Monday, 16 July 2018


BAD DOCTORS STILL PRACTICE IN CANADA 

In Bellingham, Washington, family physician Gary McCallum raped a pregnant patient in his office, the state’s medical commission ruled.


In Duluth, Minnesota, a neurosurgeon, Stefan Konasiewicz’s patients complained of mistakes that caused serious injuries, including quadriplegia and the death of a young mother, triggering regulatory sanctions and several malpractice payouts.
In San Diego, California. a children’s kidney specialist Jacques Lemire pleaded guilty to possessing sexually explicit photos of boys. The judge who sentenced Lemire to 15 months in prison called the images  as being sadistic.


American medical boards disciplined these men who were all Canadian-trained doctors for their actions while they were working stateside.


All of them had returned to Canada where physicians’ colleges in British Columbia, Ontario and Quebec let them keep or renew their medical licences.


Any patient looking up any of these doctor’s history on the colleges’ websites would find no trace of their U.S. disciplinary or criminal histories. Most Canadian regulators told the Toronto Star that privacy laws prohibit them from sharing such details with the public. That is absolute unadulterated gibberish, especially when you consider that they don’t have any qualms about displaying their bad conduct in their Canadian practices newspapers. I have always considered these Canadian regulatory bodies as jelly fish since they also have no guts.


“You can find out more about the safety record of a kitchen appliance than you can find out about your physicians,” said Robert Oshel, former associate director for research and disputes at the National Practitioner Data Bank, an American clearing house containing information on malpractice payments and disciplinary actions that is not available to the public. He said, “It’s a real problem.”


No agency in North America has a bird’s-eye view of the movement and discipline of cross-border physicians. The best estimate, provided to the Star by the Canadian Institute for Health Information based on changes to mailing addresses, suggests that, since the early 1990s, an average of 368 Canadian doctors have relocated between the U.S. and Canada each year.


Sixty-four medical regulators in Canada and the U.S. oversee nearly one million medical doctors. Their common mission is to protect the public. They each have their own policies, laws and languages that shape how this is done.


Some regulators say they have a full picture of the disciplinary, criminal and malpractice histories of these mobile doctors and have everything they need to protect patients. That is more gibberish.


“The process is as seamless as it can be,” said Dan Faulkner, interim registrar of the College of Physicians and Surgeons of Ontario (CPSO). But how much of that information is made public is another matter. He said, is “a great policy idea, but is not a priority. 


Anne-Marie Jackson of the Toronto Star said, “As a member of the public, I’d love to press a button and get all of this information available to me. But we have laws that are different in every province and jurisdiction.  


Faulkner said. “We’ve made some very careful decisions about how we’re going to provide credible and relevant high-quality information to the public.”


A Toronto Star investigation reveals that Canadian medical watchdogs keep secret the vast majority of cross-border doctors’ disciplinary histories.


The Star spent 18 months reviewing thousands of pages of doctors’ public disciplinary records to verify those who have been licensed to work on both sides of the Canada-U.S. border. We used these records, as well as interviews with physicians and regulators, to create the first comprehensive database that follows disciplined doctors — 159 of them — throughout their careers across state, provincial and country lines.


The Star’s analyses of these records show that almost half of the 159 doctors who were found guilty of professional misconduct in one place  or other went on to commit a second violation that resulted in them being disciplined again. The Star investigation discovered that 90 per cent of these doctors’ public profiles in Canada failed to report the breadth of sanctions taken against them.


The range of offences captured in the Star’s database included: incompetence, improper prescribing, sexual misconduct, substance abuse and fraud. Nearly all of the disciplined doctors we identified are male and more than half are Canadian-educated. In 45 cases, these are doctors — including Konasiewicz and Lemire—who have been disciplined in the U.S. and who currently hold an active Canadian licence. Thirty-four of 159 doctors we examined had criminal records: 13 of them were convicted in the United States and later kept or were granted a Canadian medical licence.


The Star has reached out to all of the doctors the Star  identified to give them an opportunity to respond. Among them is a pediatrician John Crysler who faked his death in New York. Now he’s practising in St. Catharines. Ontario.


There is a licensed doctor working as a surgical assistant in Regina who lost his California licence after he was declared clinically brain damaged  and a family doctor in Markham who was jailed and stripped of his U.S. medical licences after being convicted of selling opioids to an undercover agent in Hawaii.


Dr. Marie Bismark, a physician and lawyer at the University of Melbourne, who is a leading researcher in the study of doctor discipline, called the Star’s database “unprecedented.”  She said,
“The cases the Star has analyzed are only “the tip of the iceberg,”


She also said, “The few doctors who have significant disciplinary outcomes provide the sharpest lens to see the cracks in the medical regulatory system that allow some physicians to leave their disciplinary histories behind as they travel from one jurisdiction to another.” She added, “For every problem doctor who has come to the attention of regulators, there are probably a dozen who are causing similar levels of harm to patients who have not. comed to the attention of their regulators.”


In July 2001, a 7-months pregnant woman told staff at St. Joseph hospital in Bellingham, Washington that Dr. Gary McCallum had sexually assaulted her in his office. A nurse administered a rape kit, and collected semen, according to the state medical commission’s records, which redacted the victim’s name.


