July inquiry into hospital ‘error’ proceeds


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Inquiry into hospital ‘error’ proceeds
KARACHI, June 30: Although an inquiry committee has been constituted by the Sindh health minister to look into the administration of an allegedly wrong injection to an engineering university student, who has been in a coma for a week, there is almost no chance of any drastic and direct action being taken by the government against the responsible staff or management of the private hospital concerned. 

The patient, Raheel Naeem, an engineering student, was admitted to a hospital in PECHS and operated upon for the treatment of a sinus and respiratory problem on June 12. He went into a coma during post-surgery treatment. 

A Sindh health department notification issued on Sunday (June 29) said that the government had constituted the inquiry committee headed by Special Health Secretary Dr Abdul Majid (chairman), and comprising EDO Health Dr A.D. Sajnani (member/convener) and THO Jamshed Town Dr Malika Jaffery (member). The committee would conduct an inquiry regarding the patient, Raheel Naeem, son of Abdul Naeem, operated at the trauma centre who had gone into a coma after undergoing a surgery, it added. 

The committee is required to fix the responsibility for the gravity of fault, and submit its report on June 30, positively, said a source. 

It is learnt that the committee had already started its task and visited the patient, who at the moment is under treatment at another private hospital. The committee also visited the administration and medical personnel of the trauma centre on Monday. The committee has started to interview the hospital’s staff members concerned (including nurses, who have been placed under suspension), anaesthetist, OT and ICU staff, doctors and pharmacy staff. 

Mr Naeem, the patient’s father, told Dawn on Monday evening that he was not satisfied with the attitude of the trauma centre management and was left with no choice but to pray for a new lease of new life to his young and talented son. 

“They have not contacted me since shifting my son to another private hospital where, after a gap of one day, he has again been put on ventilators,” Mr Naeem added, saying that they (staff at the trauma centre) appeared “careless, inept and short of ethics”. 

Alleging that a wrong injection had caused damage to his son’s brain, he claimed that the errant hospital personnel maintained that “such mistakes do occur at hospitals”.

(By Mukhtar Alam, Dawn-15, 01/07/2009)

Painful hours

KARACHI: The room in an old style building where several youths and children were lying on beds with blood bags hanging from stands was quite an emotional sight. 

They were all thalassaemic patients registered with a famous blood bank of the city, the Husaini Blood Bank. 

Sunil Kumar was one of them. His mother had tied a leather amulet around his neck to bless the poor soul but even this maternal gesture couldn’t save him from his troubles.

His parents took him to India, Italy and other countries for a bone marrow transplantation, but had not found a matching donor.

He regularly visits Karachi from his village. “I am really tired of the disease, and find it very hard to live with it... sometime I feel that I was born just for a blood transfusion after every week,” he said.

Resident of a small traditional village Badah in district Larkana, Sunil is 20 years old but appears to be only 10, as the disease did not allow him to grow properly. He wanted to be a cricketer, but the physical weakness due to thalassaemia has crushed his dreams.

Not only Sunil, but almost everyone in the room seemed sad and tired. The blood bank’s administration has kept a television in the room for their entertainment, but the long hours of blood transfusion are too much for the youths and children. Husaini Blood Bank is a famous philanthropist society working in the city since 1979 and it has treated millions of the thalassaemic patients from across Sindh and Balochistan. At this time about 1,170 patients including 780 thalassaemic patients and 490 patients of hemophilia from across the province are registered with Husaini Blood Bank and these patients regularly receive blood, food, hospital services and even the transport fair to come from their villages. 

Thalassaemia is an inherited blood disorder and can be simply stated as the inability of the body to produce adequate amount of heamoglobin in the red blood cells. The result is severe anemia. 

Thalassaemia Foundation Pakistan Vice-President Dr. S Sarfaraz H Jafry said that the number of thalassaemic patients in Pakistan has increased alarmingly. Quoting the official data of 36 registered thalassaemic societies of Pakistan, he said up till now, 60,000 patients were reported, out of which only 24,000 patients were officially registered. “For such large number of patients, the country needs about 73,000 blood pints every day, but unfortunately Pakistan collects only 5,000 pints a day and the remaining patients have to suffer the shortfall,” he said.

Dr Jafry also works as the project director of Husaini Blood Bank. He said most of the people in Pakistan are poor and if a child is born with this disease, the parents have to pay at least Rs 50, 000 annually for the normal treatment of the child. 

Qamarunisa, 20, resident of Malir is also a thalassaemic patient and was registered with Husaini Blood Bank eight years ago. “I visit Husaini Blood Bank three to four times a month and receive blood transfusion, food and medicines...my two sisters died of thalassaemia and ever since, I am really afraid of the disease,” she said. 

