Witnesses disagreed this week on how well Mary Johnny was treated during her stay at the Watson Lake Hospital in Aug. 2012, and on why she died.
The inquest into Johnny’s death continued this week in Whitehorse. The 60-year-old died on Aug. 9, 2012, six days after being admitted to Watson Lake Hospital suffering from abdominal pains and severe dehydration.
It’s the second coroner’s inquest this year into the death of someone following treatment at the Watson Lake Hospital.
Teresa Ann Scheunert died less than two months before Johnny did in 2012.
A total of 16 witnesses have taken the stand so far this week.
They have included several nurses, physicians, members of the medevac team that flew Johnny to Whitehorse and other medical experts.
After hearing from Eva Johnny, Mary’s mother, and George Morgan, her son, on Tuesday, it was Dr. Said Secerbegovic’s turn to take the stand on Wednesday and Thursday.
Secerbegovic moved to Watson Lake in 1977 and was Johnny’s physician for 35 years.
In addition to seeing patients at the hospital, he also saw them at his private clinic, located about 200 metres away.
When Morgan married Secerbegovic’s daughter, Tanis, Johnny became a part of her physician’s family.
In the weeks leading up to Johnny’s hospital stay, Secerbegovic was on-call 24 hours a day because of the lack of physicians in Watson Lake.
His day would start at 8 a.m. and he would work through breakfast and lunch. Then, he’d go to the clinic to check on patients and come back to the hospital later in the day.
Sixteen to 18-hour workdays were normal, he said.
“Is it safe to work those kinds of hours?” asked lawyer Cindy Freedman, who represents the coroner’s office.
“No, it’s not,” Secerbegovic said. “Especially when you have a family.”
‘The damage was already done’
Secerbegovic was a full-time doctor in Watson Lake for 22 years before switching to part-time several years ago.
Now, he lives in Winnipeg and comes to the Yukon for four to six months per year.
Despite Johnny’s severe dehydration, Secerbegovic said he was afraid to overload her with fluids, which may have resulted in her death.
“She was a woman of 60 with the body of a 90-year-old,” he said.
“She had been in a major motor vehicle accident and suffered many fractures. She had also been in detox at the hospital on a dozen occasions.”
Records indicated that Johnny told the nurses at the Watson Lake Hospital she had been sober for 10 days at the time of her admission.
Secerbegovic later found out from Johnny’s mother, Eva, that her daughter had been drinking right up until the morning she was admitted.
Johnny’s health took a turn for the worse on Aug. 7. She became unresponsive, suffered from shortness of breath, her pulse increased to 100 beats per minute and her kidneys were shutting down.
Dr. Secerbegovic was asked why he didn’t make the call to medevac Johnny to the Whitehorse General Hospital that day, instead of the following morning.
He said he wanted to wait and see if he and his staff could stabilize Johnny. He also said he wasn’t sure whether he just wanted to make her comfortable or if she actually had a chance at survival after the medevac.
“It may have been that the damage was already done,” he said.
Johnny had a do-not-resuscitate order on her chart following a discussion she had with Dr. Secerbegovic a few days prior.
It meant she did not want her heart restarted if she went into cardiac arrest.
“Don’t do it, doctor. I’ll go see my friends,” she told Dr. Secerbegovic.
Shane Skarnulis was part of the medevac team that travelled to Watson Lake Hospital on Aug. 8, 2012.
As the medevac team leader, he got a brief assessment of Johnny’s condition from one of the nurses on the phone and rated the emergency as a 1, the most critical kind.
The call came in at 11:55 that morning. By 2 p.m., the plane was in the air and its wheels touched down in Watson Lake at 2:55 p.m.
By the time the team arrived at the hospital it was 3:35 p.m.
Skarnulis said he was surprised the patient wasn’t already in the hospital’s trauma bay.
After Johnny was eventually moved to the room, which has better facilities, Dr. Brad Avery put in a central line, a catheter placed into a large vein in the neck which allows for more fluids to be administered.
The medevac team left at 5:45 p.m. and was back in Whitehorse just after 7 p.m.
They provided Johnny with 4,000 cc of saline and gave her medication to bring her blood pressure up, which had been very low at 48/38.
A normal blood pressure reading would usually be 120/80, Skarnulis said.
At the time of Johnny’s transfer to Whitehorse General Hospital, her condition was still critical but had slightly improved.
Dr. Huy Chau, who works at the hospital, said her prognosis was “bleak” upon arrival and he didn’t think she’d survive.
Blood tests revealed doctors weren’t winning the battle. Johnny’s health was deteriorating very quickly.
Joy Ferguson, a licensed practical nurse who was on staff the week Johnny was admitted to Watson Lake Hospital, said she felt it was necessary to call Johnny’s family the night of Aug. 6 because of her poor condition.
Supervisors turned down the request.
“They blew me off,” she said by phone.
Johnny’s pulse was at 119 and her blood pressure was low at 48/32.
“Generally if someone is this sick, we’d medevac them,” she said.
Ferguson was asked whether, as a licensed practical nurse, she still could have called the family to let them know.
“Yes,” she said after a brief pause. “I wish I had done so.”
Another criticism levied at Dr. Secerbegovic was his issues with filling out paperwork.
On several occasions during his testimony, lawyers brought up holes or inadequacies in the paperwork he’d filled out.
Dr. Secerbegovic explained that most communication with nurses was verbal, and the charts didn’t always need to be updated unless there was a major shift in health.
“I’ve delivered over 600 people in Watson Lake so if you’re under 28 years old there’s a strong possibility I know you very well,” he said.
“Record-keeping back then wasn’t up to today’s standards. My note-taking has improved in the past five years, though.”
One example was with Johnny’s do-not-resuscitate order, which wasn’t added to her chart until Aug. 8.
Dr. Secerbegovic said it was common knowledge that Mary “was DNR” and that he’d had the conversation with Eva Johnny earlier in the week, too.
He felt it wasn’t necessary to add to the chart.
Cause of death questioned
According to the coroner’s report, Johnny died of a bowel obstruction after being originally diagnosed as having alcohol withdrawal.
However, witnesses gave a variety of explanations for her cause of death.
Dr. Allen Hiyashi, called to testify as an expert witness, said it was very unlikely Johnny died from complications of a bowel obstruction.
He said she would have been in considerably more pain upon her admission at the hospital.
Instead, the cause was likely heart failure, but that it was impossible to know for sure without an autopsy, he said.
“It’s unfortunate she died with a large amount of questions,” he said.
Dr. Chau said he believed Johnny died from hypovolemic shock, a situation where severe blood loss makes the heart unable to pump enough blood to the body.
He contacted the coroner about an autopsy but left it up to them to decide whether one was needed, he said.
Dr. Laurence Hollands, another expert witness who specializes in internal medicine, said the cause was likely congestive heart failure or possibly a pulmonary embolism.
He qualified Johnny as a “very difficult” patient to treat because she presented at the hospital with likely liver failure, kidney failure, lung failure and suffering from alcohol withdrawal.
“Patients like that can fool you,” he said.
“They can stabilize and then crash suddenly.”
He also said an autopsy would reveal a lot more answers.
Finally, Dr. Avery, who was on the medevac team that brought Johnny to Whitehorse, said there was no evidence of congestive heart failure on any of the X-rays he saw.
If there was, he would have seen it, he said.
“We’d see white fluid and increasing whiteness around blood vessels,” he said.
The inquest into Johnny’s death continues today at the courthouse in Whitehorse.
The jury of six must decide what caused her death, and may make recommendations to prevent similar deaths in the future.
Contact Myles Dolphin at firstname.lastname@example.org