The Deplorable Way I Was Treated By Toronto's The University Health Network

 To: patientrelations@uhn.ca

Whom It May Concern:

My name is Daniel Arthur Verner, 

The reason I am contacting you today is for what I feel and truly believe was a deplorable and prejudiced way I have been treated during the past few visits I have had at the Toronto General and specifically the Toronto Western Hospital

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It is a somewhat lengthy situation to explain and I pray that you may bear with me. I will do my best to summarize it as best I can.

First off, I have always been extremely impressed with the excellent care I received in the past at the Western Hospital. I have been a long term patient there going back to March 1999 when they gave me a new walk on life by the excellent results of my spinal surgery to restore my shattered C1 & C2 - C5 & C6 vertebrae

That said, here lay the reasons that lead up today's complaint.

As I am aware that you have access to readily review my case files I will only include the quoted information I feel best assists in the understanding of my complaint.

I have been diagnosed with  severe osteoporosis . This has been ongoingly treated by Dr. Miranda Boggild

I have been plagued with severe back pain and a variety of other ongoing, and increasing, ailments which Dr. Boggild has been doing her best to rectify. This has led to my having many tests and visits with her concerning the ailments.

On November 6, 2023 I attended one such appointment to receive the results of the various tests she had me have regarding the osteoporosis and the ailments I have been having.

I her November the 6th appointment notes she states:

"Assessment and Plan

Daniel Arthur Verner is a 66 y.o. year old male with osteoporosis in the context of prior dexamethasone and radiation for SCC of the tongue with a history of T12 and L3 vertebral fractures in 2021.

 

His 10-year fracture risk is High (>20%) according to the 2010 CAROC system.

 

The following recommendations were made:

1. Lifestyle factors:
   1. Calcium: Aim for a total of 1000-1200 mg daily through diet and supplementation.
   2. Vitamin D: continue 2000 IU per day
2. Physical activity: Weight-bearing, balance, and posture strengthening exercises.

 

3. Pharmacologic management: We discussed ongoing treatment and based on our discussion we will arrange for another dose of zoledronic acid. He tolerated the last dose well and has no upcoming dental work.

 

4. Back pain and left leg numbness: Xrays today showed no new vertebral fractures. I am worried about his progressive left leg weakness and numbness causing falls and he is describing some symptoms suggestive of cauda equina. I advised him to go to the ER for assessment and consideration of spine imaging and he was in agreement.

 

5. Follow up: 2 weeks telephone"

As you can see she was concerned that I may have been suffering from "cauda equina". Which I have been informed is a very serious and possible life changing affliction that can easily lead to my becoming a paraplegic.

I am sure that you can understand the anxiety I felt when I learned of this possibility. Being very concerned I immediately took her advice and attended the Toronto General ER for the stated imaging. I was at the ER all evening the night November 6th into November 7th'

Here is the assessment of that visit.

Assessment and Plan

Worsening chronic left leg sensory and motor changes. Worsening over the last month. Has resulted in multiple falls. No acute changes today, sent in by endocrinologist for consideration of MRI. PVR pending. However, given chronic nature, patient does need MRI however can ideally schedule for tomorrow for an emergent slot. Following which, patient should be seen by neurosurgery or neurology given overt difference between left and right leg.

Above note written by Nathan Balzer, MD. 

He further stated:

"Discussed with patient, happy with plan for discharge given no acute new symptoms and ongoing for last 1 to 4 months.

Patient is amatory, we have arranged for him to have a MRI of his spine done tomorrow to look for impingement.

He is aware to return to emergency department following this for reassessment and for consideration of referral to neurosurgery versus neurology depending on what is seen on MRI."

I took this situation to be extremely serious and quite frightful, to be honest. Last thing I needed or wanted after all the medical traumas of the previous five years was to become a paraplegic.

It was mutually agreed upon that rather than spend the night sitting in the ER I should go home and return the next morning. Which I gladly did. I could not sleep all night as I was so worried about what may happen.

November 8th, I attended the ER and had the MRI.

Here are the notes from the attending doctor, Dr. Dalzeg, regarding those results.

MRI spine shows the following findings: "- Persistent degenerative changes in the lumbar spine with severe spinal canal stenosis at L4-L5 causing cauda equina compression. - Evidence of adjacent segment disease in the cervical spine related to previous anterior fusion of C8-C6. No edema or myelomalacia in the spinal cord. - No evidence of osseous metastatic disease in the spine."

Assessment and Plan

Impression: At this point time given the patient's presentation, with the weakness that is progressive, sensory changes, falls, and MRI findings, I will speak to neurosurgery to request that they see and assess the patient tonight.

 

Dr. Boggild's suspected diagnosis was indeed correct. This left me in an extreme state of anxiety. 

