Could Amputation Have Been Avoided?

Brian Smith“A horror story”
BRIAN SMYTH went to the hospital with an infection in his big toe in February. By August, he was having his leg amputated, and he blames a faulty heathcare system.

Barry Gray/The Hamilton Spectator

Brian Smyth came to Hamilton General Hospital with an injured toe and six months later lost his lower left leg.

The 57-year-old Port Colborne man believes the amputation could have been avoided if he’d been treated properly from the beginning by Hamilton’s hospitals and doctors.

Hamilton Health Sciences (HHS) is reviewing the man’s care to see what if anything went wrong.

An infectious disease expert says there may have been no way to save the leg.

While another patient says she had similar trouble getting a foot injury treated and may have permanent damage.

Both patients believe they fell through the cracks and want to know why.

“This isn’t about trying to take someone down, it’s about the system itself and how it failed this man,” said Smyth’s long-time friend John Crumb. “It’s a horror story.”

Smyth didn’t think twice when he stubbed his left big toe while jumping up to answer the phone one night around the beginning of February. He didn’t know veins in his foot were blocked so the blood wasn’t flowing properly. But it became clear something was very wrong when his toe turned black over the next two weeks. He went to two Niagara emergency rooms and his family doctor who all concluded it was gangrene, which is the death of tissue caused by an interruption in blood flow. He was sent home with antibiotics and told to come back in two weeks.

But as it got worse, Crumb took his friend to Hamilton General Feb. 14.

“I thought if I take him to a bigger facility in a bigger city, he’ll get better care,” Crumb said.

Emergency room doctors got him an appointment with a vascular surgeon the next morning.

Smyth and Crumb were hoping the surgeon would remove the toe. Instead, they say he drew a pen line on it and told Smyth to come back if the gangrene spread past that point.

Over the next three months, Smyth and Crumb say they went back to Hamilton General more than a dozen times to show doctors how the gangrene was spreading down his foot and out to another toe.

“I just kept bringing him back and bringing him back,” Crumb said. “We would see someone else, go home and wait for a call. We got no care. Why they wouldn’t look after him, I don’t know.”

Smyth says the vascular surgeon finally agreed to remove part of his foot in May. But the gaping wound it left behind never healed and all around it was still black.

“It was rotting,” said Crumb, who would put Vicks VapoRub under his nose to block the smell when he visited. “It was an oozing blob of slime. It was like nothing imaginable.”

Crumb says Smyth was losing weight — up to 50 pounds by the end — and was the “colour of the sidewalk.” He brought him back to Hamilton, but went to McMaster University Medical Centre this time.

“Somebody had to help this guy,” Crumb said.

Both men claim one health-care worker vomited and another cried upon seeing Smyth’s foot. They sent him back to the vascular surgeon.

The lower part of his leg was amputated in August and Smyth is still healing while learning how to function with one leg.

“It boggles your mind how this can happen,” Crumb says.

But an infectious disease expert says there may have been no way to save the leg.

“No one wants to amputate,” said Dr. Michael Gardam, director of infection prevention and control at Toronto’s University Health Network. “If someone is deathly ill, you tend to be more aggressive. If they’re not ill right away, you try antibiotics first. But even if you start the right antibiotics at the right time, it’s sometimes not fast enough to stop the spread. It can happen.”

Smyth’s story sounds too familiar to Hamilton’s Gina Ghiabi. She went to St. Joseph’s Hospital’s emergency department Aug. 15, 2009, after a picture fell on her foot at a store. She claims she waited at least six hours to be seen after being brought by ambulance to the emergency department. She says she was bleeding and feeling so light-headed that she lied on the floor of the waiting room.

She says staff didn’t take her seriously and no one took an X-ray before stitching up her foot and sending her home.

“They didn’t care,” says the 47-year-old mom. “They were so rude to me. It was a nightmare.”

Within days, she went to see her family doctor because her foot was getting worse and she couldn’t walk on it.

“He was asking for the X-ray,” said Ghiabi, who explained to him that she never had one.

She was sent to a specialist who determined she needed immediate surgery because tendons and arteries had been damaged. By this time weeks had gone by and Ghiabi believes that made all the difference.

Over a year later, she still hasn’t been able to get back to work caring for children. She goes to physiotherapy and has no guarantee her foot will ever fully heal. She believes she would have been better long ago if she’d received the proper treatment right away.

“I don’t want this to happen to someone else,” she says.

St. Joseph’s and HHS say they can’t talk about the individual cases because of patient confidentiality. But both say they take their patients’ concerns seriously.

“Of course in every situation, one isn’t perfect,” said St. Joseph’s chief of staff Dr. Hugh Fuller.

But he points out the hospital’s patient satisfaction numbers are generally good.

“We make sure we continue to improve,” he said.

HHS is reviewing Smyth’s care.

“We’re listening to what he’s got to say,” said HHS spokesperson Agnes Bongers. “We’re very concerned about him. We’re going to take his concerns seriously.”

No matter the outcome, the patients are convinced there should have been a better ending.

“Do I think Brian’s leg could have been saved? Yes, by all means,” Crumb said. “It could have been done.”

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