by MONACHORUM
I refer to your recent report regarding the sad loss of Baby Yok Shan’s left arm following an antibiotic infusion into the premature baby’s limb that went wrong.
Pictures and follow-up reports of the baby’s condition and arm were published nationwide. It was obvious that the left forearm was gangrenous with the margins showing features of acute infection.
As reported this could have been the result of an intravenous infusion that extravasated at the level of the elbow causing compartment syndrome, cutting off blood supply further down the forearm, giving rise to the gangrene and subsequent infection.
Alternatively, it could also be possible that the doctor who inserted the IV, could have done so directly into the brachial artery which is the main artery that supplies the forearm. An injection such as vancomycin into this artery could result in disastrous circumstances including obvious shut-off of blood supply and death of tissues that this artery supplies.
A remote and far more unusual way of inflicting infection would be to actually insert the IV needle intraosseously (into the bone) also at the level of the elbow which will result in infection of the bone or rarely pulmonary embolism transmitted via the marrow. Gangrene is an unusual occurrence.
It was reported that the findings of a committee formed to look into the mishap found that the gangrene was the result of an injection given by an unsupervised house-officer and a pediatrician who was consulted only by phone which is not unusual if the pediatrician had been on-call too frequently.
More relevant is the question of what was the house-officer doing with a neonate, and that too a premature one, in the first place? Was this baby managed in a neonatal unit and were there any qualified neonatogists in this hospital. If there were, it is not usual practice to have house-officers in a neonatal unit which are usually managed exclusively by neonatologists and medical officers and not by general pediatricians.
But if there were no neonatologists, why wasn’t this baby referred to the nearby University Hospital or any other neonatal unit?
Only last week the Health Minister growled that specialists should confine themselves to their specialties. By the Health Minister’s own logic why didn’t the pediatrician and hospital confine themselves to their areas of competence and specialties? A misfortune of this nature could perhaps then been avoided.
Today, news reports suggested that the baby was to undergo a two-hour surgery but this was clarified later when an orthopaedic surgeon stated that the procedure was over in ten minutes.
Now anyone dealing with controlled dry gangrene of limbs will tell you that auto-amputation of that body part will take place eventually without too much surgery.
Why this “sandiwara”? Fault-finding after an event is almost always a cinch but the Health Minister’s frequent application of double standards at various medical communities in this country should tutor him that in medicine, no one likes complications, mortality nor morbidity and that it can happen even if all precautions have been taken even in his own backyard which appears greatly in need of both administrative and professional help.
Frequently playing to the gallery at the expense of the stage must have its consequences as in this case if the baby’s young parents decide to sue.
The Minister seriously must now look into the quality of healthcare that his ministry is meting out onto many poor and sometimes ignorant patients.
Perhaps this Minister’s advisors should advise him to refrain from using the duty of care as a bargaining tool to gain political mileage as any benefits gained by him this way may be at the expense of someone’s life… ….. or arm.
“Perhaps this Minister’s advisors should advise him to refrain from using the duty of care…”
What duty of care is that? Apparently, the houseman was negligent and there is a breach in the duty of care. The aggrieved party should be able to win damages.
DAP lawyers should offer to sue for damages. There is enough evidence of negligence on the part of the hospital. This girl will have to live the rest of her life without a forearm and hand and should be adequately compensated for damages and life long suffering. No point pointing fingers; what is done is done. Any negotiated settlement should be vetted by experienced lawyers acting on behalf of the parents so that quantum of damages is adequate not only for future treatment, but also for loss of quality of life.
Uncle Lim,
Lets start a tabung for Yok Shan
Thanks
According to NST report 28/08/2007, the Ministry of Health (“MOH”) already conceded government’s liability as there were, according to Dr Chua Soi Lek, “elements of negligence in the treatment of a Yok Shan”.
All that remains is the quantification of damages arising from such liability. According to Dr Chua, his “ministry was discussing with the Attorney-General’s Office on compensating Lai’s familyâ€Â. (Meanwhile, Health director-general Tan Sri Dr Mohamad Ismail Merican said that disciplinary action would be taken on the specialist doctor who handled Yok Shan’s case).
If the amount offered by the government is not accepted by the Lai’s family, the matter will go to court to determine quantum of damages. Whether the court will award more than the govt’s offer remains to be seen.
The main complaint, as I understand it, is that MOH has not revealed all or sufficient facts and circumstances leading to the tragedy so that the public would be better informed to judge what went wrong (medical as well as administrative) and who else, in the wider scheme of things – other than the obviously negligent specialist – may also be culpable of such professional wrong doing.
For the public to start a tabung for Yok Shan would be to reduce the amount of damages the govt needs to compensate her parents. Let’s say the govt needs to pay RM2 million to her parents. But the public had kindly donated RM1.5million. So the govt will happily pay half a million ringgit, thus havving an extra RM1.5million to drop more mat rempits on the North Pole. So the best way is to sue the underpants off the govt.
