Latest news with #obstetrics
Arab News
2 days ago
- Health
- Arab News
KSrelief opens obstetrics and gynecology clinic at Gaza hospital
RIYADH: Saudi aid agency KSrelief has officially opened a gynecology and obstetrics clinic at the Patient Friends Benevolent Society Hospital in the Gaza Strip. Founded in 1980, the hospital in Gaza City's Al-Rimal neighborhood is one of the few that remain operational in the territory amid devastating attacks by Israeli forces during their ongoing war with Hamas, which began in October 2023. KSrelief opened the clinic on Wednesday in cooperation with the UN Population Fund, which works to improve reproductive and maternal health worldwide. The initiative is part of Saudi efforts to support the Palestinian people and help improve and maintain the healthcare services available to them, the Saudi Press Agency reported. On Thursday, Saudi authorities delivered $30 million in funding to the Palestinian Authority. It was the latest installment in ongoing financial support from the Kingdom that Palestinian officials said has been instrumental in efforts to maintain the health and education sectors. It has helped meet the costs of running hospitals, purchasing medicines and medical equipment, keeping schools open, and providing other essential services.
Times
3 days ago
- Health
- Times
Times letters: Failure to follow basics of maternity care
Write to letters@ Sir, Alice Thomson's article on the 'dire state of maternity care' in the UK is to be welcomed ('Too many women see childbirth as traumatic', comment, Jun 25). I am an obstetrician who has worked in the UK, New Zealand (under a no-fault system) and Australia (with litigation). A no-fault system has appeal given the astronomical costs of maternity litigation in the UK. However, I disagree that 'a no-fault policy would encourage the medical profession to open up about their mistakes'. A 'mistake' is when a doctor or nurse gives an incorrect dose of a medication. Most of the tragedies in Morecambe Bay, Shrewsbury and Telford were not 'mistakes', they were failures to enact the basics of maternity care (failure to listen to women, failure to recognise risk factors, failure to escalate care appropriately, inappropriate attempts to achieve vaginal births and delays in performing emergency caesareans). These failings have been compounded by NHS trusts covering up errors, blaming victims and, now, destruction of records. A no-fault system will, by definition, minimise the consequences of the actions I have described at a time when women and society are seeking transparency and Rob BuistBondi Junction, New South Wales Sir, The basic truth is that the technical skill levels of those delivering babies are poor. Until that is addressed tinkering will not make much difference. The insertion of local anaesthetic into the perineum, and a carefully performed episiotomy (a surgical incision in the perineum) with a surgically accurate repair afterwards, should be the minimum standard expected of anyone delivering babies. Leaving the mother to strain and then rip her perineum is barbaric. Wes Streeting needs to listen to a wider range of opinion and devise additional training and monitoring of practices, whether by midwives, medically qualified practitioners or even a new 'birthing technician'. Perhaps that could be a meaningful role for physician associates, those non-qualified physician assistants that are being Piper, FRCSDartmouth, Devon Sir, Wes Streeting has announced a national investigation into maternity services owing to repeated failings, yet often there is a recurrent theme of women and their partners not being listened to when they feel there is a problem. Nearly 40 years ago, when my wife was in labour with our first-born, we overheard her being quickly labelled as the young female doctor making a fuss. She was given strong injections of painkillers and sedatives, one of which was used to treat schizophrenia at the time, and only then examined to reveal she was ready to push. Our daughter was delivered rapidly, flat and barely breathing. With no paediatrician in sight I was asked to give her the antidote injection. I dread to think what would have happened had I not been medically trained. Until 'attitude to patients' is given the highest priority in the training curriculum and in continuing personal educational development, I can see the same headlines in another 40 years' David MaddamsRet'd GP and GP trainer, Ware, Herts Sir, Resident doctors may be 'excited' or even 'energised' by the prospect of strike action but they appear to have lost sight of the fact that many of them are trainees ('Medical union 'excited' about walking out again', Jun 25). Are they really 'excited' to lose valuable training time, and risk damaging their exam results and harming their opportunities to achieve promotion to the higher grades? One does not learn by standing on picket Hoile, FRCSRet'd consultant surgeon, Hempstead, Kent Sir, The belligerence of the BMA and junior doctors horrifies me. The claim that they are 'excited' at the prospect of further strike action is both sad and misdirected. These newly qualified doctors need to remind themselves why they chose to study medicine. One would hope it was because they wanted to be part of our NHS, striving to cure the sick, rather than wanting mega salaries. The biggest reward is surely grateful FabriciusUpper Clatford, Hants Sir, To fund the government's pledge to spend 5 per cent of GDP on defence by 2035 (Jun 24), a 'defence bond' should be issued immediately. This would have a maturity of ten years and carry no interest. The subscribers to the bond, which would itself be non-negotiable, would benefit in terms of inheritance tax due upon their death: the bond would have 2x the value of the bond as a credit against their IHT bill. To ensure that the Treasury remained supportive of this IHT credit, the multiple of 2x the face value would be reduced for those subscribers who died before the ten-year period was completed. Many British citizens, like me, would consider this unusual investment a way of increasing the safety of our William CastellFormer chairman of the Wellcome Trust; Oxted, Surrey Sir, I agree with Robert Duffield's recommendation of a crackdown on fraud and error (letter, Jun 25) as the way to fund the £40 billion needed for our security, but many previous attempts at this have produced limited returns. We should be bold and introduce the publication of tax returns: the honest have nothing to fear; the dishonest will be caught out by their neighbours, and be forced to pay up, by HMRC and peer HaywardLlandrindod Wells, Powys Sir, I wholeheartedly agree with your leading article ('Battle of the Bulge', Jun 24) on the benefits of prescribing Mounjaro to a broader cohort of patients in need. I work in primary care and have seen astonishing results in patients paying to take this medication: it is beneficial not only in reducing the chronic illness often associated with obesity but also in the psychological wellbeing of this group. Unfortunately our local integrated care board does not share this enthusiasm and has issued a directive to all GPs in Suffolk and northeast Essex advising that GPs should not provide these medications directly for weight loss. Instead, the local NHS has chosen the community outreach service model. This means that access is available only through a specialist NHS weight management service — which is not operating at present. It would seem that those most clinically in need are subject to a postcode lottery of ShirleyNurse practitioner, Nayland, Suffolk Sir, Your editorial suggests that you agree with Wes Streeting's view that making Mounjaro widely available on the NHS will cure the country's