Whither Thy Oath ?

By Nirmala Kannangara - Pictures by Asoka Fernando

Parents of Buddhini Kaushalya Ratnayake, the five-year-old child who allegedly died inside the MRI scanner at the Nawaloka Hospital, claim that their daughter was dead when she was taken out of the machine. They accused the medical staff of rushing their daughter’s lifeless body to the Surgical Intensive Care Unit (SICU) to avoid accusations against the hospital over the child’s death.

However Director/General Manager Nawaloka Hospital Prof. Lal Chandrasena refuting allegations said that the child was never put into the MRI machine as she got bouts of fits before the procedure was carried out.
“The child was neither put into the machine nor was the machine started as the child got bout of fits and got a cardiac arrest. Consultants and emergency medical personnel rushed in and were able to resuscitate the child and was taken to the SICU,” said Prof. Chandrasena.

The parents however allege that the doctors who attended on her lifeless body attempted to mislead the grieving family members.
“When the Consultant Anesthetist Dr I. Seneviratne shouted for help after the Ambu- bag (a hand-held device used to provide positive pressure ventilation to a patient who is not breathing or who is breathing inadequately) burst inside the MRI machine room which I heard clearly, I ran to her together with an attendant. Then I saw how my daughter was taken out of the machine by which time she has turned blue and her stomach was bloated like a pregnant woman and both arms and legs were curved. Although Dr Seneviratne shouted for an oxygen cylinder the hospital staff failed to bring a matching mask for my daughter. It was on their fourth attempt, they were able to get a matching oxygen mask for my child. Meanwhile the medical team massaged my daughter’s chest to revive her heart.

Then they rushed the child to the SICU,” said Chamila Ekanayake the grieving mother.
For Buddhini’s parents, it was a rude shock to note as to how their daughter’s Pediatrician allegedly tried to mislead the parents that the child’s condition was improving when another doctor from another hospital who saw the child at SICU said that there is no purpose of having any hopes on the patient.

“This doctor did not at any time cheat us. He was a very straightforward doctor to which kind act we are ever grateful to him. We need doctors of that caliber. Hippocrates Oaths is given to safeguard the patients. This is a good lesson for other parents who have chosen this same doctor as their children’s pediatrician. Had we continued with Prof. Lamabadusuriya without switching on to this doctor, at least he (Prof. Lamabadusuriya) would have stood for justice without being prejudiced,” said the parents.
The parents also alleged the medical staff at the SICU attempted to warm Buddhini’s bed whenever they asked as to why the child’s body was cold.
“The reason given for warming the bed was to maintain the child’s body temperature. What a joke it is to warm the bed to maintain the body temperature. Even on many occasions we showed the SICU medical team how ants were creeping into my daughter’s mouth. The explanation given was that it was due to dextrose that was given to the patient. Have they given dextrose to my child orally or as an injection? This shows that the intensive care units are not properly maintained. There were ants and even mosquitoes at the SICU.

When liquids were flowing out of my child’s mouth, nose and ears they claimed that it is the natural way when brain is damaged. This was the first time I came across such a theory,” said Buddhini’s father, Thilanka Ratnayake. Ratnayake had later decided to take up the matter with the hospital management.

“I met Prof. Lal Chandrasena and Director Harshith Dharmadasa. Since the talks were unproductive I told them that I need Rs.200 million to be given for three charity organization including the Ranaviru Sevana in memory of my daughter. Since they refused my demand I then wanted the hospital to release my child immediately. This triggered the hospital management and by 6.20pm on Wednesday February 6, the medical staff wanted me to give my consent to remove the child from the life support to which I agreed.

Hadn’t I made these demands the hospital would have kept my child further,” said Ratnayake.
Ratnayake further noted that he threatened the hospital not to issue a bill for him as he would chop off the fingers of the officer who prepared the bill.

“They allowed us to remove my child’s body without giving a bill to me,” said the father questioning the rationale for this.

 

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SLMC: A failed Council?

With the recent amputation of a law student’s arm at the Matara hospital which was found to have been the result of medical negligence, serious questions on the role of the Sri Lanka Medical Council (SLMC) in bringing punitive measures against questionable cases of health care, are being raised.

Although SLMC has an obligation by the patients to maintain the standard of medical professionals in the country in order to protect them, it is hardly seen that they (SLMC) have taken any action against any doctor in the country although there are many reported cases of medical negligence.

Registrar SLMC Dr N. J. Nonis said that SLMC is currently holding more than 100 inquiries on complaints against local doctors. However according to Dr Nonis only 3 to 4 doctors have been suspended from practicing for a period of time over the years.

“Once a complaint is received against a doctor for medical negligence supported by an affidavit it is forwarded to the President of SLMC. Considering its substance he decides whether to proceed with the matter or not. If the matter is investigated, the complaint is forwarded to the Registrar SLMC. If the President thinks that it is not necessary to hold an inquiry it has to be informed to the Council. If the Council too decides that it is not necessary, we ignore the matter but if the majority of the council still wants to go ahead with the complaint, the SLMC has to hold the inquiry.  It is then forwarded to the Preliminary Proceedings Committee (PPC).

