The acting Chief Medical Officer has said that findings on some of the maternal deaths this year have indicated that there was laxity on the part of doctors as patients were not managed according to protocol.
This was relayed to Stabroek News by Dr Shamdeo Persaud in a recent interview where he discussed maternal deaths from a holistic perspective and looked at three of this year’s maternal and infant mortality cases.
Examining the report of 17-year-old Tasya Joseph who died on March 30th while being ambulanced from the Linden Hospital to the Georgetown Public Hospital Corporation (GPHC), Dr Persaud said: “They feel there was some instances where the patient was not managed according to protocol. Once again that issue comes up. Even though she is a ‘sickler’ (a person who has sickle-cell anaemia or carries the trait for sickle-cell anaemia) and high risk when she was admitted on the 28th no attempt was made to deliver her at that time. We could have taken an early action and resolve this, she didn’t have to go home in pain and come back. You don’t need to wait for pain if the patient is ready and full term.”
Joseph’s relatives accused officials at the Linden Hospital, where she was a patient for over four days, of negligence saying they knew she suffered from sickle-cell anaemia and kept her in labour bleeding and without proper medical supervision. It was only after the woman’s condition worsened that she was transferred to the GPHC. Her baby also died although it was full term.
Giving a timeline from when she was admitted to the time of her death the CMO informed that she was admitted on the 27th of March, 2012. On the 28th the report indicates that she was experiencing low abdominal pains but it was noted that she was not in labour. Samples were taken and various tests were done to ascertain her illness. They said that on the 29th it was uneventful but she continued with complaints of pains and by the afternoon her pulse had increased to 130/80 and her breathing was laboured. A high blood pressure check was done and it indicated that her pressure was slowly rising.
Other tests indicated that she was positive for dengue and the patient’s temperature was elevated.
It was stated that she was conscious and sitting in bed at 10 pm that night. Later that evening she took a turn for the worse and the decision was made to rush her to the GPHC. The nurse who accompanied her claimed that she stopped breathing as they approached Georgetown. She was pronounced dead on March 30th.
Her autopsy stated that she had died of an amniotic embolism where amniotic fluid got into her blood stream and was taken to the lung and it became too clogged with the fluid, triggering an allergic reaction and Joseph’s heart and lung collapsed.
The CMO said that doctors should have acted more promptly and performed surgery. “Caesarean should have been done – it is better performed at that time (when she was first hospitalized) because you don’t have to deal with the baby going into the birthing canal and you having to pull them back up making for more complications.”
Junior doctors
He stated that from the report, it was junior doctors who were charged with the responsibility for Joseph and that should not have been the case as they were not given enough supervision. “The junior doctors were left to manage this patient a lot on their own without adequate guidance even though we did have an obstetrician there,” he said.
A recommendation made by the seven-member committee charged with reviewing each maternal death also stated that from Joseph’s death it should be reinforced to medical personnel that it is best to wait until patients are in a stable medical state before transporting them by ambulance. This is because the fatigue of travel would complicate an already bad situation
“Transfers should take place in an ambulance when patients are stable. You don’t want to put somebody in an ambulance and they are not at least in a medically stable state to travel… everyone in the health service is so anxious about the maternal health issue that they just want to push everybody out as fast as possible and sometimes it’s not for the best… well in the best welfare of the patient,” he said.
Minister of Health Dr. Bheri Ramsaran when questioned shortly after Joseph’s death had stated that while he could not comment before the final report he was certain that Linden Hospital was capable of dealing with high risk cases.
“Why should Linden hospital not be able to manage a sickle-cell birth? Women with every ailment and sickness give birth every day. Women with cardiac problems, women with sickle cell, HIV, but we will wait on the report and action would be taken,” he had said.
On the case of the mother of two, 29-year-old Vanessa Roopnarine, who died on the 26th of April, 2012, three days after checking into the GPHC to have a dead foetus removed, the CMO said that reports found the woman was not managed in a timely manner.
Seven months into gestation, Roopnarine had an ultrasound at a private hospital after she had gotten no womb movements. It was found that the child she was carrying had died. To save on expenses of having to pay the private hospital the relatives took her to the GPHC and related the ultrasound results told to them at the first hospital.
Medical personnel at the GPHC told the woman and her relatives that she had to still undergo blood tests since they could not use the private hospital’s records. She was admitted to the ward.
She was kept there and during the course of the said night suffered a stroke due to elevated high blood pressure. According to the CMO’s report she had fallen off the bed during the night and was found frothing from the mouth.
She was given “aggressive medication” to bring the blood pressure down and plans were made to have the dead foetus removed but since her blood pressure was not under control this was not done. She remained hospitalized until she succumbed sometime around 1am on the 29th.
“Recommendations revealed that her condition was not recognized and managed in a timely basis. They should have managed the dead foetus more aggressively since that was the reason for carrying up the pressure,” Persaud said.
He further stated that doctors should understand that gestational hypertension is temporary and only due to carrying the foetus. As a result as soon as the foetus is removed blood pressure would immediately go down and in a short space of time be back to normal.
“… I am looking at this and they should have done other things to help this woman. I will have to get more on this conclusion,” the CMO said.
The investigation into the death of 17-year-old Samantha Bruce Haynes of Soesdyke who died along with one of her twins in May at the GPHC shortly after she had given birth is listed as incomplete. As such while Persaud gave documentation on her medical status from the time of admittance he could not provide any findings or recommendations.
Asked about the next plan of action on the completed investigations the CMO said: “I will have to act on these.”