economic ills by enabling patients to return to work and reducing demand on the NHS. Although there may be some people in whom a 25 per cent reduction in body weight will prompt a return to work, I suspect this will not be the case for most. This is because obesity per se does not stop you from working, and many of the psychological and social factors leading to people becoming obese are also the reasons that stop people from working. A more likely scenario is that by prolonging life expectancy these medications will lead to increased demand on the NHS and social services at a later date, with an associated and unbudgeted increase in cost to the Oliver DukeConsultant physician (ret'd), London SW2 Sir, I fear Polly Mackenzie is being rather fanciful in her idea that the government can persuade benefits claimants that finding a job would be good for them ('This is how you get the sick back to work', Jun 25). I am sure there are some people who, given the appropriate support, would welcome the chance of employment — but there are many more for whom a life on benefits is always going to be preferable to getting out of bed every morning to go to a job that is likely to be thankless, tedious and not even financially beneficial. Unfortunately the appeal of a life on benefits over the drudgery and low pay of employment has been increasing for decades. This attitude has now become baked in and will take more than gentle persuasion and platitudes to WardIpswich Sir, Steven Morris (letter, Jun 25) states that 'two in five disabled people with complex needs will struggle financially if these cuts go ahead'. This appears to be the key to the conundrum: how does the government reform the benefits system such that the target is the three in five disabled recipients of personal independence plans who would not struggle financially?Andy ThorpLittle Canfield, Essex Sir, I applaud James Marriott for reminding us of Joan Didion's motto 'I write to find out what I am thinking' ('Not reading or writing would be unthinkable', Jun 24). The problem predates AI. I taught A-level pupils for several decades and always insisted on handwritten essays, although once these were composed students were welcome to type them out if they chose. Note-taking, planning, structuring and ordering one's ideas and then writing them — with careful choice of words so as to communicate precisely the points one wants to convey — can be done competently on a computer by few seasoned writers. Many undergraduates who write directly on computers find their essays returned with low marks because they are unstructured, poorly expressed and replete with unconnected points. AI only compounds the HamlynLondon W5 Sir, I concur with Henry Mabbett (letter, Jun 25) about there being too much sport, but for more personal reasons. Whenever I look at my dear husband, he has his eyes glued to his iPhone or the television. My life is constrained by the near-constant cacophony of commentary on darts, tennis, rugby, football and cricket, whereby homely marital communication is ebbing away. I have to wait for breaks in play if I want to catch his attention. What a life!Jan NorrisBroadwas-on-Teme, Worcs Sir, India's home minister, Amit Shah, says the day is coming when Indians who speak English will feel ashamed to do so ('Modi minister tells Indians it is shameful to speak English', Jun 24. Shah might be reminded that when Jawaharlal Nehru delivered his maiden speech on becoming prime minister in 1947, he addressed the nation in English and championed it as a vital language for India's StewartLondon W11 Sir, I have often been impressed by the comments of Matthew Parris (Notebook, Jun 25). Now I learn he can spot an Englishman among the 'pixels' of 10,000 faces; no Welsh, no Scots, no Irish, no white Europeans, just Englishmen. What a BryantWinscombe, Somerset Sir, I rather like Matthew Parris's attempt to link Jarvis Cocker with the ardour, longing, irony, tenderness and passion of another five white Englishmen. May I suggest as an alternative five Gerald Finzi, Edward Thomas, Eric Ravilious, and both Mole and Mr Toad from The Wind in the Willows?Stephen PollardTunbridge Wells, Kent Sir, My mother would have agreed with Victoria Hawthorn's mother (letter, Jun 25) that a gentleman should wear well-polished shoes, but would also have insisted on a snowy white handkerchief in his CowieShandon, Argyll & Bute Write to letters@
CBC
04-06-2025
- Health
- CBC
Toronto doctor's obstetrical and gynecological care was neglectful, patients allege
Marie-Louise Fitrion says she was asleep in a hospital bed when she woke up to an obstetrician's hand in her vagina. It was Oct. 25, 2018, the morning of giving birth to her second child, and she says it triggered the memory of being sexually assaulted as a child. Fitrion is sharing her experience dealing with that doctor, Esther Park, in the wake of Dr. Park's resignation from the College of Physicians and Surgeons of Ontario (CPSO) on April 30, which came after her licence was restricted to office based gynecology on Dec. 17, 2024. The college investigated Park's practice for "infection control issues" after Toronto Public Health found medical instruments were not properly cleaned, disinfected and sterilized at her clinic. Since then, former patients have come to The Canadian Press with allegations that include abusive and inappropriate treatment, both at her Toronto office on 20 Edna Ave., and at a west-end hospital, St. Joseph's Health Centre, commonly referred to as St. Joe's. The Canadian Press spoke to several patients who described traumatic experiences with Park while under her care during labour and invasive procedures including biopsies and contraception insertions. At the time, none of the patients filed formal complaints. Like Fitrion, who says she was in "another universe of pain and suffering," these patients said they were grappling with health issues including postpartum depression, cancer and post traumatic stress, and not in a frame of mind to launch a complaint process. "I've always regretted not reporting it officially," Fitrion said. After years of consideration, she recently did just that. Park's practice not effectively monitored, patients say The patients believe regulatory bodies including the college and public health had not effectively monitored Park's practice, given some patient concerns date back almost a decade. Patients also fault a system that places the onus on them to report and prove harm. Recently, some patients sent a letter to government officials calling for an independent review of regulatory bodies. While they said the province dismissed the suggestion, Toronto Public Health told The Canadian Press it would conduct an internal review. WATCH | CBC's Talia Ricci reports on Esther Park's resignation: Toronto gynecologist linked to hepatitis, HIV exposure resigns 1 month ago Duration 2:55 In a resignation notice posted on the CPSO website in April, Park acknowledged that two public complaints prompted an investigation by the college into her practice. That investigation ended when she resigned. It was not shared with the public, nor were the nature of the complaints. "Unlike with licence revocations, doctors who sign these types of undertakings will not be able to reapply for reinstatement of their licence in the future," Mickey Cirak, a communications adviser at the college, said. Cirak said physicians are expected to abide by applicable laws, CPSO policies and clinical guidelines. "In general, college investigators may only enter a premise as part of an active investigation," he said. Paul Harte, a medical malpractice lawyer based north of Toronto, says the reason for an investigation along with its results should be publicly