BATTLES, CHANGES IN HEALTH SECTOR

2011 was a pressure-filled year not only for those entrusted with giving quality health care but also for those seeking medical attention at health institutions.

It was a year marked by a change in health ministers, industrial action, claims of medical negligence and maternal deaths.

The start of 2011 saw a change in the system for the collection of blood when on January 1, the “chit system” for blood donation was discontinued and replaced by a volunteer system.

Former health minister Therese Baptiste-Cornelis said the chit system facilitated the illegal sale of blood chits and the sale of bogus chits. However, its discontinuation resulted in a significant decrease in the availability of blood at the Blood Bank. The Ministry of Health subsequently embarked on a nationwide campaign calling on the public to donate blood.

On April 28, Baptiste-Cornelis announced the chit system would be reinstituted to stave off an impending blood shortage crisis.

In the middle of Carnival celebrations, the nation learned of 29-year-old Crystal Boodoo-Ramsoomair who died hours after she had given birth by Caesarean section at the San Fernando General Hospital (SFGH) on March 4.

Ramsoomair was considered a high risk patient, yet investigations revealed the surgery was not supervised by a senior doctor and was performed by a house doctor with relatively little experience. Her family would later learn that two arteries were mistakenly cut during the procedure, which resulted in massive bleeding.

Ramsoomair’s death would engage the nation’s attention for months and would trigger a battle of words between doctors and Baptiste-Cornelis. In the days following the young mother’s death, five doctors and four nurses from the SFGH were suspended pending an investigation. The decision to suspend the doctors and nurses was condemned by The Trinidad and Tobago Medical Association (TTMA) and the Medical Professionals Association of Trinidad and Tobago (MPATT).

On March 17, on the heels of the suspensions, came word that chief executive officer at the South West Regional Authority Paula Chester-Cumberbatch had been fired because she failed to immediately carry out instructions from the board to issue suspension letters to the doctors and nurses.

In defence of her decision to delay issuing the suspension letters by three days, Chester-Cumberbatch said she believed in proper procedure and waited to ensure all was in order before any action was taken. Her dismissal caused an uproar among MPATT and the Public Services Association.

Prime Minister Kamla Persad-Bissessar announced an inter-ministerial committee had been appointed to investigate the firing of Chester-Cumberbatch.

On March 18, then hospital medical director Dr Anand Chatoorgoon, a vocal defender of Chester-Cumberbatch, said he had been informed by the SWRHA that his contract, which was to expire on March 31, would not be renewed. Chatoorgoon had openly criticised the decision to suspend the medical staff at the hospital. On March 20, then secretary-general of MPATT Shehenaz Mohammed called on Baptiste-Cornelis to resign and claimed the minister was directly responsible for the suspension of the medical personnel. However, Baptiste-Cornelis denied having anything to do with the suspensions and said it was a decision of the board.

In the days and weeks following Ramsoomair’s death, chaos ensued as the quality of health care began to deteriorate at the SFGH with reports of overcrowding and under-staffing. Industrial action led to all elective surgeries being cancelled and only emergency surgeries were performed after anaesthetists refused to work after a directive was given by chief medical officer Dr Anton Cumberbatch, that a registrar consultant must be in attendance during a high risk C-section.

In a confidential letter sent to the hospitals’ doctors and managers, the hospital’s head of department, general surgery Dr Steve Budhooram wrote of major problems within the institution including the absence of a neurosurgeon and full-time pathologist and chronic staff shortage.

On March 23, the impasse at the SWRHA came to an end with the intervention of Persad-Bissessar. After a marathon meeting with all the various stakeholders, Persad Bissessar said normalcy would be returned to SFGH.

On April 17, findings of a report compiled by a four-member committee confirmed that Ramsoomair suffered from massive blood loss, that the medical staff failed to recognise the blood loss in a timely manner and that there was a lack of prompt and efficient intervention by both medical and nursing staff.

Tensions would resurface later that month when Baptiste-Cornelis stated MPATT would not be forwarded a copy of the report which had been sent to the Attorney General.

On June 1, Attorney General Anand Ramlogan advised that SWRHA must accept and admit liability for medical negligence in the death of Ramsoomair. Ramlogan noted there were lapses on the part of medical staff but spared the doctors and nurses of direct responsibility. He placed the greatest blame squarely on the management of the SFGH.

On October 1, acting chief executive officer at the SWRHA Anil Gosine said 12 of the 18 recommendations that were given to the hospital following Ramsoomair’s death, had been fulfilled. He also noted that the Ministry of Health had given $3.5 million to the hospital to procure equipment.

