiatric, and neuromuscular disorders, and by pain. However, cardiac and pulmonary disorders are the most common causes. Compare: Altered cardiac function

Dyspnea most often has a cardiac or pulmonary etiology, although occasionally other causes, such as anemia, acidosis or neuromuscular disorders, must be considered.

In heart failure, dyspnea may result from excess fluid in the lungs. Many antipsychotic medications are associated with Risk of Cardiac Effects . – A cardiac evaluation is important in virtually all patients with brain ischemia. Not only are cardiac and aortic embolism common, but many patients with cerebrovascular occlusive disease have concurrent coronary heart disease as will be deduced from the facts of this case.

Compare: eMedicine - Pulmonary Edema, Neurogenic : Article by Sat Sharma, ... Neurogenic shock- loss of vascular tone due to anesthesia or spinal cord injury. Compare Fluid and Electrolyte Balance.

A-5 documents Dr. Jordan's "no change in orders" at 0100 hours. Further, the same record documents that Dr. Jordan was notified of the patient's condition at 0225 hours on May 24th and he showed up at 0305 hours on May 24th, as evidenced by the record at N-4 of the nurses' notes.

At the time of her admission to the hospital, Arlene Berry's pressure was documented at 115/70, with a pulse of 79 and regular, a respiration rate of 18, with signs of mild diffuse (widespread) weakness as evidenced by the record at A-6. At the time of that assessment she was found to be "alert and oriented", with "NO Focal deficits". Even multiple brain abscesses may not cause focal deficit to suggest their presence. The bald truth however, is that Arlene Berry had presented with signs and symptoms of dehydration and hepatic dysfunction at the onset, signs and symptoms which Dr. Spiller in his professional capacity as the ED physician failed to recognize until it was too late. Further investigations suggest that Dr. Spiller had been a local appointed coroner, working under or acting for Dr. Barry McLellan. Also, Dr. Mark Spiller sits on the Board of Governors - Kirkland and District Hospital. The KDH is a partner in the N.O.R.T.H. Network.

According to the hospital record Arlene Berry was admitted to the Kirkland and District Hospital on May 23rd of 2000 by Dr. Spiller with signs and symptoms suggestive of a bout of the flu. There was emesis of yellowish fluid, what is termed as bile.

Compare: BILIOUSNESS. (Congestion of the Liver, Sluggish or Torpid Liver). Reference - When the bowels stop working the body gets toxic. Biliousness is "a symptom of a disordered condition of the liver causing constipation, headache, loss of appetite, and vomiting of bile". Constipation Factoid

When Red Blood-Cells complete their life cycle and break down naturally in the body they produce a "yellow pigment" which is then passed to the liver and excreted into bile.

Initially, the vomitus was yellow in color but a later episode may have been greenish as evidenced by "large queery bloody emesis" documented at N-5 of the Nurses' Notes. This would be considered "bilious emesis" and is suggestive of a more significant back up of intestinal material. Compare Hepatobiliary System - Biliousness, including Hepato-Biliary & Gastro-Intestinal Summary of Clincial Indications .... Compare Symptom: Vomiting - green vomit, fecal associated with Bowel Obstruction. - Cached .

When bile is present, the vomitus is greenish , or yellowish. THE MERCK MANUAL--SECOND HOME EDITION, Symptoms in Ch. 119 ... Cached

Bowel obstruction information - encyclopedia article about Bowel ...
Shock, circulatory » Medical Diagnosis [PDF] Circulatory Shock Reading Assignment
File Format: PDF/Adobe Acrobat - View as HTML Compare HYPOTENSIOM Bilious Emesis suggests Small Bowel Obstruction - Emesis stainedgreem with bile.

Arlene Berry was still neurologically responsive when I saw here following her admission and in fact she was able to reach and use for herself the kidney basin at her bedside table as she occasioned to vomit more of the same "flu-like yellowish bile" (bilious vomitus) that she had done so many times on the days before, and in fact, she used it for herself in our presence at which time a cool cloth was provided by the nurses as evidenced by that record.

It seems clear that generally a cool cloth is provided when a "mild or low grade fever" is present.

The same record documents that the patient had stated that she was then "feeling a little better" whereupon she was then assisted to bed. From that record it seems clear that she was at least benefiting from Hydration. That the effects of the given medications had not yet taken effect should also be borne in mind.

The record at N-6 also documents telephone orders received by the hospital from Dr. Jordan at 2030 hours for Stemetil 10mg by IV 4 times daily for "control of nausea", given by the RN, as further evidenced by the physician's orders seen at A-11. It is also clear that the patient was given CONTRAINDICATED medication while she was in an altered state of consciousness at that time, as evidenced on the record by extreme somnolence.

Further, Arlene Berry had stated that she was "very tired". It is also clear that Dr. Jordan sought to eliminate the symptom "nausea" ,without his attendance as evidenced by the phone order "for control of nausea" and without addressing any possible underlying causes. It seems clear that Dr. Jordan neglected to consider the etiology of the nausea and vomiting as a condition requiring prompt medical intervention.

A typical single dose of Stemetil for a small woman with low body weight is 5mg. Arlene Berry was given 10mg, (possibly x4), double the recommeded dosage, together with other medications.

According to my investigation, prochlorperazine is classed as a phenothiazine that is widely distributed into body tissues and crosses the blood-brain barrier. The drug is highly plasma protein bound (91-99%) and has a duration of activity from 4 to 6 hours.

There are two things for certain: 1) there was "yellowish bile" vomitus at the time and shortly after the patient's admission to the Kirkland and District Hospital on May 23rd of 2000, and 2) there was "bloody emesis of redish brown", and "coffee-ground vomitus" following admisistration of the drug Stemetil®.

The record at 0020 hours seen at N-6 documents the patient's discovery by duty nurses of the patient's "head against the left side bed rail with her feet under the right side rail" and "without response" to either verbal or physical stimulation that is consistent with a Dystonic reaction to the Stemetil.

Dystonia is defined as a movement disorder characterized by sustained muscle contractions, frequently causing twisting and repetitive movements (also associated with tonic-clonic seizure provoked by DRUG-toxicity) or abnormal postures that can result in distorted postures. Compare dystonia secondary to brain insult.

Compare Systemic Hypoperfusion in which brain ischemia due to inadequate cardiac output with systemic hypoperfusion can be caused by acute myocardial infarction, cardiac arrest, and life-threatening ventricular arrhythmias. Less common causes are pulmonary embolism, acute gastrointestinal or systemic bleeding, and shock.

Compare Neurological Emergencies: Coma, Seizures, Syncope, Stroke. 58. Compare Gastrointestinal Complications (gastrointestinal). Causes of hypovolemic shock include blood-loss due to trauma or gastrointestinal bleeding, and is also associated with bowel obstruction.

The admitting physician, Dr. Spiller, was up to assess the patient's condition at 0055 hours as evidenced at N-5. Upon examination he documented the patient's eyes as being "sluggish", and also that there was no response to "deep pain". She was simply repositioned by the nurses as evidenced by the record at N-6.

From that record it seems clear that the patient had suffered a near fatal reaction to the given medication at that time and that far from getting better she was becoming progressively worse as evidenced by a sense of "urgency" seen on the record to the attendance of the patient with increased activity documented and the ED physician, Dr. Spiller up to assess the patient between 0030 hours as evidenced at N-6 and also at 0055 hours as evidenced at N-5 of the Nurses' Notes. I assume that Dr. Jordan would have been alerted. According to the record he called in at 0100 hours but nevertheless opted not to change his orders as evidenced by his "no change in orders" also seen at N-5.

From that record it seems clear that both doctors should have realized that they were faced with a critically ill young woman who was not responding to treatment and they should have been acutely aware of the danger. It is also of interest to note that NO attempt was made by either of the doctors to place the patient in the ICU at that time, between 0030 and 0055 hours.

It is also clear that the patient continued to receive the prochlorperazine even after she had become comatose. There is absolutely nothing on record to suggest that the offending drug was ever discontinued.

Further, between 0200 hours and 0220 hours her BP had risen from 150/72 to 162/80, a sign of mounting hypertension such as caused or worsened in response to treatment. The record at A-26

documents 0220 hours as the time of that assessement, while N-5 documents the time of thae same assessement at 0230, but appears to have been written over.

The same record documents a Heart Rate (HR) in the 160's with a rapid drop in blood pressure (BP) to 98/70 by 0235 hours. Septic shock is a potentially lethal drop in pressure due to the presence of bacteria in the .

By 0220 hours the patient's respiration rate was documented as "deep and soaring and without constant jaw thrust", a sign of constriction. The same record at N-5 also documents gurgly respirations. Gurgly respirations are associated with fluid ion upper airway that is consistent with obstructed airway, or dysphagia (swallowing difficulty) or depressed gag reflex and diminished respiratory drive associated with adversities of toxic neuroleptic agents.

Dysphagia associated with the drug Stemetil, points to " BOWEL OBSTRUCTION [PDF]", and is also associated with "RADIOTHERAPY-INDUCED ACUTE GASTROINTESTINAL TOXICITIES". Compare Profiles and Time Course of Acute Radiation Toxicity Symptoms ...

Inability to swallow results in drooling (patient requires suctioning), and is associated with Parkinson-like symptoms. Drug-induced parkinsonism is commonly produced as an adverse effect in antipsychotic drug therapy. Abnormal sounds in the lungs is also associated with inflamatory disorders of the esophagus, gastroesophageal reflux, fluid around the lungs, fluid in lung (pulmonary edema )and/or pulmonary edema associated with congestive heart failure.

