The Ghost of Baby Faith
The death of two-year old Luke Marshall will soon be forgotten by everyone except his parents and family. In seven days time some bigger news story will bump it off the radar and we will all continue merrily living our lives until the next child dies. That next child could be yours.
Three-year-old Faith Williams visited the Eric Williams Medical Sciences Complex (EWMSC) on August 31 for repair of an umbilical hernia. After the surgery, she mysteriously slipped into a coma. She was subsequently taken to the ICU and put on life support. Faith’s parents took her off life support on September 16. An autopsy showed that Williams died from primary hypoxic encephalopathy (lack of oxygen to the brain)—and secondary cause bronchopneumonia.
At the ICU they noticed her skin had become discoloured and an odour came from her body. They were told that only the life support machine kept her body functioning when in truth and fact she was decaying from within. The Williams’ said they got a run around for information.
The ministry subsequently suspended further paediatric surgeries and Health Minister announced that investigations would take place. At a media briefing on October 20 the health ministry announced it had received reports from surgeons, nurses, anaesthetic technicians, the ministry’s biomedical technicians.
In addition, a report was submitted by Dr John Mecklendurgh, a medical devices evaluator and senior lecturer from the University of Cardiff, Wales. The Minister said an independent panel would review the reports and changes would be implemented. The findings of the various investigations were never released to the media. A ward was supposed to be named in memory of Faith at the Wendy Fitzwilliam Paediatric Hospital.
Promises, promises.
Fast forward to the death of baby Luke. A two-hour wait in the casualty department, a stunning misdiagnosis of a build-up of ear wax, sarcastic nurses laughing at the mother because she wasting their time by bringing in her baby because ‘he sleeping too much’ and no proper diagnostic tests. The mother’s complaints were totally ignored. She was desperately trying to explain that the child could no longer walk, had undergone a dramatic change in personality and could barely wake for more than an hour to watch his favourite ‘Dora the Explorer’.
An outraged Trini from the US sent me the following email:
“I am a neurologist in Florida. I have read about the death of the child recently at Mt Hope. The history given by the parents was strongly suggestive of a central nervous system disease process and not wax in the ears-pulling on the ears, change of behaviour (not being his normal self), not playful, excessive sleepiness, difficulty to walk and unsteady legs causing him to fall. The child needed admission and investigation. A CT scan of the brain and then a spinal tap would have definitely clinched the diagnosis so the child could be treated.
Some doctors and nurses must respect their limitations since they do not know how to diagnose and treat all the disease processes that exist. When in doubt they should investigate or ask for a specialist's opinion. Wax in the ears does not cause this type of clinical presentation.”
No one person is to be blamed for the death of baby Luke. A patient is supposed to be managed by a team of doctors comprising doctors and nurses with varying levels of seniority and expertise. There is an inherent check and balance in the system because it is constructed to take into account that human error is possible and that there exists the possibility of more than one diagnosis. This child’s death was caused by a complete break down in the systems and procedures at Mt Hope.
The investigation promised by the Ministry of Health should be conducted by external independent health care professionals from countries that have attained vision 2020 status. Baby Faith William’s death has proven that the Ministry and hospital investigating itself is a joke. It is left to die with time and everything is swept under the carpet just like the report from the Gladys Gaffor Commission of Enquiry. Its time to forget the jet and palace and think about our children.
But why bother, Manning seeks medical treatment in Cuba, not Mt Hope and his AG went to a private nursing home in St Clair when she fainted. Baby Luke had no choice but to go to Mt Hope. What about your child?
By Anand Ramlogan 2008-03-15
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Anand is correct to say Luke Marshall's death will fall off the radar in a short time. It cuts to the old saying "Today's headlines make tomorrow's toilet paper". In a crime infested and corruption infested Nation, what can we expect? Stories hit the newspapers and the people fast and furious. It is extremely hard to keep focus on any one issue when you are distracted by thousands of others, of serious importance. That's sad..but not as sad as the circumstances in which Luke died or other children have died in Mt Hope.
Investigations behind closed doors serve themselves, are not accountable to the public, and the public have no way of knowing whether they serve the public interest. In simple language it is a 'hush hush' job. But why? What is there to hide from. Investigations are meant to demonstrate that there is real learning from mistakes, to the people who matter i.e. you, you and you - John Public. So to hide internal investigations is to give an implied message to the people that, "So much was wrong dat we cyah show allyuh". What is an average man to think?
While we are all fuming and sad at the same time about Luke's death, we still need to maintain a degree of rationality and objectivity. The public is so far, not privy to the facts surrounding the death. And even if the public were aware of all the facts, making sense of a complex set of medical circumstances will not be easy.