McCallum, who is a Saskatchewan-trained general practitioner, had performed a pelvic exam on the patient earlier that day with a chaperone present, as per policy at the clinic, that is located 30 minutes south of the Peace Arch border with British Columbia.


What follows ae the details  of her 2001 complaint of Dr. Gary McCallum submitted as an exhibit at a disciplinary hearing of the Washington state health board.


“Later that evening, he called me at home and asked me to return to the clinic “immediately to have bacteria “scraped out of my vagina/” according to a 41-page disciplinary decision by the state health department’s Medical Quality Assurance Commission. He told me that  the baby would be hurt ifI waited.”


A chaperone was not present when the patient came back, the decision said.

The patient told the medical commission that McCallum asked her to remove her clothes, put on a gown, press the front of her shoulders against the exam table and brace herself. The patient’s belly hung over the side. She said that she felt McCallum’s legs touch the back of her thighs and shake as he placed something into her vagina.

“That object was the Respondent’s penis,” the medical commission’s 2006 decision said. The commission revoked his medical licence.


The Star reached McCallum, age 69, in Saskatoon, where he now lives. In an emailed statement, he said the medical commission’s hearing was “blatantly unfair, prejudicial, capricious and without due process.” That didn’t mean that he didn’t stick his penis into the woman’s vagina.


According to the Washington medical commission’s disciplinary records, McCallum was working on both sides of the U.S.-Canada border from 2001 until 2003, while he was under investigation by Bellingham police for rape. Both regulators screwed up when they permitted him to continue practicing medicine.


In January 2003, a Whatcom County prosecutor decided there was “insufficient evidence” to criminally charge McCallum with rape, court staff told the Star. The case was a he said, she said case with no witnesses present.


In July 2003, McCallum signed a settlement agreement with the victim in which he promised to pay her $60,000 on the condition she make no further claim against him. The agreement further states there is no admission of fault, liability or legal responsibility on McCallum’s part. All such agreements have that clause in them. It doesn’t really mean that the payer was innocent of any wrongdoing.


McCallum closed his Washington practice in 2005, the year the state’s health department brought its full charges against him, and returned to practise in British Columbia.


The State of Washington’s final order against McCallum followed a 10-day hearing after which he was found guilty of an extensive range of charges. These charges dealt with: improper prescribing; taking inappropriate Polaroid photos of a prepubescent female patient’s genitals after falsely telling her parents the images were for a clinical study; administering an expired, non-FDA approved flu vaccine he had stolen from a medical clinic in Surrey, B.C.,; aiding and abetting unlicensed practice; and the sexual assault of the pregnant woman, referred to as “Patient One.”


The decision, at a hearing presided over by a health law judge, noted the department provided “clear and convincing evidence” on the charges outlined above. It also noted that a specific felony provision in state law fit the “exact circumstances” of the sex assault in McCallum’s office, describing when “the perpetrator is a health care provider and the sexual intercourse occurs during an exam without the consent of the patient.” Even if she consented, it would still be highly improper.


“The evidence from both the Whatcom County Medical Examiner and the DNA crime lab is critically important and entirely supports Patient One’s assertion that the Respondent had sexual intercourse with her,” the decision read. “The Respondent raped Patient One.”

McCallum said in his email to the Star that he provided evidence from witnesses who testified that “not only was it impossible for the sexual assault to happen, but it did not happen.” He also denied taking Polaroid photos of the child.


The 2006 decision called McCallum “serially dishonest,” and stated that he had “co-opted” a friend he had hired as a part-time nurse to support his story that the victim had taken a vial of his sperm from the clinic’s lab, which he was going to analyze for fertility issues.


McCallum filed a petition for a judicial review of the Washington commission’s findings of fact, conclusions and final order, but a Whatcom County Superior Court judge denied his application in 2012.


McCallum told the Star “Any reasonable person” who reads the legal brief he submitted to the court will understand why I was shocked at the lack at the hearing of what I would consider basic notions of fundamental fairness in terms of the admission and/or suppression of evidence.”


The judge who rejected McCallum’s petition for review ruled there was “substantial evidence in the record” — including 6,843 pages of materials submitted by the health department in one document alone in order to uphold the medical commission’s findings of fact, conclusions of law and final order, according to a copy of the decision obtained by the Star. Subsequently, McCallum abandoned hissubsequent appeal.


The B.C. College of Physicians and Surgeons did not publicly discipline McCallum. The Washington sanction never appeared on his public profile on the B.C. college’s website.


After Washington revoked McCallum’s licence in 2006, a B.C. college spokesperson told the Star that the college had “entered into an agreement with Dr. McCallum whereby he was required to refrain from practising medicine in B.C.”


The college allowed McCallum to keep his Canadian licence for seven more years, until he resigned in 2013.


The Star could not verify whether McCallum practised in B.C., or elsewhere, during this period.


The B.C. college denied the Star’s  request to view a copy of its agreement with McCallum. “This record,” the spokesperson said, “cannot be shared without McCallum’s “express consent.”


To build the Star’s database, reporters collected physician rosters and discipline information from medical regulators in all 50 U.S. states, Washington, D.C., and 13 Canadian provinces and territories. They looked for every discipline record on one side of the border that matched the name of a doctor who held a licence on the other. The process took more than a year.