Tardive dyskinesia are involuntary movements, especially of the lower face, that develop after exposure to a group of medications known as neuroleptics. The drug Stemetil is such a medication and short spasmodic contractions of the right leg were observed following intubation. The abnormal movements include tongue thrusting, explains the use of the plastic oral airway, and the "without continuous jaw thrust" documented at N-3 of the nurses'notes. The same record at N-3 documents a BP of 163/70 at 0320 hours that by 0352 hours had dropped to 85/52.

Further, N-5 of the record documents "family in" at 0250 hours. On seeing the patient, we found her to be propped up in the arms of two nurses, gasping for air, with only a plastic oral airway in her mouth.

The same record at N-5 documents a rapid drop in BP to 98/70 at 0235 hours with physician "assessments unchanged" despite the fact that the patient had already gone into respiratory distress, as evidenced by "Cheyne-Stokes" respirations with periods of "apnea" lasting 5-8 seconds. Central sleep apnea is particularly linked with heart failure.

High blood-pressure, which is associated with sleep apnea, is also a major cause of later heart failure. Stroke victims with sleep apnea tend to have higher levels of blood protein fibrinogen than stroke victims without sleep apnea. Fibrinogen is a factor in blood that causes it to clot. Higher levels of fibrinogen have been linked to both stroke and heart attack risk. High levels of fibrinogen represented a significant risk factor for both heart attack and ischemic stroke.

Notably, the central mechanisms that regulate breathing fail in severe hypoxia leading to irregular respirations, Cheyne-Stokes breathing, apnea, and respiratory cardiac failure in which hypoxia leads to obtundation. Lack of blood-supply and/or lack of adequate oxygen delivery causes hypoxic damage to the nervous system: Apnea is due to airway obstruction caused by major decreases in pharyngeal muscle activity.

The cause of hypoxia is relatively easy to understand. It simply means that the blood is well oxygenated, there is enough oxygen carrying agent (hemoglobin) in the blood, the blood-flow (CO) is good enough to carry the oxygen rich blood to the tissue, but the tissue cannot utilize the oxygen, since there is a toxin present that prevents oxygen uptake by the cells. Shock, is defined as a reduced tissue perfusion.

Hypoxic comes from the Greek word "hypo" meaning "under", the word "oxygen," and the Greek word "ikos" meaning "pertaining to." Ischemic comes from the Greek word "ischein" meaning "to hold back" the Greek word "haima" meaning % blood," and the Greek word "ikos" meaning pertaining to." Encephalopathy comes from the Greek word "enkephalos" meaning "brain," and the Greek word "pathos" meaning "suffering." Put the two words together and you get "brain suffering."

Further, there is nothing on record to suggest that the patient was adequately oxygenated prior to intubation and from these records it is also clear that the health care providers withheld life support for the purpose of accelerating death when the patient became critically ill. A plastic oral airway does not provide needed oxygen.

The same record at 0255 hours documents a "sudden large bloody-emesis of reddish brown" or what is known in medical circles as "coffee-ground emesis" ie. dark brown tinged "vomitus" the color and consistency of coffee-grounds composed of gastric juices and old blood (old blood which can grow coagulase negative Staphylococci) indicative of a slow bleeding source in the upper GI tract. The presence of blood in the gastrointestinal tract results in increased amonnia and nitrogen absorption from the gut, and may also predispose to kidney hypoperfusion. Amonnia has multiple brain and neurotoxic effects, including altering the transit of amino acids, water, and electrolytes across the neuronal membrane. Amonnia has been considered the major compound responsible for hepatic encephalopathy. Compare acute neurotoxicity of Amonia in Portal-Systemic Encephalopathy

Notably also, multiple medications, restricted diet or poor nutrition causes gastrical intestinal or GI lesions to GI bleeding.

Reference: Pathology of Gastrointestinal Bleeding, and flu-like symptoms associated with Hepatitis C. Compare also Ischemic Hepatitis - Shock Liver Hepatic ischemia is a deficiency of blood or oxygen supply to the liver that causes injury to liver cells. Low blood-pressure resulting from any condition -- including heart failure, abnormal heart rhythms, dehydration, severe bleeding, and infection - can lead to hepatic ischemia.

Gastrointestinal bleeding is considered a potential medical emergency. From that record, it is clear that nothing was immediately done to determine a possible cause of the internal bleeding or to treat accordingly. The visible evidence is described as hematemesis, hematochezia and/or melena. In this case there is evidence of neglect with respect to both hematemesis, and melena. It is also clear that Dr. Jordan showed no concern for this patient is spite of her worsening condition. Further findings suggest that blood turns brown from lack of oxygen. Decreased amount of oxygen. = Hypoxia. Compare NINDS Cerebral Hypoxia Information Page.
.

According to my research, gastrointestinal bleeding should have been controlled if possible and blood purged from the gastrointestinal tract, but this was NOT done. Further, Dr. Spiller (the ED physician) did nothing to lessen or prevent the outcome, suggestive of his complicity, acquiescence, to cover-up for Dr. Jordan's stupidity, or outright incompetence or other negligence of his own.

The record at N-4 documents the patient's "transfer to ICU" at 0320 hours. The record at A-27 documents a BP (blood pressure) of 163/117 (high BP in response to distress or pain) at the very same time. Similarly, A-16 documents a BP of 121/81 at 0400 hours, while N-2 documents a BP of 112/57 at the very same time.

The record at A-24 documents the charting of the patients vital signs that commenced recording at 0315 hours. It is interesting to note that the patient's transfer to the ICU had NOT yet taken place, that NO attempt was made by the healthcare providers to place the patient in the ICU prior to 0320 hours and further that the patient's condition remained critical throughout the night and into the small hours of the morning notwithstanding.

The same record documents a heart rate (HR) of 174 bpm at 0320 hours during the intubation procedure that is consistent with deep pain suggestive of "internal injury".

. From these records alone it seems clear that the healthcare providers had done too little too late for this patient, as evidenced at N-9 N-10, and N-11, and also at A-3 and A-21 of the medical record.

. The record at N-4 of the Nurses' Notes documents "incontinent blood tinged urine" at 0305 hours that is consistent with impaired water excretion marked by "incontinent" urine output suggestive of possible hyponatraemia.

OP-54 of the Outpatient Record documents "large blood trace leukocytes" that is consistent with staphylococcal infections suggestive of a possible hospital acquired infection.

Incontinence is loss of bladder control and is a very serious side effect of antipsychotic medications such as Stemetil.

Predisposing factors for staphylococci infections include foreign bodies, including intravascular catheters. Additional findings suggest the presence of viruses in the blood-stream has been scientifically shown to induce a physiological state called "hypercoagulability." The risk of venous thrombosis is greater if patients are dehydrated.

N3 of the Nurses' Notes documents a " large amount of "dilute urine" at 0325 hours, only 20 minutes later, and again at 0450 hours as evidenced at N-1 of the record that is inconsistent with the record as a whole, and in particular with respect to A-16, marked by a complete absence of documentation as to water refill to justify urine-output.

Compare: Fluid overload, hypokalemia search results associated with large amount of dilute urine . A search using the terms "hypokalemic, alkalosis, low blood-pressure, antipsychotic medications can be traced to anorexia nervosa, suggestive of iatrogenic anorexia in which the main causes of nausea and vomiting can be traced to morphine. Other causes include untreated Electrolyte Imbalances. Untreated, these conditions can be life-threatening.

Anorexia Nervosa (Latin term meaning "nervous want of appetite") is a potentially fatal eating disorder. It can also have iatrogenic causes. COMPARE Dangers Of Anorexia in which death is attributed to but not limited to any (combination of) the following: heart attack or heart failure; lung collapse; internal bleeding, stroke, kidney failure, liver failure; pancreatitis, gastric rupture, and perforated ulcer. These are but a tip of the iceburg consequences of eating disorders precipitated by medical treatments/procedures leading to heart arrhythmias, shock or myocardial infarction.

It is also of interest to note that, that there is also a complete absence of documentation with respect to the patient's elimination pattern for toileting, as evidenced at N-10 of the record that is consistent with constipation.

Further, there are numerous material deficiencies in the related medical records in which several pages of documentation manifest a lack of internal consistency ranging from out of sequence reports, such as the Triage Record seen at A-5 to obviously rewritten, altered and falsified nursing notes seen at N-1 N-2 and N-3, marked by error, inconsistency and contradiction, to the Ventilation Record seen at A-16 and A-17 presenting similarly with entries that are self-serving, i.e. needlessly explanation of events,i.e "without adversities", to N-4 and N-5 presenting with less than half a page suggestive of deliberate ommission,and multiple write-overs with respect to date and time that clearly suggest that the author was neither oriented to time or date, and authenticated by what appears to be the initials 'JM', what I take to be that of of the RN as evidenced at A-15 of the record signed by what appears to be the name "J. McCrank".

The physicians Diagnostic Sheet at A-3 ought to have been placed on the record at the time of the patient's admission, as well as the Emergency Record seen at A-4, not filed in chronological order, both of which were dated using a "rubber stamp".

Further, Ambulance Call Report was filed on the record at N-7, and N-8 of the Nurses' Notes. That document ought to have been placed on the patient's file at the time of her discharge when she was sent out to Sudbury, according to the time of that event.

