Jun 06, 2011 News
By Michael Jordan
Two pregnant teens, and a 23-year-old who had taken Cytotec two months into her pregnancy, died within 32 days at the Georgetown Public Hospital Corporation (GPHC) this year.
Medical officials have suggested that the cases be reviewed by the Guyana Medical Council and the Maternal Mortality Review Committee.
Medical reports obtained by Kaieteur News showed that the three deaths occurred between February 22 and March 26.
The reports identified the patients as Preya Gafoor, 17, Joanne Peters, also 17, and 23-year-old Jasodra Khamoo.
It showed that Gafoor was transferred from the Diamond Diagnostic Centre to the GPHC with a diagnosis which indicated that she would require emergency surgery.
However, rather that being sent to the Surgical Ward, the pregnant teen was sent to the Female Medical Ward. She subsequently bled to death.
The report on Peters showed that she had bled heavily after delivering a baby boy, but there was an inadequate supply of B positive Blood at the GPHC for her.
Jasodra Khamoo, who was two months into her pregnancy, is believed to have suffered some complications after taking the drug Cytotec, which is used as an abortion pill.
When her condition became critical, doctors were unable to have her transferred to the Intensive Care Unit because there was no space available.
Contacted yesterday by telephone, Minister of Health, Dr. Leslie Ramsammy said that there had been only two maternal deaths at the GPHC for the year.
“There have been two maternal deaths in six months. Make your conclusion,” Ramsammy said when asked if this figure was an improvement on last year.
Responding to the fact that no blood was available for
17-year-old Joanne Peters, the Health Minister noted that he had repeatedly spoken about the inadequate supplies of blood at the GPHC.
“We continue to be under 12,000 units of blood…we have 8,000 units now.”
And responding to reports that one of the patients, Jasodra Khamoo, could not be transferred to the Intensive Care Unit (ICU) because of a shortage of beds, Ramsammy said “We have a limited supply of beds at the ICU as is the case in every country. Sometimes there are more patients than space.”
According to the report on Gafoor, the teen had an ectopic pregnancy (a pregnancy which occurs outside the uterus).
She bled to death at the GPHC.
Cause of death was given as a ruptured Ectopic Pregnancy and hemorrhage.
The report said that the 17-year-old was referred to the GPHC from the Diamond Diagnostic Centre at 19:50 hrs on February 22 with a diagnosis of acute abdomen (a surgical emergency), anaemia and possible diabetes mellitus.
The report, by the Health Ministry’s Maternal Mortality Committee, said that there was no previous obstetric history available for the patient.
According to the report, Gafoor was admitted to the Female Medical Ward without being seen by a triage nurse at the GPHC’s Accident and Emergency Unit.
“It is apparent that this patient had no triage at the Accident and Emergency Unit…this is totally unacceptable for the medical practice and the admitting officer/doctor needs to be evaluated as to why a patient with an acute abdomen, a surgical emergency, was sent to the Female Medical Ward and not even to the surgical ward.”
“This was a case that was poorly managed on admission to the GPHC. The referral diagnosis was not even taken into consideration by the medical doctor at the Accident and Emergency Unit.
“The case should go to the Medical Council for the medical doctor (whose name was not readable on the chart), who saw this patient at the A and E unit to say what was his or her impression of the case and why the diagnosis of Acute Abdomen was not taken into consideration in the management of this patient.
This patient was obviously only treated for the possible diabetes mellitus,” the report stated.
A report by the Maternal Mortality Review committee said that Joanne Peters, 17, of Craig, East Bank Demerara, had attended clinic at the Craig Health Centre from November 11, 2010, when she was 12 weeks pregnant. She underwent all the relevant laboratory tests, and the pregnancy progressed satisfactory with no complications.
According to the report, Peters, who had a history of lower abdominal pains, was admitted to the GPHC on March 16 at 18.30 hrs. The report noted that the teen displayed no medical problems on admission, and all her vital signs were normal.
It said that Peters delivered a live baby boy at 19:33 hrs. The delivery was done by a medical intern, who was supervised by a qualified midwife.
At this point, the teen was observed to be bleeding, (post-partum hemorrhage) and intravenous infusion was set up.
The report noted that Peters had lost 600 milliliters of blood, and that she was prepared for surgery in the Main Operating Theatre. It stated that there was “unavailability of adequate B positive blood for this patient with massive PPH (Post Partum Hemorrhage) at the national referral hospital.”
