Part Three

The following is a testimonial from a patient’s mother:

“My son Jerome (not his real name), who was 20 and built like a footballer, a strapping boy, over six and a half feet tall, complained of chest pains in July.

“I took him to the Couva Hospital, where a doctor took an ECG and family history, after which she said he had an abnormal heartbeat and had to be immediately warded at the San Fernando Hospital.

“There, the first doctor who attended to him asked for an X-ray, pronounced that he had bronchopneumonia, and then went off duty.

“Jerome was too weak to walk and had to be wheeled to his bed. He kept gasping for breath.

“Seeing my child in so much pain, I wondered if he might have been better off in a private nursing home. I went around looking for help. I found the doctor on duty and told him that my son couldn’t breathe. He did a quick check with his stethoscope and said he would be back later.

“By this time my son looked as if he was suffocating between breaths, and begged me to find help. I saw the doctor chatting with someone. I asked him: ‘Please could you give him oxygen and something to ease the pain in his chest?’

“He said my son would have to wait.

“My son asked in disbelief, ‘Mummy, I’ll have to wait?’ as if that was impossible. His feet were ice cold. I rubbed his feet and put some slippers on him.

“I left my son for about half an hour to get some lunch. By the time I came back I saw his bed was empty and sheets stripped.

“The nurses called me and told me to sit down. I asked why. They didn’t answer and instead asked me if I had seen the doctor yet.

“The doctor asked me to sit down in his office.

“I said, ‘What happened?’ 

“He didn’t answer.

“I said, almost crying: ‘What happened? He died?’

“He didn’t answer.

“I said: ‘If you had given him the oxygen when you were supposed to, he wouldn’t have died.’

“He said, ‘We gave him oxygen.’

“I said, ‘I’m sure you gave him oxygen when it was too late.’

“He didn’t answer. He didn’t even say he was sorry.

“The post mortem revealed Jerome had a clot in one of his lungs. But people live on one lung, and they didn’t even try to save him.

“If the duty doctor had read the notes from Couva, he could have saved Jerome. His medical records showed he was a high-risk case because of his family history.

“The doctor should have put him in intensive care, done a scan, ultrasound, whatever he needed to do. When my son couldn’t breathe he should have paid attention to him. If he had done what was right, my child would have still been alive today.

“A patient in a bed next to his told me Jerome cried out and fell over as soon as I had left the building, and only after he collapsed, doctors and nurses swarmed around him, beating up on him like bees. But it was too late.

“Jerome’s young face, his voice saying, ‘Why won’t the doctor come, Mummy?’ haunts me day and night.”

A doctor’s comment:

“In the US this case is worth $5 million in a malpractice suit. If the doctor had read his notes and paid attention to the fact that the boy’s feet were cold and he was having trouble breathing, he would have known the patient was going into respiratory failure and taken him into emergency.

“There are many ways to get around respiratory failure: ventilate the patient while you thin his blood. Keep him on life support until it clears up. Once you dissolve a clot it opens back up. I’ve had cases of people like that 85 years old and they’ve survived clots.

“In the absence of laws to protect the patient, the mother has no recourse. She is a victim of medical malpractice and lousy laws.

“In a country with proper laws, the Ombudsman would have demanded the patient’s medical record, had it reviewed by medical experts, asked for a report from the doctor and begun investigations, and then the lawsuit starts. The incident would have been on the doctor’s file, which would be accessible to the public.

“We have to go through a period where doctors are sued and embarrassed if anything is to change. Otherwise doctors will continue to hold the licence to kill.”

For the patients

On behalf of every patient and potential patient in this country, on behalf of those like Jerome, whose voices have been silenced forever, I am calling on the Medical Board of Trinidad and Tobago to set up the following:

·     A comprehensive code of conduct for doctors. If there are no rules, how can doctors be disciplined or struck off the register for serious malpractice?

·     A patient’s bill of rights to be handed to every patient entering every doctor’s office in every private and public institution.

·     An independent Medical Malpractice Board to examine complaints over medical treatment. This board’s decisions should allow legal action to take place within a reasonable time.

·     A medical Ombudsman.

·     A national data bank which would list doctors, their area of expertise including ongoing training, a record of complaints of breaches of codes of conduct, and a record of malpractice complaints.

·     A system of compulsory continuing medical education (in the US it is 50 hours per year).

·     A system of renewing doctors’ licences periodically. (In the US it means an examination every seven years).

·     A complaints system for timely judgments on breaches of code of conduct.

Patient /doctor relationship

The implicit agreement between doctor and patient is that the doctor has specialised knowledge that the patient lacks and pays for directly or indirectly. In return, the patient trusts the doctor to use this knowledge to his or her benefit.

Doctors must understand that it makes better business sense to inject accountability into their profession. Newly graduating doctors are entering the profession. Other highly qualified doctors are contemplating returning home to set up shop.

Attorneys are also being produced much faster than they can be absorbed into the marketplace. These people are looking for work. Already, medical sources say, there are many malpractice suits going on very quietly in this country, and doctors are settling out of court.

When doctors who practise medicine with a code of ethics enter the medical market (and this is inevitable), those doctors who now practise without controls will find their waiting rooms empty. And if exploitative doctors, young and old, are unwilling to change, then it is inevitable that business will eventually buy out this market and make it more price and quality driven, making doctors their paid employees.

The first rule of medicine, according to the Hippocratic Oath, is “Do no harm”. Currently, both in private and public health care, there is no committee to enquire into deaths, no compulsory pathological testing to ensure accountability. The chilling truth is there is nothing to stop a doctor from killing his patients, either through neglect or incompetence, again and again.

Next week: Code of conduct and patients’ charter.