A-9 of the record, Dr. Jordan's Critical Care Note documents the 'Medi-Vac team were due to arrive at approximately 0435" hours, while the Ambulance Call Report at N-8 documents the time of the call event for call received at "0620" hours.

The record at A-6 documents the patient as having a "history of metastatic lung cancer", while the record at OP-54 documents "NO metastasis", and the Mediastinoscopy which test samples of the cells and lymph nodes for examination under a microscope are clearly documented as "NEGATIVE.".

Mediastinoscopy is used to stage lung cancer. Both of the aforementioned records document the results of the testing that was done at the Timmins & District Hospital on May 16th of 2000.

There are several late dictations, all of them questionable and I can count at least 3 two-page documents seen at A-1 through A-2, including A-6 through A-7, and also at A-8 and A-9 of the medical records, as evidenced by the times and dates upon which they were dictated and transcribed.

Further, A-4 of the record, what I take to be a Trauma Legend barely visible in the Physician's Notes situated at the lower right hand side of that page there is an obliterated area suggesting perhaps a "white-out", or erasure. There may be others but due to the fact that these are photocopies and not the original records they are not well opacified, however further and other evidence may present similarly upon forensic examination.

A-1 of the record documents "she had a left lung pneumonectomy back in October of 1999", which is erroneous.

A-17 also documents the "removal of left lung in '99", the very same error , suggestive of having been copied.

The same record at A-1 documents "I was called in to see her later that night because she had become "obtunded ". According to the record at N-6, it seems clear that the patient had already become obtunded (unresponsive) as early as 0030 hours, as further confirmed at 0055 hours when the ED physician was up to assess the patient condition, prior to the time Dr. Jordan phoned in regarding the patient's condition, as evidenced at N-5 of the hospital record.

A-1 of the record also falsely documents "she died several days later with numerous metastatic lesions to her brain". According to the Death Certificate, Arlene Berry died May 24th of 2000, the very same day, unless it was falsified?.

What I take to be the Ventilation Record at A-17 documents the arrival of the ventilatory therapist, Helene Studholme in the ICU at 0330 hours after being "called in for patient requiring ventilation."

N-3 of the record documents the time of the patients intubation by Dr. Jordan at 0325 hours, 5 minutes earlier, suggesting that Dr. Jordan intubated the patient unassisted. The same record documents patient "suctioned down ET tube several times for small amount of brownish mucous", while A-17 documents the patient as "being suctioned for moderate amounts of coffee-ground emesis by RN" at 0330 hours that is consistent with GI bleeding.

N-2 of the record documents the ET (endotrachial tube) "pulled back" at 0425 hours. The patient was intubated at 0325 hours, one hour earlier. From that record it is also clear that the Endotrachial Tube or ET had been "malpositioned" one full hour before the error was discovered by one of the nurses, as evidenced by that record. Both myself and the patients foster brother were present to witness that event.

According to my research, women have a greater chance of iatrogenic injury from endotracheal tubes, because their tracheas are smaller and thus are at higher risk for iatrogenic tracheobronchial tear. In traumatized tissue, bacterium produces many toxins. Further, prolonged suction can result in infection if the mucous membranes are traumatized.

According to my research when an endotrachial tube is misplaced in the esophagus and misplacement is detected late, the compromise of the patients safety can be significant. Perforation of a viscous into the peritoneal cavity, i.e. the intra-abdominal esophagus, or other trauma related causes in which ascites may become infected secondary resulting in spontaneous bacterial peritonitis cannot be ruled out. Ascites is an excess of fluid in the membrane lining of the abdomen (the peritoneal cavity). Most cases of bacterial peritonitis occur as a result of ascites due to chronic liver disease, or in kidney failure

Clinical signs and symptoms of biliary peritonitis include abdominal pain, nausea, and vomiting. Spontaneous bacterial peritonitis is common in patients with late onset hepatic failure. When confronted with a patient complaining of abdominal pain, the provider must first rule out catastrophic causes of pain, such as dissecting aortic aneurysm, perforated viscus, or bowel obstruction. Acute mesenteric ischemia... is an abdominal emergency due to inadequate tissue perfusion. The mucosal barrier becomes disrupted as the ischemia persists, and bacteria, toxins, and vasoactive substances are released into the systemic circulation. This can cause death from septic shock, cardiac failure, or multisystem organ failure.

Mesenteric ischemia is caused by an interruption in blood flow to all or part of the small intestine or the right colon. Abdominal pain may be absent in 15-25% of cases. Associated GI symptoms are common.

Traumatic injury to the central nervous system (CNS) initiates an autodestructive cascade of biochemical and pathophysiological changes that ultimately results in irreversible tissue damage.
Esophageal Perforation, Rupture and Tears. See ESOPHAGUS ILLUSTRATION.

A-26 of the record documents a BP of 78/70 at 0235 hours, while N-5 of the Nurses' Notes documents a BP of 98/70 at the very same time that is consistent with copious error. The same record documents a body temperature above 37.0°C. Fever has been defined as a body temperature elevated to at least 1°F above 98.6°F (37.0°C). According to the record the documented temperature is just under 38.0°C

Low blood pressure is a sign of shock and can also contribute to further decreasing perfusion. Hypotension = systolic pressure <90 mm Hg). Hypotension itself is a late sign of hypovolemia or hypovolemic shock.

A-16 documents a BP of 163/117 at 0330 hours, while N-3 documents a BP of 136/85 at the very same time. (Suggests Hypertension Stage 2: *Compelling indications are high-risk situations such as CHF, MI, CHD, diabetes, kidney disease, stroke. Patients with chronic kidney disease or diabetes are treated to BP goal of less than 130/80 mm Hg. Compelling indications have specific medications). Bloodpressure is usually considered normal if it's above 90/60 mm Hg, but can vary from person to person.

Further, N-3 documents a "large amount of dilute urine" at 0330 hours, and also at 0425 hours as evidenced by the record at N-2, and again at 0450 hours as evidenced at N-1, suggestive of overly rapid "fluid overload" due to overzealous and negligent IV infusion, and may be associated with hyponatremia caused by impaired water excretion in the presence of continued water intake. Hyponatremia is a condition known as "water intoxication." It is the opposite of dehydration.

Compare Electrolyte Physiology. Excessive urine-output of very dilute urine can also result in large free water losses and severe hypernatremic dehydration. Compare: Fluid and Electrolytes. In contrast, an acute adrenal crisis can present with vomiting, abdominal pain, and hypovolemic shock.

Various edematous disorders, including heart failure and hepatic cirrhosis, are associated with hypervolemic hyponatremia.

NOTE: There is nothing on record to suggest close monitoring of serum sodium (serum Na) levels. Irreparable harm can befall a patient when abnormal serum sodium levels are administered or corrected too quickly or too slowly.

Hyponatremia is the most common electrolyte disorder and is associated with brainstem herniation due to cerebral edema. Compare:.Electrolyte Disorders. and . Traumatic Disorders. Brain herniation may also occur with bacterial meningitis.

Interestingly, hyponatremia is also associated with dehydration , and patients with clinically significant hyponatremia present with non-specific symptoms attributed to cerebral edema, ie. anorexia,nausea and vomiting, lethargy, headache, obtundation, and signs of brainstem herniation , including coma; they have fixed unilateral or dilated pupils, abnormal posturing, and respiratory arrest.

A-16 of the record also documents a blood-pressure of 121/81 at 0400 hours, while N-2 of the Nurses' Notes documents a BP of 112/57 at the very same time.

At 0352 hours the patient's blood-pressure was documented at 85/52, some 17 minutes later, as evidenced at N-2 (in which BP is inadequate for normal perfusion and oxygenation. According to my research, at the point of loss of BP the resulting end organ injury is often irreversible ie., endothelium, lung, kidney liver, etc. Compare azotemia, in which renal underperfusion cannot be rulled out.

A-24 of the record documents a Heart Rate of 154 at 0330 hours while the Ventilation Record at

From these records it is clear that nothing was done to bring the patients blood-pressure under control in a timely manner and would have resulted in "permanent brain damage" at that point. According to my research, there would have been a loss of perfusion and autoregulation with rapid drop in BP and it is also clear that when it did happen, nothing was immediately done to correct it.

NOTE:Within seconds to minutes of the loss of perfusion to a portion of the brain, an ischemic cascade is unleashed that, if left unchecked, causes a central area of irreversible infarction = Ischemic Stroke. Thrombotic strokes are a major cause of brain attacks. Researchers have determined the cause to be associated with thrombotic thrombocytopenic purpura that can lead to kidney failure or stroke. A stroke has the same relationship to the brain as a heart attack does to the heart; both result from a blockage in a blood-vessel that interrupts the supply of oxygen to cells, thus them. Compare Hemorrhagic Stroke.

The Coroner's expert documents "decreased attenuation throughout both cerebral hemispheres suggesting no cerebral perfusion", which supports 1) a loss of cerebral perfusion associated with an untimely response to a rapid drop in BP, and 2) inadequate oxygenation, despite the fact that oxygem levels were returned to normal by compensatory mechanisms, marked by a clinically evident inability to adequately ventilate and/or oxygenate. Compare: SHOCK - A clinical syndrome defined by a state of profound and widespread reduction in tissue perfusion. ? Shock/ Hemorrhage/ Thrombosis Shock - A low-perfusion circulatory ... main organs affected: brain, heart, lungs, kidney.

