A Sunday Newsday Investigation
Medical practitioners across TT can soon expect more litigation charges of malpractice against them as attorneys reveal that there are several cases of medical negligence which are now under consideration for possible court action. Sometimes people do not even know that negligence may have been involved in the loss of a loved one. Even if they suspect they do not know where to turn. Doctors support, protect and cover-up for each other. The saying that doctorsâ€™ mistakes are quickly buried is no joke. There have been reports of patients entering a hospital for one type of operation only to end up losing a limb or some healthy organ. What do they do? What can they do?
Civil litigation is usually beyond their means and attorneys are calling on Government to establish a panel of independent medical practitioners to review complaints and recommendations for compensation for people seeking justice, against what they believe is medical malpractice. Doctors are covered by insurance but this insurance is very high and the premiums range from $7,000 to $30,000 per year. The highest insurance premiums are in the field of Obstetrics and Gyanecology, while the lowest are in the field of Special Internal Medicine. Insurance companies try to cover the costs which arise from a lawsuit. Attorney-at-law Anand Ramlogan disclosed that he had about 17 cases of medical negligence before him, some of which are pending. Attorney-at-law Nyree Alfonso said she too had quite a few cases which are currently being investigated. Several other attorneys confirmed that they were considering handling a few cases but indicated they could not discuss them due to confidentiality and privacy of their clients.
Sunday Newsday began a check with attorneys when several people called to say they were pursuing legal action against the Stateâ€™s public medical health institutions or private clinics for negligence. Over the past few years, there have been reports of mothers losing babies and relatives threatening health institutions for medical negligence following incidents of â€śbad treatment.â€ť Last week, a daily newspaper reported that the infant mortality rate at the San Fernando General Hospital is 22-24 per 1,000. According to the report, the figure is calculated from the number of newborn deaths, still-births and babies who die within the first month of life. One couple, Sean and Lauren Hobson of Morvant said they are pursuing legal action after their baby son suffered brain damage (cerebral palsy) while receiving medical attention at a private medical institution.
The Hobsons said they believe the complication occurred at the institution but the childâ€™s condition improved and they described themselves lucky that they were able to get treatment at the Port-of-Spain General Hospital. A woman recently filed a lawsuit against a doctor forÂ medical negligence and special and aggravated damages. Last week, Newsday reported another case in which a widow sued the Mount Hope Medical Hospital after her husband allegedly came to the health institution to have a tooth abscess drained but died after the condition developed into a pulmonary infection, deep vein thrombosis and later to pulmonary infarction thromboembolism. Last month, there was an increased incidence of Entero-bacter bacteria which was responsible for infections in ten babies at the Mt Hope Womenâ€™s Hospital. In a Newsday article, Saturday September 13, Health Minister Colm Imbert said an investigation had been launch-ed to determine if the bacteria were caused by insanitatry conditions at the Unit.
Ramlogan, the most out-spoken of the attorneys said that the public is not aware of how many of these â€śnegligentâ€ť cases occur and heard about them only when they were published in newspapers. â€śOne expects a certain level of health care and when they feel they have been wronged they feel a need to get justice, which is why so many more people are now filing for litigation,â€ť said Ramlogan. He lamented that in TT, while we do have very competent medical practitioners, the standard of health care delivery has dropped because of a failure in the administrative policies and politics of the day. â€śIt is just sheer mal-administration and the top officials are just playing musical chairs with health care and it is filtering down into the system,â€ť he said. Ramlogan said in one of the cases he is investigating, a woman of Tacarigua gave birth to a still-born male baby on September 23, 2001.
She claimed that she was given â€śbad treatmentâ€ť by the nurses stating that they were â€śhostile and unprofessional.â€ť The womanâ€™s doctor had instructed her to go to the Mount Hope Clinic and let the doctors induce labour. The nurses reportedly told her: â€śYou should have stayed home until the baby ready,â€ť (even though the doctor had instructed her to have the labour induced). The woman told Ramlogan that when she started having labour pains, she was told to sit on a wheel-chair. In the meantime, she was in severe pain and even though the baby was already coming out, the nurses said: â€śDo not push.â€ť
She told the nurses she was not pushing and she needed help because she was beginning to feel the babyâ€™s head in her chest. By the time the doctor/s attended to her, the baby had already suffocated in her womb. Ramlogan is also investigating the death of a boy from Petit Valley, who was admitted for an operation to remove an extra finger on his hand but died after it was amputated. How could such a thing happen? Thatâ€™s what Ramlogan wants to find out. Ramlogan said there were many medical negligence cases but not all may result in legal action since doctors were unwilling or reluctant to give evidence. â€śTherefore, the injustice is against the poor and often times go unnoticed,â€ť he said.