available. The college posts if a doctor's licence is restricted or revoked on its website, but it does not state why it happened. Harte argues doctors should be routinely monitored, like restaurants. "That's the kind of proactive inspection program that I think needs to be put in place for physicians who are engaged in invasive procedures," Harte said. Attempts to reach Park for comment at her office on three occasions, by mail, and by phone were not successful. Her answering machine stopped taking messages April 16. Fitrion's story Fitrion said she went to St. Joe's with spontaneous bleeding about a month shy of her due date. Because of complications with her first pregnancy, the hospital admitted her overnight and induced her. She went to sleep with a foley catheter balloon inserted to mechanically dilate her cervix. Fitrion said she woke up to Park's hand up her hospital gown. "There was no consent," Fitrion said. "Given I have a sexual assault history it was extra challenging for me to deal with that level of neglect." When Fitrion asked what Park was doing, she said the doctor said she was checking the catheter's placement, and continued to do so, pulling it out of her vagina and breaking Fitrion's water without warning, nor explanation. "I just went into hysterics," she said, recalling inconsolable sobbing in a hospital bed. Her husband, Daniel Holloway, had gone home to sleep. "I should have been there," he said, regret still ripe in his voice. It's standard practice in medicine to ask a patient for permission before an examination. It's especially necessary when doing the vaginal examination of a sexual assault or domestic abuse survivor, said Dr. Naila Ramji, a maternal-fetal medicine specialist in Fredericton and assistant professor in obstetrics and gynecology with a cross-appointment in the department of bioethics at Dalhousie University. "Certainly the patient needs to be conscious and be able to provide consent," said Ramji, who has no connection to Park, and speaks generally about standards of care in medicine, not about specific allegations. She said spelling out exactly what you're doing and why you're doing it is key to leaving little room for misunderstanding, misinterpretation and re-traumatization for a patient. On May 14, Fitrion filed a CPSO patient complaint. "It's symbolic," she said, adding that she just wants the college to know what happened to her. "I don't want to have to hold on to this story by myself. I want to put it out there and I want to let it go," Fitrion says. She mimed off-loading a weight from her shoulder that she said felt like a boulder. "It feels like I've been holding my breath for seven years. And I'm slowly learning to breathe again." 2,500 patients warned of exposure to blood-borne viruses The Canadian Press began trying to reach Park in March, after Toronto Public Health sent a letter in February to 2,500 of her patients warning they may have been exposed to blood-borne viruses including HIV, hepatitis B, and hepatitis C. No infections have been confirmed to be attributed to Park's practices, said Dr. Herveen Sachdeva, the city's associate medical officer of health. Sachdeva said the public health unit's investigation is independent of the college, and that it is still active, solely to followup on lab results, of which they had received 563 as of May 29. She said TPH will be carrying out an internal review of the public health unit's response to "identify lessons learned" and "apply them to future investigations." Sachdeva also said the public health unit met with the college early in the investigation, and is engaging with the ministry of health, and other public health units across the province, to "review and strengthen our collective approach" to managing infection prevention and control lapses in medical settings. TPH said it was notified of a patient complaint in September 2024 and launched an investigation in October. Inspectors found medical instruments were not disassembled before they were cleaned at Park's clinic, and disinfecting solution had been significantly overdiluted. Like the CPSO, Sachdeva said they don't routinely inspect health-care settings unless a complaint is filed. In January, Park sent a notice to patients saying she was retiring and that her practice would close at the end of April. "I am grateful for the trust you have shown me over the past years and for allowing me to participate in your medical care. With mixed emotions, I am announcing my plans to retire," Park said in the letter dated Jan. 23, 2025. In March, a sign on the front door of a red brick house on Edna Avenue said: "Doctor's office closed." A woman who identified herself as Park's secretary opened the locked door and said she could not provide comment. The Canadian Press left contact information but has not heard back. Inside, plastic chairs lined an empty waiting room that several patients said was at times so crowded that they had to wait outside. The lights were dimmed, the window shutters closed. Contraception brochures in plastic display cases sat on a window ledge. The doctor's office sign was gone by mid-May and a for-lease sign was planted in the lawn. The windowsill was empty of brochures and the shutters were cracked open. That month, The Canadian Press mailed a letter to Park, which was redirected to another address, and left another in her mailbox but did not receive a response. Both Unity Health Toronto and the CPSO said they could not share Park's contact or pass on the request. According to the CPSO's website, Park obtained her medical degree from the University of Toronto in 1993, and specialized in obstetrics and gynecology in 1998. Unity Health said she started working in obstetrics at St. Joe's in 1999 before transitioning to gynecology and surgeries. In 2006, the college authorized her to open her own clinic, its website states. After 25 years of service, Park stopped practising at St. Joe's in July 2024 and resigned in December. Unity Health has a responsibility to patients, lawyer says Harte, the medical malpractice lawyer, said Unity Health has a responsibility to patients treated in its facilities. "It's absolutely incumbent upon a hospital to regularly assess the quality of care being provided to the patients at that hospital, including the quality of care provided by the physicians that they grant privileges to," Harte said. He said quality assurance auditing should indicate if there is a systemic issue with a physician. "When they're not being transparent, all it does is undermine the confidence of patients in our public health-care system." A Unity Health spokesperson would not address why Park stopped practising five months before her resignation. They also would not say if the hospital launched its own investigation but said Unity Health has "rigorous processes" in place to provide "high quality, compassionate care." They encouraged anyone with concerns to reach out to their patient experience office. CPSO would not say in March if it was investigating Park's practice at St. Joe's, and suggested patients speak with Ontario's Patient Ombudsman Craig Thompson. Thompson also would not disclose if Park's patients reached out due to privacy considerations. He said his office can get involved if a patient is not satisfied with the hospital's response to a complaint, and they'll try and help the parties reach a resolution, but ultimately the hospital bears the responsibility for the patient's experience. The ombudsman's last annual report noted a particular rise from across the province in the number of obstetrics and gynecology related complaints, including health providers' lack of trauma-informed approaches, poor communication and lack of responsive care for pregnancy complications, miscarriages, difficult births and sexual assaults. Some complaints were about serious incidents in which severe pain was ignored or dismissed, the report says. "We make sure we report that. We want to make sure people understand what it is we are seeing. What is driving that is really something for the system to try to understand. We report on it and it's really then over to the various organizations and providers to understand how that might manifest itself in their circumstance," Thompson said. 