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Sri Lanka in dire need of a better healthcare system
2013-02-14 02:15:15
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“My little girl who walked into the MRI scanner room with her usual mischievous smile returned in an unrecognizable state. By the time she was taken out of the MRI scanner bed her whole body had turned blue, the limbs had stiffened and her stomach was swollen like a balloon” says Indumathie Ekanayake as she relates the details of what she believes were the final moments of her daughter’s life.

Indumathie visited the Nawaloka hospital with her five year-old daughter Kaushalya on January 31, for a consultation with Dr. Duminda Pathirana.
“The day before, her arms and legs had stiffened up several times so I decided to consult the doctor since I have been instructed to do so due to her condition,” Indumathie explained. Little Kaushalya had been diagnosed with Rett Syndrome about two and a half years ago and they have been keeping a close eye on her ever since.
Dr Prathiba Mahanamahewa, Commissioner of the Human Rights Commission pointed out that the hospital in which the deceased child was treated in could be held vicariously liable. If there was negligence on the part of an employee, instrument, machine or anything that belongs to the hospital the hospital authorities have to be responsible and could be held vicariously liable according to Dr. Mahanamhewa.
He said legal remedies were available in such a case to sue hospital authorities under product liability if a machine or an instrument of the hospital was the cause of death. He also said legal remedies were available through medical negligence and service liability if it was the negligence of the doctors or the technicians.
“This is a life we are talking about and the responsible parties should be brought before the law. The parents have been psychologically affected. Even though laws regarding the regulation of private hospitals had not developed that much under Common Law such negligence could be brought to justice. The Law of Delict in Sri Lanka is enough to take action against medical negligence. This will also be a violation of the Children’s Rights Convention as well” he said.
He emphasized that since this case concerned a minor, the National Child Protection Authority should come forward to do an investigation of the incident.
“If the police investigations reveal that it is a criminal offence, the responsible parties would face charges for the violation of the Penal Code as well” he said.

Upon consultation, Dr. Pathirana had prescribed a few blood tests, an EEG and an MRI scan. “As there were a lot of tests to be carried out I decided to hospitalise Kaushlaya until the tests were completed.”  Upon admission in room number 1126 that afternoon, the blood tests and the EEG had been carried out. Dr. Pathirana, after studying the test reports that evening had informed Indumathie that the results indicated possible signs of Kaushalya developing epileptic seizures. “But he also added I shouldn’t worry and the condition would most probably be cured through medications.” According to Indumathie, since the intake of the first dosage of the prescribed medicine, Kaushalya’s condition seemed to have improved as the occasional stiffness of the body completely disappeared.


At about 4.30 pm, the next day (February 1) Indumathie had carried Kaushlya downstairs to the MRI scanner room along with a ward attendant as the hospital staff had refused to provide them with a wheelchair. “Anesthetist Dr. I. Senevirathne was on duty. She did not look at any of the reports and instead asked me several questions. They placed Kaushlya on the scanner bed, injected the anaesthesia through a cannula and asked me to wait outside.” The scanner room had been half open and Indumathie says she could see all the activities in the room through the reflection cast on the glistening tiled wall before her. The technician had operated the scanner at 4.20 pm and left the room. Inoka had anxiously waited outside the room for the procedure to finish. “I could hear the scanner noises but exactly ten minutes later, the Anesthetist suddenly started calling for help. She kept yelling ‘the baby bag has broken and the oxygen supply is disrupted. Somebody help!’.” As no one had responded to her calls, Inoka had pushed the ward attendant inside the scanner room hoping she would be of help.  When Kaushalya was taken out of the machine several minutes later, she had appeared deformed and unrecognisable.

According to the details related by Indumathie, the situation had worsened as the hospital staff had spent close to 20 minutes attempting to locate an oxygen cylinder with a mask that would  fit little Kaushalya’s face in order to resuscitate her. “I realized she was dead by then. But the staff kept telling me to calm down as they admitted her to the Surgical Incentive Care Unit (SICU),” she says with a sigh.


Upon receiving the news, Kaushlya’s father Thivanka Ekanayake had immediately travelled from Singapore and had visited the hospital on February 1 evening. “Therewere a lot of machines attached
to my daughter’s body but I could tell that there was no life left in her. She wasn’t moving, her body was as stiff as wood and the whole body had turned blue and she was ice cold,” Thivanka says. His tone sounds angry as he relates the events that followed. From February 1 until the 6th, attempts  had been made to prolong this little girl’s life through the use of machines and the parents had been
 Sri Lanka Medical Council (SLMC) Registrar Dr. Nihal Nonis says although they are not provisioned to take action against institutions, they are able to take action if complaints are filed against individuals who violate the standards of the medical profession. “We have methods of investigating and probing into individuals if an official complaint is lodged with the SLMC. Accordingly relevant action can be taken against those accused ranging from issuing warnings, suspending their practice as well as terminating their registrations,” he added.
Meanwhile, the national body for regulating private sector health services – the Private Health Regulatory Council (PHSRC) said it was advisable for those who visited private sector health service institutions to make sure the establishments were registered with the Council before going for treatment. PHSRC Secretary Dr. Kanthi Ariyarathne speaking to Daily Mirror said the private sector health practices should also display the registered certificate in an area where it is visible to the visitors.
“Under the Private Medical Institutions (Registration) Act No 21 of 200, registering with the PHRSC guarantees that our regulatory mechanism will ensure the standards of the private sector health service establishments are maintained with concern for human resources and equipment. We have set out 11 categories and each category has various guidelines they should be adhering to and if any of these are violated there is a series of actions that can be taken against these institutions that have been provisioned to us by law” she added.
However, she also mentioned that if an offence was committed, the establishment is provided with a reasonable period of time to rectify their errors. However, if they continued to ignore the regulations, she said legal action could be taken even to the extent of closing down the establishment. “But it is important for the public also to realize that this is a gradual process and this is a service sector and we need to observe the crises from a practical point of view,” she said.
made to undergo such trauma as they had not received any certain response on whether or not to keep any hopes on their little girl’s life.

