On June 30, 2013, Andy Crowe’s wife, Christine, died of cancer.
Since then, Mr. Crowe has been bouncing between boards and committees seeking accountability for the doctor he says mishandled his wife’s case.
From back pain to cancer
On March 12, 2013, Christine went to see her family physician, Dr. Robert Fréchette, at his office in Hawkesbury. She’d been complaining of back pain so Dr. Fréchette ordered that she have X-rays done and return within a month.
And this is where Mr. Crowe’s criticism of Dr. Fréchette begins: he says the doctor should have followed up with Christine earlier.
Christine returned on May 21, saying the pain had gotten worse and was now preventing her from sleeping. Dr. Fréchette reviewed the X-rays and diagnosed a pinched nerve and degenerative discopathy, or degenerative disc disease. The Spinal Foundation defines the disease as “a condition that results from ageing and its effects vary considerably in their nature and severity.” It adds that symptoms vary from person to person and “in many cases the sufferer will experience continuous low-level pain centred on the lower back and occasionally in the hips, groins and legs… Pain levels can vary from mostly nagging to intermittently severe and disabling.”
Upon the diagnosis, Dr. Fréchette advised Christine to take calcium and prescribed hydromorphone for the pain.
A week later, Christine returned and the pain hadn’t subsided. Dr. Fréchette upped the hydromorphone dosage from one to three pills a day, to one or two every four hours.
On June 3, Christine requested another appointment. It’s unclear whether she was offered an appointment that day or the following one. Nonetheless, she ended up in emergency at the Hawkesbury General Hospital. From this point on, Christine was no longer receiving care from Dr. Fréchette.
While in hospital, Christine underwent a series of tests, including CT scans that showed her worsening state since March. According to documents pertaining to the case from the College of Physicians and Surgeons of Ontario (CPSO), “CTs of the head and thorax show widespread metastases.” Christine was diagnosed with Stage IV melanoma and passed away later that month.
Complaint, round one
The above timeline is reconstructed based on documentation filed during the complaint process with the CPSO. The documents include summaries of letters from Mr. Crowe and Dr. Fréchette, a report from an Independent Opinion (IO) provider, decisions from the CPSO’s Inquiries, Complaints and Reports Committee, and the decision from the Health Professions Appeal and Review Board (HPARB).
The Review conducted several interviews with Mr. Crowe and twice called Dr. Fréchette’s office requesting an interview. Both times, messages were left with reception as Dr. Fréchette was unavailable. The second request specified the interview would be about Dr. Fréchette’s discipline procedure with the CPSO. Finally, we hand-delivered a written letter to his office. His lawyer, Bruno Desparts, responded via email saying, “We will not provide any comments.”
About two months after his wife’s passing, Mr. Crowe filed an official complaint against Dr. Fréchette on August 28, 2013. He only received the results of the first complaint process at the end of October 2015.
The CPSO complaints process “Frequently Asked Questions” page states the “vast majority” of cases take between three and 10 months. According to Mr. Crowe, he called the lead investigator when it had already been about a year and a half, and she told him it had become “a major investigation.”
To be clear, the CPSO doesn’t award financial compensation, nor does it focus “on determining liability, or on punishing doctors.” Rather, it states the complaints committee’s role “is to protect the public by determining whether remedial action is necessary and, if so, what action would best enhance the quality of medical care.”
The first complaint process saw a written back-and-forth between Mr. Crowe and Dr. Fréchette concerning details of calls and appointment times. According to Dr. Fréchette, he advised Christine during her first visit to see a physiotherapist and neurologist, which he says she refused to do. Mr. Crowe responded, saying Christine only told him about physiotherapy after the May 21 visit. Dr. Fréchette said he told the Crowes to go to the emergency during the June 3 phone call; Mr. Crowe maintains he never spoke directly to Dr. Fréchette and therefore was never advised to go to the emergency.
More pertinent information comes from an Independent Opinion from a neutral physician commissioned by the CPSO to review the documentation, medical records and complaint. That report was provided on March 19, 2014 and was an appendix to the complaints committee’s written decision.