It is also of significance to note that adequate cerebral perfusion must be restored within 3-5 minutes for complete neurological recovery. It is also clear that this was NOT done.

The physicians Critical Care Note, a late dictation which purports to have been dictated at 0420 hours on May 24th of 2000 seen at A-8 of the record documents "later that evening she rapidly deteriorated and became unconscious without responding to verbal stimuli or painful stimuli", while the record at

N-2 of the Nurses' Notes documents "attempts to pull away to painful stimuli" at 0400 hours only 20 minutes earlier, suggesting that she was indeed responsive. I was present at the time and had asked the patient 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, she appeared to be more "paralyzed" than anything from the given meds (with the exception of twitching or short spasmodic contractions of the right leg), suggestive of the "locked-in-state", for example, a condition in which a person is conscious and able to think but is severely paralyzed due to nerve paralysis or spinal cord compression, a condition mimiced by high cervical cord lesions and severe drug-induced dystonias eg. prochlorperazine. Paralysis as such can also be induced by chemical restraint. Chemical restraint using phenothiazines may impair heat dissipation, as well as lower seizure thresholds and potentially increase cardiotoxicity. Due to the lowered threshold, abnormal firing results in a "domino effect" of one neuron exciting another.

According to my research, multiple blood-clots in the CSF are the initial cause of post-hemorrhagic ventricular dilatation and lysis of clots.

A-16 of the record was initialled by Helene Studholme and Janice Chamaillard, jointly. The latter is the author of N-1, N-2, and N-3 of the Nurses' Notes and the co-author of A-16 of the Ventilation Record, while 75% of that record was authored by Helene Studholme, the Ventilatory Therapist.

What I take to be the Physician's Lab Record at A-24 and A-25 documents the patients vital signs at 5 minute intervals, beginning at 3:15 hours. There is a complete absence of record in several distinct columns, primarily relating to the patients vital signs at the time of the intubation procedure, suggestive of "edited lab notes" by the physician after the fact to conceal iatrogenic (doctor caused) injury. As can be seen after comparison of the records the credibility of the doctors and nurses,the physician's records, the Nurses'Notes and the record as a whole are severely impaired. As with discrepancies throughout the related medical records it also seems clear that liver function abnormalities were either omitted altogether, or falsified by Dr. Jordan and his accomplices and the falsification of these records is just one aspect of the Kirkland and District Hospital's conspiracy to cover up the truth.

What I take to form a part of a continuous 2 page record at A-24 and at A-25 appears to have been printed on two separate printers. Ironically, both pages are marked Page 1 of 1 (in lieu of Page 1 of 2, and 2 of 2), to rule out conformity or consistency. Further, when both pages are superimposed one over the other and held over light, the printed headings are misaligned. Further, the print sizes are slightly different. Similariy, A-14 shows a misaligned margin suggesting a split or cut in the page, with A-13 and A-27 presenting similarly.

The Cardiac Index at A-18 documents the patient's Vent Rate at 129 bpm at 0417 hours with heart and breath rate "increased", as confirmed by the Sinus Tachycardia that is consistent with systemic inflammatory response to clinical insult, or adverse event with arrhythmias secondary to medications, including electrolyte imbalances such as caused or worsened by medications, suggestive of Neuroleptic Malignant Syndrome (NMS)

The same record documents an unconfirmed ECG that is consistent with heart failure, according to one MD who sent me an eMedicine Case Diagnisis on Exertional Fatigue, by Michael E. Zevitz, MD who is Clinical Assistant Professor, Department of Medicine, Chicago Medical School. All aspects of that document are now currently being looked into for comparative analysis. Earlier on, another MD from South Africa has also emailled me suggesting Azotemia. Both of these doctors are right of course.

The same report documents an "inferior ischemia", a sign of decreased oxygen supply to vital organs suggestive of arterial occlusion, for example, resulting in reduced or poor blood-flow which can induce cerebral tissue ischemic injury by producing "mid-line shift " and " herniation" .Thus "Ischemia" is an insufficient supply of to an organ, usually due to a blocked artery. Decrease or blockage of flow to an organ or tissue = Ischemia. Ischemia leads to clinical event called "stroke". Compare The Pathophysiology of Hemorrhagic Shock - A clinical syndrome resulting from decreased blood and oxygen perfusion of vital organs resulting from a loss of volume.

Reduction in flow (relative ischemia) impairs O2 delivery and causes cerebral hypoxia.

The same record documents an abnormal ST&T wave segment on ECG that is consistent with adverse effects of the given medication, as reported in the Compedium of Pharmaceuticals and Specialties (CPS) 2003.

Interestingly, the patient's age was falsely documented at "55 years" when in fact she was only 41 years of age suggesting that this Chart may have been fraudulently replaced with that of another more elderly patient. Alternatively, it goes to the credibility of the remainder of that Chart, and the credibility of the remainder of the physician's records. Findings suggest that with older patients, the incidence of adverse reactions may be greater in patients over 55 years of age, since the half-lives of antipsychotic are often prolonged. The fact that age 55 showed up on the chart of a 41 year old patient is seen to be significant suggestive of a possible secret and fraudulent reporting of adverse events associated with the Stemetil.

The physician's Lab Work Summary at A-19 documents the charting of a course of HEMATOLOGY and Coagulation. It documents a FIBRINOGEN level of 4.67 H (the normal range is 2.00-4.00), increased in response to injury, hypertension, and trauma. Fibrinogen decreases with liver disease, due to decreased hepatic synthesis. However, fibrinogen may be normal or even elevated until late stages of hepatic disease. There is a significant correlation in the white blood-cells and plasma fibrinogen in thrombotic stroke. Fibrinogen allows blood to clot more easily. Compare: Hypertension and Risk in Ischemic Heart Disease

. The same record at A-19 documents a D-dimer test level of 1000 H (<500), including hematological findings in the High (H) and Low (L) ranges suggestive of pathology associated with blood disorders ".

According to my research, high levels of fibrinogen can cause abnormal arterial "clotting". Serum fibrinogen levels in a safe range is <300 mg/dL.

Fibrinogen acts to promote platelet aggregation - clumping together of platelets or cells in the presence of fibrinogen at the site of injury resulting in diminished blood flow and delivery of oxygen to the body, i.e. arteries, heart, brain, kidneys in which thrombosis and organ damage occur because of excess platelet aggregation. Thus excess fibrin clots capture the platelets and produce thrombosis (a blood clot that forms inside a blood vessel, or cavity of the heart) with impaired organ perfusion, such as associated with pathophysiology of meningococcal meningitis and septicaemia ... Severe Sepsis.

Table 1: Signs of Sepsis Syndrome

Hyperthermia/Hypothermia
Tachypnea
Tachycardia
Hyperdynamic Cardiovascular State (increased C.O.)
Hypotension (decreased SVR)
Impaired organ perfusion
Circulatory shock (poor end organ perfusion)
Metabolic abnormalities (increased or
decreased glucose; lactic acidosis)
Multiple Organ System Failure
Adult Respiratory Distress Syndrome
Renal failure
Hepatobiliary dysfunction
Central Nervous System dysfunction
(altered mental states)
Coagulopathy

Coagulase is an enzyme that induces coagulation. Further, thrombin — (an enzyme) is a kind of coagulase that acts on fibrinogen in blood causing it to clot. Excess circulating thrombin results from the excess activation of the coagulation cascade. Fibrinogen, a protein is released by platelets at the site of a wound. If thrombin is also present, the fibrinogen becomes fibrin.

D-dimer suggests "thrombosis" (blood clotting) and is the confirmatory test in Disseminated Intravascular Coagulation (DIC) . Thrombosis= Formation of a clots within vessels of the brain or neck. "Over two thirds of all strokes are due to thrombosis."

Trauma, particularly brain injury, is associated with DIC (Levi & Ten Cate, 1999). Compare Bacterial Pathogenesis

The aPTT = activated Partial Thromboplastin Time, a test used to determine the efficacy of various clotting factors used in the diagnosis of coagulation disorders documents the therapeutic range for Heparin therapy at 60-100 seconds (23-35 is the normal, >60 seconds=Panic) and is elevated in 90% of those with coagulopathy, an increased bleeding tendency due to decreased hepatic synthesis of clotting factor, i.e. with prothrombin ( a protein involved in clotting, most commonly prolonged by vitamin K deficiency and liver disease) time increased. The time of that assessment was documented at 0400 hours.

Notably, coagulopathy in severe sepsis is commonly associated with multiple organ dysfunction. Sepsis as the host response to infection, involves a series of clinical, hematological, inflammatory and metabolic responses that can ultimately lead to organ failure. Severe sepsis is typically associated with activation of the coagulation system, leading to deposition of thrombin in the microvasculature = Interaction of coagulation and inflammation. Coagulation system and platelets are fully activated in uncomplicated sepsis.
Keywords: Activated Protein C, antithrombotic, coagulation, endothelial cells, fibrinolysis, inflammation, organ dysfunction, sepsis

The same record documents the patients Blood-Cell Count beginning with the WBC's or White Blood-Cells (the normal is 4.0-11.0), also known as the Leukocytes with a count of 22.4 #PH, increased to more than double the normal range, and is associated with allergic response, presenting in this case with what I take to be an abnormally high alkaline pH (alkalosis). A pH above 7.0 is alkaline; the higher the number, the stronger the alkali. Blood Gasses.