This committee comprise of five SLMC members headed by the Vice President of SLMC. All explanations have to be given to the PPC committee by both parties,” he said.

Explaining further, Dr Nonis said, “Evidence is recorded and if there is a necessity to go ahead with the inquiry this refers to the Professional Conduct Committee (PCC), headed by the President SLMC and ten other members. They will consider the report of the PPC and decide whether to have a formal inquiry or not. At the inquiry, the lawyers prosecute the offender and the offender too can reply with the help of a lawyer. Another lawyer guides the SLMC. At the end of the inquiry if the medical practitioner is found guilty, we decide as to whether his / her name would be removed from the registration or to suspend him from practicing for a certain period,” Dr Nonis added.

In that context if only 3 to 4 doctors have been suspended up to date from practicing for a period of time, has the SLMC condoning the leveled allegations against these medical mishaps?

This raises eyebrows whether the SLMC that is called a professional body to maintain the standard of quality of our doctors is impartial or not, which is left to our readers to decide.
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Nothing went wrong with the machine: Prof. Chandrasena
Responses from the Director/ GM, Nawaloka Hospitals, Prof. Lal Chandrasena, to an e-mail forwarded by The Sunday Leader newspaper.

1. When was the MRI Scan machine in question installed in the hospital?
2. Has the hospital done the proper maintenance/repairs necessary for the machine and by whom?

1. & 2. Model: Magnetom Skyra 3.0 Tesla MRI scanner from Siemens, Germany, Brand new machine, cost Rs.300 million was installed at Nawaloka Hospitals on 19/05/2011. Supplied and installed by M/s DIMO (Private) Ltd., Jetawana Road, Colombo 14. Entered into Annual Maintenance contract with effect from 19/05/2012. Work is carried out as per the principal’s guidelines. Further this scanner is connected live to the Siemens Remote Service Center where the machine status is monitored around the clock and if there are any issues, then they communicate same to Service Engineers at DIMO.

3. Is this particular machine still in operation?
Machine is still in operation and on that particular day regular MRI scanning commenced soon after this incident. After this incident 13 Regular MRI scans were done on that day. From that day till today, Noon 14th February, we have performed 290 scans without any interruption.
4. Following the death of the 5-year-old child Buddhini, has the hospital repaired the machine and if so by which company?
No. In order to carry out repairs, no scanning was done on this child at that time and the question does not arise.

5. What exactly went wrong with the machine on that fateful day?
Nothing went wrong with the machine on that day and this child was never subjected to MRI scanning on that day. The reported incident apparently happened during the preparatory stages for scanning.

6. The parents of the child claim that the child was already dead after the mishap in the machine, but the staff insisted that the child was alive and put her in the MICU. What is your view on this?
No. The child was resuscitated and the patient was taken to the SICU connected to the monitors and with a functioning heart. This was confirmed by an Echocardiography test done in the SLCU. The patient was looked after in the Intensive Care Unit by three reputed Consultants and the evidence for this is recorded in the Bed Head Ticket by them.

7. The parents also claim that they saw ants in her mouth and some discharge from her mouth, nose and ears, whilst she was at the MICU. How do you explain this condition?
This is not true.
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Reported below are a few cases of medical negligence The Sunday Leader highlighted on earlier occasions. Not only Sri Lankan patients but also Maldivian patients too had to pay the ultimatum price from their lives due to medical negligence. According to the family members of these victims, affidavits have been submitted to the SLMC against the respective doctors seeking justice.

They accused the SLMC for not taking any action against their complaints. “They are all one lot and no body can expect justice from SLMC. They are always looking after the doctors’ interest although they claim that they provide a quality medical service to the people. The SLMC has never and will not maintain the standard of medical professionals of the country.
K. A. D. Hemamala underwent a Laparotomy procedure (Surgical incision into the abdominal cavity) by Prof. Harsha Seneviratne at Durdans Hospital on April 5, 2012. Since the first operation was unsuccessful, Prof. Seneviratne performed an Exploratorary Laparotomy on Hemamala on April 10.

Prof Seneviratne was accused of having left the country soon after the second operation as her condition was unstable. She was later transferred to Colombo South Teaching Hospital Kalubowila forcibly by Durdans where she had to live her life in the Intensive Care Unit until she breathed her last on November 23, 2012. (SLMC investigations are underway)
Shantha Pitigala (53 years) was admitted to Ward No. 33 at the National Hospital on March 25, 2010 around 3.30pm for a tiny wound in his leg. The ward nurse has first checked whether he is allergic to penicillin. Although there was a reaction against pencillin the medical staff still ignored it and administered Cloxacillin to Pitigala. Within a few minutes the patient died. (No action has been taken by the SLMC) Aishath Eyman Zaki – A 24-year-old Maldivian national was admitted to
Lanka Hospitals on November 3, 2011 under a specialist doctor for a Laparoscopic Cholecystectomy surgery to remove her gallbladder. After many complications Zaki died on November 23, 2011. The family accused the doctor for not allowing them to go for a second opinion when Zaki’s condition turned from bad to worse. (No action has been taken by the SLMC) Thilini Upeksha Maduwanthi died at Colombo South Teaching Hospital Kalubowila while undergoing a caesarian operation.

