Some correspondence from Public Health et. al

A FAVORITE RESPONSE FROM PROFESSORS ETC. WHEN THEY CAN’T SUBSTANTIATE A CLAIM “OUR EXPERTS”  please quote some literature all medical consensus found here  They can’t follow the instructions on the medication  https://jgarythompson.wordpress.com/2016/06/29/monographs-naloxone-opioid-od/

FRIEND OF MINE ASKING QUESTIONS 

From: Gary Thompson  Today 9:27 PM Aug 10, 2016 +8 more  Premier Wynne & Dr. Eric Hoskins cc’d by Ms ###&&&

Ms: &&&####

Too much fun, suffering fools gladly. Just trying to save your lives and it’s a no brainer.

What threat? Public Health will be held accountable. Crazy buggers have threatened me many times Sept. 2011 and onward, in writing and verbally.

What they are teaching is dead wrong. Read the label on the medication or talk to EMS or any hospital ED department. People are showing up damaged from chest compression’s only they were never to receive. Be assured Public Health staff will give rescue breathing only.  https://jgarythompson.wordpress.com/2016/06/29/monographs-naloxone-opioid-od/

They can’t supply any medical consensus that states chest compression’s only.  In fact CC only is strictly forbidden, basic first aid knowledge.

Gary Thompson

From Ms.  ###%%%%  Today 5:07 PM

To: Brennagh Smith <brsmith@toronto.ca>; +7 more

Ms. Smith, I’m sorry you, as a public servant, have nothing better to do with your time, and with taxpayers’ resources, than to send threatening emails to people who care enough to take respectful, appropriate actions for the sake of public safety – especially after having reviewed the astonishing, disturbing emails below. I should think you would be ashamed and embarrassed to respond to such a disgraceful and blatantly dangerous situation in this manner, rather than joining me in demanding answers, accountability and a revised protocol.  You must feel confident that neither yourself nor any of your loved ones will ever suffer a respiratory emergency in Toronto. But thank you for the revealing admission that being held accountable for their actions is seen as ‘threatening’ to Toronto’s Public Health Staff.  I guess I might feel ‘threatened’ too, at the thought of having to account for such a murderous protocol.

Best wishes, Ms. ####%%%%

On Wed, Aug 3, 2016 at 2:55 PM, Brennagh Smith <brsmith@toronto.ca> wrote:

Ms. ###&&&

I am a lawyer with the City of Toronto. The below chain of correspondence was forwarded to me by Toronto Public Health (“TPH”) for review and response. Some of your below comments approach a threatening tone directed at City staff, which the City cannot and does not condone. The City and TPH support free expression and the object of my email is not to curtail your right to express your views regarding TPH’s programs and services. The City and TPH simply ask that any expression of thought or views directed at City staff be respectful and non-threatening. Please ensure that all future communications avoid threatening and/or harassing tones and comments.

Regards, Brennagh Smith

Litigation Division City of Toronto, Legal Services 26th Floor, Metro Hall 55 John Street Toronto, Ontario, M5V 3C6 T: 416.397.5612 F: 416.397.5624 brsmith@toronto.ca

Original Message—– From: Ms. ###&&&

Sent: July 27, 2016 11:28 AM To: Barbara Yaffe <byaffe@toronto.ca> Cc: Jann Houston <jhouston@toronto.ca>; Rita Shahin <rshahin@toronto.ca>; Shaun Hopkins <shopkins@toronto.ca>

Subject: Re: Response To: Contra-indicated response to respiratory emergencies

Thank you for your admission, Dr. Yaffe. All involved in this murderous scheme will be held accountable.

Ms. ###&&&
From: Barbara Yaffe <byaffe@toronto.ca>
Date: Fri, Jul 22, 2016 at 3:59 PM
Subject: RE: Response To: Contra-indicated response to respiratory emergencies
To: ###&&&&&  ####&&&&&@gmail.com>
Cc: Jann Houston <jhouston@toronto.ca>, Rita Shahin <rshahin@toronto.ca>, Shaun Hopkins <shopkins@toronto.ca>

Dear Ms. ####&&&,

Thank you for your email.  I appreciate your continued interest in this issue.  However, Toronto Public Health does not have additional information to provide to you at this time.