'I was completely neglected' It wasn't until Alejandra Sinnett returned home and showered after the birth of her daughter that she understood the severity of incisions made during delivery May 12, 2016. The cuts ran from the top of her vagina to the back of her anus. The size came as a shock, as did the searing pain when she walked and urinated. "I started bawling," she said, adding that she was scared to touch her own body. Sinnett said she learned after the delivery that she had an episiotomy. Dr. Glenn Posner, vice chair of education for the department of obstetrics and gynecology at the University of Ottawa, said an incision of this nature would be considered an extension of an episiotomy into a fourth degree tear, which he said he's only seen twice in his career of more than 20 years. "You wouldn't do an episiotomy into the anus on purpose," said Posner, who has no association to Park. He said painkillers and stool softeners would be given to patients in these cases. After more than 12 hours in labour with her 9.5-pound, late-term baby, Sinnett remembers Park saying, "I'm just going to cut you a bit, OK?" Sinnett says she said, "OK," and her husband, Nickolas Sinnett, who was in the room, adds: "There was no explanation." He recalls blood covering the floor, the bed, the doctors, like "a murder scene in a horror film." Afterwards, he said his wife spiralled into depression. A handwritten note his wife wrote at the time said, "I am so much more than what I have been through." Sinnett said the lack of communication was particularly difficult because it echoes elements of abuse she had suffered in a prior relationship. "It's the chaos. It's the, when you don't have a choice, as a domestic abuse survivor. When you're in that situation, you don't have a lot of choices. It's whatever the person says, the abuser, the abuser's in control. And it felt very vulnerable. It felt like my choices were being taken away from me just like they were when I was in that situation," she said. She said she told Park about her history of domestic abuse at prenatal appointments. But in the end, she said, "I was completely neglected. Like completely neglected." Sinnett said no one at the hospital came back to check on her stitches or instruct her how to manage them. Weeks later at a postnatal appointment with Park, she learned the incision was infected. She was prescribed antibiotics and told to wear skirts. "Why weren't we given any of that information coming out of the hospital? We would have done all of those things before," her husband said. In urgent situations, such as those when an episiotomy is needed to get a baby out quickly, there might not be as much time for a quiet and calm conversation about consent, said Ramji, speaking generally about the procedure. "But usually you say, 'I need to make a cut for the baby's head to come out more easily.' You kind of do like an abridged version of: 'This is what I need to do. Do I have your permission to do it?"' "You typically don't just do it." It's also the law, said Toronto-based lawyer Jordan Assaraf. Sixteen of Park's patients have reached out to him, he says. "You require patient consent for any medical procedure — a patient who's asleep and then woken up with a doctor inside of her — where's the consent?" He said informed consent includes conveying the full extent of a procedure, and the potential options available to a patient. And he said it's always required, even in emergencies when there may be little time for discussion. Sinnett never filed a patient complaint. "This goes back to being a domestic abuse survivor. I didn't report that person either," she said. "I felt very small in the situation — like I was too small to deal with someone so big." 'It's like the dignity of women is not respected' Claudia Gomez went to Park for a Pap test in 2020, less than a year after she moved to Canada from Colombia. She had fibroids, growths in her uterus, and menstrual bleeding so heavy that she couldn't work when she had her period. The test was painful and long. When Gomez asked why, she said Park told her it was because she did a biopsy. "But you didn't tell me," the 48-year-old recalls saying, and Park responding with silence. When doctors see something suspicious during a Pap smear, they may want to do a biopsy, Ramji said. But the risks, benefits, complications and alternatives should be clearly communicated. Jenn McIntyre, who was the executive director of Romero House at the time, an organization just a two-minute walk from Park's clinic that provides transitional housing and support to refugee claimants, recalls speaking to Gomez, a client who became a friend. "I remember just listening to her, and hearing, and feeling so terrible for that experience because women's health is very personal, it can be very scary. So it's one of the most important areas to have really sensitive care, really good care," McIntyre said. Gomez said she never filed a patient complaint. "I was just trying to forget about her, about the situation." In Colombia she said her experience would be called "gynecologist violence." "It's like the dignity of women is not respected and they were mistreated. And it is why I feel violated." 'It made me feel infantilized' It's been just over a year since 58-year-old Esther Arbeid says she's felt like herself. On March 21, 2024, Park removed her ovaries and Fallopian tubes at St. Joe's. Arbeid said she was told it would be a routine laparoscopic surgery involving three small incisions of the same size. She says she was released the same day and given a handout about taking care of the incision and pain management, with no further aftercare discussed. When she got home, Arbeid said she discovered a 1/2-centimetre-long incision on her right side, a contrast to the others, each about a centimetre. The Canadian Press viewed a post-operative photo of Arbeid's incisions, showing the one on her right side sizably bigger than her left. "That looks like open surgery to me," she recalls thinking. Her mother, Norma Rose, who was with her the day of the surgery, also said the scar that marked the right side of her daughter's body did not look laparoscopic. "We go to a doctor, particularly a surgeon, with this huge amount of trust. And that trust was destroyed," said Rose. Posner, the Ottawa physician, said an incision of that size suggests there may have been complications. Doctors obligated to disclose unanticipated outcomes Canadian Medical Protective Association best practices state a physician is obliged to disclose unanticipated outcomes to a patient. "People understand that doctors are human and then they're making difficult decisions. People understand that complications happen, but they don't like when they get the sense that people are avoiding them," Posner said. He said he tells residents, "If there's a patient you don't want to go visit post-op or postpartum — that's the first patient you should go see." Arbeid said she left three tearful voice mails at Park's clinic over a 10-day period, begging her for help. She was in too much pain to walk and could only shuffle her legs. "I hated leaving messages on a doctor's answering machine crying. I hated it. It made me feel