After sitting in the very busy ER for most the day and with being told that I needed surgery ASAP and should continue waiting until Dr. Dalzeg could contact the spinal surgery team at the Toronto Western Hospital, I started to have a panic attack over not being able to contact my family to let them know what was taking place. Many hours had passed and Dr. Dalzeg was having difficulties contacting the Spinal Team. 

To be honest I had by this time become very agitated and emotional and was somewhat argumentative, but after talking with the doctor I settled down and digested what I had learned. I was (and still am) very afraid of what may happen to me.

Dr. Dalseg  and I came to the mutual agreement that I could go to my residence to gather a bag of clothing, etc. and to tell my son what was happening and that I may be getting hospitalized immediately with surgery ASAP. 

I hurried to my home which is only twenty minutes by streetcar from the General Hospital, quickly grabbed the items I would need while in the hospital and informed my family as to what was taking place.

I stepped off the streetcar at College and Beverley and was almost at the doors to the ER when I received a call from Dr. Balzec informing me that I could remain at home as he had yet to hear from the Western Hospital. He verbally reminded me that I was to be extremely careful not to do anything that could cause the cauda equina to progress. He informed me that I should remain at home and that Dr.Rampersaud's spinal team would be contacting me directly within a few days, perhaps as long as a week.

Having been told that I did not have to re-enter the hospital, I - with tears running down my face - got back on the streetcar and returned home.

Dr. Dalzeg's discharge instructions were as follows:

Discharge Instructions

Timothy Ross Dalseg at 8/11/2023  7:21 PM

You will be contacted by the spine service for urgent follow-up. Please follow-up with them as indicated.   Please return immediately if having increased weakness, numbness, tingling, numbness to the bottom or scrotum, incontinence of the bowel or bladder, or any other concerns immediately. This would be a sign of sudden cauda equina that would be a surgical emergency.

Dr. Dalzeg made it very clear in the phone call that I should not chance returning to the hospital via transit or a car, but rather call an ambulance to take me directly to the Toronto Western Hospital as that is where all the UHN facilities have their spinal surgeries performed. He was very adamant that I go by ambulance.

To be blunt, I was now terrified as to what may happen to me. I took his instructions to heart and stopped doing most daily activities I would usually have done. Such as light grocery shopping and the daily walking of my two small dogs. I literally became what one may call a "couch potato."

I did this until November 17th whereas I attended the Toronto General for my scheduled imaging regarding osteoporosis. After which I returned home to await the November 20th scheduled follow-up TELEPHONE APPOINTMENT with Dr. Boggild.

I had not as yet heard from the Spinal Team. It had now been twelve days since I was told of my condition and the severity of my current state.

Dr. Boggild's interim history report for that visit stated:

Interim History

- son has covid (I had not been around or in contact with my son at that time, nor anytime following. I mentioned only to inform the doctor that a family member had Covid, but that I had received my fourth booster shot at my family doctors on November 4th. Also that to be extra cautious I had performed a couple of quick tests that both showed negative results. Had they been positive I would never had attended to the hospital and risked infecting patients or staff)

- went to ER after last seen and got MRI which showed cauda equina

- was referred to neurosurgery Dr. Rampersaud; hasn't heard about appointment yet - plan was for to be seen urgently as an outpatient

- continues to have severe lower back pain and numbness in left leg which is worsening

- can't feel or push to get urine or BM out. Can't feel urine or stool come out over the past week

- was advised not to move too much at the ER. No falls

This information scared me to no end. With all that I was already going through and afflicted with, the last thing I wanted was to lose my legs and bowel/bladder functions.

Dr. Boggild's assessment and plan was as follows:

