Celebrate Judy ~ A Foundation Scholarship Fund ~ to educate regarding: avoidable / preventable iatrogenesis (A/PI), avoidable / preventable iatrogenic injury (A/PII), and harmful iatrogenic effect (HIE)
Foundation Goals & Objectives
WHAT: Reduce incidence of TOH (The Ottawa Hospital) readmission, serious damage, and fatalities
HOW?: Encourage improved patient care at all TOH Campuses, ie: Riverside, Civic, General, Queensway Carleton, & Montfort
WHAT: Reduce incidence of death / serious injury from surgical procedures (particularly laparoscopic cholesystectomy) performed on post-bariatric patients
HOW?: Educate the medical community about the 'High' probability of complications arising in such surgery and how to avoid / prevent / mitigate
WHAT: Reduce the incidence of preventable sepsis / septic shock
HOW?: Raise public awareness of the excessive cost to life, healthy bodies, and finances caused by injury and death from sepsis / septic shock
WHAT: Better equip healthcare staff to listen to the patient
HOW?: Encourage education, training, and continuous professional development in techniques such as BATHE, SWIM, SOCRATES
Judy Foley's husband, family, and friends became painfully aware of the damage that sepsis and septic shock cause, whether the patient survives or dies as a consequence. We became aware how a patient's chances of survival reduce (empirically) at a rate of 13% per hour following the point in time when the sepsis has become pervasive. This meant that - as a consequence of improper medical care being provided to Judy following surgeon errors (which occurred around 7:00 AM Thu 27-Sep-2012), then approximately six (6) to nine (9) hours for the sepsis to spread - Judy's body would have been fully compromised at some point between 8:00 PM and 11:00 PM Thu 28-Sep-2012, ie: 100/13 = approximately 8 hours following the point where the sepsis was pervasive in Judy's peritoneum. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ This experience encouraged Judy's husband - Mel Hughes - to become an ardent advocate of awareness while also becoming a proponent of procedures to reduce preventable harm, illness, and death, particularly related to sepsis / septic shock. It seems such a trite statement, but preventable death is always preventable. In this regard, Judy Foley's death was preventable at multiple points from before surgery to between fourteen (14) and seventeen (17) hours after surgery. That prevention mindset would - however - have required vigilance on the part of the healthcare provider. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ As an afterword, the 'system' continued for many years to fail Judy Foley inasmuch the autopsy wasn't officially released until May-2015, ie: the Patient Safety Death Review Committee Report plus the Coroner's Report couldn't be published until that date, a full 32 months following Judy Foley's death. Unfortunately, to finally access the Reports, it required Judy's husband to conduct 'sit-in' protests at the Regional Coroner's Office in Kingston, Ontario, then - when that Office relocated - another 'sit-in' at the Regional Coroner's Office in Ottawa, Ontario, and - finally - in the absence of appropriate action - at the Provincial Coroner's Office in Downsview, Ontario in May-2015. It was only upon full receipt of the Patient Safety Death Review Committee Report, that Mel learned how the surgeon had actually precipitated not one (1), but two (2) surgeon errors in succession during the same 'routine' laparoscopic gall bladder removal surgery..!!