infantilized, ignored," she said. Eventually, Arbeid said Park called her back and said she didn't recall the incisions being bigger than normal. She says the pain on her right side persisted through the summer, and eventually, after visiting her family doctor in October 2024, she learned she had an incisional hernia, requiring another surgery. An email Arbeid received from Shouldice Hospital, reviewed by The Canadian Press, showed an incisional specialist was scheduled to operate on her hernia March 19, 2025. Weeks before Arbeid's second procedure, she filled out a CPSO patient complaint form saying she felt ghosted, gaslit and ignored, but she never filed it. Friends, family and colleagues advised her to focus on her health. "She was just coming up to her appointment of surgery and had to take the time to focus on that and focus on her recovery properly," her mother said. "The first priority is always maintaining and guarding your health." Bakhsh's story Zahra Bakhsh said she found out in September that her IUD was "just floating around" after Park inserted it at her clinic in July 2024. The 44-year-old says another gynecologist in nearby Mississauga, Ont., made the discovery when her IUD was stuck to his glove after an exam. Ramji said IUDs can move from their initial position, and even fall out if they've migrated low enough. A study published in Obstetrics & Gynecology in 2023 found that the overall risk of IUD expulsion is five per cent. Since then, Bakhsh has thought a lot about who should have been responsible for the well-being of patients like herself. She sent a letter on April 28 to Ontario Premier Doug Ford, Toronto Mayor Olivia Chow and almost 30 other politicians with another patient, Karin Martin, who had three biopsies with Park last spring and summer before she was diagnosed with uterine cancer. Park had already stopped practising surgery at Unity Health in July, but Martin said she did not disclose this to her, delaying an urgent surgery she went into in September with another surgeon. Bakhsh and Martin questioned whether Park's resignation at about the same time that she had planned to retire held her fully accountable. "We need to understand whether this was an isolated regulatory lapse or indicative of a systemic problem in how patient complaints are handled in Ontario," they state in the letter. On April 30, Bakhsh received an email from Ford, who was the only politician to respond. For a split second, she said she got excited. "By the time I made it to the second line, I was mortified. I was like, this has got to be a joke," she said. The email thanked her for sharing her views and said that the letter would be shared with the minister of health. "I appreciate the opportunity to read your comments and get a better understanding of your perspective," the email signed by Ford said. "Your input is important. You can be sure our government will consider it when developing policies and deciding how to address the various challenges we face today." Situation should serve as wake-up call, patient says The Ministry of Health told The Canadian Press that it expects every medical professional to "uphold the highest standard of patient care and the comprehensive rules regarding how health regulatory colleges, such as the College of Physicians and Surgeons of Ontario (CPSO), must handle complaints involving patient abuse." What Martin said struck her about the health minister's response was that it stood by the current system in place. "Clearly, that does not work." Martin said this situation should serve as a wake-up call. In the letter, they say, "It underscores the importance of vigilant medical regulation and the grave consequences when that vigilance falters. We entrust our doctors with our health and our confidence; when that trust is violated on such a scale, it shakes public faith in the entire system."
CTV News
04-06-2025
- Health
- CTV News
‘Another universe of pain and suffering': Patients allege neglectful obstetrical and gynecological care by Toronto doctor
Marie-Louise Fitrion poses for a photograph in Toronto, on Friday, May 23, 2025. THE CANADIAN PRESS/Nathan Denette TORONTO — Marie-Louise Fitrion says she was asleep in a hospital bed when she woke up to an obstetrician's hand in her vagina. It was Oct. 25, 2018, the morning of giving birth to her second child, and she says it triggered the memory of being sexually assaulted as a child. Fitrion is sharing her experience dealing with that doctor, Esther Park, in the wake of Dr. Park's resignation from the College of Physicians and Surgeons of Ontario (CPSO) on April 30, which came after her licence was restricted to office-based gynecology on Dec. 17, 2024. The college investigated Park's practice for 'infection control issues' after Toronto Public Health found medical instruments were not properly cleaned, disinfected and sterilized at her clinic. Since then, former patients have come to The Canadian Press with allegations that include abusive and inappropriate treatment, both at her Toronto office on 20 Edna Ave., and at a west-end hospital, St. Joseph's Health Centre, commonly referred to as St. Joe's. The Canadian Press spoke to several patients who described traumatic experiences with Park while under her care during labour and invasive procedures including biopsies and contraception insertions. At the time, none of the patients filed formal complaints. Like Fitrion, who says she was in 'another universe of pain and suffering,' these patients said they were grappling with health issues including postpartum depression, cancer and post traumatic stress, and not in a frame of mind to launch a complaint process. 'I've always regretted not reporting it officially,' Fitrion said. After years of consideration, she recently did just that. LACK OF ACCOUNTABILITY The patients believe regulatory bodies including the college and public health had not effectively monitored Park's practice, given some patient concerns date back almost a decade. Patients also fault a system that places the onus on them to report and prove harm. Recently, some patients sent a letter to government officials calling for an independent review of regulatory bodies. While they said the province dismissed the suggestion, Toronto Public Health told The Canadian Press it would conduct an internal review. In a resignation notice posted on the CPSO website in April, Park acknowledged that two public complaints prompted an investigation by the college into her practice. That investigation ended when she resigned. It was not shared with the public, nor were the nature of the complaints. 'Unlike with licence revocations, doctors who sign these types of undertakings will not be able to reapply for reinstatement of their licence in the future,' Mickey Cirak, a communications adviser at the college, said. Cirak said physicians are expected to abide by applicable laws, CPSO policies and clinical guidelines. 'In general, college investigators may only enter a premise as part of an active investigation,' he said. Paul Harte, a medical malpractice lawyer based north of Toronto, says the reason for an investigation along with its results should be publicly available. The college posts if a doctor's licence is restricted or revoked on its website, but it does not state why it happened. Harte argues doctors should be routinely monitored, like restaurants. 'That's the kind of proactive inspection program that I think needs to be put in place for physicians who are engaged in invasive procedures,' Harte said. Attempts to reach Park for comment at her office on three occasions, by mail, and by phone were not successful. Her answering machine stopped taking messages April 16. FITRION'S STORY Fitrion said she went to St. Joe's with spontaneous bleeding about a month shy of her due date. Because of complications with her first pregnancy, the hospital admitted her overnight and induced her. She went to sleep with a foley catheter balloon inserted to mechanically dilate her cervix. Fitrion said she woke up to Park's hand up her hospital gown. 