The IO provider, which remained anonymous, criticized Dr. Fréchette for his record-keeping and assessment. For example, Dr. Fréchette’s initial response letter misidentified the vertebrae at which he recorded sensitivity in Christine’s spine. The IO provider’s report added that identifying a pinched nerve from a regular X-ray isn’t possible, the use of calcium to address pain is “inappropriate” and not re-assessing her pain despite three visits in a short time period was “below the standard of care.” Overall, the IO provider identified several errors, a lack of knowledge, a lack of skill and a lack of judgement.
“It is my opinion, based on my review above, that Dr. Fréchette’s clinical practice has the potential to expose his patients to harm or injury through inadequate assessments and inappropriate treatment,” concluded the report.
Dr. Fréchette responded to the report, saying he advised Christine to go on “complete rest” during the May 21 visit. The Crowes were raising more than 20 dogs at the time, which caused a physical strain on the 61-year-old Christine. According to Fréchette, Christine admitted during the May 28 visit that she didn’t go on complete rest. He also said a CT scan didn’t reveal any new information from the previous X-ray he ordered. Finally, he provided a different expert opinion, which concluded the “care was appropriate for the common presentation of low back pain in family practice.” Mr. Crowe called into question the independence of the opinion. He says Dr. Fréchette would not have provided his own expert opinion if it wouldn’t have agreed with his assessment.
The IO provider responded saying “there is no evidence that complete bed rest is an essential component of the treatment of low back pain”, the CT scan didn’t reveal any new information as it was done on the wrong section of Christine’s spine, and most importantly, “he seems to be blaming the patient for his failure to properly recognize the ‘red flags’ present in all three of Mrs. Crowe’s office visits.”
These red flags include things like Christine’s age, length and progression of pain, and unresponsiveness to previous therapies.
It is worth mentioning the complaints committee only reviews documentation; neither party is allowed to comment on the case in person. Mr. Crowe doesn’t agree with this policy. He says the committee would “get a better sense” of the situation if everyone could be present.
In its decision, the complaints committee wrote, “The points made by Dr. Dollin are well taken. Notwithstanding the validity of Dr. Dollin’s observations, the Committee remains extremely troubled by the poor quality of Dr. Fréchette’s documentation and his failure to consider a more sinister cause of Mrs. Crowe’s back pain.”
It ruled Dr. Fréchette “be cautioned in person” and write a two- to four-page report on preventative cancer care and how to treat back pain in patients over 50 years old.
Also as part of the ruling, he had to undergo clinical supervision for a year, professional education, a reassessment of his practice and monitoring.
In handing down its decision, the committee also mentioned that while “over time he has greatly improved his practice,” Dr. Fréchette has a “significant” history and has been subject of monitoring by the CPSO.
According to his profile on the CPSO’s website, in 2007 Dr. Fréchette had to dispose all of his in-stock medication, and lost his ability to dispense and sell medication. He also had to consent to random visits from the CPSO.
Mr. Crowe was surprised to learn about Dr. Fréchette’s history in reading the committee’s decision.
He called what Dr. Fréchette got “a slap on the wrist,” considering he’s been sanctioned before. Two weeks after receiving the decision, in November 2015, he echoed that sentiment in a letter to the Health Professions Appeal and Review Board (HPARB) filing for an appeal.
“I feel that he will continue to subject his patients to inadequate treatment,” he wrote, “possibly resulting in similar results that my wife suffered under his care.”
The HPARB is an independent body from the CPSO and agreed to review the decision.
Eight months after accepting—and following delays—the HPARB set up a conference call between Mr. Crowe, Dr. Fréchette’s lawyer and a CPSO representative. The HPARB facilitator explained that it only has the power to look at the “adequacy” of the CPSO’s investigation and “reasonableness” of its decision.
Finally, an official date was set for October 12, 2016 in Ottawa, nearly a year after the CPSO’s original decision.