“What we are angry about is the manner in which they attempted to conceal the fact that the accident inside the MRI scanner led to her death. By the second day, they plastered cotton wool to her eyelids and forced them shut. When we inquired they claimed it was to prevent contamination from germs. They kept sponging her body to retain moisture and kept applying balm on the dried lips. We sat there and watched them but very soon we exceeded our tolerance levels because we just didn’t want to see them torture our daughter’s body any longer,” this distressed father says.

Indumathie says that on February 4, an official from the Nawaloka Hospital’s HR department spoke to her. “She asked me why I was crying and whether it was due to a financial issue. In return I told her I wouldn’t think of bringing my child to a private hospital for consultation if I had financial constraints. The next day they arranged for us to meet with the management. They kept asking us what we wished them to do which was quite quizzical because they never wished to admit it was their fault that caused our daughter’s death.” Finally, when Thivanka spoke up and asked them to donate Rs. 20 million for charities the officials had sounded irritated and asked them to file for legal action if they wished to do so.

By February 6, the situation had turned worse for these aggrieved parents when the hospital management had lodged a complaint with the Slave Island police charging them of disrupting the peace within the hospital premises. “When the police officials visited the hospital they realized the real picture. When I finished my conversation with the Police officials and returned to the SICU, they had brought the agreement paper for us to sign that would enable them to remove the machines from Kaushalya’s body.

A spokesperson for the Nawaloka Hospitals who wished to remain anonymous categorically denied all allegations held against them by demised Kaushalya’s parents. He said the MRI machine functioned perfectly well and added they had carried out several other scans in the machine even after the alleged incident.
“The girl undergoing treatment for Rhett syndrome, which is a neurological issue, is incurable in spite of medical treatment. We deny their allegations because it has been made clear she died due to cardiac arrest and not of an accident that occurred within the MRI scanner. She was receiving treatment in the SICU for six days subsequent to her MRI scan and our staff attempted their level best to ensure that she was resuscitated,” he said.
 
“The hospital officials to this day have kept repeatedly rejecting our accusations and have refused to accept their fault. But their actions have betrayed the lie. They are desperately attempting to cover up. The hospital has not billed us for any of the procedures carried out or for our stay in the hospital from February 1 until eh 6th even though we repeatedly kept asking for it. They even went to the lengths of calling for a hearse to transport Kaushlya’s body for the Magisterial inquiry. Why should these people who complained against us to the Police be so accommodating towards us?” Indumathie questions.

Little Kaushalya is definitely not the first to be a victim of medical mishaps. Just weeks ago, a law student lost her left arm due to the alleged negligence of a state hospital’s authorities. These cases make headlines in newspapers and get buried in our memories until somebody else becomes a victim again.

The need for a national health policy is felt very much and not just laws but implementation of those is very much needed to bring closure to the loved ones of the vi ctims of medical negligence. Not everyone can afford to sue a hospital due to the high litigation costs but bringing the perpetrators of medical negligence to justice will at least deter other officials from passing the ball from one official to the other. Sri Lanka is in dire need of a health care system where patients’ rights are given top priority.

Pics by Gayan Madushanka


A spokesperson for the Peoples Movement for the Rights of Patients (PMRP) said that such tragedies occur mainly because of the lack of implementation of laws relating to the regulation and monitoring of private hospitals.
The spokesperson went on to point out that even though laws had been passed the implementation was woefully ineffective and most private hospitals were acting in an unacceptable manner.
“It is the super rich who can afford to undergo treatment at private hospitals. They give many tests sometimes which are not even necessary and the hospital bills cannot be afforded by everybody” he said.
He also mentioned that though there was a Director appointed by the Health Ministry to look in to the regulation and monitoring of private hospitals, this type of incidents continue to occur.
“There is no national drug policy or a national health care policy. As a result private hospital consultants are making multi millions and they make them at the expense of innocent unsuspecting patients. When private practice was established in 1969 the fee paid to the doctor and the hospital was at a 4-1 ratio but even that ratio is not taken into consideration and not even the fee charged by the private hospitals is regulated” he claimed.
He added that the government should take immediate steps to restore the health service in a state where the patients’ rights are given top priority as it is a matter of life and death.
 








Little Kaushalya receiving treatment in the SICU


Kaushalya’s parents and sisters




Comments - 3
Vijay Jayaekera Friday, 15 February 2013 09:25
I have been informed that Nawaloka Hospital pays an incentive to medical Doctors to recommend them for MRI scans and various tests etc.
Can whatever Government body inquire into this and see whether it is true.
If it is true the Doctors and Directors of Nawaloka should be held personally liable for profiting from these actions.
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M.S. Hassen Friday, 15 February 2013 15:14
Punish those responsible immediately.
Do not waste time..
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S Indralatha Saturday, 16 February 2013 10:32
This clearly a case of medical negligence partly by the anaesthetist and the hospital. Anaesthetist has not checked the equipment as she should do before any procedure and proper resuscitation equipment and emergency team was not available to resuscitate the little girl.
In Srilanka no body will held responsible for this sort of problem. Hospital should be fined at least 50-100 million ruppes, and should be instructed to have proper policy when anaesthetizing anybody not only children including having a emergency resuscitation team and Dr who was responsible for her care(Anaesthestit) should be suspended from furthre practice for negligence.
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