'There was no consent,' Fitrion said. 'Given I have a sexual assault history it was extra challenging for me to deal with that level of neglect.' When Fitrion asked what Park was doing, she said the doctor said she was checking the catheter's placement, and continued to do so, pulling it out of her vagina and breaking Fitrion's water without warning, nor explanation. 'I just went into hysterics,' she said, recalling inconsolable sobbing in a hospital bed. Her husband, Daniel Holloway, had gone home to sleep. 'I should have been there,' he said, regret still ripe in his voice. It's standard practice in medicine to ask a patient for permission before an examination. It's especially necessary when doing the vaginal examination of a sexual assault or domestic abuse survivor, said Dr. Naila Ramji, a maternal-fetal medicine specialist in Fredericton and assistant professor in obstetrics and gynecology with a cross-appointment in the department of bioethics at Dalhousie University. 'Certainly the patient needs to be conscious and be able to provide consent,' said Ramji, who has no connection to Park, and speaks generally about standards of care in medicine, not about specific allegations. She said spelling out exactly what you're doing and why you're doing it is key to leaving little room for misunderstanding, misinterpretation and re-traumatization for a patient. On May 14, Fitrion filed a CPSO patient complaint. 'It's symbolic,' she said, adding that she just wants the college to know what happened to her. 'I don't want to have to hold on to this story by myself. I want to put it out there and I want to let it go,' Fitrion says. She mimed off-loading a weight from her shoulder that she said felt like a boulder. 'It feels like I've been holding my breath for seven years. And I'm slowly learning to breathe again.' PARK'S PRACTICE The Canadian Press began trying to reach Park in March, after Toronto Public Health sent a letter in February to 2,500 of her patients warning they may have been exposed to blood-borne viruses including HIV, hepatitis B, and hepatitis C. No infections have been confirmed to be attributed to Park's practices, said Dr. Herveen Sachdeva, the city's associate medical officer of health. Sachdeva said the public health unit's investigation is independent of the college, and that it is still active, solely to followup on lab results, of which they had received 563 as of May 29. She said TPH will be carrying out an internal review of the public health unit's response to 'identify lessons learned' and 'apply them to future investigations.' Sachdeva also said the public health unit met with the college early in the investigation, and is engaging with the ministry of health, and other public health units across the province, to 'review and strengthen our collective approach' to managing infection prevention and control lapses in medical settings. TPH said it was notified of a patient complaint in September 2024 and launched an investigation in October. Inspectors found medical instruments were not disassembled before they were cleaned at Park's clinic, and disinfecting solution had been significantly overdiluted. Like the CPSO, Sachdeva said they don't routinely inspect health-care settings unless a complaint is filed. In January, Park sent a notice to patients saying she was retiring and that her practice would close at the end of April. 'I am grateful for the trust you have shown me over the past years and for allowing me to participate in your medical care. With mixed emotions, I am announcing my plans to retire,' Park said in the letter dated Jan. 23, 2025. In March, a sign on the front door of a red brick house on Edna Avenue said: 'Doctor's office closed.' A woman who identified herself as Park's secretary opened the locked door and said she could not provide comment. The Canadian Press left contact information but has not heard back. Inside, plastic chairs lined an empty waiting room that several patients said was at times so crowded that they had to wait outside. The lights were dimmed, the window shutters closed. Contraception brochures in plastic display cases sat on a window ledge. The doctor's office sign was gone by mid-May and a for-lease sign was planted in the lawn. The windowsill was empty of brochures and the shutters were cracked open. That month, The Canadian Press mailed a letter to Park, which was redirected to another address, and left another in her mailbox but did not receive a response. Both Unity Health Toronto and the CPSO said they could not share Park's contact or pass on the request. According to the CPSO's website, Park obtained her medical degree from the University of Toronto in 1993, and specialized in obstetrics and gynecology in 1998. Unity Health said she started working in obstetrics at St. Joe's in 1999 before transitioning to gynecology and surgeries. In 2006, the college authorized her to open her own clinic, its website states. After 25 years of service, Park stopped practising at St. Joe's in July 2024 and resigned in December. Harte, the medical malpractice lawyer, said Unity Health has a responsibility to patients treated in its facilities. 'It's absolutely incumbent upon a hospital to regularly assess the quality of care being provided to the patients at that hospital, including the quality of care provided by the physicians that they grant privileges to,' Harte said. He said quality assurance auditing should indicate if there is a systemic issue with a physician. 'When they're not being transparent, all it does is undermine the confidence of patients in our public health-care system.' A Unity Health spokesperson would not address why Park stopped practising five months before her resignation. They also would not say if the hospital launched its own investigation but said Unity Health has 'rigorous processes' in place to provide 'high quality, compassionate care.' They encouraged anyone with concerns to reach out to their patient experience office. CPSO would not say in March if it was investigating Park's practice at St. Joe's, and suggested patients speak with Ontario's Patient Ombudsman Craig Thompson. Thompson also would not disclose if Park's patients reached out due to privacy considerations. He said his office can get involved if a patient is not satisfied with the hospital's response to a complaint, and they'll try and help the parties reach a resolution, but ultimately the hospital bears the responsibility for the patient's experience. The ombudsman's last annual report noted a particular rise from across the province in the number of obstetrics and gynecology related complaints, including health providers' lack of trauma-informed approaches, poor communication and lack of responsive care for pregnancy complications, miscarriages, difficult births and sexual assaults. Some complaints were about serious incidents in which severe pain was ignored or dismissed, the report says. 'We make sure we report that. We want to make sure people understand what it is we are seeing. What is driving that is really something for the system to try to understand. We report on it and it's really then over to the various organizations and providers to understand how that might manifest itself in their circumstance,' Thompson said. 