I have tried to stay away here from the Natasha Richardson controversy I was involved in. For those of you unfamiliar, I wrote a piece in the Chicago Tribune that said that there was a delay in her care and that had she had the accident in one of our Colorado ski resorts equidistant from Denver, as hers was from Montreal, she probably would not have died. My intent was not to denigrate the entire Canadian medical system; it was about good medicine, not socialized or private medicine.

Well, the NY Post and some other outlets picked up the story and gave it a little racier headline, and cut a couple of sentences (I have no control over syndication changes) and made it into something it wasn’t meant to be. But my facts were solid.

Well, the stuff really hit the fan. Montreal television, Canadian newspapers and American bloggers went ballistic. I was called all sorts of names (prick, obscure Illinois physician, right-wing hack, shill for Rupert Murdock, my favorite was Betsy Reed of The Nation who accused me of shamelessly exploiting Natasha Richardson and either deception or shockingly shoddy journalism). Google it, you’ll enjoy the calumny.

Now there are two things wrong with this and neither of them is about who called me what:
First, none of these people bothered to examine the actual facts of the case. Research and discussion with people who know as much as is being divulged have brought this out. Natasha Richardson was seen by paramedics for hospital triage at a little after 3PM (this is when she was actually seen, not when she declined care). In all likelihood she suffered irreversible damage sometime around 6:30 to 6:40. That means there was 3 1/2 hours to get her to surgery. Since some of Canada’s best neurosurgeons are in a Montreal hospital 1:10 minutes by ambulance from where she was, there was over 2 hours for her to be transported and brought to the OR. But it didn’t happen and no one has explained why.

There is very little doubt the case was badly mismanaged. The error was not taking her to Montreal directly, which could have been done by ambulance and still have had a two hour window for surgery and/or not getting appropriate care from the local hospital she was brought to. An egregious error either way. The CT scan (Betsy Reed singled me out for saying she didn’t have a CT scan, I simply said we don’t know that and by the way, we still don’t know) is a nonissue -all it does is clarify how bad the error of the local hospital was).

It will be impossible to divine which one (actually it’s both for sure) without info from the local hospital, paramedics, ski resort and Montreal and no one is giving info citing confidentiality. No medical details from anyone. There will be no coroner’s inquest since she “died” in New York.

There should be a provincial inquest because it is likely at least one error was probably that paramedics followed a provincial policy in taking the patient to the local hospital, giving them no discretion to bypass and go directly to Montreal. That alone should prompt an inquiry, the provincial policy question- but there is essentially a whitewash here. The helicopter is a related but essentially tangential issue as is the helmet wearing, more below. The declining of care is a nonissue - the paramedics almost certainly would have done nothing different than what happened “stay in your room, have someone watch you and call back if you have symptoms”- their 35 minute inaction when they did have her two hours later is call for question. The socialized medicine/private medicine is a tangential issue also (but ski people here have backed me up- odds are we would have caught it in the major Colorado resorts).
Again it’s about good medicine, not which system works.

In the States a lawsuit would uncover this info- but there is no economic incentive for Liam Neeson and I doubt Vanessa Redgrave wants to do much about it. Oddly enough a suit could be filed in New York, there are probably enough grounds but no one will want to do that and the Canadians aren’t rushing to help -especially the people in Quebec.
Sanjay Gupta’s did a report on CNN that was a superficial analysis and was inaccurate in the time interval he cited for an ambulance to go to Montreal (it is 1:10, not 2:30 -verified by a number of sources). Since he failed to actually address the timeline his piece is not worth much. He didn’t analyze the case well and cost his credibility with that error on top of it. And he’s a neurosurgeon. Not exactly confidence inspiring.

So all that is reason one I’m writing now - Lots of critics who seem unconcerned about the facts, the evidence of poor medical treatment, and what seems to be the deliberate intent of Canadian authorities to put the case behind them without addressing some serious issues that will affect future patients. The only Canadians who have said so publicly are a few brave Montreal neurosurgeons and trauma people who have essentially backed up what I am saying. No one in any official capacity has presented facts that would exonerate their triage system. Neither the liberals defending socialized medicine nor the conservatives wishing to blast Obamacare are calling for a disclosure of important facts.