“In order to protect Pakistan from thalassaemia, the federal government must make legal amendments and ensure that every couple has to undergo a blood test before marriage,” Dr Saeed Ahmed, the city’s leading heamatologist and blood bank consultant, said.

He said that that government also must ensure that the blood group of an individual is mentioned on the national identity card, so that in case of an accident, the treatment could be started immediately, and also rare blood groups could be arranged. 

“We are trying to provide the best services for thalassaemic patients and we have the most modern equipment in our laboratory,” said Husaini Blood Bank CEO Asad Ali.

(By Amar Guriro, DailyTimes-B1, 02/07/2009)

PMA urges withdrawal of service charges at hospitals

KARACHI, July 2: The Pakistan Medical Association has appealed to the Sindh government to reverse its decision to impose “service charges” on essential healthcare facilities availed by patients at public sector hospitals. 

PMA president Dr Aziz Khan Tank and other office-bearers of the PMA, Karachi, at a press conference on Thursday, said the decision amounted to pushing the poor sections of society towards quacks. 

At the press conference, copies of a Sindh Health Department circular, dated June 9, were given to the journalists according to which all executive district officers for health and medical superintendents of the hospitals owned by the provincial government were directed to collect “users charges” from OPD patients for X-rays, ultrasound and all investigations. 

Patients visiting the department of dentistry will no longer be entitled to avail free scaling and filling services while those visiting the eye department will have to pay for laser-based interventions. 

Rs50 will have to be paid for spectacles, previously available free at a few government hospitals, including the Civil Hospital Karachi, through an arrangement with local philanthropists. 

“We fail to understand as to why poor patients have to be taxed despite the presence of NGOs and philanthropists assisting hospitals to have these facilities,” said Dr Samrina Hashmi. 

The PMA office-bearers also registered their concern, saying that under the notification the money collected as users charges would be distributed among doctors, paramedics, health-care committee/hospital/NGO and government treasury. 

According to the formula, 10 per cent each would be given to the doctors and the paramedics, 30 per cent would be deposited in the government treasury and 50 per cent with the health-welfare committee, or hospitals or NGOs. They feared that this would open a new avenue of corruption at the expense of poor patients.Dr Hashmi appealed to the Sindh government to look into the issue as this might be part of the scheme to malign the democratic government. 

Dr Mehmood Khan raised the issue of unilateral imposition of a fee schedule on private hospitals and clinics, without taking into confidence all the stakeholders. 

This, he said, would again make citizens an easy prey for quacks and the brunt would be borne only by them in the absence of a proper mechanism. 

Dr Tank referred to a draft prepared by the PMA to regulate private health-care facilities in 2006-2007 and presented to the government. “It has, however, been lying with the assembly for long,” said the PMA’s Karachi chapter president. 

The PMA office-bearers observed that concerted efforts were required on part of the masses, professionals, activists and civil society to persuade policy-makers to adopt a realistic approach.

(Dawn-13, 03/07/2009)

Indian doctor gives lease of life to Pakistani child
Six months have passed since Syed Saadat Ali and his wife returned from India after a successful open-heart surgery of their son, Syed Raahim, who will soon be celebrating his first birthday. As the critical phase of Raahim’s recovery is over, the couple – who had earlier been avoiding the media – believe that they are in a better position to discuss their case now. 

Ali and his wife, Nadia, travelled to India in December last year, a month after the Mumbai attack soured relations between India and Pakistan. However, that did not deter the couple from visiting the country, especially after they received a positive response from Dr Rajesh Sharma of Escorts Heart Institute in New Delhi, who was willing to offer his services to them. 

Raahim had been suffering from a rare congenital heart disorder that obstructed blood flow to the infant’s heart, making it difficult for him to breathe. Due to the lack of the required surgery facilities in Pakistan, the couple decided to go to India, but said that they were disappointed that this suggestion came from a friend, and not from local doctors who were handling Raahim’s case. 

“Raahim suffered from shortness of breath since the day he was born and had the ‘Blue Baby’ syndrome in which his skin would turn bluish or purplish due to lack of oxygen, but even doctors at one of the most leading hospitals of the city could not understand what was wrong,” said Ali, during an interview with The News at his residence in Nazimabad. 

According to doctors, about one out of every 1,000 live-born babies is born with a congenital heart defect in which the major blood vessels of the heart either do not function properly or are not formed during the early stages of fetal development. “In Raahim’s case, his vessels had not been formed,” informed Nadia. 

“We were asked to take one test after the other along with an ECG, but none of the doctors here could understand what the complication was and were hesitant to operate. We also took his reports to the Aga Khan University Hospital (AKUH), where doctors agreed to perform a surgery but failed to satisfy us when we asked about its success rate.”

