The basketball hoop still stands next to the driveway, a solemn reminder of the energetic 17-year-old who livened up the Delaware home with his drum set and electric guitar. The drums and guitar have been silenced for a year now with the death of Dan Miller at London's Children's Hospital of Western Ontario (CHWO) on Jan.
"He could play sports, he was bright, he could draw. He was a bouncy kid who liked to play. If he was sitting beside you, he would be touching you and poking you," remembers Daniel's mother, Theresa, struggling to hold back tears.
Dan, who played hockey in Mt. Brydges and lacrosse in London, has also been deeply missed by fellow students at London's St. Thomas Aquinas high school, who have written the Millers about how their son helped them with their math and science homework.
With the influenza season in full swing again, Theresa and her husband, Tim, have decided to speak out about the death of their son and the medical mistakes they maintain reduced his chances of survival.
They hope their tragic experience will serve as a warning to others and prevent similar deaths.
The Millers reject the position of the hospital and an initial finding by a local coroner that their son's treatment never went below "a reasonable standard of care."
"For the condition he had, he got the worst possible treatment you could possibly get," Tim says. "Every chance he had was taken from him."
For the hospital's part, Ellen Rosen, vice-president of children's and women's care, said London Health Sciences Centre (LHSC) acknowledges these are difficult circumstances for the Miller family.
"LHSC/CHWO regrets the sudden death of this young man and will continue to review what, if anything, could have been done to change this outcome from a systemwide perspective," she said.
Rosen said the hospital can not respond to Millers' assertion medical mistakes were made.
"This is now a matter before the Ontario College of Physicians and Surgeons. It is not appropriate for the hospital to comment on medical decision- making issues," she said.
"The hospital cannot respond to questions related to specific medical decisions made by physicians."
Theresa's first hint her son was ill came on a Saturday morning, Jan. 4, 2003. He'd had friends over the night before and he was lying on the couch.
"I was trying to get him to shovel the driveway. He just said, 'No, I don't want to do that.' "
Dan was up all that night, repeatedly throwing up. In the morning, his parents called Telehealth, Ontario's public health advice information line, and were told to take him to emergency.
Dan was sicker than Theresa and Tim had ever seen him.
At the emergency department at the children's hospital, Dan was quickly seen by a nurse and then a doctor.
His heart rate was measured at a high 140 beats a minute.
'I said, 'why is it so high?' and they said it is just part of dehydration," Theresa recalls.
The doctor decided Dan had enteritis, an inflammation of the intestines, and was dehydrated. He was started on intravenous and received 3.6 litres of saline over 4 1/2 hours.
Blood tests were done and the doctor said Dan could go home once he had urinated. When he did urinate a slight amount, he was sent home.
His parents were told to give him Gatorade, but no starchy foods. What they didn't know was that three out of five of Dan's blood test results were in the abnormal range. The Millers say their son was never reassessed before he was discharged, still vomiting.
That night and the next day, Daniel didn't improve.
"On Wednesday morning I phoned our family doctor and couldn't get him in, so Theresa took him back to the hospital in the afternoon," Tim says.
The reception at the hospital was less than welcoming, Theresa says.
"The nurse at triage said: 'Well you know, you are just going to have to wait it out.' I said, 'Are we supposed to go home?' She said, 'Well you're here so the doctor will see him,' " Theresa recalls.
Dan was seen by four doctors and eventually diagnosed with hepatitis, a diagnosis that turned out to be wrong.
"All this time his blood pressure is falling. We kept asking how come his heart rate is so high and his blood pressure is falling. They said it is just the equipment and they kept changing machines," Theresa says.
Dan was admitted to the hospital's seventh floor, where several more blood pressure machines were tried.
"We kept saying, 'Isn't that really low?' and they said, 'No, no, it is just the machine.' It turned out, the machines were right," Tim says.
By 11:30 p.m., the Millers say, their son was getting tired and told them he wouldn't get any sleep if they kept staring at him. They went to a waiting room, returned and decided they wouldn't be any good to Dan if they stayed up all night. They decided to go home and were told by nursing staff that everything would be OK.
"They said, 'Don't worry, he's fine. There are all kinds of doctors around.' "
The Millers made it home to Delaware about midnight. Two hours later they had a call from the hospital that their son was being transferred to the pediatric critical care unit.
Again, they were reassured he was fine and there was better equipment in the unit. Dan was still alert and conversing and was allowed to transfer himself.
The Millers later learned that when their son was being admitted to the unit, a resident doctor ordered he be given sedation with Fentanyl and Midazolam, two drugs that lower blood pressure.
A nurse twice questioned the order and was told to proceed with it. Within five minutes of being administered the drugs, Dan stopped breathing and his heart slowed.
His parents arrived as the medical team struggled to revive him. For the next hour and 20 minutes, they tried to resuscitate the 17-year-old.
"They had to give up, nothing was happening," Tim recalls.
At 3:50 a.m., Dan Miller was pronounced dead.