A lack of security at health institutions would also command attention during 2011. On June 17, reports surfaced that an employee at the Wendy Fitzwilliam Paediatric Facility at the EWMSC was sexually assaulted and stabbed in her leg, in a room on the third floor at the hospital. Later in November, the matter of inadequate security would take centre stage again following the courtroom testimony by a psychiatrist in charge of the Forensic Unit at the St Ann’s Hospital which houses patients convicted of murder and manslaughter.

Dr Hazel Ann Othello told the court of major flaws in security at the mental hospital. She said there is a patient-nurse ratio of ten to one at the institution, and no real protection for doctors and nurses.

The realignment of Cabinet would usher in a new health minister in late June, when Baptiste-Cornelis was replaced by Dr Fuad Khan.

Mere days after taking up his new role as Health Minister, on July 6, Khan revealed that 223 cancer patients were administered overdoses of radiation during treatment over the period of one year January 2009 to June 2010 at the Brian Lara Cancer Treatment Centre (BLCTC) in Woodbrook.

Khan said the finding was based on an independent report conducted by the Pan American Health Organisation, which concluded there was a miscalibration of a linear accelerator over a period of approximately 12 months ranging from approximately four to 20 per cent of radiation.

On July 14, the BLCTC denied any overdose of patients under its care, saying the miscalibrated increases in patient radiation were not high enough to have adverse effects. Chairman of BLCTC Dr Kongshiek Achong Low said the maximum dosages at the Centre never reached close to 20 per cent; he also claimed two former employees attempted to sabotage the medical facility.

On November 3, Khan announced the International Atomic Energy Agency (IAEA) would be visiting Trinidad to examine 223 patients who had been overexposed to radiation at the BLCTC. Khan said the IAEA submitted a preliminary report which stated anything above 10 per cent is considered over-radiation.

Khan would come under fire on July 25 when he was given an ultimatum by Persad-Bissessar to choose between his private medical practice and his ministerial position. This came after he confirmed he had been serving in his private practice as a urologist even after being appointed to the Cabinet on June 27. Persad-Bissessar stated that Khan could not hold two positions. Persad-Bissessar said not only was such behaviour inappropriate, it was also untenable.

Hours after the Prime Minister’s ultimatum, Khan issued a media release in which he stated he informed the Prime Minister that with immediate effect, he would cease his medical practice and remain as health minister.

By August, the case of Asia Archibald, an eight-year-old pupil who died of dengue, would grip the nation. On August 4, Asia died just hours after doctors at the Eric Williams Medical Sciences Complex in Mt Hope discharged her. She had been suffering from dengue-like symptoms.

Asia’s mother, Anesha, had criticised the EWMSC for not keeping her daughter at the hospital and maintained the doctors were negligent while treating the girl.

An investigation was launched. Khan said preliminary information cleared the medical staff who attended to Asia of any wrongdoing and suggested Asia might have contracted a deadly form of dengue known as neuro-dengue.

On December 13, chairman of the North Central Regional Health Authority Dr Ashvin Sharma said an independent committee investigating Asia’s death had handed in its report to the Minister of Health, the contents of which were never made public.

The Health Ministry was allocated $4.7 billion in the 2012 national budget which was delivered by Finance Minister Winston Dookeran on October 10. Khan said his intention was to focus on primary health care and to make better use of public health centres, some of which would be opened 24 hours a day. Khan identified the National Oncology Centre and the children’s hospital in Couva as priorities.

The standards for delivery and care of pregnant women at the SFGH would later come under heavy scrutiny again following the deaths of three young mothers.

SWRHA announced on October 5 it was assembling a panel to investigate the deaths of Nyca Foster, 29; Shara Mohammed, 33; and Feeza Delana, 27; at the SFGH. On September 26, Mohammed died two weeks after giving birth by C-Section and on August 31, Guyanese national Delana died at hospital after giving birth also by C-Section. Then on October 1, Foster and her unborn baby died at the SFGH High Dependency Unit. The families of all three women claimed medical negligence was to blame for the deaths.

On October 17, Khan announced over 200 Cuban doctors and nurses will be brought in to T&T by the end of November to reduce the shortage in our hospitals. He would later confirm five much-needed neurosurgeons would also be heading to this country.

At the start of December, the first batch of Cuban medics, 37 doctors and 28 nurses out of a total of 240, arrived in Trinidad.

At a post-Cabinet media briefing at the Coco Reef Hotel in Tobago on December 14, Khan stated the long delayed Scarborough General Hospital will not be delivered this month as had been promised. In his national budget presentation, Finance Minister Winston Dookeran said the Scarborough Hospital would be ready and delivered to the people of Tobago by December.

Extracted From: Trinidad Express Newspaper