Alkalosis is a condition of excess base (alkali) in the body fluids. 6.2 CHEMICAL CLASSIFICATION OF CAUSES OF CHANGES IN BLOOD pH Compare: Arterial blood gas analysis. Metabolic Alkalosis.

The White Blood-Cells (leukocytes) are also elevated with dehydration, hyperviscosity secondary to dehydration, and infection causes. It is the most common form of leukocytosis. Leucocytosis is an increase in the number of white blood-cells in the blood. It is a common feature of inflammatory reactions, particularly those caused by bacteria. The type of leucocyte increasing in number is dependent on the stimulus type and chronicity; subtypes include: neutrophilia,basophilia, eosinophilia, lymphocytosis, monocytosis. Leukocytosis with increased neutrophils Lab Findings in Genitourinary (Renal) Disease eMedicine - Urinary Tract Infection, Females : Article by Wesley W ...

Leukocytosis also can occur in intestinal obstruction and strangulated hernia. Pyuria refers to the presence of abnormal numbers of leukocytes that may appear with infection in either the upper or lower urinary tract or with acute glomerulonephritis. Usually, the WBC's are granulocytes. White cells from the vagina, especially in the presence of vaginal and cervical infections, or the external urethral meatus in men and women may contaminate the urine. White blood cells into the urine = PYURIA.

Reference:MEDLINEplus Medical Encyclopedia: WBC count. Compare LABORATORY FINDINGS - Shock

The record at A-19 documents a Lymphocyte Count of 2.0 L (low) suggestive of "Lymphocytopenia" in which LYMPHOCYTES are reduced with nutritional deficiency, infection or an exhausted immune system - a state of immunodeficiency characterized by a reduction of the number of T-lymphocytes, unlike absolute lymphocytosis in peripheral smears w/ seen in malignant disease.

Compare: Autoimmune Hepatitis, a disease in which the body's immune system attacks liver cells. This causes the liver to become inflamed (hepatitis). A person with autoimmune hepatitis has autoantibodies circulating in the blood-stream that cause the immune system to attack the liver. This disease is associated with other autoimmune diseases, including hemolytic anemia. Compare: Non-immune hemolytic anemia caused by chemical or physical agents: non-immune adverse reactions. Autoimmune disorders develop when the immune system destroys normal body tissues. This is caused by a hypersensitivity reaction. hemolytic due to toxic agents, ie. infection, bacterial lysins. Compare Drug-induced immune hemolytic anemia.

The word "auto" is the Greek word for self. The immune system is a complicated network of cells and cell components (called molecules) that normally work to defend the body and eliminate infections caused by bacteria, viruses, and other invading microbes.

In toxic shock, profound but transient lymphocytopenia associated with marked leukocytosis was the most striking laboratory finding and one not previously emphasized in the literature. S. aureus was isolated from sites of soft-tissue infection, the or the endocervix in all except one case.

. Lymphocytopenia causes may also arise from accelerated destruction of T cells or other syndromes associated with depletion of lymphocytes . Low numbers of lymphocytes may be seen in different diseases such as hepatitis, lymphoma, or AIDS. Staphylococcus Aureus - Enterotoxin L is yet another virulence factor, and it can activate T cells.

Compare: Hepatitis Central, Lymphocytes. Further, signs of toxic shock syndrome when T cells are absent: S. aureus shock in immunodeficient patient's.

Interestingly, iatrogenic lymphocytopenia is caused by cytotoxic chemotherapy and radiation therapy, marked by a reduction in the absolute number of T cells. Lymphocytes are the most sensitive to whole body radiation and their count is the first to fall in radiation sickness. The number of lymphocytes declines within the first 12 to 48 hours after exposure. This is followed over several weeks by a decline in the number of other blood-cells. The decline in lymphocytes is one of the best early signs of the severity of the radiation injury. The Immune System and Radiation - Hanford Health Information ... THE MERCK MANUAL, Sec. 20, Ch. 278, Radiation Reactions And ... Sec. 11, Ch. 135, Leukopenia And ...

The same record documents an Absolute Lymphs (Lymphocyte) Count of 124. 0.4L (low), suggestive of "ascites", a sign of chronic liver disease, or evidence of cardiac failure, due to fluid build-up in the abdomen in which liver disease is the most common cause. Among conditions that contribute to ascites development include hepatitis and heart or kidney failure. The main pathogenic factor is sodium retention. Compare: Ascites, Symptoms, Signs, and Diagnosis. Clinical review Underlying condition causes of Ascites: heart, lung, and liver disorders. What are the signs and symptoms of the condition?. As can be seen, abdominal pain is at the top of the list with causes of the condition traceable to radiation therapy, side effects of which include bowel obstruction, and heart disease, or congestive heart failure. Congestive heart failure, also known as CHF, is a condition in which a weakened heart cannot pump enough blood to body organs. Since the pumping action of the heart is reduced, blood backs up into certain body tissues.

Corticosteroids, such as prednisone, can reduce damage to healthy organs. None was prescribed nor given by the patient's oncologist, Dr. Prichard, nor any other doctor who attended to this patient while she was under their care.

If the ascites is due to liver disease the fluid may be clear to "yellowish", uninfected and have a low cell count. If bacterial infection is present in ascites this may suggest spontaneous bacterial peritonitis in which abdominal pain is a prominent finding. If peritonitis is not treated promptly and effectively multisystem organ failure occurs rapidly. Liver function tests, including clotting profiles were NOT done in a timely manner.

Further, the same report documents the Neutrophils (also known as granulocytes) with a count of 92.0 H (normal 47.0-77.0). Neutrophil accumulation in tissue is a hallmark of inflammation and is associated with a variety of pathological conditions. The same record also shows Absolute Neuts of 20.0 H (normal 1.3-6.7), and is increased in response to acute infections (bacterial or viral), blood-toxicity and hemorrhage.

Toxic change in neutrophils is not necessarily associated with "toxemia". The term derives from the fact that these abnormalities were first noticed in human patients with gram negative sepsis and endotoxemia. Toxic change in neutrophils can be associated with inflammation of any cause if severe enough to intensely accelerate neutrophil production.

Study of Information : Endotoxins and other bacterial products appear to cause direct cellular injury while eliciting cytokines that attract neutrophils, which enhance (hypersensitization, brain edema (during bacterial meningitis, brain edema can lead to increased intracranial pressure), and hypercoagulability with vascular inflammation from endotoxin) the inflammatory effect >>endotoxin shock. It has been well-described in the scientific litererature that the presence of endotoxin is common in rapidly dividing bacteria at sites of localized infection and abscesses in the gut.

The HCT (hematocrit) shows a count of 0.361 L (low). A low hematocrit is referred to as being anemic. There are many reasons for anemia. Some of the more common reasons are loss of (traumatic injury, surgery, bleeding colon), nutritional deficiency (iron, vitamin B12, folate), bone marrow problems (replacement of bone marrow by cancer, suppression by chemotherapy , kidney failure). An abnormal hematocrit = sickle cell anemia. Signs of blood loss, such as shock, hypotension, and a falling hematocrit level are associated with liver trauma. One caveat: bleeding may be severe even when the hematocrit is normal since it can take 24 to 72 hours to reflect the volume loss.

HCT - Hematocrit is thus the measurement of the percentage of red blood cells in whole bloodwith a reduction suggestive of anemia. Normal Female Range is 37-47%. Anemia is present when hematocrit is <37% in women.

The RDW (Red Blood-Cell Distribution Width) shows a count of 18.4 H (normal 11.50-16.8) increases before MCV (Mean Corpuscular Volume) becomes abnormal suggestive of anemic hemoglobinopathy.

A-19 documents a normal Hemoglobin with a Count of 120, (normal 120-160). Hemoglobin carries oxygen supply to vital organs. Facts suggest inadequate oxygenation despite the fact that oxygen levels were returned

CO2 diffuses through blood-brain barrier into the CSF to form H+ (via carbonic acid) which then causes the vasodilation

Deficient oxygenation of the blood (<90 mm Hg arterial pO2). Decreased arterial pCO2 as occurs during hyperventilation causes cerebral vasoconstriction, decreased blood flow, and cerebral hypoxia.

1) Reduction in blood flow (relative ischemia) impairs O2 delivery and causes cerebral hypoxia. 2) Unconsciousness results after only a few seconds of oxygen deprivation. Compare: Cerebral Blood Flow
View HTML

Further, RDW is a standard part of the complete blood count. (The Mean Corpuscular Volume (MCV ) test is usually used to determine what type of anemia a person may have. If elevated, it may indicate anemia from vitamin deficiency such as Vitamin B12 or folic acid. If it is below normal, it usually indicates anemia from iron deficiency.)

Mean Corpuscular Volume (MCV) Increased with
1. Vitamin B12 Deficiency
2. Folate Deficiency
3. Immune Hemolytic Anemia
4. Liver disease

The same report documents a Platelet Count of 544 H, increased with coagulopathy (platelet coagulant activities) or platelet aggregation (cohesion of platelets to each other forming clumps). Platelets are thus cells that form the primary mechanism in blood-clots.

Increased numbers of platelets in the peripheral blood = thrombocytosis. In Toxic Shock, thrombocytosis (rather than thrombocytopenia) is common.

Platelets (also known as thrombocytes) coagulate the blood. Platelets plug bleeding capillaries and vessels. With infection, or when the body is cut or otherwise injured, white blood cells (WBC's) rush to the site as the first line of defense. Platelet aggregation contributes to the coagulation cascade with activation, i.e. esophageal perforation or other trauma/procedures and can lead to DIC and hemorrhage. Platelets are also elevated with drug-reactions, including dehydration. Dehydration from any cause increases blood viscosity and raises the risk for thrombus formation.

