THE public outrage over the death of baby Luke is understandable. The instinctive reaction is to blame someone. And, ultimately, someone must accept blame.
When I dubbed this a case of institutional murder, however, I had in mind the fact that the issue was larger than the negligence or incompetence of one individual. It was a continuous, systematic and procedural failure that could be caused only by poor management and policies.
I received an e-mail this week that sought to give a balanced view from the other side:
“Dear sir, I am writing with regards to my own opinion about this tragic issue.
I am a medical doctor (a children’s one at that, too.) I have worked at the Eric Williams Medical Sciences Complex (EWMSC) in the past as an employee in the paediatric A&E department, and since then been to the UK and now (I have) returned to try and play my own part in building our nation and improving the lot of our people.
So that there must be no misunderstanding of the intention of my message, let it be stated categorically that:
This is a very unfortunate and tragic event. My condolences go to the family. I would appreciate if you let them know that persons (including a doctor) have expressed this via this medium.
There is no doubting this fact, and there must be no attempt to trivialise or cover it up at all.
That a wrong diagnosis resulted in the end point of the death of this child must not be denied.
That the right diagnosis at the time of the Monday night visit would have made a difference in the outcome—we can ask that question forever and never answer it with certainty.
Still, this cannot reduce the dreadful impact of this event on the family involved. The hope that goes with ‘what if’ can never materialise.
During my time in the A&E in EWMSC Paediatric Department, we were exceedingly short-staffed.
We worked eight persons per day—three from 8 am to 4 pm, three from 4 pm to midnight and two from midnight to 8 am—eight-hour shifts, and frequently through our lunch time (I recall holding a sandwich with my left hand and sitting to write a patient’s notes with my right).
Those days we attended to about 200 before midnight and about ten-12 overnight (six persons multiplied by eight hours multiplied by two day-time shifts per day equals 96 person hours). Ninety-six person hours to attend to about 200 patients—a patient in 30 minutes, assuming each patient had only to be attended to once and not reviewed!
The A&E in EWMSC is now (slightly) better-staffed, but the fact remains that the staff there work under very trying circumstances.
(Compared to the UK, the word ‘under-resourced’ is a bad joke), patients walking past the door and staring in, persons knocking on the door and interrupting a consultation asking, ‘I here for — number of hours! All yuh know when I am going to be seen?’
The sound of a patient cussing and threatening to beat somebody up if they are not attended to “now” is all too common.
The picture I am hoping to paint is that this is a stressful area of work, but we all have, within our chosen field of work, stresses to overcome!
It can be very busy, especially Monday 8 am to midnight (add 50 patients to the figure above).
My point: I do not know the young doctor involved. I now, like half of Trinidad, know only her name. She has been subject to stress and threats to her life and well-being.
The girl has reportedly shed more buckets of tears than ought to be due to someone. I feel the last statement is meant to underline my feeling that this individual recognises that an error in judgment has had dire consequences, but she is a human being.
She is subject to errors in her judgment. She is a junior doctor working in a stressful environment. She did not go out to work with an intention to slaughter, before shift’s end, some innocent child.
I respect your efforts at seeking redress/justice on behalf of this family. I hope I am not being seen here as trying to interfere with that process.
I would recognise that whatever form of justice that is extracted or dispensed is not going to reverse this tragedy. It shall unfortunately not bring this baby back to his family.
Address the shortcomings of the system as you have pointed out.”
By Anand Ramlogan 2008-03-23