Seven maternal deaths, still no satisfactory answers

Jul 29, 2013 News

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The names may change but the stories remain the same. An expectant mother enters hospital, often with no apparent complications, then, hours later, relatives are told that the patient has died. Accusations are made, investigations are launched, findings are revealed, recommendations are made…then silence…until the next death starts the cycle of blame and denial all over again.

Today, Kaieteur News highlights six maternal cases that remain unresolved.

A VALENTINE’S DAY TRAGEDY
Nazeema Abrahim was just 19 years old when she entered the Georgetown Hospital’s Maternity Ward on February 13, 2000. The teen’s sister-in-law, Annie Sakar would later report that she accompanied Nazeema to the ward at around 2.00 p.m. Sakar said she sat outside the ward until around 9.00 p.m. and was eventually told by a senior nurse that her sister-in-law had given birth and was fine. But Sakar was also reportedly told that Nazeema’s ‘after-birth’ was still in her and that staff had telephoned for a doctor.
The sister-in-law eventually left without being allowed to see the young mother.
She returned to the Maternity Ward at around 6.00 the following day and was told to collect Nazeema’s belongings from the Intensive Care Unit and return to see the baby. But Sakar said that when she entered the ICU, she observed that Nazeema was “breathing hard” and that tubes were attached to her body.
“I went back to the Maternity Ward and told them that my sister was dying and they said that she was okay. But when I returned to the ICU another relative who had gone there came outside crying and told me that Nazeema was dead.”
According to reports, a doctor was on duty in the Maternity Ward on February 13 when nurses informed him that there was an emergency. He was taken to Nazeema’s bed and reportedly found her in “a pool of blood.”
The doctor reportedly then asked the nurses why they had not informed him earlier about Nazeema’s condition but got no satisfactory answer. He then had Nazeema rushed to the ICU where all efforts to save her failed.
At the time, a senior hospital official had told Kaieteur News that the patient was already “in crisis” when the doctor examined her.
An internal probe was conducted into Abrahim’s death. It revealed that on February 13, an intern who had recently graduated from the University of Guyana Medical School removed the maternity patient’s placenta (or “after-birth”) shortly after Nazeema had delivered a baby girl. This was reportedly done without consulting senior medical personnel.

Interns are not allowed to carry out this medical procedure on their own.
It is alleged that the patient began to bleed profusely after her placenta was removed. Indications were that the procedure was incorrectly done.
It was also alleged that at around 7.30 p.m., the nursing staff contacted a senior doctor and informed him that Nazeema was unwell. However, the physician reportedly did not arrive until around 9.30 p.m. He found the teenage mother in “a pool of blood” and rushed her to the ICU where she died the following day.
A death certificate stated that the patient had died from Hypovolemic shock, which occurs when there is severe blood and fluid loss.
The intern was subsequently removed from the Maternity ward, but it is unclear whether any other disciplinary measures were taken against him or the senior physician who failed to immediately respond when the nursing staff contacted him.

THE DEATH OF DEBORAH CRAWFORD
It was ten years ago that 38-year-old Deborah Crawford was admitted to the New Amsterdam Hospital’s Maternity Ward. But on October13, 2003, the Corriverton, Corentyne, mother of two died after suffering massive haemorrhaging while delivering a full-term baby boy. The baby also died.
Her mother, Mariam Crawford, filed a complaint with the Guyana Medical Council, in which she claimed that her daughter had developed a diabetic condition during pregnancy and was being treated with insulin. At the time, she was attending the High Risk Clinic at the New Amsterdam Hospital as well as the Skeldon Estate Clinic.
The statement to the Medical Council said that because of the patient’s condition, a medic advised that her delivery be done by Caesarean section, since the diabetic condition would cause the baby to be larger than normal. It is alleged that although this information was documented on Crawford’s clinic card, the gynecologist ignored this advice and induced labour.

During the delivery, Crawford suffered massive haemorrhaging and her uterus was also removed.
Following an investigation, the Guyana Medical Council, headed by the now-deceased Dr. M. Y Bacchus, found that the accused physician had committed “gross professional misconduct.” The Medical Council found, among other things, that the physician had been negligent, and had been guilty of medical malpractice. It issued its findings in a letter to the physician dated August 4, 2006.
He was subsequently struck off the Register of Medical Practitioners.
However, the accused doctor took the Guyana Medical Council to court. He alleged that he was never notified of the allegation, or of the independent review the Council had taken to arrive at its decision.
The High Court subsequently ordered that the doctor be reinstated.
In September, 2006, Mrs. Mariam Crawford filed a lawsuit against the Attorney General and the physician. That matter is still before the High Court and the patient’s mother, Mariam Crawford, has since died.
‘TAKE CARE OF MY DAUGHTER’
The circumstances surrounding Maureen France’s death appear to mirror Deborah Crawford’s.
In early October 2008, Maureen France, a 21-year-old patient, was admitted to the GPHC to deliver her second child.
Her family claimed that when Ms France delivered her previous child, some two years ago, she was diagnosed as needing a Caesarean Section, because of complications she had experienced.
This time around, the hospital staff reportedly indicated that France was fit to deliver vaginally.