Ali then sought a second opinion from a doctor in India, as suggested by his close friend and within a day received a response from a doctor at one of the leading cardiac hospitals in India. Despite the talk of war and blame game between the governments of Pakistan and India, they decided to fly and save Raahim before it was too late. Unlike a regular visitor, Saadat and Nadia Ali were soon issued a visa on medical grounds. 

“Our governments may have their differences, but once we stepped into India and interacted with the common man, each one of them welcomed us with open arms,” recalled Nadia. In fact, not only did they open their doors for us, but also their pockets to save Raahim’s life, added the father. The cost of the total surgery amounted upto Rs0.65 million, most of which was borne by the hospital trust. “This financial exemption came as a surprise because we could not afford it. For a while, we had lost hope.” 

During their month-long stay in the country and frequent visits to the hospital, Nadia said that she was most touched by the support and respect they got in their times of adversity. “From the staff to the common visitor at the hospital, everyone gave us special treatment because we were from Pakistan. This just tells you how political or religious differences never trickle down to the common man, no matter how hard the government or media in both the countries try. Like us, we want more families in Pakistan to benefit from the medical community across the border”, the couple said. 

(By Aroosa Masroor, The News-13, 03/07/2009)

PMA opposes service charges in govt hospitals
KARACHI: Pakistan Medical Association (PMA) on Thursday rejected the government’s decision to apply service charges to patients visiting government hospitals for treatment. 

PMA President Dr Aziz Khan Khatak, PMA Karachi General Secretary Dr Samrna Hashmi, and Joint Secretary Dr Mehmood, at a joint press conference at the Karachi Press Club, expressed concern on the imposition of ‘user charges’ on OPD patients for x-rays, ultrasound, and other medical services at public sector hospitals.

They said that according to a letter issued by the health department, the medical superintendents, civil surgeons and directors of hospital would decide the modalities and collection method of these charges.

While adding that the letter stated that 10 percent of the collected amount would be given to doctors, 10 percent to paramedics, while 30 percent of the amount would be deposited in the government’s treasury. The remaining 50 percent would be given to hospital health welfare committees and related NGOs. 

They said these directives have been sent to all public sector hospitals. They were enraged and questioned the government’s interference, saying that when doctors, paramedics and other staff, besides medical associations and philanthropists are serving the people free of charge at government hospitals, why is the government changing the system.

They said it is already difficult for the poor and middle social classes to survive when the prices are skyrocketing, and inflation knows no bounds. They demanded to know what health provisions is the government providing to the masses.

They asserted that health care facilities are one of the fundamental rights of people and it should be given to them free of cost.

They went on to lament about the imposition of the fee schedule on private hospitals and clinics, which was decided unilaterally without taking the stakeholders into confidence. 

They said that this decision would result in extra fee burden on the patients, especially those who are not well off. Private hospitals are already shouldering the burden of high electricity tariffs, gas bills, which they do not want to pass on to the patients but the government is pushing them to do so, they regretted.

They added that there is no clarification regarding the monitoring system, which would open a new Pandora box of corruption. 

They said that PMA wants the government to take all stakeholders, associations of private hospitals, journalists and citizens into confidence and the whole process should be transparent and accountable.

Meanwhile, Sindh Minister for Health Dr Sagheer Ahmed has said that ‘user charges’ on conducting tests of patients in government hospitals from June 10, 2009 is aimed at ensuring provision of chemicals for X-Ray films other medical tests.

In a statement, Sagheer said such kind charges had also been enforced for conducting tests in past, adding but now some people and organisations are raising voice against it, adding they are misguiding the patients.

He said that hospitalised patients and patients coming in the emergency ward as well the poor would be exempted from such charges.

(DailyTimes-B1, 03/07/2009)

‘Wrong injection administered’

Probe puts blame on trauma centre

KARACHI, July 4: The preliminary report of an inquiry into the alleged ineptness of medical staff at a PECHS healthcare facility says that the resuscitation of an engineering university student could not be conducted in a timely manner as the private hospital did not have an instantaneous supply of oxygen and two of the relevant medicines. 

The student has been in a coma for the last three weeks due to the alleged administration of “the wrong injection” after undergoing “minor surgery”. 

The inquiry is being conducted by senior doctors and government health officials. 

According to the inquiry officers, the severe repercussions of the incorrect administration of ‘Aquran’ to the 20-year-old student, Raheel Naeem, son of Abdul Naeem, could have been averted if the doctors attending to patients on emergency calls were provided with the required life-support facilities and emergency medicines on demand. 

A doctor started resuscitation when the patient had completely collapsed (cyanosed with no cardiac sound) but that too without an oxygen cylinder, ambo bag, injections like Atropine, Solucartef and adrenaline, the officials found. 