But without reason two, I still wouldn’t have written this. Reason two is that to justify themselves all these critics have to blame someone and the person they are blaming is Natasha Richardson. It was her fault- most people have implied it, some have actually said it. Why? She didn’t wear a helmet (a helmet may have saved her, but it has little to do with the triage problem - and skiers tell me that not wearing a helmet on a bunny hill is not unusual). I will tell you that we never looked at the fact someone didn’t wear a seat belt or a helmet as worthy of blame. It’s something that happens. It’s a prevention issue independent of this, not a reason for blame. The second reason is that she “refused” care - right after the accident she waved off paramedics, a common scenario in epidural hematoma. She didn’t refuse care, she declined it. It’s a small difference but you can see the connotation. Refusing something makes you more culpable than declining. (I refused a cup of coffee, I declined a cup of coffee). The paramedics or EMTs (we’re not sure) who saw her when she was sick sure didn’t act quickly two hours later and we’re expected to believe they would have done something other than tell an asymptomatic patient to lay down and call if symptoms recur, essentially what happened. Like the helmet issue, this is part of medicine, not a reason to blame anyone. The rule in the ICU is you play all cases where they lay. We don’t dwell on the fact someone who turns out to have appendicitis doesn’t come in at the first twinge of a stomach ache. Some have even implied she made her situation worse by taking aspirin- they’ve written it in blog comments. Interesting they would write that when no one knows the actual medical care she got, let alone what she did before she was seen.

Here is the issue in a nutshell in the Montreal press:

Pierre Arcand défend le Québec sur les ondes de CNN
Article mis en ligne le 16 avril 2009 à 12:00
Soyez le premier à commenter cet article
Le député de Mont-Royal, ministre des Relations internationales et ministre de la Francophonie, Pierre Arcand, a corrigé la semaine dernière un certain reportage à l’émission d’Anderson Cooper sur les ondes de CNN au sujet de l’accident au Mont-Tremblant impliquant l’actrice Natasha Richardson et la qualité des soins de santé au Québec. À la suite de son intervention, CNN a corrigé certaines des informations diffusées le jeudi 9 avril 2009.

Voici le texte intégral du ministre diffusé par CNN: «Natasha Richardson’s death following her fall at Mont-Tremblant ski resort last month was a tragic and regrettable incident. To suggest that the Quebec health care system may be responsible for her death is unwarranted. While it can be argued that a helicopter medical service may have helped save her life, in the case of an epidural hematoma, most doctors Canadian and American agree that a patient’s decision to seek or refuse treatment is critical to the outcome. For the record, the closest Trauma Center from Mont-Tremblant is a 1h 45 minute drive and not 2h 30 minutes away, as was reported in your story. Our deepest sympathies go out to Natasha Richardson’s family.»

I don’t speak French but there is enough translation there. Pierre Arcand is the big shot Quebec official whose job it is to protect the province’s good name. Note two things- first it is clear he is blaming the victim in the bolded remark (in fairness, I bolded it). Second in refuting Gupta’s piece (he didn’t like it because it hinted they may have done wrong) he seized on Gupta’s error on transit time. But he didn’t correct it, he made it strategically shorter (by the way the actual sum of the transit times in her case, ski resort to local hospital, local hospital to Montreal, was 1:20, 25 minutes shorter than his comment. I am shortening by 10 minutes because it’s obvious the first stop lengthens the transit time when you slow down and a number of people have verified this). Draw your own conclusions about why the Information Minister would get the time wrong in such a critical case. That has pretty much ended the case.

So they blame Natasha Richardson when she is not remotely to blame let me repeat that -she is not remotely to blame - hey Betsy Reed, blaming the victim - THAT’s exploiting Natasha Richardson. By the way, she donated six organs. Remember that if you hear the “she was at fault” meme again.

Essentially it boils down to a terrible, preventable tragedy that few people will appreciate and a system that goes uncorrected. That’s the real inside on Natasha Richardson’s death.
There won’t be an inquiry, nobody will act. That compounds the tragedy. I don’t know anything about Natasha Richardson other than what I saw in movies and in interviews. She was a very good actress and seemed like a genuine and nice person. I have a feeling she would be outraged.
Condolences to her husband, her sons and her family.

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