Dr. Lawrence Wiser wo suffered from  brain damage ended his medical career in the U.S. Now he’s licensed to practice medicine in Saskatchewan.


Using publicly available information sych as birthdates, medical school graduation details and other records,   the Star was  able to verify the identities of 159 cross-border doctors with disciplinary records.


In creating this database, the Star logged every disciplinary decision issued by regulators. The Star noted the start and end dates of every licence we found for each physician. Then it  looked for patterns.


The Star found that the Canadian medical regulators keep more information secret from the public than their U.S. counterparts. Since the 1990s, medical regulators across North America have been using the internet to build public trust by posting brief summaries of information about the physicians on their registries. These “profiles” allow members of the public to confirm their doctors hold valid medical licences and view any red flags related to discipline.


In Canada, 90 per cent of physician profiles the Star analyzed were missing some disciplinary history that was made public in another jurisdiction; 73 per cent of the profiles showed no disciplinary history whatsoever, even though records exist in every case. In the U.S., 40 per cent of these doctors’ profiles had no information about their misconduct. More than 75 per cent of the discipline rulings that appear in the Star’s database — including the sanctions against McCallum, Konasiewicz and Lemire that were issued from the year 2000 onward. The Ontario college’s physician profiles are the only ones we found in Canada that include information about discipline imposed in other jurisdictions but only on decisions imposed after Sept. 1, 2015.


It takes years for Canadian regulators to respond to U.S. discipline. In the United States, when a doctor is found guilty of professional misconduct, an umbrella agency called the Federation of State Medical Boards (FSMB) adds this decision to its central repository that is a “one-stop shop” for licensure and disciplinary information. Regulators around the world can access this information and submit disciplinary decisions from their jurisdictions.


However, for physicians who hold licences in both the U.S. and Canada, their data shows Canadian regulators took an average of three years to impose discipline after a U.S. medical board verdict. U.S. boards acted on discipline imposed by Canadian regulators roughly two years after the fact. The FSMB also offers a “disciplinary alert service.” I should have also called those regulators sloths.


Only three Canadian regulators have signed up: Ontario and Alberta joined this program in 2015, B.C. signed up a year later.
The honour system often doesn’t work. Regulators rely on doctors to be honest on licence applications. Although there are other ways for boards and colleges to find out about a doctor’s discipline history — such as through the FSMB or from another regulator — truthfulness is a cornerstone of the system. Yet more than a quarter of the doctors in our database were later found by regulators to have lied or “failed to disclose” their discipline history.


Criminal convictions that prompt U.S. medical boards to revoke a doctor’s licence may not prompt equivalent punishment in Canada, the Star found.


The Medical Board of California revoked Dr. Jacques Lemire’s licence in 2006 after he pleaded guilty to possessing child pornography. A psychiatric evaluation stated that the children’s kidney specialist was not a pedophile.


“There’s just no explanation for it,” U.S. federal prosecutor Anne Perry told the court. “These are not pictures of naked babies lying on blankets.   These are damaging pictures that represent abuse to children. And here is a fine man, a fine doctor, somebody who’s done nothing wrong in his life, but he’s got a lot of these images on his computer.”


A year after the U.S. government deported Lemire to Canada, Quebec’s physicians’ college granted him a licence.


From 2010 to 2014, Lemire was permitted to practise only in Quebec “institutions,” and he wrked three years at an old-age home for retired nuns. He was not explicitly restricted from treating children, and the institutions category includes child and youth protection centres.


In 2014, the college limited Lemire’s licence to “administrative tasks without clinical duties,” meaning he is not to see patients. His public profile on the college’s website reflects this restriction, but provides no explanation for this decision.


Lemire, who obtained his medical degree at University of Sherbrooke in 1977, told the Star that he paid his debt to society and has worked hard to rehabilitate.


Lemire worries  that if his record is exposed in Canada, “especially at his age, the opportunities won’t be there for him anymore.


He said, “The fact that I’m doing administrative, I’m not working with patients. I think it shouldn’t be disclosed. I’m not even close to any patient.”


The Quebec college did not answer the Star’s question about why it didn’t explicitly bar Lemire from treating children. The Star found no evidence he practised pediatric medicine following his conviction.


Lemire told the Star that he disclosed his conviction to the Quebec college before it granted him  his licence.


He had treated children for 23 years before he was convicted on possession of child porn.


In Ontario, the physicians’ college refused to discuss the case of Dr. Clement Ka-Chun Yeung — another convicted felon.


Yeung, a family practitioner in Markham, served nearly a year in a Hawaii prison after pleading guilty in 2007 to two counts of prescribing controlled substances “outside the course of professional medical practice and not for a legitimate purpose.” In both instances, he sold Oxycodone to an undercover agent with the U.S. Drug Enforcement Administration. He lost his licences in Hawaii and California due to his convictions.

Unlike the other doctors in this story, Yeung’s U.S. discipline and criminal history is noted on his physician profile in Canada because it led to public discipline in Ontario.


A decision posted to his Ontario profile states the College knew of his convictions in 2008 but allowed him to keep an unrestricted licence in the province until 2012. Yeung moved to Hong Kong in 2009 and “elected not to practice medicine in Ontario” until the college dealt with the case, according to the decision.


