She Bled to Death

Dear readers, 

After last week’s column which was written as an open letter to the General Secretary of the Medical Professionals Association of T&T calling for accountability from doctors on the heels of the tragic death of 29-year-old Chrystal Boodoo-Ramsoomair—who bled to death during a routine Caesarean section conducted by an unsupervised house officer at the SFGH on Carnival Friday—my inbox was flooded with your letters. I am sorry to report that although several doctors who want to raise the standard of their profession backed me wholeheartedly, I received no response from Dr Shehenaz Mohammed, general secretary of MPATT, on the questions I had asked in the wake of Chrystal’s death. But, some more information in defence of the house officer that conducted her C-section emerged in the form of a letter from doctor X, who wrote:

“The facts haven’t come out but from what I know (without liberty to divulge) there was likely some additional pathology involved. Further, one of the house officers concerned came back from maternity leave to assist them on that day (she is 8-9 months pregnant I think). She has done over 250 operations prior, with nil complications. Does this not qualify as experience?  “I also believe that she has passed MRCOG exams (cannot be confirmed). In light of this, I suspect greater tact must be used when considering her as an inexperienced junior with a scalpel. “Many doctors agree that PR was poor on the part of MPATT. This has been raised and promised to be addressed by the MPATT executive.”

At this point, the letter felt like PR had crossed into propaganda. Do doctors really think we are that stupid? I consulted a visiting UN pathologist. I asked her if it were possible to cut two arteries during a routine C-section. Her reply was “only if you are incompetent or inexperienced.” This assisting house officer was clearly not inexperienced with over 250 operations under her belt. So are we being forced to conclude she is incompetent? Just asking. Secondly, I am shocked that instead of moving swiftly after this much publicised “botched up” job to put systems in place to ensure that no other woman would die giving birth, the MPATT executive merely pledges to “improve their PR,” which is like putting makeup on a dirty face.

Thirdly, I remember being nine months pregnant twice. Most women are exhausted and distracted. Perhaps not the best state of mind to do a C-section for which you may or not be fully qualified to do. Perhaps, this heavily pregnant house officer who was called out was alert, but what if she was tired?  

Doctor x continued in his defence of MPATT:

“Death is a sad consequence, especially when premature and when children are left motherless...but as doctors we were forced to learn that if we let the sadness overcome us, the consequences could be dire to those waiting for care. I am truly sorry if my comrades appeared callous in their media coverage. Dr X cancelled out the apology with the next line. Clearly the go-slow doctors are not repentant for the harm they caused while patients languished in wards and floors. “I am sorry that their due interest in protocol was perceived as a lack of empathy.” There they go thinking we are fools again. Translate that to  mean.  They didn’t want an independent health enquiry.

Doctor X continued:

“Doctors are not above the law.  We are governed by principles and we subject to inquisitions regularly.  It may not be prominent in the media but doctors don’t get “off the hook” with a mere warning—their licence is revoked and depending on the case, this is permanent. It has happened many times before and will continue to happen, according to proper protocol (the whole thrust of MPATT’s position).” Really? Do tell Dr X, when last was a doctor’s licence revoked?  Could you furnish us with a list? “Doctors do not fear investigation—it is part of our profession. I humbly apologise if this has all gone awry. We are public servants and sadly, the irony is that the protest by MPATT was actually to help this service run smoothly.”

And which part of the MPATT protest which left patients in need of surgery in the lurch helped “this service to run smoothly? I didn’t hear a whisper for patients’ rights during the protest.  As patients languished Dr Mohammed announced that it was the doctors who felt “demotivated, demoralised, abused and depressed.” The e-mails from you, the readers, were mind-blowing including one from a woman who, suffering from unexplained headaches, was fed countless prescription drugs and subjected to a painful “spinal tap” test, only to find out that she had pregnancy-related headaches which a (non-medical) friend diagnosed. Not one of these “bright” specialists thought to do a pregnancy test and now she is left wondering what effect the strong drugs had on her unborn baby.

One reader in particular summed up your dozens of responses to last week’s column calling for accountability from medical professionals.  She wrote: “After reading your article it was like I had to come up for a breath of air as I was choked up for so long; I was waiting to exhale.”

Another reader wrote:

“Unless we have, as you suggested, a Medical Services Ombudsman, who is given a full complement of staff to follow up on complaints as we have heard in the recent past, nothing will change. How can we start a movement to win support for such an office? “Our doctors evidently are not familiar with the Ministry’s Web site. If they were, they would be well-informed about the Patients’ Bill of Rights which can be found on the Web site. They would also seek to live up to its contents because for many of us, our approach to doctors, especially questions are predicated on what is carried in the Patients’ Bill of Rights. Doctors ought to stop treating patients and their relatives as if they were morons and talk to them in non-technical language. This is obviously a deficiency in their training.”

I, too, would like some answers to the following questions:

1 What is the complaints procedure for each RHA?

2 What are the penalties for negligence or malpractice acts by healthcare providers? In the USA a nurse or doctor can be stripped of his licence.”

I went on the Ministry of Health’s Web site (http://www.health.gov.tt) and saw a comprehensive complaints procedure. I urge you to visit. The Web site also served notice that “the Ministry will be conducting the independent investigation into the untimely death of Crystal Boodoo-Ramsoomair at the An expert Maternity Ward of the San Fernando General Hospital on March 4, 2011. recommended by the Pan American Health Organisation (Paho) will also be on the investigative committee.”

Bravo Madam Minister! Now I urge you once again, as I did last week, to keep up a fight for accountability on behalf of the ill, frail, suffering vulnerable victims of sloppy healthcare in this country. You have achieved the independent enquiry.  Now please, put together an independent malpractice board. Appoint a medical ombudsman and get a data bank on doctors. Make the men and women in white coats accountable. Meantime, the rest of us are gasping for breath, waiting for answers from MPATT...still waiting to exhale.