A diminished number of platelets (below the lower limit of normal) is called thrombocytopenia and an elevated number (above the upper limit of normal) is called thrombocytosis. WBC . Increased
. See Thrombocytosis

Larger platelet volume also indicates younger and more active platelets of recent onset volume (equivalent of MCV for Red Cells) in the Complete blood Count. See Blood Tests: Complete Blood Count Tests: Complete Count

A-19 documents a Monocyte Count of 3.0 with a marked decrease as evidenced by ABSOLUTE MONOs (monocytes) with a count of 0.60 (normal 1.0-5.5) with a reduction [<0.60] indicative of a anemia. MONOCYTE: A variety of blood cells (white). The normal range for the monocyte count is 200 - 950 /µL. A decreased lymphocyte count = lymphopenia may be caused by chronic infections, severe stress (Hyperadrenocorticism), and kidney failure. An increase in monocytes is typically observed during the phase of recovery following many infections, including hematologic neoplasms. Compare: DRUG INDUCED LYMPHOPENIA associated with -

A decrease in the number of circulating monocytes may be seen with: Innunodeficiency syndrome, including congenital (DiGeorge syndrome, etc) and acquired (AIDS) conditions, Neoplasia, including Hodgkin's disease, non-Hodgkin's lymphomas, Radiation therapy, Chemotherapy/Antineoplastic.

Monocytes are considered the bodys second line of defense against infection. In cancer, leukemia or neoplasms the moncytes become "elevated or what is called Monocytosis. An abnormal increase in the number of monocytes in the circulating blood.", to rule out Metastasis. Toxic substances can also injure monocytes.

Hemoglobin is the protein inside red blood cells that carries and provides the main transport of oxygen and carbon in the . It is composed of "globin", a group of amino acids that form a protein and "heme", which contains iron. It is an important determinant of anemia (decreased hemoglobin) or poor diet/nutrition or malabsorption. Liver disease can lead to a shortage of hemoglobin. The hemoglobin test is used to check if there is enough hemoglobin in the blood.

The record documents a Glucose Random of 13.2 H (normal 4.1 - 7.8), a condition in which the amount of blood glucose (sugar) in the blood is higher than normal suggestive of hyperglycemia, a metabolic disorder, and is associated with renal pathophysiology, such as clinical diabetes, for example, and may be associated with functional renal failure, ie. hepatorenal syndrome. If levels of serum Glucose Randon are too high, the person is hyperglycemic, and may need insulin.

Three separate types of Acute Renal Failure have been identified: pre-renal, intrinsic, and postrenal. Pre-renal ARF occurs when low blood circulation leads to significantly low blood flow, and is often caused by dehydration, shock or low cardiac output (as seen in heart failure). Glucose Test.

What do abnormal results mean? Additional conditions under which this test is performed include Acute adrenal crisis. Adrenal crisis occurs if adrenal insufficiency is not adequately treated, a prominant finding in Distributive (septic, anaphylactic, neurogenic, and adrenal insufficiency mediated) Shock. Acute adrenal crisis is a medical emergency caused by a lack of cortisol (a steroid hormone secreted by the outer portion, or cortex, of the adrenal glands) - it has marked effects on carbohydrate metabolism and is an immunosuppressant.

Risk factors for adrenal crisis include physical stress such as infection, trauma or surgery, adrenal gland or pituitary gland injury. Patients may experience lightheadedness or dizziness, weakness, sweating, abdominal pain, nausea and vomiting, or even loss of consciousness.

A-20 of the Laboratory Discharge Summary documents a Serum Potassium level of 3.4 L (low) suggestive of hypokalemia (a decrease in the serum potassium concentration below 3.5 mEq/L caused by a deficit in total body potassium stores or abnormal movement of potassium into cells) which leads to an electrolyte imbalance as caused by ongoing or severe fluid losses form the GI Tract , i.e., such as from vomiting and malnutrition which can lead to weakness, fatigue and cardiac problems. Anything below 3.5 creates a serious risk of cardiac arrhythmias leading to cardiac arrest. In addition, loss of potassium and volume contraction from vomiting potentiate metabolic alkalosis.

Potassium plays a crucial role in the body, regulating heart beat and other critical functions. Low levels of potassium--known medically as hypokalemia (HI-poh-kah-LEE-me-uh) can be dangerous and potentially fatal. Thus hypokalemia can commonly result from the loss of potassium through dehydration, vomiting, and gastric suction, and is also associated with hyponatremia. See: Potassium Metabolism.Compare: Iatrogenic Hypokalemia. Search: Metabolic Toxic Electrolyte Imbalance

Hypokalemia: Abnormally low potassium concentration in the blood ; it may result from excessive potassium loss by the renal or the gastrointestinal route, from decreased intake, or from transcellular shifts. It may be manifested clinically by neuromuscular disorders ranging from weakness to paralysis, by electrocardiographic abnormalities (depression of the T wave and elevation of the U wave) by renal disease, and by gastrointestinal disorders.

The most common problems associated with reduced potassium levels are hypertension, congestive heart failure, cardiac arrhythmias, depression, and fatigue. A variety of conditions can cause the loss of potassium from the body. The most common of these conditions are vomiting, diarrhea, and other gastrointestinal problems, such as Constipation. See: THE MERCK MANUAL, Sec. 3, Gastrointestinal Disorders . Medications can also cause depletion of potassium. Hypokalaemia is commonly caused by medication.

Compare: Electolyte Imbalance -Hypokalemia and hyperkalemia. Low potassium - Hypokalemia increases the resting membrane potential of cells, resulting in muscle weakness, impaired concentrating ability, polydipsia and arrythmias. It is usually due to gastrointestinal or renal losses of potassium. Hypercalcemia

No serum Potassium replacement was ordered or administered. It is not known what the patient's potassium level was at the time of her admission. No lab tests were performed soon enough to verify or treat accordingly.

Signs and Symptoms of potassium deficiency include cardiac arrhythmia, muscle pain, general discomfort or irritability, weakness, and paralysis. In my opinion the ED physician, Dr. Spiller should have ordered monitoring by electrocardiogram and done appropriate testing at the onset, but failed in his duty of care to do so.

That the patient was seen by family to be propped up in the arms of two nurses hyperventilating or "gasping for air" with only a plastic oral airway in her mouth should be borne in mind.

The ambulance call report seen at N-7, of the Nurses' Notes documents that the patient was intubated and vented and that she was seen to be stable but that she appeared to be "pale, dry and cool," clinical manifestations of adrenal insufficiency, or HYPOVOLEMIC SHOCK: fairly reliable signs of compromised perfusion Pale – Whitish color indicates hypo perfusion (shock), is a medical emergency. Compare:EM guidemap - Upper GI bleed, including ANS and Shock.

Compare Shock Syndromes in which vasoconstriction, pallor, cold peripheries all point to circulatory failure.

Hypovolemic shock occurs when there is insufficient or inadequate blood circulating throughout the body. The most common causes of hypovolemic shock include hemorrhage from any source, or blood volume depletion related to dehydration. Hemorrhage is defined as a loss of from any cause. Common causes of hemorrhage include traumatic injury, surgery and gastrointestinal bleeding. Compare: Understanding Shock Syndrome

There is an X mark in the box pertaining to allergies NKA suggestive of NO KNOWN ALLERGIES, and a further notation claiming "Dr. now suspects that cancer has gone to the brain". The same report documents "intracranial bleed" that is inconsistent with the "coffee-ground emesis" (bloody emesis) documented in the Nursing Notes and on the Ventilation Record on or about the time that the patient was intubated.

The same report also documents " pulses x 4 good", including "head/neckOK"; "chest OK;" "abdomen OK"; pelvis OK; and "extremities OK." Further, there is nothing on the Ambulance Call Report with respect to the bloody vomitus" or "COFFEE-GROUND EMESIS" documented in the Nurses' Notes. Compare: Castrointestinal Bleeding

The very same report documents a "Nature Code 0" (No Code = No Care) or hospital shorthand for "bed shortage", Code Zero, including a "withdrawal of life support" from a critically ill patient or DNR "do not resuscitate order" issued against family wishes, and without lawful consent. The time of that report was documented at 0620 hours on May 24th of 2000, only hours before the patient's death. Do not resuscitate (DNR) means no chest compressions, no defibrillation, no assisted ventilation, no endotracheal intubation, and no cardiotonic medications. The same record documents a Code 3.3 "Withholding Treatment".There was NO "Do Not Resuscitate" order on the patient’s health record nor had there ever been a designated agent who declined continued resuscitation on behalf of the patient. The decision to terminate Arlene Berry was made solely by Dr. Edward Henry Jordan and his accomplices.

In Dr. Jordan’s FPC letter to the College of Physicians and Surgeons of Ontario dated November 28, 2000 he writes “I discussed the situation with family members and a decision was made to intubate Ms. Berry”. It seems absolutely clear, that the doctor (as in this case) knew of the need for emergency care and after ordering it, canceled it and "waited" for her death after withdrawing life support from this critically ill patient. This is further reflected in A-1 of the medical where where Dr. Jordan writes "She died several days later with numerous metastatic lesions to her brain". It would have taken the patient several days to die without life support. Notably also, the body of the deceased was not immediately returned to Kirkland Lake. They had withheld it for several days. Arlene Berry was made to suffer a death by dehydration - .