'COMPLETELY NEGLECTED' It wasn't until Alejandra Sinnett returned home and showered after the birth of her daughter that she understood the severity of incisions made during delivery May 12, 2016. The cuts ran from the top of her vagina to the back of her anus. The size came as a shock, as did the searing pain when she walked and urinated. 'I started bawling,' she said, adding that she was scared to touch her own body. Sinnett said she learned after the delivery that she had an episiotomy. Dr. Glenn Posner, vice chair of education for the department of obstetrics and gynecology at the University of Ottawa, said an incision of this nature would be considered an extension of an episiotomy into a fourth degree tear, which he said he's only seen twice in his career of more than 20 years. 'You wouldn't do an episiotomy into the anus on purpose,' said Posner, who has no association to Park. He said painkillers and stool softeners would be given to patients in these cases. After more than 12 hours in labour with her 9.5-pound, late-term baby, Sinnett remembers Park saying, 'I'm just going to cut you a bit, OK?' Sinnett says she said, 'OK,' and her husband, Nickolas Sinnett, who was in the room, adds: 'There was no explanation.' He recalls blood covering the floor, the bed, the doctors, like 'a murder scene in a horror film.' Afterwards, he said his wife spiralled into depression. A handwritten note his wife wrote at the time said, 'I am so much more than what I have been through.' Sinnett said the lack of communication was particularly difficult because it echoes elements of abuse she had suffered in a prior relationship. 'It's the chaos. It's the, when you don't have a choice, as a domestic abuse survivor. When you're in that situation, you don't have a lot of choices. It's whatever the person says, the abuser, the abuser's in control. And it felt very vulnerable. It felt like my choices were being taken away from me just like they were when I was in that situation,' she said. She said she told Park about her history of domestic abuse at prenatal appointments. But in the end, she said, 'I was completely neglected. Like completely neglected.' Sinnett said no one at the hospital came back to check on her stitches or instruct her how to manage them. Weeks later at a postnatal appointment with Park, she learned the incision was infected. She was prescribed antibiotics and told to wear skirts. 'Why weren't we given any of that information coming out of the hospital? We would have done all of those things before,' her husband said. In urgent situations, such as those when an episiotomy is needed to get a baby out quickly, there might not be as much time for a quiet and calm conversation about consent, said Ramji, speaking generally about the procedure. 'But usually you say, 'I need to make a cut for the baby's head to come out more easily.' You kind of do like an abridged version of: 'This is what I need to do. Do I have your permission to do it?'' 'You typically don't just do it.' It's also the law, said Toronto-based lawyer Jordan Assaraf. Sixteen of Park's patients have reached out to him, he says. 'You require patient consent for any medical procedure … a patient who's asleep and then woken up with a doctor inside of her – where's the consent?' He said informed consent includes conveying the full extent of a procedure, and the potential options available to a patient. And he said it's always required, even in emergencies when there may be little time for discussion. Sinnett never filed a patient complaint. 'This goes back to being a domestic abuse survivor. I didn't report that person either,' she said. 'I felt very small in the situation … like I was too small to deal with someone so big.' 'MISTREATED AND VIOLATED' Claudia Gomez went to Park for a Pap test in 2020, less than a year after she moved to Canada from Colombia. She had fibroids, growths in her uterus, and menstrual bleeding so heavy that she couldn't work when she had her period. The test was painful and long. When Gomez asked why, she said Park told her it was because she did a biopsy. 'But you didn't tell me,' the 48-year-old recalls saying, and Park responding with silence. When doctors see something suspicious during a Pap smear, they may want to do a biopsy, Ramji said. But the risks, benefits, complications and alternatives should be clearly communicated. Jenn McIntyre, who was the executive director of Romero House at the time, an organization just a two-minute walk from Park's clinic that provides transitional housing and support to refugee claimants, recalls speaking to Gomez, a client who became a friend. 'I remember just listening to her, and hearing, and feeling so terrible for that experience because women's health is very personal, it can be very scary. So it's one of the most important areas to have really sensitive care, really good care,' McIntyre said. Gomez said she never filed a patient complaint. 'I was just trying to forget about her, about the situation.' In Colombia she said her experience would be called 'gynecologist violence.' 'It's like the dignity of women is not respected and they were mistreated. And it is why I feel violated.' 'IT MADE ME FEEL INFANTILIZED' It's been just over a year since 58-year-old Esther Arbeid says she's felt like herself. On March 21, 2024, Park removed her ovaries and Fallopian tubes at St. Joe's. Arbeid said she was told it would be a routine laparoscopic surgery involving three small incisions of the same size. She says she was released the same day and given a handout about taking care of the incision and pain management, with no further aftercare discussed. When she got home, Arbeid said she discovered a 4 ½-centimetre-long incision on her right side, a contrast to the others, each about a centimetre. The Canadian Press viewed a post-operative photo of Arbeid's incisions, showing the one on her right side sizably bigger than her left. 'That looks like open surgery to me,' she recalls thinking. Her mother, Norma Rose, who was with her the day of the surgery, also said the scar that marked the right side of her daughter's body did not look laparoscopic. 'We go to a doctor, particularly a surgeon, with this huge amount of trust. And that trust was destroyed,' said Rose. Posner, the Ottawa physician, said an incision of that size suggests there may have been complications. Canadian Medical Protective Association best practices state a physician is obliged to disclose unanticipated outcomes to a patient. 'People understand that doctors are human and then they're making difficult decisions. People understand that complications happen, but they don't like when they get the sense that people are avoiding them,' Posner said. He said he tells residents, 'If there's a patient you don't want to go visit post-op or postpartum … That's the first patient you should go see.' Arbeid said she left three tearful voice mails at Park's clinic over a 10-day period, begging her for help. She was in too much pain to walk and could only shuffle her legs. 'I hated leaving messages on a doctor's answering machine crying. I hated it. It made me feel infantilized, ignored,' she said. Eventually, Arbeid said Park called her back and said she didn't recall the incisions being bigger than normal. She says the pain on her right side persisted through the summer, and eventually, after visiting her family doctor in October 2024, she learned she had an incisional hernia, requiring another surgery. An email Arbeid received from Shouldice Hospital, reviewed by The Canadian Press, showed an incisional specialist was scheduled to operate on her hernia March 19, 2025. Weeks before Arbeid's second procedure, she filled out a CPSO patient complaint form saying she felt ghosted, gaslit and ignored, but she never filed it. Friends, family and colleagues advised her to focus on her health. 