No recollection: How a doctor's lapse of memory led to a patient’s deterioration and a three-month suspension

A Québec doctor who completely forgot about the results of an MRI he had prescribed to a patient—who was subsequently rushed to hospital and suffered long-term issues with walking and cognition—has been suspended for three months and ordered to pay the costs of investigation and hearing. In an unusual move, the disciplinary board of the Collège des médecins du Québec agreed to let Dr. Issam Saliba—a Montreal otolaryngologist who is chair of his hospital department and who teaches at the University of Montreal—serve his suspension during a period that would not disrupt the internship of one doctor and the fellowship of another. In total, Dr. Saliba was suspended for five months: three months on one count of ethic violation and two months on another count, also of the same offence. But the board has ruled that both suspension periods will be served at the same time. Dr. Saliba admitted to the disciplinary board that he failed to “integrate/process” the information texted to him by the radiologist who performed the medical resonance imaging, which revealed a “significant hydrocephalus” in the patient’s brain. Read: Suspended: Doctor failed to discuss X-ray results with patient who died of stage 4 lung cancer In fact, according to the decision document issued by the college, Dr. Saliba—who was on vacation with his family when he got the text—says he forgot that he had received the message, although he had responded to it with “Thank you … I’m taking care of it.” It was only when he looked through his past messages that he found the correspondence between him and the radiologist, Dr. Saliba told the college. “I was convinced that I had not been informed of this discovery . . . since hydrocephalus is not a common discovery and such information would normally have been of a nature to mark my memory,” he wrote in his response to the complaint filed against him by the patient’s family. “However, I was wrong, since this text exchange demonstrates that not only did I receive the information, but I even acknowledged receipt.” But that was not the only lapse on Dr. Saliba’s part that contributed to the worsening of the patient’s health. He also admitted to the college that during a follow-up assessment of the patient—who had been diagnosed previously with vestibular schwannoma in the left ear and whose health had deteriorated to the point that she could not walk by herself—he failed to look at the MRI images or read the X-ray report “in accordance with my teachings and what, to my knowledge at least until then, was systematically done.” Instead he relied on the assessment of the medical fellow he was working with. Read: Misdiagnosed emergency: Doctor's appeal is denied in the case of teen patient who lost his only testicle “He was going to check the MRI and, immediately afterwards, I remember that he came to join me with the patient and informed me that the vestibular schwannoma on (the patient’s) recent MRI was unchanged from the previous one,” Dr. Saliba wrote the college. “I therefore did not look for the signs of such a possible hydrocephalus in my questionnaire, and I evaluated the patient with tunnel vision, suggesting to me that the aggravation reported by the patient and her relatives was probably of psychogenic origin, which I wanted to have evaluated.” While the disciplinary board noted Dr. Saliba’s full cooperation with the investigation, in particular his initiative in tracing the text messages between him and the radiologist, it also pointed out that he had ignored the “red flags” raised by the patient and her family. There were signs—such as the patient’s poor muscle control and heavy gait—that pointed to hydrocephalus. Dr. Saliba should have recognized these signs, given his specialized training in otolaryngology, wrote the board in its decision. Read: 'Disproportionate, unfair' and speculative: Professions tribunal overturns college ruling

No recollection: How a doctor's lapse of memory led to a patient’s deterioration and a three-month suspension

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