In January 2012, the College suspended his licence for six months and ordered him to log all narcotics prescriptions as a result of his felony conviction. It is unclear when Yeung returned from Hong Kong.


In January 2017, the College imposed a new condition that Yeung practise under a clinical supervisor for at least a year, his profile states. The College refused to tell the Star why these conditions were imposed.


Yeung did not respond to multiple requests for comment. His clinic is in a strip mall on Kennedy Rd. He works six days a week, and offers services in Cantonese and Mandarin. On a recent morning, he refused to discuss his past with a reporter who approached him in the parking lot of his clinic. “I can’t talk to you,” he said, before driving away.


The vast majority of doctors practising in North America live up to the high standards of their profession.


The Canadian Medical Protective Association, which provides vigorous legal defence to doctors charged with medical negligence or regulatory misconduct, estimates that more than 75 per cent of complaints made to physician colleges are dismissed outright or dismissed with some concern.


But the small minority of doctors who do have red flags on their public records can cause serious damage. A 2016 study in the New England Journal of Medicine found that just 1 per cent of doctors practising in the U.S. account for a third of all paid malpractice claims in the country. More than half of 66,426 claims paid in a recent 10-year period related to significant physical injury. Nearly 20,000 of those claims related to patient deaths.


“Doctors are human,” Dr. Marie Bismark, the University of Melbourne researcher, said. “Things go wrong and there are errors in diagnosis that don’t mean someone is incompetent or unethical.”


Bismark said her work tries to distinguish doctors who make human mistakes from those “who have serious or recurring lapses in professionalism and competence.”

Many years ago, I, as a private investigator was asked by a doctor in Detroit to re-investigate the complaint by the medical regulatory organization about a pregnant woman who died on the operation table in his clinic. In the course of my investigation, I discovered that he had  left his patient unattended for an hour while he left his clinic to go across the street for lunch. The woman bled to death. After he read my report to him, he pleaded guilty to manslaughter and was sent to prison for several years.


“I don’t think regulators are really good at distinguishing between those different groups of practitioners.”


Dr. Stefan Konasiewicz’s business card for the Phoenix Rising Pain Clinic in Richmond Hill. in a notice on the wall,  he is stated as the medical director and that  he is “board certified in neurosurgery.”


Beneath his name is a string of letters stating professional designations with the American Association of Neurological Surgeons, the Royal College of Surgeons of Canada and the American College of Surgeons.


Patients who look him up on the Ontario’s physicians’ College website will see he has been licensed in the province since 1989; that he graduated from Queen’s University’s medical school; that he is fluent in five languages and that he holds active medical licences in Wisconsin and Texas. There is no mention of past discipline hearing.


Here’s the problem: Konasiewicz has faced regulatory sanctions in Minnesota, Wisconsin and Texas and been sued for malpractice at least 12 times in the U.S. following surgical mishaps that shocked some of his former colleagues and left patients severely injured or dead, according to medical board records, court documents and interviews. Patients in at least three cases received settlements totalling more than $1.3 million U.S., the Star found.


Dr. Stefan Konasiewicz, approached by Star reporters last month at his clinic in Newmarket, has faced regulatory sanctions in Minnesota, Wisconsin and Texas and been sued for malpractice at least 12 times in the U.S.


In 2010, the Minnesota Board of Medical Practice reprimanded Konasiewicz for “inappropriate” practices in his treatment of four patients.


Among them is a patient who saw Konasiewicz for chronic back pain in 2003. During a procedure, the patient’s spine was injected with the wrong type of dye, triggering spasms so severe he fractured three vertebrae.


In 2005, a 25-year-old mother of two bled to death 12 hours after spinal surgery. An autopsy ruled the cause of death to be a “surgically-induced defect” — a punctured aorta.


Also in 2005, a patient with a back injury complained that he was left “unable to stand on his right leg” with “numbness” in his groin following injections in his spine.


Following a 2007 surgery, another patient was diagnosed with “persistent cervical quadriplegia” that left her paralyzed from the neck down, the Minnesota decision found.


The Minnesota board’s 2010 decision imposed several conditions on Konasiewicz’s practice, including being supervised by a physician specializing in neurological surgery to oversee some of his procedures. The conditions were lifted two years later.


The Minnesota board declined to comment for this story. According to Konasiewicz’s physician profile on the board website, he was licensed in Minnesota from 1997 to 2009, when his licence expired.


In 2011, the medical board in Wisconsin, where Konasiewicz has held a licence since 1997, reprimanded him after its review of the Minnesota cases. Many U.S. medical boards are mandated to take action against licensees when they are disciplined in another jurisdiction.


By then, Konasiewicz was living and working in Texas, a third state.


In 2013, the Texas Medical Board reviewed two of the cases that led to discipline in Minnesota. In the case of the patient injected with the wrong dye, a panel blamed the error on a surgical technician. In the case of the paralyzed patient, the panel found Konasiewicz’s description of his “care and technique” to be “credible” and suggested the patient or anesthesiologist could have caused the outcome. The board ruled Konasiewicz failed to “maintain adequate medical records” and “safeguard against potential complications,” and ordered him to complete continuing medical education courses in record keeping and risk management.


