ontario man dies of maid after being assessed outside tim hortons
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a london, ont., doctor who assessed a patient with inflammatory bowel disease and a history of mental health issues for maid outside a tim hortons location and later personally drove the man to the place his life was ended has agreed to a minimum six months’ supervision.
in another case, dr. james maclean failed to administer one of three drugs used in assisted deaths — one that paralyzes the body’s muscles, including the muscles involved in breathing. the patient resumed spontaneously breathing again after initially being pronounced dead, and after maclean had already left the home.
as first reported monday by the the globe and mail, the doctor’s case is raising new concerns about maid’s oversight and accountability.
“what is striking is not only the seriousness of the concerns identified in these cases, but the limited regulatory response,” said dr. ramona coelho, a family physician and former member of the office of the chief coroner of ontario’s maid death review committee.
as part of an investigation by the college of physicians and surgeons of ontario (cpso) into two public complaints made against maclean, an independent assessor appointed to review a number of maclean’s charts concluded that he “did not meet the standard of practice of the profession, displayed a lack of judgment and that his conduct exposes or is likely to expose patients to harm or injury in five out of twenty charts reviewed,” according to a summary decision of the college’s inquiries, complaints and reports committee.
maclean was called before the committee to be verbally “cautioned” with respect to the maid complaints.
in addition to agreeing to mandatory clinical supervision for at least six months as part of an “undertaking” with the college, maclean will undergo ongoing review of his maid patient charts and mandatory professional education related to maid, consent, documentation, professional boundaries and professional behaviour.
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after six months, he’ll undergo an assessment of his practice, the results of which “may form the basis of further action by the college,” laura zilke, a cpso spokesperson said in an email to national post.
“the undertaking imposes extensive oversight and monitoring requirements on dr. maclean’s practice,” zilke said.
“the college takes any complaints brought to our attention extremely seriously as part of our mandate to serve the public interest and ensure safe, ethical and competent medical care for all ontarians.”
maclean declined comment when contacted by national post.
“due to the rules regarding privacy and my professional responsibilities to the cpso regarding confidentiality of complaint investigations, i am unable to respond to your questions,” he said in an email.
according to the globe and mail, one of the complaints concerns thomas dillon who suffered from crohn’s disease and died, age 45, in january 2024.
the anonymized death of the st. thomas man was also flagged by the ontario coroner’s maid death review committee.
in a report involving 2024 maid deaths, the coroner’s panel highlighted the case of “mr. a,” a male in his 40s with inflammatory bowel disease who, because of his illness, didn’t have an active social network, had difficulty maintaining a job, found personal relationships difficult and was dependent on family for housing and financial support.
he had a history of mental illness, previous bouts of suicidal thinking and on-going alcohol and opioid misuse that cost him his driver’s licence.
during a psychiatric assessment, dillon was asked if he was aware of maid and given information on the option.
there was no documented input from the family who were known to have had concerns about the maid request.
maclean and another assessor found dillon eligible for maid under track 2, designed for people whose death is not reasonably foreseeable but who suffer intolerably from a grievous and irremediable medical condition.
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maclean conducted his assessment outside the coffee shop. the cpso panel found it concerning that maclean discussed “sensitive maid-related matters in an informal public setting,” according to the summary of the inquiries and complaints committee’s decision.
“in the committee’s view, this reflected a lack of the level of formality and care expected when assessing requests for maid.”
the panel was also troubled by the “quantity and nature” of maclean’s text exchanges with dillon, which included comments about the family’s views.
maclean’s decision to drive dillon to the maid provision location — which the globe identified as an industrial-like facility where bodies are prepared for funerals — “raised concerns about professional boundaries.”
“taken together, these actions created a risk that (maclean’s) involvement could be perceived as influencing the patient,” the committee’s summary reads, especially given the patient-doctor power imbalance and dillon’s history of mental health and substance use issues.
according to a more detailed decision from the inquiries and complaints committee provided to the family and obtained by the globe and mail, dillon refused to ride to the maid procedure site with his sister when she arrived at the tim hortons, where he and maclean had again arranged to meet. maclean ultimately drove dillon himself “to ensure that patient’s final moments were dignified.” dillon didn’t want to die at home, where he lived with his mother, because he knew his family didn’t approve and he agreed to the chosen site after other options were considered, the decision said.
“in this case, the assessment occurred during a single encounter at a tim hortons coffee shop,” coelho said in an email.
“the family was not engaged in the assessment process, despite being the patient’s primary support and despite the maid provider being aware they were trying to raise concerns,” she said.
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“collateral information from those closest to the patient is essential to understanding the factors contributing to the desire to die.”
the second complaint involved a cancer patient at end of life. the man had signed a “waiver of final consent” that allows people whose natural death is reasonably foreseeable to receive maid, even if they lose capacity to give consent the moment before death.
before the chosen date, the man lost capacity and was unresponsive. maclean was called to the home.
he’d ordered a maid medication kit, but it wasn’t ready when he arrived at the pharmacy. he went to the home with a kit he already had.
according to the college, maclean administered a sedative follow by propofol, a drug used during surgery that, in high doses, puts people in a coma — a coma so deep people often cease breathing, according to dying with dignity canada.
the final drug customarily used paralyzes the muscles. deprived of oxygen, organs shut down, one by one, until the heart finally stops.
but maclean was unable to find the neuromuscular-blocking drug in his kit.
shortly after administering the propofol, and unable to hear a heartbeat, maclean pronounced the patient dead, according to the college. after he left the house, “the patient resumed spontaneous breathing.”
maclean returned, saw signs of cardiac and respiratory activity, administered more medication along with the paralyzing agent, “and again pronounced the patient’s death.”
according to the college committee, maclean “advised that he believes the stress of the situation, including the last-minute and urgent request for his attendance and the substantial number of people present with significant tension amongst them, contributed to initial failed provision of maid.”
the family complained about maclean’s professionalism and communication.
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“the level of scrutiny and accountability applied to maid is inconsistent with how other serious medical procedures are regulated,” coelho said.
the federal government “frequently points to the absence of criminal findings or disciplinary action as evidence that the maid system is functioning safely,” coelho added.
“cases such as these, along with those documented (by the coroner’s maid death review committee) confirm that important gaps in oversight and accountability remain.”
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