During the review, the CPSO representative confirmed the complaints committee didn’t receive the full text of Dr. Fréchette’s prior history. This resulted in the HPARB ruling that the CPSO’s initial investigation was inadequate. The HPARB didn’t comment on the reasonableness of the decision.
The HPARB’s ruling was made official on June 19, 2017, so it was back to the CPSO’s complaints committee.
Complaint, round two
As mentioned earlier, Dr. Fréchette declined The Review’s interview requests. Based on his CPSO profile, he received his Independent Practice Certificate in 1978. He practices out of his home office in Hawkesbury, the Prescott-Russell Residence and Chartwell Champlain Long-Term Care Residence in L’Orignal.
The complaints committee considered Mr. Crowe’s case for the second time in September 2017. This time around, it had to evaluate all of the text concerning Dr. Fréchette’s previous history with the CPSO. Despite this, “the committee remains of the view that the issues involved present a moderate risk to the public.” Its ruling reads out practically verbatim to the first one.
The latest entry on Dr. Fréchette’s profile is from 2015 and is regarding the 2007 prescription dispensing issue, not the Crowe case.
A few years ago the CPSO changed its policy on what it would post to a doctor’s public profile. Essentially, if a doctor is disciplined in an investigation beginning on or after January 1, 2015, then the result is posted online, otherwise there’s no public record.
Since Mr. Crowe filed his complaint against Dr. Fréchette in 2013, there is no record of the result on his profile despite the complaints committee’s second decision being handed down on March 7 of this year.
Mr. Crowe was unhappy with the second decision.
“The last (mistake) may not have been the worst one but it was the one that broke the camel’s back and when you take everything into account, you say, ‘Hey, this person should not be doing this job’,” says Mr. Crowe.
In a letter back to the CPSO, he writes that he read the report “with great disgust.” He outlines the fact that Dr. Fréchette previously had action taken against him in 2007, which to him, “negates your claim that Fréchette has ‘over time greatly improved his practice and that he has shown himself to be open to advice’.” He also asks how many times the CPSO followed up with visits and monitoring of Dr. Fréchette’s office.
In a letter dated April 5, the CPSO replies to Mr. Crowe saying it indeed “had before it all previous College history respecting Dr. Fréchette.” And as for the monitoring, the letter reads, “the College’s Compliance Monitoring department follows up to ensure the terms of the monitoring are fulfilled,” but doesn’t go into more detail.
Finally it refers him back to the HPARB to appeal the decision once again.
Not giving up
But Mr. Crowe isn’t going through the HPARB again. The Review asked if he would appeal on the reasonableness of the decision, but he says he doesn’t want to waste any more time.
His distrust in the CPSO has grown throughout the process and in his mind it “protects their own.”
Instead he’s looking to take the legal route and recently started looking for a local lawyer to take on the case on a contingency-fee basis.
Part of the reason why he wants to go through the courts is to compel the CPSO to answer how they monitored Dr. Fréchette’s practice.
The Review asked the CPSO about its monitoring practices. There is no information on Dr. Fréchette’s profile confirming his practice had been reassessed or what the results were of the monitoring. The Review asked if the public was supposed to just take the College’s word for it.
“Individual reports of inspection and assessments are not publically (sic) posted to the College’s website. We take our role in protecting the public seriously and where there are monitoring or reassessment requirements applied to a physician, we are committed to ensuring that they are enforced,” replied Greenfield.
A court battle could take years as Mr. Crowe would most likely be starting from scratch since information obtained through the CPSO’s complaint process isn’t admissible in court.
It’s impossible to know if Christine’s outcome would have been different had her cancer been detected earlier—but it’s a question that gnaws at Mr. Crowe. It’s why he’s still looking for accountability and ensuring doctors are held to a high standard of practice.
“I haven’t totally given up on it yet,” he says, “but as far as the College is concerned, I’ve given up on that.”
While he doesn’t hold Dr. Fréchette “100 per cent responsible”, he wonders if he could have had a few more months or years with his wife had her cancer been diagnosed sooner.