In the case of the paralyzed patient, Konasiewicz’s malpractice insurance provider paid $1 million. This was the maximum allowable payout under Konasiewicz’s policy with the Minnesota Joint Underwriting Association, the insurer of last resort for doctors that can’t get conventional malpractice coverage. The association was created by the state government and offers coverage to providers “with a history of claims.” Konasiewicz was covered by the association from 2005 to 2008, when he cancelled his policy, court records show.


Konasiewicz has a spotless record on the registry of the College of Physicians and Surgeons of Ontario. One of his former U.S. patients told Anne Marie Jackson  of the Star that Konasiewicz is now living with “intractable” pain. 


 The Star made several attempts to reach Konasiewicz for this story, by phone and with letters sent to his offices and home that outlined his U.S. history, inviting him to discuss the disciplinary actions and malpractice claims. Approached by reporters as he arrived at his Newmarket clinic in April, he refused to comment.
Today, Konasiewicz holds an active — and spotless — Ontario medical licence. He works at five pain clinics in Toronto, Newmarket, Hamilton and Richmond Hill where patients may know nothing of his past discipline, which is detailed on the websites of American medical boards but is not publicly disclosed by Ontario’s medical watchdog.



“That’s not right,” David Tekautz, the Minnesota patient whose vertebrae were fractured after he was injected with the wrong dye, said in an interview. “That’s public information. What patient wouldn’t want to know about a doctor’s record, especially some record where he has done harm?”


Dr. David McKee, who worked with Konasiewicz at a hospital in Duluth, told the Star that he and a handful of surgeons were shocked by Konasiewicz’s complications, and repeatedly brought their concerns to the administration.


“None of that went anywhere with anybody,” McKee said. A spokesperson for St. Luke’s hospital declined to comment, saying it does “not share information about current or former employees.”


Though he works in clinics, Konasiewicz’s physician profile with the Ontario college does not list any hospital privileges. He appears not to be performing surgery in any hospital in the province.


The Star sent the College a list of questions about Konasiewicz’s discipline and malpractice history. Citing privacy legislation, a spokesperson declined to discuss the case, saying there is “no further public information” beyond what is posted online.

“I did hear that he ultimately went back to Canada. It’s very concerning,” McKee said. “There should be better communication between the two countries. Clearly there is an issue.”


The  problems that society in general faces is that some of  these medical Colleges are continuing to permit these quacks and criminals to keep practicing in medicine notwithstanding that these quacks were either incompetent or acting in a criminal manner.  But as I sad earlier in this piece, most of these Colleges are jelly fish with no guts to be firm when dealing with quacks and /or criminals  in their profession.

In closing, I want to compliment the investigators in the Toronto Star for their thorough and most informative investigation of which I have used as a source of this article.  

Friday, 13 July 2018

THE THAI CAVE RESCUE      

Truly the rescue of the twelve soccer boys and their coach from the cave in Thailand is one of the world’s greatest rescues in history.  It had millions of people on edge as they got the daily reports of the attempts and finally the successful rescue of these boys and their coach.                                       

It had been more than two weeks since the young boys Thailand soccer team and its soccer coach became trapped inside a cave they were exploring in northern Thailand. The country’s annual monsoons flooded the cave while they were still inside that subsequently prompted a massive search and rescue effort. There had been no contact with the boys, since they went missing with their 25-year-old coach two weeks earlier. 

Rescuers eventually found their bicycles, football boots and backpacks near the cave and discovered handprints and footprints further in. Police Chief Komsan Saardluan told Sky News that parts of the cave get flooded to a height of up to 16 feet during the rainy season, which runs from June to October. A sign outside the site warns visitors not to enter the cave during the rainy season between July and November.

The families upon learning that the boys were in the cave, flocked to the cave and sat and waited as rescuers battled heavy rains to search the flooded system of caves where the group was thought to be trapped.

The cave has an impressive entrance chamber that is about 260 feet long and leads to an easy walk along spacious passageways that last for about a half a mile. The chamber the group was in is about 2.5 miles from the entrance of the cave, which is thought to be about 10 miles long and cut into a mountainside in far northern Thailand near the border with Myanmar. Much of the cave  is a string of narrow passageways that lead to wide chambers and then back to narrow passageways. The rocky and muddy ground makes several changes in elevation along the way. At ten kilometres in length, the Tham Luang cave is one of Thailand’s longest and one of the toughest cave to navigate with its snaking chambers and narrow passageways. Normally, no one would go that far into the cave during the rainy season as it floods many of the tunnels. When the boys and their coach went through the cave’s tunnels, they were dry. But when a rain storm occurred while they were deep in the cave, the tunnels filled up with water. They were subsequently trapped deep inside the cave. 

The coach of the youth soccer team who led them into the flooded cave in Thailand reportedly did it as part of an initiation ritual, according to a rescuer. The boys had left their backpacks and shoes outside the cave and then the boys waded into the cave and tried to make it to the end of the tunnel which they considered the ritual as a  initiation for local young boys to write their names on the wall and then make it back to their backpacks  and shoes.