Thank you,
Dr. Barbara Yaffe
Acting Medical Officer of Health
Toronto Public Health

From: David McKeown <dmckeown@toronto.ca>

Date: Fri, May 27, 2016 at 1:34 PM Subject: RE: Response To: Contra-indicated response to respiratory emergencies

Dear Ms. #^$##,

As you correctly point out, some of the references have been published after our program was launched because we continue to monitor and assess new literature related to policy decisions.  Most recently, in 2016, the New York State Technical Working Group on Resuscitation Training in Naloxone Provision Programs published their review of the issue and came to the following conclusion:

“As there is insufficient data to recommend one resuscitation method over another, clinical directors will need to determine whether rescue breathing, chest compressions, both or neither is most appropriate for inclusion in their training curricula.”

I appreciate that you have reached a different conclusion looking at the same evidence however I believe that the evidence supports our position.  I continue to stand by our protocol for the POINT program.

Thank you,

Dr. David McKeown
Medical Officer of Health
Toronto Public Health
277 Victoria St., 5th Floor
Toronto ON M5B 1W2
Tel: 416.338.7820
Fax: 416.392.0713

Dr. McKeown reference. This is a proportion of use article, not an indicator of success.   New York State Technical Working Group on Resuscitation Training in Naloxone Provision Programs

Quotes first sentence page 1 “Opioid overdose leads to respiratory depression and causes hypoxia culminating in cardiac arrest and death.”

 Recognition of a potential overdose
 Activation of Emergency Medical Services (EMS)
 Rescue breathing
 Administration of naloxone

My response: Breathe less than once every five seconds you are dying lack of oxygen give rescue breathing stops hypoxia and cardiac arrest, cause cardiac arrest sever brain death lack of oxygen.   New York State 2015 Report   See page 52 video Dr. Dailey and I are both mentioned in the 2015 AHA & ILCOR guidelines toxic ingestion’s BLS 891.  Read moderated comment this video http://youtu.be/Q4HVeYqHSLk  Q&A @16 minutes Mentions Naloxone can be ineffective.

Dr. McKeown the above quote is nonsense “As there is insufficient evidence…..”  Humankind has known for 5,000 years cause of death ‘acute respiratory failure’ and clinicians see overdose daily ‘rescue breathing essential it’s not a sudden cardiac arrest’

From: Medical Officer of Health <medicalofficerofhealth@toronto.ca>
Date: Wed, Nov 25, 2015 at 4:32 PM
Subject: RE: Response To: Contra-indicated response to respiratory emergencies
To: Ms. $##$$
Cc: Jann Houston <jhouston@toronto.ca>, Barbara Yaffe <byaffe@toronto.ca>, Shaun Hopkins <shopkins@toronto.ca>, Rita Shahin <rshahin@toronto.ca>

To: Ms. $##$$

Attached are the references used to develop the TPH Naloxone protocol. Thank you for your interest in this issue. As previously indicated we will not be revising our protocol.

Dr. David McKeown
Medical Officer of Health

SUGGEST THE DOCTOR READ HIS REFERENCES https://aliascpr.wordpress.com/2016/02/13/dr-mckeowns-references/

From Ms. #$#$#$                                                                     Nov 12 at 5:18 PM
To Medical Officer of Health
CC Public Health, Barbara Yaffe, Shaun Hopkins, Jann Houston, Jennifer Veenboer

Dear Dr. McKeown,

I did not question the use of naxolone.  I am concerned about the teaching of chest compressions rather than rescue breathing for a respiratory emergency.

Once again, please provide the details of the “extensive literature review” and “consultation with expert medical personnel” upon which you have based your teachings.

I am not asking for another vague statement about experts and literature.  I am requesting the details – the names of the experts, the communications they provided you, and the exact publications reviewed.

Ms. #$#$#$
On Thu, Nov 12, 2015 at 9:55 AM, Medical Officer of Health <medicalofficerofhealth@toronto.ca> wrote:

Dear Ms. #$#$#$:

Thank you for your email.  With regard to your first comment, Dr. Rita Shahin is the Associate Medical Officer of Health for harm reduction programming at Toronto Public Health (TPH).  She responded to your original email on my behalf.