Assessment and Plan Daniel Arthur Verner is a 66 y.o. year old male with osteoporosis in the context of prior dexamethasone and radiation for SCC of the tongue with a history of T12 and L3 vertebral fractures in 2021.   His 10-year fracture risk is High (>20%) according to the 2010 CAROC system.   MRI Nov 8 done in the ER shows cauda equina compression and he was referred urgently to neurosurgery as an outpatient but has not heard about the appointment yet.   I am concerned that he has now lost sensation of his bladder/bowel since he was last seen in the ER as well has having worsening back pain and left leg weakness. I asked him to go back to the ER for reassessment as he was advised to return if there are worsening of symptoms. He agreed and will re-present to ER.   He is scheduled for zoledronic acid Dec 4. We discussed we can reschedule depending on what happens for his cauda equina.   Follow up: telephone in January Dr. Boggild, as had Dr. Dalseg stressed that I should not chance returning to the hospital via transit or a car, but rather call an ambulance to take me directly to the Toronto Western Hospital Unfortunate for me, my symptoms did start increasing in severity. In particular the loss of sensation in my buttucks and gential areas. The numbness in my left leg had started to rise further up my left side. My overall pain level was and still is ten out of ten. This scares me even further. I contacted Dr. Boggild and she said it would be best to attend Toronto Western Hospital immediately. Not wanting to risk paralysis I immediately called the ambulance and was taken to the Toronto Western Hospital. What takes place next will and has forever scarred my faith in health care provided by the Toronto Western Hospital. As I type this from home I feel that not only was I spoken to as if I was a six year old child and not a sixty-six year old adult, but I also feel strongly that I was not taken seriously by any staff member. I was definitely belittled. Again I apologize for such a lengthy communication. I will try to keep the following information, which is the most important by far, as summarized as I may without losing what took place. I arrived at the Western's ER at approximately four pm. Whereas the ambulance attendants and I sat in the waiting area till seven pm. Then the ambulance team left and I was placed on a very hard chair and put into the general waiting area. This would be the evening of November the 20th. There I remained until approximately midnight where I was then moved to a triage bed. During the evening I had asked a few times for breakthrough pain meds as the chair was very uncomfortable and caused extreme pain in my hips. I did succeed in receiving one dose of ten mgs of Statex. From past experience I knew that I should not bring my actual medications to the hospital. Rather I brought the official drug store receipts and a handwritten note showing the dosing schedule I have had for the past five years. Also, the ambulance paramedic had recorded the same information which he told me he had passed on to the ER staff. Normally I would have taken my evening doses of 40 mgs of M-Eslon Morphine, one Percocet, one Tamisolin and one 10 mg Statex quick release morphine. A regiment that I have had, as previously stated, for the past five years. Due to her language barrier, the nurse, Matyas Hervieux, was having great difficulty understanding my explanation of the chain of events. Clearly she was frustrated and was hurriedly attempting to be done with our conversation. I equally had quite an amount of difficulty attempting to understand her. The more I tried to explain that I was in severe pain the more she "brushed me off" with statements like a doctor would assess me. She asked me numerous times why I was in the emergency. She insisted I explain my predicament over and over. I tried to convey to her that to the best of my knowledge there should be reports in my files. I even tried to show her the information on my cell phone via my UHN portal, but she refused to read it. Throughout the following hours she repeatedly ignored my requests for pain relief or to speak to a doctor. Numerous times throughout the night she completely ignored me when I tried to speak to her. At least ten times she told me very bluntly that I had the option to leave and she refused to believe that I came in by ambulance via doctor's orders. I tried once again to show her Dr. Boggild, Dr. Balsec and Dr. Dalsegs notes. At one point she accused me of lying. Stating that nowhere in my file notes did it say for me to come to the ER. As the hours passed things only worsened. Everytime I inquired as to when the doctor was going to come speak to me she told me that there were five or six people ahead of me. This continued most of the night. During which time I noticed many, many patients who had come in long after me were triaged and treated while I just sat there. Each time she told me the same thing that there were five or six patients ahead of me. The only other answer I could get from her was that I had the option to leave. Quite rudely she said this. Numerous times. This carried on until finally a doctor came and spoke with me. He apologized for my lengthy wait and the nurses' behaviour and I apologize for my frustration and anger towards her. I admit that after so many hours sitting in pain and starting to feel the withdrawal effects of the opioids I was getting a bit annoyed with her. In particular her pretending she did not hear me. Every time I went to the nurse's station she told me I could just go home and that "no one had told me to come in by ambulance." By four or five in the morning the pain was beyond my being able to handle and I admit I was extremely frustrated and at a loss as to why no one knew anything about me. Later in the day I would discover that was due to no one reading my file. At one point I finally was spoken to by a doctor who immediately understood what I was saying. I was moved out of the waiting room into a proper bed in the actual treatment area.    