Police refused to answer questions on whether the 25-year-old coach should be charged for leading the children into the cave, the Khaosod English paper reports. Lawyer Ananchai Chaiyadech said it’s likely the coach will escape charges as it appeared he didn’t have intent to put the boys in danger as it hadn’t started raining when he led them inside. When the group initially went into the cave, they noticed high water but their coach foolishly didn’t think anything of it.  That was a stupid conclusion on his part especially since the rainy season had just begun.


Previously, on the way out of the cave, four cavers found a 20-foot-long passage that sloped at a 45-degree angle. The passage was filled with water Three of the cavers managed to leave the cave but the fourth member, a novice caver, became stuck in the passage and was immersed in cold water for a minute or two. The fifth member of the group managed to free his friend from the passage, but they couldn’t leave with the water rising. They ended up staying down in the cave for 14 hours until the water receded, and they made it out of the cave themselves  although rescuers were standing by. Moving about in caves with narrow passages is very risky to say the least

 Efforts to rescue the stranded soccer team was tense as officials were in a race with the approaching heavy rains and depleting oxygen levels inside the cave. Workers labored around the clock to pump water out of the cave. 

 The twelve young members of a youth soccer team and their 25-year-old assistant coach entered Thailand's Tham Luang Nang Non cave on June 23 after a practice match. They were cut off from exiting the massive cave when a rainstorm flooded the exit.



The 25-year-old soccer coach led his youth team into the Thai cave complex where the group was stuck for more than two weeks.  He is a former Buddhist monk who's cheated death at least once before. Ekapol Chantawong, affectionately known as “Ake,” was trapped with the team of 12 boys whose ages ranged from 11 to 16 years of age.

David Spiegel, a professor of psychiatry and behavioral sciences at Stanford University’s medical school said, “Adolescents are especially social creatures, and having friends with them as well as their coach would be a tremendous help,” Imagine if you will how difficult it would be for you if you were trapped in a cave all alone.
A Calgary-based explorer who was trapped in a partly flooded cave for days says her heart goes out to the members of a boys' soccer team as they await rescue from an underground cavern in Thailand.
If safety concerns forced the boys to stay in the cave for an extended period of time, it would be important for their mental health for there to be organization and daily routines rather than do nothing. They could do exercises and mind games. Of course, later, there was a telephone line brought to them so they could talk with their parents, siblings and friends. 

 

There would have to be daily hygiene routines, regular meal times, age-appropriate cognitive activities, regular physical exercise to the extent feasible in limited space, religious/spiritual practices, and specific times for daily briefings on their situation and for communicating with their families.

 

 

On July 2nd, British divers located the missing team two weeks  after they had disappeared. At the time the boys were found, water levels in the cave were rising more than 15 centimetres every hour.


More monsoon rains wereon the way. After a break in the weather in recent days, the Thai Meteorological Department forecast for Chiang Rai calls for light rain followed by heavy rain starting and continuing through July 10. Such storms could raise water levels in the cave again and complicate the supply missions or any potential extrication, if one was needed. Interior Minister Anupong Paojinda said as a result of the forecast, the boys may need to swim out using diving gear. He said they would be brought out via the same complicated route through which their rescuers entered.

Emergency services attempted to pump water out of the cave complex after the rain flooded the caves and the passages that link them to the boys and their coach.

A team of Thai Royal Navy SEAL divers, who re-entered the cave complex earlier hadn't found any trace of the boys or their coach.

Deputy Prime Minister Prawit Wongsuwan said that the government had not ruled out hope of finding the boys and the coach alive. He said, "We are still optimistic they are all alive. Even though they may not have anything to eat, they should have water to drink."

People can go for a limited time without food or water, but the temperature around them can have an effect on their chances of survival. But several boys were reportedly suffering from malnutrition after going without food for 10 days.

For people trapped in the wild in general, dehydration is a quick killer because people generally can't go longer than a few days without water. Depending on the conditions, someone might be able to survive for up to a week if it's not too hot and they're in the shade. But most people would have a hard time surviving longer than 100 hours or so.


Presumably, the team drank the rainwater that was flooding the caves. This carried risks as well. If they were to pick up an infection from the water that caused diarrhea, that could kill them faster however, it was likely the only option they had in order to survive.


Food is another issue. Experts believe that healthy adults can survive four to six weeks without eating before starving to death. But each individual is different: People with more body fat who are in temperate conditions and have adequate hydration could potentially survive longer. When rescuers were still searching for the boys, the Chiang Rai governor told reporters they thought most people could survive 3o days without food. If the boys were thin, their survival rate could be less.  But young boys might not have the same energy reserves as adults. Luckily, the boys had been brought energy gels, pork, sticky rice, milk, and more to help them build up their strength.


Vernon Unsworth, a spelunker (someone who explores caves) who lives in Chiang Rai, said that the conditions in the cave are difficult to deal with.


He also said, "The water is rising all the time. Physically it's not a hard cave; it's just very long," he told CNN from the rescue site.


"I think we just have to wait for the navy SEALs to see what they can do and how far they can go into the cave. The conditions further on will not be easy so we just have to wait and keep our  fingers crossed."


He said that a big pool of water was continually rising in a section of the cave about 3 kilometers (1.7 miles) from the entrance. He also said that the next six to eight hours would be crucial.