For the reasons outlined in Dr. Shahin’s email [exact form letter I received from Dr. Shahin April 09, 2013 (see below)], we will not be revising our protocol.  Naloxone is an extremely effective medication in the reversal of opioid overdose, and since 2011, TPH’s POINT program has provided approximately 2000 naloxone kits to people who use opioids and are at risk of overdose; and 300 kits have been used to prevent fatal overdose situations.  It is important to ensure that the recommended naloxone administration protocol can be followed as effectively as possible therefore we train people who will be administering naloxone to use a process involving 5 steps.  If people receiving a naloxone kit from The Works already have been trained to do rescue breathing they are told to continue to use that skill.  [Question what is the cause of death, acute respiratory failure or sudden cardiac arrest?  Please make up your mind.]

As previously indicated, this protocol was based on the available literature and expert opinion regarding bystander intervention, the effectiveness of naloxone and the need to provide training that can be easily and effectively followed by non-medical personnel.

Dr. David McKeown

Medical Officer of Health

From: Helen Tolvais <htolvais@toronto.ca               May 21, 2015 12:03PM wrote

To: Gary Thompson

Michelle Maron Board of Health Barbara Yaffe Councillor Burnside Councillor Carmichael Greb Councillor Cressy Councillor Doucette Councillor Mihevc Councillor Nunziata Jann Houston Jennifer Veenboer Rita Shahin Shaun Hopkins

Dear Mr. Thompson:

Your email dated May 11, 2015, addressed to the members of the City of Toronto Board of Health, was forwarded to me for response. As previously communicated to you by Dr. Rita Shahin and myself, the naloxone program protocol regarding chest compressions has been approved by Toronto Public Health (TPH) after an extensive literature review, consultations with expert medical personnel and opiate users.  The protocol to perform chest compressions, in conjunction to calling 911, is to maintain cardiac output until naloxone has time to reverse the overdose and until emergency medical personnel arrive.  Toronto Public Health will continue with the current protocol until there is new medical evidence and best practices regarding chest compression. Sincerely,

Dr. David McKeown

Medical Officer of Health

Board of Health                                                                                             May 11 at 12:05 PM

To: Gary Thompson

Good afternoon Gary,

Please note that we have received your email and have forwarded a copy of it to Toronto Public Health at publichealth@toronto.ca .

Regards,

Antoinette Crichlow

City Clerk’s Office tel: 416-397-4579 email: boh@toronto.ca

 

Councillor Mihevc                                                                                       May 11 at 11:39AM

To: Gary Thompson

Good morning Mr. Thompson

We are in receipt of your email addressed to the Board of Health and a response will be forthcoming from the Board.

Sincerely

Michelle Maron Executive Assistant

Office of Councillor Joe Mihevc

Ward 21, St. Paul’s West T: 416-392-0208 F: 416-392-7466

From: James Thompson [mailto:jgary.thompson@mail.utoronto.ca]  Sent: May-11-15 10:35 AM To: Councillor Mihevc; Board of Health; Councillor Burnside; Councillor Carmichael Greb; Councillor Cressy; Councillor Doucette; Councillor Nunziata Subject: Toronto Public Health CONTRAINDICATED teaching

Dear BOH Committee Members:

Was just posted, moderated comments Forbes Magazine about Public Health Naloxone protocols

Forbes April 23 ‘Physicians Polled on Mark Cuban Debate’ http://www.forbes.com/sites/danmunro/2015/04/23/physicians-polled-on-mark-cuban-debate/

Forbes April 26 ‘Prescription Pain Pill Overuse Is Leading To Thousands Of Hospitalized’ Newborns http://www.forbes.com/sites/matthewherper/2015/04/26/the-pain-pill-epidemic-is-hurting-newborn-babies/

Only took three days to stop Saskatchewan from teaching this life threatening intervention.  Attached letter from Chief Medical Officer of Saskatchewan Dr. S. Shahab

Basic first aid knowledge chest compression’s only is the worst thing you could do for any respiratory emergency patient. Attached Letter H & S Foundation and Canadian Red Cross info.