With dehydration, dehydrated blood becomes thicker and sluggish, and therefore, more prone to clotting. Dehydration interrupts blood flow which causes clots, cutting off the supply of oxygen to various parts of the body such as kidney resulting in kidney clots.

Death by dehydration is accompanied by fever, convulsions, retraction of the eyes into their orbits, drying out of the mouth and skin, among other things. before death results several days later in a cruel and violent death. The element of duty is now satisfied because once the physician undertook care for the patient the physician had a clear duty to exercise reasonable care toward the patient. According to Dr. Jordan "On May 23, 2000, Ms. Berry was seen in the E.R. and admitted by Dr. Spiller with symptoms suggestive of metastatic CA of the brain." The same record documents that the patient complained of being "cold". She had the chills and so the nurses provided her with extra blankets. She was not very communicative due to extreme somnolence (fatigue) and stated that she was "very tired".

The same record at N-6 documents family in at 1915 hours and there is also a notation with respect to "emesis of ^ 100cc yellowish fluid", what is bilious vomit. Who the hell do these asshole doctors think they are?

According to the Nurses' Notes at N-1 of the record the patient was given Gravol® 50 mg x 10 by paramedics at 0620 hours, while the record at N-7 with respect to medications documents "See Nsg Notes".

Notably, Dimenhydrinate (Gravol) is contraindicated in chronic lung disease and has also been reported to "mask the presence of underlying organic abnormalities or the toxic effects of other ." 154. The complications of acute liver failure are numerous and include: sepsis, gastro-intestinal bleeding, cerebral edema, renal and cardiac failure. Varices may also result from portal vein thrombosis. Compare: Vascular Disorders of the Liver / L.J. Worobetz. DRUG-Induced liver disease can mimic viral hepatitis or biliary tract obstruction as well as any other type of liver disease. Compare: Portal-systemic encephalopathy in non-cirrhotic patients.

Disseminated Intravascular Coagulation is associated with sepsis, especially with "gram-negative" bacteria or fungal infection. DIC leads to both bleeding and thrombosis.

Respiratory failure results when the physiological capacity of the respiratory system is less than the body's physiological requirement and can be defined when the arterial PO2 (PaO2) is less than 60 mm Hg or the arterial PCO2 (PaCO2) is greater than 45 to 46 mm Hg. Clinical Features of Respiratory Failure: Pulse oximetry estimates the O2 saturation of the hemoglobin, which in this case is inconsistent with much the -work. A high CO2 level is always associated with hypoxia.

Gastrointestinal bleeding should be controlled if possible and purged from the gastrointestinal tract.

Given the known effects of penicillin and penicillin-like drugs the possible effects of concomitant administration of toxic neuroleptic agents such as prochlorperazine in the circumstances, Arlene Berry may have gone into shock, or cardiac arrest.

Following her transfer to Sudbury on May 24th of 2000 Arlene Berry was was returned to Kirkland Lake several days after family had been notified of her . Her eyes were sunken in appearance, with swelling and distortion of the face, eyes, and mouth (lips), as was the case, marked by elongated facial furrows (deep lines) with a rashlike redness (resembling a sunburn) and swelling to the face in the area just below the right eye suggestive of massive edema (swelling}, and was evidenced by all who attended Arlene Berry's wake and funeral.

Artificial ventilation and oxygen should have been prioritized and promptly administered to include withdrawal of the offending drug, but were NOT. Instead the patient was seen to be propped up in the arms of two errant nurses (not a recovery position) gasping for air, with only a plastic oral airway in her mouth for quite some time. There was consternation among the nurses - the horrific look on their faces said it all.

When Dr. Jordan finally showed up in the small hours of May 24, 2000, precious moments that followed were not taken up with measures to save his patient's life, but rather ways to accelerate her demise. He even proposed a "DNR" (do not resuscitate order) and asked us bluntly if we would prefer to let "nature take its course". The family was not impressed and so insisted that she be placed on "life support".

Obviously, Dr. Jordan did not support the use of aggressive interventionist treatment to keep alive someone he had already injured, for to give treatment to remedy a wrong would expose the fact that mistakes were made.

Arlene Berry was seen to be the victim of a botched intubation procedure which could have saved her life but instead resulted in possible internal injury and internal bleeding (e.g. esophageal or lethal gastrointestinal perforation associated with careless instrumentation), due to "malpositioning" of the endotracheal tube which triggered a quick deterioration of her condition; one full hour went by before the error was discovered and the endotrachial tube pulled back.

1) eMedicine - Esophageal Perforation, Rupture, and Tears 2) eMedicine - Esophageal Perforation, Rupture and Tears : Article Excerpt by: Martin J Carey, MD, MPH, BCh 3) Esophageal Perforation, Rupture and Tears from Emergency Medicine / Gastrointestinal

According to the medical record the intubation procedure was performed by Dr. Jordan, assisted by Helene Studholme, a Respiratory Therapist at the Kirkland and District Hospital.

Following the bungled intubation, rather than confine clotting of the blood to the site of the injury, or perhaps due to his mindless and promiscuous use of inappropriate lab settings or other negligence it seems clear that Dr. Jordan triggered a Coagulation Cascade of spontaneous slugging of the sending numerous % blood-clots" to her brain, resulting in herniation or intracerebral hemorrhage. The levels of Fibrinogen, and D-dimer charted in the medical record for May 24, 2000, together with "evidence based medicine" criterion confirms the Disseminated Intravascular Coagulation.

MEDLINEplus Medical Encyclopedia: DIC (disseminated intravascular ... Postgraduate Medicine: Disseminated intravascular coagulation - Disseminated Intravascular Coagulation (DIC) Profile, ... Acquired Disorders of Coagulation MEDSTUDENTS-GASTROENTEROLOGY THE MERCK MANUAL, Sec. 13, Ch. 156, Bacteremia And Septic Shock Adrenal Pathology Section 1: First Principles of Gastroenterology
Chapter 14 - Section 13: First Principles of Gastroenterology

At the first meeting with the coroner held at the OPP Detachment in Kirkland Lake, Ontario in July of 2001, Dr. Barry A. McLellan, the Regional Coroner admitted to family that there was "no evidence on record of metastatic cancer".

At a subsequent meeting between family and the Regional Coroner, Dr. McLellan provided us with a view of Arlene's prior CT scan that was done in Timmins, Ontario on or about the 16th of March of 2000. I had accompanied Arlene to the Timmins and District Hospital on that date. A special contrast medium (dye) was injected into a vein before the CT scan was done. "NO clinically detectable metastasis was found". A mediastinoscopy to directly see the organs inside the mediastinum, with mediastinotomy to collect tissue sample had been done on that date. The result of that testing proved "NEGATIVE". Mediastinoscopy is also used to stage lung cancer, especially when enlarged nodes are seen on chest x-ray or CT scan. Further, contrast medium-induced nephrotoxicity (CMN) is a common form of iatrogenic acute renal failure. The mechanism for CMN is not understood, but renal insufficiency, dehydration, and congestive heart failure are risk factors.

With respect to the initial CT scan hereinbefore mentioned, according to the Coroner's expert"in the right occipital region there is a spot that measures less than 1 cm that is consistent in appearance with either a small hemorrhage or perhaps a small metastatic tumor". He could only speculate.

According to my research it can also suggest 1) a neurotoxic amyloid like protein deposit or plaque which is the hallmark of Alzheimer's disease, including recent onset Alzheimer's), 2) an "old occipital bleed" such as from an old injury, 3) or a occipital dermoid cyst, or abscess secondary to occipital dermoid cyst which is the hallmark of a brain absess, or perhaps even a subdural hematoma. Further findings suggest that abscesses can mimic OTHER CONDITIONS, including tumors in presentation and radiologic studies. Lung is the primary site of infection, but the brain is the second most commonly involved organ and may be caused by staph if there are hemorrhagic multiple abscesses.

Further findings suggest the CT scan appearance of cerebritis is that of an ill-defined hypodense contrast enhancing area, or a CT scan that shows decreased density and loss of definition = NOT WELL OPACIFIED -->Blood Clots (hematomas), microabscesses or bacterial infection of the CNS. Compare CNS Tumors & Tumor Mimics in the DIFFERENTIAL DIAGNOSIS. These include subdural hematomas, brain abscesses, hydrocephalus, benign intracranial hypertension, etc...

Clinical presentation of brain abscess is usually similar to other intracranial space-occupying lesions. However, the symptoms of an abscess tend to be more rapidly progressing than those associated with a neoplasm.
Compare Neuroradiology Imaging Teaching Files showing a Cerebral Abscess with midline shift.

Further, spontaneous haemorrhage associated with a brain abscess including spontanuous brain absesses as a complication of stroke is reported in the literature.

Further submit that the occipital lobes interpret vision. Had it been a recent tumor, there would have been onset visual misperception with visual impairment and subsequent loss of vision with evolution. Arlene Berry had NO visual deficits, indeed she had "No focal deficits", apart from the signs and symptoms of hepatic dysfunction which the ED physician failed to in his duty of care to recognize. The patient had even been oriented to date, place and time at the time of her admission to the Kirkland and District Hospital on May 23rd of 2000.