Mr. Kotcha of the national parks authority said that there was around 40 chambers inside the Tham Luang Nang Non cave—both small and big ones. Rescuers suspected that the missing boys were still in the main chamber of the cave.


Thai Interior Minister General, Anupong Paochinda said that the divers could only work intermittently due to the restrictions of their equipment. He said the rescue team was trying to reduce the water level to prevent it from "reaching the ceiling of the passage" so that there would be an air pocket for the rescuers.


He also said, "The water is muddy; it has also still blocked the passage into the chamber.” The SEALs had switched to a oxygen tank with a  closed-circuit system, which allowed them to dive up to three hours at a time. Arrangements for more water pumps and electricity cable to drain water were brought to the cave. 


A total of 19 divers assisted with the rescue operations, some coming from other countries.

The twelve boys and their football coach trapped in a flooded cave for nine days. To get the boys out, divers had to guide each of them while diving through the cave’s dark, tight and twisting passages.

By all accounts, the dives into the cave have been a challenge even for experts in caving and diving who needed days to reach the boys. Getting the boys out could go faster due to the installation of dive lines, extra oxygen tanks left along the way and glow sticks lighting the path. Still, the British Cave Rescue Council said, "Any attempt to dive the boys and their coach out will not be taken lightly because there are significant technical challenges and risks to consider.

The massive rescue effort had for days been hampered by heavy rains that flooded the Tham Luang cave in northern Thailand, blocking access to chambers where it was hoped the group would be found alive.

Divers took advantage of a brief window of good weather to edge further into the cave, with the water levels dropping slowly but steadily every hour thanks to round-the-clock pumping.

They had hoped to find the boys and their coach earlier on another ledge but they had retreated 300-400 metres further as that ledge was submerged,

When Chiang Rai, the provincial governor broke the news of their discovery, it delighted the Thai nation which had anxiously followed every twist and turn of the dramatic effort to save them. the boys and their coach.

The group was found about three miles from the cave entrance by two British divers who were both experts on cave rescues.

“We found all thirteen of them all safe we will take care of them until they can be moved from the cave.” move,” Narongsak Osottanakorn told reporters, who broke into spontaneous applause and cheering. “We will bring food to them and a doctor who can dive. I am not sure they can eat as they have not eaten for a while.”

Their skinny faces illuminated by a flashlight, the Thai soccer teammates stranded more than a week in a partly flooded cave said they were healthy on a video released as heavy rains forecast for later that week could complicate plans to safely extract them. Meanwhile, the boys and their coach were given food and medicine.

In addition to food and medical supplies, the boys had been given access to telephone lines so that they could talk to their families. They were also treated for cuts and each of the 13 were given a sheet of tin-foil to keep them warm. Dr Harris, from Adelaide in Australia, has decades of diving experience. He was the one who examined the boys in the cave and gave the green light so the rescue operation could go ahead Had the boys been too weak, a rescue attempt by diving out would have been too dangerous for them.

According to media reports, Dr. Harris has taken part in cave diving explorations in Australia, China, Christmas Island and New Zealand. A anaesthetist by training, he has also been specialising in expedition medicine and retrieval operations.

For the time being though, the focus remained on building up the boys’ strength so that they could make the journey out. Aphakorn said. “We don’t have to rush. We are trying to take care of them and make them strong. Then the boys will come out to see you guys,”

Loved ones, friends and teachers of the “Wild Boar” football team refused to give up hope of seeing the young players again, holding an increasingly desperate vigil at the cave entrance. Thailand had been a nation transfixed by the plight of the “Wild Boar” team, with social media lighting up in support of the group and the country’s deeply spiritual reflexes stirred into action. Shamans and Buddhist monks have held prayers and given offerings at the cave imploring mountain “spirits” to return the boys safely.

The diving team’s travails appeared far from over with a complex operation predicted to try to bring the group several kilometres through the cave which was still partially submerged.

If it was too difficult at that time of the year to being them out of the cave, the authorities would then supply the group with four months’ worth of food and also begin teaching the boys how to scuba dive. The reference to four months most likely meant that the authorities were considering waiting until the rainy season ended in October to begin the rescue.

Learning how to scuba dive is easy. I know. I was taught how to scuba drive in a large swimming pool. I felt at ease. However, I was an adult then. For young boys to be taught scuba diving and then swimming in a narrow dark tunnel is something quite different.

Psychologically, it's a very tall task for a child to swim under water in a very hostile environment. It's even more confronting for the boys that can't even swim and if they panic, it could potentially put their lives and the lives of rescuers at risk.

Although water levels in the cave had dropped a bit, the diving conditions remained difficult and any attempt to dive in the submerged tunnels the boys and their coach would be doing could not be taken lightly because there are significant technical challenges and risks to consider.

While diving may be the group’s best hope for escape, it was still a very dangerous option. And the kind of diving these boys would have to learn to do was not the kind of diving most people are familiar with. For boys in a weakened state, who were unlikely to have ever dived before, the evacuation would obviously pose significant risks to them and their rescuers. Trying to take non-divers through a cave is one of the most dangerous situations possible, even if the dives are relatively easy. And taking them underwater can be very scary for anyone, be they trained of not trained especially if it is hard to see anything. That is why the boys would be towed by their rescuers.