My deputation BOH Aug 18, 2014 https://youtu.be/jSEEZe5Vr2o Still waiting for a reply?? Chairperson “Just trying to save your life”

Best Wishes

Gary Thompson

NOTE SASKATCHEWAN GOT IT RIGHT  ‘New pilot project launched in Sask. for Take-Home Naloxone kits’  Nov 20, 2015
http://globalnews.ca/news/2353639/new-pilot-project-launched-in-sask-for-take-home-naloxone-kits/

Attachement Dr. S. Shahab Chief Medical Officer of Sask.

On Tuesday, April 21, 2015 7:46 PM, “Shahab, Saqib HE0” <Saqib.Shahab@health.gov.sk.ca> wrote:

Dear Mr Thompson

Thank you for your voicemail, e mail and links. At present SK does not have a THN (Take Home Naloxone) program and if SK was to develop one, training materials related to that would use the best information and evidence regarding that including when and how to administer Naloxone and additional appropriate interventions as required to support airway, breathing and circulation.

Thank you once again for flagging your concerns

Sincerely

Dr Saqib Shahab FRCPC
Government of Saskatchewan
Chief Medical Health Officer
Ministry of Health, Population Health Branch
3475 Albert St, Regina SK S4S 6X6
E mail: sshahab@health.gov.sk.ca
Tel:   306 787 3220

From: Gary Thompson [mailto:jgary.thompson@mail.utoronto.ca]  Sent: Tuesday, April 21, 2015 2:43 PM To: Shahab, Saqib HE0 Subject: Re: News article April 18

Dr. Shahab:

Read with grave concern your quote of April 18 

“A key feature of the take home program is training users’ family or peers to recognize signs of overdose so they know when and how to administer the antidote, perform CPR compression’s and call 911”

http://www.thestarphoenix.com/health/Opiate+antidote+kits+possible+Sask/10983748/story.html

I hope this does not mean chest compression’s only?  Contraindicated for any respiratory emergency patient.

Read all moderated comments 2015 AHA & ILCOR ‘Opioid overdose response education’ Page 5 BLS 891 & ALS 441 http://circ.ahajournals.org/content/132/16_suppl_1/S51.full.pdf+html

2015 AHA & ILCOR hyperlinks not working??? See here http://www.slideshare.net/thompsongary/2015-aha-ilcor-cpr-guidelines-bls-891

Response to Emily Oliver RN (awaiting AHA moderator)

“….use of naloxone into their education programs. More research is needed regarding educational effectiveness…”

Do we need more research on opioid poisoning resuscitation protocols?  Clinicians see opioid poisoning daily in a clinical situation. Terminally ill are kept “comfortable” to wit OD narcotics. Cause of death acute respiratory failure.

European Resuscitation Council Guidelines for Resuscitation 2010 Section 8.b Poisoning

http://resuscitation-guidelines.articleinmotion.com/article/S0300-9572(10)00441-7/aim/

Opioids

“Opioid poisoning causes respiratory depression followed by respiratory insufficiency or respiratory arrest. The respiratory effects of opioids are reversed rapidly by the opiate antagonist naloxone.”

Modifications for Advanced Life Support

“There are no studies supporting the use of naloxone once cardiac arrest associated with opioid toxicity has occurred. Cardiac arrest is usually secondary to a respiratory arrest and associated with severe brain hypoxia. Prognosis is poor.”

Please reply

Best Wishes

Gary Thompson

OHRDP 

Chance of getting HIV or HEP C one in a billion and never been a case of Hep C transmission with rescue breathing, perpetuating fear needlessly.

From: Rita Shahin rshahin@toronto.ca Sent: Tuesday, April 17, 2012 1:57:53 PM
To: gary thompson <thompson.gary@rogers.com>

; tphfeedback <tphfeedback@toronto.ca> Subject: Re: naloxone training

Hi Gary,  thank you for your email regarding the Naloxone training.  The protocols regarding chest compressions have been approved by Toronto Public Health after extensive consultation with medical personnel both inside and outside of Toronto Public Health.  As you know, the recommendation to perform chest compressions is part of the larger protocol developed by The Works Toronto Public Health to respond to an opiod overdose.  The protocol also includes administering Naloxone and calling 911.  Naloxone is an extremely effective medical intervention for opiod overdose, including reversal of respiratory depression.

