A Better Formatted Dr. Nagase Responds Nurse and Doctors

College Complaints against Dr. Daniel Nagase from 2 family physicians in Rimbey.

Dr. Cian Hackett’s complaint was over Dr. Nagase’s speech on October 1st, over 2 weeks after Dr. Nagase left Rimbey.

Dr. Jacqueline Wolf’s complaint was that Dr. Nagase administered medications that were “potentially unsafe / have little to no evidence to their efficacy”

Here is Dr. Nagase’s response to Dr. Cian Hackett and Dr. Jacqueline Wolf.

Dr. Cian Hackett,

You are a young doctor, and I too was once a young physician.  Now, as a physician with experience far beyond my actual years of practice, I offer this heartfelt advice.  Beware of practising ego based medicine.  You and I are here for the patient.  Not the other way around.  I do not personally know the colleagues you have in Rimbey, the doctors who you work beside day in and day out in clinic.  But I do know of their work.  It is essential to your integrity as a doctor to maintain independence, your academic honesty, not for you, but for your patients.  I cannot imagine the social pressures on you working beside Rimbey’s other physicians.  I do not know what it’s like to be next door neighbours and social acquaintances with them.  Having disagreements with close friends can be difficult.  It can be even more so in the professional sphere of medicine.  However, when integrity is at stake disagree you must, for your patients.

In practice with patients, you must be exact.  You must be observant.  Most importantly, you must always keep in the back of your mind that you may be wrong.  For that is how you catch your own mistakes, before they cause harm.  That is how you do your best for the patient.

When I say antibiotics for a viral pneumonia.  We are talking about pneumonia.  Fluid in the lungs.  Fluid that can develop a bacterial superinfection.  Neutrophilia is not always apparent at the onset of bacterial growth in a mucous serous accumulation within the lungs.  Without a fibreoptic bronchoscope samples and culture, it cannot be proven that a fluid accumulation is sterile.  Because cultures take days to complete, antibiotics are given.  The diagnosis of viral pneumonia is a best guess.  The astute physician keeps in the back of his mind that he may be wrong.  There may be a bacterial pneumonia hidden within.  This is why I advise you to remedy any tendencies to ego based medicine.  Always keep in mind that you may be wrong.  It increases your diagnostic accuracy, it improves your treatment efficacy.  It makes you a better doctor.

Your accusation that I advocate for antibiotics in viral infections is inexact.  It is imprecise.  It shows a lack of attention to detail.  I specifically said pneumonia.  That lack of accuracy can have devastating consequences for your patients.  You must maintain your clarity of mind.

You also accuse me of revealing patient identities because I mentioned 70 year olds.  Do you know the exact ages of the patients I treated?  They were both in their 70’s, but neither were exactly 70.
Again.  A lack of detail.  A lack of precision.

Patients lives depend on your mental clarity.  Your intelligence.  Your health.

But that is only the first part of living up to the title of Doctor.  Doctor comes from the Latin word Docere, which means teacher.
You must also learn philosophy, history and ethics.
For then you would understand the meaning of my Nuremburg speech.  To a Just soul there is no need for inquietude.  No need for complaint.  For justice, as Plato described, is the excellence of the soul.  It is the excellence of being a doctor.

Please read these words again in a year, and then in the middle of your career.  And again at the end of your career.
I wish you the best.

Dr. Daniel Nagase

Dr. Jacqueline Wolf,

Before you claim the medications I offered were dangerous and ineffective.  Please educate yourself regarding the science.
This is the most basic level of professionalism expected of doctors.
Also, you claim that you tried to resolve your complaint directly with me.  I have had no email from you, and no phone conversation.  The only conversation I had with a local Rimbey physician about the efficacy of Ivermectin was with Dr. Ellis, which was in the context of repeated demands and then an ultimatum to leave Rimbey hospital.
Please correct this inaccuracy or withdraw your complaint to the College of Physicians and Surgeons of Alberta.
You cite a nurse’s letter to add material to your brief one sentence complaint.
As a physician you are a part of the leadership within your hospital.  It is in your scope, nay your duty to review nursing complaints, and examine them for validity.  Deficiencies of professionalism are your responsibility to address.

For your benefit, I have already written to this nursing complaint.  Please review, as I am helping you with your role as a leader in Rimbey hospital to improve nursing professionalism.

See Below.

“Attention: Complaints Director
College and Association of Registered Nurses of Alberta

I am writing in reference to this letter written by a nurse.

This nurse, whose name has been redacted by AHS, practices in Rimbey AB, exhibits some behaviors of concern that both I witnessed and that she details herself in her letter.

    1. She escalated a quiet discussion behind the nursing station at the ER, made under the same voices where a physician and nurse would normally discuss the condition of patients in the ER, and escalated this discussion into an argument.
    2. On 2 occasions she describes herself as being unable to, or having difficulty administering liquid medication dosed in milligrams per Kilogram of bodyweight.
        a. First with being “uncomfortable” giving a medication that happened to be 10mg/mL ivermectin dosed at 0.5 mg/kg bodyweight
        b. Second giving Amoxil at 50 mg / kg / day divided into 3 doses.  She facetiously describes her second difficulty as “I wanted to confirm an antibiotic dosing”.  This is a task that an RN usually performs by looking up a medication on the Alberta Health Services formulary if she wishes to confirm a milligram per kilogram dosing range.
    3. Again, she frames this daily activity, well within an RN’s scope of practice, something she should be able to perform independently, as a “communication” problem, and a complaint.
    4. This is unprofessional.
    5. Criticism and disrespect for team members.  Between this RN and the colleague she references in her letter, she refuses to disclose the fact she was denying the validity of a pharmacist’s knowledge, and her denial of a physician’s knowledge.  She refused direct scientific evidence that was printed out and left in the ER for nurses to peruse in their spare time.  Then when she had spare time, she chose to escalate a collegial discussion about patient ethics into an argument devoid of reason and scientific fact.
These behaviors are concerning from a patient care perspective.  Importantly, her disregard for the consent and desires of the patients she claims to be advocating for come through in her letter.  Instead she overrules her patients with communications behind their backs to a physician who is not caring for them.  She overrules her patients with phone calls from a doctor who is not even in the hospital.

The skill of confirming and delivering a medication dosed by bodyweight is a skill all nurses should have upon graduation from nursing school.  This level of competence is expected.  Respect for the expertise of pharmacists and physicians is also expected.
But most importantly, the ability to reason and understand basic science is expected of all healthcare team members.

Please consider this notification as an issue within the purview of the College and Association of Registered Nurses of Alberta to remedy, to maintain standards of RN practice for this name redacted RN at Rimbey Hospital Alberta.

Sincerely,

Dr. Daneil Nagase
CCFP-EM