Patients should not have to go to court
Health Minister Colm Imbert said plans are underway to repeal the Medical Board Act in order to accommodate investigations into cases of medical negligence. The comment came in the wake of information that a number ofÂ litigation cases for medical negligence were before lawyers. Former Health Minister Dr Fuad Khan, a Urologist by profession, revealed that the highest number of medical negligence cases occur in the area of Obstetrics and Gynaecology. Second is Urology and the third highest is Orthopedics (surgery of bones and joints). Dr Khan challenged Health Minister Colm Imbert to introduce the UK/US â€śMedical Surgical Auditâ€ť system across the board; in all health institutions, both public and private. He suggested that it should be part of the â€śHealth Services Quality Actâ€ť which willl serve as a tool to oversee the malpractices of doctors and provide solutions to improve health care as is done in the UK.
In an interview, Imbert said once the Medical Board Act is repealed, accommodations would be made to introduce a panel to investigate complaints so that the â€śaggrievedâ€ť persons could take action, rather than go through the court. He felt court action was not the desired route since it could be long and drawn-out and could take a number of years. â€śSometimes a person can be disadvantaged if the person passes through a kangaroo court system and the case can go on for a number of years, even until the person dies,â€ť said Imbert. â€śThat is very unsatisfactory,â€ť he added. He explained that was why he had to change the Medical Board Act in the first place, because the Board had informed him there were no proper systems to investigate medical matters and they did not have the powers to do so. He said once the Act is repealed and accommodations put in place, Govern-ment would also be able to introduce an Audit system similar to what exists in the UK and in the US. Dr Khan said a lot of negligent cases are never made public and the cases which are now being heard about are just a â€śdrop in the bucketâ€ť of what actually takes place.
Dr Colin Furlonge president of the Medical Professionals Association of TT (MPATT) pointed out that there are thousands of doctors in this country. â€śIf you multiply that by the number of interactions per day and further multiply that by the number of interactions for the year, the number of litigation cases we are now seeing is a very small percentage in comparison to the number of interactions,â€ť he said. Dr Furlonge pointed out that furthermore, litigation for medical negligence occurs all over the world. Defending his position as a Union leader, however, he said most times the cases have been found to be fair and that the people often felt that they were â€śbadly represented by their legal representation.â€ť One of the lawyers investigating such cases, attorney-at-law Nyree Alfonso, responding to this statement said: â€śAt least we know our clients will not die on us.â€ť Dr Khan lamented that there was no structure of internationally accepted medical procedures in TT. Providing a few suggestions, he said there needs to be a system in which medical practitioners can record all advice and be able to request any investigation.
As a matter of fact, he said he is considering establishing a private firm in which patients can access information and advice in cases where they feel they have been wronged. He said the health care system has deteriorated because of a lack of proper standards and procedures. Dr Khan noted as an example, the fact that there are medical practitioners who claim to be trained doctors when in fact they are not â€“ quacks. He described an example in which patientsâ€™ requests for radiological investigations take as many as six months. â€śThat is another form of medical negligence,â€ť he said.
Another problem he said is when senior medical consultants palm off their work on junior doctors.
He said a number of negligence cases also occur at the Accident and Emergency Department because junior doctors are the ones who usually attend to patients. â€śIf they are not trained enough and you canâ€™t get it right, then one can expect litigation charges,â€ť said Dr Khan. â€śThe food for medical litigation is when the infrastructure for proper procedures is not right.â€ť As a matter of fact, the attorneys and medical practitioners who spoke to Sunday Newsday, believe there will be a lot more litigation charges to come since they were â€śsuspiciousâ€ť about the qualifications of the foreign doctors who have been hired by Government to address the shortage problem in TT.
Extracted From: Trinidad & Tobago Newsday Newspaper