Doctors failed to treat patient’s life-threatening ailment
Although she was twice admitted to the West Demerara Regional Hospital, the doctors who saw 23-year-old Salima Ram apparently failed on both occasions to realise that she was a high-risk patient.
They instead treated her for a minor ailment rather than for the life-threatening Pregnancy Induced Hypertension (PIH) from which she was suffering and which caused her death.
The absence of an obstetrician consultant and the lack of a functioning operating theatre at the institution also contributed to Ram’s demise.
And the medex who saw Ram at a clinic should have had the woman referred a week earlier to hospital after her medical symptoms became obvious.
These are some of the findings of the Maternal Mortality Review Committee (MMRC) which confirmed that medical staffers at the Linden Hospital Complex and the West Demerara Regional Hospital made glaring errors while treating Ram and 35-year-old Tricia Winth.
The MMRC has recommended that the Guyana Medical Council and the General Nursing Council investigate both cases.
The report stated that Ram’s maternity chart showed that she was twice referred from a clinic and admitted to the West Demerara Regional Hospital on December 26, 2009, for shortness of breath and cough, high blood pressure and edema (swelling).
She was admitted to the hospital with a diagnosis of influenza and given two teaspoons Asthalin (medication for asthma) three times a day.
“No record is made as to…whether a diagnosis of Pregnancy Induced Hypertension (PHI) was made even though the patient presented…the classical symptoms of imminent eclampsia (a condition where a maternal patient suffers from fluctuating blood pressure that could lead to death) and full term pregnancy,” the report said.
“This patient only spends four hours in the hospital. Did the doctor miss the diagnosis of PIH of this patient “Why was asthalin given?
Did the doctor think that this patient has asthma, was there a history of this illness?”
The report said that on December 28, 2009, Ram was again referred to the West Demerara Regional Hospital (WDRH) by the same medex, complaining of, among other things, shortness of breath, pitting edema, high blood pressure. She was again seen by the doctors and given 73 milligrams of Voltaren (used to treat pain and swelling) and diagnosed to be not in labour. “While on the ward the patient’s blood pressure continued to increase and later the patient ceased to breathe on December 29 at 2.45 pm.
“This patient spent approximately 24 hours in the WDRH without any invasive treatment done for her High blood pressure in pregnancy nor was not induced into labour. This is a classical case with all the presenting signs and symptoms of an obstetric emergency of PIH
“Who was the obstetrician managing this patient? If there was no obstetrician why was the patient not referred to GPHC on admission?” the report asked.
“Is this the protocol of treatment of a patient with PIH with imminent eclampsia? These questions need to be answered by the doctors who attended to this patient.”
The report also noted that there was a delay in “the identification of the risk factors and diagnosis both at the primary and secondary levels of care.”
“Even so the doctors in the hospital on both occasions when the patient was admitted, failed to identify the PIH condition and treated the patient for a minor illness.”
The report noted that Ram had attended clinic regularly.
“She had eight visits, blood pressure was taken on every visit, urine testing and fetal heart was also taken.
All laboratory tests were also completed as per routine. However, more monitoring of this patient in regards to …weight gained and blood pressure and any deviation of abnormal finding needs to be done. The medex should have referred this patient on the first time that these symptoms presented, one week earlier.”
As in the report on Tricia Winth’s death, the Maternal Mortality Review Committee has made several recommendations for improved treatment of maternal patients.
It stated that no regional hospital should function without an obstetrician since it is the referral hospital in that region.
An Obstetrician should be available for 24 hours. It also stated that the Regional Health Authority needs to ensure that an obstetrician is assigned to the region and ensure that all facilities are functional to cater for an emergency.