No disciplinary action recommended against staff

May 17, 2010 News

Linden and West Demerara maternal deaths…

By Michael Jordan

The Guyana Medical Council has recommended that three senior Health officials be given stern reprimands for lapses that led to the death last December of maternal patient, Salima Ram, at the West Demerara Regional Hospital.
The Council has also completed its probe into the December 25, 2009 death of 35-year-old maternal patient, Tricia Winth, and her full-term baby girl at the Linden Hospital Complex.
It wants Chinese Consultant/Obstetrician Dr. Zheng Li to state in writing why she failed to visit the wards or answer her telephone although she was on call when Winth was in labour.
But the Council stopped short of recommending serious disciplinary action against the personnel whose lapses caused the women’s demise.

Salima Ram

This has not gone down well with Winth’s relatives. Her husband, Eusibo Winth, told Kaieteur News on Saturday that he will be seeking substantial damages from the Health Ministry.
Winth and Ram were both suffering from Pregnancy Induced Hypertension when they were admitted to the two hospitals. They also developed signs of eclampsia, a
life-threatening condition in which seizures occur.
The reports, seen by Kaieteur News, said that the Medical Superintendent, Regional Health Officer and the Director of Regional Health Services left Salima Ram in the care of junior doctors, who failed to diagnose her life-threatening symptoms.
The report concluded that the case should be closed “with a sharp warning to the Medical Superintendent, Regional Health Officer and the Director of Regional Health Services.”
“This is… a case of failure to put the right calibre of staff in place and asking junior doctors to do jobs without the necessary tools to help them,” the report stated.
The report concluded that the junior doctors’ limited obstetrics training would not have allowed them to save Ram unless they were given strict guidelines to follow.
It also warned that “it would not be surprising” if there were recurrences “in the near future,” if all the preventative measures are not put in place.

Tricia Winth

Salima Ram, 32, of 19 Vive-La-Force, West Bank Demerara, died at the West Demerara Regional Hospital shortly after collapsing in the Maternity Ward.
Relatives have alleged that staff repeatedly ignored Salima although she was in pain, and only went to her aid after she had collapsed.
The Medical Council’s report on Tricia Winth stated that the woman, a high-risk patient with Pregnancy Induced Hypertension, was left in the care of inexperienced doctors who failed to detect her life-threatening symptoms.
She later developed seizures.
“The records of this case show clear documentation of the appearance of all of the known signs and symptoms of this condition,” the Council said.
According to the Council’s report, the medical response of the junior doctors “showed that they did not at any time truly appreciate the severity of the condition and did not know how to respond to prevent, stop or positively affect the outcome of this case.”
It added that the lack of involvement of the qualified/knowledgeable staff in the field of obstetrics “must be labeled as the main contributory factor in the poor outcome of this case.”
According to the report, Dr. Zheng Li, the Chinese Consultant at the Linden Hospital Complex, was on call on December 26, 2009 when the doctors were attending to Winth.
“The Hospital management and nursing staff knew this information. Dr. Zheng Li however stated that she never knew about this case at all. She only found out about the case from the newspaper.”
In its report, the Council recommended that Dr. Zheng Li be asked to explain in writing her involvement in the management of the Winth case.
“There should be a strong effort made to understand just what was the role and function of Dr. Zheng Li at the Linden Hospital Complex and in particular what was expected of her on the weekend in question.
“Why did she not do ward rounds on the following day? Why did she not respond to her telephone? Is this a general practice with her (or) was this the exception?”
It said that the Medical Superintendent, Dr. Riyasat was eventually summoned to attend to Winth, but by then there was no fetal heartbeat and Winth was in the stages of severe Pregnancy Induced Hypertension with kidney failure.
In the report, a Council member stated that he “was not happy” to close the case, “as it would seem that the Consultant/ Obstetrician (Dr. Li) “abdicated her duty.”
“It would also seem that when she saw this case on the first referral she did not appreciate the possible outcome.
There seems to be a language problem here as Dr. Zheng Li was positing at the meeting with the Medical Council of Guyana that her presence in the place of a young doctor with a few months experience would have no effect on the outcome.”
But the junior doctors who failed to diagnose Winth’s condition also came in for some flack from the Council.
“I feel that the young doctors present should have been able to recognise cases like these and have them referred in a timely manner and make greater efforts to summon help to take over the management of these cases,” the report said.
“It is therefore my opinion that these doctors must be held responsible to some extent for the outcome. I think that there should have been some administrative sanction and a note/report placed in their personnel files.
So while the level of training these doctors had in the field of obstetric would not allow them to positively affect the outcome of this case, I feel it is reasonable to expect them to call for assistance at an earlier stage and to do so in a more vigorous manner.”
According to the report, the absence of theatre facilities at Linden was also “a grave undoing” in the functioning of the hospital.
While it may be argued that the late arrival of the senior staff will make this a moot point in this case, it is still inexcusable.
Tricia Winth was admitted to the Linden Hospital Complex on Christmas Eve. She succumbed on Christmas Day.
Winth was due for Caesarean surgery, but the theatre was inoperable at the time. Staff members were reportedly attempting to have her transferred to Georgetown when she succumbed.
“I am definitely going to take legal action,” her husband Eusibo Winth said.
“It’s really painful to me how my wife and daughter died. “I have three other children (aged 13, eight and nine) and I alone have to look after them.”
Over the years, only a few errant doctors have been struck off the medical register or disciplined. However, in most cases, these decisions have been overturned after the accused doctors took the Medical Council to the High Court.
Recent efforts by the Medical Council to suspend Dr. Mahendra Chand for his treatment of teen tortured by police were thwarted after Minister of Health Dr. Leslie Ramsammy ordered the Council to review their decision.