The media have reported therefore, the parent's understanding or interpretation of what they were told i.e. that the child had ear wax, and not to worry etc. I'm not suggesting that the parents are or were given a wrong understanding. What I know is that there is a lot of room for misunderstanding in communication between doctors and patients/relatives. No one has heard the other side i.e. the hospital's side. So, until the facts about what happened are known, good caution should be exercised.
Words like "stunning misdiagnosis" etc are likely to conjure up in the minds of average people gross incompetence in the doctor(s) in question. The attitude portrayed by nurses to Luke's mother, would be seen as utterly despicable by average reasonable people. These things can affect a rational and balanced assessment of what had happened.
The problem with ear complaints in children is that they are extremely common and not easy to diagnose. If otitis media is diagnosed, it has a good chance of turning to meningitis. Or if meningitis was a co-diagnosis (in hindsight) it is not as easy as the layman might think, to diagnose in children. Yes the layman will have been influenced by American movies and the vast amount of information on the internet. What the layman does not have is the practical experience of being a doctor and examining such children. No...hold your horses...I'm not trying to defend a doctor or several doctors. I'm only trying to say doctoring in this age group of children is not easy.
Yes, any 'junior' doctor should seek supervision and should be actively supervised by a consultant in cases such as Luke's. No one can argue with that, because inexperience is not a defence to medical negligence.
However, from media reports only, it appears that Luke was seen on three occasions, and his condition was worsening. That I think we can accept as fact. So, what the doctors and nurses did (or didn't do) on each occasion is of the utmost importance. Misdiagnosing is not really the core issue. The core issue is whether the institution and its workers took the requisite time and care, proportionate to the child's condition and need, to investigate and treat the child properly. It is in that context a diagnosis or misdiagnosis becomes important.
Medical experts who comment on these matters must always be aware that hindsight is usually clearer than foresight. Statements such as "A CT scan of the brain and then a spinal tap would have definitely clinched the diagnosis so the child could be treated." are simplistic in overview. First of all I am not factually aware that these tests were not done. But importantly in a percentage of cases these investigations are not as conclusive as the 'expert' suggests. This is where experts stupidly jump in with their emotions and give the impression (without full access to the facts) that health systems are negligent, thereby whipping up bias in the minds of the public. And even if the 'diagnosis' was clinched, it does not mean that treatment would have prevented the death. The latter goes against a common sense that may be common to the public - but it is correct in medical science. So, it isn't as straight forward as a) do the investigation, b) make the diagnosis c) treat the condition d) child lives. That is a fantasy that the lay public likes to believe. If the practise of medicine was that simplistic or simple few people would die in hospitals. Experts of the kind quoted in Anand's commentary should not be part of any investigation.
I think that all such deaths should be investigated independently by a team that bears no interest or perceivable allegiance whatsoever to political groups, institutions or health professionals. That is real independence. You cannot reasonably find such an investigating team from within T&T. The investigation should be held in public (with the parents consent) so there are no secrets, 'hush hush' and 'shoo shoo-ing' that goes on culturally in T&T.
However, there are different kinds of investigations. The above kind of inquisitorial investigation is about fact finding and improving systems in general. That kind can be in the public domain. There are disciplinary investigations which aim to change individuals (or to dismiss them). Those kinds of investigations are not normally a matter for the public. And the last main kind of investigation is the legal/punitive type, where the law is concerned to find fact with a view to bringing civil or criminal proceedings. The latter, for obvious reasons are not normally conducted in public. So, those calling for investigations must know what they are hoping for as outcomes, and seek to have them set up in the correct sequence. The findings of inquisitorial investigations can be used to mount disciplinary or legal proceedings. The findings of 'legal'-type investigations can be used for disciplinary-type investigations. Rules of evidence may vary in different kinds of investigations and the concept of 'bad evidence' can be a major stumbling block for some kinds of disciplinary investigations where certain legal rules apply.
As an off the cuff remark it is probably pardonable to say "This child’s death was caused by a complete break down in the systems and procedures at Mt Hope." However, I find it difficult to believe that in a place like T&T Anand could have availed himself that quickly of sufficient facts, from a 360 degree perspective to come to such a conclusion.
First off, I am not taking any doctors or patient's side in my comments. Secondly, I don't believe everything I read in the newspapers. And thirdly, not because I take issue with any particular matter means I am taking a side. I felt I needed to set out where I'm coming from - if others then want to misconstrue or twist what I say I will be able to fall back on my declaration above.