Please be assured that we are very committed to providing the most effective response possible to people who are experiencing opiod overdose.  We believe that the approach we have taken is based in good medical and scientific evidence.

Regards,

Rita

Rita Shahin, MD, FRCPC Associate Medical Officer of Health Toronto Public Health Phone: (416) 338-7924 E-Mail: rshahin@toronto.ca

 

From: Rita Shahin                        Sent: Tuesday, April 09, 2013 4:14 PM

To: Gary Thompson   jgary.thompson@mail.utoronto.ca

Subject: Re: Your letter of April 24, 2012 to Gary Thompson File No. 2012-CDC-01

Dear Mr Thompson, I write in response to your emails regarding Toronto Public Health’s (“TPH”) naloxone program at The Works.

After reviewing relevant research and consultation with various experts in the field (including RESCU — the resuscitation science and pre-hospital Medicine research centre at St. Michael’s Hospital in Toronto)[RESCU Dr. Laurie Morrison co-author 2010 AHA CPR guidelines quote “rescue breathing then you may give Naloxone continue rescue breathing” italics mine (see below)], TPH decided to exclude rescue breathing from its naloxone training protocol for the program that we launched in August 2011 (please note it was not “dropped” from our protocols as it was never included). While respiratory depression can be an important component of opioid overdose treatment, experts also suggest that there are various reasons why it can be counter-productive if not administered correctly.

Those receiving TPH’s naxolone training, are lay citizens. They are not professional emergency medical responders or care-givers. It is important that these lay citizens not be trained in a procedure that may be too complex or difficult to administer properly. [10 year olds get a certified Red Cross baby sitting certificate, rescue breathing the bulk of the course] 

Medical experts have reported that even trained first responders may have difficulty reliably identifying that unresponsive patients have no heartbeat , that mouth-to-mouth ventilations may not be an effective educational or resuscitative intervention, that mouth-to-mouth ventilations could put the health of the lay citizen at risk, and that a significant numbers of opioid-related deaths involve polysubstance overdose with cardiotoxic drugs. Painful stimulation (such as chest compressions) may in and of themselves be an effective means of increasing respiratory drive. Further, naloxone administration has no role in cardiac arrest (including those due to opioid overdose). Attempting to teach both ventilations and chest compressions could complicate the protocol without providing a demonstrable benefit. Research from the United States demonstrates that a minority of trained responders actually perform rescue breathing or chest compressions.  The important component of all programs is the naloxone administration and calling 911. TPH will continue to review new evidence as it becomes available. At the present time TPH continues to support its current program. I trust this satisfies your inquiry.  [Where are the cases of barrier masks TPH was supplied by Ontario Harm Reduction Distribution Program]

Sincerely,Rita Shahin

From: Laurie Morrison     MorrisonL@smh.ca                         Oct 8, 2012

To James Thompson

CC ‘Aaron Orkin (aorkin@gmail.com)’ [Dr. A. Orkin co-author Ontario’s protocol CJPH 2013; 104(3):e200 and co-author 2015 AHA guidelines toxic ingestion’s.  I find the 2015 guidelines very misleading 70++ references from 2015 CPR guidelines on opioid overdose and comments
https://aliascpr.wordpress.com/2015/12/13/2015-ilcor-and-aha-references-opioid-od/ Rescue breathing first line defense]

Hi James

Yes I helped craft them in accordance with the guidelines and feel the approach to chest compression only is the right way to go for many reasons. Happy to discuss with you at any time.  Aaron Orkin (copied here) and Toronto public Health were more involved than I was as I was just the expert brought in to help out.

Cell is 4165245434 or we could set up a face to face by email if you prefer.

Laurie

From: James Thompson [mailto:jgary.thompson@mail.utoronto.ca] Sent: Wednesday, October 03, 2012 5:02 PM To: Laurie Morrison MorrisonL@smh.ca Subject: naloxone training

Dr. Morrison:

I have just found out that RESCU was part of Toronto Public Health’s naloxone protocols.  I think they should be changed, as there is no scientific evidence for chest compressions only in opiate overdose.

