The death of three young children, being cancer patients at the Georgetown Public Hospital Corporation (GPHC) has once more starkly thrust that hospital into the limelight of public scrutiny, creating serious public interest in the outcome of a promised investigation into the three deaths which occurred over a matter of mere hours and days.
In the public interest, this matter must be addressed with the urgency it deserves and full findings of the investigation disclosed. In the past the hospital has not been forthcoming in detailing the full results of previous investigations, particularly with respect to culpability, punishment and remedies recommended to avoid or deter such a recurrence.
Days after the deaths of Curwayne Edwards, Roshani Seegobin and Sharezer Mendonca, were reported in the press, Public Health Minister Volda Lawrence surfaced to make her first public comment on the matter but only to state mainly that her ministry has requested technical assistance from the Pan American Health Organisation (PAHO) to aid in the investigation.
New GPHC Director of Medical and Professional Services, Dr Fawcett Jeffrey is leading the investigating team which includes GPHC’s Deputy CEO, Elizabeth Gonsalves and professionals from the paediatric department. Lawrence made a point of saying the team has been asked to work assiduously in an open and transparent manner, and this declaration followed a statement from GPHC which sought to restrain public pronouncements on the case and called for due process to follow.
That the GPHC must first launch an internal investigation into what happened is to be expected, but that investigation should have been swift following the deaths and concluded by now with the findings submitted to the subject minister and made public. Following this internal investigation, however, the Minister of Public Health should have been compelled to institute an impartial inquiry into the deaths utilising available international specialists in the same arena of medical care that the children were receiving as cancer patients. It would be futile to have, say, a general practitioner with neither experience nor expertise in oncology, being charged with investigating the deaths of the three children.
Cases of potential medical error or malpractice, as stated before in these pages, are not for determination in the media as to whether the hospital is culpable or the medical personnel vicariously culpable. This case, like the series of cases of alleged medical malpractice documented against the GPHC, is important for testing the usefulness and effectiveness of the regulatory system and its ability to conduct an open and impartial investigation, and where necessary, to recommend appropriate penalties for those found culpable, laying the groundwork for legal recourse for suffering victims or their families.
As expected, there is an overflow of scepticism regarding the promised investigation expressed by the relatives of the deceased children, and the results of this investigation will no doubt be heavily scrutinised by all affected parties. And the families cannot be faulted in this regard particularly since the family of Sharezer Mendonca had to endure more agony after the hospital mistakenly released her body to another family for burial. The family’s attorney, Ganesh Hira has indicated that the family is exploring legal options.
No large hospital in any country is immune from the individual errors, but it appears that the public hospital has more than its fair share of alleged medical errors resulting in harm to patients and emotional suffering to patients and relatives. The lack of a functioning recourse environment limits access to legal redress for those affected when things go wrong. Consequently, public mistrust of the hospital continues to climb as reports of error and negligence, whether real or perceived, pile up in the press.
The public health budget for 2019 is a sizeable $35.9B with $11.0B designated for drugs, medical supplies and construction and rehabilitation and maintenance of health infrastructure. $650 million has been budgeted for enhanced health care delivery and improved health facilities in the health sector and the GPHC is slated to receive $9.1B.
Perhaps Minister Lawrence and the newly installed management team at GPHC could update the public as to what portion of the allocation targets performance management, outlining clearly, what strategies have been developed or are in place to improve the performance characteristics of the systems in which personnel are working at the hospital. In the interest of the public, the GPHC and the Ministry must provide information on the country’s health policy on childhood cancer and what improvements have been made, if any, over the years in this area.
Already, questions are being posed regarding the type of drugs administered to the children and under what guidelines. Questions also relate to the quality of the services available locally to treat childhood cancer? Do we have Paediatric Haematologists and Oncologists managing the programme along with general Paediatricians? In addition, what are the limitations to early detection and treatment? Importantly, what advancements have been made with respect to the survival rate say, within the last ten years?
PAHO/WHO has identified cancer among the leading causes of death in children under the age of 15 years. In high-income countries, childhood cancer mortality has been reduced significantly and survival rates are 80% or higher. However, they have found that in Latin America and the Caribbean, paediatric cancer survival rates are significantly lower due to the gaps in access to early diagnosis and effective treatment.
PAHO/WHO’s involvement in the current investigation is a positive development, but an urgent need exists in this country for our policy makers to enshrine new standards of performance and accountability across the health sector, beginning with GPHC. The public must also be educated on matters pertaining to the duties and responsibilities of both patients and doctors with respect to elements of risk attendant on many medical conditions and the remedying procedures.
While we await the report of the internal investigation and the announcement of an appropriate external one, the public must join the grieving relatives in holding the feet of those in authority to the fire leading hopefully to a full revamping of the medical system in Guyana.
The three young lives lost in such depressingly quick succession compel us to do no less.
