There are some instances of carelessness on the part of public officials which result in actual physical harm. The agencies where this most commonly occurs are inevitably connected to the health sector, because it is there that personnel deal routinely with matters of life and death. As Mr Somdat Mahabir pointed out in a letter to this newspaper last week, there are no data on medical errors or medical malpractice in this country, although Attorney General Anil Nandlall has said in a different context that when in private practice he had lodged many complaints with the Medical Council on behalf of victims of alleged malpractice which were never investigated. He also alluded to the filing of several claims in the courts for medical negligence resulting in loss of life over the past six years, but no one had been held culpable.
The most recent complaint to come to public attention is that of Mrs Padminie McRae, who was admitted to hospital on the basis of a false positive Covid-19 test result, and emerged after having had one leg amputated. Both she and her husband are naturally most distressed by what has happened, but the relevant authorities, rooted as they are in their traditional mindset of denial and red tape, are not extending the level of assistance to which she is properly entitled.
We reported that Mrs McRae had gone to the Herstelling Health Centre complaining of a fever and inflamed tonsils on March 15. Owing to the fever the clinicians there administered a Covid-19 test which came back negative. However, the fever persisted, so she and her husband decided to go to the Woodlands Hospital four days later. There she received a positive antibody Covid-19 test and on that basis was referred to the Georgetown Public Hospital along with the test result. False positives are known to occur sometimes with antigen tests, and for confirmation of the diagnosis a PCR test is required. But the GPH did not administer a PCR test, and instead transferred her directly to the Infectious Diseases Hospital at Liliendaal to be treated for Covid-19.
The problem was that Mrs McRae did not have Covid-19, and she should not have been there at all. Had she not been sent to Liliendaal the sequence of events which were to cause her such anguish would not have occurred. She arrived at the Infectious Diseases Hospital the same day on Friday, March 19, and in the early hours of Saturday morning she noticed that her personal belongings had fallen on the floor behind a cupboard beside her bed. In her effort to retrieve them she fell, and attempted to break her fall by grabbing on to an oxygen cylinder which was nearby. In the process the cylinder fell on one of her feet and she related to this newspaper how she was some time on the floor crying for help before anyone came to her rescue.
Mrs McRae is diabetic, and any kind of injury to the foot is a potentially a serious problem. Unfortunately, her toes became infected and it was decided they would have to be amputated. This was done on the afternoon of Monday, March 22nd, before her husband had been informed. Understandably, he was reported to have been very upset, although he said he apologised for his behaviour later.
On the following day, March 23rd, the head doctor at Liliendaal, Dr Tracey Bovell as well as others from the GPH met with the relatives, who were advised that Mrs McRae’s leg might have to be amputated because it was becoming infected. They were informed that attempts were being made to save the leg, but later that night were told by a hospital official that the foot was infected and that the infection was spreading. If the leg was not amputated, the official said, she could get blood poisoning and die.
It was during the conversation with the relatives that the doctors learnt that Mrs McRae was being treated for Covid-19 on the basis of an antibody test, so they ordered a PCR test. That proved negative, and so the patient now found herself in the GPH’s High Dependency Unit.
It will come as no surprise to Guyanese accustomed to dealing with officialdom that the McRaes had negligible support from the health authorities after Mrs McRae was discharged from there.
There are two main issues here: one is the matter of assistance in treating the amputation, and the other is the question of compensation. As far as the first of these is concerned, Mr Nelroy McRae said that he has been taking his wife to the Health Centre during the week for her leg to be treated, but has to buy items so this could be done. After complaining to officials, he was given a roll of bandaging material. At the weekends, however, the Health Centre is closed, and he has to hire a nurse at his own expense to dress his wife’s leg. Not unreasonably, he queried why a nurse could not be sent to his home to assist with the dressing. When he approached the Ministry of Health for assistance, he said, he was referred to the Ministry of Human Services and Social Security.
As for the GPH, its Head of Strategic Planning and Communications Ms Chelauna Providence was reported as saying that as far as possible the hospital had been assisting the family and would continue to do so while her leg healed. It might be noted that Mrs McRae does now have a wheelchair to make her more mobile, but this was donated by a church.
Pursuing some kind of ex gratia payment from the government for what was clearly a mistake by the GPH at some level has proved a frustrating exercise for the family. When this newspaper contacted the Minister of Health on the matter, he was tetchy when responding. “I am not sure why they are making this into a public statement — and that is their right — but I am sure if they go to the hospital where there is an office it would be dealt with,” he said, among other things. He knows better. The GPH cannot deal with matters of compensation, something which was confirmed by Ms Providence, who also said that it was a matter for the Ministry.
Before any question of payment could be pursued, however, there would have to be an investigation by the Ministry as to what occurred. Clearly it does not want to follow this route, and so Mr and Mrs McRae are being treated to the famous governmental runaround. In more recent times, the Ministry has been forced into mounting inquiries into childbirth cases where either the babies or their mothers (or both) die, but they are clearly in avoidance mode in this instance.
It is in the public interest for it to be established what the guidelines are for referral to Liliendaal. Or is it that there are none, and it is left to the discretion of individual medical staff when to transfer and when not to? Or are there guidelines in existence but there is a shortage of PCR test kits, and if a positive result comes in from another hospital a referral to the Infectious Diseases Hospital is made automatically, even if it was an antibody test result?
Just who made the decision to send Mrs McRae to Liliendaal? In other words, are we looking at an institutional failure here, or alternatively, possible negligence on the part of an individual or individuals. If there are institutional shortcomings, it is in the interest of everyone for the Minister to have these investigated, so they can be addressed, and if there is any negligence involved, that too should be uncovered.
One can only assume that Dr Anthony is hoping that the McRaes will forget about the Ministry and pursue their compensation claims through the courts. As indicated earlier from what the AG has said, that route is not one where historically plaintiffs have enjoyed much success. Earlier this month the Ministry of Legal Affairs issued a press release concerning a meeting between the Medical Council and the Ministry regarding reform of the Medical Practitioners Act of 1991 and the Code of Conduct and Standards of Practice Regulations of 2008. These were described by the Council as “defective in many respects”, making it difficult to take disciplinary action. It will be collaborating with the Drafting Department of the Ministry to draw up a draft Bill. While this is a welcome development, it is something which lies in the future, and will not help the McRaes now. As things stand the ball lies in the Minister of Health’s court to ameliorate the situation of Mrs McRae and investigate what went wrong so it doesn’t happen again.
