By Khadidja Ba
Addressing accusations of negligence and medical malpractice, Dr. Amarnauth Dukhi, Head of the GPHC’s Neurosurgery Department, yesterday emphasized the critical importance of adhering to standard operating procedures and for patients to follow directives given by medical health professionals.
He also urged the immediate cessation of exploiting medical cases for personal gain as well as encouraged more attention to be given to the effects of Social-Media on the mental health of persons.
Diane London, mother of the late Deandra Liver-pool, has challenged the account presented by Georgetown Public Hospi-tal Corporation (GPHC) on the death of her daughter in their press release dated June 13th, 2024. This dispute arose following the circulation of a video on social media, prompting GPHC to initiate an internal investigation aimed at offering clarity and transparency to the public.
Dr. Dukhi, emphasized the thoroughness of the hospital’s investigation. “We conducted a thorough investigation of the hospital records. That is what is legally binding and that is what describes our encounters with each and every patient that we face on a daily basis,” he stated during a press conference yestefay.
Initially seen at the West Demerara Hospital and later at a private facility, Liverpool’s case was highlighted after a relative contacted the GPHC to request a consultation with Dr. Dukhi at GPHC.
Dr. Dukhi underscored the importance of professional, evidence-based in-formation sharing. “Before any surgical intervention is performed, the patient has to be studied intensively for likely causes of brain lesions,” Dr. Dukhi emphasized during the press conference. He pointed out that metastasis remains a leading cause of such lesions, necessitating thorough examination of other organs like lungs, breast, cervix, digestive tract, and skin for potential malignancies. He cautioned against proceeding with brain mass surgeries without first addressing these potential sources, citing risks of neurosurgical complications.
In respect to patient confidentiality, he referred to Liverpool’s case as Patient “X”, underscoring the need for privacy in medical disclosures.
Dr. Dukhi detailed the sequence of interactions involving Liverpool and his medical team. “On the 24th April 2024, patient X presented herself accompanied by someone identified as her mother and an accompanying relative because they had a CT scan and was told at West Demerara Hospital, that she had a mass lesion/ stroke they were not sure,” Dr. Dukhi stated during the press conference. Initially assessed at Mercy Hospi-tal, as revealed in a circulating video shared by London on Facebook.
Following the CT scan, the next course of action involved requesting an MRI. “An MRI was ordered on the 24th of April together with a series of tests that will now address the organs previously mentioned as well as any infections such as HIV etc.,” Dr. Dukhi explained. Subsequently, Liverpool was directed to undergo these examinations. “The staff at the private institution told the patient that she needs to return before 3pm if they have the results for the MRI for Dr. Dukhi to review it. According to private hospital records, the patient came back at minutes to four requesting to show the physician the MRI,” he continued.
Hostile
Dr. Dukhi noted that during this visit, the attending physician was unavailable, leading to tensions as the family sought a consultation. “The family became abusive and hostile to the staff and visited the Medical Director with the same hostility to see the doctor,” he recounted. As a result, it was emphasized that all required tests, including the MRI, must be completed before further medical consultation could proceed.
Dr. Dukhi asserted during the press conference yesterday, “The patient only returned on the 15th of May to the private institution, three weeks after the MRI was requested. Even though they had the MRI from the 24th of April, they made no attempts to have it reviewed nor were there any attempts to come to the GPHC to have it reviewed. There are no records of that. We checked everything.”
He further clarified the sequence of events, stating, “On the 15th of May, the patient returned with the MRI but without completing the other necessary tests. When I reviewed the MRI, it indicated a brain mass, prompting the need for further tests as surgical intervention was likely necessary.” Dr. Dukhi also addressed financial concerns raised by the patient’s family, noting, “The mother mentioned the high cost of removing the mass lesion, which they found too high.”
Dr. Dukhi then mentioned scheduling Liver-pool for his neurosurgical clinic on Monday, May 20th, 2024, indicating that up to this point, the patient remained stable and functional. Upon her return, he reported, “The patient was seen by an entire team of neurosurgeons.” Following the team’s assessment, Dr. Dukhi said, “They emphasized to the patient and her family the importance of completing the required tests.” He acknowledged, however, that there was a misunderstanding regarding the delay in completing these tests. “We were under the impression that the tests were not done due to financial constraints, but it turns out they were delayed because the family was exploring overseas treatment options,” he stated.
“At that point, we used the GPHC request form to reorder all necessary tests,” Dr. Dukhi continued. “Before any surgical intervention could be considered, these tests were essential to accurately diagnose the problem.”
According to Dr Dukhi, “The patient was given her medication to address swelling, seizure prevention, pain management and these were listed, given and told the importance of these. The patient at this point still did not show signs of health deterioration.”