The oxygen and medicines in question were not available on the floor where Mr Naeem was being treated. Later, the oxygen was collected from the emergency department and medicines from a sub-store located on some other floor, but by that time it was too late to slow the process of muscle paralysis and brain hypoxia, the inquiry doctors have noted, according to a source privy to the fact-finding exercise. 

As the Sindh government currently has no legislation under which to take direct action against the doctors or the private medical establishment involved, the Sindh health secretary had the inquiry committee constituted to probe the matter. It is headed by Special Health Secretary Dr Abdul Majid (chairman), and comprises EDO Health Dr A.D. Sajnani (member/convener) and THO Jamshed Town Dr Malika Jaffery (member). The patient, Raheel Naeem, was admitted to a trauma centre located in PECHS on June 10, with no co-morbids, and was operated on by an ENT specialist for an SMR problem on June 12. 

Referring to post surgery developments, the doctors in their report said that the patient was stable at the time of shifting to the room and injections such as Augumentin, Transimine, Toradol and Indent were procured from the sub-store. 

The person in charge of the sub-store, not a qualified pharmacist, handed over the medicines, including the injection Aquran, instead of Transimine, in a plastic bag. 

The inquiry report states that the unfortunate incident took place due to the negligence of three people: the person in charge of the sub-store, a staff nurse and a midwife. 

The hospital had also been held responsible for employing unsuitable people in their medical store, and also for failing to ensure the availability of an oxygen cylinder and required medicines on the same floor. 

Government’s hands are tied 

A detailed report, including recommendations, will be submitted shortly, but according to sources in the health department there is almost no chance of any drastic or direct action against the management of the private hospital concerned. 

It is up to the patient’s family members and Pakistan Steel, the company for which Abdul Naeem works and which provides health cover to his family, to go to the police and lodge a case of criminal negligence, as there is no regulatory law that authorises the health department to initiate any drastic action against the private hospital on its own, said the source.An official of the department said that people’s concerns were growing over the quality of service and the practices of private sector hospitals in the city and some other parts of the province, as there are no legal provisions for regulating healthcare institutions and make them answerable for any negligence or unethical practices. 

In recent months, the federal and provincial health ministers have repeatedly underlined the need for regulating the business of private hospitals, clinics and diagnostic centres, pledging that the government will enact a set of laws exclusively for the purpose very soon. Their efforts came amid growing public concern that no concept of patients’ rights exists in the country. 

However, no one in power seemed interested in providing relief to the public, said a source, adding that the maximum the health department could propose to the Pakistan Medical and Dental Council (PMDC) or the Pakistan Nursing Council (PNC) after receiving the inquiry report would be suspension of the registration of the doctors or nursing staff concerned, as the case may be. 

Negligence resulting in a patient’s death, unjustifiably high cost of treatment, excessive hospital charges or unnecessary removal of a patient’s organ(s) are all tantamount to criminal acts and such complaints against hospitals’ managements or medical and other staff are reported very often. However, the health department does not have the authority to lodge a case with police, said a senior health official, requesting anonymity. 

Hospitals sometimes enter into negotiations with the aggrieved party in cases of alleged malpractice, with offers made for compensation to be paid in various ways. In the absence of any regulatory system, the official added, this seems to be the most that could come from the inquiry report. 

It was further learnt that an ordinance for accreditation and regulation of private hospitals was drafted by the health department, vetted by the law department and finally endorsed by the chief minister about three years ago, but its promulgation is still hindered by influential owners of hospitals and diagnostic centres. 

Mr Naeem is currently admitted to a different hospital, where he has been taken off the ventilator. His doctors say that his condition is “relatively good”.

(By Mukhtar Alam, Dawn-13, 05/07/2009)

CHK’s centre helps infected couples have HIV-free births

KARACHI, July 5: Happiness and gratitude filled the souls of Hassan and his wife Afshan when they celebrated the first birthday of their son Usman recently. The day reminded them of the turbulent moments they had spent together, worrying about the risks to their health as well as to their unborn child. 

Both Hassan and wife Afshan, as well as their elder eight-year-old child, Alyan, are HIV positive. Fortunately, Usman, however, was born HIV negative, after medical intervention. 

“This ‘achievement’ could not have been possible if government support was not there. The cost of the required tests and drugs is simply unaffordable for a person like me,” acknowledges Hassan, a schoolteacher and resident of North Nazimabad. 

The couple is all praise for the staff working at the Civil Hospital Karachi’s Centre of Excellence-Enhanced HIV/Aids Control Programme, where they come for routine visits “We were not only educated about the disease and provided with drugs free of cost, but were also given much-needed counselling. The encouragement of doctors lifted our spirits. This, actually, helped us come out of the deep depression we had been passing through at that time after being ‘condemned’ for conception and listening to negative remarks by a number of doctors,” they say. 

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