Right - see Newsday 2008-03-21 where allegedly an anonymous doctor has spoken to the media on what must be confidential material. Reported in Newsday are the following words: 'The doctor, who spoke on condition of anonymity, said the toddler did not have to die. “If he had been brought in as was instructed, he could have been saved,” the doctor said.' It is not in his gift to speak to the media, unless he was authorised by his employers and Luke's parents. [And if that was the case there would be no need to be shoo-shooing to the media]. Such information is confidential to patients and confidential to Mt. Hope as an institution. This is called utter rubbish!! If I was in charge of Mt Hope I would be on a hunt for that doctor. I would be looking to ensure that he is disciplined for breach of confidentiality to patient and employer (and presume the doctor is probably employed at Mt Hope as the report might suggest].
And if I was Luke's parents I would be justifiably deeply upset. Oh Christ, but I forget the place is called 'Monkey Island' where all manner of monkeyness can happen and i's like nobody's business.
Leaving aside the above serious medico-legal matter, I now focus on the detail of what was said (assuming that some of it is reasonably accurate - and I know it may not be). Notice these words "However, the doctor yesterday said that new findings showed that Luke had died from a strain of bacteria known as pneumococcus — a bacteria which is becoming resistant and was not responding to antibiotics." An average layperson might think "Eh heh...so what?...nothing special or striking there." When you are not a layperson or you have slighty more intelligence than average, you are inclined to think "Rubbish..utter rubbish". Why? Notice that the bacteria was said to be 'becoming resistant'. Now what the hell does that mean in medical terms? What it means is that several strains of this bacteria are known to be resistant to certain antibiotics. Notice that the statement did not say specifically a) whether the bacterium that infected Luke was a type of pneumococcus that was resistant to a particular antibiotic and b) whether Luke was in fact prescribed an antibiotic that the infection was sensitive to. [Well I can accept that some of that may have been lost due to limitations of the reporter]. But I went into this in some detail only to show how specific you have to be to understand what is going on. The average non-medical person will not have a clue what to look for or how to interpret what is told to them. So, if the above kind of captioned explanation is given to a lay person, they might be inclined to accept it. A doctor wouldn't pull that on on me and get away though. S/he would be pure mince meat!
Finally, the supposed doctor, seems to shift responsibility for Luke's death partly on to the the Ministry and on to Luke's parents. No - it wasn't spelt out that clearly but there was reference to the parents in the statement above, that implied that had the parents acted as instructed, Luke might have lived. And the reference to the Ministry is to suggest that 'Had the Ministry taken measures to vaccinate Luke probably would not be dead. None of that is for the doctor to decide or go to the media about - in the midst of a massive investigation into the matter. It is wholly out of order and a matter that ought to be pursued from Employment and Regulatory angles.
We saw apathy in relation to the last election. We saw it develop in relation to crime. And now there will be apathy in response to the killing fields of hospitals in T&T! Occasionally a few of these headlines will jolt the population but that will not reverse the state of 'learned helplessness' the population is suffering with at the moment.
Yet another ghost was added to the crowd of them that haunt the corridors of Mt Hope. Sandra Harry died at Mt Hope on Saturday 15th March 2008 in very tragic and depressing circumstances.
Sandra had a C-Section. Shortly after she developed pain and fever. According to Cindy (in Newsday 2008-03-20), Sandra's 21 year old daughter, "I begged the nurses to give her something for the pain, but they didn’t do anything. She had a fever and was thirsty. She used to beg for water. Her lips were white and peeling, but the nurses never gave her water.”
An anonymous source at Mt Hope said to Newsday, “This was a complicated surgery. She also had chronic pelvic inflammatory disease and there are things called adhesions that attach to the pelvis. Her damage to the bowel could have been caused by these adhesions....." Newsday reported that, The source added that there was no damage to Sandra’s intestine during her C-section but could not say why the doctors decided on a second procedure.
The source in my opinion sounds medical. I already smell that the family will never get the full and true story. Why? You know - when people are giving you a theory that you're meant to find plausible and which you should accept. I've seen this too often in modern life. Large organisations give these theories to pacify. Disgruntled customers or relatives simply think "Oh well, they probably know what they're talking about I'm no expert...I can't take the headache to champion this".
Look nah man, you getting this from someone who knows the inside story on how medics and health personnel function. I know dey tricks and how dey bamboozle the public.
In reality it doesn't matter one jot, how her bowel was damaged. Good post-operative care would normally pick up these kinds of complications rather early. So unless some very exceptional circumstances occured I find it difficult to understand how Sandra's apparent bowel complications became fatal. Yes I've seen the insides of abdomens with the complications described.
I am left without a real understanding about Sandra's case. I don't sleep easy on this one. Anyone going for any procedure in Mt Hope should consider trebling life insurance coverage - or buying some if they don't already have coverage. Some insurance coverage also covers legal expenses - at least in the UK.