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COULD the death of eight-year-old dengue patient Asia Archibald last August been prevented?

An excerpt from an independent report released on Friday, January 6 stated that the train of events suggested a “set of issues which may have contributed to the unexpected outcome” and also noted some breaches of medical standards and protocols in the case.

These events included the “unusual” reason for referral from the Arima Health Facility to the Eric Williams Medical Sciences Complex (EWMSC) and a blood test to confirm dengue.

The report also stressed that a child with dengue between day five and seven who is vomiting should be tagged for early assessment and “any child who is being discharged from the emergency department should have clearance from a doctor at least at registrar level”.

“The patient did not receive the benefit of a senior physician’s review or advice prior to discharge,” the report noted.

In August 2011 Archibald was taken to the Arima Health Facility after she began vomiting and experiencing fever and weakness. She was then referred to the EWMSC for a blood test to check for dengue and between August 3 and 4 she was seen, treated and discharged, and sent home at 3 a.m.

She began presenting symptoms again and returned to the Arima Health Facility on August 4, 2011 and could not be resuscitated.

Archibald’s mother, Anesha, has severely criticised the decision by medical personnel at EWMSC to discharge her daughter as negligence. Health Minister Dr Fuad Khan has said the medical personnel should have been more “sensitive” and kept Archibald overnight instead of discharging her at 3a.m.

The report was provided to the media following a press conference Friday on the issue at the Ministry of Health’s offices, Park Street, Port of Spain.

On the discharge the report stated: “She entered the system and spent nine hours, returned home, exhausted and drowsy, fell asleep, woke up thirsty, was too weak to drink, aspirated (inhaled fluid or foreign objects into the lungs often after vomiting), developed aspiration pneumonitis (breathing in regurgitated contents of the stomach) and was barely alive or indeed already dead by the time she was returned to the Emergency Department at Arima,” the report stated.

The report noted if there were facilities to test for dengue at Arima there would have been no need for Archibald to be referred to EWMSC, and one of nine recommendations was for facilities for dengue serologic screening and full blood count to be available at all emergency centres.

The report also noted there was a suggestion from the preliminary report that Archibald may have suffered dengue neurologic complications – which was repeated by Khan and Paul yesterday – but described “this is a remote possibility for which there is little clinical evidence”. The report added that there was no conclusive evidence to support dengue haemorrhagic fever/dengue shock syndrome.

On the transfer of Archibald by relatives due to a lack of emergency vehicles at the Arima Health Facility at the time, the report found on the part of the medical personnel a “lack of staff awareness of the risk associated with transferring a patient from one facility for continuity of care utilising their personal transport”.

The report also found there were breaches in relation to: a Care of Patient standard, a Referral and Transfer Protocol and Admission and Discharge Planning Protocol of the Ministry of Health.

The independent committee that prepared the report consisted of:

Dr Surujpaul Teelucksingh – Professor of Medicine, UWI

Dr Virendra Singh – Lecturer, Child Health, UWI

Valerie Alleyne-Rawlins – Former Director Health Quality, Ministry of Health

Franka Olliviere Andrews – (Ag) Regional Nursing Manager

Angela Maharaj – Business Manager, Paediatrics

The report noted there was no counseling support for physicians involved in the care of this patient following the report of an adverse event “which could have led them to the conclusion that they were responsible for the adverse outcome”.

They suggested an adverse event protocol with all participants guided by management would have avoided this perception, and Khan noted at the press conference that a general adverse events policy had been implemented for the local health sector.

The committee reviewed patient records, statements and reports, the report of the preliminary investigation, the pathologist’s report and also conducted in-person interviews with medical staff, as well as Archibald’s mother and other relatives.

Extracted From: Trinidad Express Newspaper
Published on Jan 8, 2012

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