He then issued me my morning dose of 40 mgs of M-Eslon morphine, which is an extended release medication, that being so he also issued me an intravenous dose of 5mg morphine to help alleviate my severe pain immediately. I have great difficulties with collapsing veins and it is not uncommon for it to take ten or more attempts to place an IV in me. The nurse tried two times, said nothing, pushed the IV stand away from my bed and walked away. I thought that perhaps she was going to get another nurse to attempt inserting the IV as I have experienced that many times at blood labs and hospitals. It was hours later when a male nurse saw it hanging there and I told him what had happened that he found a vein with his first attempt and I finally felt a little less pained. By this time I realized that there was no way at all that anyone was going to take me seriously. At this point I had been in the ER for approximately 16 hours. After quite a few hours more I was informed that they had scheduled an MRI for me at 8:30am. I asked why they were doing another MRI so soon after the MRI I had just had a week or so prior. I was told that I never had any such MRI. In fact I did have a forty-five minute MRI on November the 8th. Realizing that it had been much longer than the week I had previously stated, I did not press the matter and received another forty-five minute MRI. By this time I had approximately twenty hours of sitting in extreme pain and not having so much as a drink of water or a bite of food. (Note: knowing that I was going to the hospital and thinking that I would be receiving emergency surgery as stated by three separate doctors and in their notes, I had stopped eating or consuming any liquids at supper time the previous Sunday.) Which meant that I had now gone almost two complete days without anything. Not even, as I stated, a glass of water. Twice the nurse asked if I wanted a sandwich and I replied yes. I never received the sandwich. Eventually I saw other patients coming in with coffees and asked if I could go get one. Thankfully they replied yes. That turned out to be a mistake as it was used against me to say that I couldn't be suffering too greatly if I was able to go get a coffee. Even though to do so not only took a long time but also worsened my pain and discomfort. As the day progressed I inquired numerous times as to when, if ever, a doctor was going to come and explain what was happening and what if any treatment I would receive. Only one other doctor other than the one who prescribed the initial dose of extended release morphine and the IV dose had spoken to me. However, she asked me how I was, looked at her phone and said, "I have to go." and walked away. She never returned. By this time there were now two MRI's plus aii the other written diagnoses confirming that I did indeed have cauda equina. I sat there for a few hours more until around four in the afternoon quite to my surprise, and quite shocking to me, a nurse walked up to me and literally tossed three single sealed packets of 15mg M-Eslon morphine on my bed and said I did not have cauda equina and , I quote, "This should stop the spasms." This literally gobsmacked me like a kick in the crotch. As she briskly walked away I said to her that I had been brought in via an ambulance and thinking I was going to be there for a few days minimum, had not brought any cash with me now I was to have to walk home. I readily admit that it was neglect on my part to bring funds to get home. She replied that she would see if she could get me a "cab chip". Having no idea what that meant I asked her but received no reply. A few minutes later she came to me and threw, literally threw, a single use one way "Presto TTC Pass" on the bed. Then as she briskly walked away told me to "leave". I asked to speak to the doctor that made this decision and as she walked into the nurses station repeated that I was having "spasms". It was freezing rain and by the time I managed to walk from the Hospital's Bathurst and Dundas Street entrance to College Street to get a streetcar home I was soaking wet. Also, it was the heart of rush hour and I was forced to stand in a very crowded streetcar all the way from Bathurst and College to Gerrard Street East and Coxwell Avenue. It was an extremely painful trip. What made it even more horrific was I was soaking wet from the freezing rain storm taking place and embarrassed beyond imagination by the fact that I cried all the way home. Even more so as a few concerned riders asked if I needed assistance. I felt very humiliated and hurt. Prior to this inhumane experience I had always held the UHN and the Western Hospital in the highest regard. Many times over the years, going all the way back to March 4th, 1999, when I had received the miraculous life saving surgery whereas the surgeon rebuilt my shattered neck, to the five years of excellent treatment I received from Princess Margaret Cancer Center I praised them. I was so grateful for the treatment I received from Princess Margaret that in 2020 I wrote a book about the first eighteen months of treatment praising every single soul who works or volunteers there. The book is available worldwide. It is titled, "Old Man With The 'C'." Not that that changes the deplorable and downgrading way I was now being treated and with what every doctor involved in my treatment, or lack thereof, had told me was quite a dangerous and life threatening affliction. The callous way I was TOSSED the three pills and the one way ticket sickened me. It broke me mentally. I will be seeking legal advice in the coming days as I now have to worry everyday if that will be the last day I may be able to walk. As well as I have forwarded this communication to various television stations and the Minister of Health. I will also be publishing it on my blogs. I will be doing a podcast of it as well. I cannot allow this despicable treatment to go unnoticed. Additionally, to show the public how a sixty-six year old disabled man was so rudely and cold heartedly treated by the very hospitals he once held in such high regard. I am definitely forced to seek out legal counsel in the case that something goes wrong and I become a paraplegic. When I secure the legal counsel I shall arrange for a second opinion and a forensic examination of the MRI's and all pertinent medical reports. If by doing so it is revealed that all the reports and the MRI's were in fact not lies like the staff at the emergency department want me to believe, then rest assured I will take court filed civil legal action. Until I can discover elsewise I am forced to live in the fear that I do have the originally diagnosed cauda equina and one wrong action or simple fall could leave me a paraplegic with complete loss of my bowels and bladder. As the numerous UHN doctors were so adamant that I understood how serious the diagnosis was and is. With all the physical and the accompanying psychological traumas I have been through since the cancer diagnosis, including such things as a lacerated spleen that almost took my life, it is quite a heavy and emotional weight for me to have to walk around worrying if the next step may be my last. It is with a heavy heart that I am backed into a corner and forced to do this. But, I also deserve to be treated with respect and kindness. Sincerely; Daniel Verner

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