Overseas-based doctor worried about sepsis-related deaths at GPHC

Jun 24, 2015 News

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– cites need for hygienic practices, aseptic techniques
The credibility of the Georgetown Public Hospital Corporation (GPHC) has been called into serious question by a

United States-based doctor whose relative was attended to and subsequently died there.
According to Family Physician, Lisa Singh, who practices medicine in the State of Minnesota, the recent passing of her aunt was in fact the third of her relatives to pass away at the institution. What is especially troubling is that all three, prior to their demise, were diagnosed with sepsis.
Sepsis is the presence of harmful bacteria and their toxins in the body tissues typically caused by the infection of a wound. This troubling development has led Dr Singh to believe that the hospital is lacking very needful hygienic and aseptic techniques which are required to prevent the spread of infection.
“I would challenge anyone to do an audit on the deaths of patients and see how many are dying of sepsis and they will see what the cause is – the lack of hand washing and aseptic techniques.”
Dr Singh, who migrated to the US some 22 years ago, disclosed during an interview with this publication that while the passing of one of her cousins at the beginning of this month was worrying she decided to travel home after learning that her aunt, Ms Evelyn Ramdai Carr, too, had become ill and was admitted at the GPHC. It was suspected that the aunt had developed Leptospirosis but was admitted in a critical condition to the Female Medical Ward suffering from sepsis.
But according to Singh, “normally if you suspect sepsis you are supposed to do blood work, (check) procalcitonin level, lactate level…none of these were done. You absolutely have to draw blood cultures to see which bacteria you are going to treat definitely; of course you are going to start empirical treatment with an antibiotic”.
She was also at a loss as to why her aunt’s critical condition did not prompt the medical workers to place her in the Intensive Care Unit.
Of concern to her too was the fact that her aunt was not administered Intravenous (IV) Fluid which would have been a requirement for her condition. There was also need for a Foley catheter to accurately measure her urinary output, Dr Singh said.
“She was not able to eat; she was not able to take her own medications…The very first day I got there I saw a cup with her antibiotics just sitting there. I approached the nurse and the nurse said it’s probably from the night shift…I was there at 12pm that day!” exclaimed a visibly upset Dr Singh.
After further querying about her aunt’s care, Dr Singh said that she learnt that while IV antibiotic was ordered for her aunt, this was not made available. Efforts to contact the attending doctor (name withheld) that day was not possible. However the following day she said that she was not only unable to make contact with the attending doctor, but even the emergency doctor who initially attended to her aunt.
“I asked about why the blood culture wasn’t drawn and he (the doctor) said that the machine was broken, so they couldn’t do it. I questioned about the IV fluids…he couldn’t answer me,” informed Dr Singh.
According to Dr. Singh, she has since filed a complained with the Matron of the hospital and she was given assurance that the matter will be brought to the attention of Minister of Health, Dr George Norton.
“I want to bring awareness to the public about the Georgetown Hospital practices; these are inappropriate. I don’t think they care about (some of) the people they are attending to. The nursing staff (in my opinion) is not well trained; they are rude and arrogant,” asserted Dr Singh.
Reiterating her concerns about the lack of aseptic techniques,” she added, “I saw this for myself. When a nurse was inserting the antibiotics fluids and I asked her ‘Are you going to swab (the port) with an alcohol?’ She said ‘no I am just going to push it there’…We are dealing with sepsis and then we are introducing more bacteria? How are these patients going to survive?”
Her attempts to upbraid the nurse’s action were met with a rude response together with the assertion that “this is Guyana.”
“I had to ask, who is Guyana? You (the nurse) are Guyana!” related Dr Singh as she disclosed that speaking to the Sister of the Unit did not help to appease the already daunting situation. “It was very unprofessional (the response),” Dr Singh added, as she related how nurses in the Unit were unwilling to give assistance when asked. “I said excuse me, they looked at me and then turned back to their social conversations…chatting on their cell phones, eating at the nurses’ desk…” said Dr Singh of the nurses, as she spoke of the inability to identify them because of inconspicuous name tags.
As if this was not bad enough, Dr Singh said that it was particularly appalling to observe that “not one nurse washed (or sanitised) their hands between (attending to) patients…The physicians are probably not doing it too. There is a garbage bin (on the ward) that is opened and these can all help to contribute to infection diseases…” added a very concerned Dr Singh.
“How are people going to get better? They are not going to get better,” she declared as she related how not only was she forced to assume the care of her aunt, but a simple request to change her immobile aunt’s position was not adhered to.
“I went back 24 hours later and she was still in the same position…this is a woman that couldn’t even wipe her own tears. She literally couldn’t move. I had to ask for a NG (Nasogastric) tube so she could be fed,” Dr Singh recounted.
It was upon her request too that her aunt was eventually administered IV fluids.
“I asked about her mental status…because she appeared confused and she was running a fever and so I asked about her ammonia level…” related Dr Singh.
When adults experience mental changes, disorientation, sleepiness or lapse into a coma, an ammonia level may be ordered to help evaluate the cause of the change in consciousness.
Even as she admitted that she was aware that her aunt was dying, Dr Singh said doctors take an oath which obligates them to at least try.
“Her kids had hope and so they needed to at least talk to the family,” said Dr Singh, as she related that the family was told little to nothing about her aunt’s condition.
It is the belief of Dr Singh that because she advocated for better care for her aunt during her last days that the care offered to her was not the best. According to her, she saw the need to advocate on her aunt’s behalf because of her observation that attending doctors at the institution have been failing to even explain to family members the condition of patients.
She related that during her advocacy attempts, one doctor told her that if they (medical practitioners) are aware that a patient is dying, not much is usually done for that patient.
Another distressing development was the disclosure of a doctor that if the care at the GPHC was not good enough the family should have opted for a private institution.
“But what about the people who can’t afford it? Things need to change at the Georgetown Public Hospital. People who don’t have money should be eligible for equal care as people who can pay. What is the art of nursing? Are they teaching them compassion or how to advocate for patients? Physicians need to stop thinking they are gods…they are human just like you and me, they need to start talking to families,” insisted Dr Singh as she spoke of the need for improved nurse-doctor relations at the hospital.
This, she disclosed, was based on the disclosure of a doctor that while he had ordered certain medications for her aunt, he had no control over the nursing staff to ensure that his requests are carried out.
“Of course you have control! If you write an order you should make sure that it is executed and if it is not then there should be consequences. People need to be held accountable for their actions and we cannot keep saying that this is Guyana…” insisted Dr Singh, who is hopeful that the relevant authorities will take urgent action to improve the delivery of care at the GPHC.

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