Healthcare

No Accountability: Golden hours being wasted, enquiries ‘for the sake of enquiries’ serving no purpose

As new cases come to fore, older cases of alleged medical negligence are still being probed, with reports of enquiries still to see the light of the day.   

Srinagar: In the dark and dreary night of November 20, Muddasir Ali, a journalist woke up gasping for breath. Staggering and struggling, he woke up his brother, Jehangir Ali who carries the memory of the ordeal that followed.

The sudden death of his brother, makes him raise many pertinent questions regarding the “shoddy health infrastructure” and “inefficacy of the doctors posted at the peripheral set ups.”

“My brother passed away in my arms and the medical professionals who were supposed to use their knowledge to save him behaved worse than animals. We can’t bring him back now. But I want answers,” he wrote in an emotional post on Facebook.

He said he wants answers as to why the “doctor on night-duty was not awake, why he delayed conducting an ECG while declaring a heart attack, why Muddasir was made to climb stairs when he was already in distress, why there was no stretcher and why no attempts were made to revive him?”

This death led to the constitution of a three-member committee by Directorate of Health Services Kashmir (DHSK) on November 26 and tasked with a “time-bound” report on whether Muddasir Ali was provided adequate and timely medical intervention at sub-district Hospital (SDH) Chrar-e-Sharif, where he had been taken to, minutes after he reported chest pain.

Although, the committee filed its report on December 1, it was not shared by the department and labelled “preliminary”.

In an article published by Greater Kashmir, it had said that “the committee had sought more time to investigate in detail”, however three weeks later; it is yet to file its report regarding the allegations levelled by the family.

Muddasir’s death is just a tip of the iceberg.

In the past too, cases of alleged medical negligence have shown that enquiries by hospital authorties never see the light of the day, and even CCTV footage seems to dissapear.

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A reality-check reveals the depth of this black hole where poor patients keep dying due to lack of healthcare infrastucture, and no one from the administration is held accountable.

Six months ago, a 75-year-old male hailing from the Kupwara district of North Kashmir, was presented to peripheral health facility with chest pain at about 10 pm.

He was not referred to district hospital directly but was referred to SMHS. The ambulance was not available, so his family had to wait till a cab was arranged.

“It took about 10 hours for them to reach to SMHS. That too unprepared, without counselling,” his brother said.

The ECG (electrocardiogram) test which provides information about your heart rate and rhythm, and shows if there is enlargement of the heart due to high blood pressure or evidence of a previous heart attack, done at SMHS revealed evolved “Inferior Wall Myocardial infarction.”

“He could not be thrombolysed. With the result, he went into cardiogenic shock and died the next day,” the doctor treating him at SMHS hospital said.

Similarly, one month back, a 65-year-old was admitted in Government Medical College Baramulla, as a case of Bilateral pneumonia.

“His condition worsened in two days. He was intubated at 8:00 pm and was referred to SMHS on an ambulance ventilation,” his family member said.

Surprisingly, there was no intensive care ambulance, and the patient was transported in a normal (taxi) ambulance without a health care professional.

“The attendants were unaware of the graveness of situation, and did not comply probably to adequate ambulance ventilation. We received the patient brought dead in casualty,” the resident doctor who examined him said.

What are these sudden heart attacks?

Free Press Kashmir had detailed conversation with Dr Syed Maqbool, Consultant interventional Cardiologist Government Super-Specialty hospital Shrinbagh Srinagar.

He said 80 percent of the sudden deaths occur due to heart attacks.

“We call them coronary artery disease. This suddenness is due to two reasons—There occurs an electrical instability in the heart muscle where the attack strikes,” he said.

This can result in either Ventricular tachycardia, a heart rhythm disorder caused by abnormal electrical signals in the lower chambers of the heart (ventricles) or Ventricular fibrillation, a heart rhythm problem that occurs when the heart beats with rapid, erratic electrical impulses. This causes pumping chambers in your heart to quiver uselessly, instead of pumping blood,” according to the cardiologist.

The doctor said the second reason is the “Pump failure”, which occurs when your heart muscle doesn’t pump blood as well as it should.

“Certain conditions, such as narrowed arteries in your heart or high blood pressure, gradually leave your heart too weak or stiff to fill and pump efficiently. The person can die on spot, he said.

Dr Maqbool pointed out other factors too which can result in a patient’s death.

“Due to Covid, we are reporting “Myocarditis”, also known as inflammatory cardiomyopathy, which is inflammation of the heart muscle,” he said.

Its symptoms can include shortness of breath, chest pain, decreased ability to exercise, and an irregular heartbeat, resulting in a death.

Covid can also cause (Pulmonary embolism, a blockage in one of the arteries in your lungs, he explained.