See Attached   ILCOR  and Amer Heart Assoc. Guidelines 2010

Please reply ASAP

Remember the Magic

Gary Thompson

Dr. Morrison was not “Happy to discuss” when told her bringing a tape recorder she phoned the police. I get a phone call “Can you come to the station?” “Sure be right there” Police constable “Gary I want to shake your hand you have been saving lives, bad news is Dr. Morrison wants no contact” “Fine by me she is a nut”

Dr. Morrison follow the guidelines you wrote and all medicine says past, present and future Give respiratory assist, then you MAY give Naloxone, continue respiratory assist (rescue breathing) until patient breaths adequately on their own.

ILCOR 2010 page 345 & 367       Dr. Morrison Co-chair   http://circ.ahajournals.org/content/122/16_suppl_2/S345.full.pdf+html

AHA Guidelines Part 12:7 page 840-1   Dr. Morrison Co-chair   http://circ.ahajournals.org/content/122/18_suppl_3/S829.full#sec-80

World Health Organization 2013 page 7-9   https://www.unodc.org/docs/treatment/overdose.pdf

Compressions only CPR AHA Guidelines Part 4 http://circ.ahajournals.org/content/122/18_suppl_3/S676.full.pdf+html

Dr. Aaron Orkin, P. Leece ‘Opioid Overdose Fatality Prevention’ JAMA 2013;309(9)873 Quote “Opioid users deserve the same high-quality, evidence-based practice as other patients.”

From Peter.Selby@camh.ca                                        01/30/13 at 10:35 PM

Dear Mr Thompson

Thanks for your email and the attachments [my attachments were the CPR guidelines, suggest you read them.  Guidelines are the world experts.] . After reviewing the correspondence and based on the training I received, chest compressions is the recommended practice in unconscious patients even those with respiratory arrest.  I am not  an expert in CPR policy and depend on the AHA and other CPR providers to train us in the latest options.  You may wish to engage the services of an expert in CPR to assist you in proving your claim or accept that due diligence has been done by public health even though that might go against your beliefs.

Peter Selby MBBS,CCFP,FCFP,DipABAM|Chief, Addictions|CAMH| P. 416.5358501.36859

Associate Professor|Depts of Family and Community Medicine & Psychiatry and Dalla Lana School of Public Health|University of Toronto

From: James Thompson [mailto:jgary.thompson@mail.utoronto.ca] Sent: Wednesday, January 30, 2013 7:11 PM To: Peter Selby Subject: FW: Contraindication Toronto Public Health

From: James Thompson Sent: January 30, 2013 7:02 PM To: peter_selby@camh.net Subject: Contraindication Toronto Public Health

Dr. Selby:

Dr. Bruna Brands told me to get in contact with you.  Toronto Public Health has taught over 500 people in Toronto alone chest compressions only in cases of opiate O.D.  There is no medical or scientific evidence for this anywhere.  Patient is dying from respiratory arrest needs rescue breathing.

Toronto Public Health is going to be sued, NEVER GIVE A NON-CARDIAC PATIENT CHEST COMPRESSIONS.

CONTRAINDICATED AND MALPRACTICE.  Been fighting this since Sept. 2, 2011 getting nowhere.

HOW MANY OF TPH’S SAVED LIVES ARE SUFFERING BRAIN DAMAGE, OTHER ORGAN DAMAGE NOT TO MENTION COMPLICATIONS FROM CHEST COMPRESSION WHICH THEY WERE NEVER TO RECEIVE IN THE FIRST PLACE.

PRIMUM NON NOCERE FIRST DO NO HARM

Please reply

Thank You

Gary Thompson
jgary.thompson@mail.utoronto.ca

lettershopkinssept2013-001

One of many emails College of Nurses. See following email one of many from Ministry of Health

letterCNO 001

Nurse was let go at Public Health after I sent this incident report. British Medical Journal ‘Doc2Doc’ comment #8  http://doc2doc.bmj.com/forums/open-clinical_general-clinical_ever-worked-psychopath?/  The nurse is co-author CJPH 2013;104(3)e200-4 and now works at Saint Michaels Hospital

letterMOHdec132013 001

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4 thoughts on “Some correspondence from Public Health et. al

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