It will be diving in what is effectively muddy water, possibly fast-flowing, with no sense of direction. The boys wouldn’t be able to tell what’s up, down or sideways while in the dark. 

To prepare for any type of diving rescue, the boys would have to be assessed for hydration, adequate fuel supply, adequate food so that their glucose level is adequate, and would also have to have practice dives as well.

Scores of divers — including foreign experts — had been sent into the cave with hundreds of oxygen tanks, establishing a base camp inside the chambers over the weekend.

Thai Interior Minister Anupong Paojinda considered the possibility that the boys and their coach might have to dive out of the cave under water before bad weather sets in later in the week. That would mean that the boys and their coach would have to be trained in the use of diving equipment.

The divers rescuing the kids have a few options before them. They could use full-face masks, they could use a mask and a separate breathing apparatus, or they could even use helmets with air supplied from the surface. The latter would be difficult because if the hoses got jammed, the boys would be trapped.

The rescue divers would really take control over everything, so as long as they had an air supply, the rescue divers could even literally tow ach of them along the passageways. Experienced divers were wary of taking out the boys through the dark and dangerous waters in the cave, especially since the boys and their coach  were not fully trained in underwater diving.

But how much air supply they need was another question. The boys and their coach had travelled about two kilometres into the cave and to breathe for that long, they would need more than just two or three cylinders. The rescuers were going to have to place staging cylinders on various ledges that weren’t submerged in order for the boys and their coach including their rescuers to swim under water the distance in order to reach the entrance of the cave safely.

The alternative was that the boys and their coach could spend three months down in the cave, with divers supplying them with food and comfort items until the weather dries up the passageways.  That alternative was not satisfactory to anyone involved in this drama since Thailand’s rainy season can last up until to October.

The governor said the 13 may not be extracted at the same time, depending on their condition. They've practiced wearing diving masks and breathing, in preparation for the diving possibility.

Even if they couldn’t swim, a rescue diver was able to guide them along," said Dr. Eric Lavonas, an emergency physician and trained diving medicine specialist. The divers had lights. Obviously, these were young boys and they were terrified.

Each rescue diver took one child and would almost certainly would have use a harness to keep a grip on the child  whose regulator, a breathing device, would most likely be attached to the tank worn by the rescue diver.

One serious concern is the possibility that the boys could be at risk for decompression sickness, or the bends, if the air they have been breathing in the cave has been under pressure from the rising water.

One serious concern is the possibility that the boys could be at risk for decompression sickness, or the bends, if the air they have been breathing in the cave has been under pressure from the rising water.

Eight of the 12 boys trapped with their soccer coach in a labyrinthine flooded cave complex in northern Thailand had been freed, authorities adding that the time for rescuing the others would depend on the weather. Those who were free from the cave obviously were very happy and even  in good health. Once outside the cave, they had asked for “khao pad grapao—a Thai dish of meat fried with chili and basil and served over rice. They got what they asked for. As an aside, when my wife and I were in Thailand in 2000, we also ordered the same meal. Soon after, the remaining boys and their coach was free from the cave.

Thailand’s Department of Mental Health said hospitals had been making preparations to care for the boys’ and would monitor them until their mental health is fully regained. They were also working with the families to prepare them on how to interact with the boys once they get out, such as not asking them for details about what they endured. Some events in our lives are best forgotten.

Their re-entry into the world outside the cave was  predictably be one of massive attention from family, friends and the media. It could be overwhelming.  However, the world soon loses interest in rescue stories and moves on to the next story. For this reason, it is extremely important that these survivors and their rescuers not be forgotten and the boys be closely monitored so that they can receive the best possible support that they will need in order to cope with the notoriety of their adventure. 

One of the Thai navy divers,  Petty Officer Saman Gunan, age 39,  was working as part of the effort to rescue the 12 boys and their soccer coach. He was trapped in a flooded tunnel and died from lack of oxygen.  The dead diver was a former Thai SEAL and was working in a volunteer capacity. He died during an overnight mission in which he was placing oxygen canisters in various locations. I am sure that the boys, their coach and their families will not forget the sacrifice that the deceased diver gave to save the members of the soccer team.  This underscores the risks of extracting the boys and their coach from the depths of the cave.

The boys told the rescue teams, including expert diver Claus Rasmussen, that during their nine days trapped in the cave, they had heard dogs barking, roosters crowing and children playing. Our minds can play tricks on us when we are under stress.

While the boys were in the cave, they asked a Navy SEAL   for World Cup soccer results and updates.  There was an offer for them to be taken to the final gam e, all expenses for them and their families. Unfortunately, they had to remain in the hospital for further treatment so they missed the opportunity. 

Numerous Thai special forces were part of the rescue efforts. Most notable was doctor Pak Loharnshoon and three yet-to-be-named divers who volunteered to stay by the boys' side after they were found underground.      

Hundreds of officials from more than 20 government agencies, along with private companies, were involved in the search. Rescuers came from at least six countries. One came from British Columbia, a province of Canada.       

This event in history was a remarkable event that will always be in the minds of those interested in exploring caves. I have been in six large caves—two in the United Sates, one in Hawaii, one in Cuba and two in Europe. I was never in danger since they were organized tours.