The doctor called in to try and resuscitate their son told them he suspected Dan had myocarditis, a heart infection that can cause rapid onset of heart failure. It's estimated the disease accounts for 17 to 25 per cent of unexplained sudden death in otherwise active, healthy young people.
An autopsy confirmed the doctor's suspicions.
The Millers were left reeling at the loss of their son -- the healthy, artistic teen who had a Grade 12 average of 88 per cent and had set his sights on studying biochemistry at the University of Waterloo, where his older brother and hero attended.
"At the time you are totally devastated. You know they have probably screwed up, but you know it is not going to make any difference if you do anything, so why bother," Tim says.
Once the initial shock wore off, the nagging questions started:
- Why had their son been discharged when they first took him to emergency?
- How did a 17-year-old who had been healthy only a few days ago die so quickly at a hospital that prides itself on being a top medical facility?
"They are really friendly at children's (hospital), they are wonderful, but they are just kind of nodding and patting you on the back instead of saying, 'this is really different for this one,' " Theresa says.
At the end of February, the Millers asked to meet with the doctors at CHWO and took along Dan's aunt, who had been an emergency room nurse for several years.
The Millers were told that acute myocarditis is difficult to diagnose. There was nothing the hospital could have done to save their son.
But when Dan's aunt noted he had been given sedation drugs against the hospital's own guidelines, the meeting became uncomfortable, the Millers say.
LHSC medical officials said the use of the drugs was a matter of routine.
The Millers left the meeting with more questions than answers, convinced the hospital didn't give their son the serious attention he needed.
They requested Dan's medical chart and found the blood tests done when he first arrived in emergency showed abnormalities, but the tests were never repeated to see if he had improved before he was sent home.
The hospital reviewed Dan's death, but declined a request to let the Millers participate.
Dan's death and the hospital's actions were also reviewed by the coroner.
The conclusion of the hospital's review was given to the Millers in June.
In a letter, they were told their son's care at the hospital "had met a reasonable standard" and that the use of sedation and analgesia are so common "as to not be worthy of comment."
"Dan was treated as any 17-year-old male should have been," the letter said.
While the letter acknowledged Dan's heart rate and low blood pressure should have raised concerns, at no time did Dan's care fall below a reasonable standard, it said.
The Millers had another meeting with staff at LHSC asking for a settlement that would be used to establish a foundation in their son's name to promote patient safety. No dollar figure was suggested.
In their research after Dan's death, the Millers learned that based on U.S. studies it's estimated medical mistakes cause 10,000 deaths in Canada a year. "It is like a jet airplane crashing at Toronto every week and nobody ever pays any attention to it. It just gets swept under the carpet," Tim says.
In September, the Millers received a letter from the hospital rejecting a patient safety foundation, saying there was no money for it.
The Millers were determined their son's death would not be swept away.
They learned from a Hamilton family who lost a daughter that they could ask the Ontario coroner's office to review Dan's death.
That review, carried out by a committee of doctors, agreed myocarditis is difficult to diagnose, especially in young adolescents. And the review noted the disease can progress to cardiovascular collapse for which the only effective therapy is the use of a mechanical heart assist, equipment not available in London.
But the review also said when Dan was originally seen in emergency, he was obviously unwell and had no specific symptoms that would point to myocarditis.
The review committee found:
- The original diagnosis of enteritis and dehydration was questionable.
- At the time of his transfer to the critical care unit, he had all the features of shock with multi-organ failure.
- And in contrast to LHSC's position that administering the sedation "was not worthy of comment," the coroner's review particularly noted that decision "was inappropriate."
- The committee also said the abnormal test results seemed to have been "underappreciated" and there seemed to have been inadequate input into his diagnosis and treatment at staff physician level.
The committee recommended:
- When a patient in an emergency room has abnormal lab test results, serious consideration be given to repeating the tests before a decision is made to discharge the patient.
- Medical residents/fellows be reminded to follow guidelines in place at LHSC, specifically about the use of the two drugs administered to Dan.
- LHSC review its internal death review process.
Theresa says she and Tim keep looking for what good could come out of Dan's death.
"All a family in our situation wants to know is what happened and how it will not happen again. There is nothing you can do to get your child back."
The hospital has said changes have been made as a result of their son's death.
Reviews within the emergency department pediatric critical care unit have raised awareness of myocarditis in teenagers, the hospital said in a letter to the family.
But it maintains there is "no evidence that the care Dan received was inadequate."
Theresa and Tim call that "frightening.
"This means other very sick children or adolescents who come to CHWO's emergency room may, in fact, receive the same intervention that Daniel received," Theresa says.
"We would like to know what changes will be made so another family will not endure our nightmare."
The Millers have filed complaints about their son's care with the Ontario College of Physicians and Surgeons and are keeping other legal options open. In response, they say doctors at the hospital have been advised by the Canadian Medical Protection Association not to meet further with them.
The Millers say they won't quit pushing.
"We are not about to give it up, because Daniel was just too important. We won't give it up." Theresa says softly.
"We have lots of time."