In response to a question by SN, Dr. Dukhi confirmed that he had scheduled the patient to return the next Monday, but she did not come back until 21 days after her previous visit. Allegedly, during the 21-day period, the relative subsequently made contact again with Rambarran requesting for the hospital to accommodate another request- “the family prefers to take the patient overseas for treatment. The relative went along to say to me who will be paying the medical bill for the patient when they go abroad.” The family member then asked for the GPHC to ask the neurosurgeon for a letter for them to go to the US Embassy to acquire a US visa for overseas treatment.
This was denied and Dr. Dukhi offered the following as the justification for his decision- “I was asked by the (GPHC) CEO and I engaged the family, what they were asking for was a letter from the doctor requesting for the surgery to be done overseas. So that a letter can be given to the US Embassy for a visa to be granted. I cannot recommend any surgery to be done anywhere else. I can only recommend medically for a surgery to be done overseas when it can’t be done here.”
The contrast MRI, previously ordered by Dr. Dukhi was to assess whether the lesion was capturing blood flow, was part of efforts “to optimize knowledge to offer the best care to the patients,” as stated by Dr Dukhi. “We do not order tests by our fancies, these are scientific data, evidence-driven medicine that is over the board and can be checked by any institution offering neurosurgery,” he emphasized.
Upon her return on June 10th, 2024, the findings reviewed included the ultrasound of her breast, prompting consideration for a mammogram. An examination conducted on June 10th, 2024, led Dr. Dukhi to conclude that the patient’s health had deteriorated since he last saw her three weeks prior.
At this juncture, the case became “urgent”. Dr. Dukhi said he checked with the mother to ensure the medication was given to the patient; the mother pulled out a prescription and said “I didn’t give her this tablet because I couldn’t find it”. Dr. Dukhi said the tablet was for swelling in the brain and readily available at GPHC. After the mother explained a situational problem regarding living arrangements and why the medication was not given to the patient, Dr. Dukhi surmised that the deterioration of Ms. Liverpool’s health was because of her not being given her medication.
Dr. Dukhi then requested that the patient be admitted to the ER for acute care for her headaches. He instructed one of his resident doctors to move the patient from the clinic to the ER. While being treated for her headaches, Dr. Dukhi said she had a seizure while in the Holding Bay of the ER, refuting claims made publicly that she had a seizure outside of the ER.
Dr. Dukhi then asked another doctor to assist with Liverpool’s admission as he had another case in the ER as well. Dr. Dukhi maintains that “we still could not have done any surgery because the tests were not completed and required more tests to see what was causing the lesion.” She subsequently died.
Social Media impact
Speaking to the discussions on Social Media, Dr Dukhi said, “For each and every patient that loses their lives, we feel that loss as an institution as much as those who are close to the patient. Sometimes it is also very difficult to be consistently bashed throughout social media. There was an article in SN yesterday that showed the effects of social media on the mental health. We have to start finding legislations in this country to control it. It will also affect the health care providers.”
Regarding the claim by the family of misdiagnosis after the autopsy report stated the presence of a “cyst” instead of a “brain tumour” that was previously stated, “When you do an autopsy, the Doctor doing the autopsy is doing a macroscopic evaluation of that autopsy. If he sees a cyst, he will say it’s a cyst. It is within his remit to take a sample of it and have it studied for his pathological diagnosis.”
The GPHC has requested through its press release for the family to lodge a formal complaint through the Help Desk office located within the GPHC compound. According to Stacy Peters, Public Relations Officer of GPHC, this has not yet been done. Efforts are also to be made by the GPHC to contact the family directly.
Dr. Dukhi also shared that he has led neurosurgical care in Guyana for the past 10 years. “Prior to 2015, there was no in-house neurosurgical care guided by specialized certified neurosurgeons in Guyana.” He also emphasized during this press conference, “My work at GPHC is because of the love for neurosurgery; every month my salary from GPHC goes to charity. I do this for the love of neurosurgery and building capacity in this country because when I am no longer here, this country must not wait another 60 years post-Independence to have another neurosurgeon. We are constantly building capacity and it doesn’t matter what the google Neurosurgeons and the lawless social media advocates say.” “For every 100 neurosurgical interventions done in my practice, there is an extensively high success rate of over 80%-90% intervened surgically.”
In an effort to build capacity, GPHC now boasts a team of 4 resident neurosurgeons and there is continued training programmes being offered in collaboration with local and international partners. “Neurosurgical care is not only offered publicly at GPHC but is also available at other private institutions. Currently attempting to decentralize the care as we now have the Human Resources capacity to do so.”