Dr. Mclellan also provided us with a view of a CT scan which he purports that was done at the time of Arlene's death . It reveals numerous blood clots and traumatized tissue with brain abscesses (blood and pus isolates), including visceral microabscesses and/or blood clots with massive edema of the right cerebral hemisphere, including a 1 cm midline shift that is consistent Bacterial (pyogenic) infections of the CNS: and herniation.

Disseminated abscesses can occur in multiple organs,including the brain, eyes, kidney, heart, liver and spleen.

Staphylococcus aureusabscesses often occur following haematogenous (blood borne) infections.

Further submit that a CT scan measures density and cannot by itself differentiate between blood clots and tumors. All cerebral hematomas, whatever the cause, have a similar resolution pattern on CT. Plain radiographic findings are nonspecific, but they may be useful in showing the extent of associated skeletal trauma. Vascular malformations and brain tumors are better visualized on MRI. Magnetic resonance imaging (MRI) of the head is done to: 1) Evaluate blood flow to the brain, 2) MRI can diagnose bleeding in or around the brain, 3) Diagnose tumors, infections, or inflammatory conditions (such as encephalitis or meningitis) of the brain or brain stem; hence with MRI, it is possible to detect tumors, chemical reactions, blood clots, and so on.

In this case, an MRI to detect blood clots or abscesses was NOT done.
HEMATOMA - Definition
What causes a brain abscess to form?

Abscesses arising from the extension of a paranasal sinus infection often contain the bacterium Streptococcus , and abscesses resulting from trauma contain bacteria of the "Staphylococcus" variety.

The only test that can absolutely make a diagnosis of a brain tumor is a biopsy.

Further, NO autopsy was done to acurately deternine cause of death .
Among causes of Hemorrhagic Stroke include untreated hypertension, coagulopathies, and ICP (Increased Intracranial Pressure).

With the decreased attenuation throughout the cerebral hemispheres due to rapid or spontaneous development of blood clots there would have been little or no perfusion.

Had Arlene Berry been started on corticosteroids (cortocosteroids: a type of steroid usually given to reduce inflammation) to reduce brain swelling, and had she been treated responsibly, she could have enjoyed respite from her condition and may have recovered without further complications. But without timely response due to medical mismanagement and criminal negligence on the part of the doctors and nurses involved herein, Arlene Berry died unnecessarily.

Further findings suggest that patients with a diagnosis of a primary or metastatic brain tumor associated with a CNS event should have a meticulous review of their history for possible "iatrogenic" causes. As can be seen from this case, little or no attention was paid to the patient.

Further submit that drug intoxication is a reversible cause of coma that might mimic brain tumors . Further, coma with fixed, dilated pupils and an isoelectric electroencephalogram can mimic brain tumors . Acute metabolic derangement and endocrine crisis can mimic brain tumors but more often diffuse cerebral edema, extensive demyelination, or anoxic ischemic injury, is a consequence of these derangements. Examples are brain edema in fulminant hepatic failure. In this case there was evidence of massive cerebral edema. Compare Ischemic stroke: in which basilar artery thrombosis impairs brainstem perfusion and can cause coma at onset. Large hemisphere ischemic strokes may develop massive cerebral edema and result in compression of the brainstem over days from onset. Cerebellar hemisphere strokes (ischemic or hemorrhagic) can result in coma over hours to days. See BACTERIAL PATHOGENESIS.

The College of Physicians and Surgeons of Ontario conducted an investigation into the death of Arlene Berry which consisted primarily of downplaying all complaints by "omission" and in fact failing to address the key concerns put forth. They deliberately ignored evidence of altered medical records. The bald truth is that they "tailored" the investigation "to suit themselves". The investigator, C. Michelle Mann was either uninformed, ignorant, or outright criminal in her investigation.

To downplay by omission is to "obfuscate the truth". In my opinion she violated the provisions of the Criminal Code. All of the doctors and hospitals named in the Arlene Berry coverup were "partners" in the NORTH Network, a telehealth network experiment undertaken by the Harris government from a 1995 OMA study to compensate for hospital funding cutbacks and doctor shortages. They all had and still have a vested interest in protecting each other against the legal pitfalls of treating patients unseen at arm's length, over the telephone . They are now, by their own doings the key players in the Arlene Berry coverup conspiracy for which I will hold all of them criminally liable.

Dr. Barry McLellan was one of the original proponents of the NORTH project, leaving his position as medical director of the North network to become Regional Coroner for Northeastern Ontario. In fact, he was affiliated and closely tied to all of the doctors and hospitals named in the Arlene Bearry "coverup", all of whom were partners in the North telehealth network. As such, Dr. McLellan had a personal and vested interest in the Arlene Berry case as to affect his personal judgment. He allowed his professional duty to come into conflict with his personal interests as to constitute a conflict of interest, ahead of public duty, which he misused for personal ends. Conflict of interest is a precondition for biased or corrupt behaviour. He had a duty to disclose such interest(s) and by failing to do so he acted illegally, and in my opinion, contrary to the provisions of the Criminal Code of Canada, via provisions related to corruption in public office, and the Conflict of Interest Code, breach of trust and public endangerment.

SERIOUS breach of standard which goes to impeach the credibility of the Coroner's investigation into the unnecessary death of Arlene Berry. Further, Dr McLellan was Vice-President of Medical Trauma and Clinical Services at Sunnybrook Health Science Centre in Toronto Ontario for 5 years. He was medical director of the NORTH Network and had recently assumed the position of Regional Coroner. A question has arisen with respect to his "relationship" with Dr. Mark Spiller.

A family request for a formal inquest into Arlene Berry's elicited to following response from Dr.McLellan: "I want to stress that an inquest is not intended to be the vehicle by which someone is found to be responsible or accountable for a % "As a result of my investigation and having carefully reviewed all information available I do not feel.. that a jury might make useful recommendations directed to the avoidance of similar circumstances". . "The venue to determine accountablity is either the criminal or civil courts". . "After careful consideration of all information available to me I have therefore made a decision to not hold an inquest into Ms. Berry;s death ".

Further, Dr. McLellan had told the deceased's family that he had no dealings through his office with the College of Physicians & Surgeons. He "lied", in fact he conducted what Dr. Jordan's legal counsel described as a "parallel investigation" with "multiple communication" between the Coroners' office and the College. The Coroner had seized the medical records for almost a year before family was allowed to get them. The KDH would not release them to us without Dr. McLellan's approval even after Dr. McLellan had completed his investigation. The Coroner possesses superior knowledge or the means of discovering discrepencies in the medical record which he either ignored or deliberately withheld from the police - turning a blind eye that which should have been obvious or suspicious.

Medical omission, especially lack of diagnostic thoroughness, medication errors, negligent and callous nursing care, and even ignoring symptoms and outcomes to FATAL conclusions undoubtedly permeate hospital case histories at the Kirkland and District Hospital. Tales of such negligence, bedeviled by imprudent nurses, with variances of the “play dumb” rule invariably fill the Kirkland and District Hospital patient records with disgust to excess.

At the time of her death, I was informed that Arlene Berry’s eyes had been taken by Dr. Sauvé at the Sudbury Regional Hospital upon remote party consent, utilizing deception to obtain that consent, bypassing permission from Arlene Berry's immediate family. According to Dr. Jordan she was transferred to Sunbury under the care of Dr. Adegbite. She ultimately ended up under the care of Dr. Sauvé. No pathological confirmation of the cause of death was given on the death certificate. According to Dr. Sauvé, she died meeting “brain criteria”. Iterestingly, Dr. Sauvé was a classmate of Dr. Spiller from the University of Toronto, Class of '89.

The fraudulent taking of the patient’s eyes to conceal the true nature of the death is seen as “theft”. The investigation continues, however, new evidence suggests that the Dr. Sauvé merely pretended to take the deceased victim's eyes to conceal 'sunken eyes", associated with a withdrawal of life support in a critically ill patient and in particular "dehydration" in a Nonketotic Coma. Nonketotic coma is associated with a severe infection or kidney failure.

From the record, the ED physician, Dr. Spiller is guilty of negligence in failing to use reasonable care under the circumstances to discover a foreseeable dangerous condition, ie. with respect to a "resistant bacteria", a condition which Dr. Spiller and the healthcare providers who attended to the patient, which each of them either knew or should have known due to being in a position of superior knowledge, and in failing to warn each other as well as the attending physician of its existence, and/or to exercise appropriate monitoring, dilligence or caution, and in failing to diagnose and treat toxic shock syndrome associated with a resistant bacteria resulting in substantial bodily harm and . In my opinion Dr. Spiller is guilty of of criminal negligence causing bodily harm, or manslaughter by gross negligence.

The genetic simplicity of many infectious agents allows them to undergo rapid evolution and to develop selective advantages that result in constant variation in the clinical manifestations of infection. Case - brain abscess

Suspected reasons for the coverup: 1) Outbreaks of nosocomial invasive infections may become the subject of adverse publicity and legal suits against institutions and medical personnel. 2) The adverse publicity associated with gram-negative meningitis type hospital acquired infections may deter patients from seeking care at the facility and may influence potential financial contributors to support other facilities. 3) Doctors and nurses could face criminal charges of all kinds in this case, ranging from patient neglect to under-treatment to criminal negligence causing death; accessory related (altering medical records), and criminal conspiracy - including medical shame, etc. 4) Legal consequences could give rise to possible domino-effect whereby if Dr. Jordan goes down - may cause all others involved to fall down in succession. This is by far the most sordid instance of lack of due diligence on the part of all connected parties.