But the family alleged that internal rupturing ensued during the delivery because of the baby’s size. They also claimed that France was apparently left in the Operating Theatre, where she bled to death. France’s mother, Marlyn France, has said that she told the nurses that her daughter had a C-Section before. At this point, the mother said, the nurses asked a flurry of questions and when she tried to respond, one of the nurses asked if her daughter was unable to speak for herself.
Leaving her daughter in the care of the GPHC, France’s mother left with one request of the nurses: “Take care of my daughter.”
It was not until she returned to the GPHC the following day that she learnt that her daughter was in a critical condition, and that her baby had died during childbirth.

DAMNING REPORT ON CONDITIONS AT SKELDON, N/A HOSPITALS
In 2010, a preliminary report into four maternal deaths was heavily critical of conditions at the Skeldon and New Amsterdam Hospitals. The report concerned the deaths of patients Esther Dwarka-Bowlin, an acting headmistress; Nadira Sammy, a 15-year-old from Number 69 Village, Corentyne, who died on September 16; Rebekah Seegobin (also called Rebekah Chinamootoo), 27, of Number 36 Village, Corentyne, who also died in September and Heerawattie Bisham, 21, (also called Yogeeta Bisham), who died on October 20.
The report on Esther Dwarka-Bowlin revealed that although she was a high-risk maternal patient, no ultrasound was ordered for the acting headmistress, no blood was available for her when she needed a transfusion, and no doctor was present when she was ready to deliver.
It stated that hers was a post-term pregnancy (a pregnancy lasting 42 weeks or more). She was referred to the High Risk clinic at 36 weeks and again at 41 weeks.
According to the report, Bowlin was admitted to the Skeldon Hospital 44 weeks into her pregnancy on October 15, at 19:45 hrs. It said that her blood pressure increased on two occasions, and she was given Aldomet (a medication for hypertension) and advised to rest. The report stated that giving a patient Aldomet at this stage “is a waste of time.”
According to the report, Dwarka-Bowlin pushed through an undilated cervix at 23.38 hours (delivering a baby boy).
It also added that the patient was not monitored during labour.
The report stated that at around 05.30 hrs, Bowlin’s condition deteriorated. However, though she needed a transfusion, no blood was available at the Skeldon Hospital. She became unconscious, and ceased to breathe at 05.40 hrs. A post-mortem showed that Bowlin died from internal injuries.
In a section of the report marked ‘questions’, queries were raised as to why no ultrasound was done on the patient.
Cabinet Secretary Dr. Roger Luncheon later summoned officials from the Skeldon Hospital to appear before a special Cabinet sub-committee, to explain the circumstances that led to Dwarka-Bowlin’s death.
The review on the death of 15-year-old Nadira Sammy of Number 69 Village, Corentyne, stated that she had 15 ante-natal clinic visits at the Skeldon Hospital.
She was referred from Skeldon Hospital and admitted on September 16 to New Amsterdam Hospital at around 14.05 hrs.
No vaginal examination was done because the patient was not complaining of abdominal pains.
According to the report, at around 21.25 hrs that night, the teen was seen by the consultant. This was some seven hours and five minutes after she was admitted to the institution.
The report said that the teen subsequently developed shortness of breath. Her condition deteriorated and she ceased to breathe. She passed away before delivery.
A post mortem report stated that Nadira Sammy died from cerebral haemorrhage and eclampsia (a condition that causes seizures or coma in a patient).
The Health Ministry report queried why the consultant was not informed about Sammy when she was admitted to hospital. It also stated that there was a delay in the management of the patient for Pregnancy Induced Hypertension. According to the report, the junior doctor who treated the teen failed to recognise the signs of imminent eclampsia and inform the consultant.
One of the observations made in the report was that high-risk patients were left in the hands of junior doctors, who were unable to handle emergency maternal cases.
A similar observation was made during the Guyana Medical Council investigation earlier in 2010 into the deaths of high-risk maternal patients Tricia Winth and Salima Ram at the Linden Hospital and the West Demerara Regional Hospital respectively. No staffers were disciplined, although investigations revealed that negligence contributed to both deaths.
A complete review of the four cases was to have been done by the Expert Maternal Mortality Committee.
This report was to have been followed by a comprehensive report fashioned by an ongoing investigation.
In late October, 2010, Former President Bharrat Jagdeo ordered an independent investigation into the spate of maternal deaths at the New Amsterdam Hospital and promised that if negligence was found to be the cause, then those culpable will face the brunt of disciplinary action.
Jagdeo had told journalists that a strong message must be sent to those that go to work and laze around while persons under their care are in pain.
He said that the investigation will not be hidden, given that they will make the findings known emphasising that there shall be no cover up.
Now, nearly three years later, the recent death of 28-year-old Luan Rodney has once again raised questions about the quality of care maternity patients receive at the GPHC and other state facilities.

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