'She was just coming up to her appointment of surgery and had to take the time to focus on that and focus on her recovery properly,' her mother said. 'The first priority is always maintaining and guarding your health.' WHAT'S NEXT Zahra Bakhsh said she found out in September that her IUD was 'just floating around' after Park inserted it at her clinic in July 2024. The 44-year-old says another gynecologist in nearby Mississauga, Ont., made the discovery when her IUD was stuck to his glove after an exam. Ramji said IUDs can move from their initial position, and even fall out if they've migrated low enough. A study published in Obstetrics & Gynecology in 2023 found that the overall risk of IUD expulsion is five per cent. Since then, Bakhsh has thought a lot about who should have been responsible for the well-being of patients like herself. She sent a letter on April 28 to Ontario Premier Doug Ford, Toronto Mayor Olivia Chow and almost 30 other politicians with another patient, Karin Martin, who had three biopsies with Park last spring and summer before she was diagnosed with uterine cancer. Park had already stopped practising surgery at Unity Health in July, but Martin said she did not disclose this to her, delaying an urgent surgery she went into in September with another surgeon. Bakhsh and Martin questioned whether Park's resignation at about the same time that she had planned to retire held her fully accountable. 'We need to understand whether this was an isolated regulatory lapse or indicative of a systemic problem in how patient complaints are handled in Ontario,' they state in the letter. On April 30, Bakhsh received an email from Ford, who was the only politician to respond. For a split second, she said she got excited. 'By the time I made it to the second line, I was mortified. I was like, this has got to be a joke,' she said. The email thanked her for sharing her views and said that the letter would be shared with the minister of health. 'I appreciate the opportunity to read your comments and get a better understanding of your perspective,' the email signed by Ford said. 'Your input is important. You can be sure our government will consider it when developing policies and deciding how to address the various challenges we face today.' The Ministry of Health told The Canadian Press that it expects every medical professional to 'uphold the highest standard of patient care and the comprehensive rules regarding how health regulatory colleges, such as the College of Physicians and Surgeons of Ontario (CPSO), must handle complaints involving patient abuse.' What Martin said struck her about the health minister's response was that it stood by the current system in place. 'Clearly, that does not work.' Martin said this situation should serve as a wake-up call. In the letter, they say, 'It underscores the importance of vigilant medical regulation and the grave consequences when that vigilance falters. We entrust our doctors with our health and our confidence; when that trust is violated on such a scale, it shakes public faith in the entire system.' This report by The Canadian Press was first published June 4, 2025. Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content. Hannah Alberga, The Canadian Press
CBC
31-05-2025
- General
- CBC
Kelowna General Hospital doctors warn of 'collapse' of primary maternity care coverage
Doctors in the department of obstetrics and gynecology at Kelowna General Hospital (KGH) are warning that the maternity ward is on the verge of collapse amid a shortage of family physicians. A joint statement from all nine members of the department issued Thursday said that "without immediate action from health authorities and government decision-makers, the safety of patients and newborns is at serious risk." "Due to a critical shortage of family physicians willing or able to provide this care— worsened by a failure to recruit replacements—our hospital is facing a collapse of its primary maternity care coverage as early as June 1, 2025. "This means that many pregnant patients may arrive at the hospital in labour with no doctor available to provide safe, continuous care during delivery." The doctors said their concerns about staffing and support have gone largely unanswered and they're demanding immediate action from Interior Health. The doctor representing the group declined an interview request from CBC News. Dr. Hussam Azzam, executive medical director for Interior Health South, acknowledged the physicians' concerns, saying KGH leadership is in regular contact with with the ob-gyns to address a complex issue with "multiple pillars to it that we need to address." "We are open to listen and we're open to work with them collaboratively to meet their needs and to deliver the best quality care that they've trained to do," Azzam said. Dr. Charlene Lui, president of the professional association Doctors of B.C., said family doctors often handle low-risk patients with obstetricians focused on cases that are high risk and more complex. "When we have fewer low-risk maternity providers that are family physicians, then that puts additional pressure on our obstetricians to sometimes need to be in several places at the same time when an emergency arises," Lui said. The statement followed last week's announcement of an extended closure of the pediatric unit at KGH. The health authority said it temporarily closed the pediatric care unit at the hospital to address scheduling gaps due to limited physician availability. "We are very alarmed to hear that the issues at Kelowna General continue to escalate without solutions from the health authority," Lui said Friday. KGH is a regional referral centre with over 1,800 deliveries each year and a Tier 4 neonatal intensive care unit (NICU) caring for babies born at 30 weeks gestation or later, according to the doctors' letter. Dr. Jeff Eppler, an emergency department physician at KGH, told CBC News on Friday that he was heading into a weekend shift amid staff shortages, including no pediatricians and a limited number of ob-gyns. "Our staff is burning out. All of these service disruptions just make the job so much harder for all of us in the emergency department," Eppler said. "And even though we are all starting to burn out, we are going to have to pick up extra shifts this summer to make up for all the shortcomings in the system." In a statement, B.C. Health Minister Josie Osborne said parents can be assured that all of the hospital's critical care services for children remain open, including the emergency department and NICU. Gavin Dew, the B.C. Conservative MLA for Kelowna-Mission, described the situation at the hospital as a "crisis of government neglect." "We have multiple departments of the hospital who clearly feel as if they are not being heard by the folks who should be listening to them and are resorting to making public the crisis-level conditions at the hospital," Dew said. The hospital ob-gyns said they have warned administrators of the risks, and have tried to offer solutions. "We have submitted multiple letters, proposals, and formal communications urging action," reads the statement. "Our concerns have gone largely unanswered." They are calling on Interior Health and B.C.'s health ministry to create a contingency plan to ensure patients are cared for and to support the transfer of maternity patients if care can't be provided locally. Osborne acknowledged the hard work of pediatricians at KGH, saying they have been dealing with staffing shortages and are "understandably experiencing burnout." She went on to say the province's efforts to recruit health-care workers are starting to pay off. Two new pediatricians have accepted offers to work at KGH, she said, with the first set to arrive in July.
