The management responded to the accusation that they were negligent and released a statement, but a group believed they could have done more and so sent in their own statement. Read below:
The Eko hospital press release on the recent maternal death
seems to have gained a favorable response from a good section of the public.
Some have even branded it professional. We at Patient Safety Nigeria think
otherwise. In italics is our commentary and the questions we would like
answered:
In addressing the misinformation contained in an expectedly
emotion laden though vitriolic missive by a “good samaritan” over what is truly
a sad and tragic outcome of an event, the hospital will consistently respect
the ethical patient-doctor privileges even as it acknowledges the deep sense of
loss being felt by the family, friends, colleagues and indeed her husband and
parents.
Given the public interest in the matter however, it is
important to be aware of these facts:
Every loss of life
is regrettable and death is occasionally inevitable in a hospital, EKO hospital
will continue to dedicate itself to the highest level of healthcare service
which allows it to treat from the simplest to some of the most complicated
cases for almost forty (40) years. It also uses all in its capacity to avoid
preventable fatal outcomes.
Pulmonary embolism, the cause of death in this case is an
entirely preventable outcome. She reportedly complained of leg pain and
attended your hospital days prior to her death. This may have been the warning
for an impending pulmonary embolus. Was she assessed for a deep vein thrombus
at that time?
The late Mrs.
Adesanya became our patient from October 2011 and delivered one previous
pregnancy successfully without any incident in a hospital where thousands of
babies have been delivered in the last two years with mortality rate way below
half of the National average despite being a tertiary referral center.
Hope this release of sensitive health information was appropriately consented to and said consent
is documented in writing. Also hope the family were given a copy of this press
release and their permission sought prior to it being published.
…’way below half of the national average’, really! Whoever
suggested this phrase needs to be relieved of their position. Your target for
maternal deaths is ZERO as far as a press release addressing concerns around
patient safety in your hospital is concerned.
The late Mrs.
Adesanya booked late for antenatal care at 26weeks.
Why is her late presentation for antenatal included? What
does it add except to disparage Mrs Adesanya in the eyes of the public. Would
her presenting earlier have made any difference to the outcome? It seems not as
by your own admission, ‘the antenatal period was uneventful’.
The antenatal
period was uneventful until she was admitted into the labour ward at 36 weeks
gestation complaining of backache and lower abdominal pain resulting in her
difficulty in walking. Clinical evaluation was performed. Certain
investigations including abdominal ultrasound was performed and she ruptured
her water during the latter. She was taken to the labour room where she was
delivered of a premature baby.
She delivered the
current baby prematurely at 36 weeks in a position that she found most
comfortable in the labour room and the baby was resuscitated and is now in a
stable condition in the special care baby unit.The administration of care and
counseling to the late Mrs. Adesanya is well documented. Appropriate modalities
of care were discussed with and offered Mrs. Adesanya at every stage.
The immediate post
delivery period was satisfactory and she was transferred to the post-natal ward
in a stable condition. Her condition remained stable for 34 hours after
delivery.
The writer of the ‘missive’ was more specific in the
timelines however here there’s no real specificity on the timelines involved.
It would be interesting to look at the documentation of the exact times all the
above things took place
On the faithful
day she suddenly developed a cough, became breathless and collapsed and all
efforts to resuscitate her proved unsuccessful. A clinical diagnosis of
pulmonary embolism was made. Pulmonary embolism sometimes occurs in people with
predisposing factors e.g. post-surgery and post deliveries etc without warning.
Again here there is no indication as to the timelines
involved. What time did she start to complain? when were her vital signs taken?
When was she assessed by the doctor? What kind of efforts were made to
resuscitate her? Was she thrombolysed? There are many more questions to be
answered.
Further
insight/confirmation into the cause of death and other predisposing factors
would have been revealed by post mortem examination which the family refused,
and we had to respect.
The hospital did
not abandon the corpse but gave room to the request by the family members to
exercise their faith and belief in the efficacy of prayers in the post mortem
period which lasted 24hours; this was also equally respected.
The hospital
participated in a meeting on Friday, 10th of April 2015 with the HMO and her
employers.
Is a maternal death of this nature not a coroners case? Was
the consent of the coroner sought prior to the body being taken away?
The Hospital wants to state categorically that there has
been no compromise to patient safety in this case, which is always the top
priority. We appreciate that sudden unexpected death in whatever form can be
traumatic and can lead to sometimes inappropriate actions from those affected
understandably.
This is beyond belief and borders on insulting Mrs Adesanya
and her family! How can Eko hospital be judge and jury in its own case? How can
you claim there was no compromise in patient safety? Are you claiming your
systems and staff to be perfect? It is ethically outside your purview to arrive
at a conclusion of ‘no compromise to patient safety’ when a young healthy
mother dies while giving birth under your care.
The hospital respects and asks that the public allow the
family to grieve in this trying time. During this time, the hospital will
continue to do its best to minimize the trauma for the family.
We thank patrons and concerned members of the public who
called in for the support offered both the family and the hospital.
Our heartfelt condolence goes to the husband and family of
Mrs. Adesanya.
In our opinion, this press release has shown anything but
respect for the Adesanya family. It reeks of the paternalistic and uncaring
attitude that pervades the practice of medicine in Nigeria. If you really want
to respect Mrs Adesanya’s memory, treat her case as a sentinel event. Rather
than just put out a press release, you should set up an independent panel of
experienced professionals in obstetrics and patient safety. Give them
unfettered access to all the records and staff involved in her care. You must
then commit to implementing their recommendations unreservedly to improve your
systems. This is how you show respect to a young lady who died under your care
and her family.
Eko hospital made over 50 million Naira in profit and spent
over 5 million Naira on marketing in the 2014 financial year, you should be
able to spare some cash to conduct this investigation that will improve patient
care and outcomes. Moreover, this is an opportunity to set yourselves apart as
a beacon for patient safety and quality care in Nigeria, ‘top priority’ for Eko
hospital. We hope you will take it up and are happy to aid your efforts in
improving patient safety.
Patient Safety Foundation Nigeria
https://patientsafetyng.wordpress.com
patientsafetyng@gmail.com
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