Tuesday, January 16, 2018

Need for external review of Mt Hope

Mt Hope hospital is supposed to be our gold standard of medical care, and yet within the last year we have witnessed medical mishaps there, especially in the womenís hospital, that have reminded us that in medicine we seem still to be climbing out of the third world. As I wrote in a column in 2013, three women have come forward on the television pleading for the authorities to provide answers regarding deaths of newly born babies there. One pregnant woman, while under supposed medical supervision, was allowed to go to the toilet to relieve her discomfiture only to have the misfortune of delivering her baby there.

A second woman reported that her baby was born prematurely with bruises all over its face that the authorities attributed to tubes used in the process of its care. A third mother had triplets prematurely, and all died because of what the hospital said were medical complications. Two other couples who had babies born there found that the babies they took home were of the wrong race, and indeed had been switched.

Now we have baby Simeon, denied a chance in this world by a surgeonís scalpel which found its way into his delicate brain. And we have the hospital telling us that the attending doctor was in fact competent, having successfully delivered babies 100 times before.

One of the annoying aspects of these cases, which tend to involve humble citizens, is that the hospital tends to direct attention away from itself to victims. So we hear that the delivery was complicated, or that the woman had had a high number of pregnancies before. The Minister puts out a statement about high risk deliveries, an intervention that will be interpreted by many as an attempt to introduce a hypothesis about the death other than incompetence.

But how does high risk lead to mutilation of a baby in the womb?

There has been some confusion surrounding the case, especially on the question of the whereabouts of the consultant at the time of the delivery, and whether he or she should not have been at the bedside.

We have now come to the tipping point at Mt Hope. The population seems to be at the mercy of the hospital, and ordinary citizens are expressing reservations about the competence of the doctors there. Is it hit or miss there when you go to deliver a baby? The remedy is external review at two levels, firstly of the most recent case, and secondly a more general review of the approach to maternal care and delivery at Mt Hope.

The authorities should look outside of this country to a hospital known for its high standards of excellence and care and should invite a team of expert medical practitioners to come here to review the case, and more generally to observe approaches and procedures employed in the treatment of pregnant women, including actual observations of the delivery of babies by regular methods and by C-section. It should take no more than one month for us to find out what really is the problem at Mt Hope.

UWI itself should back away from the case, and allow external experts to intervene. It has too much of a stake in the proceedings to be objective.

This is the right thing to do. It is what the situation demands. Otherwise what we will get from this will be perceived to be a cover-up.

We are already seeing some push-back by the chairman of the North Central Regional Health Authority (NCRHA) Dr Shehenaz Mohammed, who expressed dismay about UWIís defence of the attending doctor. She expressed the following view: ďIím surprised that they can draw a conclusion without any discussions with us and Iím even more surprised that anyone can draw conclusions without any facts when we ourselves have to appoint an expert panel in order to reach a conclusion.Ē

This matter has been framed in terms of UWI on one side, defending the doctors, and the NCRHA on the other, searching for truth, by writing to UWI asking for cooperation. This spells disaster for the university if it continues on this path. It has to back away. Good universities in this situation will do this.

This cannot be a case of physicians healing themselves. The public is losing faith in the integrity and competence of Mt Hope. There is need for external review here. UWI has to step aside and must play no part in this. Let an independent set of physicians, with no horse in the race, who do not sip champagne with the principals in the case, come to the country to review baby Simeonís matter, and the general question of the health of Mt Hope. Nothing short of external review would suffice here. Mt Hope itself may be ill and we need to restore its health as a place of excellence. It must rebound from this very low level of practice to which it has descended.

Mt Hope must be benchmarked against international standards of care. That is what the situation demands, and what taxpayers who pay to support the facility demand.

óTheodore Lewis is emeritus professor, University of Minnesota