There were tears to the entrance of the uterus and sections of the vagina. These were repaired but there was “ongoing bleeding from the uterus… continued…a total of three litres,” the report said.
A decision was made to have the patient undergo surgery to have her uterus removed. It is estimated that the patient lost a total of four litres of blood.
Peters suffered massive post partum haemorrahge, and was transferred to the ICU, where she suffered from cardiac arrest.
The report stated that on March 19, Peters was diagnosed to have suffered Hypoxia Ischaemic brain injury.
“Despite all treatment,” the teen passed away at around 16:20 hrs.
“This was a complicated case of PPH who developed problems and despite all interventions did not recover. This case should be reviewed by the MMR committee.”
The report on 23-year-old Jasodra Khamoo
of Enmore, East Coast Demerara said that she was admitted to the GPHC’s Accident and Emergency Unit on March 21, 2011. At the time, she had complained of vomiting 15 times a day and of numbness to the head.
According to the report, the physician who examined
Khamoo said her physical ‘seemed fair’. The doctor also confirmed that the patient was pregnant.
Khamoo was sent home after being given ORS (Oral Rehydration Solution) and gravol tablets.
“This patient was vomiting excessively and no other signs of dehydration were noted by the medical doctor.
“What did the doctor mean as ‘seems fair’?
Were any laboratory tests done (serum electrolytes) to determine her electrolyte balances before being sent home?”
“If not, why not?”
The report noted that no mention was made as to if Khamoo was told when to return to the hospital.
Two days later, the 23-year-old, who was two months into pregnancy, was readmitted to the GPHC’s Accident and Emergency Unit. Again, she was vomiting excessively, and suffering from weakness and headaches.
A doctor who saw the patient surmised that Khamoo’s pregnancy was inducing the vomiting.
She was admitted to the Ward E.
The report revealed that Khamoo’s husband claimed that she had taken a Cytotec tablet orally and inserted another tablet in her vagina.
According to the report, Khamoo was fully conscious but appeared to be “pale, weak and disoriented, and ill–looking.”
She was given intravenous fluids.
At 22.00 hrs, she was seen by another doctor and appeared to be normal.
On March 24, a physician was called to review the patient who appeared to be restless.
At around 03.30 hrs, Khamoo suffered a seizure which lasted 60 seconds.
“Did the doctors who saw Khamoo recognise the fact that the patient probably had Cytotec toxicity that affected the brain?” the report asked.
“The treatment leaves much to be desired…management should have been more aggressive…the patient (was) fitting continuously without any proper treatment.”
According to the report, Khamoo suffered another seizure at 05:30 hrs and at 06.15 hrs, to 08.15 hrs, became semi-conscious and was convulsing.
She was seen at 09.40 hrs by the Obstetrician consultant, Dr Du on morning rounds.
At around 16:00 hrs, the patient’s husband informed a physician that she occasionally suffered seizures and had been on treatment “on and off” for the last three years, but was never seen by the psychiatric doctor.
Khamoo was referred to Internal Medicine and the hospital’s Obstetric Consultant reviewed the patient.
On March 26, Khamoo’s condition worsened and she became unresponsive to verbal and painful stimuli. She was deemed to have suffered a cerebral Vascular Accident (the sudden death of brain cells), and was listed as being in a critical condition.
Preparations were made to have her transferred to either the High Dependency Unit (HDU) or the Intensive Care Unit (ICU).
However, at around 09.10 hrs, a nurse stated that there was no space available in the ICU to manage the patient.
“HSDU stated that beds were available but Internal medicine needed to be contacted to co-manage the patient,” the report stated.
“Attempts made (at 09:14 hrs) to contact internal medicine failed…patient observed to be not breathing, no rise and fall in the chest,” the report added. Khamoo was then certified dead.
The postmortem revealed intraparenchymal brain haemorrhage. The postmortem also mentioned Khamoo’s use of Cytotec with abortive purpose with eight weeks of pregnancy. Bronchial asthma was also mentioned as an indirect Cause of death.
The report concluded that “more aggressive management of this patient was needed. A CT scan should have been ordered earlier.”
“The internal medicine treatment leaves much to be desired. Was this patient seen by the Medical consultant?
“The recording of the timing of the events in the chart leaves much to be desired. This case should be reviewed by the MMR Committee.”
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