Health Minister defends system at GPHC Operation Theatre

Jan 31, 2011 News

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Removal of teen mom’s uterus…

– no probe of incident

By Michael Jordan

Minister of Health Dr. Ramsammy has defended the system that the Georgetown Hospital uses in deciding which patients should have priority for emergency surgeries.
Ramsammy made the response recently when asked about a recent case in which 17-year-old maternity patient Keane Austin suffered a ruptured uterus while waiting in the hospital’s operating theatre to undergo a Caesarean Section.
The life-threatening condition occurred when Austin went into labour and had a vaginal delivery. Surgeons were forced to remove the damaged uterus, rendering the teen incapable of having any more children.
Some hospital sources have stated that the situation occurred because GPHC officials have not responded to requests to have the operating theatre ready on a 24-hour basis for maternal emergencies.
Responding to these claims, Dr. Ramsammy said that the surgeons would consult on which patients should be given priority.
“Whether it’s Guyana or any other place, the surgeons would make decisions which one would go first. There’s always a protocol. If there’s more than one case that comes to the theatre, the consultants would work with each other to see which one is first.”
“Each case is judged on its own merit. It works like that everywhere…90 percent of the time you don’t have an issue. I would never support a case where a particular case has priority all the time. I challenge anyone to show me where this is not the case anywhere in the world.”
He said that as far as he is aware, there is no investigation into Austin’s case.
A veteran private physician told Kaieteur News that the GPHC once had an Obstetrics Operating Theatre, but contended that even if one was set up, there will still be challenges when more than one patient is due for surgery.
“It (conditions at the hospital) would improve to some extent, but if two (maternity patients) have to use at the same time we would have to choose (which is priority).”
“What we should do is use the facilities better…just look at the situation and follow the protocol (for surgical patents).”
The Health Minister acknowledged that too many cases are being referred to the GPHC. “That is true and we’ve always said this. The number of referrals to Georgetown Hospital is too many.”

The private physician, who spoke to Kaieteur News, also said that it is “an open secret that regional hospitals are not fully equipped 24-7 to deal with emergencies.”
“Everything needs to be done to improve the quality of service at regional hospitals. If we improve the services, we can take the workload off the Georgetown Hospital.” Seventeen-year-old Kean Austin had told Kaieteur News that she has a one-year-old son who was delivered via Caesarean section.
The teen, who had not attended a clinic during her second pregnancy, said that she was taken to the GPHC after having what she thought were labour pains.
However, she was told to return home and to have an ultrasound done.
Austin said that the following night, she felt intense pains and a sister took her back to the Maternity Ward.
She said that this time, a doctor advised that she be taken to the operating theatre for her Caesarean section. But the teen alleged that she waited some two hours in the Operating Theatre when she began to experience labour pains. She said that a doctor assisted her in having a vaginal delivery.
According to Austin, she was taken back to the Maternity Ward, where she was “blacking out” and having trouble breathing.
She has no recollection of being taken back to the Operating Theatre.
Kaieteur News was told that after having the delivery, Austin was taken back to the Maternity Ward, since the staff were unaware of her life-threatening condition.
A source said that fortunately, an alert nurse in the ward sensed that something was amiss and had the patient sent back to the Operating Theatre. She underwent surgery the following day.
According to the official, the nurse saved Austin from bleeding to death.
Austin said that some time after being taken back to the Maternity Ward, a nurse eventually informed her that her ‘womb’ had been removed. The teen and her sister alleged that hospital officials did not explain why her uterus had to be removed.
Kaieteur News was told that there were two other emergency maternity cases on the same night that Austin was admitted.
One of them was a patient with an ectopic pregnancy, (a high risk pregnancy in which the fetus implants outside the uterine cavity). She reportedly had to wait almost four hours to be taken to the Operating Theatre.
Another high-risk patient with the same symptoms that caused the death of Linden maternity patient Inga Nieuenkirk, was reportedly forced to wait three hours before being taken for surgery.
Some private doctors, who have been assisting the GPHC in improving the Maternal Department, are said to be peeved that GPHC officials have not responded to requests to have the facility ready on a 24-hour basis for maternal emergencies such as Austin’s.
According to the sources, this led to former Medical Council Chairman, Dr. Galton Roberts, who had come on board to improve the Maternal Department, quitting abruptly.

In his recent budget presentation, the Health Minister had said that he had hoped to achieve a maternal death rate of no more than eight per 10,000 as at the end of the first six months of last year. But he said that the following four months completely defeated these efforts.
“In the first six months of last year we were on pace to achieve the best results in our history, but those four months destroyed that chance.”
He admitted that several measures were put in place but somehow these broke down, causing the public health sector to suffer a severe blow in the area of maternal and child health.
At the Georgetown Public Hospital Corporation (GPHC) for instance, he explained that there should be about 120 midwives, but only 64 are within the entity’s employ.  However, he noted that efforts have since been made to improve upon this significantly.
The Minister revealed that he has instructed that a doctor remain on the ward at certain hospitals, including the GPHC, the New Amsterdam Hospital, the Linden Hospital and the West Demerara Regional Hospital, at all times. The operations of these hospitals have in the past year been investigated for disturbing cases of maternal deaths.
“I have approved 11 more physicians to join the staff in the Maternity Department at the GPHC alone…I have insisted in the past, but it is not always followed, that certain Maternity Departments should always have a doctor in the ward. What happens is that we have doctors on call who are not in the ward too often…”
More than 150 high-risk and serious pregnancies had been referred to the GPHC last year, according to the Health Minister, who said that doctors and nurses of the public health facility have worked tirelessly to gain the desired results.

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