I think the Ministry has not shirk its responsibility and has concluded and accepted that negligence is the cause of the complication here. They have done this in a reasonable time frame. We have to admit that complications of treatment occur all the time and sometimes in the most experience hands everywhere. It would be unfair to the Health Minister if we think that every complication that arises out of treatment it attributed to him. In terms of compensation, the medical defence insurance of the paediatrician is the one who usually fork out money assuming the coverage extends to neonatology.
either way….we lose. Govt compensate = rakyat’s money. As long as no heads roll, the govt will conitnue with its tidak apa attitude. Lousy services at the expense of rakyat hv been going on for too long. All the taxpayers’ money down the drain in dodgy contracts.
Starting a tabung is no point. Coz tabung = people’s money. Govt’s money = people’s money also.
Either way, whatever the case, we still lose and will continue to lose for the next 50 years unless drastic steps are taken by Malaysians in the upcoming general election.
We deserve a much better and higher quality of life and healthcare. We must demand for more. What should be ours and not be siphoned off offshore via creative shell companies through multi-level commission plans of public infrastructure projects either by way of Govt projects or Government Linked Corporations.
First HP6 govt, then hp6 cabinet, then hp univ/education, then hp6 judiciary, then hp6 pdrm, then hp6 public works, then hp6 transportation and now hp6 medical services. What have I miss out? Remember the ambulance without enough petrol from Klang hospital to travel to rescue an accident victim and other negligence cases? Its happening too often to be a coincidence. Its hp6 and substandard services and personnel.
Is Chua Soi Lek going on medical leave in a foreign land?
In countries other malaysia, someone in authority will have humbly resign his govt. post. Malaysia has lost the respect of many countries.
Madmix says: DAP lawyers should offer to sue for damages.
I think we should help the baby to grow up well. A good compensation will help a long way.
I read in the Chinese paper that the health minister had agree to ensure adequate medical care for Yok Shan’s future need like artificial limb. What I fear is by the time many years down the road when Yok Shan needs the limb, the health minister may not be around. Therefore, the parents should get the proper adequate compensation now. That is the least we need to ensure to be fair. We all feel bad for the family now that a young baby at the start of her life had been permanently disfigured.
Lets start a tabung for Yok Shan by stopping government fund to build mosque from now till 2008 and channel all the funds to this tabung so that Yok Shan will get a Mayo hand immediately.
The minister talk is cheap, you cannot ensure she will get a limp in the future unless there is black and white prepared by a lawyer.
Chua Soi Lek not holiday overseas. He is overseas getting expert advice. Rakyat pay for all his expenses.
The Compensation is important as it is a long way for Yok Shan and her parents to go. But, sorting out the cause, technically and administratively is even more important as it “may” help to rectify and prevent further mishandling. If anyone in that system had been responsible or an alert or monitoring system is there, the problem could very well be found out earlier and had taken the necessary rectification before it became irreversible.
However, is the Legal system be prepared to do it? Any lawyer with such experience with do it? Any medical specialists in the field be willing to give competent and independent view? Anyone in the Administration will give their independent view on the proper procedures and thereby, in one way testifying that something had done wrong in the whole administration of the Hospital – a government Hospital?
The overall is “Has anyone seen facts finding been a culture in the Government?” when transparency and accountability are hardly found in many levels of the Government!!
TO BE A RESPONSIBLE MOH, an immediate fund should be made available pending final to be after the investigation of an well constituted committee with professionals – medical, legal, insurance and NGO, etc.. on the causes and so with recommendations, including an suggested amount of compensation from various parties- no only the doctor(s) concerned by the administration!!
Please make a NEW Page after 50 years!!
If this is not done by MOH, the Parliament should then make the instruction. BUT, will Parliament care??
Generally speaking, the over all standards of healthcare, including in-patient treatment, is not up to the highest professiopnal standards,due to the limited international exposure doctors recieve, the sloppy standards of nurses due to staff shortages/brain drain,and the overdependence of “in-house” solutions/lack of overseas/international exposure. We have (like other industries which lack foreign exposure) become complacent, forever thinking we can “do it on our own”, and our reputation has suffered. Those who can afford to do so seek treatment in Singapore and other countries which have a better reputation.
It would be better for Minister Chua to charter a rocket to send him to the moon, making the trip way before our astronauts.
The main problem is “Any Public system in Malaysia” work according to any Code of Practice so that it is self regulated with a Sense of Duty or social responsibility?
Any Public system being monitored at different level so that it does not require special instruction, or, report from outside, or, until it is so big and irreversible then came to the attention of someone “big”?
Unfortunately, even this someone “big” cannot act or provide a solution!
SO WHAT KIND OF SYSTEMS THE GOVERNMENT HAD DELIVERED??