“In most cases, pulmonary embolism is caused by blood clots that travel to the lungs from deep veins in the legs or, rarely, from veins in other parts of the body,” he said.

What needs to be done

Dr Maqbool said there are two ways to prevent a heart attack: Either give the patient a clot dissolving drug called as thrombolysis or the second more superior treatment, called Primary angioplasty.

Primary angioplasty, is a procedure which treats blockages within the coronary arteries and improves blood flow to the heart.

“In this treatment, the patient is immediately shifted to the cath lab. An angiography is done there which identifies the blockage and we treat it with a stunt. The patient becomes absolutely well. But primary angioplasty is only available in tertiary care hospitals where as thrombolysis can be done in all major district and sub-district hospitals,” Dr Maqbool said.

He maintained that if the treatment in heart attack-like situations is not given on time, the chances of morbidity is more. “For example, if you wait for a long time, the pain can end, however, the heart muscle gets dead. And person a becomes disabled for a lifetime”

Dr Maqbool stressed that “early detection and immediate treatment” is the key in heart attacks.

“The golden hour should not be lost. In that timeframe, the heart muscle can be salvaged.”

Save Heart Initiative and Administrative Lapse

The Save Heart Kashmir initiative is a WhatsApp group, which was started by three doctors in 2017. Now, it includes a network of over 1,000 doctors who are saving patients suffering cardiac emergencies especially in the peripheries. However, in the wake of abrogation of article 370 and pandemic, their functioning has stalled to some extent.

A doctor and member of Save Heart initiative said that while the slow internet speed is one of the reasons, there are other major factors too.

“What we have seen and observed is that emergency rooms (ER) are not functioning properly in district and sub-district hospitals. The supply of life saving drugs used to break down clots in some cases of heart attack is not available,” the medico said.

The doctor said that there is nothing available at the periphery in the name of ER rooms.

“The ECG monitors don’t function properly, the batteries are not charged. It is a mess. The problem is systematic. In this situation, how will the experts in the save heart group give any suggestions and what use are they?”

On the other side, Nodal Officer, Non Communicable Diseases Programme, Dr Junaid Kousar said there is no acute shortage of drugs in the peripheral hospitals as such.

“We allocate a sufficient budget for the peripheral Hospitals under the NCD programme. Of late, the list of medicines provided by the government under NCD has been revised. The list is the number and the name of the drugs that has to be supplied to the peripheral institutions. Recently, I toured some district hospitals where they had some complaints with regard to availability of medicines. I also found that they had an old list of medicines,” he said.

He said that a meeting comprising of all the medical officers was held wherein they were directed to update the list according to the latest guidelines.

“Also, there are other factors involved in issuing the medicines. We can only provide the drugs which are mentioned in the list Many a times, the medicines prescribed are combination drugs which may not be in the list,” Dr Junaid said.

Legal Aspects 

High Court Lawyer, Umar Mir told Free Press Kashmir that whenever a case of medical negligence comes forward, the aggrieved person has three legal options available.

“Firstly, he can file a complaint under consumer protection act for defunct services on part of service provider and get compensation,” he said.

Secondly he can file a civil suit claiming compensation from the guilty persons for loss and wrong done to him or deceased. For that matter the medical negligence must fulfil the following criteria:

“A legal duty of the party complained of to exercise due care towards the party complaining the former’s conduct within the scope of his duty; Breach of the said duty; and Consequential damage that follows,” he said.

He explained if person does not want to claim damages or compensation but wants a penal action against the guilty doctor under penal law, he can file a complaint either before police for action and penalty under section 304 A of IPC. 304A of IPC refers to ‘Causing death by negligence.

“Another constitutional remedy is to approach the High court or supreme court for violation of right to life by the government or its employees in case of death or injuries caused due to medical negligence,” he said.

What Doctors Association has to say

President DAK Dr Suhail Naik said that in past decade we have observed that people have been engulfed silently by obesity, diabetes, hypertension, heart attacks and strokes due to their unhealthy food habits and lack of exercise.

“Very young people are dying suddenly due to massive attacks. It is high time to have cardiac cath labs in all district hospitals in general, and particularly in government medical college Baramulla and Anantnag so that primary coronary intervention can be done within golden hour to salvage heart muscle and prevent sudden deaths,” he said.

Dr Suhail noted that this short term measure must be followed with a long term plan to develop cardiac emergency centers in every district hospital.

“We have enough number of well-trained cardiologists available in J&K, who can start cardiac care and it is fundamental right of people to get such services at door steps. This is high time to decrease time intervals between onset of heart attack to primary intervention of coronary artery,” he said.

But as new cases come to fore, older cases of alleged medical negligence are still being probed, with reports of enquires still to see the light of the day.

 

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