She had to undergo a caesarian operation due to the ward doctor’s failure to attend on her when she got labour pains. She was admitted to Ward 21 on May 28, 2010 and died on June 7, 2010. A senior house officer has performed the operation and the epidural injection – the anesthetic injection given around the nerves of her spinal cord had affected her brain. (Action has not been taken by the SLMC) Manoharan Madlina (4years) was admitted to Ward 2 at the Colombo South Teaching Hospital Ragama on March 2, 2008 after she was stung by a viper. Although the doctors told the parents on admission at 3.30pm that they have anti venom injections they later failed to attend on her till 8pm when the child passed blood with urine.

The doctors were alleged to have been chatting with their friends and were discussing recipes over the phone by ignoring the mother’s appeals. (No action has been taken by the SLMC) Elizabeth Hettiaratchi (59 years). After being admitted for a slight cough to Lanka Hospital under Consultant Chest Specialist Dr Channa Ranasinghe on May 16, 2007 she died on June 5, 2007.

Since the doctor could not diagnose her illness she had been treated for all possible illnesses such as TB, cancer and pneumonia, according to house officers who attended on her. In their own words the doctor was ‘firing’ drugs for all possible lung deceases. Since she was a kidney patient the kidneys had packed up for administering lots of medicine.

Meanwhile Dr Nalaka Gunaratne who claimed that he is attached to the Lady Ridgeway Hospital had obtained Rs 2.5 lakhs from the parents of Ian Perera when he was under treatment for dengue hemorrhage at the Lady Ridgeway Hospital under the pretext of obtaining the best medicine for the child. He has also asked the parents to keep ready another Rs.2 million for further treatment but the child had died on January 1, 2012. (No action has been taken by the SLMC) Achala Priyadharshini (Law student whose left hand was amputated recently) It is now reported that the investigating committee who probed into Achala’s case over the amputation of her left hand has determined that it was due to negligence of the medical staff of the Matara hospital.
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‘It was a cardiac arrest’

A closeup of the AMBU bag

Refuting the allegations Director Harshith Dharmadasa and Director/General Manager Prof. Lal Chandrasena said that the child died due to a cardiac arrest but not because of any other complications the parents were alleging.

“When the child was not put into the MRI machine how could she be injured by it? This is a state-of-the-art machine and presently one of the best in the world. This machine is 1 ½ years old and was maintained at all times by the local agents of Siemens. It was in perfect working order and even after this incident took place on February 1, MRI scans were performed on 13 patients the same evening.” Records of this was available in the Scanner Room records as proof he confirmed.

“This clearly shows that the machine was in perfect working order and not blown out as alleged by the parents. The child got fits even at the SICU and this has affected the child’s brain. Due to lack of oxygen received to her brain the child’s brain was dead. But her heart still functioned well till the last minute. When her heart too started packing up two medical professionals decided to remove her from the life support machine,” said Prof. Chandrasena.

He noted that there were records to prove that the heart was functioning till then, and that the allegation of explosion in the machine did not arise as the mother could not have entered the scanner room if the machine was in operation.

Prof. Chandrasena further said that the child was alive when taken into the SICU and ECG monitoring was done and even the Echo study showed a structurally and functionally normal heart. “The child had fits even at the SICU but she was successfully resuscitated due to the prompt action by the skilled team of doctors and emergency personnel. There was no negligence or fault whatsoever on the part of the Nawaloka Hospital. We have always maintained and will continue to maintain the highest standards in patient treatment and care,” said Prof. Chandrasena.

When asked what the sound the mother had heard if the child was not put into the MRI Scanner, both Prof. Chandrasena and Dharmadasa denied reportsof any burst of a pipe or machine in the MRI room as claimed by the mother.
“This will be investigated in due course. There wasn’t a blast as such,” said Prof. Chandrasena. Radiographer Mr. Sugathadasa was present at the MRI scanner room when the unfortunate incident happened.

“When the Anesthesiologist was getting ready to give anesthesia to the child the child developed a fit and the doctor placed the Ambu-bag connected to a mask on the child’s face. While squeezing the Ambu-bag to help breathe on her own it burst. This is the sound the mother was referring to. This Ambu bag was later produced in court for further investigations,” said Sugathadasa.

Ms. Manjula the CT, MRI Coordinator at Nawaloka Hospital agreed. Prof. Chandrasena and Mr. Dharmadasa told The Sunday Leader that they cannot allow the two doctors who have been levelled allegations against, to make any comments.

“They have to give evidence in courts tomorrow. They will not talk to the press,” they said.
Prof. Chandrasena added that were contacted both doctors have refused to speak to The Sunday Leader.
“They said that it is not advisable for them to make any comment as they have to make statements in courts on Monday,” said Prof. Chandrasena.